Changes In Service Provision Research Articles

WP1.15 - Advances in remote electronic monitoring of patient-reported outcomes following discharge after surgery: a systematic review

Abstract Aims Standardising post-discharge care is critical to improving surgical recovery. The COVID-19 pandemic caused major changes to in-person visits and surgical follow-up. An earlier review examined the pre-pandemic capture of electronic patient-reported outcomes (ePRO) post-discharge after surgery. This updated review explores how the pandemic has influenced the use of ePRO systems. Methods Databases (Medline/Embase/PsycINFO/CINAHL/Cochrane) were searched from July 2019-August 2023 using terms for ‘patient-reported outcomes’, ‘electronic’, ‘surgery’ and ‘at home’. Primary research studies collecting ePROs in adult surgical patients post-discharge were included. Data extraction/analyses characterised study design, patient characteristics, ePRO system features, the scope within which ePROs are used post-discharge, what PRO data is collected, adherence to ePRO monitoring, impact on primary/secondary outcomes and the patient and clinician experience of using ePRO systems. Results 12,805 articles were identified, of which 81 were included. Emerging findings indicate an increase in research examining ePRO systems in the post-discharge care of surgical patients, with ∼20 articles/year published post-pandemic, compared to ∼3/year in the 5 years pre-pandemic. Usage of ePROs seems to be most prevalent in orthopaedic and gastrointestinal surgery. Full findings will be available for presentation at the conference. Conclusions Interest in using ePROs to support post-discharge care of surgical patients is growing, in response to service provision changes. Important advances in the capabilities of ePRO systems include real-time clinician feedback and integration with hospital electronic records. The findings of this review will highlight important directions for improving the design of ePRO systems and future research examining the effectiveness of ePRO systems at improving post-surgical recovery.

Structural violence and necropolitics among Indigenous Peoples living with HIV who use substances in the Prairie provinces during COVID-19

BackgroundWithin Manitoba and Saskatchewan, pre-existing health inequities amongst Indigenous groups were intensified during the COVID-19 pandemic. Service disruptions in the health and social service sector—combined with the effects of intersectional stigma—disproportionately impacted Indigenous peoples living with HIV (IPLH). IPLH experience structural violence and necropolitical exclusion through systemic forms of stigma situated within Canada's expansive colonial history. Utilizing the theoretical foundations of structural violence and necropolitics, this qualitative study examines how the COVID-19 pandemic amplified preceding states of inequity for IPLH. MethodsSemi-structured interviews were conducted with 60 participants. The sample comprised of those with lived experience (n = 45) as well as those who provided services for IPLH (n = 15). Indigenous Storywork guided the data collection and analysis process. Topics explored within each interview included access to health and social services, harm reduction, substance use, and experiences in providing services during COVID-19 pandemic. Thematic analysis was used to identify common themes throughout each story. ResultsOur results indicate that the COVID-19 pandemic exposed and amplified pre-existing forms of structural violence and necropolitical logics for IPLH within Manitoba and Saskatchewan. Specifically, we describe how structural violence and necropolitics are manifested via three main avenues— (i) restrictions and removal of care, (ii) bureaucracy and institutional care politics, and (iii) discrimination and systemic racism within the Canadian healthcare system. ConclusionThe COVID-19 pandemic within Manitoba and Saskatchewan sparked massive changes in service provision within settler-colonial and neoliberal institutions of care. For those services that remained open to IPLH, masking requirements, questionnaire requirements, scheduling requirements, and a lack of in-person services acted as only some of the barriers described by community members as detrimental to care access. Increased experiences of discrimination in health care on the basis of substance use or HIV status further limited access to needed services.

