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Introduction and Objective: Suicide is a major public health concern. Recently, suicide rates have increased among traditionally low-risk groups (e.g., white, middle-aged males). Suicide risk assessments and prevention strategies should be tailored to specific at-risk populations. This systematic review examines suicide risk detection and management in primary care, focusing on treatments to reduce suicide rates and improve prevention efforts. Methodology: A systematic review was conducted following PRISMA guidelines. Literature was collected and analyzed using Boolean operators with relevant keywords in databases (e.g., PubMed, Google Scholar, PsycINFO) to identify randomized and non-randomized studies focusing on suicide risk factors and management strategies in primary care, published in the past 10 years. The risk of bias 2.0 and Newcastle Ottawa scale was used to assess risk of bias, and data from moderate-quality studies were synthesized. Results: Thirteen moderate-quality studies were reviewed. Key findings include the need for assessing modifiable risk factors like substance use and mental health. General practitioner (GP) engagement post-suicide attempt (SA) improves outcomes and reduces repeat SAs. Effective strategies include comprehensive risk assessments, collaborative treatment, and enhanced GP support. Barriers to effective suicide prevention include insufficient information, judgmental communication, lack of positive therapeutic relationships, and inadequate holistic assessments. These findings highlight the need for tailored suicide prevention strategies in primary care. However, the evidence sample size is small with reduced statistical power that limits generalizability. The included studies were also regional examinations, which restrict their broader relevance. Discussion: Significant risk factors, barriers, and effective strategies for suicide prevention were identified. For children aged 12 or younger, preexisting psychiatric, developmental, or behavioral disorders, impulsive behaviors, aggressiveness, and significant stressful life events within the family were critical. For adults, loneliness, gaps in depression treatment, and social factors are significant. Barriers to suicide prevention included insufficient information, judgmental communication, lack of positive therapeutic relationships, inadequate holistic risk assessments, lack of individualized care, insufficient tangible support and resources, inconsistent follow-up procedures, variability in risk assessment, poor communication, stigma, and negative attitudes. Effective methods include the Postvention Assisting Bereaved by Suicide training program, continued education, comprehensive clinical assessments, individualized care, and community-based interventions like the SUPRANET program. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024550904.

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The increasing frequency of climate-related hazards poses a significant risk to supply chains and marine insurance companies, which are already grappling with complex and interdependent global operations. Through a survey, this research examines the perceptions of an international cohort of marine insurers regarding their organization's participation in the Supply Chain Risk Management (SCRM) framework for climate change. In addition, the influence of respondents' experience levels and the World Bank's country classifications by income level are investigated. A repeated measures analysis of variance (ANOVA) is conducted to examine the effect of the SCRM framework's steps on perception, revealing significant variations among the steps and identifying gaps for improvement. While experience levels do not significantly affect involvement in the SCRM framework, distinct patterns emerge within each experience group, highlighting nuanced risk management practices. Comparing perceptions across World Bank income level categories reveals that higher country income levels generally correlate with higher average perception scores, indicating a potential association with greater awareness and management of climate change risks. The research also highlights the need for comprehensive involvement in all steps of the SCRM framework. Addressing climate change and building resilient supply chains requires a multi-faceted approach that includes enhanced risk management practices, and to this end, the authors' present areas for future research.

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Land use types, land development and utilization intensity within watersheds have changed based on intensifying human activities and climate change, thereby inducing spatiotemporal variations in non-point source pollution (NPS), significantly impacting soil and water quality. This study performed a case study on an ecological environment functional zone at the northern foot of Qinling Mountains, an area strongly affected by human activities and land use changes. It employed an improved potential non-point pollution index (PNPI) model to analyze potential non-point source pollution (PNPS) and associated risk evolution characteristics in watershed over the past 30 years. The results indicate that from 1990 to 2020, the dominant land use categories were forest and arable land, making up 95 % of the entire watershed area. Notably, urban residential land presented the most significant expansion rates and nearly doubled in area between 1990 and 2020, whereas shrubland, grassland, and unused land showed a decreasing trend. With the application of the quantile classification method, PNPS risk values were divided into five categories: very low, low, moderate, high, and very high. A polarized trend in risk was observed, with increases in areas influenced by human activities and rapid expansion of very high-risk regions. Concurrently, the pollution risk in the upstream water source area decreased. In recent years, accelerated urbanization has been the main driver causing expansion of high PNPS risk regions. This study explores the spatial and temporal evolution of PNPS risk in the Heihe Basin by using an improved PNPI model. The improved model is more accurate in calculations and provides a better understanding of the distribution of PNPS, which is an important reference for watershed management and water resource governance.

