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Wen B, Kliengchuay W, Suwanmanee S, Aung HW, Sahanavin N, Siriratruengsuk W, Kawichai S, Tawatsupa B, Xu R, Li S, Guo Y, Tantrakarnapa K. Association of cause-specific hospital admissions with high and low temperatures in Thailand: a nationwide time series study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101058. [PMID: 38596004 PMCID: PMC11000193 DOI: 10.1016/j.lanwpc.2024.101058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Background Non-optimum temperatures are associated with a considerable mortality burden. However, evidence of temperature with all-cause and cause-specific hospital admissions in tropical countries like Thailand is still limited. Methods Daily all-cause and cause-specific hospital admissions for outpatient and inpatient visits were collected from 77 provinces in Thailand from January 2013 to August 2019. A two-stage time-series approach was applied to assess the association between non-optimum temperatures and hospital admission. We first fitted the province-specific temperature-morbidity association and then obtained the national association in the second stage using a random-effects meta-analysis regression. The attributable fraction (AF) of hospital admissions with 95% empirical confidence interval (eCI) was calculated. Findings A total of 878,513,460 all-cause outpatient admissions and 32,616,600 all-cause inpatient admissions were included in this study. We observed a J-shaped relationship with the risk of hospital admissions increasing for both cold and hot temperatures. The overall AFs of all-cause hospital admissions due to non-optimum temperatures were 7.57% (95% eCI: 6.47%, 8.39%) for outpatient visits and 6.17% (95% eCI: 4.88%, 7.20%) for inpatient visits. Hot temperatures were responsible for most of the AFs of hospital admissions, with 6.71% (95% eCI: 5.80%, 7.41%) for outpatient visits and 4.50% (95% eCI: 3.62%, 5.19%) for inpatient visits. The burden of hospital admissions was greater in females and in children and adolescents (0-19 years). The fractions of hospital admissions attributable to non-optimum temperatures exhibited variation among disease categories and geographical areas. Interpretation The results indicate that low and high temperature has a significant impact on hospital admissions, especially among the females, and children and adolescents (0-19 years). The current investigation could provide evidence for policymakers to develop adaptation strategies and mitigate the adverse effects of climate change on public health in Thailand and other tropical countries. Funding National Research Council of Thailand (NRCT): E-Asia Joint Research Program: Climate change impact on natural and human systems (N33A650979).
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Affiliation(s)
- Bo Wen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Wissanupong Kliengchuay
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Environment, Health and Social Impact Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - San Suwanmanee
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Htoo Wai Aung
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narut Sahanavin
- Faculty of Physical Education, Srinakharnwirot University, Nakhon Nayok, Thailand
| | | | - Sawaeng Kawichai
- Research Institute of Health Science, Chiang Mai University, Chiang Rai, Thailand
| | | | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Environment, Health and Social Impact Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Calderon Ramirez C, Farmer Y, Frolic A, Bravo G, Gaucher NO, Payot A, Opatrny L, Poirier D, Dahine J, L'Espérance A, Downar J, Tanuseputro P, Rousseau LM, Dumez V, Descôteaux A, Dallaire C, Laporte K, Bouthillier ME. What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? BMC Med Ethics 2024; 25:31. [PMID: 38504267 PMCID: PMC10949716 DOI: 10.1186/s12910-024-01030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario's protocols were presented to the public in a democratic deliberation during the summer of 2022. OBJECTIVES (1) To explore the perspectives of Quebec and Ontario citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. METHODS This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. RESULTS A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value - a less acceptable tiebreaker. CONCLUSION Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria.
