面向疫情危机的城市公共卫生系统韧性

为有效应对城市公共卫生危机,公共卫生系统韧性至关重要。以武汉新冠肺炎(COVID-19)疫情防控成功经验为例,运用扎根理论分析政府、社区、医疗机构、媒体、非政府组织在COVID-19疫情防控中的观念与行为,解析出反映系统韧性特征的疾病监测体系、防疫资源管理、合作治理能力等10个主范畴及对应的52个子范畴,由此将系统韧性细分为功能韧性、过程韧性和整体韧性。运用解释结构模型(ISM)构建提升公共卫生系统韧性的层次结构模型,揭示多元社会主体通过前述韧性要素集合:社会防疫基础、防疫科技与文化、疫情风险综合治理的层级递进应急准备,实现城市公共卫生系统韧性提升目标。     

The impact of the COVID-19 pandemic on the safety management in Italian Seveso industries

The paper discusses the impact of the COVID-19 pandemic on the Italian chemical and process industries, where Directive 2012/18/EU Seveso III, for the control of Major Accident Hazard (MAH), is enforced. The Safety Management System (SMS) for the control of MAH, which has been mandatory for 20 years in Italian Seveso Establishments, has been highly stressed by the external pressure, related in some way to the COVID-19 pandemic. Fairly, most companies, in particular in oil and gas sectors, have demonstrated an adequate capability to reconcile operation continuity and health requirements. This experience is providing the establishment operators and the regulators with valuable suggestions for the improvements of the SMS-MAH. Within this framework, an innovative organisational resilience model is proposed, aiming at the development of a higher capability to face future new crisis. The current SMS-MAH already includes some basic pillars to enhance resilience, which were valuable during the pandemic crisis, but a full and rationale development is still needed. Starting from the first pandemic phase experience, this paper presents a novel tool to assess the degree of “resilience” of a SMS-MAH. It is based on a questionnaire, featuring 25 questions grouped into eight items, according to the typical SMS-MAH structure. A two level AHP model has been developed in order to define the weights to be assigned to each point. The AHP panel included industrial practitioners, regulators, authorities and researchers. The results are based on the COVID-19 experience and consequently the developed model is tailored to face health emergencies, but the approach may be easily transferred to other external crises.     

COVID-19 and individual performance in global virtual teams: The role of self-regulation and individual cultural value orientations

Since the onset of the COVID-19 pandemic, global virtual teams (GVTs) have become increasingly important. Drawing on conservation of resources theory and self-regulation theory, we examined the mechanism and process underlying individuals' performance in GVTs in this specific situation. We posit that the local severity of the pandemic has a negative effect on individuals' performance in GVTs and that self-regulation functions as a coping mechanism in times of pandemic-related ambient stress, reducing its negative effect on performance. We suggest that three cultural value orientations, that is, uncertainty avoidance, collectivism, and long-term orientation, explain different levels of self-regulation, which in turn moderates the relationship between the local severity of the pandemic and individual performance in GVTs. Based on a sample of 2727 individuals from 31 countries participating in an international business consulting project during the early stage of the unfolding pandemic, we show that (a) the local severity of the pandemic had a negative effect on individuals' performance, (b) the negative effect of the pandemic on performance is weaker for individuals with high self-regulation, and (c) uncertainty avoidance and long-term orientation are positively associated with self-regulation, which mediates the moderating relationship between the cultural value orientations and the relationship between the COVID-19 pandemic and individual performance in GVTs.     

The direct cost burden of 13 years of disabling workplace injuries in the U.S. (1998–2010): Findings from the Liberty Mutual Workplace Safety Index

Introduction: Although occupational injuries are among the leading causes of death and disability around the world, the burden due to occupational injuries has historically been under-recognized, obscuring the need to address a major public health problem. Methods: We established the Liberty Mutual Workplace Safety Index (LMWSI) to provide a reliable annual metric of the leading causes of the most serious workplace injuries in the United States based on direct workers compensation (WC) costs. Results: More than $600 billion in direct WC costs were spent on the most disabling compensable non-fatal injuries and illnesses in the United States from 1998 to 2010. The burden in 2010 remained similar to the burden in 1998 in real terms. The categories of overexertion ($13.6B, 2010) and fall on same level ($8.6B, 2010) were consistently ranked 1st and 2nd. Practical application: The LMWSI was created to establish the relative burdens of events leading to work-related injury so they could be better recognized and prioritized. Such a ranking might be used to develop research goals and interventions to reduce the burden of workplace injury in the United States.     

