OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

BACKGROUND: Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates. METHODS: Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being. RESULTS: 86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = -0.096, 95% CI -0.176, -0.033), multiple ACEs (β = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being. CONCLUSIONS Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.
Adolescent ; Adult ; Adverse Childhood Experiences/statistics & numerical data* ; Cross-Sectional Studies ; Female ; Health Status ; Humans ; Latent Class Analysis ; Male ; Mental Health/statistics & numerical data* ; Models, Psychological ; Prevalence ; Stress, Psychological/psychology* ; Students/statistics & numerical data* ; Universities ; Young Adult

BACKGROUND: The 2019 novel coronavirus disease (COVID-19) emerges in China, which spreads rapidly and becomes a public health emergency of international concern. Chinese government has promptly taken quarantine measures to block the transmission of the COVID-19, which may cause deleterious consequences on everyone's behaviors and psychological health. Few studies have examined the associations between behavioral and mental health in different endemic areas. This study aimed to describe screen time (ST), physical activity (PA), and depressive symptoms, as well as their associations among Chinese college students according to different epidemic areas. METHODS: The study design is cross-sectional using online survey, from 4 to 12 February 2020, 14,789 college students accomplished this online study, participants who did not complete the questionnaire were excluded, and finally this study included 11,787 college students from China. RESULTS: The average age of participants was 20.51 ± 1.88 years. 57.1% of the college students were male. In total, 25.9% of college students reported depression symptoms. ST > 4 h/day was positively correlated with depressive symptoms (β = 0.48, 95%CI 0.37-0.59). COVID-19ST > 1 h/day was positively correlated with depressive symptoms (β = 0.54, 95%CI 0.43-0.65), compared with COVID-19ST ≤ 0.5 h/day. Compared with PA ≥ 3 day/week, PA < 3 day/week was positively associated with depression symptoms (β = 0.01, 95%CI 0.008-0.012). Compared with low ST and high PA, there was an interaction association between high ST and low PA on depression (β = 0.31, 95%CI 0.26-0.36). Compared with low COVID-19ST and high PA, there was an interaction association between high COVID-19ST and low PA on depression (β = 0.37, 95%CI 0.32-0.43). There were also current residence areas differences. CONCLUSIONS Our findings identified that high ST or low PA was positively associated with depressive symptoms independently, and there was also an interactive effect between ST and PA on depressive symptoms.
Adult ; COVID-19/psychology* ; China/epidemiology* ; Cross-Sectional Studies ; Depression/etiology* ; Exercise ; Female ; Humans ; Male ; Mental Health/statistics & numerical data* ; Screen Time ; Students/psychology* ; Time Factors ; Universities ; Young Adult

BACKGROUND: From 2010 to 2015, there was a twofold growth of new HIV/AIDS infection in Beijing among young students aged 15-24. HIV/AIDS education was found effective in promoting positive behavior change related to HIV/AIDS prevention. However, little evidence was found on the evaluation of HIV/AIDS education policy. This study aimed to evaluate the college-based HIV/AIDS education policy in Beijing. METHODS: By using a mixed method approach, the current study reviewed college-based HIV/AIDS education policy at national level and in Beijing from 1985 to 2016 and conducted policy content analysis to evaluate the policy ability to structure implementation. Cross-sectional surveys in 2006 and 2016 were used to evaluate college's implementation of relevant policies. T test, χ test, and logistic regression were used to analyze college students' perception of HIV/AIDS education provided in their colleges and their knowledge of HIV/AIDS and their risk factors. RESULTS: Fourteen pieces of national policy and four pieces of Beijing's policy were identified. Policy's ability to structure implementation was at moderate level. The percentage of students in Beijing who ever perceived HIV/ADIS education at colleges decreased from 71.14 to 39.80%, and the percentage of students with comprehensive knowledge of HIV/AIDS dropped from 50.00% in 2006 to 40.42% in 2016. CONCLUSIONS HIV/AIDS education in college had drawn considerable attentions from the Chinese government, while the policy implementation needs further strengthening.
Acquired Immunodeficiency Syndrome ; psychology ; Adolescent ; Beijing ; Cross-Sectional Studies ; Female ; HIV Infections ; psychology ; Health Education ; statistics & numerical data ; Health Knowledge, Attitudes, Practice ; Health Policy ; Humans ; Male ; Universities ; statistics & numerical data ; Young Adult

