Economic Evaluation of Mobile Mental Health Units in Greece: The Case of Cyclades Islands

Background: In Greece, the provision of mental health services is limited to people residing in rural and remote areas. The operation of Mobile Mental Health Units (MMHUs) has been introduced in the Cyclades islands. It is an innovative policy intervention that has been shown to be effective and efficient internationally. Objective: The aim was to evaluate the operation of MMHUs in the Cyclades islands based on real-world evidence (RWE), from a societal perspective. Methods: A cost-effectiveness analysis was performed where outcomes and costs were elaborated and classified based on two comparators, 1) with MMHUs’ operation and 2) without MMHUs’ operation. Clinical primary outcomes were based on RWE data and were elaborated for the Disability-Adjusted Life Years (DALYs) values calculation, for a 12 months’ time horizon. Data descriptive statistics were performed with SPSS Statistics 22.0. Direct medical, non-medical and indirect costs were incorporated. Unit costs and monetary values were extracted from published data. Sensitivity analysis was undertaken to test the robustness of the results. Results: The operation of MMHUs in the Cyclades islands led to an incremental cost of €12,250.78 per DALY averted. A substantial higher increase is observed in the direct non-medical costs of the non-MMHUs’ operation where patients had to pay approximately €2,602 per capita annually for their transportation and accommodation due to hospitalization and outpatient care. Informal care expenses are 3 fold increasing in the non-MMHUs’ operation arm. Both direct non-medical and informal care costs correspond to high out of pocket payments totally covered by the patients. The sensitivity analyses demonstrated that the decision does not change when we varied the unit costs by ±10%. Conclusions: The operation of MMHUs appears to be a cost-effective option for treating patients with mental disorders in remote areas and islands in Greece. MMHUs appear to overcome the existing NHS structural inefficiencies by minimizing public expenditures and patients’ income losses by preventing and improving their mental health status.

The Enforcement of Occupational Safety and Health Requirements in Public and Private Sectors in the Emirate of Abu Dhabi, the United Arab Emirates

Research Problem: In Abu Dhabi, limited implementation of OSH Regulations contributes to the general unawareness among employees and workers about occupational hazards and safety measures, resulting in slow responsiveness toward enforcement measures and a lack of self-regulatory approaches within companies. Purpose: The purpose of this study is to examine the implementation methods practised in Abu Dhabi with those in developed countries with established OSH regulatory bodies. Methodology: Qualitative and quantitative research methods were employed to gather primary research data. Workers from various industries in Abu Dhabi were sampled on purpose and asked to respond to questionnaires and interviews on OSH protocol awareness and implementation, and circumstances of workplace incidence. Results: The findings of this study showed that the enforcement of OSH requirements in UAE positively correlated to a reduction in the rate of work-related injury and improved business performance. The quantitative research data showed that the energy sector had the highest score (15) while the tourism sector had the lowest score (5.3) in occupational health systems and improvements in business efficiency and productivity. Implications: The outcomes of this study shed light on the importance of implementing OSH Guidelines for companies to empower their safety managers to fully enforce OSH requirements in their organisations. In conclusion, effective OSH enforcement requires cooperation between general workers and OSH managers and facilitation from business owners.

Maternal Mortality Rates among Im/Migrant Populations in the United States

Introduction: Maternal mortality rates have more than doubled in the U.S over the last two decades, making it one of the few places in the world where maternal mortality is increasing. Differences in maternal mortality among certain races and ethnicities are known but few studies examine maternal mortality among immigrants. Since immigrants represent 13.7% of the U.S. population, it is essential to examine immigrant subsets to understand maternal mortality among this vulnerable population. Methods: A literature search identified 318 articles on maternal mortality and immigrants, with 12 articles from the U.S. The keywords included maternal mortality, United States, migrants, asylum seekers, immigrants, and disparities. Maternal mortality statistics were obtained from the World Health Organization and Center for Disease Control. Results: Studies analyzed in this review found an overall lower maternal mortality rate among immigrant women compared to U.S.-born women, except for Hispanic immigrant women. Black women had the highest maternal mortality rate, regardless of immigration status. Conclusion: Although the literature points to lower maternal mortality among immigrants, the data is still somewhat mixed, making it challenging to draw comprehensive conclusions. Additional research examining maternal mortality among Im/migrants in the U.S. is needed to guide future training among healthcare professionals and policymakers.

