Temporal and geographical variations in diagnostic imaging in Norway.

BACKGROUND: Unwarranted temporal and geographical variations are acknowledged as a profound problem for equal access and justice in the provision of health services. Even more, they challenge the quality, safety, and efficiency of such services. This is highly relevant for imaging services. OBJECTIVE: To analyse the temporal and geographical variation in the number of diagnostic images in Norway from 2013 to 2021. METHODS: Data on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and inpatient data afforded by fourteen hospital trusts and hospitals in Norway. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics. RESULTS: More than 37 million examinations were performed in Norway during 2013-2021 giving an average of 4.2 million examinations per year. In 2021 there was performed and average of 0.8 examinations per person and 2.2 examinations per person for the age group > 80. There was a 9% increase in the total number of examinations from 2013 to 2015 and a small and stable decrease of 0.5% per year from 2015 to 2021 (with the exception of 2020 due to the pandemic). On average 71% of all examinations were outpatient examinations and 32% were conducted at private imaging centres. There were substantial variations between the health regions, with Region South-East having 53.1% more examinations per inhabitant than Region West. The geographical variation was even more outspoken when comparing catchment areas, where Oslo University Hospital Trust had twice as many examinations per inhabitant than Finnmark Hospital Trust. CONCLUSION: As the population in Norway is homogeneous it is difficult to attribute the variations to socio-economic or demographic factors. Unwarranted and supply-sensitive variations are challenging for healthcare systems where equal access and justice traditionally are core values.

Spatial accessibility and equity of residential care facilities in Beijing from 2010 to 2020.

In recent years, the aging population in Beijing has rapidly increased and the demand for residential care facilities (RCFs) has also risen. As RCFs have quickly developed, the question of whether residential care resources dynamically match the changes in the demand of the elderly population is an urgent issue that must be addressed. This study analyzes the spatiotemporal variation in the supply and demand of RCFs, applies a Gaussian two-step floating catchment area method with a multi-level search radius to measure the spatial accessibility of RCFs in Beijing in 2010 and 2020, and evaluates the equity of spatial accessibility. The results show that the elderly population was decentralized from the central urban area to New Urban Development Area. However, the distribution of RCF beds shows further agglomeration towards the central urban area. The accessibility of residential care resources in the central urban area and New Urban Development Area has increased, while accessibility in Ecological Protection Area has decreased. The spatial disparities in accessibility have been reduced and the spatial equity in accessibility has been improved over the past decade. The findings provide policy recommendations for the future allocation of RCFs by considering the spatiotemporal changes in the distribution of the supply and demand of residential care resources.

"And this is the life jacket, the lifeline they've been wanting": Participant perspectives on navigating challenges and successes of prescribed safer supply.

BACKGROUND: In 2021, 43% of drug toxicity deaths in Ontario were reported by public health units serving medium-sized urban and rural communities. Safer supply programs (SSPs) have been primarily established in large urban centres. Given this, the current study is based on an evaluation of a SSP based in a medium-sized urban centre with a large catchment area that includes rural and Indigenous communities. The aim of this research paper is to understand the challenges and successes of the nurse practitioner-led SSP from the perspective of program participants. METHODS: Interpretive description was used to understand the experiences of 14 participants accessing a SSP. Each participant was interviewed using a semi-structured approach, and 13 of the interviewees also completed surveys accessed through Qualtrics. An iterative process using NVivo software was used to code interviews, and a constant comparative data analysis approach was used to refine and categorize codes to themes. FINDINGS: Three overarching themes were the result of this analysis: feeling better, renewed hope, and safety. These three themes capture the experiences of participants in the SSP, including both the challenges and successes they faced. CONCLUSION: The findings and subsequent discussion focus on both the key best practices of the program, and areas for future development and improvement. Despite barriers to services, prescribed SSPs are improving the lives of people who use drugs, and the current outcomes align with reports and evaluations from other SSPs across Canada.

Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan.

