Exploring the association of paid sick leave with healthcare utilization and health outcomes in the United States:a rapid evidence review

Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.

Satisfaction of Village Doctors with the Township and Village Health Services Integration Policy in the Western Minority-inhabited Areas of China

Township and Village Health Services Integration Management（TVHSIM） is an essential form of China＇s two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China＇s new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors＇ satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors＇ personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels（all P〈0.05）. Age（P〈0.05） and years of practice（P〈0.01） were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level（P〈0.05） was negatively correlated with Operations Management as well. However, social insurance status（P〈0.05） was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors＇ satisfaction with TVHSIM（P〈0.01）. In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

Plasma Metabonomics of Human Adenovirus-infected Patients with Pneumonia and Upper Respiratory Tract Infection

Objective Human adenovirus(HAdV)infection is common and can develop to serious conditions with high mortality,yet the mechanism of HAdV infection remains unclear.In the present study,the serum metabolite profiles of HAdV-7-infected patients with pneumonia or upper respiratory tract infection(URTI)were explored.Methods In total,35 patients were enrolled in the study following an outbreak of HAdV-7 in the army,of whom 14 had pneumonia and 21 had URTI.Blood samples were collected at the acute stage and at the recovery stage and were analyzed by untargeted metabolomics.Results Over 90% of the differential metabolites identified between the pneumonia patients and URTI patients were lipids and lipid-like molecules,including glycerophospholipids,fatty acyls,and sphingolipids.The metabolic pathways that were significantly enriched were primarily the lipid metabolism pathways,including sphingolipid metabolism,glycerophospholipid metabolism,and linoleic acid metabolism.The sphingolipid metabolism was identified as a significantly differential pathway between the pneumonia patients and URTI patients and between the acute and recovery stages for the pneumonia patients,but not between the acute and recovery stages for the URTI patients.Ceramide and lactosylceramide,involved in sphingolipid metabolism,were significantly higher in the pneumonia patients than in the URTI patients with good discrimination abilities[area under curve(AUC)0.742 and 0.716,respectively;combination AUC 0.801].Conclusion Our results suggested that HAdV modulated lipid metabolism for both the patients with URTI and pneumonia,especially the sphingolipid metabolism involving ceramide and lactosylceramide,which might thus be a potential intervention target in the treatment of HAdV infection.

Arterial Hypertension-Related Factors within Custodial Settings of Southern Benin in 2023

Introduction: Hypertension, a non-communicable disease, is a major public health threat worldwide, accounting for a high level of morbidity and mortality. Although it has been extensively published among the general population, further research is needed to understand the reality of hypertension within the custodial setting. This study aimed to investigate the factors associated with arterial hypertension in custodial settings in southern Benin in 2023. Methods: This was a cross-sectional, descriptive, analytical study held in prisons in southern Benin from March to April 2023, involving inmates selected by two-stage random sampling. In the first stage, four prisons out of the six in the southern region of Benin were selected by simple random sampling. In the second stage, the prisoners were selected by systematic random sampling, with the sampling frame being the numbered list of eligible prisoners in each prison selected. Data collected by observation and questionnaire survey were analyzed using Stata 11 software. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg. Overweight was defined by a body mass index (weight/height2 (kg/m2) ≥ 25. Factors associated with hypertension were identified by multiple logistic regression, at a 5% threshold of significance. Results: Altogether 336 inmates aged 37.55 ± 1.72 years were surveyed. The prevalence of hypertension in custodial settings in southern Benin in 2023 was 31.32% (95% CI [17.06;52.57]). Associated factors were inmate age (ORa = 3.36 95% CI: [1.94;5.85]) and abnormal waist circumference (ORa = 2.61 95% CI [1.27;5.40]). Conclusion: The prevalence of arterial hypertension in prisons of southern Benin (31.32%) is high when compared with the national average (25.9% (22.5-29.3)). The ministries of the Interior and Health need to collaborate to involve inmates in preventive strategies for non-communicable diseases, including hypertension.