Diabetic and Prediabetic Profile of Patients in a Family Health Care Unit of Salvador, Northeastern Brazil

Diabetes Mellitus is one of the most prevalent diseases in the world. In Brazil, 8.7% of the population between 20 and 79 years of age has diabetes, estimating 11.6 million diabetics. It is commonly associated with other co-morbidities such as hypertension, dyslipidemia and obesity, which put these patients into a high cardiovascular risk profile. This study was performed using the medical records of enrolled population attending a Family Health Unit of Alto do Coqueirinho, Salvador, Northeastern Brazil, consisting of one doctor, one nurse, one dentist, one nursing technician and six community health workers. Medical records and data provided by the system of the Primary Care Information (SIAB), showed total of 2495 patients. Considering the prevalence morbidities in this population, hypertension was present in 9.8% of patients and Type 2 Diabetes in only 3.6%. Since the prevalence of morbidities is the key indicator to the development of public health policies, it seems important a better knowledge on the prevalence rates of diabetes, prediabetes and its co-morbidities of this population. Future plans and projects for health professionals will be based on a consistent medical record.

Volunteering in the United Arab Emirates’ Health System—Motivations and Challenges

Background: The volunteer role has been cited as an important in supporting healthcare organizations in diverse areas such as contributing to research, health professional’s education, health care delivery, health policy development and patient administration. Proper motivation of volunteers is required for sustaining volunteer performance, while encumbrances to optimal engagement in health systems need to be addressed. This study aimed to investigate the main factors that motivate volunteers to participate in the UAE healthcare system, along with exploring the barriers and challenges being faced. Methods: This study was designed as a quantitative cross-sectional study in United Arab Emirates (UAE). A purposive sample of the Adult citizens and residents using purposive sampling directed at all major health volunteer recruitment agencies in UAE, who have volunteered at least once in the health system over the preceding 12 months. Participants Adult UAE residents were selected by a purposive sampling method from February to April 2017. Data were collected through electronic questionnaires using modified Volunteer Motivation Inventory (VMI). Data were analyzed from 667 adults’ residents who were reported to volunteer at least once in healthcare opportunities. Results: About 53% (n = 290) of the volunteers in this sample were full time employed individuals. Almost 63% (n = 422) were female. Overall, assessed self-reported motivations of volunteer participants were high. The main motivation for volunteering in healthcare opportunities in the UAE was Understanding dimension (Mean = 4.68), followed by self-esteem dimension (Mean = 4.60). Eight elements of volunteer motivation showed no statistically significant differences between male and female respondents. Organization/system barriers dimension was the highest among respondents (Mean = 2.9), followed by individual barriers (Mean = 2.6), interpersonal (Mean = 2.06) and contextual (Mean = 2.04). Conclusion: UAE health sector volunteers who participated in this study appeared to be highly motivated. The main motivation factor was understanding dimension which allowed volunteers in healthcare to gain a new perspective on things, through practical training and learning new things, dealing with different groups in the health sector, for example doctors, nursing, patients. What makes the health sector volunteer understand them self and the world around them. Therefore the organization should focus on volunteer motivation to ensure future intensions of them. The four main barriers to volunteer were Individual barriers, Interpersonal barriers, contextual barriers and organizations system barriers. Concerted efforts are needed to raise awareness about available volunteer opportunities, and optimally align the motivations of volunteers with organizational objectives in the UAE health sector.

