Assessing Healthcare Facilities Preparedness for Mass Fatalities Incident

Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics;emergency plans;equipment and infrastructure;collaborative agreements;personnel trainings;emergency communications;laboratory facilities;treatment protocols;security;and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion: Most of healthcare facilities have morgues, but there are limitations with the current capacity and the lack of resources to increase their capacity in case of a disaster. Management of an MFI must be part of every hospital’s emergency plan, and must include collaborative agreements with forensic authorities, emergency management and public health agencies, and the community.

Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

Determinants of malaria from environmental and poverty aspects in Indonesia:A spatiotemporal perspective,2016-2020

Objective:To investigate the environmental and social aspects of poverty contributing to malaria incidence in Indonesia from 2016 to 2020.Methods:Random forest regression was used to analyse the independent variables contributing to malaria incidence.Environmental conditions were extracted from remotely sensed data,including vegetation,land temperature,soil moisture,precipitation,and elevation.In contrast,the social aspects of poverty were obtained from government statistical reports.Results:From 2016 to 2020,the contribution of each environmental and social aspect of poverty to malaria incidence fluctuated annually.Generally,the top three essential variables were people aged 15 years and above,experiencing poverty(variable importance/VI=32.0%),people experiencing poverty who work in the agricultural sector(VI=14.4%),and precipitation(VI=9.8%).It was followed by people experiencing poverty who are unemployed(VI=9.2%),land temperature(VI=5.2%),people experiencing poverty who have low education(VI=8.0%),soil moisture(VI=7.4%),elevation(VI=6.0%),and vegetation(VI=3.8%).Conclusions:Poverty and variables related to climate have become the crucial determinants of malaria in Indonesia.The government must strengthen malaria surveillance through climate change mitigation and adaptation programs and accelerate poverty alleviation programs to support malaria elimination.

Mental emotional disorder is a predictor of stroke incidence in adults:Ten year results of the Bogor Cohort Study on Non-Communicable Disease Risk Factors in Indonesia

Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of"the Bogor Cohort Study on Non-Communicable Disease Risk Factors".Data were collected by interview method with structured questionnaires,physical measurements three times a year,and laboratory examination every two years during a 10-year follow-up(2011-2021,without examination in 2020).The incidence of stroke is based on anamnesis results and examination by a neurologist.Other stroke predictor variables include characteristics,biological conditions,and risk behavior.We analysed 4445 stroke-free samples with Cox proportional hazard regression test.Results:During the 10-year observation,stroke incidence was 440 person-years per 100000 population(95%CI 370-530).During the follow-up of ten years,the main predictor of stroke was mental-emotional disorders with HR 4.2(95%CI 2.8-6.3)after adjustment by age,hypertension,obesity,abdominal obesity,and high LDL-cholesterol levels.Conclusions:Mental-emotional disorders are the strongest predictor of stroke incidence.Hence,psychological factors must be controlled in a stroke prevention program.

Comprehensive evaluation framework for intervention on health effects of ambient temperature

Despite the existence of many interventions to mitigate or adapt to the health effects of climate change,their effectiveness remains unclear.Here,we introduce the Comprehensive Evaluation Framework for Intervention on Health Effects of Ambient Temperature to evaluate study designs and effects of intervention studies.The framework comprises three types of interventions:proactive,indirect,and direct,and four categories of indicators:classification,methods,scope,and effects.We trialed the framework by an evaluation of existing intervention studies.The evaluation revealed that each intervention has its own applicable characteristics in terms of effectiveness,feasibility,and generalizability scores.We expanded the framework's potential by offering a list of intervention recommendations in different scenarios.Future applications are then explored to establish models of the relationship between study designs and intervention effects,facilitating effective interventions to address the health effects of ambient temperature under climate change.

Attitudes of nursing students about palliative care:an analysis of influencing factors

Background:As the population continues to age and the number of people suffering from incurable diseases,such as malignant tumors and Alzheimer’s disease,increases,the need for quality end-of-life care is becoming more and more prominent.Nursing students,as a reserved talent in the nursing field,have an attitude towards palliative care that will directly affect the quality of care for future terminal patients.Methods:This descriptive and cross-sectional survey was conducted from November 2020 to January 2021.A stratified sampling method randomly selected 1168 undergraduate and postgraduate nursing students as respondents.Students’attitudes were measured using a revised palliative care attitude questionnaire.Results:The palliative care attitude score was 7.233±1.812 with a score of 72.3%and a median score of 7.50 with a range of 0-10.63.10%of the nursing students had an attitude score of 7 or more and only 2.40%of the nursing students had a negative attitude towards palliative care.The results showed that gender,grade level,health status,and attitudes toward the nursing profession affected nursing students’attitudes toward palliative care(P<0.05).Conclusion:Currently,Chinese nursing students have better attitudes towards palliative care,but are less likely to want to pursue a career in palliative care in the future.Medical schools can take into account their actual gradual opening of palliative care courses,using a variety of teaching methods to stimulate the interest of nursing students to learn and improve their willingness to palliative care services.

