Unexpected Health Research Articles

Mainstreaming production and nutrient resilience of vegetable crops in megacities: pre-breeding for terrace cultivation.

Modern megacities offer convenient lifestyles to their citizens. However, agriculture is becoming increasingly vulnerable, especially during unexpected public health emergencies such as pandemics. Fortunately, the adaptability of terrace vegetables cultivation presents an opportunity to grow horticultural crops in residential spaces, bringing numerous benefits to citizens, including enhanced nutrition and recreational engagement in the cultivation process. Although certain planting skills and equipment have been developed, the citizens tend to sow some seeds with unknown pedigree, it is rare to find new plant varieties specifically bred for cultivation as terrace vegetables. To expand the genetic basis of new breeding materials, elite parents, and varieties (pre-breeding) for terrace cultivation, this review not only discusses the molecular breeding strategy for the identification, creation, and application of rational alleles for improving horticultural characteristics including plant architecture, flavor quality, and ornamental character, but also assesses the potential for terrace cultivation of some representative vegetable crops. We conclude that the process of pre-breeding specifically for terrace cultivation environments is vital for generating a genetic basis for urban terrace vegetable crops.

Clinical Internship Teaching Management During the COVID-19 Epidemic

Against the backdrop of the global COVID-19 pandemic, the teaching and management of clinical medical interns have been facing tremendous challenges. When interns majoring in clinical medicine enter the internship position,they lack self-protection awareness and have limited ability to respond to unexpected public health events. This article explores the cognitive situation, existing problems, and improvement measures of clinical medical interns in the post-epidemic era. Therefore, this article proposes a series of improvement measures, including strengthening epidemic training and education for interns, enhancing personal protective awareness, and lastly achieving the role transition from intern to doctor.

Current Threats and Risks to Health Tourism in Bulgaria

Over the last decade, modern society and various economic actors have faced risky instabilities, trials and challenges due to increasing globalization and the emergence of various global crises. Considering the last five years to date, management in the tourism sector is by no means immune from the unexpected threats, economic and health crises that continue to negatively impact all processes and future business development prospects. The need for the emergence of a new economic concept of risk and its management has been identified as urgent. The rapid development of tourism in the country and the absence of an adequate risk management strategy lead to the emergence of a number of undesirable consequences, aggravation of existing problems and generation of numerous adverse trends in the tourism and hotel industry in the country. The object of the study is health tourism in the hospitality industry in Bulgaria. The hotel product is complex, designed to satisfy the needs of guests. Composed of different elements, this paper focuses and analyses the complementary product, which with its service complements and enriches the final needs and satisfaction of the customer. Medical Spa Centres, as the subject of the study, are an example of a pulling force in the choice of a destination in health tourism. They improve economic growth, industry competitiveness and stimulate tourism consumption. The processes in the Medical Spa Centers are strongly influenced by the surrounding external and internal environment, working together under the wing of the hotel complex. Respectively, they increase the valuation of the economic entity, contribute to higher financial performance and at the same time satisfy various human needs of a health and wellness nature. The role and importance of Medical Spas has been proven in the development of the hotel product, therefore the need to implement strategic management approaches to address risk and unexpected threats should be analyzed. The methodology is based on a systematic approach and on different research methods, including: theory, publications, analysis and systematization. The empirical research was conducted through in-depth interview with managers of hotel complexes with Medical Spa centers to identify threats and risks typical for health tourism, and ways to overcome them in their organization with actual management measures. The last part of this paper analyzes the application of a model risk management system for a hotel tourism enterprise and the need to implement such a standard in our country.

Emissions leakage embodied in inter-provincial trade brings unexpected air quality and health benefits

Inter-provincial trade can bring “emission leakage”, and consequently influence the air quality and public health. However, there has been a lack of systematic research on air pollution and public health related to emission leakage embodied in inter-provincial trade of China. Here, we systematically evaluated for the first time the influence of emission leakage on national air pollution and related premature deaths in 2012 of China. Unexpected opposite influences of emission leakage on emission and air quality/public health were discovered. Emission leakage embodied in inter-provincial trade in 2012 of China led to an increase of 1.4 % to 4.8 % in national air pollutant emissions, but a decrease of 1.5 % (−0.8 μg·m−3) in population-weighted concentration of PM2.5, while avoiding 1.1 % (−1.4 × 104 people) of premature deaths. Therefore, to reveal the intrinsic mechanism of this opposite influences, we proposed two coefficients, the Concentration per unit primary PM2.5 emission (CPE, unit: μg·m−3/t) and the Death per unit primary PM2.5 emission (DPE, unit: people/t), to characterize the response of air quality and health to emission leakage embodied in inter-provincial trade. Statistical analysis indicated that both the above coefficients showed significant negative correlation (P < 0.05) with provincial PM2.5 emissions changes. The findings offer a means of adjustment and its related evaluation parameters for the emission transfer caused by inter-provincial trade, thereby contributing to further improvement environmental and health benefits through inter-provincial trade.

