Views and Experience on Patient Engagement in Healthcare Professionals and Patients—How Are They Different?

A patient-centered approach is used to build a therapeutic alliance between patients and the healthcare professionals in care process which should be supported by a good engagement of both parties. The study aimed to explore the gap between healthcare professionals and patients on patient engagement in hospital. It was a cross-sectional survey. 2774 doctors and nurses from Department of Medicine of public hospitals completed the self-administered questionnaire and 1042 patients discharged from corresponding wards completed the telephone interviews. Participants were interviewed using structural questionnaires. The Mann-Whitney test or Pearson’s chi-square test was used to analyze the agreement between health-care professionals and patients on the views and experiences of patient engagement. A difference was considered to be statistically significant when the p-value was <0.05. Although both groups valued the importance of patient engagement, there was a discrepancy on understanding, views and experiences. More healthcare professionals particularly in nursing were concerned about the possible negative impact of the engagement. The majority of healthcare professionals reported that they engaged well with patients, and perceived more difficulties than patients did. The findings highlighted the mutual understanding of patient engagement, involvement and challenges encountered by both groups in Department of Medicine, which was crucial in efforts to provide meaningful patient engagement in regards to jurisdictions, health system, specialty, discipline and background of patients. It provided insight that a collaborative strategy involving both healthcare professional and patients might be an alternative approach to improving patient engagement.

The Relationship with Previous Use of Community-Based Services and Informal Caregiver Support and Elderly and Informal Caregivers’ Views of Living Arrangement: Analysis of Official Statistics from 2004 to 2014

Background and Objectives: Views on living arrangement from elderly and informal caregivers are crucial to “ageing in place”. They might be related to the experience in the use of elderly care services, which remains inconclusive in previous literature. This study aimed to explore the association of previous experience in formal and informal long-term care services with views of both elderly and their informal caregivers on living arrangement. Research Design and Methods: This study adopted a cross-sectional design. Assessment records of Minimum Data Set-Home Care for community-dwelling elderly who were eligible for subsidized long-term care services in Hong Kong from 2004 to 2014 were made available. Multivariate logistic regression was applied to examine associations between both views on elder’s living arrangement from the elderly, caregivers and their previous informal caregiver support, and experience in formal care services. Results: 82,306 dyads of elderly and informal caregivers were included in the analysis. The elderly with previous use of home and community-based services (OR = 0.84, 95% CI 0.80 - 0.88) and informal caregivers (OR = 0.78, 95% CI 0.76 - 0.81) believed that the elderly should live away from home. Temporal trends of fewer elderly and caregivers supporting the idea of living away from home were also observed. Discussion and Implications: The results highlighted the importance of informal caregiver’s support and previous utilization of formal home and community-based services. It was concluded that resources and information of community-based care have a significant association with views on living at home also proper support services and training of care for the elderly should be made available to informal caregivers to reduce their burden.

Net effect of air pollution controls on health risk in the Beijing-Tianjin-Hebei region during the 2022 winter Olympics and Paralympics

Due to the non-linearity in ozone(O_(3))formation,reducing the emission of nitrogen oxides(NO_(x))may increase O_(3) concentration.Given the counteractive O_(3) response to NO_(x) reduction,overall impact of air pollution controls can be ambiguous when the assessments focus on the changes in pollutant concentrations.In this study,a risk-based method was used to gauge the net effect of air pollution controls on mortality risk in the Beijing–Tianjin–Hebei(BTH)region during the 2022 Winter Olympics and Paralympics(WOP).This mega-event presents a unique opportunity to investigate the efficacy of deep cuts in pollutant emissions.Results show that O_(3) concentrations greatly increased as nitrogen dioxide(NO_(2))concentrations decreased in the BTH.Due to the active photochemical formations,O_(3) became the dominant pollutant that affected human health during the WOP.Despite the substantial O_(3) increases,the health benefits of NO_(2) reductions overwhelmed the adverse health effects of O_(3) increases in most regions of the BTH(at 81 out of 112 stations).After considering the impacts of particulate matter,the integrated health risk of air pollution mixtures declined almost everywhere in the BTH.Our results underscore the great necessity of changing the assessment paradigm of pollution control from using concentration-based methods to using risk-based methods.Together with the carbon neutrality policy,stringent control of NO_(x)emission from combustion sources is a promising way to achieve synergistic control solutions for air pollution and climate change.

