Medical students' AI literacy and attitudes towards AI: a cross-sectional two-center study using pre-validated assessment instruments.

BACKGROUND: Artificial intelligence (AI) is becoming increasingly important in healthcare. It is therefore crucial that today's medical students have certain basic AI skills that enable them to use AI applications successfully. These basic skills are often referred to as "AI literacy". Previous research projects that aimed to investigate medical students' AI literacy and attitudes towards AI have not used reliable and validated assessment instruments. METHODS: We used two validated self-assessment scales to measure AI literacy (31 Likert-type items) and attitudes towards AI (5 Likert-type items) at two German medical schools. The scales were distributed to the medical students through an online questionnaire. The final sample consisted of a total of 377 medical students. We conducted a confirmatory factor analysis and calculated the internal consistency of the scales to check whether the scales were sufficiently reliable to be used in our sample. In addition, we calculated t-tests to determine group differences and Pearson's and Kendall's correlation coefficients to examine associations between individual variables. RESULTS: The model fit and internal consistency of the scales were satisfactory. Within the concept of AI literacy, we found that medical students at both medical schools rated their technical understanding of AI significantly lower (MMS1 = 2.85 and MMS2 = 2.50) than their ability to critically appraise (MMS1 = 4.99 and MMS2 = 4.83) or practically use AI (MMS1 = 4.52 and MMS2 = 4.32), which reveals a discrepancy of skills. In addition, female medical students rated their overall AI literacy significantly lower than male medical students, t(217.96) = -3.65, p <.001. Students in both samples seemed to be more accepting of AI than fearful of the technology, t(745.42) = 11.72, p <.001. Furthermore, we discovered a strong positive correlation between AI literacy and positive attitudes towards AI and a weak negative correlation between AI literacy and negative attitudes. Finally, we found that prior AI education and interest in AI is positively correlated with medical students' AI literacy. CONCLUSIONS: Courses to increase the AI literacy of medical students should focus more on technical aspects. There also appears to be a correlation between AI literacy and attitudes towards AI, which should be considered when planning AI courses.

Health risk assessment and prevalence of work-related musculoskeletal disorders among the aged brick molders, in India.

The Brickfield Industry is the major and oldest informal industry in India, where millions of brickfield workers make their livelihood. Aged brickfield workers are also involved in different activities in the brickfield, especially in brick mold activities owing to poor socioeconomic conditions. A cross-sectional study was designed to determine the prevalence of work-related musculoskeletal disorders among the aged brick molders and compare them with aged control subjects. A Nordic Questionnaire was applied to assess the discomfort felt among both groups of workers and the Rapid Upper Limb Assessment (RULA) method was used to evaluate posture during their job. The RULA posture analysis showed that the posture adopted by aged brick molders required changes immediately. The result of the ART tool also stated that the brick molding activities' exposure level was high and required further investigation urgently. The study concluded that due to working in a forward bending posture for a prolonged period, aged brickmolders suffered from severe low back and knee pain along with upper-limb disorders due to repetitive activities.

Brazilian Scale for Evaluation of Mental Health Care Needs: Additional Evidence.

OBJECTIVE: To investigate validity evidence of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM). METHODS: This is a psychometric study, which seeks additional evidence of internal structure. Data collection was carried out in 11 Primary Health Care (PHC) services , which implement the Health Care Planning (HCP) methodology, distributed across the five Brazilian regions. The preliminary version of CuidaSM, containing a block self-referred by the user and another block evaluated by PHC professionals, was applied to users aged 18 or over who attended the PHC services for consultation with a higher education professional. The techniques of confirmatory factor analysis and network analysis were used to investigate validity evidence. For the primary data of the confirmatory factor analysis, the factorial loads and the item's predictive power (R2) were used. Six model adjustment indices were adopted and reliability was measured by three indicators using Bayesian estimation. RESULTS: A total of 879 users participated in the study. By confirmatory factor analysis, factorial loads ranged from 0.43 to 0.99 and R2 from 0.19 to 0.98. Both the primary indicators and the model adequacy indices were established at satisfactory and consistent levels. The network analysis showed that the items were appropriately associated with their peers, respecting the established dimensions, which again indicates the sustainability and stability of the proposed model. CONCLUSIONS: The study findings confirm a consistent and reliable model of the instrument, through a combination of techniques. Considering the importance of using solid instruments in clinical practice, CuidaSM is a promising tool for population-based management and network care organization, aligned with HCP proposals.