Demand Prediction of Emergency Supplies in Campus Public Health Emergencies Based on GM-GA-BP Neural Network

Medical alcohol is the most widely used and highly demanded emergency supply in both campus public environments and medical settings. It has a sharp contradiction between supply and demand in the event of a public health event. For this reason, forecasting the demand for medical alcohol is crucial for averting and managing unexpected public health issues on campus. An enhanced GM-GA-BP neural network prediction model was put out in this article. The benefits of the equal dimension and new information complement GM(1,1) model's new and old information replacement and small sample data prediction are combined. Following data fitting and modification, a BP neural network based on conjugate gradient algorithm is built to carry out training and prediction. Meanwhile, the connection weight and threshold were globally optimized through genetic algorithm.To forecast the demand for medical alcohol at a certain university in Yibin City from 2022 to 2023, a thorough comparison of a combination model vs the conventional BP neural network model was made. The results showed that the MAPE had been decreased by roughly 3% and the absolute percentage error was as low as 0.12686%. These findings have provided a scientific reference for the university to improve its emergency material reserve strategy represented by medical alcohol.

Depression and academic engagement among college students: the role of sense of security and psychological impact of COVID-19.

The negative consequences of depression in college students have garnered global attention, especially in relation to academic achievement during the COVID-19 pandemic, which need critical assessment. This study investigated whether a sense of security mediated the relationship between depression and academic engagement among college students during the pandemic and whether the moderating psychological impact of COVID-19 has a moderating effect on this relationship. In this cross-sectional study, we recruited 466 college students from 30 provincial-level administrative regions in China via the Internet and used established scales to measure depression, academic engagement, a sense of security, and the psychological impact of COVID-19. The mediating and moderating effects were tested using the bootstrap method. Depression was found to negatively influence academic engagement, with a sense of security partially mediating this relationship. Moreover, the psychological impact of COVID-19 was shown to have a moderating effect on this mediating process. This study could aid in crafting pertinent strategies to mitigate the adverse effects of depression on learning amid unexpected public health crises and foster better mental health among college students.

Respiratory Protection: Lessons Learned from a Global Pandemic.

The COVID-19 pandemic exposed the limitations of global health systems' abilities to manage the rapid spread of a novel infectious disease, which was exacerbated by shortages of respiratory protective devices and other critical personal protective equipment (PPE). An advisory panel of experienced health-care professionals with backgrounds in Occupational and Environmental Health and Safety (OEHS), Infection Prevention, Nursing, and Clinical Application Specialists convened to discuss challenges and strategies associated with the selection and use of respiratory protective devices as experienced during the first year of the COVID-19 pandemic. This discussion led to the following recommendations: 1) the need for clear communication of alternative respiratory protection selection and use recommendations in accordance with US regulatory and agency guidance; 2) the need for collaboration between Infection Prevention, OEHS, clinical staff, supply chain/materials management, emergency preparedness, executive leadership, and finance; 3) the need for adequate stockpiling, inventory rotation, and diverse respiratory protection options to accommodate the majority of health-care workers; 4) the need for efficient and innovative strategies to communicate evolving regulatory, agency, and facility recommendations and to deliver appropriate training on respiratory protection; and 5) the need for additional research on respiratory protection use - involving filtering facepiece respirators (FFRs) as well as other respirator types designed to be reused - to balance infection prevention best practices with a sustainable process. In conclusion, these considerations may offer guidance and identify areas for research on preparedness, communication, education, and training to enhance the preparation of health-care facilities including community-based health-care organizations for unexpected public health events.

When should retirees tap their home equity?