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Background and Aims: Medication errors (MEs) are a significant source of preventable harm in patient care. Voluntary incident reporting and ME reporting systems are essential for managing medication safety. Analyzing aggregated ME reports instead of individual reports can reveal organizational risks. Organizational culture influences reporting activity and the effectiveness of safety improvements depends on their system-focus. This study uses aggregated ME reports to investigate the ME management process and reporting culture in medication safety. It aims to create a hierarchy for ME improvement actions and analyze their strength and management flow in aggregated reports. Methods: A retrospective, cross-sectional study was conducted to review improvement proposals and actions of ME reports in a Finnish tertiary hospital in 2017-2021. The improvement proposals and actions were categorized into strength classes during three stages: reporter proposals, manager proposals, and documented actions. The report management flow was analyzed. Descriptive statistics were used to describe the characteristics and the chi-squared test for categorical variables in the statistical analysis. Results: A new strength classification hierarchy was created with three classes and corresponding numerical values: "strong (3)," "medium (2)," and "weak (1)" Additionally, categories for "no action (0)" and "vague (0)" were included. Out of 5463 ME reports analyzed, improvement proposals and actions were predominantly weak, ranging from 23.4% to 54.2% across different stages of the management process. A significant proportion had no action included (20.5-49.1%) or were vague (4.2-20.6%). Conclusion: Analyzing the strength of improvement proposals and actions in aggregated ME reports provides new insights into reporting culture and the ME management. The new combined strength classification hierarchy is a suitable tool for this analysis.

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Efficient management of pollutant risks in water bodies is crucial for public health and aquatic ecosystem sustainability. However, the toxicities of pollutants, such as ammonia nitrogen (NH3-N), are often affected by multiple water quality factors, including the pH and water temperature. Extensive spatial and temporal variability in these factors hinders tailor-made management of risk. This study used high-frequency monitoring data collected over 1 year to evaluate the long-term NH3-N risk in China's aquatic ecosystems. High accuracy and interpretability were achieved by decomposing NH3-N risk into the contributions of key influencing factors using random forest models and Shapley Additive Explanations. Two distinct types of NH3-N risk hotspots were identified across 18 cities: 15 cities with high NH3-N concentrations and 3 cities with low environmental carrying capacity due to high pH levels or elevated water temperatures. For the former, rapid NH3-N abatement measures are necessary to bring NH3-N concentrations back below the environmental capacity. For the latter, it is recommended that NH3-N related industries are relocated to regions with high environmental capacities because fragile environments are not suitable for such industries. Importantly, this study investigated methods for attributing pollutant risks in the context of non-linear influencing factors, and the risk of NH3-N was predicted to increase by 6.1 % by the end of 2100 in the context of increasing temperatures under the SSP 2-4.5 scenario. The methodology is also adaptable and suitable for integration into global ecosystem risk management efforts to balance development and aquatic ecological sustainability.

