Association between Presenteeism, Associated Factors, and Outcomes among Intern Physicians in Public Hospitals during the COVID-19 Pandemic: A Cross-Sectional Study.

Background and Objectives: Presenteeism, when employees continue to work despite being sick, may have increased among intern physicians during the COVID-19 pandemic due to the necessity of performing unfamiliar tasks. This study aimed to investigate the prevalence of presenteeism among intern physicians (IPs) in Thailand, its associated factors, and outcomes. Material and Methods: A total of 254 IPs participated in this cross-sectional study conducted from June to July 2022. Participants completed a nationwide online questionnaire including demographics, financial status, underlying diseases, hospital location and affiliation, department, resource problems, manpower shortage, workload intensity, presenteeism, and its outcomes. IPs were recruited via various social media platforms. Statistical analysis was performed using multivariable zero-inflated Poisson regression and multivariable linear regression. Results: The average age of IPs was 25.5 years (SD 1.9), and 57.5% were female. The majority of IPs reported dealing with resource problems (74.8%), insufficient manpower (94.9%), and intense workload (83.5%). Presenteeism was prevalent among 63.8% of IPs, with the most common of the diseases being allergic rhinitis (31.3%). IPs with underlying diseases had an increased rate of presenteeism (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) 1.33-4.55). IPs working in community hospitals during their rotations exhibited a lower rate of presenteeism (aOR 0.39, 95% CI 0.16-0.94) compared to other departments within general or regional hospitals. The IPs frequently exposed to insufficient manpower had an increased rate of presenteeism (aOR 4.35, 95% CI 1.02-20.00) compared to those not exposed. Additionally, IPs with presenteeism had more exhaustion (ß 1.40, 95% CI 0.33 to 2.46), lower perceived well-being (ß -0.65, 95% CI -1.26 to -0.03), and job satisfaction (ß -0.33, 95% CI -0.63 to -0.03). Conclusions: During COVID-19, intern physicians in Thailand often exhibit presenteeism due to physical conditions, resource scarcity, and personnel shortages, impacting exhaustion, well-being, and job satisfaction. Recommendations include assessing healthcare workforces, allocating resources more effectively, enforcing policies to promote responsible use of sick leave, and implementing sick leave systems.

Family Medicine Implementation to Maternal and Child Health in Rural Japan: A Narrative Review.

This research provides a critical narrative review of maternal and child health (MCH) in rural Japan, reflecting broader challenges faced by aging societies globally. The study explores the intertwined roles of professional and lay care in sustaining rural communities, emphasizing the unique position of family medicine and primary care in enhancing MCH services. The scarcity of healthcare resources, particularly the shortage of obstetricians and the weakening of traditional community support systems, underscores the challenges in these areas. Our review method involved a comprehensive search of PubMed for articles published from April 2000 to August 2024, focusing on MCH issues in rural Japan. This study highlights several critical gaps in rural MCH provision: the migration of medical professionals to urban centers, the transformation of social structures affecting traditional caregiving, and the lack of specialized MCH training among primary care physicians. We discuss potential solutions such as incentivizing obstetric care in rural areas, integrating MCH education within family medicine curricula, and revitalizing community-based support systems. By addressing these issues, the research aims to formulate actionable strategies to bolster MCH services, thus ensuring better health outcomes and sustainability of rural communities in Japan and similar settings worldwide.

The Distribution of Dermatologists in the Philippines.

BACKGROUND: Equitable health manpower distribution is essential for the successful implementation of the Universal Health Care (UHC) program by the Philippine Department of Health. Mapping the distribution and profile of dermatologists in the Philippines can improve Filipinos' access to skin disease treatment. METHODS: A review of the database of dermatologists from the Philippine Dermatological Society (PDS) members' directory (as of November 2023), as well as the Philippine Health Insurance Corporation (PhilHealth) database (as of July 2023), was conducted. The distribution of PDS-accredited dermatologists was analyzed by geographic location, demographic profile (age and sex), density (per 100,000 people), and the dermatologist-to-general practitioner (GP) ratio. Heatmaps illustrating the distribution of dermatologists in the Philippines and the ratio of PhilHealth-accredited PDS board-certified dermatologists to GPs were created. RESULTS: Out of 1389 PDS board-certified dermatologists, 1345 resided in the Philippines. The majority were women (1221/1345, 90.78%), with a median age of 47 years (range: 23 to 85). More than half were practicing in the National Capital Region (NCR) (684/1345, 50.86%). The overall dermatologist density was approximately 1 per 100,000 people (1.19); it was highest for the Luzon Island group (1.54) (NCR, 4.80) and lowest for the Mindanao Island group (0.27; the Bangsamoro Autonomous Region of Muslim Mindanao or BARMM, 0.04). Less than one-third (396/1345, 29.44%) of dermatologists were PhilHealth-accredited, with a density of 0.35 dermatologists per 100,000 people. Out of 45218 PhilHealth-accredited physicians, 396 (0.88%) were dermatologists while 11748 (25.98%) were GPs. The overall dermatologist-to-GP ratio among PhilHealth-accredited physicians was 1:30; it was highest in the Luzon Island group (1:20) and lowest in the Mindanao Island group (1:118). CONCLUSION: The Philippines lacks dermatologists in regions outside the NCR. The majority are women, and few are PhilHealth-accredited. The dermatologist-to-GP ratio among PhilHealth-accredited physicians is low. Dermatology training programs should encourage more applicants, especially men, and prioritize applicants from underserved regions.

