Travel Cost Research Articles

Exercise-Based Telerehabilitation for Heart Failure Patients Declining Outpatient Rehabilitation - A Randomized Controlled Trial.

Purpose: Cardiac rehabilitation participation rates are low despite strong recommendations, and many chronic heart failure patients remain physically inactive. Rural living, long travel distance, costs, age, and frailty might be factors explaining this. To increase cardiac rehabilitation uptake, we designed an exercise-based randomized controlled telerehabilitation trial enabling chronic heart failure patients unable or unwilling to participate in outpatient cardiac rehabilitation to exercise at home. Aim was to evaluate the long-term effects of telerehabilitation on physical activity levels.Methods and results: CHF patients (n = 61) with reduced (≤40%), mildly reduced (41-49%), or preserved ejection fraction (≥50%) were randomized (1:1) to telerehabilitation (n = 31) with an initial 3-month group-based high-intensity exercise telerehabilitation program or control (n = 30), with regular follow-up visits over a 2-year period. All participants attended a "Living with heart failure" course. Outcomes were measures of physical activity, peak oxygen uptake, 6-minute walk test distance, quality of life, morbidity, and mortality. We found no significant differences between groups for long-term changes in moderate to vigorous activity (MVPA) or peak oxygen uptake from baseline to the 2-year follow-up. Nor quality of life differed between groups, but both groups had significant within-group improvements in score on the Minnesota living with heart failure questionnaire (p = 0.000) and improvement in EQ-5D VAS score was significant (p = 0.05) in the telerehabilitation group.Conclusions: Telerehabilitation performed as home-based real-time high-intensity exercise sessions provided by videoconferencing for participants unable or unwilling to participate in standard outpatient cardiac rehabilitation did not affect long-term physical activity levels or physical capacity as expected. Still, a positive effect on health-related quality of life was seen in both groups.

Developing a Model to Study Walking and Public Transport to Attractive Green Spaces for Equitable Access to Health and Socializing Opportunities as a Response to Climate Change: Testing the Model in Pu’er City, China

Green space is not always equitably located in cities, and the attractiveness of green space varies, leaving some residents with easy access to high-quality parks and others with little or no access or access to under-maintained parks. To remedy these inequities, this study identified attractive and well-utilized recreational green spaces and developed a model to measure the likelihood of using these recreational green spaces (PSG). The goal was to reduce the travel time and cost of walking or using public transportation to get to green spaces and to design all green spaces to be attractive. The data come from the perspective of the city’s public transportation system and residents’ personal choices. First, the attractiveness of recreational green spaces was calculated from big data on the geolocation of cell phones, measuring the level of provision of recreational green spaces and the trip rates of urban residents. After that, the travel cost to reach recreational green space in residential areas was calculated according to residents’ travel habits. Finally, the probability of all recreational green spaces in the city being used was calculated by combining the population size of residential areas. Taking Pu’er City in China as an example, the attractiveness and utilization rates of recreational green spaces were calculated by PSG, and the results of the study showed that the probability of residents choosing to use the recreational green spaces that are closer to the residential area, with a larger population capacity, and with a higher attractiveness is the highest. The results of the study help promote equitable access to health and socialization opportunities for individuals and communities, thereby promoting environmental justice to help mitigate and respond to climate change.

Optimizing Traveler Behavior Between MADINA and JEDDA Using UPPAAL Stratego: A Stochastic Priced Timed Games Approach