INTRODUCTION: Assessing gestational age accurately is crucial for saving preterm newborns. In low and middle-income countries, such as Pakistan, where access to antenatal ultrasonography (A-USG) is limited, alternative methods are needed. This study evaluated the diagnostic accuracy of foot length (FL) measurement for identifying preterm newborns in rural Pakistan using A-USG as the reference standard. METHODS: A test validation study was conducted between January and June 2023 in rural Sindh, Pakistan, within the catchment area of the Global Network for Maternal Newborn Health Registry, Thatta. Singleton newborns whose mothers had an A-USG before 20 weeks of gestation were enrolled. A research assistant measured FL three times using a rigid transparent plastic ruler within 48 hours of birth and the average FL was reported. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios were calculated. The optimal FL cut-off for the identification of preterm newborns was determined using the Youden Index. RESULTS: A total of 336 newborns were included in the final analysis, of whom 75 (22.3%) were born before 37 weeks of gestation. The median gestational age of the newborns was 38.2 weeks, and the median FL was 7.9 cm. The area under the curve was 97.6%. The optimal FL cut-off for identifying preterm newborns was considered as ≤7.6 cm with a sensitivity of 90.8%, specificity of 96.0%, PPV of 86.7% and NPV of 97.3%. A lower cut-off of ≤7.5 cm had a sensitivity of 95.4%, specificity of 84.0%, PPV of 63.1% and NPV of 98.5%. CONCLUSION: In conclusion, this study highlights the utility of FL measurement for identifying preterm newborns in rural settings where A-USG is unavailable before 20 weeks of gestation. Optimal cut-offs of ≤7.6 and ≤7.5 cm provide a simple, cost-effective and reliable tool for clinicians and frontline healthcare providers in rural areas, respectively. TRIAL REGISTRATION NUMBER: NCT05515211.

Geographic Dialysis Facility Density and Early Dialysis Initiation.

Importance: The decision of when to start maintenance hemodialysis may be affected by health system-level support for high-intensity care as manifested by area dialysis facility density. Yet an association between early hemodialysis initiation and higher area density of dialysis facilities has not been shown. Objective: To examine whether there is an association between area dialysis facility density and earlier dialysis initiation. Design, Setting, and Participants: Cross-sectional analysis was conducted of publicly reported claims and geographic-based population data collected in the Medical Evidence files of the US Renal Data System (USRDS), a comprehensive registry of all patients initiating hemodialysis in the US, from calendar years 2011 through 2019. Data were linked to the American Community Survey, using residential zip codes, and then to health service area (HSA) primary care and hospitalization benchmarks, using the Dartmouth Atlas crosswalk. Data were analyzed from November 1, 2021, to August 31, 2023. Exposure: Dialysis facility density at the level of HSA (number of dialysis facilities per 100 000 HSA residents) split into 5 categories. Main Outcomes and Measures: The odds of hemodialysis initiation at an estimated glomerular filtration rate (eGFR) greater than 10 mL/min/1.73 m2 vs less than or equal to 10 mL/min/1.73 m2. Results: Hemodialysis was initiated in a total of 844 466 individuals at 3397 HSAs at a mean (SD) eGFR of 8.9 (3.8) mL/min/1.73 m2. Their mean (SD) age was 63.5 (14.7) years, and 484 346 participants (57.4%) were men. In the HSA category with the highest facility density, individuals were younger (63.3 vs 65.2 years in least-dense HSAs), poorer (mean percent of households living in poverty, 10.4% vs 8.4%), and more commonly had a higher percentage of Black individuals (40.6% vs 11.3%). More individuals in the dialysis-dense HSAs than least-dense HSAs had diabetes (60.1% vs 58.5%) and fewer had access to predialysis nephrology care (60.8% vs 64.1%); the rates of heart failure and immobility varied, but not in a consistent pattern, by HSA dialysis density. The mean (SD) facility density was 4.1 (1.89) centers per 100 000 population in the most dialysis-dense HSAs. Compared with patients in HSAs with a mean of 1.0 per 100 000 population, the odds of hemodialysis initiation at eGFR greater than 10 mL/min/1.73 m2 were 1.07 (95% CI, 1.03-1.11) for patients in the densest HSAs, and compared with HSAs with 0 facilities, the odds of early hemodialysis initiation were 1.06 (95% CI, 1.02-1.10) for patients in the densest HSAs. Conclusions and Relevance: In this cross-sectional study of USRDS- and HSA-level data, HSA dialysis density was associated with early hemodialysis initiation.