BACKGROUND: The study aimed to explore whether sugary beverage consumption is a key mediator of late chronotype, sleep duration, and weight increase in college students in China. METHODS: The cross-sectional study was conducted in four universities using a sample of 800 undergraduate students recruited by cluster sampling. A self-reported questionnaire was given out to collect information, including the characteristic of social demography, state of physical exercise and sugary beverage intake, the types of chronotype, and psychological conditions. Then, two structural equation models (SEMs) were constructed to test the mediating effect of sugary beverage consumption. RESULTS: The significant indirect effect of sugary beverage consumption was found between chronotype and BMI (effect = - 0.03, SE = 0.01, 95% CI [- 0.05, - 0.02]) and between sleep duration and BMI (effect = - 0.12, SE = 0.05, 95% CI [- 0.16, - 0.09]). In addition, physical exercise and psychological condition also play mediating effects between chronotype and BMI (effect = - 0.04, SE = 0.01, 95% CI [- 0.06, - 0.01] and effect = - 0.03, SE = 0.02, 95% CI [- 0.05, - 0.01]), but their mediating effect was not found between sleep duration and BMI. CONCLUSION Preventive measures should be taken to decrease student's sugary beverage consumption, improve physical exercise, and increase individual well-being to avoid the harmful effects of eveningness. Moreover, the issue of short sleep duration among college students may be further investigated in future research.
Adolescent ; Adult ; Beverages ; statistics & numerical data ; Body Weight ; China ; Circadian Rhythm ; Cross-Sectional Studies ; Feeding Behavior ; Female ; Humans ; Male ; Sleep ; Students ; statistics & numerical data ; Sugars ; analysis ; Universities

INTRODUCTION: Postgraduate medical education in Singapore underwent a major transition recently, from a British-style system and accreditation to a competency-based residency programme modelled after the American system. We aimed to identify the relative importance of factors influencing the choice of sponsoring institution (SI) for residency among medical students during this transition period. METHODS: A questionnaire-based cross-sectional study of Singapore undergraduate medical students across all years of study was performed in 2011. Participants rated the degree of importance of 45 factors (including research, academia and education, marketing, reputation of faculty, working conditions, posting experience and influence by peers/seniors) to their choice of SIs on a five-point Likert scale. Differences in gender and seniority were compared. RESULTS: 705 out of 1,274 students completed the survey (response rate 55.3%). The top five influencing factors were guidance by mentor (4.48 ± 0.74), reputation for good teaching (4.46 ± 0.76), personal overall experience in SI (4.41 ± 0.88), quality of mentorship and supervision (4.41 ± 0.75), and quality and quantity of teaching (4.37 ± 0.78). The five lowest-rated factors were social networking (2.91 ± 1.00), SI security (3.01 ± 1.07), open house impact (3.15 ± 0.96), advertising paraphernalia (3.17 ± 0.95) and research publications (3.21 ± 1.00). Female students attributed more importance to security and a positive working environment. Preclinical students rated research and marketing aspects more highly, while clinical students valued a positive working environment more. CONCLUSION Quality of education, mentorship, experiences during clerkship and a positive working environment were the most important factors influencing the choice of SI.
Accreditation ; Cross-Sectional Studies ; Curriculum ; Education, Medical, Graduate ; economics ; organization & administration ; Education, Medical, Undergraduate ; economics ; organization & administration ; Female ; Humans ; Internship and Residency ; Male ; Mentors ; Models, Organizational ; Schools, Medical ; Singapore ; Students, Medical ; statistics & numerical data ; Surveys and Questionnaires ; United States ; Universities

PURPOSE: The purpose of this study was to survey the current state of measles vaccination in university nursing students during a measles outbreak and to identify factors influencing nursing students' vaccination rate. METHODS: In 2014, this study used a self-administered questionnaire to survey 380 university nursing students. Factors influencing measles vaccination were identified through logistic regression analysis using variables between the vaccinated and nonvaccinated groups. RESULTS: Measles vaccination rate was 52.1%. The vaccination rate was significantly higher in juniors, seniors, and those who had heard about measles. In relation to health beliefs, the measles vaccination rate was higher when perceived benefits were high and perceived barriers were low. CONCLUSIONS: A systematic measles vaccination program targeting nursing students upon their entry to university is needed. In order to increase the measles vaccination rate, application of effective promotion campaigns and education programs is necessary.
Adult ; Disease Outbreaks/*prevention & control ; Female ; *Health Knowledge, Attitudes, Practice ; Humans ; Immunization Programs/*statistics & numerical data ; Male ; Measles/*prevention & control ; Republic of Korea ; Students, Nursing/*psychology ; Surveys and Questionnaires ; Universities ; Vaccination/*psychology ; Young Adult

INTRODUCTIONAlthough cosmetic procedures have become increasingly popular among the younger population in recent years, limited research on this subject has been done in the Asian context. We aimed to explore the views and knowledge regarding cosmetic procedures among junior college (JC) and medical students in Singapore.