This study looks at how travelers move between MADINA and JEDDA, using the UPPAAL Stratego tool to tackle the complexities of urban mobility. As cities grow, effective transportation planning becomes more challenging. Travelers have three options: car, bus, and train. The choices for car and bus travel are impacted by traffic conditions, which can vary between heavy and light, affecting both travel time and cost. We propose a detailed mathematical model that captures all possible scenarios related to these travel options, incorporating the uncertainties of real life. This allows us to simulate different traffic situations. By using UPPAAL Stratego, we evaluate three strategies: the Safe Strategy, which minimizes risk; the Fast Strategy, which aims to reduce travel time; and the Fast and Safe Strategy, which seeks a balance between speed and safety. This paper starts with an introduction to the Stochastic Priced Timed Games approach, highlighting its relevance in modeling dynamic travel environments. We then provide an overview of UPPAAL Stratego, showcasing its abilities in generating, optimizing, and comparing strategies. Next, we outline our mathematical model, explaining the assumptions, parameters, and data sources we used. Our simulation results illustrate how each strategy performs under different conditions, shedding light on traveler preferences and behaviors. The findings underscore the significance of accounting for traffic variability in travel planning and offer important insights for urban transportation policies aimed at improving the traveler experience and optimizing resource use. Additionally, we emphasize the theoretical contributions of our model by demonstrating its applicability to real-world scenarios and its potential to inform future research in urban mobility optimization. Ultimately, this research adds to the growing knowledge of smart transportation systems, demonstrating how formal mathematical modeling can address complex real-world challenges and inform future urban mobility strategies.

Patient-initiated follow-up supported by asynchronous telemedicine versus usual care in spondyloarthritis (TeleSpA-study): a randomised controlled trial of clinical and cost-effectiveness.

With rising health-care expenditures and workforce shortages, sustainable alternatives to traditional outpatient follow-up strategies are required to optimise care efficiency. We aimed to investigate the cost-effectiveness and clinical effectiveness of patient-initiated follow-up (PIFU) supported by asynchronous telemedicine for patients with spondyloarthritis compared with usual care in daily practice. TeleSpA was a multicentre, pragmatic, open-label, randomised controlled trial. Patients with spondyloarthritis and stable disease were randomly assigned (1:1) to either the PIFU and asynchronous telemedicine group or usual care group. All patients received a scheduled outpatient visit at baseline and after 1 year. Patients were monitored remotely at 6 months (PIFU and asynchronous telemedicine) or at the discretion of the treating rheumatologist (usual care). The primary outcome was the number of rheumatology visits within a 1-year period. A trial-based 1-year health-economic evaluation from a Dutch health-care perspective (only including health-care costs) and societal perspective (also including travel costs and work productivity losses), per the Dutch guidelines was used to estimate cost-effectiveness. The safety analysis was done in the intention-to-treat population and was based on spontaneous reports of adverse events and serious adverse events or as observed by the research team. The primary analysis was in the intention-to-treat population. Individuals with relevant lived experience were involved in the study design. This trial was registered with the Dutch National Trial Register (NL71041.068.19) and ClinicalTrials.gov (NCT04673825) and is completed. Between Dec 2, 2020, and June 20, 2022, 200 patients were randomly assigned to PIFU and asynchronous telemedicine (n=100) or usual care (n=100). 79 (40%) of 200 participants were women, 121 (60%) were men, and the mean age was 55·0 years (SD 11·9). After 1 year, the mean number of rheumatology visits was 1·9 (SD 1·5) for the PIFU and asynchronous telemedicine group and 2·6 (1·3) in the usual care group (mean difference -0·7 [95% CI -1·0 to -0·3]; 25·4% reduction; p<0·0001). PIFU and asynchronous telemedicine was cost-effective from a health-care perspective, saving health-care costs (-€180 [95% CI -921 to 560]) without a loss in quality-adjusted life-years (0·004 [95 % CI -0·022 to 0·030]). Seven non-trial-related adverse events occurred in the PIFU and asynchronous telemedicine group and eight in usual care group (including one death). PIFU and asynchronous telemedicine resulted in significant and clinically meaningful reductions in rheumatology visits. This was not at the expense of health outcomes and saved health-care costs. Dutch Arthritis Society.