Health impact of borders: general reflections and a case study from the Polish-German border.

BACKGROUND AND OBJECTIVE: Political, economic, communicative and cultural borders still limit the accessibility of acute healthcare services for patients so that they frequently have to accept longer distances to travel to the next provider within their own country. In this paper, we analyze the impact of borders and opening of borders on acute medical care in hospitals and on patients in border regions. METHODS: We develop a conceptual framework model of cross-border healthcare and apply it to the Polish-German border area. The model combines the distance decay effect, a catchment area analysis, economies of scale and the learning curve. RESULTS: Borders have a major impact on acute medical care in hospitals and on patients. Setting of new borders will reduce the accessibility of health facilities for patients or require the establishment of new hospitals. Reopening borders might induce a vicious circle leading to the insolvency of a hospital which might result in poorer health for some patients. CONCLUSION: Strong effort should be invested to overcome political and cultural borders to improve the health of the population in border regions. Similarly, increased cross-border acute healthcare must be seen in the context of rural health and the special situation of small rural hospitals in rural peripheral areas.

Profissão e vocação: a enfermagem em questão / Profession and vocation: nursing in question / Profesión y vocación: la enfermería en cuestión

Objetivo: Identificar os motivos pelos quais levaram os estudantes a escolherem a formação universitário em Enfermagem. Metodologia: Estudo exploratório- descritivo, sob abordagem qualitativa, desenvolvido com 276 acadêmicos de Enfermagem de uma universidade pública do Noroeste do estado do Ceará, Brasil. As informações foram coletadas por meio de um questionário eletrônico, aplicado por meio da plataforma Google Forms®. Essas por sua vez, foram analisadas a partir de análise de conteúdo proposto por Minayo, com o suporte do software N VIVO 11®. Resultados: As palavras mais referidas pelos estudantes ao serem questionados acerca dos motivos na escolha do curso de Enfermagem, foram: "Área", "Saúde", "Curso" e "Profissão", as quais suscitam que em algumas situações a escolha do curso aconteceu pela área da Saúde e não pelo curso em específico. Entretanto, outras palavras com maior quantitativo de repetição foram identificadas: "Sempre", "Gosto" e "Enfermagem", que por sua vez, demonstram a identificação com o curso de Enfermagem em específico e com o fazer da profissão. A partir de então, foram definidas seis categorias de análise, a saber "Identificar-se com a profissão", "Determinação Social e Mercado de Trabalho", "Enfermagem como segunda ou única opção", "Influências externas", "Permanência na área da Saúde" e "Vocação e visão solidária-romântica". Considerações finais: A partir dos discursos dos participantes em estudo, evidenciou-se que os motivos pelos quais levaram esses a ingressarem no curso universitário em Enfermagem estão associados ao imaginário da vocação, da concepção da Enfermagem enquanto profissão voltada para o cuidar/cuidado, bem como pelo o interesse de atuação na área da saúde.

Objective: To identify the reasons why students chose a university degree in Nursing. Methodology: Exploratory-descriptive study, under a qualitative approach, developed with 276 Nursing students from a public university in the Northwest of the state of Ceará, Brazil. Information was collected through an electronic questionnaire, applied through the Google Forms® platform. These, in turn, were analyzed based on the content analysis proposed by Minayo, with the support of the N VIVO 11® software. Results: The words most mentioned by students when asked about the reasons for choosing the Nursing course were: "Area", "Health", "Course" and "Profession", which suggest that in some situations the choice of course happened by the Health area and not by the specific course. However, other words with a higher number of repetitions were identified: "Always", "I like" and "Nursing", which, in turn, demonstrate identification with the Nursing course in particular and with the profession. From then on, six categories of analysis were defined, namely "Identifying with the profession", "Social Determination and the Labor Market", "Nursing as a second or only option", "External influences", "Permanence in the area of Health" and "Vocation and solidarity-romantic vision". Final considerations: From the speeches of the participants in the study, it was evident that the reasons why they entered the university course in Nursing are associated with the imaginary of the vocation, of the conception of Nursing as a profession focused on care/care, as well as as well as the interest in acting in the health area.