Risk factors and natural history of breast cancer in younger Chinese women

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fiftytwo women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger(< 40 years old) vs older patients(≥ 40 years old) for subsequent analyses.RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise(85.4% vs 73.2%, P < 0.001), having high stress in life(46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets(20.2% vs 12.9%, P < 0.001),having alcohol drinking habit(7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity(43.3% vs 17.8%, P < 0.001) and an early age at menarche(20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology(45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion(39.6% vs 33.2%, P = 0.003), and having multifocal disease(15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.

The association of grip strength with cardiovascular diseases and all-cause mortality in people with hypertension:Findings from the Prospective Urban Rural Epidemiology China Study

Background:Both hypertension and grip strength(GS)are predictors of mortality and cardiovascular disease(CVD),but whether these risk factors interact to affect CVD and all-cause mortality is unknown.This study sought to investigate the associations of GS with the risk of major CVD incidence,CVD mortality,and all-cause mortality in patients with hypertension.Methods:GS was measured using a Jamar dynamometer(Sammons Preston,Bolingbrook,IL,USA)in participants aged 3570 years from 12 provinces included in the Prospective Urban Rural Epidemiology China Study.Cox frailty proportional hazards models were used to examine the associations of GS and hypertension and the outcomes of all-cause mortality and CVD incidence/mortality.Results:Among 39,862 participants included in this study,15,964 reported having hypertension,and 9095 had high GS at baseline.After a median follow-up of 8.9 years(interquartile range,6.79.9 years),1822 participants developed major CVD,and 1250 deaths occurred(388 as a result of CVD).Compared with normotensive participants with high GS,hypertensive patients with high GS had a higher risk of major CVD incidence(hazard ratio(HR)=2.39;95%confidence interval(95%CI):1.863.06;p<0.001)or CVD mortality(HR=3.11;95%CI:1.596.06;p<0.001)but did not have a significantly increased risk of all-cause mortality(HR=1.24;95%CI:0.921.68;p=0.159).These risks were further increased if hypertensive participants whose GS level was low(major CVD incidence,HR=3.31,95%CI:2.604.22,p<0.001;CVD mortality,HR=4.99,95%CI:2.649.43,p<0.001;and all-cause mortality,HR=1.93,95%CI:1.472.53,p<0.001).Conclusion:The present study demonstrates that low GS is associated with the highest risk of major CVD incidence,CVD mortality,and all-cause mortality among hypertensive patients.High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.

Uptake of prostate cancer screening and associated factors among Chinese men aged 50 or more: a population-based survey

Objective: To investigate the uptake rate of prostate specific antigen(PSA) testing among Hong Kong Chinese males aged 50 or above, and identify factors associated with the likelihood of undergoing a PSA test.Methods: A population-based telephone survey was conducted in Hong Kong in 2007. The survey covered demographic information, perceived health status, use of complementary therapy, cancer screening behavior, perceived susceptibility to cancer and family history of cancer. Descriptive statistics, percentages and logistic regression analysis were used for data analysis.Results: A total of 1,002 men aged 50 or above took part in the study(response rate =67%), and the uptake rate of PSA testing was found to be 10%. Employment status, use of complementary therapy, perceiving regular visits to a doctor as good for health and the recommendations of health professionals were significant factors associated with PSA testing.Conclusion: The uptake rate of PSA testing in the study population was very low. Among all the factors identified, recommendations from health professionals had the strongest association with the uptake of PSA testing, and they should therefore take an active role in educating this population about cancer prevention and detection.

Kidney health for all: bridging the gap in kidney health education and literacy

The high burden of kidney disease,global disparities in kidney care,and poor outcomes of kidney failure bring a concomitant growing burden to persons affected,their families,and carers,and the community at large.Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find,understand,and use information and services to make informed health⁃related decisions and actions for themselves and others.Rather than viewing health literacy as a patient deficit,improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease.For kidney policy makers,health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care.The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders.Advances in telecommunication,including social media platforms,can be leveraged to enhance persons’and providers’education;The World Kidney Day declares 2022 as the year of“Kidney Health for All”to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy.Kidney organizations should work toward shifting the patient⁃deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers.By engaging in and supporting kidney health-centered policy making,community health planning,and health literacy approaches for all,the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.