Telemedicine and telehealth

Regular hospital visits can be expensive due to travel costs, especially in rural areas. Fortunately, when telemedicine services are used through video conferencing or other virtual technologies, doctor visits can be reduced. Therefore, telemedicine saves the patient and the medical staff time and treatment costs. In addition, with its fast and efficient operations, it can simplify the workflow of hospitals and clinics. This innovative technology makes it easier to monitor discharged patients and manage their recovery. In conclusion, it is enough to say that telemedicine can create a win-win situation. The purpose of this article is to examine the main trends, treatment workflow characteristics, and barriers to the use of telemedicine in healthcare. As a new technology, telemedicine is preferred by large hospitals. With the development of Internet technology, digitization and information have been applied to telemedicine, but telemedicine still has many limitations due to many factors. This article summarizes the evolution of telemedicine. The development of telemedicine at home and abroad was discussed. The use of telemedicine was explored including the feasibility and limitations of commercialization and development. and provide a vision for the integration of these technologies into the medical field has resulted in the telephone, which is now available worldwide. This article presents telemedicine in three main areas, including current status, challenges and opportunities based on research and implementation. he integration of these technologies into the medical field has resulted in the telephone, which is now available worldwide. This article presents telemedicine in three main areas, including current status, challenges and opportunities based on research and implementation.

Visualization of commuting areas and examination of jobs-housing balance with the adoption of excess commuting

Rapid urban growth extends the boundaries of urbanized areas and makes people spend extra travel cost on the journey to work. Scholars have examined commuting behaviors between residence and work places within a region, and suggested the conceptual theory of jobs-housing balance to evaluate if there are sufficient job opportunities for residents in the region. A quantitative measurement of excess commuting is proposed to reflect the degree of jobs-house balance. However, current studies focus on the evaluation of excess commuting and the causality of spatial restructuring between residence and workplace, the spatial extend of excess commuting in an urban region is not visually delineated. In addition, conventional studies acquire static data such as statistic data or other survey data to analyze impacts of commuting patterns on urban formation. Today the emergence of spatial big data sheds light on the causality of urban commuting from higher spatial and temporal resolutions. This study aims to examine the degree of jobs-housing balance through the calculation of excess commuting and represent the spatial extent of excess commuting of Taichung metropolitan area in Taiwan. Electronic Toll Collection (ETC) data, the spatial big data which is publicly accessible in Taiwan, is introduced as the commuting data and to calculate three key parameters of excess commuting, Tmin, Tobs, and Tmax. The three parameters are used to visualize the extent of commuting zones and examine commuting patterns of Taichung metropolitan area and observe the spatial relationship between those patterns and land-use types. The evaluation of excess commuting indicates that the degree of jobs-housing imbalance in Taichung metropolitan area is similar to Los Angeles metropolis in US. The analytical results explain how ETC data can be successfully used for the calculation of excess commuting, and visualization of the extent of commuting regions. In addition, after the cluster analysis of residential areas, it is intuitive to observe spatial correlation between hot zones of residential areas and the spatial extent of theoretical maximum commuting, and shows that the scenarios of commuting can be considered as an indicator to explain the possibility of urban expansion in the future.

Post COVID-19 – Students’ Expectations of HyFlex Learning Opportunities

Posterior to COVID-19, many universities have returned to ordinary classroom education. Recognizing the impact of the isolation in the form of psychological strain, one of the takes were to return to on campus education to secure follow up and the personal contact with lecturers and fellow students. However, in some studies, the COVID-19 paved the way for combinations of ways of studying that many students had been waiting for. Hence, returning to an on-campus solution is not an option. Each year after the COVID-19 we have done investigations into “if” and “why” the students prefer a HyFlex solution and many of the same answers keeps being repeated: home situation, work situation and travel costs. The last investigations have also included “sustainability” as a reason for not attending classes physically. Through our mixed methods approach to collecting data, we will present and discuss our findings and the trend in the longitudinal study.

Economic and environmental pollutant impact of Maternal-Fetal Telemedicine.