What we learned from the infection control and what we need in the future: A quantitative and qualitative study on hospital infection prevention and control practitioners (HIPCPs) in Tianjin, China.

BACKGROUND: In December 2022, the epidemic prevention and control policy was upgraded, and China entered a different stage of epidemic control. This study aims to identify implications for better infection control and health care supply during the epidemic. METHODS: A longitudinal quantitative and qualitative study was performed based on 2 comprehensive questionnaire surveys among 497 hospital infection prevention and control practitioners (HIPCPs) before and during the epidemic peak in Tianjin, China. RESULTS: The workload (8.2 hours vs 10.14 hours, P = 0) and self-reported mental health problems (23.5% vs 61.8%, P < .05) among the HIPCPs increased significantly in the peak period. Ward reconstruction and resource coordination were the most needed jobs in hospital infection control, and rapidly increased medical waste during the epidemic needs to be considered in advance. Community support for health care personnel and their families, maintaining full PPE to reduce simultaneous infection of medical staff, and clinical training of infectious diseases for medical staff, especially doctors, in advance are the most important things we learned. CONCLUSION: Although it has been 4 years since the first outbreak of coronavirus disease 2019, more improvements should be made to prepare for the next epidemic of potential diseases.

Integration of primary care and palliative care services to improve equality and equity at the end-of-life: Findings from realist stakeholder workshops.

BACKGROUND: Inequalities in access to palliative and end of life care are longstanding. Integration of primary and palliative care has the potential to improve equity in the community. Evidence to inform integration is scarce as research that considers integration of primary care and palliative care services is rare. AIM: To address the questions: 'how can inequalities in access to community palliative and end of life care be improved through the integration of primary and palliative care, and what are the benefits?' DESIGN: A theory-driven realist inquiry with two stakeholder workshops to explore how, when and why inequalities can be improved through integration. Realist analysis leading to explanatory context(c)-mechanism(m)-outcome(o) configurations(c) (CMOCs). FINDINGS: A total of 27 participants attended online workshops (July and September 2022): patient and public members (n = 6), commissioners (n = 2), primary care (n = 5) and specialist palliative care professionals (n = 14). Most were White British (n = 22), other ethnicities were Asian (n = 3), Black African (n = 1) and British mixed race (n = 1). Power imbalances and racism hinder people from ethnic minority backgrounds accessing current services. Shared commitment to addressing these across palliative care and primary care is required in integrated partnerships. Partnership functioning depends on trusted relationships and effective communication, enabled by co-location and record sharing. Positive patient experiences provide affirmation for the multi-disciplinary team, grow confidence and drive improvements. CONCLUSIONS: Integration to address inequalities needs recognition of current barriers. Integration grounded in trust, faith and confidence can lead to a cycle of positive patient, carer and professional experience. Prioritising inequalities as whole system concern is required for future service delivery and research.

Day and Time of Admission to ICU Affects Patient Outcome: An Illogical Belief?

How to cite this article: Krishna B. Day and Time of Admission to ICU Affects Patient Outcome: An Illogical Belief? Indian J Crit Care Med 2024;28(5):414-415.

Nursing labor supply in Iran: a survey in Shiraz public hospitals in 2022.