Study on the association of multimorbidity with sleep and diet in young and middle-aged adults in Chongqing region,China

Background:The prevalence of multimorbidity is increasing,with a notable shift towards younger age groups.Methods:Convenience sampling was employed to select 15,988 young and middle-aged adults in Chongqing as the study population.The Apriori algorithm was used to identify the multimorbidity patterns within this population,while an unordered binary logistic regression model was applied to assess the association between sleep,diet and the risk of multimorbidity.Results:The study population had an average age of 39.2±10.1 years.Apriori association rules revealed that the most prevalent binary chronic disease multimorbidity pattern was dyslipidaemia+hypertension(14.78%),while the most common ternary chronic disease multimorbidity pattern was diabetes+dyslipidaemia+hypertension(9.66%).The logistic regression analysis revealed that a lower rating of sleep quality was associated with an elevated risk of multimorbidity(odds ratio(OR)=1.17,95%confidence interval(CI):1.01,1.36).Individuals who adhere to a meat-based diet(OR=1.45,95%CI:1.25,1.68)and those with elevated salt intake(OR=1.22,95%CI:1.01,1.47)were also observed to have an increased risk of multimorbidity.Additionally,a greater likelihood of multimorbidity was observed among those following a spicy diet(OR=1.3,95%CI:1.11,1.52)and consuming more oil(OR=1.16,95%CI:1.01,1.33).Conclusion:A poor sleep quality and a dietary preference for meat-based,salt,spicy and oils were found to be associated with an increased risk of multimorbidity progression among young and middle-aged populations.It is recommended that young and middle-aged adults should pay attention not only to sleep duration but also to sleep quality and improve dietary habits to reduce the likelihood of multimorbidity.

Benefits and harms of endoscopic screening for gastric cancer

Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.

Mobile device-based Reporting System for Sichuan Earthquake-affected Areas Infectious Disease Reporting in China

Objective To describe the experience of the China CDC in rebuilding reporting capacity and response to the Sichuan earthquake through use of mobile phones. Methods Software engineering and business modeling are used to design and develop a cell phone-based reporting system. The PDA-based system used by the Field Adapted Survey Toolkit （FAST） was deployed Results Approximately one week after deployment of the mobile phone-based reporting system, the cumulative reporting rate reached the same level （81%） as the same period in 2007. In the Sichuan provincial pilot investigation for infectious disease, 1339 records were collected using PDAs developed and deployed by FAST. Conclusion The mobile-based system is recognized as a quick and effective response solution to this public health challenge. Our experience suggests that mobile-based data collection tools provide faster, cleaner, standardized, and shareable data for critical decision making. This system could be adapted as complementary to national infectious disease reporting systems after natural disaster occurrences.

Performance of 18-fluoro-2-deoxyglucose positron emission tomography for esophageal cancer screening

AIM To evaluate the performance of 18-fluoro-2-deoxyglucose positron emission tomography(FDG-PET) for esophageal cancer(EC) screening.METHODS We retrospectively analyzed the data of consecutive asymptomatic individuals who underwent FDG-PET and esophagogastroduodenoscopy(EGD) simultaneously for cancer screening at our institution from February 2004 to March 2013. In total, 14790 FDG-PET and EGD procedures performed for 8468 individuals were included in this study, and the performance of FDGPET for EC screening was assessed by comparing the results of FDG-PET and EGD, considering the latter as the reference.RESULTS Thirty-two EC lesions were detected in 28 individuals(31 squamous cell carcinomas and 1 adenocarcinoma). The median tumor size was 12.5 mm, and the depths of the lesions were as follows: Tis(n = 12), T1a(n = 15), and T1b(n = 5). Among the 14790 FDG-PET procedures, 51 examinations(0.3%) showed positive findings in the esophagus; only 1 was a true-positive finding. The screen sensitivity, specificity, positive predictive value, and negative predictive value of FDGPET for ECs were 3.6%(95%CI: 0.1-18.3), 99.7%(95%CI: 99.6-99.7), 2.0%(95%CI: 0.0-10.4), and 99.8%(95%CI: 99.7-99.9), respectively. Of the 50 FDG-PET false-positive cases, 31 were observed in the lower esophagus, and gastroesophageal reflux disease was observed in 17 of these 31 cases.CONCLUSION This study is the first to clarify the FDG-PET performance for EC screening. Based on the low screen sensitivity, FDG-PET is considered to be difficult to use as a screening modality for ECs.