This paper analyzes a household's optimal demand for a reverse mortgage. We study a rich life-cycle model that can explain the low demand for reverse mortgages as observed in US data. We find that the demand for reverse mortgages is particularly pronounced for cash-poor, house-rich retirees, and households with a strong bequest motive and low pension income. We analyze the optimal response of a household that is confronted with a health shock or financial disaster. If an agent suffers from an unexpected health shock, she reduces the risky portfolio share and is more likely to enter a reverse mortgage. If there is a large drop in the stock market, she keeps the risky portfolio share almost constant by buying additional shares of stock. Furthermore, the probability to take out a reverse mortgage is hardly affected unless her financial wealth is small.

Research on the service quality of emergency medical language services during major unexpected public health events.

Emergency Medical Language Services (EMLS) have played a crucial role in the COVID-19 pandemic. Research on the quality and its influencing factors of EMLS is necessary. This study used the SERvice QUALity (SERVQUAL) model to determine factors affecting the quality of EMLS during the pandemic. An online questionnaire was completed by 206 participants who received the service in 2021-2022. Structural Equation Modeling (SEM) indicated that the service provider and service process significantly influenced the Service Results. In the service process, the evaluation of service content and responsiveness were highly correlated, and both factors significantly affected user satisfaction. In the service provider, tangibility and reliability were highly correlated. The key factors for user willingness to recommend the service were service content and tangibility. Based on the results of the data analysis, it can be inferred that EMLS should be improved and upgraded in terms of service organization, talent cultivation, and service channel expansion. To enhance service organization, an emergency medical language team should establish a close collaboration with local medical institutions and government departments, and an EMLS center should be established with the support of hospitals, government, or civil organizations.

Studying informal care during the pandemic: mental health, gender and job status

Unexpected negative health shocks such as COVID-19 put pressure on households to provide more care to relatives and friends. This study uses data from the UK Household Longitudinal Study to investigate the impact of informal caregiving on mental health during the COVID-19 pandemic. Using a difference-in-differences analysis, we find that individuals who started providing care after the pandemic began reported more mental health issues than those who never provided care. Additionally, the gender gap in mental health widened during the pandemic, with women more likely to report mental health issues. We also find that those who began providing care during the pandemic reduced their work hours compared to those who never provided care. Our results suggest that the COVID-19 pandemic has had a negative impact on the mental health of informal caregivers, particularly for women.

Northward Shifts of the Sahara Desert in Response to Twenty-First-Century Climate Change

Abstract The spatial extent of the Sahara (the largest nonpolar desert) has significant impacts on the livelihood of people residing in its surrounding areas. Despite the fact that climate change would foreseeably impact the location and size of the desert, its future responses (i.e., advance or retreat) are rarely explored in previous studies. Here, through the development of an ensemble Bayesian discriminant analysis approach, we use 10 of the latest high-resolution GCM (global climate model) simulations to document robust annual and seasonal responses of the Sahara Desert to twenty-first-century climate change, with the consideration of modeling uncertainties. We find northward shifts of the Sahara/Sahel and eastern expansion of the nondesert zone under both SSP2–4.5 and SSP5–8.5 scenarios, the former more pronounced in the wet season and the latter in the dry season. Countries located near the Mediterranean may thus experience higher risks of drought, while the projected retreat of the Saharan southern boundary will be beneficial to the local water availability of proximal countries. Significance Statement Given that sub-Saharan Africa is one of the most vulnerable regions to climate change, the Sahara’s expansion would bring unexpected health risks to billions of people. It is thus vital to understand its robust response to global warming. However, previous studies are merely focused on using a simple precipitation threshold as the definition criterion to estimate the varying size of the Sahara Desert. In addition, significant uncertainty in precipitation projections also limits relevant investigations of the Sahara’s future responses. Here, by developing an ensemble Bayesian discriminant analysis approach, we could provide an objective basis for desert identification under large intermodel uncertainty. Further, we find significant northward shifts of both the Sahara and the Sahel, which may induce higher risks of drought over the northwest of North Africa.

Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study.

Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age. This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use. We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ≥50 years) with a sampling error of 2.04%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year. We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95%) and obtained information from peers (348/442, 78.7%) the most; followed by web-based self-tracking related to health issues (305/442, 69%), and only a few (52/442, 11.3%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters. Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients.

