Workplace violence and associations with health outcomes in public health administration agencies in Taiwan: a survey during the COVID-19 pandemic

Objectives: To investigate the prevalence of workplace violence in public health administration agencies and its effects on health outcomes. Methods: A survey was conducted in March 2022. Staff who had been working for at least one year in the Ministry of Health and Welfare or its subordinate agencies, the Department of Health, or in public health centers were recruited. Data were collected anonymously with a structured, online questionnaire. A total of 492 valid questionnaires were collected. Results: A total of 48.17% participants reported having experienced workplace violence (physical, psychological, verbal, or sexual). The most common type of violence was verbal (43.50%), followed by psychological (31.71%). Supervisors were the primary perpetrators of verbal and psychological violence, followed by clients and colleagues. Staff reported long working hours and high levels of psychological and physical stress. Furthermore, 22.97% of workers reported poor self-rated health, 60.57% had personal burnout levels higher than 50, and 63.41% reported poor mental health. Regression analyses showed that low workplace justice was most strongly associated with internal verbal and psychological violence, whereas routine work requiring interaction with the public was most strongly associated with external verbal violence. Staff who had experienced workplace violence in the past year had significantly higher risks of poor self-rated health, mental health, and personal burnout, and poor health was more strongly associated with workplace violence that originated inside the organization than with workplace violence that originated from outside the organization. Conclusions: This survey was conducted on-line anonymously, so the representativeness of our findings might be limited. However, heavy workloads and workplace violence in public health administration agencies during the COVID-19 pandemic are important issues deserving urgent attention. (Taiwan J Public Health. 2023;42(1) :42-61)

Governing systemic and cascading disaster risk in Indonesia: where do we stand and future outlook

PurposeThis paper aims to identify key factors for a contextualised Systemic Risk Governance (SRG) framework and subsequently explore how systemic risks can be managed and how local institutional mechanisms can be tweaked to deal with the complex Indonesian risk landscape.Design/methodology/approachUsing a case study from Palu triple-disasters in Central Sulawesi, Indonesia, the authors demonstrate how inland earthquakes in 2018 created cascading secondary hazards, namely tsunamis, liquefactions and landslides, caused unprecedented disasters for the communities and the nation. A qualitative analysis was conducted using the data collected through a long-term observation since 2002.FindingsThe authors argue that Indonesia has yet to incorporate an SRG approach in its responses to the Palu triple-disasters. Political will is required to adopt more appropriate risk governance modes that promote the systemic risk paradigm. Change needs to occur incrementally through hybrid governance arrangements ranging from formal/informal methods to self- and horizontal and vertical modes of governance deemed more realistic and feasible. The authors recommend that this be done by focusing on productive transition and local transformation.Originality/valueThere is growing awareness and recognition of the importance of systemic and cascading risks in disaster risk studies. However, there are still gaps between research, policy and practice. The current progress of disaster risk governance is not sufficient to achieve the Sendai Framework for Disaster Risk Reduction (2015–2030) unless there is an effective governing system in place at the local level that allow actors and institutions to simultaneously manage the interplays of multi-hazards, multi-temporal, multi-dimensions of vulnerabilities and residual risks. This paper contributes to these knowledge gaps.

Faktory ovplyvňujúce duševné zdravie sestier v období pandémie covidu-19

Súhrn Úvod: Zdravotnícki pracovníci, predovšetkým sestry, môžu byť v exponovanom období počas pandémie covidu-19 vystavení zvýšenej psychickej záťaži. Cieľ: Zistiť, aký je dopad zvýšených nárokov na poskytovanie zdravotnej starostlivosti spojený s koronakrízou, na úroveň psychickej záťaže a kvality života sestier na rôznych pracoviskách. Metodika: Prierezová, prieskumná štúdia merania duševného zdravia u 504 sestier. Bol použitý štandardizovaný dotazník SF-36 a Meisterov dotazník miery neuropsychickej záťaže. Výsledky: Škála preťaženia a monotónnosti významne (p < 0,05) a negatívne (r < 0) koreluje s kvalitou života v každej z domén. Celková záťaž významne (p < 0,05) a negatívne (r < 0) koreluje s kvalitou života v každej z domén. Vek respondentov významne (p < 0,05) a pozitívne (r > 0) koreluje s kvalitou života v doménach vitalita, mentálne zdravie a duševné zdravie a negatívne (r < 0) koreluje s kvalitou života v oblastiach fyzické fungovanie, telesná bolesť, celkové vnímanie zdravia a celkové fyzické zdravie. Záťaž signifikantne lepšie zvládali muži. Signifikantne vyššia bola v skupine respondentov pracujúcich na jednotkách intenzívnej starostlivosti a v primárnej zdravotnej starostlivosti. Záver: Zvýšené nároky na poskytovanie zdravotnej starostlivosti spojené s koronakrízou negatívne pôsobili na úroveň psychickej záťaže a kvalitu života sestier. Horšie výsledky boli zaznamenané u sestier pracujúcich na jednotkách intenzívnej starostlivosti a v primárnej zdravotnej starostlivosti.Alternate :Introduction: Health care workers, especially nurses, may be exposed to increased psychological stress during the COVID-19 pandemic. Objective: To determine how the increased demands on health care delivery associated with the coronavirus crisis affect the level of psychological stress and quality of life of nurses in different workplaces. Methods: A cross-sectional exploratory study of mental health in 504 nurses. The standardized SF-36 questionnaire and Meister's questionnaire for neuropsychological strain were used. Results: The overload and monotony scales are significantly (p < 0.05) and negatively (r < 0) correlated with quality of life in each of the domains. The total load is significantly (p < 0.05) and negatively (r < 0) correlated with quality of life in each of the domains. The age of respondents is significantly (p < 0.05) and positively (r < 0) correlated with quality of life in the domains of Vitality, Mental Health, and Mental Component Summary, and negatively (r > 0) correlated with quality of life in the domains of Physical Functioning, Bodily Pain, General Health, and Physical Component Summary. Men handled the stress significantly better. Stress levels were significantly higher in the group of respondents working in intensive care units and in primary care. Conclusions: The increased demands on health care delivery associated with the coronavirus crisis had a negative impact on the level of psychological load and the quality of life of nurses. Worse results were found in nurses working in intensive care units and in primary care.

