Implementation of Evidence-Based Patient Safety Practices: 4-Years’ Follow-up of a Nationwide Regulatory Intervention in Brazilian Hospitals

Background: Regulatory interventions are widely recommended to improve the quality of health services, but there are few studies on the possible models and their effects. The aim of this study is to describe the implementation process and analyse the results of a nationwide regulatory intervention for the implementation of patient safety practices.Methods: Four nationwide annual cross-sectional assessments were conducted in Brazilian hospitals with Intensive Care Unit beds. The participants involved all facilities operating during 2016-2019 (average N=1,989). The regulatory intervention theory aimed to increase adherence to safe evidence-based practices through national annual assessment involving a set of 21 validated structure and process indicators related to patient safety practices. At moment 1(Risk assessment), data were collected to classify hospitals according to the risk. In the sequence, the Sanitary Surveillance Centers (VISAS) carried out the analysis of the information sent by the hospitals. VISAS classified services into three groups according to compliance with the composite adherence indicator: High (67-100%); Medium (34-66%); and Low Compliance (0-33%). Moment 2 (Risk management) used responsive actions according to the hospital’s classification. Results: The intervention resulted in six annual cyclic stages and, between 2016-2019, 782 (40.1%), 980 (49.0%), 1,093 (54.3%) and 1,255 (61.8%) hospitals participated, respectively. 17 of the 20 indicators with at least two measurements had a significant improvement after national interventions (p<0.05). The overall percentage of compliance increased from 70.7 to 84.1 (p<0.001) and the percentage of hospitals with high compliance increased from 59.1 to 83.0 (p<0.001).Conclusion: The regulatory intervention used was a good tool to strengthen the information system and government actions to promote patient safety. The set of low-cost interventions seems to be useful to prioritise hospitals at higher risk and to induce responsive measures to implement patient safety practices in the evaluated context, promoting the efficiency of the regulatory process.

Intervention analysis with autoregressive integrated moving average models for time series of urban air pollutants

The objective of this paper is to show an intervention analysis with autoregressive integrated moving average models for time series of air pollutants in a Latin American megacity. The interventions considered in this study correspond to public regulations for the control of urban air quality. The study period comprised 10 years. Information from 10 monitoring stations distributed throughout the megacity was used. Modelling showed that setting maximum emission limits for different pollution sources and improving fuel were the most appropriate regulatory interventions to reduce air pollutant concentrations. Modelling results also suggested that these interventions began to be effective between the first 4 days-15 days after their publication. The models developed on a monthly timescale had a short autoregressive memory. The air pollutant concentrations at a given time were influenced by the concentrations of up to three months immediately preceding. Moving average term of the models showed fluctuations in time of the air pollutant concentrations (3 months - 14 months). Within the framework of the applications of physics for the air pollution control, this study is relevant for the following findings: the usefulness of autoregressive integrated moving average models to temporal simulate air pollutants, and for its suitable performance to detect and quantify regulatory interventions.

Newspapers’ coverage of the COVID-19 pandemic in Eswatini: from distanciated re/presentations to socio-health panics

This paper examines the coverage and re/presentation of the coronavirus pandemic by two mainstream newspapers in the Kingdom of Eswatini, namely, the Times of Eswatini and the Eswatini Observer between January and June 2020. Framing and discourse analyses are used in the examination of news stories. The key to this study is how the coverage and re/presentation evolved as ‘new facts’ about the virus emerged. From being re/presented in a distanciated form to becoming a localised scare, the travelling of the virus in space and time and its profile in the newspapers are examined. When the virus began to enjoy widespread coverage, news stories focused on virus incidence and later started paying attention to the internal evolution of the virus and how the government was responding to it. The analysis shows that political indexing sustained the coverage of the COVID-19 pandemic. Due to political and official indexing, media coverage largely reproduced the views of those in power, especially the construction of lockdown regulations as rational and legitimate. The government and security officials characterised the coronavirus as an invading enemy that could only be defeated through ‘war’. The news media reproduced the war language of the government and security officials, and thus legitimised the lockdowns and security surveillance. In addition to regulatory interventions, the results reveal that the government and civil society initiated prayer and fasting sessions as part of response interventions. This paper concludes that health journalism pays less attention to health scares that are seen to be happening ‘elsewhere’. However, once the problems become local, the news value of proximity enables journalists to provide extensive coverage. In addition, the coverage of pandemics begins with increased coverage and panic, followed by constant attention and after some time, the stories leave front pages as journalism fatigue kicks in.