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Affiliation(s)
- Claudia Calderon Ramirez
- Biomedical Sciences Program, Clinical Ethics, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry 2900 Bd Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Yanick Farmer
- Department of Social and Public Communication, Faculty of Communication, succursale Centre-Ville, Université du Québec à Montréal, Montréal, Québec, C.P 8888, H3C 3P8, Canada
| | - Andrea Frolic
- Program for Ethics and Care Ecologies (PEaCE), Hamilton Health Sciences - King West, P.O. Box 2000, Hamilton, ON, L8N 3Z5, Canada
| | - Gina Bravo
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 Bd de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Nathalie Orr Gaucher
- Research Centre of the Sainte-Justine University Hospital, 3175 Chem. de la Côte-Sainte- Catherine, Québec, Montreal, H3T 1C5, Canada
- Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Bd Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Antoine Payot
- Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Bd Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Lucie Opatrny
- Executive Office Administration, Faculty of Medicine, McGill University Health Centre, Site Glen 1001 boul. Décarie, Montréal, Québec, H4A 3J1, Canada
| | - Diane Poirier
- CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1, Canada
| | - Joseph Dahine
- Department of Medicine and Medical Specialties, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry 2900 boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Audrey L'Espérance
- École nationale d'administration publique (ENAP), 4750 Av. Henri-Julien, Montréal, Québec, H2T 2C8, Canada
| | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, 43 Rue Bruyere St. 268J, Ottawa, ON, K1N 5C8, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, 501 Smyth Rd, Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Louis-Martin Rousseau
- Faculty of Engineering, Montreal Polytechnic, Chem. de Polytechnique, Montréal, Québec, 2500, H3T 1J4, Canada
| | - Vincent Dumez
- Centre d'Excellence sur le Partenariat avec les Patients et le Public (CEPPP) CRCHUM -, Pavillon S 850, rue St-Denis, porte S03.900, Montréal, Québec, H2X 0A9, Canada
| | - Annie Descôteaux
- Bureau du Patient Partenaire, Faculté de médecine, Université de Montréal, Pavillon Roger- Gaudry 2900 boulevard Édouard-Montpetit, bureau R-815, Montréal, Québec, H3T 1J4, Canada
| | - Clara Dallaire
- Bureau du Patient Partenaire, Faculté de médecine, Université de Montréal, Pavillon Roger- Gaudry 2900 boulevard Édouard-Montpetit, bureau R-815, Montréal, Québec, H3T 1J4, Canada
| | - Karell Laporte
- Medical residency program, Faculty of Medicine, Université de Montréal, Pavillon Roger- Gaudry 2900 boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Marie-Eve Bouthillier
- Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Bd Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.
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Phua J, Kulkarni AP, Mizota T, Hashemian SMR, Lee WY, Permpikul C, Chittawatanarat K, Nitikaroon P, Arabi YM, Fang WF, Konkayev A, Hashmi M, Palo JE, Faruq MO, Shrestha BR, KC B, Mat Nor MBB, Sann KK, Ling L, Haniffa R, Al Bahrani M, Mendsaikhan N, Chan YH. Critical care bed capacity in Asian countries and regions before and during the COVID-19 pandemic: an observational study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:100982. [PMID: 38143717 PMCID: PMC10733690 DOI: 10.1016/j.lanwpc.2023.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of critical care. The aim of the current study was to compare the number of adult critical care beds in relation to population size in Asian countries and regions before (2017) and during (2022) the pandemic. Methods This observational study collected data closest to 2022 on critical care beds (intensive care units and intermediate care units) in 12 middle-income and 7 high-income economies (using the 2022-2023 World Bank classification), through a mix of methods including government sources, national critical care societies, personal contacts, and data extrapolation. Data were compared with a prior study from 2017 of the same countries and regions. Findings The cumulative number of critical care beds per 100,000 population increased from 3.0 in 2017 to 9.4 in 2022 (p = 0.003). The median figure for middle-income economies increased from 2.6 (interquartile range [IQR] 1.7-7.8) to 6.6 (IQR 2.2-13.3), and that for high-income economies increased from 11.4 (IQR 7.3-22.8) to 13.9 (IQR 10.7-21.7). Only 3 countries did not see a rise in bed capacity. Where data were available in 2022, 10.9% of critical care beds were in single rooms (median 5.0% in middle-income and 20.3% in high-income economies), and 5.3% had negative pressure (median 0.7% in middle-income and 18.5% in high-income economies). Interpretation Critical care bed capacity in the studied Asian countries and regions increased close to three-fold from 2017 to 2022. Much of this increase was attributed to middle-income economies, but substantial heterogeneity exists. Funding None.