BACKGROUND: The labor supply of nurses, as one of the main healthcare workers, is an important issue in health human resources planning in all health systems. Finding the factors affecting it, could help policymakers to solve the shortage of nursing work supply. The present study aimed to investigating the quantity and factors affecting the nurses' labor supply in Iran. METHOD: In this cross-sectional study, a sample of 598 nurses working in public hospitals of Shiraz (Iran) were selected via proportionate stratified random sampling method. The required data was collected using a structured questionnaire which asked working hours and other related factors. To analyze the data, descriptive statistics, univariate analysis and multivariate linear regression were performed using STATA 15. The multivariate labor supply model was estimated separately for married and single nurses.  RESULTS: The average weekly working hours of nurses was 54.65 h in all medical centers and 50.28 h in the main hospital. The regression results showed that the labor supply of nurses with work experience (ß = - 0.368, P = 0.014), satisfaction with work shift arrangement (ß = - 2.473, P = 0.001), income between 60-89 million rial (ß = - 14.046, P = 0.002), income between  90-119 million rial(ß = - 12.073, P = 0.012), and working in the emergency department (ß = - 5.043, P = 0.017) had negative and significant relationship; But there was a positive and significant relationship with satisfaction of the work environment (ß = 1.86, P = 0.011), workload at work (ß = 1.951, P = 0.023) and employment status (contractual employees) (ß = 4.704, P = 0.004). CONCLUSION: The labor supply function of nurses is affected by demographic, economic and non-economic factors. The most contributing factors were related to non-economic variables. It seems that the non-financial cost and benefits related to the job as well as internal factors have more important role on the nurses' labor supply.

The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data.

BACKGROUND: Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies. METHODS: We conducted a cross-sectional analysis of daily reports of clinical incidents in maternity inpatient areas matched with inpatient staffing levels for three maternity services in England, using data from April 2015 to February 2020. Incidents resulting in harm to mothers or babies was the primary outcome measure. Staffing levels were calculated from daily staffing rosters, quantified in Hours Per Patient Day (HPPD) for midwives and maternity assistants. Understaffing was defined as staffing below the mean for the service. A negative binomial hierarchical model was used to assess the relationship between exposure to low staffing and reported incidents involving harm. RESULTS: The sample covered 106,904 maternal admissions over 46 months. The rate of harmful incidents in each of the three services ranged from 2.1 to 3.0 per 100 admissions across the study period. Understaffing by registered midwives was associated with an 11% increase in harmful incidents (adjusted IRR 1.110, 95% CI 1.002,1.229). Understaffing by maternity assistants was not associated with an increase in harmful incidents (adjusted IRR 0.919, 95% 0.813,1.039). Analysis of specific types of incidents showed no statistically significant associations, but most of the point estimates were in the direction of increased incidents when services were understaffed. CONCLUSION: When there is understaffing by registered midwives, more harmful incidents are reported but understaffing by maternity assistants is not associated with higher risk of harms. Adequate registered midwife staffing levels are crucial for maintaining safety. Changes in the profile of maternity service workforces need to be carefully scrutinised to prevent mothers and babies being put at risk of avoidable harm.

Strengthening of District/Taluk Level Hospitals Through Implementation of Post-graduate Medical Courses in Karnataka, India.

The World Health Organization (WHO) recommends the requirement of human resource for health (HRH) stands at 44.5 skilled health workers per 10,000 population. WHO recognizes India as one of the countries which has HRH crisis. Karnataka, a southern state in India, has the highest number of medical colleges yet faces the shortage of specialists in the public hospitals. We conducted desk review to understand the HRH crisis, particularly the medical specialists in India. Simultaneously, we conducted secondary research to explore the initiatives taken by the Government of Karnataka (GoK) to mitigate the shortage of medical specialists in the rural areas. GoK scaled up the National Board of Examination in Medical Sciences (NBEMS) postgraduate and super-speciality courses such as Diplomate of National Board (DNB), Diploma, and Doctorate of National Board (DrNB) in district hospitals (minimum 250-500 bedded) and taluk hospitals (minimum 100 bedded) by utilizing the existing resources. Karnataka is the first state in India to expand the NBEMS (DNB and Diploma) courses in taluk hospitals and to begin DrNB courses in district hospitals. The paper documents the process of implementation of the NBEMS courses at district and taluk hospitals of Karnataka, which has supported in strengthening these hospitals in the state.

The leading role of expert safety knowledge in supporting the mission of caring for patients during man-made and natural disasters: state of emergency medicine in Ethiopia, Myanmar, and Ukraine.

Preparedness to endure extreme situations such as natural disasters or military conflicts is not commonplace in healthcare training programs. Moreover, multidisciplinary teams in health services rarely (if ever) include experts in security. However, when emergency situations occur, prevailing healthcare demands do not cease to exist, and unexpected demands often surge due to the shortage of other services and supplies or as a consequence of the emergency condition itself.With services in 45 countries, AIDS Healthcare Foundation (AHF) has operated in several conflict zones, facing broad and challenging security demands. Since 2017 AHF has implemented the Global Department of Safety and Security (GDSS), a dedicated intelligence and safety program that had a key role in the security monitoring, preparedness, and defense responses, assisting staff members and clients during recent conflicts.In this manuscript, we describe the experience of AHF's GDSS in three recent military conflicts in Ethiopia, Myanmar, and Ukraine, and provide insights into steps that can be taken to assure staff safety and support the mission of caring for patients throughout catastrophic events.

