Optimizing preventive medicine to bridge the gap between clinical medicine and public health for disease control in China: A lesson from COVID-19

Respiratory Syncytial Virus (RSV) and Intention to Recommend RSV Vaccination: A Cross-Sectional Survey of Cardiologists and Cardiac Nurses in Southern Italy

As respiratory syncytial virus (RSV) vaccine distribution gains traction in Europe and Italy, healthcare workers (HCWs) can strategize about vaccine promotion to increase uptake among patients at risk of RSV consequences, such cardiac patients. This cross-sectional survey investigated the knowledge about and attitude towards RSV and RSV vaccines, and the intention to recommend vaccination within a cardiological hospital in Italy. To explore factors associated with the outcomes of interest, multivariate logistic regression analyses were conducted. Of 197 invited HCWs, 78.2% returned the survey. The knowledge about market authorisation for new RSV vaccines for older adults (present in 46.9% of respondents) was significantly associated with the HCWs' age, education, and previous update on vaccinations. HCWs with a higher educational level and those with a positive attitude towards RSV vaccines safety reported a higher attitude towards the importance of vaccinating people at risk. The willingness of recommending RSV vaccination to patients (70.5% of respondents) was more likely in HCWs who were knowledgeable about market authorisation for RSV vaccines and in physicians. This tempestive research sheds light on current factors influencing the strategies of cardiac HCWs regarding RSV vaccination. The results suggest the need for training events on the protective role of RSV vaccination in cardiac patients.

Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China

BACKGROUND

Public health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students' preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute.

METHODS

Based on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students' stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute.

RESULTS

A total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students' WTP for a job located in the county or city is much lower than that of urban students.

CONCLUSIONS

The heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.

A cross-sectional study on the response abilities of clinical and preventive medical students in public health emergency

Inconsistent training programs for public health emergency (PHE) have been criticized as a contributing factor in PHE's managerial weak points. In response, to analyze the relevant discrepancies among the medical students in the class of 2021 from Xiangya School of Medicine of Central South University, the present study conducted an online questionnaire survey using convenience sampling. The questionnaire comprised four sections, including the basic information, the subjective cognition in PHE, the rescue knowledge and capabilities of PHE, and the mastery of PHE regulations and psychological intervention abilities. To compare the abovementioned aspects, related data were collected from 235 medical students divided into two groups, namely, clinical medical students (Group A) and preventive medical students (Group B). We found a more positive attitude in PHE (P = 0.014) and a better grasp of the PHE classification (P = 0.027) and the reporting system in group B compared with group A. In addition, even if group B showed the same response capability in communicable diseases as group A, the former had less access to clinical practice, resulting in poorer performance in the noncommunicable diseases during a fire, flood, and traffic accidents (P = 0.002, P = 0.018, P = 0.002). The different emphasis of each training program contributed to the uneven distribution of abilities and cognition. Meanwhile, the lack of an integrated PHE curriculum led to unsystematic expertise. Hence, to optimize the PHE management system, equal attention should be paid to medical students with diverse majors along with a complete integrated PHE curriculum.

'You say you are a TB doctor, but actually, you do not have any power': health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China

BACKGROUND

In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into 'designated' public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB 'designated' hospitals in Zhejiang province, we explored factors influencing hospital-based health workers' motivation in the context of integrated TB service delivery.

METHODS

We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation.

RESULTS

Health workers tasked with TB care in 'designated' hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems.

CONCLUSIONS

Inadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.

Enhancing preventive medicine over curative medicine: Role of telemedicine

Historically, healthcare has been skewed towards curative medicine neglecting preventive care leading to high cases of preventable diseases and mortalities. Preventive medicine does not only contribute towards improving health and well-being (SDG3) but also reduces poverty (SDG1). This article aims to highlight the need for prioritizing preventive medicine over curative medicine and also explore opportunities of telemedicine in its promotion.

Using the PRAPARE Tool to Examine Those Tested and Testing Positive for COVID-19 at a Community Health Center

The PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences) tool is an instrument that has been used to assess social determinants of health within community health centers in the US. We sought to examine the association between PRAPARE scores and getting tested for and testing positive with the SARS-CoV-2 virus. We used medical record data collected from a community health center in the US between March-August 2020. Employing logistic regression analyzes, we explored the association between demographic factors, history of screening positive for depression, and PRAPARE scores and patients' odds of getting tested and testing positive for COVID-19. While variables such as ethnicity mirrored similar findings from other sources, we found the PRAPARE score to be associated with increased odds of being tested for COVID-19; however, it was not significantly associated with testing positive. These findings can help health care workers and health educators craft messages to explain screening protocols for communicable diseases, such as COVID-19, to best reach vulnerable populations.