Risk Management and Healthcare Policy最新文献

{"title":"Associated Factors of Pre-Anesthesia Blood Pressure Elevation in Elective Non-Cardiac Surgical Patients: A Case-Control Study Comparing Two Diagnostic Thresholds.","authors":"Xiao-Min Li, Yan Yang, Hao Pan, Wang Li, Ge-Yi Ai, Xi-Jiang Liu, Guang-Fen Zhang, Jie Guo","doi":"10.2147/RMHP.S612564","DOIUrl":"10.2147/RMHP.S612564","url":null,"abstract":"<p><strong>Background: </strong>Pre-anesthesia blood pressure (BP) elevation frequently occurs in normotensive elective surgical patients and may disrupt perioperative safety. This study adopted two mainstream diagnostic criteria (absolute and relative thresholds) to define BP elevation, and integrated physical, laboratory and psychological indicators to systematically explore relevant associated factors.</p><p><strong>Methods: </strong>This case-control study enrolling a total of 528 non-cardiac surgical patients. Patients were divided into case (elevated pre-anesthesia BP) and control (normal pre-anesthesia BP) groups. Pre-anesthesia BP elevation was defined as absolute threshold (systolic BP [SBP] ≥140 mmHg and/or diastolic BP [DBP] ≥90 mmHg), and relative threshold (≥20% increase from baseline). Multivariable logistic regression was used to screen associated factors.</p><p><strong>Results: </strong>The incidence of pre-anesthesia BP elevation was 35.6% (n=188) under the absolute threshold and 28.2% (n=149) under the relative threshold. Multivariable analysis revealed that increasing age (absolute threshold: odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10, relative threshold: OR 1.03, 95% CI 1.01-1.04), hyperlipemia (absolute threshold: OR 2.66, 95% CI 1.84-3.86, relative threshold: OR 1.49, 95% CI 1.18-1.88) and anxiety (absolute threshold: OR 1.17, 95% CI 1.10-1.25, relative threshold: OR 1.07, 95% CI 1.02-1.13) were correlated with BP elevation under both definitions (all p < 0.01). Under the absolute threshold, body mass index (BMI) (OR 1.12, 95% CI 1.03-1.21) and alcohol drinking (OR 2.74, 95% CI 1.55-4.84) were positively correlated (both p < 0.01), whereas prolonged sleep duration (2-4 hours: OR 0.37, 95% CI 0.15-0.95, 4-6 hours: OR 0.14, 95% CI 0.06-0.35, 6-8 hours: OR 0.12, 95% CI 0.04-0.34) was negatively correlated (all p < 0.05).</p><p><strong>Conclusion: </strong>Increasing age, hyperlipemia and preoperative anxiety are consistently associated with transient pre-anesthesia BP elevation under both criteria. Further studies are required to confirm causal links and verify whether intervening on these correlates can reduce perioperative BP fluctuations.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"612564"},"PeriodicalIF":2.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Electronic Prescription Circulation Under Employee Medical Insurance Outpatient Coordination: Evidence from a Pilot City in China.","authors":"Yilun Peng, Yangyang Zheng, Chaoqun Wang, Wenyuan Yang, Qiuyue Li, Zhonghu Xiao, Jiahao Yang","doi":"10.2147/RMHP.S614621","DOIUrl":"10.2147/RMHP.S614621","url":null,"abstract":"<p><strong>Objective: </strong>To examine and analyze the barrier factors influencing prescription circulation in Xiangyang City under the outpatient coordination policy and to provide reference evidence for promoting prescription circulation.</p><p><strong>Methods: </strong>To assess the practical implementation of prescription circulation under the outpatient coordination policy in retail pharmacy, a targeted questionnaire survey was administered to clinicians from medical institutions at all levels in Xiangyang City. Chi-square tests and structural equation modeling were employed to systematically identify key implementation challenges and to explore the underlying causes within the current electronic prescription circulation process.</p><p><strong>Results: </strong>The findings indicated that clinicians in Xiangyang City possessed a high level of awareness regarding electronic prescription circulation policies. However, the actual circulation rate remained low, and circulation willingness was generally neutral to conservative. Professional title and degree of policy understanding were identified as significant factors influencing circulation willingness. Structural equation modeling further demonstrated that policy incentives and regulatory constraints indirectly affected clinicians' willingness through multiple mediating pathways, including system functional deficiencies and patient cognitive biases.</p><p><strong>Conclusion: </strong>Clinicians in Xiangyang City exhibited high awareness of electronic prescription circulation policies, yet actual circulation rates remained limited, accompanied by neutral to conservative willingness. Complicated system procedures, ambiguous delineation of authority and responsibilities, and insufficient incentive mechanisms constituted the primary barriers to implementation. Policy familiarity and patient misperceptions were confirmed as critical factors influencing clinicians' willingness to participate in prescription circulation.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"614621"},"PeriodicalIF":2.