Workload and job satisfaction of rural doctors during the new healthcare reform in China: a cross-sectional mixed methods study

Background With the integration of urban and rural health insurance, the demand for health services from rural residents increases rapidly, which in turn, bring heavier workload for doctors from county public hospitals (CPHs). Meanwhile, township healthcare centers (THCs) are required to provide more additional public health services under the integration of public health and primary care, which also brings challenges for its doctors’ workload. As a result, Chinese rural doctors from both CPHs and THCs have to cope with heavier workload that may have an adverse effect on their job satisfaction. This study sought to investigate the association between the workload and their job satisfaction during the new healthcare reform in China. Methods A cross-sectional survey using mixed methods targeting Chinese rural doctors from both CPHs and THCs in three provinces of Gansu (the west province of China), Shanxi (the middle province of China), and Shandong (the east province of China) was conducted. Correlation analyses of three dimensions of workload and job satisfaction were performed. The association between workload and job satisfaction was estimated using discrete choice regression and the detail parts of workload were analyzed using qualitative data collected from interviews with some agency administrators and representatives from the respondents. Results Of the 849 rural doctors enrolled, 52.18% thought that the proportion of time spent on non-medical activities (PT) was too high; 78% reported that they worked more than 8 hours in a working day; up to 40% of rural doctors from county public hospitals (CPHs) reported unaffordable clinical visit number per day (CV), which was significantly higher than that from township healthcare centers (THCs). Both of the proportion of time on non-medical issues and working hours (WH) were significantly and negatively associated with the job satisfaction of rural doctors. However, the effects of clinical visit number were mixed, with a significantly negative association with the job satisfaction of doctors from CPHs rather than from THCs. Qualitative analysis indicated that non-medical activities constituted the main source of Chinese rural doctors workload, in terms of a performance assessment criteria for doctors from CPHs and public health services for doctors from THCs. Conclusion The workload, dominated by non-medical activities, working hour and clinical visit number, are non-negligible factors that negatively associated with Chinese rural doctors’ job satisfaction in the healthcare reform setting. The growing number of patients towards CPHs and the additional public health service imposed on the THC doctors were the main source for the workload that worsened rural doctors’ job satisfaction. Policy makers should consider some feasible measures to reduce non-medical activities for rural doctors so that they could dedicated their limited energy and time to the medical service.

After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions

The first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient “lockdown and fear” phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. This multicenter, retrospective, cross-sectional study involved five general EDs of a large Italian city (January–August 2020). Percent changes were calculated versus 2019, using four 14-day periods (FW peak, early/mid/late post-wave). ED visits were 147,446 in 2020, versus 214,868 in 2019. During the FW peak, visits were reduced by 66.4% (P < 0.001). The drop was maximum during daytime (69.8%) and for pediatric patients (89.4%). Critical triage codes were unchanged. Reductions were found for all non-COVID-19 diagnoses. Non-COVID-19 hospital admissions were reduced by 39.5% (P < 0.001), involving all conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas. In the early, mid, and late post-wave periods, visits were reduced by 25.4%, 25.3% and 23.5% (all P < 0.001) respectively. In the late period, reduction was greater for female (27.9%) and pediatric patients (44.6%). Most critical triage codes were unchanged. Oncological, metabolic/endocrine, and hematological diagnoses were unchanged, while other diagnoses had persistent reductions. Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.

Health care for undocumented immigrants during the early phase of the Covid-19 pandemic in Lombardy, Italy

Despite concern on the impact of coronavirus disease 2019 (COVID-19) pandemic on undocumented immigrants, quantitative evidence on the issue is scant. We analyze socioeconomic and health conditions of 1590 undocumented immigrants in Milan, Lombardy, one of the regions with the highest COVID-19 clinical burden in the world that does not guarantee access to primary care for these individuals. We document a sharp reduction in visit number after lockdown, with 16% frequency of acute respiratory infections, compatible with COVID-19. Moreover, housing conditions make it difficult to implement public health measures. Results suggest the need to foster primary care by undocumented immigrants to face COVID-19 emergency.

