A Study on Medical Welfare in Vietnam

Medical welfare are services provided to people with little or no fee, for the sake of a standardised health care for the general public. There are many methods are being implemented to achieve the goal of health welfare in Vietnam. These methods are being adopted simultaneously, including: (i) Investing in input resources to reduce costs; (ii) Incorporating public health services that are not provided by the private sector; (iii) providing support with health insurance and medical assistance. Healthcare welfare policies have exerted their effects on developing the national healthcare system. But, which require new modification and rectification for the sake of remarkable achievements in the future.

Digital Technology, Knowledge Level, and Food Safety Governance: Implications for National Healthcare System

Exploring the intrinsic relationship between digital technology and the efficiency of food safety supervision contributes to a better understanding of the role of digital technology in food safety supervision and how to maximize its influence. This study employed sample data from 31 regions in China between 2015 and 2017 for an empirical analysis of the correlation between the two and to examine the moderating effects of the knowledge levels of food producers and consumers. The results show that the development of digital technology contributes to enhancing the efficiency of food safety supervision. In this process, the higher the knowledge level of consumers, the greater the positive promotional effect of digital technology. On the contrary, when the knowledge level of producers is higher, it is not conducive to enhancing the effect of digital technology on the efficiency of food safety supervision. The author holds the view that this is related to the fact that employees in the food production and manufacturing industry have insufficient moral and legal knowledge. This not only limits the effect of digital technology on enhancing the efficiency of food safety supervision, but also opens the door to illegal production for some unprincipled producers. The policy implications are that digital technology should be used to improve food safety supervision, the moral and legal knowledge of food producers should be improved, and consumers should be encouraged to use digital technology more in the pursuit of food safety. Implications for national healthcare system would be also discussed in our paper.

Prevalence of Advanced Parkinson’s Disease in Patients Treated in the Hospitals of the Spanish National Healthcare System: The PARADISE Study

Background: Advanced Parkinson’s disease (APD) has been recently defined as a stage in which certain symptoms and complications are present, with a detrimental influence on the overall patient’s health conditions and with a poor response to conventional treatments. However, historically, the term APD has been controversial, thus consequently, APD prevalence has not been previously studied. Objectives: The main objective was to determine the prevalence of APD in patients diagnosed with idiopathic PD in hospitals of the Spanish National Healthcare System. Secondary objectives were the prevalence and incidence of PD and the clinical and sociodemographic characteristics and quality of life of patients with APD or non-APD. Methods: This was a non-interventional, cross-sectional, multicenter, national study in the hospital setting. Results: The study population included 929 patients with PD (mean age 71.8 ± 10.1 years; 53.8% male) and a mean time since diagnosis of 6.6 ± 5.4 years. At the time of diagnosis, 613 patients (66.06%) reported having had premotor symptoms. The Hoehn and Yahr stage was 1 in 15.7% of the patients, 2 in 42.8%, 3 in 30.1%, 4 in 9.9%, and 5 in 1.4%; 46.9% of the patients had comorbidities (mean age-adjusted Charlson comorbidity index 3.5 ± 1.7; median 10-year survival 77%) and the mean 8-item Parkinson’s Disease Quality of Life Questionnaire was 27.8 ± 20.5. We found an APD prevalence of 38.21% (95%CI: 35.08%–41.42%), a PD prevalence of 118.4 (95%CI: 117.3–119.6), and a PD incidence of 9.4 (95%CI: 5.42–13.4) all per 100,000 population. Among the APD population, a 15.2% were receiving some form of therapy for advanced stages of the disease (deep brain stimulation, levodopa/carbidopa intestinal gel, or apomorphine subcutaneous infusion). Conclusions: The percentage of patients with APD in the hospitals of the Spanish National Healthcare System was 38.2%.

Prevalence and risk factors for SARS-CoV-2 infection and seroprevalence among clinical and non-clinical staff in a national healthcare system

Background While many studies have reported the rate and risk of SARS-CoV-2 infection among healthcare workers (HCWs), there are scant data regarding the impact of employment type and job grades upon such risk. Methods We determined the rate of SARS-CoV-2 infection based on a positive nasopharyngeal swab (NPS) PCR among employees of a large national healthcare system. Antibody testing was performed on those who agreed to provide a blood sample. Using logistic regression analysis, we determined the risk of infection (PCR+) associated with demographic characteristics, job family and job grade. Results We identified 35,075 staff (30,849 full-time, 4,226 outsourced) between March 1-October 31, 2020. Among full-time employees, 78.0% had a NPS (11.8% positive). Among outsourced staff, 94.4% had a NPS (31.1% positive). Antibody testing was performed on 33.9% full-time employees (13.0% reactive), and on 39.1% of the outsourced staff (47.0% reactive). PCR-positivity was higher among outsourced staff (31.0% vs. 18.3% in non-clinical and 9.0% in clinical full-time employees) and those in the low-grade vs. mid-grade and high-grade job categories. Male sex (OR 1.88), non-clinical job family (OR 1.21), low-grade job category (OR 3.71) and being an outsourced staff (OR 2.09) were associated with a higher risk of infection. Conclusion HCWs are a diverse population with varying risk of infection. Clinical staff are at a lower risk likely due to increased awareness and infection prevention measures. Risk is higher for those in the lower socioeconomic strata. Infection is more likely to occur in non-healthcare setting than within the healthcare facilities.