Dietary assessment and prevention of hypertension in Nigeria: Protocol for a retrospective cross-sectional study for the development and validation of a food frequency questionnaire for clinical use.

Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. With a transition from whole foods to processed foods in Nigeria, diet plays a key driver of hypertension. To combat this, the national nutritional guidelines in Nigeria were implemented, but their translation into actionable tools for clinicians remains a challenge. Currently, there are no simple dietary assessment tools that are concise and suitable to be incorporated into clinical care without requiring extensive data analysis while still providing personalised dietary support to their patients. This study aims to deliver a clinically tested and validated short dietary assessment tool for clinicians, patients, and researchers across Nigeria to provide personalised dietary advice for patients with hypertension. The study will be conducted in two phases: Phase 1 (n = 75) will investigate the feasibility of the short FFQ and its agreement with 24-hour dietary recalls (3x) in a clinical setting in Nigeria. During the analysis of Phase 1 data, a scoring system will be developed based on the associations between individual food items in the FFQ and measures of hypertension. Phase 2 (n = 50) will assess the acceptability of the FFQ and validate the association between the FFQ score and hypertension. Expected outcomes: The development of a clinically tested and validated short food frequency questionnaire that will be ready to use by clinicians, patients, and researchers across Nigeria to support the prevention and management of hypertension. This study will contribute to knowledge on dietary assessment and hypertension prevention by developing a validated and acceptable FFQ, which will be valuable for clinicians and researchers for personalised dietary recommendations to combat hypertension in Nigeria.

Assessment of breast cancer awareness among female pharmacy students at a university in Turkey.

BACKGROUND: Female breast cancer is the most frequently diagnosed cancer, and knowledge of breast cancer risk factors, and symptoms is crucial for early diagnosis and prevention. This study aims to evaluate breast cancer awareness among female students at a pharmacy faculty in Turkey. METHODS: A cross-sectional online survey study was conducted among female students at the Suleyman Demirel University Faculty of Pharmacy between 2 November and 17 November 2023, in Isparta, Turkey. RESULTS: This survey was answered by 237 (74.5%) female students. The median breast cancer risk factors score was 8 (IQR, 5-11), and the median breast cancer symptoms score was 5 (IQR, 2-8). Additionally, the breast cancer risk factors score was 46.16% (mean/max = 8.31/18, SD = 4.33) and the breast cancer symptom score was 58.5% (mean/max = 4.68/8, SD = 2.8). Few of the respondents (26.2%, and 20.3%, respectively) knew breast cancer risk factors such as late menopause, and no childbirth experience. Most respondents correctly answered symptoms of breast cancer, such as a painless and palpable breast lump, indrawing of the nipple, and sudden changes in breast shape (76.8%,44.3%, and 67.1% respectively). The students' sources of information were medical websites (29.5%), social media (27%), physicians (22.8%), friends & family (14.8%), and pharmacists (5.9%). CONCLUSIONS: This study showed that students' knowledge of breast cancer risk factors was poor, but their knowledge of breast cancer symptoms was acceptable. Breast cancer awareness courses should be included in faculties. Additionally, more attention should be given to different educational interventions such as social media, television, and brochure distribution.

Polish version of the COMQ-12 questionnaire, a new validated tool for the assessment of the quality of life in patients with chronic otitis media.

