Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial / Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

Developing and testing an environmental economics approach to the valuation and application of urban health externalities.

Background: Poor quality urban environments have substantial impacts on public and planetary health. These costs to society are not readily quantifiable and remain largely external to mainstream measures of progress. Methods for accounting for these externalities exist, but their effective application is in development. Yet there is an increasing urgency and demand given the profound threats to quality of life both now and in the future. Methods: We combine data from a series of systematic reviews of the quantitative evidence linking characteristics of the urban environment with health consequences and the economic valuation of these health impacts from a societal perspective within a spreadsheet-based tool. The tool-named HAUS-allows the user to estimate the health impacts of changes in urban environments. The economic valuation of these impacts in turn facilitates the use of such data in broader economic appraisal of urban development projects and policies. Findings: Using the Impact-Pathway approach, observations of a variety of health impacts associated with 28 characteristics of the urban environment are applied to forecast changes in cases of specific health impacts that result from changes in urban contexts. Unit values for the societal cost of 78 health outcomes are estimated and incorporated in the HAUS model in order to allow the quantification of the potential effect size of a given change in the urban environment. Headline results are presented for a real-world application in which urban development scenarios that have varying quantities of green space are evaluated. The potential uses of the tool are validated via formal semi-structured interviews with 15 senior decision-makers from the public and private sectors. Interpretation: Responses suggest that there is significant demand for this kind of evidence, that it is valued despite the inherent uncertainties, and has a very wide range of potential applications. Analysis of the results suggest expert interpretation and contextual understanding is critical for the value of evidence to be realized. More development and testing is needed to understand how and where it may be possible to apply effectively in real world practice.

The Role of the COVID-19 Crisis in Shaping Urban Planning for Improved Public Health: A Triangulated Study.

This paper aims to assess the impact of the COVID-19 pandemic on the link between urban planning practices and public health. A triangulated study was conducted to gain a comprehensive understanding of the topic. The first phase consisted of semi-structured interviews with health and urban planning experts, which were analyzed with the aid of Artificial Intelligence tools. The second phase involved an on-site investigation in the city of Algiers, including a survey, site visits, and a thorough analysis of the master plan for land use and urban planning. The findings emphasize the critical importance of a comprehensive health-centric approach to city design, improved governance and management practices, community involvement, and political commitment to prioritize health in urban planning. Furthermore, the results proved a strong correlation between prioritizing public health in urban planning practices and residents' satisfaction with the city's response to the COVID-19 pandemic. In conclusion, it is necessary to consider public health as a priority in urban planning practices and as a need for all stakeholders to work towards a healthier and more equitable urban environment.

Internet use and rural-urban mental health inequalities: Evidence from China.

Introduction: In the context of the new digital era, clarifying the relationship between Internet use and urban and rural residents' mental health is of important value for reducing rural-urban health inequalities. This paper aims to study the association between Internet use and rural-urban mental health inequalities. Methods: Based on the data of the China Family Panel Studies (CFPS) in 2020, we firstly examined the existence and specific manifestation of mental health inequalities between urban and rural residents. Secondly, we examined the mediating effect of Internet use by the Bootstrap mediating effect measure. Finally, we verified the robustness of the mediating effect. Results: There are significant mental health inequalities between urban and rural residents, and urban residents have better mental health than rural residents (p < 0.01). In addition, the test results for the mediating effect of Internet use on mental health inequalities between urban and rural residents were significant (p < 0.01), with a direct effect of -0.028 (p < 0.01) and an indirect effect of -0.49 (p < 0.01), and this result remained significant in the robustness test. Discussion: In such a new age of the Internet, mental health inequalities between urban and rural residents objectively did exist, and the use of the internet played a positive mediation effect on the formation of mental health inequalities between urban and rural areas.

Urban agrobiodiversity, health and city climate adaptation plans.