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a Life Hope Program on Self-Care Ability and Hope Levels in Hemodialysis Patients: A Randomized Controlled Trial.","authors":"Qingqing Jia, Zhenglingxue Wang, Fang Li, Lingzhi Shi","doi":"10.2147/RMHP.S620418","DOIUrl":"10.2147/RMHP.S620418","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether the Life Hope Program, when added to routine nursing care, improves self-care ability (primary outcome) and hope levels (co-primary outcome), as well as psychological well-being, nutritional status, quality of life, and complication rates in uremic patients receiving hemodialysis.</p><p><strong>Methods: </strong>In this randomized controlled trial, 120 uremic hemodialysis patients were assigned to either routine care (control, n=60) or routine care plus a 3-month Life Hope Program (study, n=60). The program integrated goal-setting, psychological support, behavioral and nutritional guidance, cognitive restructuring, and social support. The co-primary endpoints were the Exercise of Self-Care Agency Scale (ESCA) and the Herth Hope Index (HHI). Secondary outcomes included depression (SDS), anxiety (SAS), fatigue (PFS), quality of life (WHOQOL-BREF), nutritional biomarkers (hemoglobin, prealbumin, albumin, transferrin), and complications. Baseline-adjusted analysis of covariance (ANCOVA) was used as the primary analytical method, with adjusted mean differences, 95% confidence intervals (CIs) and Cohen's d effect sizes reported. Bonferroni correction was applied for the two co-primary endpoints to control family-wise Type I error; secondary endpoints are reported with nominal P values and interpreted as exploratory.</p><p><strong>Results: </strong>All 120 participants completed the study with no dropouts or missing data. At 3 months, the study group showed significantly greater improvement in ESCA (adjusted mean difference 16.4, 95% CI 11.3-21.5, Cohen's d = 1.16, large effect) and HHI (adjusted mean difference 5.7, 95% CI 3.8-7.6, Cohen's d = 1.09, large effect) compared to controls (both P<0.001, below the Bonferroni-corrected threshold of α = 0.025). Significant between-group differences favoring the study group were also observed for SDS (d=1.13), SAS (d=1.28), PFS (d=0.92), and all WHOQOL-BREF domains (all nominal P<0.001; all remained significant after FDR correction). Nutritional biomarkers improved more in the study group (all nominal P<0.01; all remained significant after FDR correction), and risks of vascular access infection (RR 0.12, 95% CI 0.02-0.96), constipation (RR 0.44, 95% CI 0.21-0.94), and dyspepsia (RR 0.45, 95% CI 0.24-0.87) were lower, while urinary tract infection rates did not differ significantly.</p><p><strong>Conclusion: </strong>The Life Hope Program was associated with significant improvements in self-care ability, hope, psychological well-being, and nutritional status in hemodialysis patients, alongside reductions in fatigue and certain complications. Given the multi-component nature of the intervention, the single-blind design, and the 3-month follow-up period, these promising findings warrant confirmation in attention-controlled trials with longer-term assessment.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"620418"},"PeriodicalIF":2.6,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incentive Configuration Pathways for Standardization of Cancer Multidisciplinary Teams in China: A Fuzzy-Set Qualitative Comparative Analysis.","authors":"Yiqing Mao, Linru Jie, Bowen Zhang, Dingding Kang, Jiawen Xiao, Hongwei Pang","doi":"10.2147/RMHP.S618402","DOIUrl":"10.2147/RMHP.S618402","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the current implementation of incentive means and schemes in cancer multidisciplinary teams (MDTs) in China, and identified configuration pathways that affect the standardization level of MDT implementation.</p><p><strong>Methods: </strong>A questionnaire was constructed drawing upon practical experience with the implementation of MDT and relational incentives theory. A total of 1,332 MDT members were selected to participate in the survey. The fuzzy-set qualitative comparative analysis (fsQCA) was used to explore the non-linear and synergistic influence pathways of different incentive means and schemes combinations on the standardization level of cancer MDT implementation.</p><p><strong>Results: </strong>Two pathways of incentive means leading to high standardization were identified: a comprehensive pathway characterized by performance rewards, autonomy, and interpersonal relationships, and an intrinsically driven pathway relying on learning/development, autonomy, and interpersonal relationships. Four pathways of incentive schemes were found, categorized into procedure‑standardized scenarios (with efficiency of performance distribution and performance evaluation standards as core) and result‑oriented scenarios (with level of performance distribution, method of distribution, and perceived team fairness as core).