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Background and purpose: Radiotherapy plans with excessive complexity exhibit higher uncertainties and worse patient-specific quality assurance (PSQA) results, while the workload of measurement-based PSQA can impact the efficiency of the radiotherapy workflow. Machine Learning (ML) and Lean Six Sigma, a process optimization method, were implemented to adopt a targeted PSQA approach, aiming to reduce workload, risk of failures, and monitor complexity. Materials and methods: Lean Six Sigma was applied using DMAIC (define, measure, analyze, improve, and control) steps. Ten complexity metrics were computed for 69,811 volumetric modulated arc therapy (VMAT) arcs from 28,612 plans delivered in our Institute (2013-2021). Outlier complexities were defined as >95th-percentile of the historical distributions, stratified by treatment. An ML model was trained to predict the gamma passing rate (GPR-3 %/1mm) of an arc given its complexity. A decision support system was developed to monitor the complexity and expected GPR. Plans at risk of PSQA failure, either extremely complex or with average GPR <90 %, were identified. The tool's impact was assessed after nine months of clinical use. Results: Among 1722 VMAT plans monitored prospectively, 29 (1.7 %) were found at risk of failure. Planners reacted by performing PSQA measurement and re-optimizing the plan. Occurrences of outlier complexities remained stable within 5 %. The expected GPR increased from a median of 97.4 % to 98.2 % (Mann-Whitney p < 0.05) due to plan re-optimization. Conclusions: ML and Lean Six Sigma have been implemented in clinical practice enabling a targeted measurement-based PSQA approach for plans at risk of failure to improve overall quality and patient safety.

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OBJECTIVE: This study aims to evaluate the effectiveness of the Quality Risk Management (QRM) system in hospital pharmacy intravenous admixture services (PIVAS). METHODS: Failure Modes and Effects Analysis (FMEA) and risk matrix methods were used to systematically assess the critical risk points in PIVAS. By collecting and comparing relevant data from 2019 to 2023, key performance indicators (KPIs) before and after the implementation of the QRM system were quantitatively evaluated. RESULTS: The results showed that the safety and efficiency of pharmacy services significantly improved after the implementation of the QRM system. The medication error rate significantly decreased from 3.2% to 1.1%, the average medication preparation time reduced from 15.5 min to 8.2 min, and staff satisfaction increased from 6.0 to 8.5 points. Other indicators, such as cross-contamination rates and handling errors, also showed significant improvement (all outcomes p < 0.001). DISCUSSION: Systematic risk management effectively enhanced the operational performance of PIVAS, reduced medication errors, and improved the quality of healthcare services. This study highlights the key role of QRM in enhancing medication safety and productivity, providing empirical support for the implementation of similar systems in other healthcare institutions.

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Accurate population data is crucial for assessing exposure in disaster risk assessments. In recent years, there has been a significant increase in the development of spatially gridded population datasets. Despite these datasets often using similar input data to derive population figures, notable differences arise when comparing them with direct ground-level observations. This study evaluates the precision and accuracy of flood exposure assessments using both known and generated gridded population datasets in Sweden. Specifically focusing on WorldPop and GHSPop, we compare these datasets against official national statistics at a 100 m grid cell resolution to assess their reliability in flood exposure analyses. Our objectives include quantifying the reliability of these datasets and examining the impact of data aggregation on estimated flood exposure across different administrative levels. The analysis reveals significant discrepancies in flood exposure estimates, underscoring the challenges associated with relying on generated gridded population data for precise flood risk assessments. Our findings emphasize the importance of careful dataset selection and highlight the potential for overestimation in flood risk analysis. This emphasises the critical need for validations against ground population data to ensure accurate flood risk management strategies.

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BACKGROUND: Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging. OBJECTIVE: This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women. METHODS: Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics. RESULTS: We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%). CONCLUSIONS: Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women.

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Previous research ignored the characteristics of environmental, social, and governance (ESG). ESG is soft information. Geographical proximity is important for external stakeholders to monitor firms' soft information. This study examines the impact of customer geographic proximity (CGP) on firms' ESG performance. We hand-collect data on the geographical distance of 29,111 pairs of Chinese A-share listed companies and their top-five customers from 2009 to 2022. First, we find that CGP promotes firms' ESG performance. The results still hold after considering the exogenous influence of the introduction of high-speed rail on CGP. Second, cross-sectional analysis shows that CGP exerts a more pronounced influence on firms with severe information asymmetry. Third, impact channel tests indicate that CGP promotes firms' ESG performance by increasing firms' cash flows. Fourth, the impact of CGP is more obvious when customers have stronger risk management motivation. Collectively, this study provides new insights into factors affecting firms' ESG performance.