Proposal for Guidelines on the Notation and Investigation of Scientific Names for the Source of Natural Food Additives in Japanese Standards

The official specifications for food additives from natural sources list the species according to their scientific and Japanese names, thereby providing a unique identifier for the species. This helps to prevent the use of nonprescribed species, which might cause unexpected or unintended health hazards. However, there are cases in which the names of the source species listed in the official specifications differ from the accepted scientific names based on the latest taxonomic research. In this paper, we argue that it is more important to define scientific and Japanese names with an emphasis on traceability in order to control the range of food additive ingredients in a rational and sustainable manner. Therefore, we proposed a method for ensuring traceability as well as a specific notation procedure for scientific and Japanese names. Using this method, we examined the source species for three food additives. In some cases, the range of sources species expanded with the change in scientific names. Ensuring traceability is extremely important, but it is also necessary to confirm whether unexpected species are included when names are changed.

"You knew you had to be there, it had to be done": Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain.

The COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned. We carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi's 7-step data analysis method. During the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic. In the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemic.

When Households Spend More than they Earn: Overcoming Deficit with Institutions, Relatives, or Selling Property?

Durations of households’ deficits reveal the difficulty of gathering the means to get by. They involve coverable means. A two-stage Heckman estimation coupled with endogenous regressions of coverable means and subjective health applied to the Korean Longitudinal Study on Aging, 2006-2020, shows that the deficit is likely when family heads are elderly or women, unemployed, with children, living in apartments, with dependants, with housing expenses, or dependent on transfers from parents. These heads take longer to overcome a deficit, whatever the choice of coverable means. People who use bank loans are employed, healthy, and live in a metropolis. Unexpected health expenses (not covered by insurance) drive people to use a means of coverage, which challenges the permanent income hypothesis and risk management theory. Extending national health insurance to chronic diseases, protecting precarious jobs, subsidizing caregivers, microcredit, encouraging family solidarity, or reconciling work and family are avenues for reform.

Synchronization of water-energy consumption in residential and non-residential buildings during COVID-19

ABSTRACT COVID-19 has made working from home (WFH) a widely prevalent mode of work, resulting in highly complex changes of energy and water consumption in buildings. To understand these changes, this study applies the concept of water-energy nexus (WEN) in the analysis of energy and water data in residential and non-residential buildings in Ontario, Canada, before and during the pandemic. The study found the overall energy and water consumption of buildings exhibited a decreasing trend, with the most significant change found in water consumption. Energy and water consumption increased in residential buildings but decreased in non-residential buildings; the changes in energy and water consumption were synchronized over the WFH period. This study also elucidated that changes were related to the demographic and job attributes. When dealing with the peak load of residential consumption with a high consumption benchmark, due consideration should be given to the stronger synchronization of the two types of resources to improve the resilience of residences to cope with the uncertainty of unexpected large-scale public health crisis. Applying WEN to building resource consumption during WFH for the first time, the findings shed light on the need to enhance integrated water and energy management.

Empirical Analysis on Price Discovery Efficiency of Cotton Futures in China

Futures markets are fundamentally driven by price discovery. China has the highest cotton output and consumption, so enhancing the cotton futures price discovery function promotes the sustainable and healthy growth of China's cotton sector. We used cotton futures and spot prices from 2018 to 2022 as research samples to examine the changes in cotton futures price discovery efficiency amid the Sino-US trade war and the appearance of Covid-19. Using the IS model, we observed that: (1) the cotton futures market always holds a dominating position in price discovery throughout 2018-2022, and (2) the impact of Covid-19 significantly lowered the price discovery function of the cotton futures market, which shows that: (1) the Chinese cotton futures market is not yet able to endure the impact of unexpected and large-scale health events such as Covid-19; and (2) when emergencies arise, we should respond expeditiously in order to reestablish market stability.

The consequences of health shocks on households: Evidence from China

Unexpected health shocks may bring catastrophic consequences for households. This paper examines the effect of unexpected adverse health shocks on household members' physical and mental health, labor supply, household income and asset, and health behaviors in China by analyzing two nationally representative datasets and adopting a difference-in-differences method augmented with coarsened exact matching. We find that an unexpected health shock results in a discounted out-of-pocket medical expenditure of 16,943 RMB (US$ 2647) over five years for an average household, a reduction of household income per capita of 841 RMB per year (US$ 131, or 6.0% of household annual income per capita), and a loss of net household asset per capita of 13,635 RMB (US$ 2130, or 9.7% of household asset per capita). It raises the probability of an average household applying for public poverty relief allowance by 2.8 percentage points. In addition, we document a strong intra-household spillover effect of health shocks on mental health and health behaviors. A simple back-of-envelope calculation shows that the health shock induces a private cost of 34,966 RMB (US$ 5463) over 5 years for an average household, and incurs a social financial burden of 6066 RMB (US$ 948) in 5 years per household in medical reimbursement and social welfare transfers. At a national scale, the total social burden of health shocks from cardiovascular and cerebrovascular diseases amounts to 1.1 trillion RMB (US$ 172.1 billion) over 5 years.