Excessive Drowsiness among Truck Drivers in Benin in 2023: Associated Factors and Risk of Crashes Occurrence

Introduction: Over-drowsiness is a condition with serious consequences, including road accidents. The condition, however, is often ignored both by carers as well as victims themselves. The aim of the present study was to investigate the factors associated with excessive drowsiness in Cotonou, Benin 2023, along with its influence on the occurrence of crashes among truck drivers. Methods: This was a descriptive and analytical cross-sectional study, held from March 13 to April 10, 2023, focusing on large truck drivers over 18 years of age, selected by convenience from parking lots in and around the city of Cotonou. Data collected using questionnaires on socio-demographic and behavioral factors, sleeping habits and working conditions were processed using Stata 15.0 software. Excessive drowsiness was defined by a score above 10 on the Epworth scale. Associated factors were found by multiple logistic regression, at a threshold of 0.05. Results: Altogether 304 drivers, all male and aged 35.98 ± 8.42 years, were surveyed. The prevalence of excessive drowsiness was 29.2%. The associated factors identified were not practicing sport OR = 2.27, CI95% = [1.33;3.86], p = 0,002;sleep duration per working day OR = 1.82;CI95% = [1.06;3.11], p = 0,027 and average distance travelled per day OR = 3.40;CI95% = [1.53;7.56], p = 0,003. Excessive drowsiness was associated with a 1.73-fold increased risk of road accidents (CI95% [1.04;2.87];p = 0.03). Conclusion: Communicating excessive drowsiness and its associated factors to all the stakeholders in the haulage chain is essential to help prevent road accidents.

Associations of centralization with health care quality for gastric cancer patients receiving gastrectomy in China

Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.

Health Hot Spots: Mapping Hospital Costs and Social Determinants of Health

Accountable care organizations (ACOs) and hospitals are facing additional requirements and financial rewards for improving population health. Therefore, ACOs and hospitals will need tools to understand the relationship between their patients and social determinants and health. We demonstrate the use of hot spotting for identifying geographical sources of high hospital costs and examining links between social determinants of health and these high-cost areas, known as hot spots. In 2012, using hospital data, we generated maps of inpatient costs from 2011 throughout New Haven and within an example neighborhood, Dixwell. We defined hot spots as addresses where costs were in the top 25%. We also overlaid data on concerns and assets in the community. Finally, we calculated the number of concerns and assets that fall within the 250 and 500 ft radii of the defined hot spots. We found that 34 addresses in Dixwell accounted for 70% of total costs for Dixwell. Hot spotting is a straightforward, approachable, and easily understood method for ACOs and hospitals to begin to address population health.

Healthcare practice strategies for integrating personalized medicine:Management of COVID-19

Personalized medicine is the tailor-made clinical treatment to the individual characteristics of each patient.It may be considered an extension of traditional approaches to knowing and treating diseases.Personalized medicine has the potential to change the way of identification and management of health problems.Coronavirus disease 2019(COVID-19)is an infectious disease that primarily affects the patients’lungs.The first case of pneumonia of unknown cause was reported in Wuhan,China on December 31,2019.As thus,we are quickly approaching the era of personalized medicine.This review discusses the practices currently used in the management of COVID-19 and how they relate to person-alized medicine.

Policy options for addressing the high cost of specialty pharmaceuticals

The cost to U.S.consumers of specialty drugs is too high,and cost-sharing obligations are reducing patient access to affordable and life-changing medications.While accounting only for approximately two percent of prescriptions filled,specialty drugs accounted for nearly 45 percent of the U.S.drug spend in 2018,and this rate continues to rise.This review analyzes the current state of the U.S.specialty drug market and recommends six policy options for decreasing out-of-pocket costs to consumers.A systematic review was conducted,gathering articles from peer-reviewed and government resources published from January 2014 to May 2019 using databases such as PubMed,OVID,and the Congressional Research Service(CRS).Articles were reviewed for unique and relevant information relating to cost specialty drugs,industry trends,underlying legislation and policy challenges,and viable policy options.The findings show that,while the cost of specialty drug prices is growing,the rate of growth is projected to slow to a compound annual growth rate(CAGR)of 4 to 7 percent between 2019 to 2023,as compared to a CAGR of 7.2 percent from 2014 to 2018,largely due to the Food and Drug Administration's approval of 10 new biosimilars in 2018 and early 2019.However,specialty drug spending as a percentage of total spending continues to rise and can cost payers and patients more than USD 3,500 on average per month.We recommend six policy options for reducing consumers'out-of-pocket cost obligations:(1)discourage"pay-for-delay"agreements and patent evergreening;(2)align incentives across the specialty drug supply chain with value-based pricing;(3)tighten orphan drug eligibility or impose a sales tax on drugs if the sales tax exceeds a specified threshold until federal subsidies are recouped;(4)increase transparency in transactions between specialty drug supply chain stakeholders;(5)tax the direct-to-consumer advertising of specialty drugs and use the proceeds to fund public research;and(6)support copay cards and patient assistance programs.While the consensus across the industry is that the out-of-pocket costs of specialty drugs to patients are too high,industry stakeholders must agree about which set of policy options to implement.Lawmakers must explore options for reducing the out-of-pocket costs of specialty medications and gather public input on how to best align stakeholder incentives across the specialty drug supply chain.