CDC's research portfolio in older adult fall prevention: a review of progress, 1985-2005, and future research directions

PROBLEM: Falls are a leading cause of mortality and morbidity among adults age 65 and older. Population models predict steep increases in the 65 and older population bands in the next 10-15 years and in turn, public health is bracing for increased fall rates and the strain they place on health care systems and society. To assess progress in fall prevention, the Centers for Disease Control and Prevention conducted a research portfolio review to examine the quality, relevance, outcomes and successes of the CDC fall prevention program and its impact on public health. METHODS: A peer review panel was charged with reviewing 20 years of funded research and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis for extramural and intramural research activities. Information was collected from grantees (via a survey instrument), staff were interviewed, and progress reports and products were reviewed and analyzed. RESULTS: CDC has invested over $24,900,000 in fall-related research and programs over 20 years. The portfolio has had positive impacts on research, policies and programs, increasing the public health injury prevention workforce, and delivering effective fall prevention programs. DISCUSSION: Public health agencies, practitioners, and policy makers recognize that while there are some evidence-based older adult fall prevention interventions available, many remain unused or are infeasible to implement. Specific recommendations across the public health model, include: additional research in gathering robust epidemiologic data on trends and patterns of fall-related injuries at all levels; researching risk factors by setting or sub-population; developing and testing innovative interventions; and engaging in translation and dissemination research on best practices to increase uptake and adoption of fall prevention strategies. CDC has responded to a number of suggestions from the portfolio review including: funding translation research of a proven Tai Chi fall intervention; beginning to address gaps in gender, ethnic, and racial differences in falls; and collaborating with partner organizations who share in CDC's mission to improve public health by preventing falls and reducing fall-related injuries. IMPACT ON INDUSTRY: Industry has an opportunity to develop more accessible and usable devices to reduce injury from falls (for example, hip protectors and force reducing flooring). By implementing effective, evidence-based interventions to prevent falls and reduce injuries from falls, significant decreases in health care costs can be expected.     

A graduate level course: Teaching stress management skills to occupational health physicians and practitioners

The WHO Study Group on Training and Evaluation in Occupational Medicine has recently emphasized the importance of incorporating theoretical and practical aspects of stress prevention and management in the professional training of occupational health practitioners. Such a course was developed for the Tel-Aviv University Medical School graduate program in occupational health. The course objectives are consistent with the current call for improved training in psychosocial issues in medical care. Twenty-three occupational health practitioners (physicians, nurses, hygienists and social workers) participated in a bi-semester course. The first part included a stress management and prevention program based on the RET (Rational-Emotive Training) model. The second involved developing and implementing a field project on primary and secondary prevention of stress and its outcomes. Pre-, mid-and post-course questionnaires showed significantly improved psychosocial ability and reduced irrational/dysfunctional thinking, considered a causal factor in stress and burnout. Acquiring such anti-stress resources may benefit practitioners and clients/patients, both potential victims of occupational stress alike. We recommend the inclusion of such extended courses to the professional training of occupational health practitioners.     

基于社会燃烧理论的突发公共卫生事件网络情绪传播模型

为有效引导和管控突发公共卫生事件网络舆情,考虑社会相关性和网络群体间情绪状态转移的不确定性,基于社会燃烧理论研究突发公共卫生事件网络情绪传播机制.首先基于社会燃烧理论分析网络用户群体的社会影响因素,建立未燃-阴燃-燃烧-抑燃-稳定(UDBFS)网络情绪传播模型和考虑干预措施的网络情绪传播模型;然后以新冠肺炎(COVID...     