Contagion Risks and Systemic Stability in Financial Networks

An agent-based model is proposed, constructing an evolutionary banking system, where interbank loans and investment strategies are, respectively, determined by liquidity shortage and utility maximization. The causes of systemic risk are then explored based on the evolutionary banking system, which is calibrated by a sample from China. The regulatory interventions indicate the positive effects of increased investment assets, while the negative but inappreciable effects of increased interbank counterparties on contagion risks decrease. This observation hints at the possibility of promoting systemic stability by incentivizing more diversifications in investment assets instead of interbank counterparties. The results also demonstrate the advantages of prudential liquidity requirements, interbank liquidity facilities, and monetary policies from the central bank in promoting banking system stability.

The economics of managing evolution

Humans are altering biological systems at unprecedented rates, and these alterations often have longer-term evolutionary impacts. Most obvious is the spread of resistance to pesticides and antibiotics. There are a wide variety of management strategies available to slow this evolution, and there are many reasons for using them. In this paper, we focus on the economic aspects of evolution management and ask: When is it economically beneficial for an individual decision-maker to invest in evolution management? We derive a simple dimensionless inequality showing that it is cost-effective to manage evolution when the percentage increase in the effective life span of the biological resource that management generates is larger than the percentage increase in annual profit that could be obtained by not managing evolution. We show how this inequality can be used to determine optimal investment choices for single decision-makers, to determine Nash equilibrium investment choices for multiple interacting decision-makers, and to examine how these equilibrium choices respond to regulatory interventions aimed at stimulating investment in evolution management. Our results are illustrated with examples involving Bacillus thuringiensis (Bt) crops and antibiotic use in fish farming.

Regulated free banking in Switzerland (1881–1907)

The free-banking history of Switzerland is subdivided into periods with unfettered competition (1826–1881), and strict banknote regulation (1881–1907). This paper suggests that the Federal Banknote Act of 1881 was introduced to remedy the fragmentation of the unfettered-competition period, during which private note-issuing banks were unable to issue standardised paper money. Although the corresponding minimum-reserve and mutual-acceptance rules led to a standardisation, they created new problems. For example, these regulatory interventions reduced the flexibility (or “elasticity”) of the paper-money supply. It turned out that a central note-issuing bank is needed to supply adequate amounts of standardised banknotes.

Exploring the Governance and Fairness in the Milk Value Chain: A Case Study in Vietnam

Governance and fairness in the food value chain have gained considerable attention from both policymakers and scholars, especially in developing countries. This study analysed the milk value chain, exploring its governance and fairness, and assessed the regulatory interventions across the milk value chain in Vietnam using a qualitative framework and the global value chain governance model. The results show that Vietnam’s milk production and dairy market have developed notably since the reforms. The value chain is structured according to three governance models, i.e., relational, captive, and hierarchy models. Vietnam’s milk value chain has progressed through three building phases, expanding in breadth, and undergoing in-depth development, and the governance models have adjusted accordingly. However, Vietnamese dairy farms have been exposed to a low level of fairness across the supply chain. Although dairy farmers in the relational model may benefit from more power and fairness in the short term, farmers in the captive model may gain benefits and potential fairness in the long term. Vietnam has diverse regulatory interventions to enhance farmers’ fairness and welfare, and the results are notable. However, not all farmers have benefitted from these policies, and measures regarding fairness and welfare should be diverse, gradual, and inclusive.