The global issue of greenhouse gas emissions has significant implications for the environment and human health. Telemedicine provides a valuable tool for delivering healthcare while reducing gas emissions by limiting the need for patient travel. However, the environmental effects of telemedicine in high-risk pregnancy populations remain unassessed. The aim of this study was to estimate the economic and environmental impact of an outpatient teleMFM program. This retrospective cohort study examined all visits at 3 teleMFM clinics more than 90 miles away from the nearest in-person MFM office between 10/1/2021 and 6/1/2022. Travel distances and times were calculated for each appointment between the patient's home, telemedicine clinic, and nearest in-person clinics, using zip code data and Google Maps web-based map calculator tools. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if in-person using inflation-adjusted Internal Revenue Service annual standard mileage reimbursement rate ($0.58 per mile), and the U.S. Environmental Protection Agency Office of Transportation and Air Quality's average annual emissions and fuel consumption for gasoline-fueled passenger vehicles. During the study period a total number of 2,712 appointments were scheduled, of which 2,454 were kept (cancellations removed) and analyzed. Visiting a teleMFM clinic resulted in 204 miles, 200 minutes and 118.32 dollars saved per patient visit compared to visiting the nearest in-person clinic. Over a 7 month period a total of 96.6 metric tons of emissions were saved. This study demonstrates the positive economic and environmental impact of teleMFM utilization in communities remote from in-person care. Given the contribution of greenhouse gas emissions to climate change, such findings may provide strategies for our specialty make informed policy, advocacy, and business decisions.

Impact of low back pain and care-seeking behavior in an Indigenous community in Suriname: a qualitative approach.

Low back pain is a significant global public health issue affecting over half a billion people and contributing to disability worldwide. The impact of disability related to low back pain is growing, particularly in low- and middle-income countries. In contrast with previous research, current evidence shows Indigenous Peoples also experience low back pain's disabling effects. A clinical ethnographic can contribute by attempting to understand the data through the perspective of Indigenous Peoples. A clinical ethnographic study was conducted in Galibi, a Kalinya rural Indigenous village in Suriname, with support of the local traditional authority. The main objective was to explore the impact of low back pain and care-seeking behavior from the perspective of Indigenous Peoples with low back pain. The findings were that low back pain had a significant physical and emotional impact. Despite aggravating their low back pain, participants continued many of their activities of daily life since these were essential for their (economic) survival. Furthermore, participants expressed anxiousness, financial worries, and concerns about the cause and future of their low back pain. To address their low back pain, the Kalinya Indigenous Peoples used both western and traditional care. Visits to western healthcare practitioners were limited due to logistical challenges and travel costs, and the experience was often negative. The study highlights the experiences of Kalinya Indigenous Peoples dealing with low back pain. Low back pain is a burden within Indigenous Peoples of Galibi but accepted as an integral part of their life. When in pain, Indigenous Peoples face many barriers to access western health care and visits to healthcare practitioners were often unhelpful. This contributed to a long-lasting negative impact on the Indigenous people with low back pain. Further research is needed to develop strategies that improve health outcomes related to low back pain while reducing its associated disability in Indigenous Peoples.

Economic, Environmental, and Social Value of Virtual Care in Otolaryngology: Sustainability in Quality Improvement Framework.