Associations Between Physical Therapy Visits and Pain and Physical Function After Knee Arthroplasty: A Cross-Lagged Panel Analysis of People Who Catastrophize About Pain Prior to Surgery

Objective Physical therapy visit number and timing following knee arthroplasty (KA) are variable in daily practice. The extent to which the number and timing of physical therapy visits are associated with current and future pain and function—and, alternatively, whether pain and function are associated with the number of future physical therapy visits following KA—are unknown. The purpose of this study was to determine temporal and reciprocal associations between the number of physical therapy visits and future pain and function in people with KA. Methods A cross-lagged panel design was applied to a secondary analysis of data from a randomized clinical trial of patients with pain catastrophizing. The 326 participants underwent KA and completed at least 7 of 9 health care diaries over the year following surgery. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function subscales were completed preoperatively and multiple times during follow-up. Separate cross-lagged panel analyses were conducted for WOMAC pain and physical function. Results From surgery to 2 months postsurgery, reciprocal associations were generally not found between physical therapy visit number and future pain or function. From 2 to 6 months postsurgery, a greater number of physical therapy weekly visits were associated with higher (worse) 6-month pain and function. Higher (worse) WOMAC pain at 2 and 6 months led to more visits from 2 to 6 and 6 to 12 months, respectively. Conclusions Higher pain scores 2 months postsurgery were associated with higher physical therapy use in the 2 to 6 months following surgery. However, patients with increased physical therapy use from 2 to 6 months had significantly higher pain scores 6 months postsurgery. Those patients with persistent pain 6 months postsurgery were higher users of physical therapy 6 to 12 months postsurgery. This reciprocal positive association between pain and physical therapy during this time period suggests minimal benefit of physical therapy despite an increased physical therapy use for patients with higher pain. Impact This is the first study to determine the association between the number and timing of physical therapy visits and current and future pain and function. Based on the results, physical therapy might not be a cost-effective strategy to treat patients with persistent pain following KA.

Examination of high-resolution feed intake data of grower finisher pigs confronted with typical short-term disturbances in stable routine

Modern pig feeding systems allow the collection of highly detailed feeding data for each animal. These data enable the examination of individual feeding behaviours to assess an animal’s wellbeing. As such, four different treatments ‒ undisturbed control, starving (no feed for 24 h, restrictive feeding), feed change (changes in feed composition) and social stress (exchanging of animals between the pens and short-term reduction of accessible water) ‒ were designed to simulate typical short-term disturbances in a practical stable routine. Each treatment was conducted over 2 pens with 12 animals each. Zootechnical performance and feed intake behaviour measures were assessed for each animal. Treatments did not affect zootechnical performance. Results showed that short-term disturbances did not influence feed intake behaviours, such as daily feed intake, amount of intake per feeder visit, number of daily feeder visits and daily feeding action with highest feed intake. Animals developed individual feeding patterns that persisted through artificial short-term disturbances. However, data suggested that an individual animal’s behavioural pattern was strongly influenced by the group (pen) due to group dynamics among animals.

Randomized Controlled Crossover Dose-Response Trial Shows Low Dose (2 g) Barley β-Glucan Provided in Waffles Lowers Post-Prandial Glycaemic Response In Healthy Adults