Social determinants of type 2 diabetes and health in the United States

Diabetes is the sixth leading cause of death in the United States. To date, most research and resulting clinical strategies have focused on the individual with shortterm health improvements that have not been maintained over time. Researchers more recently have recognized the need to consider the social determinants of diabetes and health along with individual factors. The purpose of this literature review is to examine current understanding of the social determinants affecting diabetes and health. A search of medical and nursing literature was conducted using PubMed, PsychInfo, CINAHL and MEDLINE databases, selecting articles published between 2000 and 2013. Search terms included: type 2 diabetes, social determinants, and health determinants. Inclusion criteria were: English language, human studies, social determinants of diabetes and health, and research in the United States. Additional search methods included reference chaining of the literature. Twenty research articles met the inclusion criteria for the review and analysis and included quantitative and qualitative methods. All studies selected for this review were descriptive in nature(n = 20). Fifteen studies were quantitative studies and five were qualitative studies. No intervention studies met inclusion criteria. Each study is summarized and critiqued. Study findings indicate that external or upstream factors consistentlyaffect individuals diagnosed with diabetes, influencing self-management. Significant methodological limitations result directly from small sample sizes, convenience or nonprobability sampling, and low statistical power.

Mothers’ Knowledge of Health Caring for Premature Infants after Discharge from Neonatal Intensive Care Units in the Gaza Strip, Palestine

Background: Preterm labor is one of the most public health problems related to neonates admitted to Neonatal Intensive Care Unit (NICU). Poor knowledge among mothers about the care requirements of a preterm neonate is immediate cause for post-discharge medical problems in premature and neonates readmission to NICU. Hence, this study aims to evaluate mothers’ knowledge of caring for premature infants post-discharge from Neonatal Intensive Care Units in the Gaza strip. Methods: A Quantitative-based cross-sectional designs study was used to survey 120 mothers of preterm neonates at the time of preterm neonates discharge by face-to-face interview at Al-Shifa medical complex and Nasser hospital between February and June 2018. Results: The results showed that only about 58.4% of mothers of premature babies had good knowledge about health care needed for premature infants after discharge from NICU. Furthermore, there was no statistically significant difference between the level of knowledge and mother’s sociodemographic characteristics (P-values > 0.05). Conclusion: Mothers’ knowledge of premature infants care was not at the optimal level, which might put the newborns at risk. Therefore, the study emphasizes the necessity of thoughtful exchange of health information between team members and mothers and establishing pre- and post-discharge plans with mothers to start their healthy transition of preterm neonate to home and to ameliorate family concerns.

从学习进阶到内容重构:基于情境链的体育与健康课程大单元的内部构建

情境链是体育与健康课程大单元教学内容重构的重要支撑,能有效解决中小学体育教学实践中的教学内容低级重复、情境创设连贯性较弱和延展性不够等问题。基于情境链的体育与健康课程大单元教学重视链式整合的课程样态,依托递进的情境进行专项运动技能的有效学练,通过情境链串联目标、任务、内容等课程元素,整体规划体育与健康课程大单元的学习路径。情境认知理论、境脉学习理论与学习进阶理论为情境链的深入理解提供了理论基石与实操框架。结合三大理论的基本要素探讨基于情境链的体育与健康课程大单元的构建流程,聚焦核心素养的整体性,通过水平二“篮球保护和控制球能力的提升”大单元主题案例,从“精准分析学情,确立大单元学习目标”“提取关键概念,规划大单元学习路径”“串联进阶元素,重构大单元学习内容”“基于真实情境,评价学生的学习表现”展现完整的情境链研究。

大单元视阈下体育与健康教学模式的经验汲取与应用策略

核心素养导向的体育与健康大单元教学亟需从专家的理念引领转化为教师的课堂实践。体育与健康大单元教学组织形式与教学模式均顺应教学专业化的要求,试图找寻能够指导基层课堂教学的规律、原理,教学模式着眼于结构程序与操作框架,教学组织形式立足于作用机制与环境特征。围绕体育与健康大单元教学的关键内核:多课时的教学单位是大单元教学整体规划的载体;结构化的教学设计是大单元教学内容整合的抓手;运动项目完整的体验与理解是大单元教学情境设计的依据,研究汲取了运动教育模式、领会教学模式、个人与社会责任教学模式等的教学组织经验,提出大单元视阈下体育与健康教学模式的应用策略:基于学习体验、任务拆解规划教学单元;围绕学习主题、概念原理整合教学内容;依循认知规律、活动架构创设学习情境。