CUF, a herbal formula for the treatment of asthma: A randomized, double-blind, placebo-controlled study in the treatment of childhood asthma

Background: Complementary and alternative medicines are increasingly used for the treatment of asthma worldwide. A five-herb herbal formula (CUF) has been found to be effective and safe in an animal model of asthma and in a preliminary clinical study. Objective: The objective of this study was to evaluate the safety and efficacy of CUF in children suffering from asthma. Design: A randomized, double blind, and placebo-controlled, parallel study. Interventions: Subjects received CUF or placebo for 6 months. Efficacy variables included changes in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), Paediatric Asthma Quality of Life Questionnaire (PAQLQ), and steroidal consumption. Results: A total of 100 asthmatic children were enrolled and assigned to two treatment groups. The first group received CUF 6 capsules (3 g/day) and the second group received placebo. There was a statistically significant difference in mean spirometric indexes in CUF group at baseline and follow-up visits. In the CUF group, the activity domain showed significant improvement (p = 0.045). FEV% was significantly improved in the CUF group (p strated. It improved the pulmonary functions of the children, namely, FEV1 and FVC. However, further research on a larger scale is warranted.

Comparing the incidence of major cardiovascular events and severe microvascular complications in patients with type 2 diabetes mellitus:A systematic review and meta-analysis

BACKGROUND Type 2 diabetes mellitus(T2DM)causes both macrovascular and microvascular complications.However,currently,selection of glycemic measures and their thresholds to diagnose T2DM,and efficacy outcomes in evaluation of anti-diabetic drugs is predominantly informed by the relation of T2DM to microvascular complications.We can be severely mistaken on T2DM by neglecting macrovascular complications which are generally more severe,if they also occur more commonly than microvascular complications.AIM To compare the incidence of major cardiovascular events(MACEs)and severe microvascular complications(SMICs)in T2DM patients.METHODS MEDLINE,EMBASE,and Cochrane Central Register of Controlled Trials were searched from inception to September 2017.Cohort studies or trials of T2DM patients aged 18 years or older that reported incidence of both MACEs and SMICs were included.MACEs were defined as nonfatal myocardial infarction and stroke,and cardiovascular death,while SMICs included serious retinopathy,nephropathy and diabetic disorder.The relative risk(RR)was estimated as the incidence of MACEs divided by that of SMICs in same patients and combined with meta-analysis in a random-effect model.RESULTS Twelve studies with a total of 16 cohorts and 387376 patients were included,and the combined RR was 2.02(95%CI:1.46–2.79).The higher incidence of MACEs remained in various subgroup and sensitivity analyses.CONCLUSION Patients with T2DM are much more likely to develop MACEs than SMICs.By taking more serious consequences and relatively higher incidence into consideration,macrovascular complications deserve more emphasis in developing the diagnostic criteria of T2DM and in evaluating the efficacy of antidiabetic drugs.

Quantitative and qualitative subgenomic RNA profiles of SARS-CoV-2 in respiratory samples: A comparison between Omicron BA.2 and non-VOC-D614G

The SARS-CoV-2 Omicron variants are notorious for their transmissibility,but little is known about their subgenomic RNA(sgRNA)expression.This study applied RNA-seq to delineate the quantitative and qualitative profiles of canonical sgRNA of 118 respiratory samples collected from patients infected with Omicron BA.2 and compared with 338 patients infected with non-variant of concern(non-VOC)-D614G.A unique characteristic profile depicted by the relative abundance of 9 canonical sgRNAs was reproduced by both BA.2 and non-VOCD614G regardless of host gender,age and presence of pneumonia.Remarkably,such profile was lost in samples with low viral load,suggesting a potential application of sgRNA pattern to indicate viral activity of individual patient at a specific time point.A characteristic qualitative profile of canonical sgRNAs was also reproduced by both BA.2 and non-VOC-D614G.The presence of a full set of canonical sgRNAs carried a coherent correlation with crude viral load(AUC¼0.91,95%CI 0.88–0.94),and sgRNA ORF7b was identified to be the best surrogate marker allowing feasible routine application in characterizing the infection status of individual patient.Further potentials in using sgRNA as a target for vaccine and antiviral development are worth pursuing.