Objectives Barley β-glucan (BG) has reported post-prandial (PP) glycemic response lowering effects. The objective of this study was to ascertain the minimum and most effective dose of BG on PP glucose and insulin response using waffles as the test food. Methods Healthy adults (7 men/17 women) completed a randomized controlled crossover trial at the Asper Research Institute in Winnipeg, MB. Each participant attended five 2.5-hour study visits separated by 3–14 days (average = 7 days). At each visit participants ate waffles containing 30 g available carbohydrates (AC) with varied doses of BG (0, 2, 4, or 6 g). Wheat waffles with low fibre and protein (0g-1) and wheat waffles matched to BG waffles for insoluble dietary fibre and protein (0g-2) were used as controls. The order of treatments was random. Fasting, 15, 30, 45, 60, 90 and 120 minute PP capillary blood samples were collected for analysis of blood glucose and plasma insulin levels. Data were analyzed using analysis of covariance with treatment, participant, visit number and interaction between treatment and visit number included in the model. Differences (P ≤ 0.05) among treatments were determined using least square means adjusted using the Tukey option. Results There was a significant effect of treatment on both glucose and insulin iAUC (P &lt; 0.0001). Glucose iAUC was 31–40% lower after eating 2, 4 and 6 g BG waffles compared to both 0 g waffles. Glucose iAUC was not significantly different between 0 g waffles or among BG waffles. Insulin iAUC was not significantly different between 0 g waffles. Insulin iAUC was 32% lower after eating 2 g BG compared to 0g-1, but not significantly different from 0g-2 waffles. Insulin iAUC was 36–58% lower after eating 4 and 6 g BG compared to both 0 g waffles, and 38% lower after eating 6 g BG compared to 2 g BG waffles. Conclusions The low dose (2 g BG per 30 g AC) provided a physiological benefit (reduction in PP glucose response &gt;20%). Increasing dose to 4 or 6 g BG did not provide additional glucose lowering benefits, but insulin response decreased as BG dose increased. Lack of difference in glucose and insulin iAUC between the two 0 g control waffles (insoluble fibre 1 g vs 8 g; soluble fibre 0 g), but higher PP glycemic responses than BG waffles emphasizes that the type of fibre is key to PP glycemic responses. Funding Sources Agriculture and Agri-Food Canada.

SUCCESSFUL AGING AND HEALTHCARE SERVICE UTILIZATION IN EAST ASIA: NATIONAL COMPARISONS OF CHINA, KOREA, AND JAPAN

As the older population increases and lives longer, the demand for healthcare has been increased dramatically. To date, it is unknown whether older people’s healthcare utilization varies between countries and how it relates to successful aging. Using Rowe and Kahn’s model, we examine cross-national differences in the relationship between successful aging and healthcare service utilization in East Asia. Harmonized datasets at baseline from China Health and Retirement Longitudinal Study (CHARLS), Korean Longitudinal Study (KLoSA), and Japanese Study on Aging and Retirement (JSTAR) were used. Including 7,651 participants (aged 65-75 years), successful agers were identified using Rowe and Kahn’s criteria (i.e., no disease, no disability, high cognitive function, and active engagement). Healthcare service utilization includes hospital visit, number of hospital stay, number of nights per hospital stay, regular medical center visit, number of medical center visits, and possession of private insurance in previous year. Generalized linear models showed that successful agers’ healthcare service utilization is significantly different from non-successful agers (e.g., OR=2.19, p&lt;.001 for regular medical center visits), and Korean and Chinese healthcare service utilization is different from Japanese (e.g., OR=0.44 and OR=10.18 for Chinese and Korean number of medical center regular visits, respectively, p&lt;.001). Furthermore, the number of nights in hospital among Chinese and Korean successful agers tend to be greater than that of Japanese successful agers (OR=2.93 and OR=1.99 for Chinese and Korean successful agers, respectively, p&lt;.001). This study indicates cross-national variations in pattern of healthcare service utilization between successful and non-successful agers in East Asia.

Hubungan Brand Equity (Brand Awarenees, Brand Associations, Perceived Quality) dengan Keputusan Pemanfaatan Klinik Laktasi di Rumah Sakit Muhammadiyah Lamongan