上海市74所医疗机构ICU手卫生用品消耗量及依从性相关分析

目的 了解上海市二级及以上医疗机构重症监护病房(ICU)手卫生用品消耗量与依从性,为进一步开展医务人员手卫生监测工作提供依据。方法 通过医院感染监测系统,对2017—2021年上海市二级及以上医疗机构ICU手卫生用品消耗量及依从性监测结果进行分析。结果 共纳入74所医疗机构105个ICU,手卫生用品平均消耗量为79.24(44.88~258.63)mL/(床·日),不同类型ICU手卫生用品平均消耗量比较,差异具有统计学意义(P<0.001);手卫生用品平均消耗量从2017年的65.75 mL/(床·日)增至2021年的87.55 mL/(床·日),呈逐年增加趋势(P<0.001)。医务人员手卫生依从率为82.13%,护士手卫生依从率最高(86.59%),医技最低(48.90%),不同职业医务人员手卫生依从率比较,差异具有统计学意义(P<0.001)。手卫生实施的方式中,采取流动水洗手占39.86%,速干手消毒剂擦手占42.27%,未采取手卫生措施占13.22%,戴手套未采取手卫生措施占4.65%,不同ICU医务人员手卫生实施方式比较,差异具有统计学意义(P<0.001)。手卫生用品平均每床日消耗量与医务人员手卫生依从率存在正相关关系(r=0.703,P<0.05)。结论 上海市ICU手卫生用品平均每床日消耗量与医务人员手卫生依从率均逐年增加,不同类型ICU手卫生用品平均每床日消耗量和手卫生依从率存在差异,可通过连续监测手卫生用品平均每床日消耗量评估手卫生执行情况。

体育与健康课程大单元教学中核心素养、结构化、情境化:要义阐释与关联表征

课程标准是体育与健康课程的顶层文本,是当下开展大单元教学的刚性要求。在课程标准的话语体系中核心素养、结构化、情境化是新理念的重要组成,成为基于课程标准的体育与健康课程大单元教学的重要支点。体育与健康课程大单元教学作为实现体育课堂教学改革的新型教学组织形式,也是核心素养、结构化、情境化落实的中介桥梁。教师唯有深刻认识核心素养、结构化、情境化的价值与内涵,把握彼此的相互关系,才能对体育与健康课程大单元教学有更明确的认识,从而有效指引专项运动技能教学的实践。核心素养统领大单元学习目标,贯穿于大单元教学始终,是学生全面发展的重要保障;结构化指引大单元学习内容,清晰呈现知识与技能的逻辑关系和层次结构,有助于学生更好地理解专项运动技能的内在逻辑和规律;情境化变革大单元学习活动,将抽象的知识和核心素养融入真实、具体的情境中,让学生在真实情境、实践共同体的互动中理解专项运动技能的实际价值和意义。体育与健康课程大单元教学中核心素养、结构化和情境化三者相互制约、相互促进,共同构成学生专项运动技能学习与全面发展的关键所在。

基于VMD-TCN的水电机组健康状态监测系统设计

针对常规的水电机组运行监测系统以高频振动信号监测为主,低频振动信号监测失误问题较多,影响水电机组正常运行的问题,设计了基于VMD-TCN的水电机组健康状态监测系统。硬件方面,设计了AC102加速度传感器;软件方面,采集水电机组健康状态数据,对水电机组状态信号进行处理,判断机组健康状态。基于VMD-TCN分解水电机组健康状态监测信号,根据采集到的状态信号进行信号频段子模态分解,确保监测精准度。系统测试结果表明:该设计提升了系统的监测效果,系统性能良好。