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Affiliation(s)
- Jason Phua
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
| | - Atul Prabhakar Kulkarni
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Toshiyuki Mizota
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chairat Permpikul
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kaweesak Chittawatanarat
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Phongsak Nitikaroon
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
| | - Yaseen M. Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Aidos Konkayev
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Jose Emmanuel Palo
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
| | - Mohammad Omar Faruq
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
| | - Babu Raja Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Bijay KC
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | | | - Kyi Kyi Sann
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Maher Al Bahrani
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
| | - Naranpurev Mendsaikhan
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Asian Critical Care Clinical Trials (ACCCT) Group
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
- International Islamic University Malaysia Medical Centre, Kuantan, Malaysia
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
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Phattharapornjaroen P, Carlström E, Atiksawedparit P, Holmqvist LD, Pitidhammabhorn D, Sittichanbuncha Y, Khorram-Manesh A. The impact of the three-level collaboration exercise on collaboration and leadership during scenario-based hospital evacuation exercises using flexible surge capacity concept: a mixed method cross-sectional study. BMC Health Serv Res 2023; 23:862. [PMID: 37580718 PMCID: PMC10426132 DOI: 10.1186/s12913-023-09882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Hospitals play a crucial role in responding to disasters and public health emergencies. However, they are also vulnerable to threats such as fire or flooding and can fail to respond or evacuate adequately due to unpreparedness and lack of evacuation measures. The United Nations Office for Disaster Risk Reduction has emphasised the importance of partnerships and capacity building in disaster response. One effective way to improve and develop disaster response is through exercises that focus on collaboration and leadership. This study aimed to examine the effectiveness of using the 3-level collaboration (3LC) exercise in developing collaboration and leadership in districts in Thailand, using the concept of flexible surge capacity (FSC) and its collaborative tool during a hospital evacuation simulation. METHODS A mixed-method cross-sectional study was conducted with 40 participants recruited from disaster-response organisations and communities. The data from several scenario-based simulations were collected according to the collaborative elements (Command and control, Safety, Communication, Assessment, Triage, Treatment, Transport), in the disaster response education, "Major Incident Medical Management and Support" using self-evaluation survey pre- and post-exercises, and direct observation. RESULTS The 3LC exercise effectively facilitated participants to gain a mutual understanding of collaboration, leadership, and individual and organisational flexibility. The exercise also identified gaps in communication and the utilisation of available resources. Additionally, the importance of early community engagement was highlighted to build up a flexible surge capacity during hospital evacuation preparedness. CONCLUSIONS the 3LC exercise is valuable for improving leadership skills and multiagency collaboration by incorporating the collaborative factors of Flexible Surge Capacity concept in hospital evacuation preparedness.
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Affiliation(s)
- Phatthranit Phattharapornjaroen
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden.
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40100, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- USN School of Business, University of South-Eastern Norway, Kongsberg, 3603, Norway
| | - Pongsakorn Atiksawedparit
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, 10540, Thailand
| | - Lina Dahlén Holmqvist
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, 40530, Sweden
| | - Dhanesh Pitidhammabhorn
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, 10540, Thailand
| | - Yuwares Sittichanbuncha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Disaster Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
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Mahasing C, Kittikraisak W, Mott JA, Yoocharoen P, Piyaraj P, Tanathitikorn C, Punjasamanvong S, Wongrapee T, Suttha P, Rattanathumsakul T, Davis WW, Westercamp M, Chottanapund S. Changes in Personal Protective Equipment Usage Among Healthcare Personnel From the Beginning of Pandemic to Intra-COVID-19 Pandemic in Thailand. Ann Work Expo Health 2023:7147884. [PMID: 37129889 DOI: 10.1093/annweh/wxad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/06/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVES Personal protective equipment (PPE) use is associated with reduced risk of SARS-CoV-2 infection among healthcare personnel (HCP). There are limited data on the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on the PPE use of HCP. We describe the changes in PPE use from just before the widespread of community outbreaks ('pre-pandemic') to intra-pandemic time points, and examine factors associated with not changing in PPE use behavior among HCP in four Thai hospitals. METHODS We performed a retrospective cohort evaluation using two-time points: (i) February-March 2020 (pre-pandemic period); and (ii) January-March 2021 (intra-pandemic period). Self-reported frequency of appropriate PPE use was measured by a Likert scale. We used multivariable logistic regression to identify factors associated with no increase in self-reported PPE use. RESULTS Of 343 HCP, the proportion of participants reporting 'always' using PPE rose from 66% during the pre-pandemic period to 80% during the pandemic. Factors associated with HCP who did not increase in PPE use included having high baseline reported PPE, being a non-registered HCP (e.g. nurse assistants, dental assistants, porters), being male, and having a low perceived risk of becoming infected with any respiratory virus while working in the hospital. CONCLUSION PPE education, training, and risk communication content should target all cadres of HCP, regardless of registered/non-registered status, with a focus on behavior change for improved prevention and control of SARS-CoV-2 and other respiratory viruses in healthcare settings.