Apply the Sustainability in Quality Improvement framework to virtual care for Otolaryngology-Head and Neck Surgery (OHNS) patients to understand the economic, environmental, and social impacts. This project consisted of retrospective analysis of anonymized data from all appointments that took place in three academic ambulatory OHNS clinics (pediatrics, head and neck, and otology/neurotology) from fiscal years of 2021 to 2023. Data were obtained from our institution's Virtual Care Dashboard. The following metrics were calculated: travel costs avoided with virtual appointments (economic value), fuel and carbon emissions avoided with virtual appointments (environmental value), and differences in Ontario Marginalization (ON-Marg) Index scores between patients seen virtually versus in-person (social value). A total of 41,343 visits occurred over the 2-year period (18.1% virtual). Nearly all virtual visits were by telephone (99.6%). The average cost savings per virtual care visit was $87.50, and total cost savings across all 3 clinics was $640,300. Total environmental savings were 82,500 L of fuel and 246.6 metric tons of carbon emissions. There were no statistical differences in monthly average marginalization (ON-Marg) indices in patients seen virtually compared to in-person. Virtual care demonstrated financial and environmental savings for OHNS patients that can accumulate over multiple appointments. No difference in ON-Marg indices between patients assessed virtually versus in-person suggests that virtual care was accessible for patients regardless of social background. Our data suggests that virtual care may be a viable complement for delivering OHNS care that leads to fiscal and environmental savings for patients and ensures equitable access to care.

Patient and provider costs of the new BPaL regimen for drug-resistant tuberculosis treatment in South Africa: A cost-effectiveness analysis.

Drug-resistant (DR) tuberculosis (TB) is typically characterized by resistance to a single or combination of first- and/or second-line anti-TB agents and commonly includes rifampicin-resistant (RR)-TB, multidrug-resistant (MDR)-TB, pre-extensively drug-resistant (pre-XDR)-TB and XDR-TB. Historically, all variations of DR-TB required treatment with second-line drugs which are less effective and more toxic than first-line options, have a longer treatment duration and are more expensive to both patients and providers. The World Health Organization (WHO) now recommends a new second-line 3-drug 6-month all-oral regimen consisting of bedaquiline, pretomanid, and linezolid referred to as BPaL. We estimate patient and provider costs of DR-TB treatment with BPaL compared to the current standard of care in South Africa. In coordination with South Africa's BPaL clinical access programme (CAP) we conducted an economic evaluation of A) patient costs through a cross-sectional patient cost survey and B) provider costs through a bottom-up costing analysis consisting of a retrospective medical record review (patient resource-use) and top-down financial record review (fixed/shared costs such as overhead). Across both costing perspectives, we compare costs of 1) BPaL, to current standard of care options including the 2) 9-11-month standard short oral regimen (SSOR) and 3) 18-21-month standard long oral regimen (SLOR). Eligible patients included those ≥14 years old with confirmed sputum pulmonary RR/MDR-TB, pre-XDR or XDR-TB. All costs are reported in 2022 United States Dollar (US$). A total of 72 patients were enrolled and completed the patient cost survey (41.7% on BPaL, 16.7% on the SSOR and 41.7% on the SLOR). Mean on-treatment patient costs were lowest among those on BPaL ($56.6) and increased four-fold among those on the SSOR ($228.1) and SLOR ($224.7). Direct medical patient costs were negligible across all treatment regimens, while direct non-medical patient and guardian costs for travel, food and nutritional supplementation accounted for the largest proportion of total costs ($54.6, $227.8 and $224.3 for BPaL, the SSOR and SLOR respectively). In assessing provider costs, a total of 112 medical records were reviewed (37.5%, 41.1% and 21.4% on BPaL, the SSOR and SLOR respectively). Total provider costs for producing a favorable treatment outcome (cured/completed treatment) were similar among those on BPaL ($4,948.7 per patient) and the SSOR ($4,905.6 per patient) with costs increasing substantially among those on the SLOR ($8,919.9 per patient). Based on incremental cost-effectiveness ratios (ICERs), at even the lowest willingness to pay (WTP) threshold, treatment with the new BPaL regimen was more cost-effective than current standard of care treatment options (ICER: $311.4 < WTP: $3,341). When using the newly recommended BPaL regimen, cost to patients decreased by 75% compared to current standard of care treatment options in South Africa. Due in part to higher resource-use within the BPaL CAP offsetting the shorter treatment duration, cost of treatment provision through BPaL and the 9-11-month SSOR were similar. However, when considering cost and treatment outcomes, BPaL was more cost-effective than other standard of care regimens currently available for DR-TB in South Africa.