Leadership in intellectual disability practice: design, development, and evaluation of a programme to support practice

BackgroundIntellectual disability services have and continue to experience changes in service provision. This has an implication for leadership in practice as the quality of leadership has a direct influence on staff practice and care provided.AimTo design, deliver, and evaluate a leadership programme for nurse and social care managers in Ireland.DesignAn accredited programme was designed based on evidence from literature, practice, and national expertise. A cross-sectional survey was used to collect information on the attitudes and behaviour of participants before commencing and after completing the programme. Data from the questionnaires were analysed using SPSS and open-ended questions were analysed using content analysis.SettingIntellectual disability services.Participants102 participants completed the programme and survey.MethodsPre-post survey and reported using the CROSS guidelines.ResultsParticipants’ expectations were rated highly, and all items scored higher in the post-survey. Qualitative data was overall positive regarding opportunities for more time to work through each aspect of the programme. The key learning was through the forum day where participants shared their group projects.ConclusionsOverall, the programme was positively evaluated and through engaging with the programme participants’ perceptions moved from seeing leadership as mostly task-oriented to realising that qualities such as good communication, person-centredness, advocacy, supporting, role modelling, and empowering are key to leadership.

Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland

BackgroundSubstance use disorder treatment and recovery support services are critical for achieving and maintaining recovery. There are limited data on how structural and social changes due to the COVID-19 pandemic impacted individual-level experiences with substance use disorder treatment-related services among community-based samples of people who inject drugs.MethodsPeople with a recent history of injection drug use who were enrolled in the community-based AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland participated in a one-time, semi-structured interview between July 2021 and February 2022 about their experiences living through the COVID-19 pandemic (n = 28). An iterative inductive coding process was used to identify themes describing how structural and social changes due to the COVID-19 pandemic affected participants’ experiences with substance use disorder treatment-related services.ResultsThe median age of participants was 54 years (range = 24–73); 10 (36%) participants were female, 16 (57%) were non-Hispanic Black, and 8 (29%) were living with HIV. We identified several structural and social changes due the pandemic that acted as barriers and facilitators to individual-level engagement in treatment with medications for opioid use disorder (MOUD) and recovery support services (e.g., support group meetings). New take-home methadone flexibility policies temporarily facilitated engagement in MOUD treatment, but other pre-existing rigid policies and practices (e.g., zero-tolerance) were counteracting barriers. Changes in the illicit drug market were both a facilitator and barrier to MOUD treatment. Decreased availability and pandemic-related adaptations to in-person services were a barrier to recovery support services. While telehealth expansion facilitated engagement in recovery support group meetings for some participants, other participants faced digital and technological barriers. These changes in service provision also led to diminished perceived quality of both virtual and in-person recovery support group meetings. However, a facilitator of recovery support was increased accessibility of individual service providers (e.g., counselors and Sponsors).ConclusionsStructural and social changes across several socioecological levels created new barriers and facilitators of individual-level engagement in substance use disorder treatment-related services. Multilevel interventions are needed to improve access to and engagement in high-quality substance use disorder treatment and recovery support services among people who inject drugs.

Are Medicaid and Medicare Patients Treated Equally?

We examine whether Medicaid recipients receive the same health care services as those on Medicare. We track the services provided to the same individual as they age into Medicare from Medicaid at age 65, becoming dual enrolled. Cost sharing remains negligible across the insurance switch, implying that observed changes in service provision reflect supply-side factors. Service provision increases by about 20 percent upon switching to Medicare, across a range of categories and treatments including high-value care. We find that 60 to 90 percent of the increase in office visits is explained by physicians averse to accepting new Medicaid patients. Geographic variation in our estimates shows that the average increase in utilization is larger in those states with lower Medicaid acceptance rates and higher Medicare acceptance rates. By contrast, we find relatively small increases in care from existing Medicaid providers. This analysis indicates that Medicaid’s smaller provider network plays a large role in limiting service provision.