Trial characteristics and treatment effect estimates in randomized controlled trials of Chinese herbal medicine: A meta-epidemiological study

Background:Previously published meta-epidemiological studies focused on Western medicine have identified some trial characteristics that impact the treatment effect of randomized controlled trials(RCTs).Nevertheless,it remains unclear if similar associations exist in RCTs on Chinese herbal medicine(CHM).Further,Chinese medicine-related characteristics have not been explored yet.Objective:To investigate trial characteristics related to treatment effect estimates on CHM RCTs.Search strategy:This meta-epidemiological study searched 5 databases for systematic reviews on CHM treatment published between January 2011 and July 2021.Inclusion criteria:An eligible systematic review should only include RCTs of CHM and conduct at least one meta-analysis.Data extraction and analysis:Two reviewers independently conducted data extraction on general characteristics of systematic reviews,meta-analyses and included RCTs.They also assessed the risk of bias of RCTs using the Cochrane risk of bias tool.A two-step approach was used for data analyses.The ratio of odds ratios(ROR) and difference in standardized mean differences (dSMD) with 95%confidence interval (CI) were applied to present the difference in effect estimates for binary and continuous outcomes,respectively.Results:Ninety-one systematic reviews,comprising 1338 RCTs were identified.For binary outcomes,RCTs incorporated with syndrome differentiation (ROR:1.23;95%CI:[1.07,1.39]),adopting Chinese medicine formula (ROR:1.19;95%CI:[1.03,1.34]),with low risk of bias on incomplete outcome data (ROR:1.29;95%CI:[1.06,1.52]) and selective outcome reporting (ROR:1.12;95%CI:[1.01,1.24]),as well as a trial size≥100 (ROR:1.23;95%CI:[1.04,1.42]) preferred to show larger effect estimates.As for continuous outcomes,RCTs with Chinese medicine diagnostic criteria (dSMD:0.23;95%CI:[0.06,0.41]),judged as high/unclear risk of bias on allocation concealment (dSMD:-0.70;95%CI:[-0.99,-0.42]),with low risk of bias on incomplete outcome data (dSMD:0.30;95%CI:[0.18,0.43]),conducted at a single center (dSMD:-0.33;95%CI:[-0.61,-0.05]),not using intention-to-treat analysis (dSMD:-0.75;95%CI:[-1.43,-0.07]),and without funding support (dSMD:-0.22;95%CI:[-0.41,-0.02]) tended to show larger effect estimates.Conclusion:This study provides empirical evidence for the development of a specific critical appraisal tool for risk of bias assessments on CHM RCTs.

Wastewater Surveillance Provides Spatiotemporal SARS-CoV-2 Infection Dynamics

Wastewater surveillance(WWS)can leverage its wide coverage,population-based sampling,and high monitoring frequency to capture citywide pandemic trends independent of clinical surveillance.Here we conducted a nine months daily WWS for severe acute respiratory syndrome coronavirus 2(SARSCoV-2)from 12 wastewater treatment plants(WWTPs),covering approximately 80%of the population,to monitor infection dynamics in Hong Kong,China.We found that the SARS-CoV-2 virus concentration in wastewater was correlated with the daily number of reported cases and reached two pandemic peaks three days earlier during the study period.In addition,two different methods were established to estimate the prevalence/incidence rates from wastewater measurements.The estimated results from wastewater were consistent with findings from two independent citywide clinical surveillance programmes(rapid antigen test(RAT)surveillance and serology surveillance),but higher than the cases number reported by the Centre for Health Protection(CHP)of Hong Kong,China.Moreover,the effective reproductive number(R_(t))was estimated from wastewater measurements to reflect both citywide and regional transmission dynamics.Our findings demonstrate that large-scale intensive WWS from WWTPs provides cost-effective and timely public health information,especially when the clinical surveillance is inadequate and costly.This approach also provides insights into pandemic dynamics at higher spatiotemporal resolutions,facilitating the formulation of effective control policies and targeted resource allocation.