Quantifying the unseen benefits: an innovative economic valuation of the social and cultural values of trees, woods, and forests at risk

ABSTRACT Trees, woods, and forests in England are associated with a wide range of social and cultural values (S&CV). However, these treescapes (i.e. trees in any location) face increasing risks from pests, diseases, climate change, and biosecurity threats. This study addresses the urgent need for comprehensive estimates of S&CV related to England’s treescapes. Current UK policies and resource allocations are based on limited “value at risk” estimates. The study proposes a novel anchor value method for holistic S&CV valuation, resulting in an annual benefits flow ranging from £7 to £10 billion. This estimate surpasses the current natural capital accounts for England’s woodlands and underscores the importance of including S&CV in total ecosystem benefits assessments. The study also applies traditional methods, namely Willingness to Pay (WTP) and Travel Cost Method (TCM), to economically value S&CV of trees at risk from pests and diseases. These methods, focusing on local use values, yield similar estimates of just under £1 billion per year. This preliminary valuation invites further debate and scrutiny.

What does it take for rural-urban commuters to switch from driving to carpooling?

This study aims at identifying the potential ways to increase the willingness to carpool, particularly in rural–urban travel settings, where there is no/minimal public transit service (due to low population density) and purchasing a personal vehicle poses a significant financial burden for many households. To do so, we used time flexibility, defined as the tolerance for increased commute time (which can happen because of re-routing and picking up others when carpooling), as a proxy to willingness to carpool. Using structural equation modeling and survey responses from about 1000 workers and college students living in a rural county in Central Pennsylvania, we analyzed the sociodemographic, attitudinal, and situational factors that can lead to higher time flexibility when carpooling. We also investigated whether people’s time flexibility changes when they are offered monetary incentives (in terms of travel costs reimbursement). The results indicated that being a driving fan and seeking privacy when traveling reduces time flexibility, while being conscientious about environment and health leads to higher time flexibility. Moreover, females, people who had inconvenient past carpool experiences, and those living closer (within 20 min of driving) to their workplace/college showed lower time flexibility. On the other hand, people with lower income and higher driving costs were willing to tolerate longer commute times if reimbursed for a portion of their travel costs. We also found that if there is no initial level of willingness to carpool, reimbursement offers cannot do much to sway people’s decisions.

To Sustainably Ride or Not to Ride: Examining the Green Consumption Intention of Ride-Hailing Services in the Sharing Economy by University Students

An increase in ride-hailing services in the sharing economy can help to reduce the number of vehicles on the road, which will lead to a decrease in air pollution and noise pollution, an improvement in environmental conditions, a decrease in travel costs, and an increase in social benefits to travelers. Hence, there is a great need to examine the consumer’s intention toward usage of ride-hailing services in the sharing economy. The current study aims to examine the green consumption intention of eco-friendly services as an outcome of environmental responsibility and environmental knowledge. It also attempts to examine the serial mediation of green concern, value co-creation, and mediated moderation of social support as an explanatory mechanism of green consumption intention of eco-friendly services. The research design was cross-section and deductive. The respondents of the study were registered university students in Islamabad who were active consumers of major ride-hailing services in Pakistan, i.e., Uber, Careem, Uplift, InDriver, B4U Cabes, and SUVL. A total of 402 responses were gathered using purposive sampling. Partial Least Squares Structural Equation Modeling (PLS-SEM) in Smart PLS is used to evaluate the reliability of measurement instruments and the validity of the research model. The current study results showed that environmental responsibility and knowledge positively and significantly affect motivation to engage in green consumption. Furthermore, environmental concern and value co-creation partially mediate the proposed relationship. In addition, social support also moderates the association between green concern and value co-creation such that it strengthens the connection. The current research findings are an addition to the existing literature and have managerial applications with limitations preceded by future research directions.