Changing and unfinished narratives of the mental health impact of HIV in the UK

The mental health impacts of HIV have evolved significantly over the last four decades, in parallel with changes in the virus's overall health consequences. This study charts transformation in narratives about mental health problems associated with HIV over the course of the epidemic, as outlined by people with HIV (40%), professional carers (45%) and activists (25%) in the UK. In particular, our study examines evolving mental health impacts and changing service provision during three key periods: The early days of the epidemic; after the introduction of effective antiretroviral therapy (ART) in 1996; and in more recent times as HIV came to be regarded as a chronic manageable condition. Fifty-three participants were recruited: Male (68%), female (32%), White (90%), African/Afro Caribbean (6%) and South Asian (4%). Results indicate that despite important changes in the severity and nature of the mental health impacts of HIV, there were persistent challenges, related to the long-term mental health consequences of HIV among earlier generations of people with HIV. There were additional challenges associated with: ageing with HIV; the development of sexual dysfunction; and the possibility of neurocognitive impairment. The organization of mental health care for people with HIV moved from specialist teams to general practice, presenting challenges of mainstreaming care. The commissioning and delivery of mental health services need to be sensitive to the ever-changing social contexts and the potential for ‘left behind’ people living with HIV, despite the overall ‘naturalisation’ of HIV.

Utilization of Maternal, Nutritional and Child Health Care Services Amidst COVID-19 Pandemic in Uttar Pradesh, India

Background: All maternal health services are essential to be continued for pregnant mothers during lockdown and avoid COVID infection with awareness of people by following all precautions from COVID-19. We aimed to examine changes in service provision and utilization of MNCH services during the pandemic in Uttar Pradesh, India and identify the factors affecting the utilization and service delivery. Objective: To assess the effects of the COVID-19 pandemic on utilization and delivery of maternal health services at health facilities in Uttar Pradesh, India. Method: COVID -19 pandemic data has been collected form website https://prsindia.org/covid-19/cases which provides the day wise data for four major components such as confirmed cases, active cases, cured/discharged and death and pandemic effects on the maternal services including ANC registration, pregnant women registered for ANC within 1st trimester and home and institutional deliveries during April 2019, April 2020 and April 2021. At the same time, through informal discussion with key healthcare professionals and focused desk reviews of published scientific, grey and media-based information and country-specific healthcare policies. Results and summary: Huge difference in the percent change of the beneficiaries received maternal health services among April 2019, April 2020 and April 2021. It is found that there is 88 percent change in the ANC registration for pregnant women in April 2020 against April 2019. It simple means that 371065 pregnant women registered for ANC in April 2019 whereas only 44987 pregnant women registered in April 2019 which is very less number of pregnant women went for ANC visit in public health facilities in Uttar Pradesh. While, during the 2nd wave of COVID-19 pandemic regarding the ANC service, it reflects only 3 percent change based on government HMIS data set, as 361201 pregnant women registered for ANC in April 2021 and its close to April 2019 i.e. 371065. Similarly, 12 percent change for institutional deliveries was found in April 2020 and no change for the institutional deliveries during April 2021. Moreover, more institutional deliveries are occurred during April 2021 against April 2020 and April 2019. The main reason for delayed health seeking was lockdown in April 2020 due to COVID-19 pandemic. The health situation was very worst in all the public health facilities during April 2021 due to COVID-19. Conclusions: COVID-19 severely affected the provision and use of MNCH services in Uttar Pradesh, India, despite efforts at service restoration and adaptations. Strengthening logistics support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.

Measuring supply-side service disruption: a systematic review of the methods for measuring disruption in the context of maternal and newborn health services in low and middle-income settings

ObjectivesDuring the COVID-19 pandemic, most essential services experienced some level of disruption. Disruption in LMICs was more severe than in HICs. Early reports suggested that services for maternal and newborn...

Barriers and facilitators to HIV pre-exposure prophylaxis uptake among transgender women in Colombia: A qualitative analysis using the COM-B model.

Transgender women [TGW] in Colombia are disproportionately affected by HIV due to their low sociodemographic conditions, varied risk behaviours, difficulty accessing health services, and discrimination. Offering pre-exposure prophylaxis [PrEP] as part of a combination of prevention strategies is an appropriate option for this population to reduce their risk of HIV infection. However, little is known about how to implement a PrEP program for TGW in Colombia. Between June and October 2020, we conducted individual interviews with 16 TGW from four different cities in Colombia. The interviews assessed contextual influences, knowledge, skills, perceptions, and beliefs. We used qualitative thematic analysis to identify themes and the Capability, Opportunity, Motivation, and Behavior framework to further delineate barriers and possible interventions. After delineating the main themes across the three subdomains of the model, nine barriers were identified: one related to capability, knowledge, and perception of PrEP; six related to opportunity, which includes, family relations, sexual work environment, stable partner relations, interactions with healthcare workers, health service provision, and community interactions and opportunities; and two related to motivation, mental health, and concerns about medication side effects. Mapping barriers with interventions generated the following intervention functions: education, training, enablement, and environmental structure; and the following policy functions: communication/marketing, legislation, and changes in service provision. Examples of possible interventions are presented and discussed.