义务教育体育与健康大单元教学的底层逻辑与实现路径

为全面贯彻落实义务教育体育与健康大单元教学的要求,运用逻辑分析法、文献研究法等阐述了义务教育阶段体育与健康大单元教学概念内涵、底层逻辑、实现路径等。研究认为中小学体育与健康课程教学缺乏整体教学理念,碎片化、蜻蜓点水式的教学问题突出等是义务教育大单元教学的逻辑基点;运动技能形成规律、系统化教学等是义务教育大单元教学的底层逻辑;正确把握大单元的时代要求、从学校层面进行科学谋划等是义务教育体育与健康大单元教学的实现路径。

英国西苏格兰大学精神卫生护理专业教育的现状与启示

该文介绍了英国西苏格兰大学精神卫生护理专业教育的目标、课程设置、教学和学习评价方式、实践培训内容与安排,以期为我国精神科护理学课程建设、提升我国护理专业学生的精神卫生护理能力提供参考。

基于氢储能的煤电机组灵活性改造方案研究

现有的煤电机组灵活性改造方案,聚焦局部与短期,难以消除频繁快速变负荷对热力系统造成的长期寿命折损与安全风险。为提高煤电机组参与电力市场辅助服务的安全性与经济性,提出建立基于氢储能系统的煤电机组系统级灵活性改造方案。分析了现有制氢路线,认为固体氧化物电解槽路线与煤电机组结合度高,且具有辅助煤电机组削减碳排放、提升经营收益的综合优点。以某国产1000 MW超超临界二次再热燃煤机组为应用对象,提出了氢储能系统与煤电机组的可行性结合方案。相关研究成果对于开发新型系统级的安全、健康经济的煤电灵活性提升改造方案具有参考意义。

基于动态工况实测数据图像和深度学习的锂电池容量估计方法

针对实际应用中基于动态工况下电池状态参数的片段数据进行电池健康状态(state of health,SOH)实时估计的问题,提出基于动态工况下锂离子电池状态参数(电压、电流、温度)实测数据二维特征图像和深度学习的锂离子电池容量估计算法。首先,将动态工况下电池状态参数监测量(电压、电流和温度)的片段数据转化为二维特征图像。其次,提出基于残差卷积神经网络(residual convolutional neural network,Res-CNN)和门控循环单元(gate recurrent unit,GRU)网络结合的多通道深度学习模型Res-CNN-GRU,以构建动态工况下电池状态参数特征图像和SOH之间的复杂非线性关系,其中电压、电流和温度的二维特征图像以三通道的方式输入到Res-CNN-GRU模型中,模型输出为对应电池的相邻参考充放电循环实验所获得容量的差值。研究结果表明:此方法在锂电池随机充放电工况下对电池健康状态估计效果更佳,且Res-CNN-GRU模型的泛化性和全局特征提取能力较强。论文研究为现实工况下电池健康状态估计的进一步深入研究提供了参考。

广西壮族自治区三级医院ICU有创机械通气病人口腔健康现状及其影响因素

目的:调查广西壮族自治区三级医院重症监护室(ICU)有创机械通气病人口腔健康现状,并分析其影响因素。方法:采用便利抽样法,于2023年7月抽取广西壮族自治区5所三级医院的204例ICU有创机械通气病人为研究对象。采用一般资料问卷、Beck口腔评估量表(BOAS)进行调查。结果:204例ICU有创机械通气病人BOAS评分为(7.79±2.86)分,口腔健康无受损者62例(30.39%)。随机森林模型结果显示,重要性评分较高的前5位变量为机械通气时长、是否使用专用漱口水、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、是否使用牙刷、是否口唇保湿。逐步回归分析结果显示,APACHEⅡ评分、是否使用牙刷、是否使用专用漱口水、是否口唇保湿是ICU有创机械通气病人口腔健康的主要影响因素(P<0.05)。结论:口腔健康受损的ICU有创机械通气病人比例较大,其受多种因素影响,建议采用综合干预措施以促进病人口腔健康。