Objetivo: Identificar las razones por las cuales los estudiantes eligieron la carrera universitaria de Enfermería. Metodología: Estudio exploratorio-descriptivo, con abordaje cualitativo, desarrollado con 276 estudiantes de Enfermería de una universidad pública del Noroeste del estado de Ceará, Brasil. La información se recolectó a través de un cuestionario electrónico, aplicado a través de la plataforma Google Forms®. Estos, a su vez, fueron analizados con base en el análisis de contenido propuesto por Minayo, con el apoyo del software N VIVO 11®. Resultados: Las palabras más mencionadas por los estudiantes cuando se les preguntó acerca de los motivos de la elección de la carrera de Enfermería fueron: "Área", "Salud", "Curso" y "Profesión", lo que sugiere que en algunas situaciones la elección de la carrera pasó por la carrera de Enfermería. área y no por el curso específico. Sin embargo, fueron identificadas otras palabras con mayor número de repeticiones: "Siempre", "Me gusta" y "Enfermería", que, a su vez, demuestran identificación con la carrera de Enfermería en particular y con la profesión. A partir de ahí, se definieron seis categorías de análisis, a saber, "Identificación con la profesión", "Determinación social y mercado de trabajo", "Enfermería como segunda o única opción", "Influencias externas", "Permanencia en el área de la Salud". " y "Vocación y visión solidaria-romántica". Consideraciones finales: A partir de los discursos de los participantes en el estudio, se evidenció que las razones por las cuales ingresaron a la carrera universitaria en Enfermería están asociadas al imaginario de la vocación, de la concepción de la Enfermería como profesión enfocada en el cuidado, así como el interés por actuar en el área de la salud.

Gravity models for potential spatial healthcare access measurement: a systematic methodological review.

BACKGROUND: Quantifying spatial access to care-the interplay of accessibility and availability-is vital for healthcare planning and understanding implications of services (mal-)distribution. A plethora of methods aims to measure potential spatial access to healthcare services. The current study conducts a systematic review to identify and assess gravity model-type methods for spatial healthcare access measurement and to summarize the use of these measures in empirical research. METHODS: A two-step approach was used to identify (1) methodological studies that presented a novel gravity model for measuring spatial access to healthcare and (2) empirical studies that applied one of these methods in a healthcare context. The review was conducted according to the PRISMA guidelines. EMBASE, CINAHL, Web of Science, and Scopus were searched in the first step. Forward citation search was used in the second step. RESULTS: We identified 43 studies presenting a methodological development and 346 empirical application cases of those methods in 309 studies. Two major conceptual developments emerged: The Two-Step Floating Catchment Area (2SFCA) method and the Kernel Density (KD) method. Virtually all other methodological developments evolved from the 2SFCA method, forming the 2SFCA method family. Novel methodologies within the 2SFCA family introduced developments regarding distance decay within the catchment area, variable catchment area sizes, outcome unit, provider competition, local and global distance decay, subgroup-specific access, multiple transportation modes, and time-dependent access. Methodological developments aimed to either approximate reality, fit a specific context, or correct methodology. Empirical studies almost exclusively applied methods from the 2SFCA family while other gravity model types were applied rarely. Distance decay within catchment areas was frequently implemented in application studies, however, the initial 2SFCA method remains common in empirical research. Most empirical studies used the spatial access measure for descriptive purposes. Increasingly, gravity model measures also served as potential explanatory factor for health outcomes. CONCLUSIONS: Gravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods-both for methodological developments and applications in empirical research. While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements.