Abstrack: The visit number of patient at the lactation clinic of Muhammadiyah Lamongan Hospital tends to be small and decreases every year. A decrease in the visit number of patient may indicate that the utilization of health services is lacking. In utilizing health services, consumers are influenced by several considerations. One of affects consumer considerations is brand equity (brand awareness, brand associations, and perceived quality). This study aims to determine the relationship of brand equity (brand awareness, brand associations, and perceived quality) with the decision of lactation clinic utilization at Muhammadiyah Lamongan Hospital. This research used correlational quantitative design to know the relationship between brand awareness (X1), Brand Associations (X2), perceived quality (X3), with decision of utilization of lactation clinic at Muhammadiyah Lamongan Hospital (Y). The population in this research was all patient who used lactation clinic at Muhammadiyah Lamongan Hospital and the sample were 32 patients, who visited the lactation clinic at Muhammadiyah Lamongan Hospital during April until May 2017. Technique of collecting data used questionnaire. Data analysis was correlation test, multiple linear regression test. Based on the results of the analysis, this study shows that there is a significant relationship simultaneously between brand awareness, brand associations, and perceived quality with the decision of utilization of lactation clinic at Muhammadiya Lamongan Hospital. Based on the result of coefficient of determination (R2) of 0.569 which means that Brand Awareness (X1), Brand Associations (X2), Perceived Quality (X3) have contribution equal to 56.9% to decision of utilization to laktasi clinic at Muhammadiyah Hospital Lamongan (Y).Keywords:Brand Awareness, Brand Associations, Perceived Quality, Utilization of Health Care Service.Abstrak: Jumlah kunjungan pasien di klinik laktasi Rumah Sakit Muhammadiyah Lamongan cenderung sedikit dan mengalami penurunan setiap tahun. Penurunan jumlah kunjungan pasien dapat menunjukkan bahwa pemanfaatan pelayanan kesehatan yang kurang.Dalam memanfaatkan pelayanan kesehatan,konsumen dipengaruhi oleh beberapa pertimbangan, salah satu yang mempengaruhi pertimbangan konsumen ialah Brand Equity.Penelitian ini dilaksanakan dengan tujuan untuk mencari hubungan antara Brand Awareness, Brand Associations, dan Perceived Quality dengan keputusan pemanfaatan klinik laktasi di Rumah Sakit Muhammadiyah Lamongan. Rancangan penelitian ini adalah kuantitatif korelasional dengan sampel sebanyak 32 orang. Teknik pengumpulan data menggunakan kuesioner. Analisis data menggunakan uji korelasi pearson dan uji regresi linier berganda. Hasil analisis penelitian didapatkan ada hubungan yang signifikan antara Brand awareness, Brand asssociations, Perceived quality secara bersama-sama dengan keputusan pemanfaatan klinik laktasi di Rumah Sakit Muhammadiyah. Berdasarkan hasil koefisien determinasi (R2) sebesar 0,569 yang berarti bahwa Brand Awareness (X1), Brand Associations (X2), Perceived Quality (X3) mempunyai kontribusi sebesar 56,9% terhadap keputusan pemanfaatan terhadap klinik laktasi di Rumah Sakit Muhammadiyah Lamongan (Y). Kata kunci: Brand Awareness, Brand Associations, Perceived Quality, Keputusan Pemanfaatan Pelayanan Kesehatan

Buckling down on torus fractures: has evolving evidence affected practice?

Purpose The purpose of this study was to evaluate the management of paediatric torus fractures of the distal forearm in current practice in light of growing evidence supporting a ‘minimalist’ approach with splint immobilization and limited follow-up. We hypothesized that ‘traditional’ cast-based management has persisted despite alternative evidence. Methods A retrospective review was performed of a consecutive series of paediatric patients diagnosed with torus fractures of the distal forearm between 2011 and 2014. Records were reviewed to abstract the type of immobilization (splint versus cast) prescribed at each visit, number of radiographic exams, duration of immobilization, number of clinical visits and complications. The primary outcome was the proportion of patients exclusively managed in splints. Injuries were grouped based on treatment into a cast group (CG) and a splint group (SG) for statistical analyses. Additionally, injuries were grouped by epoch of time to determine if immobilization usage patterns evolved. Results A total of 240 forty injuries met criteria for inclusion. Of these, 16 (6.7%) were exclusively splinted (SG). Relative to the CG, the SG had fewer clinical visits (p < 0.001), fewer radiographic exams (p < 0.001) and a shorter total encounter time (p = 0.015). No change in immobilization use occurred over the study period. In all, 21 (9.4%) of the CG experienced complications. No clinically significant displacements occurred in either group. Conclusion Cast utilization and frequent radiographic follow-up remain prevalent at our institution in the management of paediatric torus fractures. Splint-only management was associated with fewer clinical visits, fewer radiographic exams and a shorter total encounter time. Level of Evidence Level III Therapeutic retrospective cohort study