Objective: To identify the scope and nature of agricultural biodiversity actions within the climate adaptation plans of a sample of large world cities. Methods: I evaluated data from the 2021 Cities Climate Adaptation Actions database curated by the Carbon Disclosure Project. Cities with a population over 1 million and reporting at least one adaptation action were included. I identified actions involving agriculture and biodiversity using a framework consisting of five agrobiodiversity categories: urban and peri-urban land use and water management, and urban food supply chains, food availability and food environments. I also identified reported health co-benefits and health sector involvement. Findings: Of 141 cities reviewed, 61 cities reported actions on agricultural biodiversity, mostly supporting land use or water management. Key health outcomes addressed were illnesses linked to air pollution and excessive heat and vector-borne diseases, corresponding with cities' major health concerns. Greenhouse gas mitigation was also addressed by many cities. Fewer cities reported actions in food categories or concern for noncommunicable diseases or poor nutrition. Nearly two thirds of cities (40/61) reported health co-benefits or health-sector involvement for at least one intervention. A higher proportion of the 43 cities in low- and middle-income countries reported agrobiodiversity actions and health co-benefits than the 18 cities in high-income countries. Conclusion: Cities are key partners in achieving sustainable global agriculture that promotes health and supports climate and biodiversity goals. Cities can enhance this role through climate adaptation plans with strong health engagement, a focus on nature-based solutions and greater emphasis on food and nutrition.

Effectiveness of Mobility and Urban Sustainability Measures in Improving Citizen Health: A Scoping Review.

BACKGROUND: The relationship between mobility and health has multiple dimensions, and the mobility model can be considered a public health intervention. Increasingly, mobility in cities is oriented towards incorporating sustainability criteria; however, there are many very diverse measures that cities carry out in terms of mobility and urban sustainability, and in many cases, these do not receive subsequent evaluation and/or study to analyse their effectiveness or impact. Currently, the literature does not offer any updated review of the measures applied in the different communities and countries. AIM: To carry out a panoramic review of the measures implemented in the last 5 years to analyse which ones report a greater effectiveness and efficiency in health. RESULTS: After applying the exclusion criteria of the study, a total of 16 articles were obtained for evaluation. The measures applied in terms of sustainability are grouped into four subgroups and their subsequent evaluation and possible impact on public health is analysed. CONCLUSIONS: The present study found a large heterogeneous variety of sustainability measures in local settings around the world, which seem to reflect positive impacts on population health. However, subsequent evaluation of these measures is inconclusive in most cases. Further research and sharing across macro-communities are needed to establish universal criteria.

Linking the Urban Environment and Health: An Innovative Methodology for Measuring Individual-Level Environmental Exposures.

Environmental exposures (EE) are increasingly recognised as important determinants of health and well-being. Understanding the influences of EE on health is critical for effective policymaking, but better-quality spatial data is needed. This article outlines the theoretical and technical foundations used for the construction of individual-level environmental exposure measurements for the population of a northern English city, Bradford. The work supports 'Connected Bradford', an entire population database linking health, education, social care, environmental and other local government data over a period of forty years. We argue that our current understanding of environmental effects on health outcomes is limited both by methodological shortcomings in the quantification of the environment and by a lack of consistency in the measurement of built environment features. To address these shortcomings, we measure the environmental exposure for a series of different domains including air quality, greenspace and greenness, public transport, walkability, traffic, buildings and the built form, street centrality, land-use intensity, and food environments as well as indoor dwelling qualities. We utilise general practitioners' historical patient information to identify the precise geolocation and duration of a person's residence. We model a person's local neighbourhood, and the probable routes to key urban functions aggregated across the city. We outline the specific geospatial procedure used to quantify the environmental exposure for each domain and use the example of exposure to fast-food outlets to illustrate the methodological challenges in the creation of city and nationwide environmental exposure databases. The proposed EE measures will enable critical research into the relationship and causal links between the built environment and health, informing planning and policy-making.

Understanding the Meaningful Places for Aging-in-Place: A Human-Centric Approach toward Inter-Domain Design Criteria Consideration in Taiwan.