</p><p><strong>Conclusion: </strong>The configuration pathways of incentive means indicate a substitutive effect among factors. Practitioners can flexibly emphasize specific elements based on local resources and stages, and this flexibility has policy implications for hospital governance. The pathways for incentive schemes reveal population applicability differences, so schemes should be tailored to diverse needs, enhance implementation, and prevent ineffectiveness, guiding policy makers in designing flexible regulations.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"618402"},"PeriodicalIF":2.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13426491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Management of Large Language Model-Based Exercise and Health Guidance: A China-Anchored, Comparatively Informed Six-Dimensional Trigger Matrix and Lifecycle Governance Framework for the Wellness-to-SaMD Continuum.","authors":"Kaijiang Pan, Xinyu Lin, Shengqi Huang, Caihua Huang","doi":"10.2147/RMHP.S624615","DOIUrl":"10.2147/RMHP.S624615","url":null,"abstract":"<p><p>LLM-based exercise and health guidance creates a distinctive risk-management challenge: seemingly modest changes in product claims, target users, data inputs, personalization, automation, human oversight, or updates may move a tool from general wellness support toward higher-risk medical use. In exercise prescription and rehabilitation, an unsafe recommendation can affect physical load, recognition of warning symptoms, and timely referral. We conducted a structured narrative review and doctrinal/comparative legal analysis, anchored in China's National Medical Products Administration (NMPA) framework and informed by the European Union Medical Device Regulation (MDR), the EU Artificial Intelligence Act, and US Food and Drug Administration (FDA) and International Medical Device Regulators Forum (IMDRF) materials. Peer-reviewed literature was primarily searched for 2019-2026, with foundational regulatory, legal, and technical guidance included where directly relevant. We propose a six-dimensional trigger matrix covering intended use and claims, user context, depth of personalization, data and sensor sources, automation, human oversight and closed-loop control, and upgrade and change pathways. The framework includes anchored Green/Yellow/Red coding rules, non-compensatory aggregation rules, a structured governance checklist, and a lifecycle pathway for evidence generation, risk management, and change control. In a preliminary application exercise, three independent raters applied the coding rules to seven standardized hypothetical scenarios and achieved complete agreement on all dimension-level and overall designations (Fleiss' kappa = 1.00). This small exercise supports initial reproducibility of the rubric but does not establish legal classification accuracy, clinical validity, or real-world effectiveness. The proposed framework is intended to support earlier risk identification, evidence planning, procurement review, and dialogue among developers, healthcare institutions, and regulators; it does not replace product-specific legal analysis or regulatory determination.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"624615"},"PeriodicalIF":2.6,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tivozanib versus Sorafenib as Subsequent-Line Therapy for Advanced Renal Cell Carcinoma: A Cost-Effectiveness Analysis from a US Healthcare Perspective.","authors":"Xiaoyu Zhang, Ruming Liu, Yani Hu, Jiaxi Ye, Mingdong Yang, Junjun Xu, Houci Yang, Xiaomin Yang, Zhiheng Xu, Haibin Dai, Huimin Xu","doi":"10.2147/RMHP.S617441","DOIUrl":"10.2147/RMHP.S617441","url":null,"abstract":"<p><strong>Purpose: </strong>The incidence of advanced renal cell carcinoma (aRCC) continues to rise in the United States. While first-line combinations of immune checkpoint inhibitors and tyrosine kinase inhibitors have improved outcomes, most patients eventually require subsequent-line therapy. The Phase III TIVO-3 trial demonstrated that tivozanib significantly prolongs progression-free survival (PFS) compared to sorafenib in relapsed or refractory aRCC, though without overall survival advantage. However, its economic value remains unestablished. This study aimed to evaluate the cost-effectiveness of tivozanib versus sorafenib from a US healthcare perspective.</p><p><strong>Patients and methods: </strong>A Partitioned Survival Model was developed using TreeAge Pro 2022 to simulate clinical outcomes over a 10-year lifetime horizon. Survival data were reconstructed from TIVO-3 trial Kaplan-Meier curves and extrapolated using standard parametric distributions. The model incorporated direct medical costs, including drug acquisition, monitoring, adverse event management, and terminal care. Health utilities were sourced from published literature. Costs and quality-adjusted life years (QALYs) were discounted at 3% annually. Sensitivity and scenario analyses were performed to assess model robustness.</p><p><strong>Results: </strong>In the base-case analysis, tivozanib yielded 1.65 QALYs at a cost of $634,441.98, compared to 1.61 QALYs and $438,239.46 for sorafenib, corresponding to an incremental QALY gain of 0.04. The incremental cost-effectiveness ratio (ICER) was $4,865,127.00 per QALY, substantially exceeding the $150,000 per QALY threshold. Probabilistic sensitivity analysis indicated that tivozanib was unlikely to be cost-effective at current pricing. Scenario analysis revealed that tivozanib only achieves cost-effectiveness if its acquisition cost is reduced by more than 49%.