<b><br>Introduction:</b> The COMQ-12 questionnaire is a tool to assess the quality of life in patients with chronic otitis media in many countries. The questionnaire consists of 12 questions: seven relating to the severity of symptoms, two regarding the impact of the disease on lifestyle and work, two concerning the impact on the need for healthcare, and one is a general question. Each question is rated on a scale from 0 to 5.</br> <b><br>Aim:</b> To present the validation process and the final version of the Polish version of the COMQ-12 questionnaire.</br> <b><br>Material and methods:</b> The Polish version of the COMQ-12 questionnaire was prepared based on an independent translation of the English version by three physicians (two otolaryngology specialists and one physician in the process of specialization in otolaryngology). The questionnaire was validated in a study including 60 participants: 30 patients with chronic otitis media and 30 volunteers without a history of middle ear diseases or hearing disorders. Each participant was asked to complete the COMQ-12 questionnaire twice at an interval of 4 weeks apart. The internal consistency, reliability, and construct validity of the questionnaire were analyzed using Cronbach's alpha and McDonald's omega coefficients, Spearman's rho correlation coefficient, and the Mann-Whitney test, respectively.</br> <b><br>Results:</b> High internal consistency, reliability, and construct validity of the Polish version of the COMQ-12 questionnaire were shown in the course of statistical analysis. The overall internal consistency was 0.95 and 0.97 as assessed by Cronbach's alpha and McDonald's omega coefficients, respectively. Spearman's rho correlation coefficient was above 0.89 for each question. Statistically significant differences in the COMQ-12 total scores were obtained between patients with chronic otitis media and the control group.</br> <b><br>Conclusions:</b> The Polish version of the COMQ-12 questionnaire can be a valuable clinical tool for the assessment of the quality of life in patients suffering from chronic otitis media.</br>.

Household income and health-related quality of life in children receiving treatment for acute myeloid leukemia: Potential impact of selection bias in health equity research.

OBJECTIVE: Examine the influence of household income on health-related quality of life (HRQOL) among children with newly diagnosed acute myeloid leukemia (AML). DESIGN: Secondary analysis of data prospectively collected from pediatric patients receiving treatment for AML at 14 hospitals across the United States. EXPOSURE: Household income was self-reported on a demographic survey. The examined mediators included the acuity of presentation and treatment toxicity. OUTCOME: Caregiver proxy reported assessment of patient HRQOL from the Peds QL 4.0 survey. RESULT: Children with AML (n = 131) and caregivers were prospectively enrolled to complete PedsQL assessments. HRQOL scores were better for patients in the lowest versus highest income category (mean ± SD: 76.0 ± 14 household income <$25,000 vs. 59.9 ± 17 income ≥$75,000; adjusted mean difference: 11.2, 95% CI: 2.2-20.2). Seven percent of enrolled patients presented with high acuity (ICU-level care in the first 72 h), and 16% had high toxicity (any ICU-level care); there were no identifiable differences by income, refuting mediating roles in the association between income and HRQOL. Enrolled patients were less likely to be Black/African American (9.9% vs. 22.2%), more likely to be privately insured (50.4% vs. 40.7%), and more likely to have been treated on a clinical trial (26.7% vs. 18.5%) compared to eligible unenrolled patients not enrolled. Evaluations of potential selection bias on the association between income and HRQOL suggested differences in HRQOL may be smaller than observed or even in the opposing direction. CONCLUSIONS: While primary analyses suggested lower household income was associated with superior HRQOL, differential participation may have biased these results. Future studies should partner with patients/families to identify strategies for equitable participation in clinical research.

Variations and inequities in access to cardiac diagnostic services in Ontario Canada.

OBJECTIVES: Echocardiography is an essential diagnostic modality known to have wide regional utilization variations. This study's objectives were to quantify regional variations and to examine the extent to which they are explained by differences in population age, sex, cardiac disease prevalence (CDP), and social determinants of health (SDH) risk. METHODS: This is an observational study of all echocardiography exams performed in Ontario in 2019/20 (n = 695,622). We measured regional variations in echocardiography crude rates and progressively standardized rates for population age, sex, CDP, and SDH risk. RESULTS: After controlling for differences in population age, sex, and CDP, Ontario's highest rate regions had echocardiography rates 57% higher than its lowest rate regions. Forty eight percent of total variation was not explained by differences in age, sex, and CDP. CDP increased with SDH risk. Access to most cardiac diagnostics was negatively correlated with SDH risk, while cardiac catheterization rates were positively correlated with SDH risk. CONCLUSION: Variations analysis that adjusts for age and sex only without including clinical measures of need are likely to overestimate the unwarranted portion of total variation. Substantial variations persisted despite a mandatory provider accreditation policy aimed at curtailing them. The associations between variations and SDH risks imply a need to redress access and outcome inequities.

Exploring pre-MRI imaging tests: patient survey reveals potential implications for healthcare efficiency in Israel.