Assessment of the supply/demand balance of medical resources in Beijing from the perspective of hierarchical diagnosis and treatment.

Considering the United Nations' Sustainable Development Goals (SDGs) and the need for a balanced spatial distribution of urban medical resources capable of perspective of hierarchical diagnosis and treatment, i.e. providing continuous and accessible medical services during potential public health emergencies, we assessed accessibility and service capacity of the three hospital levels in Beijing. Using geographical information systems (GIS) and the two-step floating catchment area method with the street as research unit, we found that there is an over-supply of medical resources in the centre of the city with weaker support in the peripheral areas as manifested by less supply in relation to popular demand of medical services. The spatial distribution of hospitals at all levels and their resources was found to be uneven: 82.4% of the residents can reach a tertiary hospital (a hospital offering advanced specialized medical and health services to multiple regions) within a 15-minute drive; 50.6% can reach a secondary hospital (a hospital offering comprehensive medical and health services to various communities) within a 10-minute drive; and 77.6% can reach a primary hospital (a hospital directly delivering prevention, medical treatment, healthcare, and rehabilitation services to the community of a certain population) within a 15- minute walk. It was noted that the supply/demand balance of medical resources in the tertiary hospitals decreases from the centre to the periphery, while the secondary hospitals show a dual-centre pattern and the primary hospitals a more uneven distribution, with oversupply in the East and the opposite in the Centre. The results of the study provide supplementary decision support for improving the hierarchical diagnosis and treatment system and accelerate the overall deployment of medical resources.

Cardiac Arrest Survival at Emergency Medical Service Agencies in Catchment Areas With Primarily Black and Hispanic Populations.

Importance: Black and Hispanic patients are less likely to survive an out-of-hospital cardiac arrest (OHCA) than White patients. Given the central importance of emergency medical service (EMS) agencies in prehospital care, a better understanding of OHCA survival at EMS agencies that work in Black and Hispanic communities and White communities is needed to address OHCA disparities. Objective: To examine whether EMS agencies serving catchment areas with primarily Black and Hispanic populations (Black and Hispanic catchment areas) have different rates of OHCA survival than agencies serving catchment areas with primarily White populations (White catchment areas). Design, Setting, and Participants: A cohort study including adults with nontraumatic OHCA from January 1, 2015, to December 31, 2019, in the Cardiac Arrest Registry to Enhance Survival was conducted. Data analysis was conducted from August 17, 2022, to July 7, 2023. Exposure: Emergency medical service agencies, categorized as working in catchment areas where the combination of Black and Hispanic residents made up more than 50% of the population or where White residents made up more than 50% of the population. Main Outcomes and Measures: The unit of analysis was the EMS agency. The primary outcome was agency-level risk-standardized survival rates (RSSRs) to hospital admission for OHCA at each EMS agency, which were calculated using hierarchical logistic regression and compared between agencies serving Black and Hispanic and White catchment areas. Whether differences in OHCA survival were explained by EMS and first responder measures was evaluated with additional adjustment for these factors. Results: Among 764 EMS agencies representing 258 342 OHCAs, 82 EMS agencies (10.7%) had a Black and Hispanic catchment area. Overall median age of the patients was 63.0 (IQR, 52.0-75.0) years, 36.1% were women, and 63.9% were men. Overall, the mean (SD) RSSR was 27.5% (3.6%), with lower survival at EMS agencies with Black and Hispanic catchment areas (25.8% [3.6%]) compared with agencies with White catchment areas (27.7% [3.5%]; P < .001). Among the 82 EMS agencies with Black and Hispanic catchment areas, a disproportionately higher number (32 [39.0%]) was in the lowest survival quartile, whereas a lower number (12 [14.6%]) was in the highest survival quartile. Additional adjustment for EMS response times, EMS termination of resuscitation rates, and first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator before EMS arrival did not meaningfully attenuate differences in RSSRs between agencies with Black and Hispanic compared with White catchment areas (mean [SD] RSSRs after adjustment, 25.9% [3.3%] vs 27.7% [3.1%]; P < .001). Conclusions and Relevance: Risk-standardized survival rates for OHCA were 1.9% lower at EMS agencies working in Black and Hispanic catchment areas than in White catchment areas. This difference was not explained by EMS response times, rates of EMS termination of resuscitation, or first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator. These findings suggest there is a need for further assessment of these discrepancies.