Containing the rising cost of insulin: select policy recommendations

Diabetes is a chronic disease that affects over 30 million people in the United States.Of these,approximately 7.4 million use one or more formulations of insulin to manage their condition.There is a significant financial burden on diabetic individuals,as the price of insulin keeps increasing each year.Such consistent and drastic increases in the price of insulin are due to the complexities in the insulin supply chain,pricing mechanisms particularly due to pharmacy benefit managers(PBMs),and the dominance of a few insulin manufacturers in the market.This policy analysis has been undertaken independently and is based on information from peer-reviewed journals,government organizations and agencies,and credible news sources.Politicians and various stakeholders in the supply chain have made several policy recommendations on the pricing of insulin.From the data and information collected,we suggest basing a patient's co-payment on the net price instead of the list price of insulin,and that there should be real-time transparency in the negotiations between PBMs and pharmaceutical companies on rebates.

The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa

Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.

Measurement of the Effects of Nutritional Education for Reducing Sodium Intakes and Increasing Potassium Intakes

Background: The Togolese population, like those around the world, frequently consumes foods high in salt/sodium and low in potassium, thus exposing them to cardiovascular disease (CVD). Nutritional intervention can help reverse this consumption pattern and reduce related CVD morbidity and mortality. The objective of this study was to measure the effects of a nutrition education intervention on the consumption frequencies of foods rich in sodium and potassium. Methods: The study was a quasi-experimental before- and-after study, conducted from 08 January to 16 April 2023. It involved 200 adults aged 25 - 64 years, randomly selected from two areas: an intervention area and a non-intervention area. Data were collected in two phases at 3-month intervals in both groups. The intervention consisted of nutrition education (awareness raising and cooking demonstrations) on reducing salt/sodium intake and increasing potassium-rich food intake. The kobocollect electronic questionnaire was administered to the respondents to collect data on the frequency of consumption of foods rich in sodium and potassium. Results: The median age of the respondents was 33 years old (30;38) and 56% of the participants were women, 44% and 69% respectively in the control and intervention groups. Most participants lived in rural areas (51%), 52.4% and 49.5% in the control and intervention groups respectively. Overall, 4% (p individuals reduced their frequency of adding salt at mealtime from more than 3 times a week to less than 3 times, i.e., 5.6% in the intervention group and 1.7% in the control group. The proportion of individuals who consumed meals with green leafy vegetable sauces was reduced from more than 3 times a week to less than 3 times, i.e., 7.5% (p < 0.022), or 1% in the intervention group and 4% in the control group. Education level (0.23 [0.10 - 0.50];p - 6.35];p < 0.0006) were associated with reduced salt addition at meals. The same trend was observed for increased consumption of green leafy vegetable sauces (0.95 [0.03 - 0.99];p male (2 [1.08 - 1.84];p Conclusion: This study was able to measure the effects of a nutrition education intervention for adequate sodium and potassium intakes on changing favourable dietary behaviour through a quasi-experimental study. The results show that the continuation of the intervention will contribute to the adoption of favourable behaviours for the reduction of dietary sodium intakes and the optimisation of potassium intakes.