BACKGROUND: Medical imaging tests are vital in healthcare but can be costly, impacting national health expenditures. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for assessing medical conditions. However, the rising demand for MRI scans has frequently strained available resources. This study aimed to estimate the prevalence of different imaging tests in individuals who eventually had an MRI, in the Israeli public health system. METHODS: An online survey of patient experience of scheduling an MRI was conducted in January-February 2023, among 557 Israeli adults, representing all four health maintenance organizations (HMOs). All participants had undergone an MRI in the public health system within the past year. RESULTS: Results showed that 60% of participants underwent other imaging tests before their MRI scan. Of those, computed tomography (CT) scans (43%), X-rays (39%), and ultrasounds (32%) were the most common additional imaging procedures. In addition, of the 60% of participants, 23% had undergone more than one prior imaging examination. CONCLUSIONS: These findings highlight the high prevalence of preliminary imaging tests prior to MRI, with many patients undergoing multiple tests for the same problem. The health system may need to evaluate whether current clinical guidelines defining the use of various imaging tests are cost-effective.

Home symptom management training programme: carer evaluation.

OBJECTIVES: Most people say if they had a terminal illness, they would prefer to be cared for at home and, if possible, to die there. Often this is not possible without a carer to assist with on-going practical care and symptom management. If breakthrough symptoms are not treated in a timely manner, symptoms can escalate quickly causing increased suffering resulting in unwanted hospital transfers. Many carers report feeling motivated but uneducated for the task of medicine management, especially if it involves preparation and/or administration of subcutaneous medicines This study assesses the impact of an education and resource package, caring@home, on carers' confidence, knowledge, and skills in managing palliative symptoms at home using subcutaneous medicines. METHODS: Nurses trained volunteer carers on the use of the package. Carers were invited to complete a 10 min written evaluation survey and to consider consenting to a 30 min semistructure phone interview. RESULTS: Fifty carers returned surveys and 12 were interviewed. Most carers agreed or strongly agreed that the package provided them with the necessary knowledge, skills and confidence to safely and confidently manage breakthrough symptoms using subcutaneous medicines, further, they would recommend the package to others. Interview analysis revealed three main themes: (1) hesitation and motivation to adopt expanded carer role; (2) the importance of a layered approach to support; and (3) avoiding perceived unnecessary contact with nurses. CONCLUSION: The programme can be used by clinical services to empower carers to help enable a person to be cared for, and to die at home.

Characterization of teaching-learning tutors in public health services and topics of interest for their work.

OBJECTIVE: To describe the profile of teaching-learning tutors in public health services and investigate which topics are of greatest interest in development spaces for these actors. METHOD: Cross-sectional study. Eligible tutors of Health Care Planning. Data collection using an electronic questionnaire composed of closed questions on sociodemographic characteristics, training and performance. Chi-square test used to compare proportions according to tutor typologies. RESULTS: A total of 614 tutors worked in Brazil's five geographic regions, the majority in primary care (82%), followed by state/regional work (13%) and specialized outpatient care (5%). The majority reported being female, of brown skin color, from the nursing field, having worked as a tutor for less than a year, and with no previous experience in preceptorship or similar. The most important topics were Health Care Networks, risk stratification for chronic conditions and the functions of specialized outpatient care. CONCLUSION: The predominance of certain characteristics among tutors was identified, with differences between the types of work. The findings can support managers in the process of selecting and developing tutors in Health Care Planning.

Factors influencing the intention to purchase health insurance: a study of Indian tobacco and alcohol consumers.

Introduction: This study empirically investigates the attitude of tobacco and alcohol consumers towards health insurance purchase in India. The study aims to determine the factors which plays a significant role in determining the purchase intention of health insurance among tobacco and alcohol consumers. Methods: We propose an extended theory of planned behavior (TPB) model comprising factors like attitude, subjective norms, perceived behavior control, perceived usefulness, perceived product risk, and intention to purchase. We collected responses from 420 tobacco and alcohol consumers through a Google Form link shared via different social media platforms. SPSS has been used to perform exploratory factor analysis, whereas AMOS has been used to validate the constructs, confirm the relationships among the variables, and analyze the data. Results: The analysis outcomes demonstrate that subjective norms, perceived product risk, and perceived behavioral control are the factors that have a positive and significant effect on health insurance purchase intention among consumers. Discussion: This research offers valuable insights to the insurance sector, government officials, policymakers, and academicians. Insurance companies may consider the criteria analysed when creating policies to promote the expansion of the health insurance sector.