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OBJECTIVE: To measure the 1 year cumulative incidence of and analyse the risk factors associated with workplace violence directed towards the ambulance service in a Swedish region. DESIGN: Prospective cohort study. SETTING: The ambulance services in Örebro County Council (Sweden) contain approximately 300 000 inhabitants. PARTICIPANTS: All ambulance missions during the period of 12 months (n=28 640) were assessed. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was workplace violence together with the associated risk factors. RESULTS: The 1 year cumulative incidence of workplace violence within the ambulance service was 0.7%. Non-physical violence was most common. There was an increased odds for violence when the patient was under the influence of alcohol or drugs or suffering from mental illness. There was an association between the dispatch categories intoxication, unconsciousness or mental health problems and workplace violence against ambulance personnel. The offenders were mostly men aged 18-29 and workplace violence was more likely to occur in public places. CONCLUSIONS: The 1 year cumulative incidence of workplace violence within the regional ambulance service was low in comparison to that of previous research. The overall regression model had low explanatory power, indicating that the phenomenon is complex and that additional variables need to be taken into account when trying to predict when workplace violence will occur. Additional research is needed to fully understand why workplace violence within the ambulance service occurs and how to mitigate such situations.

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INTRODUCTION: Australia's remote health sector has chronic understaffing issues and serves an isolated, culturally diverse population with a high burden of disease. Workplace health and safety (WHS) impacts the wellbeing and sustainability of the remote health workforce. Additionally, poor WHS contributes to burnout, high turnover of staff and reduced quality of care. The issue of poor WHS in Australian very remote primary health clinics was highlighted by the murder of remote area nurse (RAN) Gayle Woodford in 2016. Following her death, a national call for change led by peak bodies and Gayle's family resulted in the development of many WHS recommendations and strategies for the remote health sector. However, it is unclear whether they have been implemented. The aim of this study is to identify which WHS recommendations have been implemented, from the perspective of RANs. METHODS: A cross-sectional online survey of 173 RANs was conducted during December 2020 and January 2021. The survey was open to all RANs who had worked in a very remote (MM 7 of the Modified Monash (MM) Model) primary health clinic in Australia more recently than January 2019. A convenience sampling approach was used. The survey tool was developed by the project team using a combination of validated tools and remote-specific workplace safety recommendations. Broad recommendations, such as having a safe clinic building, safe staff accommodation, local orientation, and 'never alone' policy, were broken down into specific safety criteria. These criteria were used to generate workplace safety scores to quantify how well each recommendation had been met, and clustered into the following domains: preparation of staff, safe work environment and safe work practices. Descriptive statistics were used and the safety scores between different states and territories were also compared. RESULTS: Overall, the average national workplace safety score was 53% (standard deviation (SD) 19.8%) of recommendations met in participants' most recent workplace, with median 38.5% (interquartile range (IQR) 15.4-61.5%) of staff preparation recommendations, median 59.4% (IQR 43.8-78.1%) of safe work environment recommendations, and median 50.0% (IQR 30.0-66.7%) of safe work practices recommendations met. Within domains, some recommendations had greater uptake than others, and the safety scores of different states/territories also varied. Significant variation was found between the Northern Territory (57.5%, SD 18.7%) and Queensland (41.7%, SD 16.7%) (p<0.01), and between South Australia (74.5%, IQR 35.9%) and Queensland (p<0.05). Last, many RANs were still expected to attend after-hours call-outs on their own, with only 64.1% (n=107/167) of participants reporting a 'never alone' policy or process in their workplace. CONCLUSION: The evidence from this study revealed that some recommended safety strategies had been implemented, but significant gaps remained around staff preparation, fatigue management and infrastructure safety. Ongoing poor WHS likely contributes to the persistently high turnover of RANs, negatively affecting the quality and continuity of health care in remote communities. Variation in safety scores between regions warns of a fragmentation of approaches to WHS within the remote health sector, despite the almost identical WHS legislation in different states/territories. These gaps highlight the need to establish and enforce a national minimum standard of workplace safety in the remote health sector.