Prevention of Maternal Low-Grade Chronic Inflammation: The Diet’s Inflammatory Potential in Pregnant Women in Southern Benin

Background: Pathogenic mechanisms link maternal systemic low-grade chronic inflammation to intrauterine development. A pro-inflammatory diet during pregnancy is associated with chronic maternal systemic inflammation. The objective of the study was to determine the diet inflammatory index and identify associated foods and nutrients in pregnant women of Ouidah city, Benin. Methods: The cross-sectional study conducted among pregnant women randomly selected by cluster sampling. Nutrient intakes and food consumed were estimated based on data of two 24-hour non-consecutive recalls. The inflammatory weightings of each nutrient were used to calculate the diet inflammatory index for each pregnant woman. Results: The average age of the 310 pregnant women surveyed was 27.20 ± 5.99 years. The median diet inflammatory index was -3.026 (-16.59;1.86). The pregnant women with inflammatory diet accounted for 11.30%. Vitamin A and zinc were negatively correlated with the diet inflammatory index. Fruits, roots, tubers and sweetened drinks consumed were positively correlated with the diet inflammatory index. On the contrary, the quantities of cereals, vegetables, legums and fish consumed were negatively correlated with the diet inflammatory index. Conclusion: More than one pregnant woman out of ten in the Ouidah city had a pro-inflammatory diet. Reducing maternal systemic low-grade chronic inflammation may include increasing the consumption of identified anti-inflammatory foods.

Dysfunctions in the Management of Patients Whose Outcome Was Classified as “Maternal Death” from 2017 to 2021, at the Departemental University Teaching Hospital of Borgou Alibori (Chud-Ba), Benin

Background: Maternal death is a major public health problem worldwide, particularly in sub-Saharan Africa. Objective: This study sought to investigate dysfunctions in the management of patients whose outcome was classified as “maternal death” in the Gynaecology-Obstetrics section of the Departmental University Teaching Hospital of Borgou Alibori (CHUD-BA) from 2017 to 2021. Method: This was a retrospective cross-sectional study with descriptive and analytical purposes. The study population consisted of pregnant women, parturients and puerperas admitted into the CHUD-BA maternity ward from 2017 to 2021. Result: A total of 2011 patients were included in this study. The in-hospital maternal mortality ratio was 1526 per 100,000 live births. The dysfunctions identified were the amount of time spent in the referring center (more than 48 hours) (p = 0.001), delay of more than 2 hours between referral and admission into the referral center (p < 0.001), means of transport (motorcycle or public transport) (p compliance to the protocol for emergency obstetric and neonatal care (SONU) (p < 0.001) and delay of more than 2 hours in the etiological management of pregnant women (p Conclusion: Particular attention should be paid to the management of pregnant women in our healthcare system if we are looking forward to reducing maternal mortality.

Knowledge, Attitudes and Practices of the Populations of Dapaong and Its Surroundings in Togo on Sodium/Salt and Potassium Intakes

Background: Food plays an important role in human health. A healthy diet contributes to the improvement of the health of populations. A diet high in sodium/salt and low in potassium has been shown to contribute to cardiovascular disease. The objective of this study was to assess the knowledge, attitudes and practices (KAP) of the inhabitants of Dapaong and its surroundings on dietary intakes of sodium/salt and potassium. Methods: This was a cross-sectional study conducted from 1 November to 15 December 2022 involving 400 adults aged 25 to 44 years. Sampling was done using the probability method and the multistage random sampling technique with proportional allocation. These two methods were applied to select villages, households, and primary targets in each locality according to whether the area of residence was urban or rural. The electronic kobocollect questionnaire was administered to people in households and the interview guide was to resource persons, administrators and community leaders to collect the data. Results: Overall, 80.25% of the respondents had low knowledge of sodium/salt intakes;88.50% had poor attitudes towards the use of foods that provide more sodium/salt and 92.75% had behaviours that were not conducive to reducing excessive salt consumption. With regard to potassium, the same trend was observed in the order of 91%, 72% and 73.75%. Conclusion: The KAP levels of the people studied were not good. The populations are prone to cardiovascular disease. A multisectoral nutritional intervention would be essential to improve the knowledge of the populations on sodium/salt and potassium intakes and therefore favourable to the fight against CVD/NCD.

Barriers in the Transition of Care for Heart Failure Patients Attending Clinics in Mwanza City, Tanzania

Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.