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program.

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

Development of the Nursing Assessment Tool for the Patient With Inflammatory Bowel Disease.

This study aims to develop and validate a nursing assessment tool for patients with inflammatory bowel disease. In this cross-sectional descriptive study using a quantitative approach, nurses were invited to participate. The Delphi technique was used to obtain a consensus among expert nurses. Descriptive analysis was used for each item on the nursing assessment tool. Overall, 345 nurses were identified; 32 were eligible as experts and 13 validated the consultation. Of the 13 expert nurses, most were female (11, 84.62%), their mean age was 46.36 ± 10.59 years, eight (61.54%) graduated from public institutions, and eight (61.54%) had a master's degree. The initial version had 106 items, which was reduced to 95 items. The content of four domains (identification, health-disease profile, psychobiological needs, and physical examination) was validated in two rounds about the content with more than 80% of agreement. Two domains (sociodemographic data and health conditions, and personal cares) were validated in the first round with more than 80% of agreement. All domains were validated for their appearance during the first round with more than 80% of agreement. The Nursing Assessment Tool for Patients with Inflammatory Bowel Disease (IBD) had a considerable level of agreement regarding content and appearance validation in all dimensions.

Factors influencing smartphone overdependence among adolescents.

Adolescents are particularly vulnerable to smartphone overdependence. Therefore, we identified the factors influencing smartphone overdependence and risk subgroups among adolescents. The current study is a secondary analysis of nationally representative data from the 2020 Korea Youth Risk Behavior Survey. The survey targeted middle- and high-school students in South Korea aged 12-18 using stratified, clustered, multistage probability sampling, and 53,457 students from 793 schools participated in this study. Complex sample data were analyzed considering the strata, clusters, and weights. Multiple logistic regression analysis revealed age, gender, household economic status, anxiety, loneliness, depressive symptoms, and experience of violent treatment as significant predictors of smartphone overdependence. Adolescents with severe anxiety were at a 3.326 times higher risk of smartphone overdependence than adolescents with minimal anxiety. Decision tree analysis showed that anxiety, gender, loneliness, and depressive symptoms were important in differentiating risk subgroups, with anxiety being the most significant factor. Group 13, comprising girls with severe anxiety, had the highest risk at 52.9%. Thus, early detection and prevention of issues such as anxiety, loneliness, and depressive symptoms, as well as treatment for violence, can prevent smartphone overdependence among adolescents. Additionally, more thorough interventions for anxiety are warranted to prevent smartphone overdependence.

Cross-cultural adaptation and psychometric validation of point-of-care outcome assessment tools in Chinese palliative care clinical practice.

BACKGROUND: A standardized national approach to routinely assessing palliative care patients helps improve patient outcomes. However, a quality improvement program-based on person centered outcomes within palliative care is lacking in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality. This study aimed to culturally adapt and validate three measures that form part of the PCOC program for palliative care clinical practice in China: The PCOC Symptom Assessment Scale (PCOC SAS), Palliative Care Problem Severity Scale (PCPSS), Palliative Care Phase. METHODS: A study was conducted on cross-cultural adaptation and validation of PCOC SAS, PCPSS and Palliative Care Phase, involving translation methods, cognitive interviewing, and psychometric testing through paired assessments. RESULTS: Cross-cultural adaptation highlighted the need to strengthen the link between the patient's care plan and the outcome measures to improve outcomes, and the concept of distress in PCOC SAS. Analysis of 368 paired assessments (n = 135 inpatients, 22 clinicians) demonstrated that the PCOC SAS and PCPSS had good and acceptable coherence (Cronbach's a = 0.85, 0.75 respectively). Palliative Care Phase detected patients' urgent needs. PCOC SAS and PCPSS showed fair discriminant and concurrent validity. Inter-rater reliability was fair for Palliative Care Phase (k = 0.31) and PCPSS (k = 0.23-0.30), except for PCPSS-pain, which was moderate (k = 0.53). CONCLUSIONS: The Chinese version of PCOC SAS, PCPSS, and Palliative Care Phase can be used to assess outcomes as part of routine clinical practice in Mainland China. Comprehensive clinical education regarding the assessment tools is necessary to help improve the inter-rater reliability.