Active travel in the university setting: Assessing the effects of social behavior, socioeconomics, and spatial location

University campuses are pooling efforts to promote active mobility to reduce their negative impacts on the urban environment, which is significantly influenced by the overreliance on motorized modes of transport. Providing sufficient and safe accessibility conditions for active travel has been highlighted as a crucial strategy for transforming campuses into more livable and sustainable areas in cities. To further explore the likelihood of active mobility uptake at university campuses, this study explored university students’ mobility patterns over time, examining the role of social behavior, socioeconomics, and spatial location factors. The Faculty of Engineering at the University of Porto, Greater Oporto, Portugal, provided the empirical focus for this research. The data analyzed were acquired through surveys of representative samples and spatial analysis over the academic years of 2012, 2017, and 2023. The statistical analysis explained the tendencies and multifactorial influences on travel behavior among university students. Results indicated that travel distance is associated with housing options and travel costs, whereas access to a metro station was associated with walking or cycling. Hence, this study contributed to a deeper understanding of active travel behavior. It provided insights to guide planning practitioners and decision makers in creating integrated transport policy packages that address the barriers and needs of the university community and the surrounding neighborhoods.

Prevalence of hypertension and factors associated with the utilization of primary health care services for hypertension among hypertensive population aged 40 years and above in Pyin Oo Lwin Township, Myanmar.

Utilization of hypertension services at primary health care levels has not been assessed at township level, since launching of PEN interventions in Myanmar. This study aimed to determine the factors associating with the utilization of primary health care services for hypertension among 40 years and above hypertensive population. Community-based cross-sectional study was done in Pyin Oo Lwin Township, 2023. Multi stage sampling was conducted to recruit 40 years and above participants; response rate was 85%. Joint National Committee (JNC7) classification was used to define hypertension. Among hypertensive participants, descriptive analysis, Chi squared test and multiple logistic models were conducted, with a significance level of 0.05. Out of 1001 screening participants, prevalence of hypertension was 38.6% (386). Among 386 participants, 51.8% (200) utilized primary health care services provided by public health facilities. Rural residents (AOR = 2.79, CI = 1.68, 4.67), known hypertension (AOR = 4.36, CI = 2.39, 8.23), good perception on hypertension (AOR = 0.30, CI = 0.14, 0.62), perceived cost of travel as necessary (AOR = 0.57, CI = 0.35, 0.92) and awareness of available services (AOR = 4.11, CI = 2.55, 6.71) were associated with the utilization of primary health care services for hypertension. This study provided context-specific scientific evidence to tackle existing problems of low utilization of PHC services for hypertension. Strengthening health care infrastructure for quality hypertension care at primary health care level was also recommended.

Determining Tourist Destination Priorities Using Website-Based Particle Swarm Optimization Methods (Case Study : North Padang Lawas Regency)

. Optimization of tourist routes is very important to minimize travel time and reduce travel costs. This study focuses on optimizing tourist routes in North Padang Lawas Regency using Multi Attribute Utility Theory (MAUT), and Particle Swarm Optimization (PSO) in the context of the Traveling Salesman Problem (TSP). This study discusses problems such as the lack of priority of tourist destinations and the need for shorter travel times. The research process includes problem identification, literature review, data collection through field observations and interviews, and data processing with MAUT to prioritize destinations. The identified priority destinations are Hotel Sapadia Gunung Tua, Barumun Nagari, Batik Sekar Najogi, Durian and Manggis Agrotourism, Rumah Makan Holat Alhamdulillah, Waterboom Gunung Tua, and Candi Bahal I, II, III. Furthermore, PSO is applied to determine the optimal travel route. PSO finds a route with a total travel time of 351 minutes, although the three-day travel time is extended to 375 minutes.