METHODSIn the first phase of the study, a cross-sectional, self-administered survey of 1,500 JC students aged 16-21 years from six JCs was conducted in 2010. The same survey was then conducted on a random sample of Year 2-5 medical students from an undergraduate medical school in 2011.

RESULTSIn total, 1,164 JC and 241 medical students responded to the surveys. There was an overall female to male ratio of 1.3:1. Of all the respondents, 2.5% of the JC students and 3.0% of the medical students admitted to having undergone cosmetic procedures. Among those who claimed to have never had cosmetic procedures done, 9.0% and 44.0% of the JC and medical students, respectively, responded that they would consider such procedures in the future. Those who disapproved of their peers undergoing cosmetic surgery comprised 35.0% of JC students and 56.8% of medical students. Among the JC and medical students, 52.0% and 36.1%, respectively, were unaware of any risks associated with cosmetic procedures.

CONCLUSIONThe younger population is increasingly accepting of cosmetic procedures. However, there is a general lack of understanding of the risks associated with such procedures. Education of both the general public and medical students may help prevent potential medicolegal issues.

Adolescent ; Adult ; Asian Continental Ancestry Group ; Attitude to Health ; Cross-Sectional Studies ; Female ; Humans ; Male ; Singapore ; Students ; statistics & numerical data ; Students, Medical ; statistics & numerical data ; Surgery, Plastic ; utilization ; Universities ; Young Adult

OBJECTIVETo investigate the annual effective doses from indoor radon received by academic staff in the Faculty building.

METHODSMeasurements of indoor radon concentrations were performed in the Arts and Sciences Faculty of Dokuz Eylül University for two surveys of about 1 month duration respectively using the SSNTD (Solid State Nuclear Track Detectors) method with LR115 detectors. Time integrated measurements comprised different locations inside the faculty building: classrooms, toilets, canteen and offices. Homes of academic staff were also tested for radon.

RESULTSThe arithmetic mean radon concentration is 161 Bq m-3 with a range between 40 and 335 Bq m-3 in the Faculty. Six offices and three classrooms have a radon concentration above 200 Bq m-3. The results show that the radon concentration in classrooms is generally higher than in offices. Based on the measured indoor radon data, the annual effective doses received by staff in the Faculty were estimated to range from 0.79 to 4.27 mSv, according to UNSCEAR methodology. The annual effective doses received by staff ranged from 0.78 to 4.20 mSv in homes. On average, the Faculty contributed 56% to the annual effective dose.

CONCLUSIONReported values for radon concentrations and corresponding doses are within the ICRP recommended limits for workplaces.

Air Pollution, Indoor ; analysis ; Environmental Monitoring ; Faculty ; Housing ; statistics & numerical data ; Humans ; Radiation Dosage ; Radon ; analysis ; Risk Assessment ; Turkey ; Universities ; statistics & numerical data

OBJECTIVE: To investigate the prevalence status and the influential factors for smokers of undergraduates in Huaihua. METHODS: The undergraduates from different grades and different professions in Huaihua were selected randomly and investigated using a self-developed questionnaire. The influential factors for smokers of students were analyzed using a Chi-square test and a logistic regression. RESULTS: A total of 1 050 undergraduates were surveyed in our study. Among them, 973 were valid. The rate for students with a habit of smoking was 21.17%. 53.7% of smokers began to smoke at the stage of primary and high schools. The main reason for smoking was due to curious (47.1%) or depressive (45.2%). The male students were more likely to smoke than female students (OR=6.730). The attitudes of parents on smoking, such as no intervention, were important risk factors that affect the children's behavior on smoking (OR=1.866). CONCLUSION The periods in primary and high school are the most possible time for student to begin smoking. The curiosity and depression are the most risk factors, and the gender and family education are also the important factors that affect the behavior of undergraduates on smoking.
China ; epidemiology ; Female ; Humans ; Logistic Models ; Male ; Parents ; Prevalence ; Risk Factors ; Smoking ; epidemiology ; Students ; statistics & numerical data ; Surveys and Questionnaires ; Universities