Counts and child protection reports of diagnosed child maltreatment before and after the COVID-19 pandemic onset

BackgroundMechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic. ObjectiveTo examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19. Participants and settingAll emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021. MethodsUsing linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter. ResultsCM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03–1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05–1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05–1.12). ConclusionsThis study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset.

What factors affect early mobilisation following hip fracture surgery: a scoping review

ObjectivesIdentify and evaluate factors affecting early mobilisation on the day following hip fracture surgery.DesignMixed methods, scoping review.Data sourcesMEDLINE, AMED, CINAHL, APA PsycINFO, APA PsycArticles, ISRCTN, Clinical Trials registry and grey...

Left behind in a public services wasteland? On the accessibility of public services and political trust

Public discourse and scholars alike argue that the spatial divide in voting behavior and attitudes is rooted in geographic inequalities that serve as breeding grounds for political discontent. In previous studies, scholars have mainly focused on the economic conditions to analyze how place-based context influences the voting behavior of citizens. However, this focus on voting behavior and a small set of contextual variables do not allow us to draw direct conclusions as to how, and which, place-based factors relate to discontent on the attitudinal level.I argue that the accessibility of public service infrastructure specifically serves as a low-intensity information cue for citizens to evaluate the political performance of modern welfare states. These evaluations complement objective economic perceptions and are part of the performance-trust link. Hence, citizens should trust the government less if public services are not provided or only hard to access.I test this relationship for the German case by spatially linking the addresses of survey respondents with the location of public service facilities and collective municipallevel data. The resulting unique data set allows to explore the relationship between the accessibility of public service facilities and political trust as well as their temporal development. Results of multilevel analyses indicate that shorter distances to train stations are associated with increased trust in the government, but all other results, such as the change in service provision, remain inconclusive. The findings implicate that a long-term lack of public services contributes to geographically polarized discontent in Germany.

DS02 British Society for Dermatological Surgery sustainability guidance

Abstract Skin surgery and the patient pathway for those with skin cancer significantly contribute to the climate crisis. Dermatological surgeons recognize the role of global climate change as a significant contributor to increasing skin cancer rates and hence increase service demand. The British Society for Dermatological Surgery (BSDS) sustainability subgroup’s aim is to facilitate the integration of sustainability within all levels of service provision through the development of national sustainability guidance. We systematically searched MEDLINE, Embase, Google Scholar and the grey literature for English-language published articles related to sustainability in skin surgery. Relevant selected evidence-based articles were critically evaluated for inclusion by 11 authors and, if sufficiently rigorous, were included in the final recommendations. The guidance then underwent multiple iterations of appraisal by the guidance development group consisting of expert consultant dermatologists and Mohs surgeons, trainees and patient–public involvement. A system-wide change in service provision is required to reduce long-term service demand. This can be achieved through a focus on skin cancer prevention, patient education and facilitating early recognition of skin cancer in primary care. Another aspect includes encouraging patient empowerment through self-monitoring, thus reducing the frequency of follow-up. Lean dermatology service delivery reduces waste by utilizing efficiency, optimizing teledermatology and one-stop see-and-treat clinics, reducing travel distances, using electronic health records and identifying unnecessary/missed appointments. Reducing carbon intensity involves using low-carbon alternatives for patient/staff transport, sustainable staff food options and a wider review of procurement and supply chain that reflects sustainable trade standards. Skin surgery must re-evaluate its consumption and waste, involving reusable equipment and surgical clothing, opting for repair over machinery replacement, reducing single-use sets and using absorbable sutures and single-wrapped biodegradable packaging. Departments should preserve water used in surgery/handwashing, conserve electricity and use renewable energy sources, in addition to surgical waste management through segregation, recycling, proper disposal of environmentally harmful waste and surgical smoke evacuation. Dermatological surgery departments can advocate system-wide change by establishing a sustainability policy, which incorporates departmental sustainability education for their staff, prioritizing waste auditing and life cycle assessments and encouraging ethical purchasing. Further skin surgery sustainability research and innovation are necessary to encourage circular economy solutions for consumables and equipment use and develop sustainability quality-improvement projects and new methods of sustainable dermatological surgery service delivery. The BSDS sustainability guidance is publicly available (https://bsds.org.uk/wp-content/uploads/2022/09/2022-BSDS_Sustainability_Guidance.pdf) to inform and inspire dermatological surgery sustainability.