Performance Evaluation for the Expansion of Multi-Level Rail Transit Network in Xi’an Metropolitan Area: Empirical Analysis on Accessibility and Resilience

As the main form of new urbanization, the coordinated development of cities in metropolitan areas requires reliable and efficient rail transit skeleton support. However, in the rapid development of metropolitan areas, the layout and analysis of multi-level rail transit systems have a certain lag. Taking the Xi’an metropolitan area as an example, this study analyzes the comprehensive accessibility and resilience of the multi-level rail transit network, and proposes an expansion plan accordingly. The traffic analysis zone (TAZ) is divided by towns and streets, and the relationship between points of interest (POIs) and the regional average level is analyzed using DEA. The improved weighted average travel time model is built with the analysis results as regional weights; a site selection model based on multiple construction influencing factors is proposed, and four expansion plans, namely, economic optimal, environmental optimal, transport optimal, and integrated optimal, are designed. The peak passenger flow scenario and the “failure–reparation” scenario during the entire operation period are designed to analyze the resilience of four plans, and the resilience is quantified by the elasticity curve of the maximum connected subgraph ratio (MCSR) changing over time. The research results show that the transport optimal plan has the best comprehensive accessibility and resilience, reducing travel costs in Houzhenzi Town, which has the worst accessibility, by 34%. The expansion model and evaluation method in this study can provide an empirical example for the development of other metropolitan areas and provide a reasonable benchmark and guidance for the development of multi-level rail transit networks in future urban areas.

Economic Benefits and Uses of Indigenous Seasonal Weather Forecasts in Zimbabwe

This study presents a seminal contribution regarding the economic value of indigenous seasonal weather forecasts in Zimbabwe. Many farmers (58%) use indigenous seasonal weather forecasts to make maize farming decisions such as selecting suitable varieties. The main indicators used for indigenous seasonal weather forecasts are flowering and fruition of specific trees. Based on travel cost analysis, which incorporates a multi-purpose visit scenario, the study establishes the economic importance of indigenous seasonal weather forecasts with a consumer surplus of US$1,044 per year among the 290 farmers using the forecasts. There is therefore a need to integrate indigenous weather forecasts into national seasonal weather forecasting and disaster risk reduction systems to complement modern seasonal weather forecasts. Co-production of seasonal weather forecasts with farmers is proposed in this regard. This further calls for the need to digitally document, visualize, and disseminate indigenous seasonal weather forecast indicators to a wider audience to increase their use.

Physician preferences for Online and In-person continuing medical education: a cross-sectional study

BackgroundThe worldwide market for continuing medical education (CME) was severely affected by the COVID-19 pandemic, which precipitated an increase in web-based CME course attendance. Virtual education methods may be effective for engaging learners and changing behaviors. However, more information is needed about physician preferences for in-person vs. livestreamed CME courses in the postpandemic era. Because of the paucity of data regarding this topic, the current study was designed to evaluate CME participant characteristics, preferences, engagement, and satisfaction with traditional in-person vs. virtual educational methods.MethodsA cross-sectional study was performed of attendees of two large internal medicine CME courses held in 2021. Both CME courses were offered via in-person and livestream options, and were taught by Mayo Clinic content experts. Participants, who consisted of practicing physicians seeking CME, completed a 41-question survey after CME course completion. Statistical comparisons were performed by using Fisher exact tests for all survey items, except for those with ordinal response sets, which were compared with Cochran-Armitage trend tests.ResultsA total of 146 participants completed the survey (response rate, 30.2%). Among the 77 respondents who attended in-person courses, the most frequent reasons indicated were the opportunity to travel (66%) and collaboration/networking with others (25%). Among the 68 respondents who attended the livestream courses, the most frequent reasons indicated included COVID-19–related concerns (65%), convenience (46%), and travel costs (34%). The percentage of respondents who indicated that they would choose the same mode of attendance if given the option again was higher for those who attended in person than for those who attended via livestream (91% vs. 65%, P < .001).ConclusionsThese data suggest that in-person course offerings will continue to be a preferred learning method for some physicians. However, most respondents who attended virtually preferred that method. Therefore, hybrid CME models offering both in-person and virtual options may be most beneficial for meeting the needs of all CME learners.