Traumatic brain injury mortality among U.S. children and adolescents ages 0–19 years, 1999–2017

IntroductionTo examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0–19 years by sex, age, urbanicity, state, and intent/causes of injury. Method: TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models. Results: Age-adjusted TBI mortality among Americans aged 0–19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = −4.8%, 95%CI: −6.3%, −3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15–19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10–14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15–19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states. Conclusions: Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10–19 years.     

Identifying the impact of the COVID-19 pandemic on driving behavior using naturalistic driving data and time series forecasting

Introduction: COVID-19 has disrupted daily life and societal flow globally since December 2019; it introduced measures such as lockdown and suspension of all non-essential movements. As a result, driving activity was also significantly affected. Still, to-date, a quantitative assessment of the effect of COVID-19 on driving behavior during the lockdown is yet to be provided. This gap forms the motivation for this paper, which aims at comparing observed values concerning three indicators (average speed, speeding, and harsh braking), with forecasts based on their corresponding observations before the lockdown in Greece. Method: Time series of the three indicators were extracted using a specially developed smartphone application and transmitted to a back-end platform between 01/01/2020 and 09/05/2020, a time period containing normal operations, COVID-19 spreading, and the full lockdown period in Greece. Based on the collected data, XGBoost was employed to identify the most influential COVID-19 indicators, and Seasonal AutoRegressive Integrated Moving Average (SARIMA) models were developed for obtaining forecasts on driving behavior. Results: Results revealed the intensity of the impact of COVID-19 on driving, especially on average speed, speeding, and harsh braking per 100 km. More specifically, speeds were found to increase by 2.27 km/h on average compared to the forecasted evolution, while harsh braking/100 km increased to almost 1.51 on average. On the bright side, road crashes in Greece were reduced by 49% during the months of COVID-19 compared to the non-COVID-19 period.     

新型冠状病毒肺炎疫情对城市建筑内电梯检验检测及设计的影响

新冠疫情是一个需要多学科、多行业、多部门协同配合,才能有效应对的重大公共健康挑战.本文简要介绍了新型冠状病毒(COVID-1 9)的疫情发展过程,解析了它的传播途径及防护级别分级,并依据国家市场监督管理总局的疫情防控期间电梯安全监管指导思想,重点分析了疫情对电梯检验检测的影响及对策,探索了电梯设计中防疫技术的开发,为当...     

The effects of primary prevention policies on mortality from motor-vehicle crashes among children in the United States

Introduction: Every year, 4500 children die in motor-vehicle crashes in the United States, with estimated costs of more than $40,000 and $240 billion in productivity losses. The majority of deaths and injuries are associated with improper use of restraint devices, alcohol, high speeds, and built environments. Methodology: This is a retrospective study using U.S. panel data from 1997 through 2005. Data sources included the Fatality Analysis Reporting System, the Insurance Institute for Highway Safety, the U.S. Census Bureau, the Atlas of Presidential Elections, and the U.S. Bureau of Labor Statistics. This study used conditional fixed effects negative binomial regression to analyze the effect of the covariates on mortality by state and year. Results: A total of 32,893 children died in motor-vehicle crashes (MVCs). States that allowed fines greater than $50 for lack of restraint use experienced significant reductions in mortality as well as states with laws allowing the use of red light cameras. Graduate licensing programs requiring a minimum age of 16 for the intermediate-level experienced mortality reductions as much as 90% compared with a minimum age of 14. Higher posted speeds were associated with higher mortality rates, particularly on local roads. Conclusion: This research focuses on the effects injury prevention laws have on mortality, but not on how effectively these laws are implemented and/or enforced. Results may be useful to policy-makers and public health practitioners involved in injury prevention and public health. Practical applications: Design appropriate education and training programs in road safety, implement effective road safety interventions and improve traffic safety legislation.     