The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men

Using prostate-specific antigen(PSA)for prostate cancer(PCa)screening led to overinvestigation and overdiagnosis of indolent PCa.We aimed to investigate the value of prostate health index(PHI)and magnetic resonance imaging(MRI)prostate in an Asian PCa screening program.Men aged 50–75 years were prospectively recruited from a community-based PSA screening program.Men with PSA 4.0–10.0 ng ml^(−1) had PHI result analyzed.MRI prostate was offered to men with PSA 4.0–50.0 ng ml−1.A systematic prostate biopsy was offered to men with PSA 4.0–9.9 ng ml^(−1) and PHI≥35,or PSA 10.0–50.0 ng ml^(−1).Additional targeted prostate biopsy was offered if they had PI-RADS score≥3.Clinically significant PCa(csPCa)was defined as the International Society of Urological Pathology(ISUP)grade group(GG)≥2 or ISUP GG 1 with involvement of≥30%of total systematic cores.In total,12.8%(196/1536)men had PSA≥4.0 ng ml^(−1).Among 194 men with PSA 4.0–50.0 ng ml^(−1),187(96.4%)received MRI prostate.Among them,28.3%(53/187)had PI-RADS≥3 lesions.Moreover,7.0%(107/1536)men were indicated for biopsy and 94.4%(101/107)men received biopsy.Among the men received biopsy,PCa,ISUP GG≥2 PCa,and csPCa was diagnosed in 42(41.6%),24(23.8%),and 34(33.7%)men,respectively.Compared with PSA/PHI pathway in men with PSA 4.0–50.0 ng ml^(−1),additional MRI increased diagnoses of PCa,ISUP GG≥2 PCa,and csPCa by 21.2%(from 33 to 40),22.2%(from 18 to 22),and 18.5%(from 27 to 32),respectively.The benefit of additional MRI was only observed in PSA 4.0–10.0 ng ml^(−1),and the number of MRI needed to diagnose one additional ISUP GG≥2 PCa was 20 in PHI≥35 and 94 in PHI<35.Among them,45.4%(89/196)men with PSA≥4.0 ng ml^(−1) avoided unnecessary biopsy with the use of PHI and MRI.A screening algorithm with PSA,PHI,and MRI could effectively diagnose csPCa while reducing unnecessary biopsies.The benefit of MRI prostate was mainly observed in PSA 4.0–9.9 ng ml^(−1) and PHI≥35 group.PHI was an important risk stratification step for PCa screening.

Characteristics and fate behavior of environmentally persistent free radicals in atmospheric particulate matter

Background,aim,and scope Environmentally persistent free radicals(EPFRs)have received significant attention due to their longer lifetime and stable existence in various environments.The strong environmental migration ability of particulate matter allows EPFRs to migrate over long-distance transport,thereby impacting the quality of the local atmospheric environment.Additionally,EPFRs can also adhere to atmospheric particles and interact with typical gaseous pollutants to affect atmospheric chemical reactions.EPFRs can produce some reactive organic species,promoting oxidative stress in the human body,damaging biological macromolecules and ultimately affecting the organism health.EPFRs are considered as a novel type of pollutant that affects human health.Despite their significance,there are few literatures available on the characteristics and fate behaviors of EPFRs up to date.Therefore,supplemental reviews are crucial for providing comprehensive understanding of EPFRs.Materials and methods This review summarizes the characteristics of EPFRs in particulate matter,outlines the generation mechanism and influencing factors of EPFRs,and the impacts of EPFRs on environmental quality and organism health.Results The content of EPFRs in particulate matter ranges from 1017 to 1020 spins∙g−1.Due to the strong mobility of atmospheric particulate matter,the long-term exposure to high levels of EPFRs may aggravate the impact of particulate matter on human health.The interaction between EPFRs and typical gaseous pollutants can alter their fate and influence atmospheric chemical reactions.EPFRs are mainly produced by transition metal elements and substituted aromatic hydrocarbons through electron transfer.Additionally,the chemical bond rupture of organic substances through heat treatment or ultraviolet radiation can also produce EPFRs,and heterogeneous reactions are capable producing them as well.The production of EPFRs is not only influenced by transition metal elements and precursors,but also by various environmental factors such as oxygen,temperature,light radiation,and relative humidity.Discussion EPFRs in atmospheric particulates matters are usually rich in fine particulates with obvious seasonal and regional variations.They can easily enter the human respiratory tract and lungs with inhalable particulates,thereby increasing the risk of exposure.Additionally,EPFRs in atmospheric particulates can interact with some typical gaseous pollutants,impacting the life and fate of EPFRs in the atmosphere,and alter atmospheric chemical reactions.Traditionally,EPFRs are generated by transition metal elements and substituted aromatic hydrocarbons undergoing electron transfer in the post-flame and cool-zone regions of combustion systems and other thermal processes to remove HCl,H_(2)O or CO groups,ultimately produce semiquinones,phenoxyls,and cyclopentadienyls.Recent studies have indicated that EPFRs can also be generated under the conditions of without transition metal elemental.Organics can also produce EPFRs through chemical bond rupture during heat treatment or light radiation conditions,as well as through some heterogeneous reactions and photochemical secondary generation of EPFRs.The presence or absence of oxygen has different effects on the type and yield of EPFRs.The concentration,type,and crystal type of transition metal elements will affect the type,content,and atmospheric lifetime of EPFRs.It is generally believed that the impact of transition metal element types on EPFRs is related to the oxidation-reduction potential.The combustion temperature or heat treatment process significantly affects the type and amount of EPFRs.Factors such as precursor loading content,pH conditions,light radiation and relative humidity also influence the generation of EPFRs.EPFRs can interact with pollutants in the environment during their migration and transformation process in environmental medium.This process accelerates the degradation of pollutants and plays a crucial role in the migration and transformation of organic pollutants in environmental media.The reaction process of EPFRs may lead to the production of reactive oxygen species(ROS)such as∙OH,which can induce oxidative stress,inflammation and immune response to biological lung cells and tissues,leading to chronic respiratory and cardiopulmonary dysfunction,cardiovascular damage and neurotoxic effects,ultimately impacting the health of organisms.Conclusions The interaction mechanism between EPFRs in particulate matter and gaseous pollutants remains unclear.Furthermore,research on the generation mechanism of EPFRs without the participation of transition metals is not comprehensive,and the detection of EPFRs is limited to simple qualitative categories and lack accurate qualitative analysis.Recommendations and perspectives Further research should be conducted on the generation mechanism,measurement techniques,migration pathways,and transformation process of EPFRs.It is also important to explore the interaction between EPFRs in atmospheric particulate matter and typical gaseous pollutants.