Conceptual Model for Automatic Early Warning Information System of Infectious Diseases Based on Internet Reporting Surveillance System

Objective To establish a conceptual model of automatic early warning of infectious diseases based on internet reporting surveillance system, with a view to realizing an automated warning system on a dally basis and timely identifying potential outbreaks of infectious diseases. Methods The statistic conceptual model was established using historic surveillance data with movable percentile method. Results Based on the infectious disease surveillance information platform, the conceptual model for early warning was established. The parameter, threshold, and revised sensitivity and specificity of early warning value were changed to realize dynamic alert of infectious diseases on a dally basis. Conclusion The instructive conceptual model of dynamic alert can be used as a validating tool in institutions of infectious disease surveillance in different districts.

Cost Effectiveness of DOTS and Non-DOTS Strategies for Smear-positive Pulmonary Tuberculosis in Beijing

The cost effectiveness of DOTS (Directly Observed Treatment, short course) and non DOTS strategies for smear positive pulmonary tuberculosis in Beijing was evaluated. Cost calculation was based on the expenses of drugs, chest X ray films, sputum smears and cultures for the patients. Effectiveness of the intervention was assessed in two aspects: direct benefits to the patients treated and indirect benefits to the others through reduced transmission of tuberculosis; disability adjusted life of year (DALY) was used as an index. The results showed that one DALY could be saved with 45.7 Yuan by DOTS and 471.4 Yuan by non DOTS. DOTS is a good control strategy for smear positive tuberculosis.

Real-World Data for the Drug Development in the Digital Era

Randomized clinical trials(RCTs)have long been recognized the gold standard for regulatory approval in the drug development.However,RCTs may not be feasible in some diseases and/or under certain situations,and findings from RCTs may not be generalized to real-world patients in routine clinical practice.Real-world evidence(RWE),which is generated from various real-world data(RWD),has become more and more important for the drug development and clinical decision-making in the digital era.This paper described RWD and real-world data studies(RWDSs),followed by the characteristics and differences between RCTs and RWDSs.Furthermore,the challenges and limitations of RWD and RWE were discussed.Finally,this paper highlights that the efforts must be made during RWE generation from data collection/database selection,study design,statistical analysis,and interpretation of the results to minimize the biases and confounding effects.

Contemporary Approaches for Identifying Rare Bone Disease Causing Genes

Recent improvements in the speed and accuracy of DNA sequencing, together with increasingly sophisti- cated mathematical approaches for annotating gene networks, have revolutionized the field of human genetics and made these once time consuming approaches assessable to most investigators. In the field of bone research, a particularly active area of gene discovery has occurred in patients with rare bone disorders such as osteogenesis imperfecta （OI） that are caused by mutations in single genes. In this perspective, we highlight some of these technological advances and describe how they have been used to identify the genetic determinants underlying two previously unexplained cases of OI. The widespread availability of advanced methods for DNA sequencing and bioinformatics analysis can be expected to greatly facilitate identification of novel gene networks that normally function to control bone formation and maintenance.

Key Social Determinants to Narrow the Gap between Health-adjusted Life Expectancy and Life Expectancy in Megacities

Objective Improvement in the quality of life is reflected in the narrowing of the gap between healthadjusted life expectancy(HALE)and life expectancy(LE).The effect of megacity expansion on narrowing the gap is rarely reported.This study aimed to disclose this potential relationship.Methods Annual life tables were constructed from identified death records and population counts from multiple administrative sources in Guangzhou,China,from 2010 to 2020.Joinpoint regression was used to evaluate the temporal trend.Generalized principal component analysis and multilevel models were applied to examine the county-level association between the gap and social determinants.Results Although LE and HALE in megacities are increasing steadily,their gap is widening.Socioeconomic and health services are guaranteed to narrow this gap.Increasing personal wealth,a growing number of newborns and healthy immigrants,high urbanization,and healthy aging have helped in narrowing this gap.Conclusion In megacities,parallel LE and HALE growth should be highly considered to narrow their gap.Multiple social determinants need to be integrated as a whole to formulate public health plans.

Mental Health Disorders of the Indonesian People in the Early Stages of the COVID-19 Pandemic:Who is Vulnerable to Experiencing it?