某三级甲等医院ICU工作人员手卫生依从性及正确性调查分析

目的 研究某三级甲等医院重症监护病房(ICU)工作人员手卫生依从性及正确性,为手卫生干预提供理论基础。方法 2023年4月,专职感染监控人员对该院17个ICU的工作人员进行现场调查,填写手卫生依从性和正确性监测表。结果 使用隐蔽观察法共观察874次手卫生时机,执行手卫生时机501次,依从率57.32%,正确执行273次,正确率54.49%。不同ICU工作人员手卫生依从率及正确率差异较大。不同岗位工作人员手卫生依从率和正确率比较差异有统计学意义,保洁员的手卫生依从率(31.97%)低于护士(63.83%)、医生(58.77%)和其他人员(58.14%);保洁员的手卫生正确率(30.77%)低于护士(58.17%)。不同岗位人员及不同手卫生时刻未执行手卫生的原因差异有统计学意义:接触患者后未执行任何手卫生措施的比率(84.75%)高于接触患者前(41.27%)、清洁无菌操作前(30.00%)、接触血液体液后(45.45%);接触患者周围环境后未执行任何手卫生措施的比率(66.67%)高于接触患者前和清洁无菌操作前。不同岗位工作人员手卫生步骤不全的比率及时间不够的比率比较差异有统计学意义,其他人员的手卫生步骤不全的比率(82.35%)高于医生(52.63%);医生(82.46%)及护士(78.18%)手卫生时间不够的比率高于保洁员(51.85%)。结论 在ICU,不同职业的人群、不同时刻手卫生执行情况存在明显差异,需要综合其特点进行干预。

基于CNN-GRU神经网络的锂电池SOH估计与RUL预测

随着近几年新能源汽车市场的蓬勃发展,消费者对锂电池的电池性能和储能系统的整体要求逐步提升。锂电池作为新能源汽车的重要组成部分,对新能源汽车品牌的经济性能具有重要影响。针对锂电池健康状态(State Of Health,SOH)估计与剩余有效工作时间(Remaining Useful Life,RUL)预测无法直接测量,为了攻克在线准确测量的难题,提出基于卷积神经网络-门控循环单元(Convolutional Neural Network-Gated Recurrent Unit,CNN-GRU)的锂电池SOH估计与RUL预测方法。运用Python编程语言在TensorFlow框架下搭建CNN-GRU神经网络,利用GRU长时间记忆能力与CNN避免了对数据的复杂前期预处理,采用NASA开放实验数据测试,经过实验结果对比,基于CNN-GRU神经网络的估算模型相对于BP、CNN、GRU单独神经网络模型拥有更高的计算精度,以及更稳定的预测结果。

ICU护士对重型颅脑损伤患者目标体温管理知信行问卷的编制及信效度检验

目的编制ICU护士对重型颅脑损伤(severe traumatic brain injury,STBI)患者目标体温管理(target tem-perature management,TTM)知信行(knowledge,attitude and practice,KAP)问卷并检验其信效度。方法以知信行理论为框架,通过文献分析及小组讨论初步构建问卷条目池,再通过德尔菲法和预调查确定问卷初稿。采用便利抽样法,于2022年10月选取甘肃省4所医院240名ICU护士进行调查,进行问卷信效度检验。结果ICU护士对重型颅脑损伤患者目标体温管理知信行问卷共包含3个维度,32个条目。问卷整体内容效度指数为0.955,条目内容效度指数为0.800~1.000。探索性因子分析提取4个公因子,累积方差贡献率为58.889%,问卷整体Cronbach’sα系数为0.862,重测信度为0.890;知识、态度及行为维度的Cronbach’sα系数分别为0.713、0.925及0.924,重测信度分别为0.801、0.943及0.950。结论ICU护士对重型颅脑损伤患者目标体温管理知信行问卷具有良好的信效度,可作为ICU护士对重型颅脑损伤患者目标体温管理知信行水平的测评工具。