Achieving a real-time online monitoring system for conservation culturomics.

Environmental monitoring is increasingly shifting toward a set of systems that describe changes in real time. In ecology specifically, a series of challenges have prevented the rollout of real-time monitoring for features such as biodiversity change or ecosystem service provision. Conservation culturomics, a field concerned with interactions between people and nature, is well placed to demonstrate how monitoring might move toward a network of real-time platforms, given its existence exclusively in the digital realm. We examined a set of considerations associated with the development of real-time monitoring platforms for conservation culturomics and introduce a near real-time platform for the Species Awareness Index, a global index of changing biodiversity awareness derived from the rate of change in page views for species on Wikipedia. This platform will update automatically each month, operating in near real time (https://joemillard.shinyapps.io/Real_time_SAI/). There are plans to make the underlying data queryable via an application programing interface independent of the platform. The real-time Species Awareness Index will represent the first real-time and entirely automated conservation culturomic platform and one of the first real-time platforms in the discipline of ecology. Real-time monitoring for culturomics can provide insight into human-nature interactions as they play out in the physical realm and provide a framework for the development of real-time monitoring in ecology. Real-time monitoring metrics can be processed on private virtual machines and hosted on publicly available cloud services. Conservation now needs an online, real-time observatory that can evolve with the structure of the web.

정신장애인 대상 지역사회통합돌봄의 실행 및 성과에 대한 실무자의 인식 연구

Through focus group interviews, this study explores perceptions of practitioners participating in the community care for people with mental illnesses and analyzes the operation process and performance of the community care. The main contents are ① evaluation of the overall circumstances that have changed while promoting the community care project, ② public participation and its role in the service delivery process, ③ collaboration with various service delivery entities, ④ expansion of regional social network for providing multi-field services, and ⑤ changes in awareness of people with mental disabilities and mental health through the community care. In terms of changes in users, the major keywords include expansion of community services and user-centered service provision method. In regards to changes in the service delivery system, the major keywords are ① securing access to regional services, ② changes in service provision methods based on linkage and cooperation, and ③ general changes in community service provision and community perceptions of care. The results of the analysis serve as evidence in evaluating the changes in the service users and the service delivery system, and identifying the performance and limitations of the community care project for people with mental illnesses. This study provides basic knowledge necessary to develop a community-centered mental health service system and service delivery method in the future. This study will contribute to the establishment and expansion of a community-centered mental health service model that supports the mentally disabled to return to the community and normalized life.

P019 Improving new patient appointment utilisation in rheumatology advanced practice physiotherapy