An AI-empowered indoor digital contact tracing system for COVID-19 outbreaks in residential care homes

An AI-empowered indoor digital contact-tracing system was developed using a centralized architecture and advanced low-energy Bluetooth technologies for indoor positioning,with careful preservation of privacy and data security.We analyzed the contact pattern data from two RCHs and investigated a COVID-19 outbreak in one study site.To evaluate the effectiveness of the system in containing outbreaks with minimal contacts under quarantine,a simulation study was conducted to compare the impact of different quarantine strategies on outbreak containment within RCHs.The significant difference in contact hours between weekdays and weekends was observed for some pairs of RCH residents and staff during the two-week data collection period.No significant difference between secondary cases and uninfected contacts was observed in a COVID-19 outbreak in terms of their demographics and contact patterns.Simulation results based on the collected contact data indicated that a threshold of accumulative contact hours one or two days prior to diagnosis of the index case could dramatically increase the efficiency of outbreak containment within RCHs by targeted isolation of the close contacts.This study demonstrated the feasibility and efficiency of employing an AI-empowered system in indoor digital contact tracing of outbreaks in RCHs in the post-pandemic era.

Resource Allocation in Public Healthcare: A Team-DEA Model

This paper combines the theory of teams and data envelopment analysis（DEA） to design a mechanism to optimally allocate resources in public healthcare. A statutory authority and the public hospitals under its governance are interpreted as a team, the members of which seek to operate efficiently under the shared institutional constraint that public healthcare is a public good. The individual public hospital exploits DEA to maximize own-payoff, subject to the team-condition that the payoff of each other public hospital does not fall and thereby subtract from the external effects created by the public supply of healthcare. The resulting team-DEA solution, which is shown to be both an individuallyefficient and team-satisficing equilibrium and to be computable in terms of a convergent algorithm, can then be applied by the authority to determine the optimal allocation of resources in public healthcare.A case based on Chinese data is presented to illustrate the team-DEA model＇s ready operationalization and computation.

Impact of climate change on dengue fever epidemics in South and Southeast Asian settings:A modelling study

The potential for dengue fever epidemic due to climate change remains uncertain in tropical areas.This study aims to assess the impact of climate change on dengue fever transmission in four South and Southeast Asian settings.We collected weekly data of dengue fever incidence,daily mean temperature and rainfall from 2012 to 2020 in Singapore,Colombo,Selangor,and Chiang Mai.Projections for temperature and rainfall were drawn for three Shared Socioeconomic Pathways(SSP126,SSP245,and SSP585)scenarios.Using a disease transmission model,we projected the dengue fever epidemics until 2090s and determined the changes in annual peak incidence,peak time,epidemic size,and outbreak duration.A total of 684,639 dengue fever cases were reported in the four locations between 2012 and 2020.The projected change in dengue fever transmission would be most significant under the SSP585 scenario.In comparison to the 2030s,the peak incidence would rise by 1.29 times in Singapore,2.25 times in Colombo,1.36 times in Selangor,and>10 times in Chiang Mai in the 2090s under SSP585.Additionally,the peak time was projected to be earlier in Singapore,Colombo,and Selangor,but be later in Chiang Mai under the SSP585 scenario.Even in a milder emission scenario of SSP126,the epidemic size was projected to increase by 5.94%,10.81%,12.95%,and 69.60%from the 2030se2090s in Singapore,Colombo,Selangor,and Chiang Mai,respectively.The outbreak durations in the four settings were projected to be prolonged over this century under SSP126 and SSP245,while a slight decrease is expected in 2090s under SSP585.The results indicate that climate change is expected to increase the risk of dengue fever transmission in tropical areas of South and Southeast Asia.Limiting greenhouse gas emissions could be crucial in reducing the transmission of dengue fever in the future.