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Introduction: Neonatal sepsis, classified into early-onset and late-onset based on symptom timing, poses significant risks of morbidity and mortality, especially in low birth weight infants. Effective clinical risk management protocols are crucial in reducing these risks. Methods: This before-and-after study evaluated the impact of a newly implemented clinical risk management protocol in the Neonatology and Neonatal Intensive Care Unit (NICU) at Policlinico Hospital-University of Bari. The study included 399 neonates over three years, comparing pre- and post-protocol outcomes. Data collection focused on maternal and neonatal demographics, infection rates, and hospital stay lengths. Statistical analysis included t-tests, Wilcoxon-Mann-Whitney tests, and logistic regression models. Results: The study found no significant differences in neonatal pathologies or demographics between pre- and post-protocol groups. However, post-protocol implementation showed a notable reduction in umbilical venous catheter (UVC) infections (p = 0.018) and improved hospital stay lengths. Blood and urine cultures did not show significant changes in microbial patterns post-protocol. Discussion: The findings underscore the effectiveness of structured clinical risk management protocols in enhancing neonatal outcomes, particularly in reducing specific infection risks. Despite the study's limitations, including its observational nature and sample size, the results advocate for broader adoption and further research on these protocols in diverse healthcare settings. The positive outcomes highlight the importance of continuous clinical risk management efforts in high-risk neonatal environments.

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Waste is the materials left over after the processing of ores. Significant disasters involving waste disposal structures have occurred in Brazil in recent years and caused severe damage by contaminating soil, rivers and coastal areas, destroying native fauna and flora, interrupting the water supply and compromising its potability, putting the population's health, livelihoods and economy at risk, as well as causing 289 irreparable human deaths. Regulatory laws have become stricter, and since 2019, after the tailings dam tragedies occurred in 2015 and 2019 in Mariana and Brumadinho, in Minas Gerais, the operation of  upstream-raised tailings dams has been prohibited in Brazil. In 2022, a waste slide from a sterile pile at the Pau Branco Mine in Nova Lima promoted a dike overflow. There was the death of five people whose car was buried by a landslide on a hillside. New strategies and technologies, such as reprocessing and recycling, can be tested to ascertain whether they can help improve practices in tailings management. Indeed, mining companies' corporate responsibility and sustainability practices need to be evaluated to verify whether they better match expectations. On the other hand, more specific and detailed regulations and resolutions are required to ensure the safe monitoring and management of sterile waste piles. This paper presents a review of the facts, a discussion of the literature (mainly on recent tailings dam disasters), the current situation of mining-containing waste structures in Brazil, a brief sustainability analysis and perspectives aimed at preventing/minimising catastrophes in the future.

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Biomonitoring has been widely used in assessing exposures in both occupational and public health complementing chemical risk assessments because it measures the concentrations of chemical substances in human body fluids (e.g., urine and blood). Biomonitoring considers all routes and sources of exposure. An occupational biomonitoring guidance document has been elaborated (OECD Occupational Biomonitoring Guidance) within the OECD framework and specifically, the Working Parties on Exposure and Hazard Assessment by scientific experts from 40 institutes and organizations representing 15 countries. The guidance provides practical information for assessing chemical exposures in occupational settings including the three common routes of exposure: inhalation, skin absorption and ingestion due to hand to mouth contact. The elaborated stepwise approach for conducting biomonitoring is tailored for occupational health professionals, scientists, risk assessors, and regulators. It includes methods for selecting appropriate biomarkers, devising sampling strategies, and assessing laboratories for validated analytical methods for the biomarker of interest, and ensuring timely feedback of results. Furthermore, it describes procedures for setting up efficient biomonitoring programs based on the Similar Exposure Group (SEG) approaches. Derived health-based human exposure biomarker assessment values called Occupational Biomonitoring Levels (OBLs) are proposed for use in occupational exposure and risk assessment. It also helps with the interpretation of biomonitoring results routinely collected and procedures for communicating biomonitoring results at individual, collective, and workplace levels. Ethical considerations associated with biomonitoring are also discussed. The ultimate goal of this biomonitoring approach is to promote harmonized application and interpretation of biomarkers as well as evidence-based occupational risk management measures.