Evaluation of medical equipment maintenance and skilled manpower requirement among private dental centres in Riyadh, Saudi Arabia: A pilot study.

BACKGROUND: Adequate equipment maintenance is necessary to ensure efficient dental care facilities and satisfactory medical equipment performance. OBJECTIVE: This study aimed to assess maintenance practices and manpower adequacy in private dental centres (DCs) across Riyadh, Saudi Arabia. METHODS: A questionnaire was designed to evaluate equipment maintenance and manpower strength based on international and national standards. Thirty-three private DCs were visited in-person with the designed questionnaire to conduct the study. The Chi-square test and t-test were performed. RESULTS: Only 21 dental centres had a scheduled maintenance plan for medical equipment, whereas the rest had no plan. Furthermore, only 22 DCs maintained equipment maintenance records, while 11 DCs did not have any records. Additionally, the study found a lack of trained personnel to handle medical equipment and overall inadequate maintenance practices. Significant differences were observed between the responses for many questions (p< 0.05). CONCLUSION: These findings increase health risks to both the patient and the user. To address these issues, DC administrators should implement stricter measures to adhere to local DCs standards and hire qualified personnel who can periodically maintain and repair medical equipment.

Barriers and facilitators in implementing early essential newborn care of well-born babies in low- and middle-income countries: A mixed-method systematic review.

BACKGROUND: Evidences have demonstrated the effectiveness of early essential newborn care. However, the implementation of early essential newborn care is suboptimal. The aim is to identify and synthesise the barriers and facilitators impacting the implementation of early essential newborn care in low- and middle-income countries. DATA SOURCES: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, CNKI, Wan Fang Data, SinoMed and Google Scholar. METHODS: Two authors independently screened, performed quality assessment using the Mixed Methods Appraisal Tool and extracted data. This review includes papers that reported the barriers and facilitators of implementing early essential newborn care in low- and middle-income countries from the view of healthcare providers. Barriers and facilitators were coded according to the consolidated framework for implementation research in a deductive way and then been inducted into five common themes. This review followed synthesis without meta-analysis reporting guideline. RESULTS: A total of 28 studies were included. Five inductive common themes influencing implementing early essential newborn care in low- and middle-income countries were system-level healthcare factors, healthcare providers' knowledge and beliefs, the requirements of mothers or families, adapting to routine practice and the working climate of organisation. CONCLUSION: The factors were from system level, facility level and individual level and were inducted into five themes. Based on this review, decision-makers could tailor implementing strategies to narrow the gap between the evidence and implementation. RELEVANCE TO CLINICAL PRACTICE: The study offers guidance for health professionals to identify barriers and facilitators in implementing early essential newborn care and make tailored strategies when implementing early essential newborn care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contributions.

The effect of the intensive care unit nurse manpower on care behaviours and stress level on the nurses.

BACKGROUND: Nurses working in the intensive care units (ICU) regarding the work-index-nursing work environment, the effect level ICU environment has on the nurses' care behaviors and stress levels of the nurses should be determined. OBJECTIVE: The study aimed to investigate the effect of the nurse manpower on care behaviours and stress level of the nurses working in the ICU. METHODS: This was a cross-sectional and correlational study. The sample of the study consisted of 123 nurses working in the ICUs. The data were collected using the survey form, Distress Thermometer (DT), The Practice Work Environment Scale of the Nursing Work Index (PES-NWI), and Caring Behaviors Scale-24 (CBS-24). RESULTS: The mean age of nurses in the ICU was 30.2±5.6 and the mean of working time in the intensive care unit of nurses in the ICU was 3.7±3.1 years. The mean of the DT was 4.8±3.4, and the mean score of PES-NWI was 2.6±1.0 and the mean score of CBS-24 was 4.7±1.1 in nurses in the ICU. The regression model which was studied to investigate the relationship between caring behaviors and stress and nurse manpower of nurses working in intensive care unit was significant. CONCLUSION: Care behaviors and stress levels of nurses working in intensive care units are negatively affected by insufficient nurse manpower.

Obstetric anaesthesiology: manpower and service provision issues in India.

Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care.

[The brief characteristic of manpower potential in health care of Greece, Spain, Bulgaria].