Hydrochemistry and strontium isotope fingerprints of solute sources and CO2 consumption in Changbai Mountain area, Northeast China.

As one of the most representative forms of groundwater, mineral water provides a critical understanding of regional hydrogeochemical features and rock weathering processes. However, current studies have mostly focused on the quality of mineral water and have rarely addressed the weathering process during its formation. Therefore, a multi-tracer approach combines chemical parameters, major ions, selected trace elements, and 87Sr/86Sr ratios for mineral water samples in Changbai Mountain during 2020-2021. First, we determined the hydrogeochemical characteristics of different types of mineral water. Secondly, the water-rock interaction processes governing the water mineralization were described to fix the hydrogeochemical background. Thirdly, the chemical weathering rate was calculated. The total dissolved load generated by rock weathering was around 6.76 tons/km2/year in the mineral water catchment area; 44.6% and 36.9% of the dissolved load were derived from silicate and carbonate weathering, respectively. The trace carbonates also played an important role in the overall rock weathering. Finally, after fully considering various influencing factors, we concluded that lithological characteristics and the soil environment rich in organic acids were the most important factors affecting rock weathering in the Changbai Mountain area. Overall, this study highlights the mineral water's role in the fluxes of CO2 in local area and reveals possible influence of the unique ecological and geological environment on rock weathering in Changbai Mountain. It can provide a reference for the subsequent assessment of environmental stability for basalt areas and the possibility of sustainable water resources development.

MSM with HIV: Improving prevalence and risk estimates by a Bayesian small area estimation modelling approach for public health service areas in the Netherlands.

Despite close monitoring of HIV infections amongst MSM (MSMHIV), the true prevalence can be masked for areas with small population density or lack of data. This study investigated the feasibility of small area estimation with a Bayesian approach to improve HIV surveillance. Data from EMIS-2017 (Dutch subsample, n = 3,459) and the Dutch survey SMS-2018 (n = 5,653) were utilized. We applied a frequentist calculation to compare the observed relative risk of MSMHIV per Public Health Services (GGD) region in the Netherlands and a Bayesian spatial analysis and ecological regression to quantify how spatial heterogeneity in HIV amongst MSM is related to determinants while accounting for spatial dependence to obtain more robust estimates. Both estimations converged and confirmed that the prevalence is heterogenous across the Netherlands with some GGD regions having a higher-than-average risk. Our Bayesian spatial analysis to assess the risk of MSMHIV was able to close data gaps and provide more robust prevalence and risk estimations.

Condutas não profissionais no uso das mídias sociais por estudantes da área da saúde: revisão integrativa da literatura / Unprofessional conduct in the use of social media by medical, nursing and dental students: integrative literature review / Conducta no profesional en el uso de las redes sociales por estudiantes del área de la salud: revisión integrativa de la literatura

O objetivo deste artigo é revelar o comportamento nas mídias sociais de estudantes de cursos de graduação na área da saúde do ponto de vista da ética profissional. Realizou-se uma revisão integrativa da literatura com base na pergunta norteadora: "Há condutas não profissionais na produção de conteúdo nas mídias sociais por estudantes da área da saúde?". Foram encontrados 495 estudos nas bases de dados pesquisadas. Destes, dez atenderam aos critérios de inclusão. Os estudos incluídos haviam sido feitos com estudantes dos cursos de enfermagem, medicina e odontologia. Todos demonstraram sua má conduta nas mídias sociais em algum momento. Há mais relatos de visualizações de condutas antiprofissionais nos perfis de outros colegas do que autorrelatos quanto a esse aspecto. Conclui-se que é evidente a má conduta, nas mídias sociais, de estudantes de enfermagem, medicina e odontologia