Abstract Background/Aims Long Rheumatology waiting lists in the UK were further affected by the COVID-19 pandemic; resulting in negative impacts upon the timeliness and efficiency of patient care. The use of Advanced Practitioners within Rheumatology care pathways has been shown to be safe and effective; they can support the Rheumatology workforce and expedite care where patients are appropriately triaged to them. As part of a service provision change in a NHS Trust, an Advanced Practice Physiotherapist (APP) post was funded with the intent to harness these benefits. Initial utilisation of the APP appointments within the Rheumatology provision was found to be low and could be improved. A Quality Improvement (QI) Project was initiated, with the aim to increase APP appointment utilisation to at least 85% over a period of four months, and for at least 75% of these appointments to contain patients who had been appropriately triaged. Methods The ‘Model for Improvement’ was chosen as the QI approach. The project was led by an APP. Firstly, a stakeholder analysis was performed to identify staff with influence and interest in the project. A root cause analysis found lack of awareness of triaging clinicians and challenges with booking processes as potential reasons for lower-than-expected appointment utilisation. Change interventions were devised and tested over three Plan, Do, Study, Act (PDSA) cycles. PDSA one developed communication with booking and triage staff to clarify these processes with them. PDSA two educated clinical staff about the APP role, triage criteria and the booking procedures confirmed in PDSA one. PDSA three focused upon sustaining change by reinforcement of the topics established in PDSA two among staff. Outcome measures used were the percentage of available APP appointments utilised per week, and the percentage of these which contained patients who were appropriately triaged. Results APP appointment utilisation increased from a mean of 22% pre-project to 61% during the change intervention period. Sixty-three patients were seen over the 17-week change intervention period; of which 86% had been appropriately triaged. Data showed that 70% of the patients directed to the APP were managed by them (24% discharged and 46% reviewed). Of the remaining patients, 13% were followed up by a Rheumatologist, 12% did not attend and 5% had an alternative outcome such as awaiting advice. Conclusion This QI project led to an improvement in Rheumatology care provision locally. Engagement with support staff, education of clinical staff and implementation of clear standard operating procedures improved the utilisation of the Rheumatology APP resource. Results suggest that the APP role was effective locally in managing appropriately triaged patients, without a negative effect on patient care or other services. Continuing to improve utilisation will support management of the Rheumatology waiting list and improve patient care. Disclosure S. East: None. G.J. McCall: None. P.A. Watson: None. P. Smith: None.

Profile of injury cases before, during and after lockdown of COVID-19 pandemic: a hospital based study

Background: Injuries show a significant burden of morbidity, disability and mortality throughout world, especially in lower-middle income nations. Injuries result from road traffic crashes, falls, burns, and acts of violence against oneself or others, among other causes. Road Traffic Accidents are especially dominant among injuries, which are unintentional. The lockdown has resulted in dramatic changes in service provision from emergency departments and hospitals. And the pattern of the injuries has differed because of different reasons being reduced mobility, isolation at home, boredom and so on. The aim of this study was to assess the type of injury cases reaching a tertiary care hospital in Bangalore before, during and after lockdown of the COVID-19 pandemic and its profile. Methods: The data was collected from the hospital records of all inpatients of selected tertiary care hospitals. Results: Incidence of RTA and Assaults are observed to be high constituting 52.5% and 31.4% respectively. The change in trend of injuries indicated a dropdown in injury cases during lockdown and the increase of cases after lockdown relaxations. Conclusions: Road traffic accidents was the most common cause of injury observed in this study, with specifically 2-wheeled vehicles were most involved. The development of trauma registries all over the country containing minimum epidemiologically desired data is the need of the time for India. The data in the hospital records should be standardized and centralized.

Land-Use/Land-Cover Change and Ecosystem Service Provision in Qinghai Province, China: From the Perspective of Five Ecological Function Zones

Qinghai Province is an important part of the Qinghai-Tibet Plateau and has special importance in the construction of ecological civilisation in China, which is related to the ecological security of the country and long-term development. The land is the basis of terrestrial ecosystem services. Land use/cover change (LUCC) can alter the structure, distribution and processes of terrestrial ecosystems, thereby affecting ecosystem services. Ecological Function Zone (EFZ) is the special zone designated by the government to protect ecosystems more effectively. Studying the response of ecosystem services value (ESV) to LUCC within EFZ is of great significance to the construction of ecological civilization in Qinghai Province. This study uses five periods of land use data from 1980 to 2020 and selects the equivalent factor method, correction method and elasticity model to analyse the characteristics of land use change and its impact on the value of ecosystem services. The conclusions are as follows. (1) The results showed that the ESV of Qinghai Province decreased from 822.559 billion yuan in 1980 to 819.903 billion yuan in 2000, and then increased rapidly to 905.775 billion yuan in 2020, showing a total increase of 83.216 billion yuan (1 RMB equates to 0.144129 USD). The restoration of grassland and the expansion of water bodies are the main reasons for the growth of ESV. (2) The ESV of Sanjiangyuan EFZ was the highest, followed by Qaidam EFZ, Qinghai Lake EFZ and Qilian Mountains EFZ, while Hehuang EFZ was the lowest. (3) The elasticity of the ESV to LUCC generally declined in all EFZs. Every 1% change in the LUCC in the Qaidam EFZ will result in a 4.78% change in ESV, followed by the Sanjiangyuan EFZ (2.56%), Qilian Mountains EFZ (2.1%), Qinghai Lake EFZ (1.01%), and the Hehuang EFZ with the lowest elasticity index (0.53%). (4) The distribution of the high values of the ESV elasticity gradually expands, with a clear spatial distribution characteristic of high west and low east. (5) The most suitable area for urban construction in Qinghai Province is the Hehuang EFZ, and urban construction in the Qaidam EFZ should avoid encroaching on water bodies or polluting water sources. The conclusions can provide a reference for optimising the land use structure and harmonising conservation and development in Qinghai Province.