A Project to Distribute Personal Protective Equipment to Homecare Agencies during the COVID-19 Pandemic: Its Association with the Sense of Security Improvement among Homecare Nurses/Helpers

During the early period of COVID-19 pandemic, there was a serious shortage of personal protective equipments (PPEs), which caused difficulty in homecare agencies to make home visits to those (possible) positive COVID-19 cases. An organization with the help of several foundations started a special program to distribute PPEs to those agencies in which there was a possible case or those cases that had close contact with the positive cases. This study examined whether this voluntary activity contributed to increasing the sense of security in providing care among homecare workers. We conducted a survey with homecare agencies that received PPEs from the program between July 2020 and February 2021. The participants were agency managers who applied for PPEs. We conducted the survey twice, before and after receiving PPEs. In the questionnaire, we asked about the overall sense of security in providing care for those infected with COVID-19, reasons for applying for PPE, symptoms of the client or his/her family who caused the PPE request, and the agency's and clients' characteristics. We analyzed the data from 802 responses. Before PPE distribution, the sense of security was associated with the focal client having a cognitive impairment (β = −0.096), having cough (β = −0.088), fatigue (β = −0.085), or headache (β = −0.078). Agencies that did not visits those (possibly) positive cases (β = −0.123) had lower sense of security. Overall, the mean sense of security increased after receiving PPE. Factors that contributed to the increase in sense of security included a lower sense of security before the application (β = −0.529), visiting clients without dyspnoea (β = −0.109), the agency that did not visit positive cases before the application (β = −0.089), and with higher satisfaction with the days of PPEs received (β = 0.144). These results underline the benefit of the special PPsE distribution program.

Managing systemic risk in emergency management, organizational resilience and climate change adaptation

PurposeThis paper applies the theory of cascading, interconnected and compound risk to the practice of preparing for, managing, and responding to threats and hazards. Our goal is to propose a consistent approach for managing major risk in urban systems by bringing together emergency management, organisational resilience, and climate change adaptation.Design/methodology/approachWe develop a theory-building process using an example from the work of the Greater London Authority in the United Kingdom. First, we explore how emergency management approaches systemic risk, including examples from of exercises, contingency plans and responses to complex incidents. Secondly, we analyse how systemic risk is integrated into strategies and practices of climate change adaptation. Thirdly, we consider organisational resilience as a cross cutting element between the approaches.FindingsLondon has long been a champion of resilience strategies for dealing with systemic risk. However, this paper highlights a potential for integrating better the understanding of common points of failure in society and organisations, especially where they relate to interconnected domains and where they are driven by climate change.Originality/valueThe paper suggests shifting toward the concept of operational continuity to address systemic risk and gaps between Emergency Management, Organizational Resilience and Climate Change Adaptation.

Attitudes among physicians toward vaccine mandates for emerging infectious disease: the case of the COVID-19 vaccine

Objectives: The outbreak of SARS-CoV-2 resulted in a global pandemic. Vaccine mandates were implemented in several countries, including in Taiwan, and often targeted health-care workers in particular. This study investigated attitudes among Taiwanese physicians toward such policies and how ethical beliefs and logic influenced attitudes. Methods: A total of 16 physicians were recruited by using the snowball method from hospitals in northern Taiwan. Data were collected through semi-structured interviews. Results: Physicians tended not to support mandatory vaccination. Five themes emerged: (1) Individual rights, including violation of autonomy and labor rights;(2) vaccine performance, including safety and efficacy;(3) institutional norms, including the degree of relevancy of the policy-issuing unit and the employment relationship between physicians and institutions;(4) social and workplace stigma resulting from coercive policies in different job categories or departments;and (5) professional ethics of physicians. Conclusions: Autonomy and professional ethics among physicians influence attitudes toward vaccine mandates. Vaccine performance, institutional norms, and stigma also influence attitudes toward vaccine mandates and decision-making. Even with high ethical awareness, the study participants tended not to support vaccine mandates. The government should formulate mandatory vaccination policy means for healthcare workers that can be used by hospitals. Each hospital should assess their unique risks and implement policies that best suit their needs. (Taiwan J Public Health. 2023;42(1):75-87)

Guimarães NA, Hirata HS. O Gênero do Cuidado: desigualdades, significações e identidades. São Paulo: Atêlie Editorial, 2020

A obra Gênero do Cuidado: desigualdades, significações e identidades1, publicada em 2020, emerge como um marco, justamente em tempos em que a palavra cuidado elevou-se - na emergência pandêmica - quase como palavra de ordem. Nestes tempos, evocar o cuidado em suas versões teóricas, históricas e sociológicas, contribui com o campo da saúde coletiva como leitura obrigatória. Ao tensionar o cuidado como campo relacional, nas relações materiais de produção, reconhecemos as assimetrias de poder e dominação que o atravessam. Nesse sentido, na urgência de memorializar os quase 700 mil mortos no Brasil, em virtude da pandemia, precisamos perguntar quem são estes mortos, e como o Cuidado precisa ser reconhecido como política e direito. Cabe interrogar a presença das pessoas ausentes, nas mortes inventariadas, nas desigualdades e nos descuidos, quase como um testemunho à la Luc Boltansky2.Urge interpretar a pandemia nas relações entre cuidado e interseccionalidade3. A interseccionalidade remete aos efeitos transversais "do racismo, cisheteropatriarcado e capitalismo”3(p.23), e também da corponormatividade, como estruturas de desumanização. A leitura interseccional faz-se necessária para fazer os mortos falarem, e perguntar sobre as expressões de discriminação que interferem no cuidado. O conceito de "fato social total”4, nas análises sobre a Pandemia de COVID-195 e sobre a Epidemia de Zika6, exige atualizações críticas em seus efeitos interseccionais, produtores de vulnerabilização.Guimarães e Hirata1, já na "Apresentação”, nos reenviam à imagem de obra: expressão de grandeza, organicidade, labor, artesanato, agenciamento. As autoras construíram uma trajetória - no sentido Bourdieusiano - de intersecções entre sociologia, economia, ciência política, para retirar o Cuidado de perigosas leituras essencialistas, reificadoras de supostas "naturezas”, das armadilhas do "bom em si”. Há que equivocar o Cuidado, interrogá-lo, encarná-lo em lugares sociais, nos planos das relações sociais, das desigualdades que sustentam a sociedade capitalista, e suas gramáticas de exclusão. A obra renova e aquece o debate sobre Cuidado, em tempos muitos e de pandemia, onde "internalização do trabalho (daqueles que puderam se confinar) no âmbito do domicílio, jogaram luz sobre múltiplas relações e contradições no provimento do cuidado e sobre a necessidade de pensarmos o futuro das nossas sociedades, fundadas num outro tipo de regime moral que tenha no cuidado um valor universal”1(p.22). Iluminamos dois aspectos: (1) o Cuidado como valor universal, fundante de um outro regime moral;(2) o confinamento para agenciar a interseccionalidade como lente interpretativa e analítica do fato social pandemia.Para questionar "o” Cuidado como um valor universal, devemos interrogá-lo como gramática, em seus idiomas e trânsitos. Nessa transitoriedade, talvez possamos valorizar os seus "circuitos” como referem as autoras no capítulo 3. Viviana Zelizer7 nos faz atentar para isso que nomeia como "dualidades perigosas”, das esferas separadas e dos mundos hostis. Sinteticamente, tais teorias sustentam o capitalismo industrial do século XIX, e se organizam complementarmente. A teoria das esferas separadas opera com organizações ou domínios antinômicos: racionalidade, eficiência e planejamento em oposição a solidariedade, sentimento e impulso. Tal teoria em diálogo com a dos mundos hostis, enuncia que se esses mundos entrarem em contato, haveria uma contaminação de uma pela outra. Ou seja, relações intimas e transações econômicas não devem moralmente se comunicar, mas há que zelar por sua separação. No entanto, Zelizer (op. Cit) nos alerta para o quanto tais teorias são falhas, sustentando casos concretos, desde mercados de leilões até trabalhos domésticos, onde as redes de relações interpessoais, na intimidade e impessoalidade, convivem em um idioma próprio e legitimo.O capítulo 1 da obra1 merece destaque. Para nós intelectuais orgânica da saúde, aprendemos e refletimos com a revisão de fôlego empreendida. Revisar histórica e sociologicamente as Teorias do Care significa reconhecer economia e política, das desigualdades na dimensão relacional do cuidado, e no papel das ondas feministas que o interpretam.O Cuidado como relacional, remete às localizações sociais de quem cuida e de quem recebe os cuidados. Por isso o Gênero do Cuidado1 comparece dialogado com raça, classe, e as desigualdades que se desvelam e interseccionam por meio das opressões e assimetrias. "Nomear, reconhecer e obscurecer”, título do capítulo 2, comparece como um trabalho sociológico e histórico, ao revisitar a emergência da palavra cuidador e suas flexões de gênero e número, no acervo de um jornal brasileiro de 1875 a 2019. Vale refletir como os anos 2000 do século 21, e sua primeira década revela-se um marco para agendas de cuidado na atenção à saúde, e marco de 80% dos anúncios identificados na pesquisa. Neste capítulo "Nomear, reconhecer, obscurecer” são menos movimentos contraditórios e mais de reintegração de lutas por reconhecimento, sem necessariamente corresponder à valorização. No capítulo 3, o Cuidado se configura o tema das interfaces, tencionando macro e microssociologia. As expressões "circuitos e cadeias” surgem como recursos para um diálogo tanto com a Sociologia das Emoções, quanto para uma Economia do Cuidado. Instiga o debate com a sobrevivência, na discussão sobre consubstancialidade e configurações mercantis e relacionais do Cuidado. No capítulo 4 as autoras nos presenteiam com análises dos dados do Censo de 2010, onde a nova Classificação Brasileira de Ocupações inclui na família das ocupações a de "Cuidadores de crianças, jovens, adultos e idosos”. O Cuidado domiciliar se configura nas mercantilizações e profissionalizações, preservando ainda uma clivagem de classe ao se analisar quem pode ter acesso ao trabalho profissional de Cuidado em domicílio. Isso nos fala não somente de gênero, mas de desigualdade de classe nas relações de Cuidado. Esse argumento nos lança ao capítulo 5, no Cuidado como "ajuda” - categoria êmica deveras presente nos estudos da saúde coletiva, nos cuidados com crianças com deficiências e condições de saúde crônicas, raras e complexas, nas quais se incluem as crianças atingidas pelo Vírus da Zika. Para as classes populares, das periferias, o cuidado ainda se sustenta pelas e nas redes de vizinhança, de pessoalidade. E aí ganham destaque as pesquisas de proximidade, onde os casos são mais que casos, e sim situações passíveis de generalização. Nos "esforços para ganhar a vida” ou nas diversas "formas de viração”, os significados remetem às retribuições em novos circuitos de trabalho relacional, os circuitos de "ajudas”. Essas reflexões nos preparam para que no capítulo 6 seja valorizada a perspectiva metodológica mais próxima às experiências, onde processos de construção narrativa são explorados. Não surpreende que para alcançar o trabalho de cuidado nas suas tessituras do corpo e sexualidade seja a "liberdade da palavra”7(p.212) a grande aposta. Para essa dimensão sensível, a sexualidade dentro das instituições dedicadas ao cuidado comparece, para reafirmar a importância do trabalho em equipes, onde a reflexividade, se valorizada, pode promover a competência profissional, na dimensão relacional de quem cuida e quem recebe. A Sociologia das Emoções, retorna como chave, para não produzir corpos assexuados ou naturalizar/banalizar o contato "com” e "entre” os corpos no cuidado. Para formar equipes precisamos retomar experiências produzindo reflexividade. No capítulo 7, o caso brasileiro emerge com pesquisas comparativas com França e Japão, tendo por centro o envelhecimento populacional e as demandas por cuidado. Para a autora o trabalho de cuidado precisa ser examinado de acordo com suas localizações de sexo, raça, classe, etnia, nacionalidade. Essas localizações nos reenviam às co figurações distintas em cada país examinado, com pontos comuns que contrastam desvalorização desse trabalho e reconhecimento de que os sujeitos dele precisam para viver, e sustentar a reprodução material. O capítulo 8 encerra o livro, com as autoras nos apresentando o Cuidado e as Crises, flexionada no seu plural. Aqui a Pandemia comparece, sendo retomadas as perspectivas de desvalorização do trabalho de cuidado e de suas cuidadoras, no Brasil e no mundo. O paradoxo se estabelece: aplaudimos quem cuida e cuidou tão intensamente nas encruzilhadas da Pandemia, e ainda não temos desenvolvido pleno reconhecimento de nossa interdependência. Esta que nos re-situa como diferenciadamente vulneráveis, frente a um Estado que Des-Cuidado, ainda não remunera dignamente, como trabalho essencial, o trabalho de cuidado e de seus/suas cuidadores/as.A obra de Nadya Guimarães e Helena Hirata se torna leitura obrigatória para pesquisadores da área de saúde coletiva, atualizando as discussões sobre o Cuidado não somente nas suas bases fenomenológicas, mas nas suas dimensões materiais. As gramáticas feministas e suas ondas, revisitadas pelas autoras, são um convite atual e importante para que a saúde coletiva encare o cuidado como política, interdependência constitutiva, e direito fundamental.

Změny v ošetřovatelské edukaci stresových a copingových strategií: longitudinální studie v České republice

Úvod: Dlouhodobý stres je všeobecně považován za jeden z psychosociálních faktorů, který negativně ovlivňuje studijní výsledky studentů ošetřovatelství. Cíl: Zjistit, jaké jsou zdroje, úroveň stresu a strategie zvládaní stresu u studentů ošetřovatelství v kontinuu bakalářského studia. Metody: V průběhu tří akademických roků byli sledováni studenti jednotlivých ročníků bakalářského studijního programu Ošetřovatelství po absolvování klinické praxe v daném akademickém roku. Na sběr dat byly použity dotazníky Perceived Stress Scale;Physio-Psycho-Social Response Scale, and Coping Behavior Inventory. V 1. ročníku bylo do studie zařazeno 44 studentek, ve 2. ročníku 39 a v posledním ročníku 40 studentek. Výsledky: Nejvýznamnějším zdrojem stresu během tří ročníků studia byl stres z nedostatku vědomostí a zručností. Nejvyšší stres byl na začátku studia, pak klesal. Ve 3. ročníku, kdy v rámci covidové pandemie měli studenti nařízenou pracovní povinnost, opět dosáhl úrovně 1. ročníku. Stres se projevoval zejména v oblasti emocí. Nejčastěji užívanou copingovou strategií bylo řešení problémů. Závěr: Výsledky longitudinální studie potvrzují, jak pandemie covidu-19 ovlivnila percepci a projevy stresu u studentů během jejich studia. V percepci úrovně klinických i akademických stresorů a projevů stresu nebyla zjištěna jednoznačně klesající tendence. Využívání copingových strategií bylo stabilní, bez významnějších rozdílů během celého studia.Alternate :Introduction: Long-term stress is generally considered to be one of the psycho-social factors that negatively affect the academic performance of nursing students. Objectives: To discover the sources of stress, degree of stress, and coping strategies used as a reaction to stress in nursing students of the bachelor program. Methods: Over the course of three academic years, students in each year of the bachelor in nursing program were monitored after completing the clinical practice for the given academic year. Questionnaires regarding the Perceived Stress Scale;Physio-Psycho-Social Response Scale, and Coping Behaviour Inventory were used to gather data. In the first year, 44 students were included, in the second year there were 39 students, and in the final year 40 students took part in the research. Results: The most significant source of stress appears to be a lack of knowledge and relevant skills. The highest degree of stress was recorded at the beginning of a student's studies, after which it decreased. In the third year, when students were required to work due to the covid pandemic, the stress again reached the levels of the first year. The stress manifested mainly in emotions and problem solving was the most frequently used coping strategy. Conclusions: The results of the longitudinal study confirmed how the COVID-19 pandemic affected the perception and manifestation of stress in students during their studies. The perception of the degree of clinical and academic stressors showed that no clear descending tendency was identified. The use of coping strategies was stable, with no significant differences throughout the study.

A promessa ou possibilidade de passar a existir uma cultura médica de vida saudável na América Latina

Os desafios enfrentados por pacientes e suas famílias para terem acesso a cuidados médicos referentes a condições de saúde crônicas fazem com que os profissionais de saúde responsáveis por seu atendimento médico se sintam, com elevada frequência, impotentes. Às vezes convém atribuir a reponsabilidade por esses desafios a um ou mais grupos específicos, tais como os formuladores de políticas ou o sistema de seguro-saúde. No entanto, as verdadeiras razões desses desafios são bem mais complexas, existindo múltiplos fatores presentes, com interrelação. Torna-se necessário realizar uma análise sistêmica mais ampla, bem como ter uma visão mais abrangente, de forma a integrar o contexto sociocultural, focando particularmente as populações vulneráveis e aquelas precariamente atendidas, incluindo-se os adultos mais idosos, a população de áreas densamente povoadas e os indivíduos com status socioeconômico de nível inferior, assim como os migrantes e as minorias1. Neste contexto, a equidade e a justiça social constituem fundamentos aplicáveis essencialmente em um estado de utopia, mas estes fundamentos são indispensáveis à implementação de mudanças futuras.A justiça social constitui um apelo bastante significativo como conceito, a ser plenamente reconhecido em todas as profissões relacionadas aos cuidados de saúde2. O conceito afirma que todos devem, independentemente das circunstâncias legais, políticas, econômicas ou outras3, ter acesso igual à riqueza, ao bem-estar, aos privilégios e às oportunidades, bem como à saúde. Além disso, esse conceito é dirigido para dimensões que vão além dos princípios do direito civil ou penal e transcendem, entre os indivíduos e a sociedade, a relação cujo propósito é ter e manter uma vida gratificante. Portanto, a justiça social é de aplicação universal, devendo ser relacionada a propósitos sociais em todas as regiões do mundo.Como região, a América Latina tem muitos países e com numerosos pontos em comum. Antes da pandemia do coronavírus de 2019 (COVID-19), existiam desafios significativos com relação à saúde na América Latina, incluindo a escassez de medicamentos, a falta de acesso a alimentos saudáveis ou a cuidados primários, seja para migrantes ou pessoas desabrigadas. De acordo com o Índice de GINI, a América Latina é a região mais injusta do planeta, com 185 milhões de pessoas auferindo uma renda abaixo do limiar de pobreza, o equivalente a 66 milhões de indivíduos em estado de pobreza extrema4. Para superar essas deficiências, as comunidades precariamente atendidas se apoiam mutuamente, trabalhando em projetos locais, bancos de alimentos e organizações religiosas, mas desafios significativos continuam existindo.A abordagem atual, com respeito aos cuidados de saúde para indivíduos fragilmente representados e que vivem em comunidades mal atendidas, não é mais sustentável. O caminho a adotar deve incluir como base a medicina para uma vida saudável (HLM, na sigla em inglês), promovendo em sua essência atividades físicas, boa alimentação, ter um peso corporal mediano e abster-se de fumar. Em nível sistêmico, essa mudança cultural diz respeito ao estabelecimento de políticas e práticas.Apromessa ou possibilidade de ter uma existência gratificante encontra-se aqui, na América Latina. Essa abordagem precisa abraçar o conceito de justiça social para que todos tenham oportunidades semelhantes com relação a ter um estilo de vida saudável, minimizando-se os efeitos deletérios das doenças crônicas.Alternate :The challenges that patients and their families experience to access care for chronic health conditions often make the health professionals responsible for their care feel powerless. At times, it may be convenient to lay the blame for these challenges on a singular group, such as policymakers or the health insurance system. However, the true reasons such challenges exist are much more complex, multifactorial, and interrelated. A broader systemic analysis and broader visio is needed to integrate the sociocultural context and place a particular focus on vulnerable, underserved populations, including older adults, people living in densely populated areas, people with lower socioeconomic status, migrants, and minorities11 Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, Hangoma P, Hanvoravongchai P, Obando C, Petrosyan V, Rao KD, Ruano AL, Shi L, de Souza LE, Spitzer-Shohat S, Sturgiss E, Suphanchaimat R, Uribe MV, Willems S. Health equity and COVID-19: global perspectives. Int J Equity Health 2020;19(1):104.. In this context, equity and social justice are constructs that may only feasible in a Utopia but are essential to effect change moving forward.Social justice as a concept is quite appealing and should be fully embraced by all health care professions22 Arena R, Laddu D, Severin R, Hall G, Bond S, HL-PIVOT Network. Healthy living and social justice: addressing the current syndemic in underserved communities. J Cardiopulm Rehabil Prev 2021;41(3):E5-E6.. The concept professes that all people should have equal access to wealth, well-being, privilege, opportunity, and health regardless of legal, political, economic, or other circumstances33 Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN., Manderscheid R, Troutman A. Health disparities and health equity: the issue is justice. Am J Public Health 2011, 101(Suppl. 1):S149-S155.. Moreover, this concept focuses on dimensions beyond civil or criminal law principles and the relationship between individuals and society to lead fulfilling lives. Therefore, social justice is relatable and universal for all regions in the world.Latin America as a region hosts many countries that share numerous commonalities. Prior to the coronavirus disease 2019 (COVID-19) pandemic, there were significant health related challenges in Latin America, including prescription drug shortages, lack of access to healthy food or primary care for migrants, and homelessness. According to the GINI Index, Latin America is the most inequitable region globally;185 million people's income is below the poverty threshold, of whom 66 million live in extreme poverty44 Garcia PJ, Alarcón A, Bayer A, Buss P, Guerra G, Ribeiro H, Rojas K, Saenz R, Salgado de Snyder N, Solimano G, Torres R, Tobar S, Tuesca R, Vargas G, Atun R. COVID-19 response in Latin America. Am J Trop Med Hyg 2020;103(5): 1765.. While these underserved communities support each other to supplement these shortcomings by working with local movements, food banks, and religious organizations, significant challenges remain. The current approach to health care in underrepresented individuals who live in underserved communities is no longer sustainable. The way forward must include healthy living medicine (HLM) as a foundation, at its core promoting physical activity, good nutrition, average body weight, and not smoking. On a systemic level, this cultural change refers to the establishment of policies and practices. The promise or possibility of being is here in Latin America. This approach needs to embrace the concept of social justice so that all individuals in the population have similar opportunities to embrace a healthy lifestyle and minimize the deleterious effects of chronic disease.

"Trying to Find People to Fit the Tech…”: A Qualitative Exploration of the Lessons Learnt Introducing Artificial Intelligence-Based Technology into English Social Care

Digital technology is expected to improve care and address significant service pressures within the National Health Service and social care though evidence on how their implementation might be optimised is lacking. This study explores how one such example, home-based sensors with artificial intelligence capabilities, was implemented in English social care to identify changes in behaviour that indicate the onset of potentially more serious issues. Its focus was staff perspectives on decision-making processes and implementation, to inform recommendations for others exploring the potential of new and emerging technology. Qualitative data were collected from 18 semistructured interviews conducted across three sites delivering social care, with senior decision makers, operational leads, and care staff. We identified several issues with the selection process and implementation of AI-based technology in social care, including a lack of consensus around what success would look like, problems identifying and evaluating alternatives, and technical challenges to implementation, as well as obstacles to developing a longer-term, more preventative approach in a system experienced as focused on responding to acute needs. Ultimately, the research confirmed a number of recognised implementation challenges associated with training, resource, and acceptability to staff and patients. It added particular insights around the anxieties experienced by frontline staff and the cultural shift required of preventative interventions in a system geared to meeting acute crises. That many barriers are familiar suggests a particular need to focus on helping policymakers/local leaders avoid similar pitfalls in the future.

The scope of COVID-19 vaccine insurance coverage and possible disputes

In response to the COVID-19 pandemic, many countries have implemented large-scale vaccination programs. In Taiwan, COVID-19 vaccine insurance is available. However, as the COVID-19 vaccine is a new vaccine, there is limited research assessing its safety, and many physicians are not fully informed about its potential risks. Additionally, there is limited recognition of the risks associated with the COVID-19 vaccine by the government and insurance companies, making it difficult for individuals to prove that an injury is a result of the vaccine. This study examined legal elements, insurance coverage, and potential disputes related to COVID-19 vaccine insurance in Taiwan. This study proposed three ways to resolve vaccine insurance disputes: 1. Insurance companies should clarify the scope of insurance policies and the difference between adverse events following vaccination and adverse reactions. 2. The government should proactively update and supplement the information available on the adverse effects of COVID-19 vaccines. 3. The courts should reduce the burden of proof for individuals with vaccine injuries by interpreting insurance contracts and evidence law. (Taiwan J Public Health. 2023;42(2):153-164)

Identifikace prediktorů duševní pohody vysokoškolských studentů během pandemie covidu-19

Pandemie covidu-19 byla široce zkoumána jako ekonomická i zdravotní krize s důrazem na zvyšování duševního zdraví a pohody vysokoškolských studentů. Tato studie zkoumá vztahy mezi fyzickým zdravím, sociální podporou a gramotností v oblasti duševního zdraví s duševní pohodou studentů malajsijských univerzit během pandemie covidu-19. Studijní soubor tvořilo 199 studentů. Průřezový průzkum byl proveden pomocí dotazníků, které si sami zadali. Tyto dotazníky využívaly Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS), nástroj Multidimenzionální škála vnímané sociální podpory a nástroj Škála duševního zdraví. Průzkum zahrnoval i položky z dotazníku Global Physical Activity Questionnaire (GPAQ). Výsledky této studie ukázaly, že fyzické zdraví má pozitivní a silný vztah k duševní pohodě. Podobně výsledky ukázaly, že sociální podpora má významný a pozitivní vztah k duševní pohodě. Nicméně duševní zdravotní gramotnost nebyla významně spojena s duševní pohodou. Výsledky tohoto výzkumu by mohly poskytnout zákonodárcům, odborníkům z praxe a vedení univerzit užitečné poznatky, které podporují pozitivní výsledky provádění intervenčních programů ke zlepšení duševní pohody studentů.Alternate :The Covid-19 pandemic has been widely examined to be both an economic crisis and health with updates of increasing the mental health and well-being of university students. This study examines the relationships between physical health, social support, and mental health literacy with the mental well-being of Malaysian university students during the Covid-19 pandemic. The study population comprised 199 students. A cross-sectional survey was conducted with self-administered questionnaires that used the Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS), the Multidimensional Scale of Perceived Social Support instrument, and the Mental Health Literacy Scale. The survey also included items from the Global Physical Activity Questionnaire (GPAQ). The results of this study showed that physical health had a positive and strong relationship with mental well-being. Similarly, the results indicated that social support had a significant and positive relationship with mental well-being. However, mental health literacy was not significantly associated with mental well-being. The results of this research might provide policymakers, practitioners, and university management with useful insights that foster the positive outcome of conducting intervention programs to improve the mental well-being of students.

Pandemia de la COVID-19 y las Políticas de Salud Pública en el Perú: marzo-mayo 2020/COVID-19 pandemic and Public Health Policies in Peru: March-May 2020

Objetivo El trabajo tiene como objetivo analizar la dinámica del comportamiento de la COVID-19 en el Perú, estimar y evaluar el impacto de la política pública de supresión (cuarentena). Métodos El modelo epidemiológico SIR y la estimación con el método de Mínimos Cuadrados Ordinarios (MCO). Resultados Se encontró que el número básico de propagación (Ro) cayó de 6,0 a 3,2 habiéndose reducido en 54% por efecto de la estrategia de supresión, y dos meses después cayó a 1,7. Sin embargo, sigue siendo alto y evidencia que aún continúa en expansión el nivel de infectados, con los efectos sociales y económicos adversos que esta medida implica. Conclusión La COVID-19 es una enfermedad que crece exponencialmente, por lo cual, la política de salud basada en la estrategia de supresión ha permitido aplanar la curva de contagio, evitando el colapso del Sistema de Salud. Objective The objective of the study is to analyze the behavior dynamics of COVID-19 in Peru, estimate and evaluate the impact of the suppression public policy (quarantine). Methods The SIR epidemiological model and the estimation with the ordinary Least Squares (OLS) method. Results It was found that the basic number of propagation (Ro) fell from 6,0 to 3,2 having been reduced by 54% due to the suppression strategy;and two months later it falls to 1,7. However, it remains high and evidence that the level of those infected continues to expand with its adverse social and economic effects. Conclusion COVID-19 is a disease that grows exponentially, and that the health policy based on the suppression strategy has allowed to flatten the contagion curve, thus avoiding the collapse of the Health System.

Očekávání žen ohledně porodu a vnímaný vliv protokolů COVID-19 na porod

Cíl: Studie hodnotila očekávání žen ohledně porodu a vnímané účinky protokolů COVID-19 na porod ve vybraných zdravotnických zařízeních v Umuahia, Abia, Nigérie. Metodika: Byla použita průřezová deskriptivní výzkumná metoda. Do studie bylo v období od března do prosince 2020 cíleně vybráno tři sta čtyři (304) žen z vybraných zdravotnických zařízení v Umuahii. Jako nástroj pro sběr dat byl použit validovaný dotazník vyvinutý výzkumnými pracovníky. Získaná data byla podrobena deskriptivní statistice četností, průměrů a směrodatných odchylek. Výsledky: Hlavní zjištění ukázala, že vysoce hodnocená očekávání žen během porodu byla zapojení žen do rozhodování o péči (3,69 ± 3,20), poskytování adekvátních informací o péči o miminko (3,65 ± 3,17) a pozitivní přístup poskytovatelů zdravotní péče (3,59 ± 3,11). Větší počet účastníků plně souhlasil s tím, že lockdown během pandemie vedl k vážným porodním závěrům (3,25 ± 2,98);a zpoždění při dodržování protokolů COVID-19 kvalifikovaným personálem během porodu představuje velkou hrozbu pro matku a dítě (3,58 ± 3,12). Na druhou stranu pozorování sociálního distancování porodními asistentkami (1,57 ± 1,28) a testování žen na covid-19 před přijetím (1,96 ± 1,58) nemělo na porod žádný negativní vliv. Závěr: Zapojení žen do rozhodování o jejich porodních plánech a péči představuje očekávání žen od jejich porodu. Poskytovatelé zdravotní péče musí těmto očekáváním plně porozumět a poskytovat péči, která je s nimi v souladu. Je také nezbytné, aby informace poskytované ženám v prenatálním období, zejména v době pandemie, byly komplexní a srozumitelné. To by mělo být použito k otevřené komunikaci o problémech, které mohou ovlivnit jejich porodní zkušenost, zejména během pandemie.Alternate :Aim: The study assessed women's childbirth expectations and perceived effects of COVID-19 protocols on delivery in selected healthcare facilities in Umuahia, Abia State, Nigeria. Methods: The study adopted a cross-sectional descriptive survey research design. 304 women were purposively recruited from March through December 2020 from selected healthcare facilities in Umuahia. A validated researcher-developed questionnaire was used as instrument for data collection. Data obtained were subjected to descriptive statistics of frequencies, means, and standard deviations. Results: Major findings showed highly rated expectations of women during childbirth were women's involvement in decision making about their care (3.69 ± 3.20), provision of adequate information on baby care (3.65 ± 3.17), and positive attitude of healthcare providers (3.59 ± 3.11). A greater number of the participants strongly agreed that COVID-19 lockdown led to severe labor outcomes (3.25 ± 2.98) and delays in observing COVID-19 protocols by skilled personnel during delivery pose a great threat to mother and baby (3.58 ± 3.12). On the other hand, observation of social distancing by midwives (1.57 ± 1.28) and testing women for COVID-19 before admission (1.96 ± 1.58) did not have any negative effect on the women's delivery. Conclusions: Women's involvement in decision making concerning their birth plans and care are among the women's expectations for their birth. Healthcare providers need to fully understand these expectations and provide care that is consistent with them. It is also essential that information provided to antenatal women, especially during pandemics, is comprehensive and comprehensible. This should be used to openly communicate issues that may impact their birth experience, particularly in pandemics.

Effectiveness of different measures in reducing the daily number of moderate to severe cases of COVID-19

Objectives: Interventions for controlling COVID-19 can be classified into case-based (e.g., contact tracing and quarantining) and population-based (e.g., using masks and receiving vaccines) measures. The objective of pandemic control has now shifted from reducing the daily number of cases to reducing that of hospitalizations through vaccination. COVID-19 has started exhibiting flu-like characteristics. Therefore, in this study, we compared different measures in terms of their effectiveness in reducing the daily number of moderate to severe cases of COVID-19. Methods: The branching model developed by Hellewell (2020) was used for simulation. The epidemiological data of the Omicron variant and various hypothetical scenarios were analyzed. The outcome variable of our study was the daily number of hospitalizations under different measures and their combinations. Results: Population-based measures were more effective than case-based measures;however, their combination led to the best outcomes. If vaccination reduced the number of COVID-19-related hospitalizations, the focus was on increasing vaccine coverage to increase medical capacity rather than enhancing vaccine efficacy. Conclusions: While loosening case-based measures, the government must consider whether population-based measures can support this change. Furthermore, to reduce the daily number of moderate to severe cases of COVID-19, vaccine coverage, rather than vaccine efficacy, must be improved. (Taiwan J Public Health. 2023;42(1):32-41)

Dodržování hygieny rukou v nemocničním prostředí - dotazníkový průzkum zaměřený na zjištění compliance v používání rukavic

Úvod: Hygiena rukou je považována za jedno z nejdůležitějších a nejúčinnějších opatření v prevenci a kontrole šíření infekcí. Hraje také zásadní roli při snižování výskytu infekcí spojených se zdravotní péčí. Hlavním cílem je posoudit dodržování hygieny rukou - se zvláštním zaměřením v používání rukavic při poskytování péče v lůžkových zařízeních. Metody: Průřezový dotazníkový průzkum dodržování standardů bezpečné zdravotní péče v lůžkových zařízeních na území České republiky v roce 2018 před pandemií COVID-19. Osloveno bylo celkem 80 lůžkových poskytovatelů zdravotních služeb v České republice. Odpovědi byly hodnoceny na 6stupňové škále od "vždy" (100 bodů) do "nikdy" (0 bodů). Analýza dat byla provedena pomocí IBM SPSS Statistics verze 22. Výsledky: Dotazník vyplnilo 2 049 zdravotnických pracovníků z 80 oslovených lůžkových zdravotnických zařízení na území České republiky. Respondenti byli rozděleni dle medicínského oboru. Respondenti pracovali v interních oborech (43 %), chirurgických oborech (28 %), na psychiatrii (14 %), v zařízeních dlouhodobé lůžkové péče (9 %) a v ostatních nezařazených oborech (6 %). Závěr: Předkládaná studie ověřila dobrou úroveň v dodržování hygienických standardů u poskytovatelů lůžkové péče v České republice. Identifikovány byly rozdíly v metodickém opatření pro hygienu rukou v České republice a mezinárodních doporučených postupech, které jsou podloženy vysokou úrovní vědeckých důkazů. Vhodným opatřením by bylo zavést národně akceptované klinické doporučené postupy s přesně vymezenou úrovní důkazů.Alternate :Introduction: Hand hygiene is considered one of the most important and effective measures for infection prevention and control. It also plays a vital role in reducing healthcare-associated/acquired infections. The main goal is to assess hand hygiene compliance - with a special focus on using gloves when providing care in inpatient settings. Methods: A cross-sectional survey on compliance with hand hygiene was conducted in health care facilities in the Czech Republic in 2018 before the COVID-19 pandemic. The participants were from 80 inpatient health care providers in the Czech Republic. Responses were scored on a 6-level scale, from "always" (100 points) to "never" (0 points). Data analysis was performed using IBM SPSS Statistics version 22. Results: The questionnaire was filled in by 2,049 health care personnel from 80 inpatient health care facilities in the Czech Republic. Respondents were further divided according to the medical specialty. Respondents worked in the field of internal medicine (43%), surgical fields (28%), psychiatry (14%), long-term care facilities (9%), and other non-classified fields (6%). Conclusions: The presented study verified the good level of declared compliance with hygiene standards in inpatient healthcare providers in the Czech Republic. Significant differences were found between the observed hand hygiene measures established in the Czech Republic and international best practices based on a high scientific evidence level. An appropriate measure would be to establish national clinical best practices based on convincing scientific evidence at the national level.

Herd culture and herd immunity

Although communicable diseases affect our bodies, they occur in a society that interprets and gives them meaning. Herd immunity provides the body protection;however, long-term protection requires shifts in the way people interpret and respond to disease, cultural transformation that enables the development of the knowledge, habits and skills that make herd immunity feasible and sustainable. Herd culture allows individuals to protect themselves and restrict their liberty in order to protect others;it is a form of exercising positive liberty and a necessary complement to herd immunity in a democratic society. Key words Herd immunity, Herd culture, COVID-19, Liberty, Cultural changeAlternate :Resumen Aunque las enfermedades transmisibles afectan nuestros cuerpos, ocurren en una sociedad que las interpreta y dota de significado, y cuyos individuos causan o evitan. La inmunidad de rebaño permite lograr una protección del cuerpo, sin embargo, para su sustentabilidad, se requiere de cambios en la manera cómo las personas interpretan y responden a la enfermedad, de transformaciones culturales que permitan desarrollar conocimientos, hábitos y destrezas que hagan factible y sostenible la inmunidad de rebaño. La cultura de rebaño permite a los individuos protegerse y restringir su libertad para proteger a los demás, es una forma de ejercicio de la libertad positiva y el complemento necesario de la inmunidad del rebaño en la sociedad democrática.Palabras clave:Inmunidad de rebaño;Cultura de rebaño;COVID-19;Libertad;Cambios culturales

Reasons for Not Adopting COVID-19 Permitted Changes to Legal Duties: Accounts from English Local Authorities

In England, "easements,” introduced via the Coronavirus Act 2020, were brought in at the start of the pandemic to support English local authority adult social care services. They enabled local authorities to suspend some of their mandatory duties under the Care Act 2014. Easements were only adopted by eight local authorities and for short periods, and the provision was rescinded in late 2021. This article examines why a sample of 16 local authorities, some of which were statistically close to the eight local authorities that did decide to use easements, decided not to do so. It draws on data from interviews undertaken in 2021 with Directors of Adult Services and Principal Social Workers that explored their decision-making about using easements. It also outlines their preparations prior to the pandemic reaching England, how they had operated using "flexibilities” within the Care Act thus not needing to adopt easements, and their views on those authorities that had adopted them.