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OBJECTIVE: Few studies have examined the relationship between systemic oxidative stress and prostate cancer (PCa) risk. This study aimed to explore potential correlations between PCa and oxidative balance score (OBS), which measures systemic oxidative stress. DESIGN: A cross-sectional study. SETTING: The National Health and Nutrition Examination Survey. PARTICIPANTS: A total of 8156 individuals were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: Weighted logistic regression with multivariable adjustment and restricted cubic splines (RCS) were used to assess the correlation between PCa and OBS. A sensitivity analysis was conducted specifically on patients with PCa to verify the results. RESULTS: The prevalence of PCa was 2.55%. The multivariable logistic regression model revealed no correlation between OBS, dietary OBS, lifestyle OBS and PCa. Compared with the lowest quartile of OBS, the adjusted ORs for the highest quartile of OBS, dietary OBS and lifestyle OBS were 1.852 (95% CI 1.028-3.339), 1.565 (95% CI 0.841-2.913) and 1.575 (95% CI 0.915-2.710), respectively. Additionally, all p values for trend were greater than 0.05. Subgroup analysis revealed a consistent lack of association between OBS and PCa across various population settings. Furthermore, analysis using RCS confirmed this absence of association, indicating no significant relationship in either a linear or non-linear context. A sensitivity analysis focusing exclusively on patients with PCa showed a strong association (OR=2.737, p=0.008). CONCLUSION: This cross-sectional study reveals no significant association between systemic oxidative stress, measured by OBS, and PCa risk. Notably, a sensitivity analysis focusing solely on PCa patients suggested a potential link, warranting further investigation.

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Biological therapies have revolutionized medical treatment by targeting the key mediators or receptors involved in inflammatory responses, thereby effectively suppressing inflammation and achieving beneficial outcomes. They are more advanced than conventional therapies using corticosteroids and immunosuppressants, offering effective solutions for autoimmune diseases, cancer, transplant rejection, and various infectious diseases, including coronavirus disease 2019. Although they exert low immunosuppressive effects, biological therapies can reactivate specific biological targets associated with infections. This review summarizes the currently available biological therapies and discusses their immunosuppressive mechanisms and clinical applications, highlighting the variations in the types and frequencies of infection recurrence induced by different biological agents. Additionally, this review describes the risk factors associated with various biological agents, thus aiding clinicians in selecting the most appropriate biological therapy.

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Artificial intelligence (AI)-the field of computer science that designs machines to perform tasks that typically require human intelligence-has seen rapid advances in the development of foundation systems such as large language models. In the workplace, the adoption of AI technologies can result in a broad range of hazards and risks to workers, as illustrated by the recent growth in industrial robotics and algorithmic management. Sources of risk from deployment of AI technologies across society and in the workplace have led to numerous government and private sector guidelines that propose principles governing the design and use of trustworthy and ethical AI. As AI capabilities become integrated in devices, machines, and systems across industry sectors, employers, workers, and occupational safety and health practitioners will be challenged to manage AI risks to worker health, safety, and well-being. Five risk management options are presented as ways to assure that only trustworthy and ethical AI enables workplace devices, machinery, and processes. AI technologies will play a significant role in the future of work. The occupational safety and health practice and research communities need to ensure that the promise of these new AI technologies results in benefit, not harm, to workers.