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Affiliation(s)
- Chayanit Mahasing
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand
| | - Joshua A Mott
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Georgia 30329, USA
| | - Pornsak Yoocharoen
- Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Phunlerd Piyaraj
- Parasitology Department, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | | | | | - Thanapat Wongrapee
- Internal Medicine Department, Phaholpolpayuhasena Hospital, Kanchanaburi 71000, Thailand
| | - Patama Suttha
- Internal Medicine Department, Bamrasnaradura Infectious Diseases Institute, Nonthaburi 11000, Thailand
| | - Thanit Rattanathumsakul
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - William W Davis
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Georgia 30329, USA
| | - Matthew Westercamp
- Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention, Georgia 30329, USA
| | - Suthat Chottanapund
- Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
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Wannachot W, Phukrongpet P, Rattanasuteerakul K, Daovisan H. “Even though we are elders living alone”: has social support reshaped the care of older adults during the COVID-19 pandemic? INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2023. [DOI: 10.1108/ijhrh-09-2022-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose
This study aims to explore how social support has reshaped the care of older adults living alone in northeast Thailand during the COVID-19 pandemic.
Design/methodology/approach
This study used a qualitative method using a narrative gerontological perspective with a descriptive design. Purposive sampling was conducted from 20 in-depth narrative interviews between November 2021 and February 2022 in Maha Sarakham province, northeast Thailand. Data transcriptions were performed using a narrative analytical process.
Findings
The in-depth narrative interviews indicated that older adults living alone during the coronavirus pandemic valued a comfortable life, a sense of place, favourable living arrangements, self-reliance, life goals and meaningful life. The gerontological analysis showed that social support for older adults living alone included a social safety net, networking, supporting needs, physical care and mental health responses to the COVID-19 pandemic.
Originality/value
To the best of the authors’ knowledge, this is the first qualitative narrative gerontological study to explore how social support reshaped the care of older adults living alone during the COVID-19 pandemic in northeast Thailand.
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Ramirez CC, Farmer Y, Bouthillier ME. Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review. DISCOVER HEALTH SYSTEMS 2023; 2:16. [PMID: 37206881 PMCID: PMC10169297 DOI: 10.1007/s44250-023-00027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/14/2023] [Indexed: 05/21/2023]
Abstract
Background To reduce the arbitrariness in the allocation of rare resources in intensive care units (ICU) in the context of the pandemic, tiebreakers were considered in some COVID-19 triage algorithms. They were also contemplated to facilitate the tragic decisions of healthcare workers when faced with two patients with similar prognosis and only one ICU bed available. Little is known about the public's perspective on tiebreakers. Objectives To consolidate the available scientific literature on public consultations, particularly on tiebreakers and their underlying values. Also, to obtain an overview of the key arguments presented by the participating public and to identify potential gaps related to this topic. Methods The steps described by Arksey and O'Malley was the preferred method to our approach. Seven electronic databases were searched from January 2020 to April 2022, using keywords for each database: PubMed, Medline, EMBASE, Web of Science, PsycINFO, EBM reviews, CINAHL complete. We also searched in Google and Google Scholar, and in the references of the articles found. Our analysis was mainly qualitative. A thematic analysis was performed to consider the public's perspectives on tiebreakers and their underlying values, according to these studies. Results Of 477 publications found, 20 were selected. They carried out public consultations through various methods: surveys (80%), interviews (20%), deliberative processes (15%) and others (5%) in various countries: Australia, Brazil, Canada, China, France, Germany, India, Iran, Italy, Japan, Korea, Netherlands, Portugal, Spain, Switzerland, Thailand, United Kingdom, and United States. Five themes emerged from our analysis. The public favored the life cycle (50%) and absolute age (45%) as a tiebreaker. Other values considered important were reciprocity, solidarity, equality, instrumental value, patient merit, efficiency, and stewardship. Among the new findings were a preference for patient nationality and those affected by COVID-19. Conclusions There is a preference for favoring younger patients over older patients when there is a tie between similar patients, with a slight tendency to favor intergenerational equity. Variability was found in the public's perspectives on tiebreakers and their values. This variability was related to socio-cultural and religious factors. More studies are needed to understand the public's perspective on tiebreakers. Supplementary Information The online version contains supplementary material available at 10.1007/s44250-023-00027-9.