This article aims to reveal the behavior of medical, nursing and dental students from the point of view of professional ethics on social media. An integrative review was carried out based on the research question: "Are there unprofessional behaviors in the production of content on social media by medical, nursing and dental students?". A total of 495 studies, of which ten have satisfied the inclusion criteria, were found in the searched databases. The included studies had been carried out with students from universities for nursing, medical and dentistry education. Everyone has demonstrated misconduct on social media at a moment or other. There are more assertions that they see unprofessional behaviors in the profiles of other colleagues than self-assertions regarding this aspect. We can conclude that the misconduct of medical, nursing and dental students on social networks is evident

El objetivo de este artículo es revelar el comportamiento, en las redes sociales, de los estudiantes de cursos del área de la salud del punto de vista de la ética profesional. Se realizó una revisión integrativa a partir de la pregunta de investigación: "¿Existen comportamientos no profesionales en la producción de contenidos en redes sociales por parte de estudiantes del área de la salud?". Se encontraron 495 estudios, de los cuales diez han cumplido los criterios de inclusión, en las bases de datos investigadas. Los estudios habían sido realizados con estudiantes de los cursos de enfermería, medicina y odontología. Todos ellos han demostrado mala conducta en las redes sociales en algún momento. Hay más afirmaciones acerca de visualizaciones de comportamientos no profesionales en los perfiles de otros compañeros que autoaserciones sobre este aspecto. Es posible concluir que la mala conducta de estudiantes de enfermería, medicina y odontologíaen las redes sociales es evidente

Cancer-related information behavior among Black and Hispanic populations in an NCI-designated comprehensive cancer center catchment.

OBJECTIVE: This study aims to better understand health behaviors, particularly health information seeking, and how this impacts cancer care within underserved minority populations in a specific catchment area in Florida. METHODS: We conducted an analysis of survey data from a 2019 community health survey conducted by the Moffit Cancer Center (MCC). We utilized the Comprehensive Model of Information Seeking (CMIS) as a framework and performed structural equation modeling (SEM) and related statistical analyses. RESULTS: Our findings confirm that characteristics and demographics present a positive relationship to Online Health Information Seeking (OHIS). We also found that Utility had a negative significant relationship to OHIS. CONCLUSIONS: We concluded that the CMIS is a useful framework for studying cancer-related information seeking, and that when properly executed in the confines of a study, can lend itself to in-depth statistical analyses as found in SEM. IMPLICATIONS: The SEM revealed the CMIS to be promising with results in our analysis worthy of further investigation of cancer care and healthcare information access considering undeserved and minority populations. PRACTICE IMPLICATIONS: Models such as the CMIS can be useful for understanding information seeking behaviors and to design information and communication interventions to improve access and health outcomes.

Measuring spatial accessibility of residents' medical treatment under hierarchical diagnosis and treatment system: Multi-scenario simulation in China.

In order to improve the operational efficiency of medical institutions and build a more complete and efficient medical system, the Chinese government is vigorously promoting the reform of hierarchical diagnosis and treatment. We constructed a multi-factor composite selection weight to characterize the residents' medical treatment behavior in the context of hierarchical diagnosis and treatment. By combining the weight with the two-step floating catchment area method, we analyzed the spatial variation characteristics of residents' accessibility to medical care under different scenarios. Results show that the referral rate between medical institutions increases gradually along with the occurrence of public health events. When there is a major public health event, the proportion of the population transferred from the primary medical institutions to the county hospitals and the county hospitals to the municipal hospitals exceeded 65%. In three scenarios, the spatial pattern of accessibility shows obvious consistency and local differences. Among the three-tier medical institutions in China, the service capacity of county hospitals is poor, and the contribution rate of accessibility is less than 20%. The results clearly show the spatial differences in the accessibility of Chinese residents in different scenarios and the impact of public health events on accessibility. This research can provide a reference for the layout optimization of medical resources in the future.