</p><p><strong>Conclusion: </strong>Despite superior PFS, tivozanib is unlikely to be a cost-effective subsequent-line therapy for aRCC compared to sorafenib at its current US market price. The high ICER is primarily driven by substantial drug costs relative to modest incremental health gains. Substantial price reductions are necessary to improve its value proposition within the US healthcare system.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"617441"},"PeriodicalIF":2.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Predictive Screening Model for Congenital Heart Disease in High-Altitude Children.","authors":"Xulin Hu, Yangyan Liu, Bo Li","doi":"10.2147/RMHP.S586432","DOIUrl":"10.2147/RMHP.S586432","url":null,"abstract":"<p><strong>Background and purpose: </strong>Current congenital heart disease (CHD) screening protocols adopt plain-standard criteria, yet they predispose to missed diagnoses and misdiagnoses in high-altitude hypoxic environments. This study aimed to develop and validate a predictive model for early CHD screening in plateau-region school-aged children and to evaluate the cost-effectiveness of different screening strategies.</p><p><strong>Methods: </strong>Cross-sectional data from 7315 school-age children undergoing initial school screening in high-altitude areas were analyzed using R 4.2.0 and SPSS 26.0. A logistic regression model predicting CHD detection rate was built via stepwise selection. Model performance was assessed through decision curve analysis (DCA), calibration curves, and ROC analysis. Variable importance was visualized via random forest plots. Cost-effectiveness of three screening strategies was evaluated using a Markov model.</p><p><strong>Results: </strong>Logistic regression model identified drug use (OR=4.368) and respiratory infections (OR=5.795) were independently associated with CHD diagnosis, followed by age (OR=0.680) and smoking (OR=1.476). The model showed excellent discrimination (AUC=0.867). Random forest analysis confirmed respiratory tract infections as the significant associated factor. Cost-effectiveness analysis identified the three-tier screening model as dominant, offering the lowest cost (¥2604) and highest health benefit (0.060 QALYs), with the favorable incremental cost-utility ratio. Single-stage diagnosis was the least cost-effective (¥15,400).</p><p><strong>Conclusion: </strong>The three-tier screening strategy, prioritizing children with maternal history of drug use or smoking exposure, younger age, and history of respiratory tract infections, shows a promising cost-effective approach for early CHD detection in high-altitude settings.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"586432"},"PeriodicalIF":2.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Internal Validation of an Explainable Machine Learning Model for Compassion Fatigue Risk Stratification Among Clinical Nurses in China.","authors":"Meng Chen, Chengcheng Che","doi":"10.2147/RMHP.S617883","DOIUrl":"10.2147/RMHP.S617883","url":null,"abstract":"<p><strong>Background: </strong>Compassion fatigue (CF) is a significant occupational challenge among nurses and is associated with adverse workforce and patient-care outcomes. In China's demanding healthcare system, identifying nurses at elevated risk of CF may help inform targeted support strategies. This study aimed to develop and internally validate an explainable machine learning (ML)-based model for CF risk stratification among clinical nurses.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 969 clinical nurses in Liaoning Province, China. CF status was classified using established Professional Quality of Life Scale questionnaire cutoff criteria. A hybrid approach combining the Boruta algorithm and Least Absolute Shrinkage and Selection Operator regression was employed. Eight ML algorithms were developed and compared. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, recall, and F1-score. Shapley Additive exPlanations (SHAP) analysis was used to interpret the optimal model and quantify the contribution of important risk factors.</p><p><strong>Results: </strong>Based on questionnaire-defined criteria, 56.2% of participants were classified as having elevated CF symptoms. Among the evaluated algorithms, the Naïve Bayes (NB) model demonstrated the best overall performance, achieving an AUC of 0.924 (95% confidence interval [CI]: 0.894-0.954) in the testing set. It also showed favorable calibration and potential net benefit. SHAP analysis indicated that social support, work engagement, and mindfulness were important protective factors, whereas exposure to workplace violence, frequent night shifts, prolonged daily working hours, and department assignment were important risk factors associated with elevated CF symptom classification.