National cross-sectional cohort study of the relationship between quality of mental healthcare and death by suicide

BackgroundPatient safety-based interventions aimed at lethal means restriction are effective at reducing death by suicide in inpatient mental health settings but are more challenging in the outpatient arena. As an alternative approach, we examined the association between quality of mental healthcare and suicide in a national healthcare system.MethodsWe calculated regional suicide rates for Department of Veterans Affairs (VA) Healthcare users from 2013 to 2017. To control for underlying variation in suicide risk in each of our 115 mental health referral regions (MHRRs), we calculated standardised rate ratios (SRRs) for VA users compared with the general population. We calculated quality metrics for outpatient mental healthcare in each MHRR using individual metrics as well as an Overall Quality Index. We assessed the correlation between quality metrics and suicide rates.ResultsAmong the 115 VA MHRRs, the age-adjusted, sex-adjusted and race-adjusted annual suicide rates varied from 6.8 to 92.9 per 100 000 VA users, and the SRRs varied between 0.7 and 5.7. Mean regional-level adherence to each of our quality metrics ranged from a low of 7.7% for subspecialty care access to a high of 58.9% for care transitions. While there was substantial regional variation in quality, there was no correlation between an overall index of mental healthcare quality and SRR.ConclusionThere was no correlation between overall quality of outpatient mental healthcare and rates of suicide in a national healthcare system. Although it is possible that quality was not high enough anywhere to prevent suicide at the population level or that we were unable to adequately measure quality, this examination of core mental health services in a well-resourced system raises doubts that a quality-based approach alone can lower population-level suicide rates.

The impact of Covid-19 vaccination on the Italian healthcare system: a scenario analysis

Introduction: The objective of this study is to estimate the effects of the national immunisation strategy for Covid-19 in Italy on the national healthcare system. Methods: An epidemiological scenario analysis was developed in order to simulate the impact of the Covid-19 pandemic on the Italian national healthcare system in 2021. Hospitalisations, ICU admissions and death rates were modelled based on 2020 data. We forecast the impact of the introduction of a primary prevention strategy on the national healthcare system by considering vaccine efficacy, availability of doses and potential population coverage over time. Results: In the absence of immunisation, between 57,000 and 63,000 additional deaths are forecast in 2021. Based on the assumptions underlying the two epidemiological scenarios from the 2020 data, our model predicts that cumulative hospital admissions in 2021 will range from 3.4 to 3.9 million. The deployment of vaccine immunisation has the potential to control the evolution of 2021 infections and avoid from 60 to 67 percent of deaths compared to not vaccinating. Conclusions: In order to inform Italian policymakers on delivering a mass vaccination programme, this study highlights and detects some key factors that must be controlled to ensure that immunisation targets will be met in reasonable time.

Telemonitoring in the Covid-19 Era: The Tuscany Region Experience

Covid-19 has brought many difficulties in the management of infected and high-risk patients. Telemedicine platforms can really help in this situation, since they allow remotely monitoring Covid-19 patients, reducing the risk for the doctors, without decreasing the efficiency of the therapies and while alleviating patients’ mental issues. In this paper, we present the entire architecture and the experience of using the Tel.Te.Covid19 telemedicine platform. Projected for the treatment of chronic diseases, it has been technologically updated for the management of Covid-19 patients with the support of a group of doctors in the territory when the pandemic arrived, introducing new sensors and functionalities (e.g., the familiar use and video calls). In Tuscany (Central Italy), during the first wave of outbreak, a model for enrolling patients was created and tested. Because of the positive results, the latter has been then adopted in the second current wave. The Tel.Te.Covid19 platform has been used by 40 among general practitioners and doctors of continuity care and about 180 symptomatic patients since March 2020. Both patients and doctors have good opinion of the platform, and no hospitalisations or deaths occurred for the monitored patients, reducing also the impact on the National Healthcare System.

Trends over time in the risk of adverse outcomes among patients with SARS-CoV-2 infection

ObjectivesWe aimed to describe trends in the incidence of adverse outcomes among patients who tested positive for SARS-CoV-2 between February and September 2020 within a national healthcare system.SettingUS Veterans Affairs national healthcare system.ParticipantsEnrollees in the VA healthcare system who tested positive for SARS-CoV-2 between 2/28/2020 and 9/30/2020 (n=55,952).OutcomesDeath, hospitalization, intensive care unit (ICU) admission and mechanical ventilation within 30 days of testing positive.The incidence of these outcomes was examined among patients infected each month and trends were evaluated using an interrupted time-series analysis.ResultsBetween February and July 2020, during the first wave of the US pandemic, there were marked downward trends in the 30-day incidence of hospitalization (44.2% to 15.8%), ICU admission (20.3% to 5.3%), mechanical ventilation (12.7% to 2.2%), and death (12.5% to 4.4%), with subsequent stabilization between July and September 2020. These trends persisted after adjustment for sociodemographic characteristics, comorbid conditions, and documented symptoms and after additional adjustment for laboratory test results among hospitalized patients, including among subgroups admitted to the ICU and treated with mechanical ventilation. Among hospitalized patients, use of hydroxychloroquine (56.5% to 0%), azithromycin (48.3% to 16.6%) vasopressors (20.6% to 8.7%), and dialysis (11.6% to 3.8%) decreased while use of dexamethasone (3.4% to 53.1%), other corticosteroids (4.9% to 29.0%) and remdesivir (1.7% to 45.4%) increased from February to September.ConclusionsAmong patients who tested positive for SARS-CoV-2 in a large national US healthcare system, risk for a range of adverse outcomes decreased markedly between February and July, with subsequent stabilization from July to September. These trends were not explained by changes in measured baseline patient characteristics.