247 Private equity acquisition of nursing homes and the impact on long stay residents and racial disparities in care outcomes

OBJECTIVES/GOALS: To investigate nursing homes (NHs) acquired by private equity (PE) firms and estimate the effect of PE NH acquisitions on NH care quality for NH residents and whether PE NH acquisitions exacerbate racial inequities in quality of care. METHODS/STUDY POPULATION: My research estimates the causal effect of NH PE acquisitions on NH access and quality of care for NH residents and whether acquisitions exacerbate racial disparities in NH care for about 115 PE-owned NHs in the US, measuring the quality of care at the facility survey year level, and using an array of NH-level data sources. I identified 115 PE-owned NHs (treatment group) and 665 non-PE-owned NHs between 2003 and 2010, using the Online Survey Certification and Reporting database to obtain facility characteristics. I compare facility characteristics (e.g., payer mix, staffing levels, and quality measures such as pressure ulcers, unexpected weight loss, acuity, and health deficiencies). I will then test whether effects differ by race, with hypotheses informed by Public Health Critical Race Praxis approach. RESULTS/ANTICIPATED RESULTS: Preliminary results show that staffing levels differ between PE and non-PE-owned NHs in a way that aligns with a shift in focus toward the Medicare population i.e. short stays. We also find that deficiencies increased in PE-owned NHs compared to non-PE-owned NHs. We expect that PE acquisitions may lead to slightly widening racial disparities in NH care quality. Results may show that PE-owned NHs have a higher share of low-rated, high-BIPOC facilities. In weak markets, PE-owned NHs may have a higher share of BIPOC residents compared to highly competitive markets. This is because PE managers may prioritize cost over quality by cutting services. However, since quality measures are self-reported, except for measures related to deficiencies, this predicted lower quality of care may not be evident in observed data. DISCUSSION/SIGNIFICANCE: Understanding how PE ownership impacts nursing home care quality for long-stay residents, especially those funded by Medicaid, can help develop intervention strategies to effectively mitigate racial inequities in NH care, as Medicaid funded NH residents are more likely to be Black, Indigenous, and people of color.

Assessment of adverse events for a home-use intense pulsed light hair removal device using postmarketing surveillance.

Home-use intense pulsed light (IPL) hair removal devices are convenient for consumers. Consumer safety associated with home-use IPL devices, however, remains a subject of interest. In this descriptive analysis, we assessed the most commonly reported adverse events (AEs) for a home-use IPL device from postmarketing surveillance and qualitatively compared these with AEs from clinical studies and medical device reports of home-use IPL treatments. For this analysis of voluntary reports, we queried a distributor's postmarketing database for IPL devices for the period beginning January 1, 2016, to December 31, 2021. All sources of comments, for example, phone, e-mail, company-sponsored web sites, were included in the analysis. AE data were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) terminology. Also, we conducted a PubMed search to identify AE profiles from existing literature on home-use IPL devices and we searched the Manufacturer and User Facility Device Experience (MAUDE) database for reports on home-use IPL devices. These results were qualitatively compared to the data in the postmarketing surveillance database. A total of 1692 cases involving IPL were identified from voluntary reports of AEs between 2016 and 2021. The shipment-adjusted reporting rate for AE cases (number of AE cases/100,000 shipped IPL devices) was 67/100,000 during this 6-year period. The most commonly reported AEs were pain of skin 27.8% (470/1692), "thermal burn" 18.7% (316/1692), and erythema 16.0% (271/1692). Among the top 25 AEs reported, no unexpected health events were observed. The reported AEs were qualitatively similar to the pattern seen in clinical studies and the MAUDE database associated with such home-use IPL treatments. This is the first such report documenting AEs for home-use IPL hair removal from a postmarketing surveillance program. These data are supportive of the safety of such home-use low-fluence IPL technology.