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Patient safety reporting and learning systems (PSRLS) are tools to promote patient safety culture in healthcare organisations (HCO). Many PRSLS are locally developed. WHO Global Action Plan on Patient Safety 2021-2030 urges governments to deploy policies for healthcare risk management including PSRLS. The Ministry of Health of Catalonia (MHC) faced challenges in addressing quality and patient safety (Q&PS) issues due to disparate information systems. To address these challenges, the MHC developed a territorial PSRLS and embedded it in the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027 (QPSS Plan Cat). METHODS: Four-step process: (1) creation of a governance model, a web platform and reporting forms for a PSRLS in Catalonia (SNiSP Cat); (2) SNiSP Cat roll out; (3) embed SNiSP Cat information in the accreditation model for HCO and the PS scorecard; (4) Development of SNiSP Cat within the QPSS Plan Cat 2023-2027. RESULTS: The SNiSP Cat is in use by 63/64 acute care hospital (ACH), 376/376 primary healthcare teams (PCT) and 17/98 long-term care facilities (LTCF). 1335/109 273 professionals were trained. Until 2022, 127 051 incidents have been migrated and reported (2013-2022). The system has generated three comprehensive risk maps for HCO: one for ACH, including patients' falls, medication, clinical process and procedures; second for PCT, including clinical process and procedures, clinical administration and medication; and a third for LTCF, included patients' falls, medication, digital/analogical documentation. SNiSP Cat provided information to support 53 standards out of 1312 of the ACH accreditation model and 14 standards out of 379 of PCT one. Regarding the MHC patient safety scorecard, 14 indicators out of 147 of ACH and 4 out of 41 of PCT are supported by SNiSP Cat data. CONCLUSIONS: The availability of a territorial PSRLS (SNiSP Cat) allows MHC leads the Q&PS policy with direct information, risk maps and data support to the standards for the Catalan accreditation models and PS scorecard linked to incentivisation, turning the SNiSP Cat into a driven tool to implement the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027.

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Adverse events (AEs), and particularly adverse drug events (ADEs), represent a health problem as they can cause permanent damage or death. Understanding the frequency, location, and causes of ADEs can prevent harm to patients. The Global Trigger Tool, produced by the Institute for Healthcare Improvement (GTT/IHI), is widely used to identify AEs. Recognizing the profile of patients who suffer ADEs can reveal clinical or individual characteristics that predispose to the occurrence of AEs. A cross-sectional study was carried out through a retrospective analysis of 120 medical charts of patients discharged from hospital between October 2020 and April 2021. Patients over 18 years old, with a length of stay of more than 24 h, were included. The list of triggers used was from the medication module of the GTT/IHI, which was adapted for use in the institution. Two primary reviewers and a medical reviewer applied this tool. The primary reviewers independently assessed the randomized charts. A meeting to achieve consensus among the reviewers was held every 2 weeks to validate the identified ADEs; classifications were based on harm severity. Multivariate logistic regression was utilized to assess the variables that predicted the occurrence of ADEs, using the backward stepwise method. A total of 43 ADEs were identified, with a frequency of 36 per 100 admissions (43/120). Of these, five ADEs (12%) were responsible for patients being admitted to hospital. In the case of in-hospital ADEs, there were 42.2 per 1000 patients/day. The clinical manifestation of altered kidney function (16%) and the anatomical drug group of the nervous system (33%) were the most frequent ADEs. The multivariate logistic regression model was significant (×2 = 44.960, P < .001), indicating that factors such as: known drug allergy [odds ratio 5.728; 95% confidence interval (CI): 1.249, 26.274, P = .025]; being clinically hospitalized (odds ratio 7.504; 95% CI: 1.654, 34.037; P = .009); number of medicines used (odds ratio 1.100; 95% CI: 1.054, 1.148; P < .001); and being under the care of internal medicine (odds ratio 3.633; 95% CI: 1.257, 10.511; P = .017) were predictor variables associated with the occurrence of ADEs. A significant percentage of hospitalized patients experienced at least one ADE, with rates surpassing those found in similar studies. The GTT/IHI effectively assessed medication-related harm, emphasizing the need for tailored triggers based on population characteristics. Predictor variables can inform preventive strategies. Overall, the tool facilitated a localized risk assessment of medication use.

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