Current Approaches to Serving Catchment Areas in Cancer Centers: Insights from the Big Ten Cancer Research Consortium Population Science Working Group.

In 2021, the NCI issued updated guidance clarifying the mission and organizational structure for Community Outreach and Engagement (COE) for Cancer Center Support Grants. These guidelines outlined how cancer centers should address the cancer burden of the catchment area (CA) and define how COE would partner with the community to inform cancer research and implement programs to reduce the cancer burden. In this paper, the Common Elements Committee of the Population Science Working Group in the Big Ten Cancer Research Consortium describes their respective approaches to implementing these guidelines. We discuss our definitions and rationales for each CA, data sources used, and our approach to assessing the impact of COE efforts on the burden of cancer in our respective CA. Importantly, we describe methods of translating unmet CA needs into our cancer-relevant outreach activities, and cancer research addressing the needs of respective CAs. Implementing these new guidelines is a challenge, and we hope that sharing approaches and experiences will foster cross-center collaborations that may more effectively reduce the burden of cancer in the US and meet the mission of the NCI's Cancer Center Program.

Influences of Spatial Accessibility and Service Capacity on the Utilization of Elderly-Care Facilities: A Case Study of the Main Urban Area of Chongqing.

With the unprecedented growth of the elderly population in China, elderly-care facilities (ECFs) are in a fast expansion process. However, limited attention has been paid to the imbalance at the actual utilization level of ECFs. This research aims to reveal the spatial inequity of ECFs and to quantitatively examine the effect of accessibility and institutional service capacity on utilization. Taking Chongqing, China, as the study area, we measured the spatial accessibility of different travel modes by the Gaussian Two-Step Floating Catchment Area (G2SFCA) method and investigated distribution differences in spatial accessibility, service capacity, and utilization of ECFs by the Dagum Gini Coefficient and its decomposition. Then, the impact of spatial accessibility and service capacity on the utilization of regional ECFs was quantified by multiscale geographically weighted regression (MGWR). The study findings can be summarized as follows. (1) Walking accessibility has the most significant impact on the utilization of ECFs and shows geographic heterogeneity. Developing a pedestrian-oriented network of pathways is essential to enhance the utilization of ECFs. (2) Accessibility by driving and bus-riding does not correlate with regional ECFs utilization, and relevant studies cannot rely on them alone for assessing the equity of ECFs. (3) In the utilization of ECFs, since the inter-regional difference is more significant than the intra-regional difference, efforts to reduce the overall imbalance should be oriented toward inter-regional variation. The study's findings will assist national policymakers in developing EFCs to enhance health indicators and quality of life for older adults by prioritizing financing for shortage areas, coordinating ECFs services, and optimizing road systems.

Quantitative Evaluation of Spatial Accessibility of Various Urban Medical Services Based on Big Data of Outpatient Appointments.

Equity of urban medical services affects human health and well-being in cities and is important in building 'just' cities. We carried out a quantitative analysis of the spatial accessibility of medical services considering the diverse demands of people of different ages, using outpatient appointment big data and refining the two-step floating catchment area (2SFCA) method. We used the traditional 2SFCA method to evaluate the overall spatial accessibility of medical services of 504 communities in Xiamen city, considering the total population and the supply of medical resources. Approximately half the communities had good access to medical services. The communities with high accessibility were mainly on Xiamen Island, and those with low accessibility were further from the central city. The refined 2SFCA method showed a more diverse and complex spatial distribution of accessibility to medical services. Overall, 209 communities had high accessibility to internal medicine services, 133 to surgery services, 50 to gynecology and obstetrics services, and 18 to pediatric services. The traditional method may over-evaluate or under-evaluate the accessibility of different types of medical services for most communities compared with the refined evaluation method. Our study can provide more precise information on urban medical service spatial accessibility to support just city development and design.

Spatial Accessibility of Primary Care in the Dual Public-Private Health System in Rural Areas, Malaysia.

Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia's dual public-private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development.