The extraordinary situation related to COVID-19 makes people worry about their health,family health,work,finances,and other daily activities.This condition can lead to social unrest,which has consequences for mental health problems.This study aims to determine the mental health consequences at the beginning of the COVID-19 pandemic in Indonesia.This is a cross-sectional study involving a target population aged 18 years and over who had access to electronic communication devices.An online questionnaire was randomly distributed and snowballed throughout 34 provinces in Indonesia.The study was conducted from 2 to 4 May 2020.Non-parametric and multi-variate linear regression analyses were performed to identify factors associated with anxiety and depression.Two thousand seven hundred forty-three participants were involved in this study,with 69.16%female.In sum,6.92%of participants had General Anxiety Disorder-7(GAD-7)scores≥10 for moderate-severe anxiety symptoms,and 8.57%had Patient Health Questionnaire-9(PHQ-9)scores≥10 for moderate-severe depressive symptoms.The multivariate linear regression analyses showed that the strongest factors influencing anxiety and depression were a history of mental illnesses,chronic illnesses,the group affected by layoffs or job seekers,unemployed,students,younger age group,living in a rented house,single,and female.In contrast,the lower and secondary education level seems to reduce the risk of depression compared to those with higher education levels.Anxiety and depression occur during the periods of activity restriction during the COVID-19 pandemic and are influenced by several modifiable and non-modifiable factors.There is an urgent need to emphasize vulnerable groups such as those with a history of illness,those affected by layoffs/looking for work,and the younger age group.

China's unique role in the field of global health

China's participation in global governance,inspired by the 17 United Nations Sustainable Development Goals,is driven by the guiding principle of"Building a Community of Shared Future for Mankind".China has been promoting the Belt and Road Initiative and South-South Cooperation and has made significant contributions to the prosperity of human beings.Along with the opportunities that globalization brought about such as the World Health Organization and the boom in the economy,global health challenges also emerged.This resulted in certain obstacles for China when it sought to advocate the Belt and Road Initiative and when it attempted to carry out its strategy to address global health issues.What are the emerging challenges for global health?What can China do for global health?Why does global health need China?We tried to address these questions as China's global engagement continues to expand in the new era.This article makes the case for Chinese approaches,including getting involved in public health,being consistent in addressing local conditions,and sharing China's experience with handling health services and staying in the lead through government action while being guided by relative policies.China has a lot to offer in the promotion of global health and in overcoming the challenges and risks that this goal currently faces.Thus,China should be considered an inseparable part of global health governance and bilateral health development cooperation.

Artificial Intelligence and the Sustainable Development Goals: An Exploratory Study in the Context of the Society Domain

Artificial Intelligence (AI) experienced significant advancements in recent years, and its potential power is already recognized across various industries. Yet, the rise of AI has led to a growing concern about its impact on meeting the Sustainable Development Goals (SDGs). The aim of this paper was to evaluate contributions and the potential influence of AI to sustainable development in the society domain. Furthermore, the study analyzed GPT-3 responses, as one of the largest language models developed by OpenAI, descriptively. We conducted a set of queries on the SDGs to gather information on GPT-3’s perceptions of AI impact on sustainable development. Analysis of GPT-3’s contribution potential towards the SDGs showcased its broad range of capabilities for contributing to the SDGs in areas such as education, health, and communication. The study findings provide valuable insights into the contributions of AI to sustainable development in the society domain and highlight the importance of proper regulations to promote the responsible use of AI for sustainable development. We highlighted the potential for improvement in neural language processing skills of GPT-3 by avoiding imitating weak human writing styles with more mistakes in longer texts.

Unintentional Carbon Monoxide Poisoning Outbreak from 2 to 9 October 2019 in Ulaanbaatar, Mongolia

Carbon monoxide poisoning (COP) from 2 to 9 October 2019 was a major public health concern in Ulaanbaatar, Mongolia, after a transition from consumption of raw coal to upgraded briquette fuel. During the period, a total of 186 residents, which is 16 times more than the previous years, were exposed to COP and 6 persons died at home. We conduct a cross-sectional study by using registration data and medical history of all hospitalized patients with a diagnosis of COP from 2 to 9 October 2019 and had an in-depth interview. 144 (77.4%) people from 85 households registered as potential cases and 124 (86.1%) people were diagnosed with COP. All households used upgraded briquettes, and 41 households (48.2%) used them for the first time. In 50% of cases, the stove was broken, the chimney was short, not heated, and the clay joint connecting the wall stove was broken. The majority of interviewees were unaware of COP and improperly used briquettes, and the safety of chimneys and stoves was insufficient which caused unintentional COP. It is necessary to provide information to the local population about the potential risks of COP, install CO alarms in households, and educate the population. In further, a well-established poisoning surveillance system is an important aspect of public health emergency preparedness in Mongolia.

Prevalence and Risk Factors for Chronic Obstructive Pulmonary Disease Among Adults Aged 50 and Above-10 CKB Study Areas,China,2020–2021

What is already known about this topic?The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults,but the risk factors for this age group were unclear.What is added by this report?The prevalence was estimated at 12.8%and 5.7%for males and females over 50 in 2020–2021,with confirmed risk factors of cigarette smoking,a family history of respiratory diseases,respiratory symptoms,and a history of cough or respiratory diseases during childhood.What are the implications for public health practice?The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner.