Trade agreements and tobacco control policy: analysis of the impact of FCTC on regulatory contents of trade agreements from 2001 to 2019.

BACKGROUND: This study aims to analyze the impact of Framework of Convention of Tobacco Control (FCTC) on regulatory contents of trade agreements from 2001 to 2019. METHODS: A search of trade agreements from'WTO Regional Free Trade Agreement Database' using keywords including "tobacco", "cigarette", "smoking" and "FCTC" from May to August 2020 resulted in a total sample of 268 trade agreements, from which 69 trade agreements were coded and analyzed. Provisions in trade agreements, identified via the aforementioned keywords, were categorized into 6 trade measures. The word counts of the provisions containing; FCTC; were calculated. Chi-square tests were applied to analyze the differences of regulatory patterns between different time frames. The import and export values (USD) of tobacco products under trade agreements containing the term "FCTC" were further collected from the "International Trade Statistics 2001-2020" for understanding the impact of the provision on the trade flow. RESULTS: Among 69 agreements, the percentage of trade agreements containing keyword as "FCTC" increased significantly from 0% to 2011 to 12% after 2011. A significant decrease of using trade measures as "the exclusion list" was found after 2011 (from 10% to 0). The word counts of provisions containing; FCTC; increased from 24 words in 2011 to 164 words in 2018, and the content of the provisions became more concrete over time. There are six trade agreements containing "FCTC", and all these 6 agreements were ratified by European Union (EU). Despite EU ratified trade agreements with "FCTC", the import and export values of tobacco products between EU and the other party countries increased with time. But the gap of average trade values between trade agreements with and without "FCTC" being widened with time. CONCLUSIONS: As a first study evaluated the impact of FCTC on regulatory contents of trade agreements, our study results showed that after countries signed trade agreements containing keyword FCTC, the regulatory contents changed significantly. Further studies are recommended to understand the reason and criteria for incorporating FCTC provisions into trade agreements, especially in the EU.

Short-term mediating effects of PM2.5 on climate-associated COPD severity.

The impact of short-term exposure to environmental factors such as temperature, relative humidity (RH), and fine particulate matter (PM2.5) on chronic obstructive pulmonary disease (COPD) remains unclear. The objective of this study is to investigate PM2.5 as a mediator in the relationship between short-term variations in RH and temperature and COPD severity. A cross-sectional study was conducted on 930 COPD patients in Taiwan from 2017 to 2022. Lung function, COPD Assessment Test (CAT) score, and modified Medical Research Council (mMRC) dyspnea scale were assessed. The mean and differences in 1-day, 7-day, and 30-day individual-level exposure to ambient RH, temperature, and PM2.5 were estimated. The associations between these factors and clinical outcomes were analyzed using linear regression models and generalized additive mixed models, adjusting for age, sex, smoking, and body mass index. In the total season, increases in RH difference were associated with increases in forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC), while increases in temperature difference were associated with decreases in FEV1 and FEV1/FVC. Increases in PM2.5 mean were associated with declines in FEV1. In the cold season, increases in temperature mean were associated with decreases in CAT and mMRC scores, while increases in PM2.5 mean were associated with declines in FEV1, FVC, and FEV1/FVC. In the warm season, increases in temperature difference were associated with decreases in FEV1 and FEV1/FVC, while increases in RH difference and PM2.5 mean were associated with decreases in CAT score. PM2.5 fully mediated the associations of temperature mean with FEV1/FVC in the cold season. In conclusion, PM2.5 mediates the effects of temperature and RH on clinical outcomes. Monitoring patients during low RH, extreme temperature, and high PM2.5 levels is crucial. Capsule of findings The significance of this study is that an increase in ambient RH and temperature, as well as PM2.5 exposure, were significantly associated with changes in lung function, and clinical symptoms in these patients. The novelty of this study is that PM2.5 plays a mediating role in the association of RH and temperature with COPD clinical outcomes in the short term.

The impact of air pollution on respiratory diseases in an era of climate change: A review of the current evidence.

The impacts of climate change and air pollution on respiratory diseases present significant global health challenges. This review aims to investigate the effects of the interactions between these challenges focusing on respiratory diseases. Climate change is predicted to increase the frequency and intensity of extreme weather events amplifying air pollution levels and exacerbating respiratory diseases. Air pollution levels are projected to rise due to ongoing economic growth and population expansion in many areas worldwide, resulting in a greater burden of respiratory diseases. This is especially true among vulnerable populations like children, older adults, and those with pre-existing respiratory disorders. These challenges induce inflammation, create oxidative stress, and impair the immune system function of the lungs. Consequently, public health measures are required to mitigate the effects of climate change and air pollution on respiratory health. The review proposes that reducing greenhouse gas emissions contribute to slowing down climate change and lessening the severity of extreme weather events. Enhancing air quality through regulatory and technological innovations also helps reduce the morbidity of respiratory diseases. Moreover, policies and interventions aimed at improving healthcare access and social support can assist in decreasing the vulnerability of populations to the adverse health effects of air pollution and climate change. In conclusion, there is an urgent need for continuous research, establishment of policies, and public health efforts to tackle the complex and multi-dimensional challenges of climate change, air pollution, and respiratory health. Practical and comprehensive interventions can protect respiratory health and enhance public health outcomes for all.

Climate change and mortality rates of COPD and asthma: A global analysis from 2000 to 2018.

BACKGROUND: Climate change plays a significant role in global health threats, particularly with respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma, but the long-term global-scale impact of climate change on these diseases' mortality remains unclear. OBJECTIVE: This study aims to investigate the impact of climate change on the age-standardized mortality rates (ASMR) of COPD and asthma at national levels. METHODS: We used Global Burden of Disease (GBD) data of ASMR of COPD and asthma from 2000 to 2018. The climate change index was represented as the deviance percentage of temperature (DPT) and relative humidity (DPRH), calculated based on 19-year temperature and humidity averages. Annual temperature, RH, and fine particulate matter (PM2.5) levels in 185 countries/regions were obtained from ERA5 and the OECD's environmental statistics database. General linear mixed-effect regression models were used to examine the associations between climate change with the log of ASMR (LASMR) of COPD and asthma. RESULTS: After adjusting for annual PM2.5, SDI level, smoking prevalence, and geographical regions, a 0.26% increase in DPT was associated with decreases of 0.016, 0.017, and 0.014 per 100,000 people in LASMR of COPD and 0.042, 0.046, and 0.040 per 100,000 people in LASMR of asthma for both genders, males, and females. A 2.68% increase in DPRH was associated with increases of 0.009 and 0.011 per 100,000 people in LASMR of COPD. We observed a negative association of DPT with LASMR for COPD in countries/regions with temperatures ranging from 3.8 to 29.9 °C and with LASMR for asthma ranging from -5.3-29.9 °C. However, we observed a positive association of DPRH with LASMR for both COPD and asthma in the RH range of 41.2-67.2%. CONCLUSION: Climate change adaptation and mitigation could be crucial in reducing the associated COPD and asthma mortality rates, particularly in regions most vulnerable to temperature and humidity fluctuations.

Unveiling the future of COVID-19 patient care: groundbreaking prediction models for severe outcomes or mortality in hospitalized cases.

Background: Previous studies have identified COVID-19 risk factors, such as age and chronic health conditions, linked to severe outcomes and mortality. However, accurately predicting severe illness in COVID-19 patients remains challenging, lacking precise methods. Objective: This study aimed to leverage clinical real-world data and multiple machine-learning algorithms to formulate innovative predictive models for assessing the risk of severe outcomes or mortality in hospitalized patients with COVID-19. Methods: Data were obtained from the Taipei Medical University Clinical Research Database (TMUCRD) including electronic health records from three Taiwanese hospitals in Taiwan. This study included patients admitted to the hospitals who received an initial diagnosis of COVID-19 between January 1, 2021, and May 31, 2022. The primary outcome was defined as the composite of severe infection, including ventilator use, intubation, ICU admission, and mortality. Secondary outcomes consisted of individual indicators. The dataset encompassed demographic data, health status, COVID-19 specifics, comorbidities, medications, and laboratory results. Two modes (full mode and simplified mode) are used; the former includes all features, and the latter only includes the 30 most important features selected based on the algorithm used by the best model in full mode. Seven machine learning was employed algorithms the performance of the models was evaluated using metrics such as the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and specificity. Results: The study encompassed 22,192 eligible in-patients diagnosed with COVID-19. In the full mode, the model using the light gradient boosting machine algorithm achieved the highest AUROC value (0.939), with an accuracy of 85.5%, a sensitivity of 0.897, and a specificity of 0.853. Age, vaccination status, neutrophil count, sodium levels, and platelet count were significant features. In the simplified mode, the extreme gradient boosting algorithm yielded an AUROC of 0.935, an accuracy of 89.9%, a sensitivity of 0.843, and a specificity of 0.902. Conclusion: This study illustrates the feasibility of constructing precise predictive models for severe outcomes or mortality in COVID-19 patients by leveraging significant predictors and advanced machine learning. These findings can aid healthcare practitioners in proactively predicting and monitoring severe outcomes or mortality among hospitalized COVID-19 patients, improving treatment and resource allocation.

Analyzing self-evaluation capacity scores related to infectious disease control in International Health Regulations during the first year of COVID-19 pandemic.

This study aimed to identify changes in the average score of countries' International Health Regulation (IHR) self-evaluation capacity (e-SPAR) in 2020 compared to 2019, and the factors associated with these changes. We collected the data from the World Health Organization (WHO) website in May 2021, then calculated the significant differences between the e-SPAR score in both years. Next, we conducted a test to identify the association between changes in member states' e-SPAR capacity scores and their COVID-19 case fatality rate (CFR), Human Development Index, Civil Liberties, and Government Effectiveness. The results showed that the average e-SPAR scores in 2020 were significantly higher than in 2019. Among the 154 countries, we included in this study, the scores of 98 countries increased in 2020, of which 37.75% were lower-middle-income countries. Meanwhile, among the 56 countries whose scores did not increase, 26 (46.42%) were high-income countries. The COVID-19 CFR was significantly associated with the changes in e-SPAR scores of 154 countries (p < 0.01), as well as the countries whose scores increased (p < 0.05). In conclusion, we consider e-SPAR to still be a useful tool to facilitate countries in monitoring their International Health Regulation (IHR) core capacity progress, especially in infectious disease control to prepare for future pandemics.

Climate-mediated air pollution associated with COPD severity.

Air pollution has been reported to be associated with chronic obstructive pulmonary disease (COPD). Our study aim was to examine the mediating effects of air pollution on climate-associated health outcomes of COPD patients. A cross-sectional study of 117 COPD patients was conducted in a hospital in Taiwan. We measured the lung function, 6-min walking distance, oxygen desaturation, white blood cell count, and percent emphysema (low attenuation area, LAA) and linked these to 0-1-, 0-3-, and 0-5-year lags of individual-level exposure to relative humidity (RH), temperature, and air pollution. Linear regression models were conducted to examine associations of temperature, RH, and air pollution with severity of health outcomes. A mediation analysis was conducted to examine the mediating effects of air pollution on the associations of RH and temperature with health outcomes. We observed that a 1 % increase in the RH was associated with increases in forced expiratory volume in 1 s (FEV1), eosinophils, and lymphocytes, and a decrease in the total-lobe LAA. A 1 °C increase in temperature was associated with decreases in oxygen desaturation, and right-, left-, and upper-lobe LAA values. Also, a 1 µg/m3 increase in PM2.5 was associated with a decrease in the FEV1 and an increase in oxygen desaturation. A 1 µg/m3 increases in PM10 and PM2.5 was associated with increases in the total-, right-, left, upper-, and lower-lobe (PM2.5 only) LAA. A one part per billion increase in NO2 was associated with a decrease in the FEV1 and an increase in the upper-lobe LAA. Next, we found that NO2 fully mediated the association between RH and FEV1. We found PM2.5 fully mediated associations of temperature with oxygen saturation and total-, right-, left-, and upper-lobe LAA. In conclusion, climate-mediated air pollution increased the risk of decreasing FEV1 and oxygen saturation and increasing emphysema severity among COPD patients. Climate change-related air pollution is an important public health issue, especially with regards to respiratory disease.

Characteristics of COVID-19 infection clusters occurring among workers in several Asia-Pacific countries.

The types of workplaces and occupations with coronavirus 2019 (COVID-19) clusters vary between countries and periods. We aimed to characterize major occupational groups with mass outbreaks of COVID-19 infections in several Asia-Pacific countries. Data on the major occupations or workplaces reporting COVID-19 cases in workplaces from January 2020 to July 2021 was collected from industrial hygiene professionals in nine countries. The proportion of workers accounted for 39.1 to 56.6% of the population in each country. The number of workers covered in the national statistics varies among nations based on their definition of a worker. None of the countries examined here have systematically collected occupational data on COVID-19 illnesses and deaths classified by type of industry, occupation, or job. Most countries experienced COVID-19 clusters among health and social care workers (HSCW) in hospitals or long-term care facilities. The types of occupations or workplaces with virus clusters in some participating countries included prisons, call centers, workplaces employing immigrants, garment facilities, grocery stores, and the military, which differed among countries, except for a few common occupations such as HSCW and those populated by immigrants. Further study is necessary in order to seek ways to control infection risks, including revisions to industrial-health-related laws.

Effect of heat treatment and γ-irradiation on pasting, rheological, and fungal load of whole and dehulled millets.

Millets are important food crops in food systems and application of physical treatments could improve the functional properties of millet-based products. Therefore, we investigated the effect of heat and γ-irradiation treatments on the pasting, rheological, and microbial load of whole and dehulled millets (sorghum, foxtail millet, and pearl millet). Moreover, similarity in treatment effect was evaluated by principal component analysis (PCA). The results revealed the significant (p < 0.05) decrease in pasting properties of whole and dehulled millets, except for pasting temperature (71.03 to 74.88 °C). Likewise, significantly (p < 0.05) decreased tendency was observed for all rheological properties, except for phase angle (0.05 to 0.30°) and yield point (13 to 5089). Samples showed a significant (p < 0.05) reduction in fungal growth (89.75 × 104 to 4.46 × 104 CFU/g) compared to control (110.30 × 104 CFU/g). Moreover, samples individually formed 3 clusters (clusters 1: sorghum, 2: pearl millet, and 3: foxtail millet) based on pasting properties, which was confirmed by PCA. Therefore, the findings concluded that the effect of heat and γ-irradiation would be necessary to decrease pasting, rheological, and no microbial growth characteristics of dehulled and whole millets for the development of specific millet-based food products.

From Cognition to Behavior: Associations of Workplace Health Culture and Workplace Health Promotion Performance With Personal Healthy Lifestyles.

Introduction: The aim of this study was to explore associations of workplace health culture and workplace health promotion (WHP) performance with employees' healthy lifestyles and health statuses. Methods: In total, 27 enterprises and 1,732 participants were recruited for a cross-sectional designed survey. At the group level, Workplace Health Scorecard was used to measure WHP performance, and it was filled out by the WHP representative at each workplace. At the personal level, a personal questionnaire was used to measure workplace health culture, healthy lifestyles, and health statuses. A hierarchical linear model analysis was used to assess correlations between these variables. Results: Workplace health culture was significantly related to WHP performance, healthy lifestyles, and health statuses. In particular, the peer support domain was greatly related to healthy behaviors like physical activity (ß = 0.596, p < 0.001), vegetable consumption (ß = 0.291, p < 0.001) and fruit consumption (ß = 0.285, p < 0.05), and it may illustrate the importance of establishing peer support to promote healthy behaviors. Conclusions: WHP performance was significantly related to workplace health culture especially health policies, health climate, and peer and supervisor support. Hence, building a good workplace health culture should be taken seriously, and more studies exploring associations of health culture and WHP performance with employees' health are needed.

Overview of Legal Measures for Managing Workplace COVID-19 Infection Risk in Several Asia-Pacific Countries.

BACKGROUND: Despite the lack of official COVID-19 statistics, various workplaces and occupations have been at the center of COVID-19 outbreaks. We aimed to compare legal measures and governance established for managing COVID-19 infection risks at workplaces in nine Asia and Pacific countries and to recommend key administrative measures. METHODS: We collected information on legal measures and governance from both general citizens and workers regarding infection risks such as COVID-19 from industrial hygiene professionals in nine countries (Indonesia, India, Japan, Malaysia, New Zealand, Republic of the Philippines, Republic of Korea, Taiwan, and Thailand) using a structured questionnaire. RESULTS: A governmental body overseeing public health and welfare was in charge of containing the spread and occurrence of infectious diseases under an infectious disease control and prevention act or another special act, although the name of the pertinent organizations and legislation vary among countries. Unlike in the case of other traditional hazards, there have been no specific articles or clauses describing the means of mitigating virus risk in the workplace that are legally required of employers, making it difficult to define the responsibilities of the employer. Each country maintains own legal systems regarding access to the duration, administration, and financing of paid sick leave. Many workers may not have access to paid sick leave even if it is legally guaranteed. CONCLUSION: Specific legal measures to manage infectious disease risks, such as providing proper personal protective equipment, education, engineering control measures, and paid sick leave are recommended to be stipulated in Industrial safety and health-related acts.

Acceptability of COVID-19 Vaccines and Protective Behavior among Adults in Taiwan: Associations between Risk Perception and Willingness to Vaccinate against COVID-19.

This study aims to evaluate acceptance of COVID-19 vaccines and the impact of risk perception on vaccine acceptance and personal health protective behaviors in Taiwan. A nationwide cross-sectional study was conducted from 19 to 30 October 2020; 1020 participants were included in the final analysis; chi-square and logistic regression analyses were conducted. In total, 52.7% of participants were willing to receive COVID-19 vaccines, 63.5% perceived the severity of COVID-19 in Taiwan as "not serious", and nearly 40% were worried about COVID-19 infection. Participants with higher perceived severity of COVID-19 had significantly higher odds of refusing the vaccine (OR = 1.546), while those worried about infection had lower odds of poor health protective behaviors (OR = 0.685). Vaccine refusal reasons included "the EUA process is not strict enough" (48.7%) and "side effects" (30.3%). Those who had previously refused other vaccinations were 2.44 times more likely to refuse the COVID-19 vaccines. Participants' age had an influence on COVID-19 vaccine acceptance. In general, the Taiwanese public's acceptance of the vaccine was lower than that in other high-income countries. Elderly participants and those with college-level education and above who had previously refused vaccines had lower willingness to receive a COVID-19 vaccine. Risk perception was positively associated with personal health protective behaviors but negatively associated with COVID-19 vaccine acceptance.

Individual and family preferences of job qualities matter: association between face needs, locked-in job status, and burnout among high-tech workers in Taiwan.

BACKGROUND: Studies on the health impacts of being locked in a job are primarily conducted in Western countries, with the theory based on the value of individualism. But the socially-oriented concerns should be considered in workers' locked-in status in Chinese society. So the current study aims at evaluating socially-oriented concerns on workers' locked-in status in Taiwan. METHODS: Anonymous surveys were conducted with 1102 workers at high-tech companies in Taiwan from October 2015 to January 2016 to assess their "face" needs-- a sociological concept linked to the dignity, prestige, and reputation that a person has in terms of their social relationships, locked-in status of the job, and burnout. In addition to being separated into three groups by lock-in score, participants were categorized by the conflict of preference of the job between themselves and their family. Chi-square, ANOVA, Pearson correlation, and regression tests were conducted. RESULTS: Among the 1102 participants, 18% had jobs that they did not prefer but their family preferred. Participants with higher face needs and higher locked-in status had a significantly higher risk of developing personal and work-related burnout. However, the analysis using "locked-in job conflict of preference between themselves and their family" showed a more coherent result. Participants with a job which "self does not prefer but family do" had twice the risk of having personal and work-related burnout (OR = 2.03 and 2.34, respectively). Participants with a job which neither themselves nor their family prefer had four times the risk of having personal and work-related burnout (OR = 4.10 and 4.17, respectively). CONCLUSIONS: The current study suggests an importance in considering a socially-oriented job preference in locked-in status evaluations within the Chinese culture. Workers' whose locked-in status preference conflicted with their family's preference showed a significantly negative impact on their health.

Attitudes towards Mandatory Occupational Vaccination and Intention to Get COVID-19 Vaccine during the First Pandemic Wave among Mongolian Healthcare Workers: A Cross-Sectional Survey.

Mandatory occupational vaccination for health care workers (HCWs) is a debatable issue, especially during the COVID-19 pandemic. This study aimed to determine Mongolian HCWs' attitudes towards mandatory occupational vaccination, the intention to get the COVID-19 vaccine, and the associated factors. A cross-sectional study based on an online survey with a convenience sampling strategy was conducted from February to April 2021 among 238 Mongolia HCWs. Chi-square and logistic regression were performed for analysis. While only 39.9% of HCWs were aware of recommended occupational vaccinations, they highly agreed with the mandatory occupational vaccination on HCWs (93.7%). The agreement rate is significantly higher than their attitude toward general vaccination (93.7% vs. 77.8%). HCW's willingness to get the COVID-19 vaccine was high (67.2%). HCWs aged 26-35 years old who worked in tertiary level hospitals had less willingness to get the COVID-19 vaccine (50%). Participants with lower confidence in the efficacy of the COVID-19 vaccine (ORs = 15.659) and less positive attitudes toward general vaccination (ORs = 5.288) were less likely to get the COVID-19 vaccine. Mongolian HCWs' agreement rate of mandatory occupational vaccination is higher than other countries. Their intention to get the COVID-19 vaccine is high and associated with confidence in the effectiveness of the vaccine.

Depression Severity and Depression Stigma Among Students: A Survey of Universities in Five Countries.

In the university setting, mental disorders have come under greater scrutiny and more attention has been given toward addressing the social stigmas associated with mental illness in an effort to promote mental well-being and improve mental health care delivery on-campus. Depression has been previously linked to a reduction in quality of life, suicidal ideation, and poor academic performance. However, few studies have directly compared the burden of depression or stigmatized views between multiple universities. As a result, this cross-sectional study of university students from five countries was performed to determine the burden of depressive disorders, the stigmatizations of beliefs related to depression, and international variation. A questionnaire consisting of a sociodemographic survey, Patient Health Questionnaire-9 (PHQ-9), and Depression Stigma Scale (DSS) was distributed via multiple routes to undergraduate and graduate students at institutions in the United States, Taiwan, United Arab Emirates, Egypt, and Czech Republic. The point prevalence of depression was determined by using the algorithm scoring method of the PHQ-9. Depression severity was determined according to the summed-item scoring method of the PHQ-9. The degree of stigmatization of beliefs was determined by continuous scores on the DSS subscales for personal and perceived stigma. Differences in depression severity, personal stigma, and perceived stigma were determined according to analysis of variance and further studied using post hoc Tukey's tests. Responses were collected from students in the United States (n = 593), United Arab Emirates (n = 134), Taiwan (n = 217), Egypt (n = 105), and Czech Republic (n = 238). Of 1287 responses, 30.7% (n = 396) screened positive for a depressive disorder: 18.0% (n = 232) for major depressive disorder and 12.7% (n = 164) for another depressive disorder. Depression severity differed internationally (p < 0.001). Emirati students significantly exhibited most depression followed by Czech, American, and Taiwanese students (all ps < 0.001). There was also a difference between students of different countries in terms of personal stigma (p < 0.001), with Emirati students holding more stigmatized personal views than Czech, American, Egyptian, and Taiwanese students (all ps < 0.001). Students similarly demonstrated differences in terms of personal stigma (p < 0.001). Egyptian students exhibited the most perceived stigma followed by Emirati, Taiwanese, American, and Czech students (all ps < 0.001). These findings suggest a high point prevalence of depression among university students and differences in the severity of depression, which has implications for the delivery of mental health care in this population. There were significant differences in terms of personal and perceived stigma between university students, indicating resource allocation for university-based campaigns to reduce depression stigma may need to be tailored to the population. After implementation of stigma reduction programs, future follow-up surveys can be done to compare degrees of stigma before and after the intervention.

Are countries' self-reported assessments of their capacity for infectious disease control reliable? Associations among countries' self-reported international health regulation 2005 capacity assessments and infectious disease control outcomes.

BACKGROUND: This study aimed to evaluate associations among countries' self-reported International Health Regulation 2005 (IHR 2005) capacity assessments and infectious disease control outcomes. METHODS: Countries' self-reported assessments implemented by percentages as IHR Monitoring Tools (IHRMT) in 2016 and 2017 were used to represent national capacity regarding infectious disease control. WHO Disease Outbreak News and matched diseases reports on ProMED-mail were collected in 2016 to represent disease control outcomes of countries. Disease control outcomes were divided in good, normal and bad groups based on the development of outbreaks listed in the reports. The Human Development Index (HDI), density of physicians and nurses, health expenditure, number of arrivals of international tourists were also collected for control. Chi-square test and logistic regression were applied for analysis. RESULTS: A total of 907 cases occurred in 92 countries. For all diseases, cases occurring in high international travel volume countries presented twice the risk of having a bad disease control outcomes than cases occurring in low international travel volume countries (OR = 2.19 for IHR 2016, OR = 2.97 for IHR 2017). Cases occurring in low IHR average score countries had significant higher risk (OR = 7.83 for IHR 2016 and OR = 2.23 for IHR 2017) of having a bad disease control outcomes than countries with high IHR average scores. For only human diseases, cases occurring in high international travel volume countries presented twice the risk of having a bad disease control outcomes than cases occurring in low international travel volume countries for IHR 2017 (OR = 2.79). Cases occurring in low IHR average score countries had significant higher risk (OR = 11.16 for IHR 2016 and OR = 3.45 for IHR 2017) of having a bad disease control outcomes than countries with high IHR average scores. The HDI, health workforce density and total health expenditure were all positively associated with disease control outcomes. CONCLUSIONS: Countries' self-reported infectious disease control capacities positively correlated with their disease control outcomes. While the self-reported IHR scores were accountable to some degree, this approach was useful for understanding global capacity in infectious disease control and in allocating resources for future preparedness.

Does a Free-Trial Approach Increase Purchase and Use of a Household Water Treatment and Safe Storage Product in Rural Haiti?

A cluster, randomized control trial was conducted to assess the effects of social marketing approach on purchase rates and water treatment behavior of Klorfasil, a chlorine-based household water treatment product among seven villages in Thomassique, Haiti, from May to December 2016. Villages were randomized to the free-trial (257 households) or cost-sharing (240 households) group. Households in the free-trial group were allowed 30 days of free Klorfasil use before purchase decision. Households who purchased Klorfasil were then followed up for 30, 60, and 180 days. At the last follow-up, respondents were asked if they would like to repurchase Klorfasil. Questionnaire survey and water quality assessment by residual-free chlorine were conducted in each survey. Chi-square test, t-test, and logistic regression were applied. The first purchase rate of the cost-sharing group was significantly higher than that of the free-trial group (79.2% versus 67.3%). By contrast, the repurchase rate of the free-trial group was higher (82.9% versus 66.3%). However, the overall repurchase rate was 71.6% and the proportion of long-term users was significantly higher in the cost-sharing group (56% versus 47%). Water treatment rates in the cost-sharing group were significantly higher than those in the free-trial group in the first and final surveys (odds ratio [OR] = 0.15, OR = 0.32). Households with high and medium economic status both had significantly higher purchase rates than low economic status households (OR = 4.40, OR = 1.94). Households with higher educated respondents had significantly better water treatment practices (OR = 2.15). The free-trial approach did not increase the first purchase rate but increased the repurchase rate later. The cost-sharing approach significantly encouraged long-term usage.

Is countries' transparency associated with gaps between countries' self and external evaluations for IHR core capacity?

BACKGROUND: This study aims to evaluate the gap between countries' self-evaluation and external evaluation regarding core capacity of infectious disease control required by International Health Regulations and the influence factors of the gap. METHODS: We collected countries' self-evaluated scores (International Health Regulations Monitoring tool, IHRMT) of 2016 and 2017, and external evaluation scores (Joint External Evaluation, JEE) from WHO website on 4rd and 27rd November, 2018. There were 127 and 163 countries with IHRMT scores in 2016 and in 2017, and 74 countries with JEE scores included in the analysis. The gap between countries' self-evaluation and external evaluation was represented by the difference between condensed IHR scores and JEE. Civil liberties (CL) scores were collected as indicators of the transparency of each country. The Human Development Index (HDI) and data indicating the density of physicians and nurses (HWD) were collected to reflect countries' development and health workforce statuses. Then, chi-square test and logistic regression were performed to determine the correlation between the gap of IHRMT and JEE, and civil liberties, human development, and health workforce status. RESULTS: Countries' self-evaluation scores significantly decreased from 2016 to 2017. Countries' external evaluation scores are consistently 1 to 1.5 lower than self-evaluation scores. There were significantly more countries with high HDI status, high CL status and high HWD status in groups with bigger gap between IHRMT and JEE. And countries with higher HDI status presented a higher risk of having bigger gap between countries' self and external scores (OR = 3.181). CONCLUSION: Our study result indicated that countries' transparency represented by CL status do play a role in the gap between IHR and JEE scores. But HDI status is the key factor which significantly associated with the gap. The main reason for the gap in the current world is the different interpretation of evaluation of high HDI countries, though low CL countries tended to over-scored their capacity.

Occupational Stress and Burnout Among Health Care Workers Caring for People Living With HIV in Eswatini.

We used the Effort-Reward Imbalance Questionnaire and Copenhagen Burnout Inventory in our cross-sectional study to examine associations between occupational stress and burnout among 368 health care workers (HCW) who cared for people living with HIV (PLWH) in Eswatini. Chi-square and logistic regression analyses were conducted. HCW caring for PLWH reported high efforts, imbalanced effort-reward ratios, overcommitment, and low rewards. Health care managers, physicians, and nurses reported higher work efforts, effort-reward ratios, overcommitment, and personal, work-related, and client-related burnout than laboratory staff or peer counselors. HCW with high work efforts, effort-reward ratios, and overcommitment had significantly higher risks of having personal (odds ratio [OR] = 4.60), work-related (OR = 3.96), and client-related burnout (OR = 2.20). HCW with low rewards had a significant risk of having personal (OR = 3.13) and work-related (OR = 2.08) burnout. Our results suggested the need for policies to reduce work stress for HCW caring for PLWH.