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Affiliation(s)
- Claudia Calderon Ramirez
- Biomedical Sciences Program, Clinical Ethics, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Québec H3T 1J4 Canada
| | - Yanick Farmer
- Department of Social and Public Communication, Faculty of Communication, Université du Québec à Montréal, C.P 8888, Succursale Centre-Ville, Montréal, Québec H3C 3P8 Canada
| | - Marie-Eve Bouthillier
- Department of Family and Emergency Medicine and Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Québec H3T 1J4 Canada
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Wilasang C, Modchang C, Lincharoen T, Chadsuthi S. Estimation of Excess All-Cause Mortality Due to COVID-19 in Thailand. Trop Med Infect Dis 2022; 7:tropicalmed7070116. [PMID: 35878128 PMCID: PMC9322618 DOI: 10.3390/tropicalmed7070116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 01/27/2023] Open
Abstract
Thailand has experienced the most prominent COVID-19 outbreak in 2021, resulting in a new record for COVID-19 cases and deaths. To assess the influence of the COVID-19 outbreak on mortality, we estimated excess all-cause and pneumonia mortality in Thailand during the COVID-19 outbreak from April to October 2021. We used mortality from the previous 5 years to estimate the baseline number of deaths using generalized linear mixed models. The models were adjusted for seasonality and demographics. We found that, during the outbreak in 2021, there was a significant rise in excess fatalities, especially in the older age groups. The estimated cumulative excess death was 14.3% (95% CI: 8.6–18.8%) higher than the baseline. The results also showed that the excess deaths in males were higher than in females by approximately 26.3%. The excess deaths directly caused by the COVID-19 infections accounted for approximately 75.0% of the all-cause excess deaths. Furthermore, excess pneumonia deaths were also found to be 26.2% (95% CI: 4.8–46.0%) above baseline.
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Affiliation(s)
- Chaiwat Wilasang
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (C.W.); (C.M.); (T.L.)
| | - Charin Modchang
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (C.W.); (C.M.); (T.L.)
- Centre of Excellence in Mathematics, MHESI, Bangkok 10400, Thailand
- Thailand Center of Excellence in Physics, Ministry of Higher Education, Science, Research and Innovation, 328 Si Ayutthaya Road, Bangkok 10400, Thailand
| | - Thanchanok Lincharoen
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (C.W.); (C.M.); (T.L.)
| | - Sudarat Chadsuthi
- Department of Physics, Research Center for Academic Excellence in Applied Physics, Faculty of Science, Naresuan University, Phitsanulok 65000, Thailand
- Correspondence:
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9
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Purwadianto A, Sugiharto AF, Sari FA, Roberia, Cahyono U, Budiningsih Y, Alim DP, Faddila NU. Ethicomedicolegal aspects of the COVID-19 health services in preparing regulations and intermediaries for clinical dispute resolution: a systematic review. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.oa.225718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused many medical, ethical, and medicolegal changes, including constant adjustments in service guidelines. Continuing to revise healthcare regulations and guidelines can potentially cause clinical disputes or medical negligence that require ethical and legal solutions. This study aimed to determine the ethical and medicolegal aspects of the potential factors that cause clinical disputes during the pandemic and provide anticipative solutions to national ethicomedicolegal policies.
METHODS A systematic literature search in PubMed, ScienceDirect, ClinicalKey, and Google Scholar was performed using keywords “clinical dispute,” “ethics,” “medicolegal,” “ethicolegal,” and “COVID-19”. The inclusion criteria were articles that contained information on shortage, justice, ethical distribution in intensive care, the possibility of lawsuits and disputes among stakeholders during the pandemic, and stakeholders’ roles in managing the pandemic. Key evidence was analyzed and synthesized following national ethicomedicolegal policies.
RESULTS We identified 19 articles from the 4 databases. Based on the literature, the main ethicomedicolegal impact of the COVID-19 pandemic appears in 3 aspects: (1) a shortage of fair and ethical intensive care services with fair and ethical distribution efforts, (2) legal protection for medical personnel from legal charges while providing health services during the pandemic, and (3) the government’s role in managing the pandemic together with the stakeholders involved.
CONCLUSIONS Ethicomedicolegal clinical dispute management and its norms require an update, especially when deciding the complexity of COVID-19 service standards. Ethicomedicolegal professionals are needed as intermediaries to manage cases of clinical disputes and to implement fair malpractice criteria in Indonesia.