Characteristics of ride share services for older adults in the United States

Introduction: Safe and accessible transportation options are important for older adults’ health, safety, mobility, and independence. Ride share services may promote older adult health and well-being. This is the first study that describes ride share services available to older adults (65+ years) in the United States, including factors that may affect use of services. Methods: We analyzed secondary data from two research and administrative databases provided by ITNAmerica, a national non-profit transportation service for older adults: ITNRides, which tracks information on older adults who used ITN in 29 locations across the United States from 1996 to 2019, and Rides in Sight, the largest national data source on ride share services for older adults. We conducted a literature review, and telephone interviews with nine key informants representing ride share services, referral services, and other organizations. We offer a conceptual framework describing factors that may affect older adults’ use of ride share services. Results: This study identified 917 non-profit ride share services and eleven for-profit ride share services available for older adults in the United States as of August 2018. Services varied by corporate structure, location, use of technology, and business model. The majority of non-profit services served primarily older adults, while the for-profit services served primarily younger adults. Riders from one multi-site non-profit service had a median age of 82. Use of ride share services is affected by individual needs and preferences; social conditions; and business and policy factors. Conclusion: Ride share services may offer a promising alternative to driving for older adults and may help to address negative health consequences associated with driving cessation. Practical applications: These findings may help policy makers, practitioners, and other stakeholders understand older adults’ needs related to use of ride share services in order to offer solutions that prioritize public health and safety.     

国内公共卫生安全研究的文献计量分析

为系统掌握国内公共卫生安全领域的研究现状和发展前沿,利用Citespace,Vosviewer,Gephi软件,从发文趋势、期刊分布、作者群落、研究机构、关键词等角度分析公共卫生安全领域研究态势.结果 表明:公共卫生安全领域研究呈现萌芽起步一缓慢发展一高度关注3个阶段;载文期刊主要集中在安全科学与医疗卫生领域;领域内核...     

Child passenger fatality: Child restraint system usage and contributing factors among the youngest passengers from 2011 to 2015

Objective: Motor-vehicle crashes (MVC) remain a leading cause of preventable injury and death for children aged 0–3 in the United States. Despite advancement in legislation and public awareness there is continued evidence of inappropriate child restraint system (CRS) use among the youngest passengers. The current study focuses on appropriate CRS use from 2011 to 2015 using data from the Fatality Analysis Reporting System (FARS) for children aged 0–3. Methods: Child-, driver-, vehicle-, and trip-related characteristics were investigated within a sample of 648 children from 625 crashes over 5-years in which a child aged 0–3 was fatally injured while unrestrained or wearing an identified CRS type. Multivariable log-binomial regression was used to obtain relative risk. Results: Only 48% of the fatally injured children were appropriately restrained in a CRS. Premature transition to a booster seat and seat belt was evident. The largest proportion of rear-facing restraint use was reported in < 1 year olds (40%), with less reported in 1 (11%) and 2 year olds (2%) and no usage in 3 year olds. Younger children were more likely to be in an appropriate CRS, while Black children, driver not restrained in a lap-shoulder belt configuration, and riding in a pickup truck were less likely to be restrained appropriately. Conclusions: Evidence of inappropriate CRS use supports the use of more stringent legislation and parental interventions to communicate best practice recommendations and educate caregivers regarding appropriate child restraint methods. Practical applications: Public health campaigns focused on increasing appropriate restraint use in children are of great importance as optimally restrained children are less likely to sustain injuries, or require crash-related hospitalization compared to unrestrained children. Researchers and practitioners may find these surveillance findings essential when developing education and interventions targeting child–parent dyads at the greatest risk for a MVC-related fatality.     

新冠疫情背景下建筑从业人员统计生命价值研究

为研究建筑职业风险和新冠疫情风险下的统计生命价值(VOSL),以成都市建筑从业者为对象采集数据,基于生存分析处理删失数据的特性,运用二分式条件价值法(CVM)和Kaplan-Meier法测算不同背景下的VOSL,运用COX回归对VOSL影响因素进行分析。研究结果表明：成都市建筑从业者在职业风险和新冠疫情风险下的VOSL分别为429.472,459.079万元,生命价值评估具有情境依赖性且存在“引导悖论”;2种风险背景下受访者学历、月收入及安全重视程度的提高均会增强支付意愿,而安全满意程度的提高则会降低支付意愿;职业风险下影响支付意愿的关键因素为安全设备保障满意程度、重视程度和学历,新冠疫情风险下影响支付意愿的关键因素为卫生安全重视程度、学历和月收入。     

When evidence is not enough: the challenge of implementing fall prevention strategies

Problem

As the evidence-based movement has advanced in public health, changes in public health practices have lagged far behind creating a science to service gap. For example, science has produced effective falls prevention interventions for older adults. It now is clearer WHAT needs to be done to reduce injury and death related to falls. However, issues have arisen regarding HOW to assure the full and effective uses of evidence-based programs in practice.