Health status of Syrian refugees in Ireland - research and routine data informing service provision.

The Irish government agreed to accept up to 4000 Syrian refugees for resettlement in Ireland in 2016. Prior to their arrival in Ireland, health screening was carried out by the International Organisation for Migration. GP assessments to address immediate health needs and facilitate integration into local primary care were conducted on arrival. Cross-sectional data from a self-completed questionnaire among Syrian Refugees aged 16 years and older resident in emergency reception centres (EROCs) are reported along with data from GP assessments. The questionnaire, comprising validated instruments, was developed for a similar study in Norway. From the research questionnaires, two-thirds of the respondents reported their overall health status to be good or very good. The most common health condition was headache and the most common medications used were painkillers. Those experiencing chronic pain were three times less likely to rate their general health as good compared with those without pain. From the GP assessment data, we identified that 28% had high blood pressure, 61% were assessed to be in need of dental care and 32% of refugees were found to have an issue with their vision. Our findings were communicated to the Health Service Executive via the Partnership for Health Equity and informed a change in service provision in relation to dental services in EROCs. In terms of further action, we conclude that pain is an important symptom to consider in terms of diagnosis and treatment, and impact on health status.

Patient‐reported outcomes post prophylactic risk‐reducing mastectomy: improved breast and psychosocial satisfaction yet poorer physical well‐being

Few studies have investigated patient-reported outcomes (PROs) for patients with high breast cancer risk undergoing elective risk reduction mastectomy and reconstruction. These patients incur operative risk in the absence of active cancer, which renders their treatment experience unique. This study aimed to identify longer-term quality of life (QoL) issues that persist in this patient cohort. A cross-sectional cohort study assessed PROs in 48 women with high breast cancer risk who attended the Royal Melbourne Hospital Risk Management Clinic, at least 12 months post-mastectomy and reconstruction, with surgery between 2011 and 2020, using the BREAST-Q© Likert surveys. The BREAST-Q© internationally validated QoL instrument scales survey data from 0 (worst) to 100 (best) in 14 domains addressing satisfaction and psychosocial issues. There was higher overall breast and psychosocial satisfaction, with scores of 11 and four, respectively, yet lower chest, abdomen and sexual well-being scores with 14, three and four, respectively, in contrast to normative BREAST-Q© data from >1000 women without prior breast cancer or breast operations. High average scores >90 were found for patient satisfaction with surgical, medical and office staff. Twenty-one patients had an average score of 63 for satisfaction with breast implants, while 27 patients post-DIEP had average scores >72 for abdominal well-being, appearance and overall outcomes. Higher mean QoL outcomes were found with DIEP flap in all domains, compared with breast implant reconstruction. QoL assessment with PROs 12 months post-risk reduction mastectomy and reconstruction demonstrated higher psychosocial well-being, yet highlights physical implications, with patients experiencing reduced chest, abdomen and sexual well-being, compared with normative BREAST-Q© control data. Higher mean QoL outcomes were found with DIEP flap compared with breast implant reconstruction. PROs studies can identify unmet needs and facilitate change in service provision.