</p><p><strong>Conclusion: </strong>The NB-based model demonstrated strong discrimination and interpretability for stratifying nurses at elevated risk of CF within this study population. The findings highlight potentially modifiable factors associated with elevated CF symptoms and may support targeted occupational health strategies. External and prospective validation studies are still needed before broader implementation in clinical or administrative settings.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"617883"},"PeriodicalIF":2.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Public Health Approaches to Crisis Response: Putting People First.","authors":"Susannah H Mayhew, Alhaji U N'jai, Luisa Enria","doi":"10.2147/RMHP.S607706","DOIUrl":"10.2147/RMHP.S607706","url":null,"abstract":"<p><p>This commentary is written by the co-editors of the Collection entitled \"Rethinking Public Health Approaches to Crisis Response: Putting People First\". Specifically, in the call for submissions, we welcomed articles that detailed the actions, experiences, models, and mechanisms of involvement of community members and local knowledge in response to any clearly defined public health crisis, as a manifestation of how health systems are \"putting people first\". This commentary is a reflection on the seven papers eventually accepted for that Collection. The papers cover diverse settings, from South Korea and Saudi Arabia to sub-Saharan Africa and a variety of conflict settings. Collectively, these papers show a continuing gap in scholarship that convincingly progresses our thinking on approaches to achieve a people-centred public health crisis response. Nonetheless, the papers identify specific examples of local actions, including generating community trust for preventative actions and experiential learning in emergency care, showing how community involvement influences government legitimacy, intervention feasibility and societal recovery. Two papers present critical challenges for us: to build trust at the grass-roots level and to use health as a peacebuilding tool. These papers extend our understanding of the epidemic response beyond the conventional global health security paradigms and underscore the importance of shifting to a new paradigm that is people-centred and peace-led as the best way to protect future generations and their health. At a time of huge funding cuts to global health and development, and shifting political commitments to international solidarity, local citizen-led action to re-imagine health and well-being beyond security and national interest becomes simultaneously more challenging and crucial than ever before.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"607706"},"PeriodicalIF":2.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13388371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convergence-Related Visual Symptoms Across Occupations with Varying Near Visual Demands: A Cross-Sectional Study with Implications for Healthcare Policy.","authors":"Saeed Aljohani","doi":"10.2147/RMHP.S618271","DOIUrl":"10.2147/RMHP.S618271","url":null,"abstract":"<p><strong>Purpose: </strong>Convergence insufficiency (CI) is a common binocular vision disorder associated with visual discomfort during near tasks, yet occupational differences in convergence-related symptoms remain poorly understood. Therefore, this study aimed to compare convergence-related symptom burden across eight occupational categories using the validated Arabic Convergence Insufficiency Symptom Survey (CISS) and to identify which occupational groups show the greatest symptom burden.</p><p><strong>Methods: </strong>In this cross-sectional survey, adults aged 18 years or older from the Qassim region of Saudi Arabia completed the validated Arabic CISS. Participants represented eight occupational categories. Individuals with high refractive error or dry eye disease were excluded. Symptomatic status was defined as CISS ≥21. Differences in prevalence across occupations were assessed using chi-square tests. Multivariable logistic regression identified predictors after adjustment for age and gender.</p><p><strong>Results: </strong>A total of 751 participants were included (mean age 28.9 ± 9.1 years; 56.3% male). The overall mean CISS score was 16.9 ± 10.7, and 268 participants (35.7%) met the symptomatic threshold. Although unadjusted prevalence did not differ significantly across occupations (χ²(7)= 7.63, p= 0.367), adjusted analysis showed higher odds of symptomatic CISS among technology professionals (OR 2.16, 95% CI 1.16-4.02, p= 0.015), engineers (OR 2.11, 95% CI 1.13-3.91, p= 0.018), and students (OR 2.03, 95% CI 1.08-3.81, p= 0.029) compared with health professionals. Increasing age was associated with symptomatic status (OR 1.04 per year, p< 0.001), whereas gender was not significant (p= 0.158).</p><p><strong>Conclusion: </strong>Convergence-related symptoms are common in working-age adults and show occupational variation after adjustment for demographic factors. Occupations with sustained near visual demands may warrant targeted vision screening and clinical evaluation for convergence insufficiency, supporting the integration of visual health into occupational health policies and preventive healthcare strategies.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"618271"},"PeriodicalIF":2.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}