Summary

Lessons learned from the science and practice of implementation provide guidance for how to change practices by developing new competencies, how to change organizations to support evidence-based practices, and how to change public health systems to align system functions with desired practices. The combination of practice, organization, and system change likely will produce the public health benefits that are the promise of evidence-based falls prevention interventions.

Impact on public health

For the past several decades, the emphasis has been solely on evidence-based interventions. Public health will benefit from giving equal emphasis to evidence-based implementation.

Impact on Industry

We now have over two decades of research on the effectiveness of fall prevention interventions. The quality of this research is judged by a number of credible international organizations, including the Cochrane Collaboration (http://www.cochrane.org/), the American and British Geriatrics Societies, and the Campbell Collaboration (http://www.campbellcollaboration.org/). These international bodies were formed to ponder and answer questions related to the quality and relevance of research. These developments are a good first step. However, while knowing WHAT to do (an evidence-based intervention) is critical, we also need to know HOW to effectively implement the evidence. Implementation, organization change, and system change methods produce the conditions that allow and support the full and effective use of evidence-based interventions. It is time to focus on utilization of implementation knowledge in public health. Without this focus the vast amount on new evidence being generated on the prevention of falls and related injuries among older adults will have little impact on their health and safety.     

Aging without injury in the United States requires action today

Introduction: In 2017, unintentional injuries were the seventh leading cause of death among older adults (age ≥ 65), resulting in over 55,000 deaths. Falls accounted for more than half of these deaths. Given that older adults are the fastest growing age group in the United States, we can anticipate that injuries will become an even greater health concern in the near future. Methods: Aging without injury is possible. There are evidence-based strategies that can reduce falls. However, older adults may not realize that falls can be prevented or they may be afraid to admit their fear of falling or difficulty with walking as these issues may signal their inability to live independently. Results: In this commentary, we will highlight what the Centers for Disease Control and Prevention is doing to prevent older adult falls. We also highlight the importance of broadening older adults' awareness about falls to successfully empower them to begin contemplating and preparing to adopt fall prevention strategies that can help them age in place. Conclusions: Older adult falls are common and can result in severe injury and death but they can be prevented. Broadening older adults' awareness about falls can empower them to take the actions necessary to reduce their fall risk. Practical applications: Increasing awareness about falls can help older adults, healthcare providers, and local and state health departments take steps to reduce fall risk.     

How can process safety and a risk management approach guide pandemic risk management?

The coronavirus disease (COVID-19) brought the world to a halt in March 2020. Various prediction and risk management approaches are being explored worldwide for decision making. This work adopts an advanced mechanistic model and utilizes tools for process safety to propose a framework for risk management for the current pandemic. A parameter tweaking and an artificial neural network-based parameter learning model have been developed for effective forecasting of the dynamic risk. Monte Carlo simulation was used to capture the randomness of the model parameters. A comparative analysis of the proposed methodologies has been carried out by using the susceptible, exposed, infected, quarantined, recovered, deceased (SEIQRD) model. A SEIQRD model was developed for four distinct locations: Italy, Germany, Ontario, and British Columbia. The learning-based approach resulted in better outcomes among the models tested in the present study. The layer of protection analysis is a useful framework to analyze the effect of different safety measures. This framework is used in this work to study the effect of non-pharmaceutical interventions on pandemic risk. The risk profiles suggest that a stage-wise releasing scenario is the most suitable approach with negligible resurgence. The case study provides valuable insights to practitioners in both the health sector and the process industries to implement advanced strategies for risk assessment and management. Both sectors can benefit from each other by using the mathematical models and the management tools used in each, and, more importantly, the lessons learned from crises.