Pregnancy Loss in Relation to the Risks of Female-Specific Cancers in a Population-Based Cohort and Mendelian Randomization Study — China, 2004–2017

Summary What is already known about this topic?Limited evidence exists regarding the relationship between pregnancy loss and female-specific cancers within the Chinese population from prospective cohort studies.What is added by this report?Terminations were associated with a 13%lower risk of endometrial cancer,whereas stillbirths were related to an 18%higher risk of cervical cancer.Rural residents with a history of pregnancy loss experienced a 19%and 38%increased risk of breast and cervical cancers,respectively,compared to their urban counterparts.Moreover,a positive graded relationship between live births and pregnancy loss on cervical cancer was observed.What are the implications for public health practice?This study has significant implications for identifying women at an increased risk for breast and genital cancers and contributes to the development of effective public health strategies for female cancer prevention.Future research on reproductive history,particularly in rural areas,should be given priority in efforts to improve female cancer screening and early detection.

Health Emergency and Disaster Risk Management (Health-EDRM) in Remote Ethnic Minority Areas of Rural China:The Case of a Flood-Prone Village in Sichuan

Remote,rural ethnic-minority communities face greater disaster-related public health risks due to their lack of resources and limited access to health care.The Ethnic Minority Health Project(EMHP) was initiated in 2009 to work with remote,disaster-prone ethnic-minority villages that live in extreme poverty.One of the project's aims is to develop and evaluate bottom-up health risk reduction efforts in emergency and disaster risk management(HealthEDRM).This article shares project updates and describes field intervention results from the Yi ethnic community of Hongyan village in China's Sichuan Province,an area that experiences recurrent floods.It was found that 64% of the village respondents had never considered any form of disaster preparation,even with the recurrent flood risks.Health intervention participants showed sustained knowledge retention and were nine times more likely to know the correct composition of oral rehydration solution(ORS) after the intervention.Participants also retained the improved knowledge on ORS and disaster preparedness kit ownership12 months after the intervention.

Cost effectiveness of nonpharmacological prevention programs for diabetes:A systematic review of trial-based studies

Trial-based economic value of prevention programs for diabetes is inexplicit.We aimed to review the cost-effectiveness of nonpharmacological interventions to prevent type-2 diabetes mellitus(T2DM)for high-risk people.Six electronic databases were searched up to March 2022.Studies assessing both the cost and health outcomes of nonpharmacological interventions for people at high-risk of T2DM were included.The quality of the study was assessed by the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist.The primary outcome for synthesis was incremental cost-effectiveness ratios(ICER)for quality-adjusted life years(QALYs),and costs were standardized in 2022 US dollars.Narrative synthesis was performed,considering different types and delivery methods of interventions.Sixteen studies included five based on the US diabetes prevention program(DPP),six on non-DPP-based lifestyle interventions,four on health education,and one on screening plus lifestyle intervention.Compared with usual care,lifestyle interventions showed higher potential of cost-effectiveness than educational interventions.Among lifestyle interventions,DPP-based programs were less cost-effective(median of ICERs:$27,077/QALY)than non-DPP-based programs(median of ICERs:$1395/QALY)from healthcare perspectives,but with larger decreases in diabetes incidence.Besides,the cost-effectiveness of interventions was more possibly realized through the combination of different delivery methods.Different interventions to prevent T2DM in high-risk populations are both cost-effective and feasible in various settings.Nevertheless,economic evidence from low-and middle-income countries is still lacking,and interventions delivered by trained laypersons and combined with peer support sessions or mobile technologies could be potentially a cost-effective solution in such settings with limited resources.