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Teerawattananon Y, Kc S, Chi YL, Dabak S, Kazibwe J, Clapham H, Lopez Hernandez C, Leung GM, Sharifi H, Habtemariam M, Blecher M, Nishtar S, Sarkar S, Wilson D, Chalkidou K, Gorgens M, Hutubessy R, Wibulpolprasert S. Recalibrating the notion of modelling for policymaking during pandemics. Epidemics 2022; 38:100552. [PMID: 35259693 PMCID: PMC8889889 DOI: 10.1016/j.epidem.2022.100552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 disease models have aided policymakers in low-and middle-income countries (LMICs) with many critical decisions. Many challenges remain surrounding their use, from inappropriate model selection and adoption, inadequate and untimely reporting of evidence, to the lack of iterative stakeholder engagement in policy formulation and deliberation. These issues can contribute to the misuse of models and hinder effective policy implementation. Without guidance on how to address such challenges, the true potential of such models may not be realised. The COVID-19 Multi-Model Comparison Collaboration (CMCC) was formed to address this gap. CMCC is a global collaboration between decision-makers from LMICs, modellers and researchers, and development partners. To understand the limitations of existing COVID-19 disease models (primarily from high income countries) and how they could be adequately support decision-making in LMICs, a desk review of modelling experience during the COVID-19 and past disease outbreaks, two online surveys, and regular online consultations were held among the collaborators. Three key recommendations from CMCC include: A ‘fitness-for-purpose’ flowchart, a tool that concurrently walks policymakers (or their advisors) and modellers through a model selection and development process. The flowchart is organised around the following: policy aims, modelling feasibility, model implementation, model reporting commitment. Holmdahl and Buckee (2020) A ‘reporting standards trajectory’, which includes three gradually increasing standard of reports, ‘minimum’, ‘acceptable’, and ‘ideal’, and seeks collaboration from funders, modellers, and decision-makers to enhance the quality of reports over time and accountability of researchers. Malla et al. (2018) A framework for “collaborative modelling for effective policy implementation and evaluation” which extends the definition of stakeholders to funders, ground-level implementers, public, and other researchers, and outlines how each can contribute to modelling. We advocate for standardisation of modelling processes and adoption of country-owned model through iterative stakeholder participation and discuss how they can enhance trust, accountability, and public ownership to decisions. COVID-19 models need appropriate adaptation to reflect contextual differences across settings. Upholding scientific standards is equally important as providing evidence for policymaking during pandemics. Wider stakeholder engagement with an iterative process for re-evaluating decisions is required for effective policy implementation.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | - Sarin Kc
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand.
| | - Y-Ling Chi
- Centre for Global Development Europe, Great Peter House, Abbey Gardens, Great College St, Westminster, London SW1P 3SE, UK
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Hannah Clapham
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | | | - Gabriel M Leung
- Li Ka Shing Faculty of Medicine (HKUMed), Hong Kong University, 21 Sassoon Rd, Pok Fu Lam, Hong Kong
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences (KMU), Kerman 7616911320, Iran
| | - Mahlet Habtemariam
- Africa Centres for Disease Control and Prevention, African Union Commission, Roosevelt Streeet, Addis Ababa, Ethiopia
| | - Mark Blecher
- National Treasury, 120 Plein Street, Cape Town, Republic of South Africa
| | - Sania Nishtar
- Poverty Alleviation and Social Safety Division, Government of Pakistan, Cabinet Secretariat, 4th Floor, Evacuee Trust Complex, F-5/1, Islamabad, Pakistan
| | - Swarup Sarkar
- Indian Council for Medical Research (ICMR), Government of India, V. Ramalingaswami Bhawan, P.O. Box No. 4911, Ansari Nagar, New Delhi 110029, India
| | - David Wilson
- Bill and Melinda Gates Foundation (BMGF), 500 5th Ave N, Seattle, WA 98109, USA
| | - Kalipso Chalkidou
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - Marelize Gorgens
- World Bank Group (WBG), 1818H Street, N.W., Washington, DC 20433, USA
| | - Raymond Hutubessy
- World Health Organisation (WHO), Avenue Appia 20, 1211 Geneva, Switzerland
| | - Suwit Wibulpolprasert
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Rd., Nonthaburi 11000, Thailand
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Tangcharoensathien V, Bassett MT, Meng Q, Mills A. Are overwhelmed health systems an inevitable consequence of covid-19? Experiences from China, Thailand, and New York State. BMJ 2021; 372:n83. [PMID: 33483336 PMCID: PMC8896039 DOI: 10.1136/bmj.n83] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Drawing on international experiences, Viroj Tangcharoensathien and colleagues argue that immediate extensive action to contain local transmission of new infectious diseases protects health systems from being overwhelmed
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Affiliation(s)
| | - Mary T Bassett
- Harvard University T H Chan School of Public Health, François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Boston, Massachusetts, United States
| | - Qingyue Meng
- Peking University School of Public Health, Beijing, China
| | - Anne Mills
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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