BACKGROUND: Aging is key to inclusion, and it should be taken into account when designing every place of human activity. However, the implementation of such guidelines often fails the human-centric aspiration as health and design domain interpretation gaps impede the suitable reading and implementation strategies. PURPOSE: This study aimed to understand critical factors in the place-of-aging and to examine the gap in domain interpretation affecting age-friendly housing. METHODS: Using grounded theory as a base, questionnaire interviews were implemented either face-to-face or through an online process by health and design domain experts. Overall, 40 respondents (20 health and 20 design experts) evaluated the key criteria to prioritize according to their value of importance. The factor analysis resulted in the stated deviation, suggesting a necessity to redefine the attributes of the dwelling based on a people, place and process framework. RESULTS: The systemic analysis affirmed the inter-disciplinary gap to enhancing the dwelling provision. The health domain experts consistently ranked the criteria higher or equal than the design domain except for safety and security criteria. Both domains agreed that affordability is a main concern, as elders must be able to afford their dwelling choice. CONCLUSION: The valuable finding of the key criteria in the study is to uphold the value of the urban health resilience implication as the core of this study.

The correlation between attack rates and urban health indicators during the third wave of the COVID-19 outbreak in Turkey.

This study aims to analyze the inter-provincial variation in the increase of attack rates in the third wave of the COVID-19 outbreak in Turkey and to determine their relationship with potential urban health indicators. In this ecological study, dependent variables were selected as the COVID-19 attack rates of provinces before the third wave and during the third peak and the attack rate increase ratio. Urban health indicators that can function as determinants of health were calculated for each province under five headings: demographic, health capacity, economic, environmental, and socio-cultural. The epidemiologic maps were produced to show the spatial distribution of COVID-19 attack rates pre- and during the third wave. The associations with urban indicators were conducted using bivariate analysis, including Pearson or Spearman correlation analysis. A multiple linear regression model was run with variables significantly associated with increased attack rates. The results of our study show significant regional variations in COVID-19 attack rates both at the beginning and during the third wave of the COVID-19 pandemic in Turkey. Among the provinces, the attack rate increase ratio has only shown significant correlations to education level and some economic indicators, such as income, employment, industrial activity measured by electric consumption, and economic activity in the manufacturing industry. The multivariate analysis determined that the indicator of economic activity in the manufacturing industry is related to the increase of the attack rate in the third wave. Our results show that the COVID-19 cases are higher in more developed cities with more manufacturing sector activity. It makes us think that it is mainly related to inequalities arising from access to health institutions and testing. It can be determined that the partly lockdown strategy, which excluded the industrial activity in the country, concluded the higher increase in the attack rates in highly industrialized provinces.

Factors Influencing Health Seeking Behaviour among Persons with Diabetes Attending Urban Health Care Settings.

BACKGROUND: Health seeking behaviour can influence outcomes in chronic diseases such as diabetes. As diabetes burden is higher in urban areas and under half receive adequate diabetes care and support in Nepal, this study aimed to assess factors influencing health behaviour among persons with diabetes attending urban health care settings. METHODS: A cross-sectional study was conducted at two private healthcare settings with a pretested semi-structured questionnaire to assess health behaviour in particular with gender and regular diabetes follow-up. Bivariate analysis alongwith univariate and multivariate logistic regression was used to assess factors that influence HSB (P<0.05). Adjusted odds were reported within 95% confidence intervals. RESULTS: Among 385 PWDs (42.3% women) with a median diabetes duration of 7 years (IQR: 3 to 14 years), three fourths (75.1%, 95% CL: 70.5 to 79.1%) reported regular follow-up for diabetes care. After adjusting for confounders, the odds of regular follow-up were higher for those with a family history of diabetes (AOR: 1.82, 95% CI: 1.11 to 3.00) and non-smokers (AOR: 2.08, 95% CI: 1.34 to 3.61). The odds of follow-up were lower among the elderly (? 60 years) (AOR: 0.59, 95% CI: 0.35 to 0.97) and those with a family income below 35,000 Nepali rupees (AOR:0.39, 95% CI: 0.23 to 0.67). CONCLUSIONS: A plurality of health seeking behaviours such as regular follow-up care, taking glucose lowering medications and diabetes information seeking was observed among persons with diabetes attending private urban heath care settings during the COVID-19 pandemic period. Older age, family history of diabetes, non-smoking status and low family income were found to influence regular follow-up. In particular, psychosocial mechanisms that influence behavior among persons who smoke may need exploration.

Probing key informants' views of health equity within the World Health Organization's Urban HEART initiative.

To date, no studies have assessed how those involved in the World Health Organization's (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, "how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?", with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as "unnecessary"; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms "health inequity" and "health inequality" were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.