Changes in Subjective Sleep,Physical Condition,and Mental Health during the COVID-19 Pandemic:A Nationwide Survey in Japan

This study aimed to investigate how people’s subjective health changed after the coronavirus disease 2019(COVID-19)pandemic.This survey was conducted in May 2021 as a nationwide online self-reported survey in Japan.The respondents indicated how their sleep,physical condition,and mental state altered after the pandemic.Furthermore,they answered questionnaires about their intention to get vaccinated,the means of gathering information,etc.A logistic regression analysis was performed.Of the 2,573 responses,there was a decline of approximately 13.6%,14.0%,and 23.8%in subjective sleep,physical condition,and mental health after the pandemic,respectively.The logistic regression analysis demonstrated that regarding sleep,the affected group was younger,got vaccinated against influenza annually,had lower income,experienced poor sleep quality in the past month,and had worse physical and psychiatric symptoms than before the pandemic.Concerning the physical condition,the affected group lived alone,witnessed deficient sleep quality in the past month,and had deteriorated mental health status than before the COVID-19 pandemic.In terms of mental status,the affected group was younger,females,had access to more sources of information,and experienced worse sleep and physical conditions than the unchanged or improved group(p<0.05).Each group indicated an association with the background factors,confirming that the subjective sleep,physical condition,and mental state affected each other.From a preventive perspective,the results of this study suggested that factors such as youth,gender,sleep quality,pregnancy,reduced income,and greater access to information,may be necessary for physical and mental support.The above-mentioned factors should be considered in light of community life and approached accordingly.

A Systematic Analysis of Early Life Exposure to the Chinese Famine(1959-1961)and the Health of Older Adults-China,2008-2023

What is already known about this topic?There is mounting evidence indicating that the aging process initiates during early life stages,with in utero the individual’s environment playing a significant role.Consequently,it is crucial to comprehend the enduring effects of early life circumstances on health in old age.What is added by this report?In this study,we conducted a meta-analysis to examine the effects of the Chinese Famine(1959–1961)on the health of older adults.We also explored potential mechanisms underlying these effects.What are the implications for public health practice?The complex interplay between early life circumstances,multiple health-related sectors,and healthy aging necessitates a comprehensive life-course approach and strategic interventions to enhance public health in an aging society.

Suicide risk in juvenile open angle glaucoma patients

AIM:To investigate the association between juvenile open angle glaucoma(JOAG)and mental health among Koreans.METHODS:This study used nationally representative data from the 8th Korea National Health and Nutrition Examination Survey(KNHANES)2021.Glaucoma diagnosis followed the International Society of Geographical and Epidemiological Ophthalmology criteria based on glaucomatous structural defects,visual field defects,corrected vision,and intraocular pressure.As outcomes,suicidal behaviors,psychiatric counseling,and depression were evaluated through mental health questionnaires.Odds ratios(ORs)with 95%confidence intervals(CIs)were estimated using logistic regression models,adjusting for covariates.RESULTS:Among 7090 participants,3446 met the inclusion criteria for analysis,and 88(2.6%)were diagnosed with open angle glaucoma(OAG).After adjusting for age,sex,and best-corrected visual acuity(VA),participants with OAG were revealed to have significantly higher odds of suicidal behaviors(i.e.,ideation,planning,or attempts)compared with those without OAG(OR:2.70;95%CI:1.12-6.54;P=0.028).This association remained significant after further adjustments for socioeconomic status,lifestyle factors,and presence of chronic conditions(P=0.031 and 0.035,respectively).However,there was no significant difference for the other two outcomes,psychiatric counseling and depression.An age-stratified analysis revealed a stronger association between OAG and suicidal behaviors in younger JOAG participants(<40y)than in older OAG participants(≥40y;OR:3.80 vs 2.22;95%CI:0.79-18.22 vs 0.56-8.80,respectively).CONCLUSION:OAG patients show a higher risk of suicidal behaviors than those without glaucoma particularly in JOAG patients.

Prioritizing Strategies for Building the Resilience of Public Health Systems to Disasters Across Multiple Communities and Countries

The COVID-19 pandemic highlighted the urgent need to strengthen public health systems.In response,the United Nations Disaster Risk Reduction(UNDRR) Public Health System Resilience Scorecard(Scorecard) was applied in workshops across multiple countries.The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience.We conducted a workshop from 14 to 16 March 2023,at the UNDRR Global Education and Training Institute in Incheon,Republic of Korea.A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies.These were drawn from 70 strategies identified from 13 distinct workshops in eight countries.After two surveys,23 strategies were finalized.Ten received ratings of "High" or Very High" from89% of participants.These related to the inclusion of public health risks in emergency plans,integrating multidisciplinary teams into public health,enabling local transport mechanisms,and improving the ability to manage an influx of patients.The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience.By leveraging this methodology,our study demonstrated how resilience strategies could inform disaster risk reduction funding,policies,and actions.