The article presents brief descriptive review of manpower resources in health care of Greece, Spain and Bulgaria. It is noted that countries differ in redundancy of specialists at relative deficiency of general practitioners. The medical personnel of analyzed countries are characterized by aging, tendency to migration to other countries, deficiency of paramedical personnel and excess of required number of dentists that is especially pronounced in Bulgaria. Furthermore, accessibility of medical care is reduced by limits of number of patients per one physician established for specified time period in Greece. The salary level of physicians in these countries varies from minimal (Greece, Bulgaria) to maximal in Spain. At that, training of medical personnel is implemented according to Bologna system (bachelor course, magistracy, etc.) and is characterized by long period (4-5 years) of training physician for independent work.

Manpower cost for a hypertension health campaign: A cross-sectional study.

Introduction: The overall prevalence of hypertension is high, and many people are unaware of their condition. Screening campaigns can effectively identify this group of patients. The study aimed to determine the cost of manpower for a health campaign for detecting undiagnosed hypertension and the prevalence of hypertension. Method: This cross-sectional study was conducted at two health centres. Sociodemographic characteristics, hypertension and treatment statuses were recorded. Blood pressure (BP) was measured by either doctors or nurses using automated BP machines. The cost of manpower was calculated as the average salaries of manpower during the 3-day health campaign divided by the total number of days. The final sum was the cost of detecting undiagnosed hypertension. Results: A total of 2009 participants median age = 50 (IQR = 18-91) were included in the study. The overall prevalence of hypertension was 41.4% (n=832). Among the patients with hypertension, 49.2% (n=409) were unaware of their hypertension status. Conversely, 21.1% (n=423) were known to have hypertension, among whom 97.4% (n=412) were on medications. Among those who were on medications, 49% (n=202) had good BP control. The average total cost of manpower during the 3-day health campaign was RM 5019.80 (USD 1059). The cost of detecting an individual with elevated BP was RM 12.27 (USD 2.59). Conclusion: The prevalence of hypertension and unawareness is high. However, the average cost of manpower to detect an individual with elevated BP is low. Therefore, regular public health campaigns aiming to detect undiagnosed hypertension are recommended.

Why Treat Patients with a Major Orthopaedic Surgery Only to Send Them Back to the Vulnerable Conditions That Made Them Sick in the First Place? A Conceptual Scenario to Improve Patient's Journey.

Individuals with severe cartilage degeneration of the hip or knee or collapsed vertebrae that cause spine deformities can suffer from joint and neuropathic pain in the back, disuse of the affected limb, and restriction of movements. Surgical intervention is the most widespread and successful solution to date. There is a general belief that eating healthy and staying physically and mentally active might have a preventive role against musculoskeletal disease occurrence, while instead, we are more certain of the benefits deriving from a healthy diet and exercise therapy after major orthopaedic procedures. These aspects are in fact vital components in enhanced recovery after surgery programmes. However, they are applied in hospital settings, are often centre-dependent, and lack primary and tertiary preventive efficacy since end once the patient is discharged. There is the lack of initiatives at the territorial level that ensure a continuum in the patient's journey towards orthopaedic surgery, home transition, and a healthy and long-lasting life. The expert panel advocates the integration of an intermediate lifestyle clinic that promotes healthy eating, physical activity, and sleep hygiene. In this facility directed by professionals in enhancing recovery after surgery, patients can be referred after the surgical indication and before home discharge. Surgery is in fact a moment when individuals are more curious to do their best to heal and stay healthy, representing a timepoint and opportunity for educating patients on how lifestyle changes may optimise not only their surgical recovery but also long-term future health state.

Shaping the Future: The Transformative Path of the Arab Board of Rheumatology.

Rheumatology fellowship programs represent a pivotal juncture for aspiring specialists, embarking on a transformative journey of expertise and care. The League of Arab States, comprising 22 nations and a collective population of 464.68 million as of 2022, established the Arab Board of Health Specialization in February 1978. This visionary initiative aimed to curb the emigration of Arab physicians and address the scarcity of specialized medical practitioners in the Arab world. Since the establishment of the Internal Medicine specialty in 1979, the curriculum and examinations have undergone sustained refinement and enhancement. In a significant stride, the Arab Board established the Scientific Committee of the Rheumatology Fellowship Program on November 28, 2022. Its main goal is to ensure that graduating fellows will be of high caliber and can contribute to the care of patients with rheumatic disease in the Arab world. This editorial illustrates the historical trajectory of the Arab Board's evolution and chronicles the dynamic expedition of shaping the rheumatology fellowship program.