Is there a stronger willingness to pay for photovoltaic power generation with high education in China?

Adoption of clean electric energy depends not only on administrative regulations, but also on public support, in particular, the public is willing to pay for environmental improvements. However, the increase of solar photovoltaic power generation willingness to pay (WTP) associated with higher education attainment and the identification of their causality has been missing. Present paper used the enactment of the Compulsory Schooling Law as an instrumental variable to solve the causal relationship between education and willingness to pay for photovoltaic power generation. The results are as follows:Heckman two-stage model and instrumental variable both confirmed that higher education has a positive impact on WTP for solar photovoltaic power generation. For each level of public education in the east, the WTP of photovoltaic power generation will increase by 7.540 CNY, 8.343 CNY and 8.343 CNY respectively, the central public will increase by 9.637 CNY, 10.775 CNY and 11.758 CNY, and the western public will increase by 12.723 CNY, 15.740 CNY and 17.993 CNY respectively. The positive influence of education level is smaller among the people who know the ladder price better, but it is bigger among the people who are male, older than 45 years old, healthier, higher income and stronger awareness of safe electricity use. The total socio-economic value of photovoltaic power generation is significantly different in eastern, central and western region China.

Do predator attacks on productive species and the respective economic losses influence the psychological distress of farmers in Uruguay? A cross-sectional study.

INTRODUCTION: In Uruguay, productive animals are attacked by various predators, causing injuries and financial losses, leading to great concern for farmers. The objective of this study was to determine, using a cross-sectional study, if predator attacks on productive animals during the year 2021 influenced the psychological distress of farmers. METHODS: Four hundred and forty-two farmers from around the country were surveyed with questions according to the Kessler Psychological Distress Scale (dependent variable), and predator attacks received in 2021 (independent variable). RESULTS: Of the total number of farmers surveyed, approximately 49% (216/442) had animals that had been attacked by predators. Farmers whose productive species were attacked in 2021 had higher levels of psychological distress than those whose animals were not attacked (p<0.01). Additionally, farmers who reported the highest levels of psychological distress had more deaths of productive species (and more financial losses) from predator attacks in 2021 than those who did not. CONCLUSION: The losses of productive species and the financial costs negatively influenced the psychological distress of farmers. This information highlights the need to generate public policies about farmers wellbeing that help them in these situations.

Self-identified rurality in a nationally representative population in the US.

INTRODUCTION: In the US, health services research most often relies on Rural-Urban Commuting Area (RUCA) classification codes to measure rurality. This measure is known to misrepresent rurality and does not rely on individual experiences of rurality associated with healthcare inequities. We aimed to determine a patient-centered RUCA-based definition of rurality. METHODS: In this cross-sectional study, we conducted an online survey asking US residents, 'Do you live in a rural area?' and the rationale for their answer. We evaluated the concordance between their self-identified rurality and their ZIP code-derived RUCA designation of rurality by calculating Cohen's kappa (κ) statistic and percent agreement. RESULTS: Of the 774 participants, 456 (58.9%) and 318 (41.1%) individuals had conventional urban and rural RUCA classifications, respectively. There was only moderate agreement between perceived rurality and rural RUCA classification (κ=0.48; 95% confidence interval (CI)=0.42-0.54). Among people living within RUCA 2-3 defined urban areas (n=51), percent agreement was only 19.6%. Discordance was driven by their perception of the population density, proximity to the nearest neighbor, proximity to a metropolitan area, and the number of homes in their area. Based on our results, we reclassified RUCA 2-3 designations as rural, resulting in an increase in overall concordance (κ=0.56; 95%CI=0.50-0.62). DISCUSSION: Patient-centered rural-urban classification is required to effectively evaluate the impact of rurality on health disparities. This study presents a more patient-centric RUCA-based classification of rurality that can be easily operationalized in future research in situations in which self-reported rural status is missing or challenging to obtain. CONCLUSION: Reclassification of RUCA 2-3 as rural represents a more patient-centric definition of rurality.

Outreach work in Belgian primary care practices during COVID-19: results from the cross-sectional PRICOV-19 study.

BACKGROUND: General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand. METHODS: Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index. RESULTS: Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice's patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice's patient population and with the level of deprivation of the municipality where the practice is situated. CONCLUSIONS: In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population.