Demand For Care Research Articles

Scheduling, Income, and School Closures: Unlocking the Key Drivers of Home Care Personal Support Unplanned Absences Through Time-to-Event Regression Analysis.

Healthcare workers' unplanned workplace absences are a global challenge with consequences for care recipients, employers, and healthcare systems. With rising home care demand, understanding drivers of home care personal support worker (PSW) absences can inform management of labor supply through government and employer policies. In this paper, we examined predictors of PSWs' unplanned absences within a large, administrative, longitudinal dataset (2019-2021) from a home care organization in Ontario, stratified by time (pre-, early-, and mid-pandemic). After an initial spike, unplanned absence rates were generally lower during the pandemic. Cox-proportional hazard regression models for unplanned absences highlighted how increasing income and reducing travel distance between visits can be expected to decrease the hazard of unplanned absences. School closures significantly correlated with unplanned absences, highlighting disruptions within the broader care economy. As demand for home care accelerates, reducing unplanned absences will improve care consistency for those relying on PSWs to remain safe at home.

Exploring the scope and output of neurosurgery in nepal: analysis of workforce development, challenges, and opportunities to neurosurgical care

Background: The Lack of access to competent neurosurgical treatment in low-income countries is a serious concern. To advance the field, research plays a crucial role. This article provides an overview of the neurosurgical landscape in Nepal, identifying areas that require further research for better patient outcomes. Recent initiatives offer hope for closing the access gap and improving neurosurgical care globally. Methodology: The authors used PubMed database to search for articles containing the keyword “Neurosurgery in Nepal” with at least one Nepali author. All the articles published between 1 January 2000, and 29 March 2023, were included. The data obtained from this search was downloaded in CSV format and manually entered into Excel for analysis. Additionally, data regarding the number of medical colleges that train neurosurgery residents were gathered from the website of the Ministry of Education. Results: A review of 316 neurosurgery-related articles in Nepal revealed case reports (93) as the most common, alongside review articles (41) and clinical studies (25). Seven medical colleges provide MCh training, and one institute offers NBMS training, producing 11 neurosurgeons annually. This underscores the need to bridge the neurosurgical gap in Nepal. Conclusion: In conclusion, to address the growing demand for specialized care and provide better access to neurosurgical services, it is essential to prioritize the expansion of neurosurgical residency programs and the promotion of evidence-based medicine training.

Development of a Microsimulation Model to Project the Future Prevalence of Childhood Cancer in Ontario, Canada.

Estimates of the future prevalence of childhood cancer are informative for health system planning but are underutilized. We describe the development of a pediatric oncology microsimulation model for prevalence (POSIM-Prev) and illustrate its application to produce projections of incidence, survival, and limited-duration prevalence of childhood cancer in Ontario, Canada, until 2040. POSIM-Prev is a population-based, open-cohort, discrete-time microsimulation model. The model population was updated annually from 1970 to 2040 to account for births, deaths, net migration, and incident cases of childhood cancer. Prevalent individuals were followed until death, emigration, or the last year of simulation. Median population-based outcomes with 95% credible intervals (CrIs) were generated using Monte Carlo simulation. The methodology to derive model inputs included generalized additive modeling of cancer incidence, parametric survival modeling, and stochastic population forecasting. Individual-level data from provincial cancer registries for years 1970 to 2019 informed cancer-related model inputs and internal validation. The number of children (aged 0-14 y) diagnosed with cancer in Ontario is projected to rise from 414 (95% CrI: 353-486) in 2020 to 561 (95% CrI: 481-653) in 2039. The 5-y overall survival rate for 2030-2034 is estimated to reach 90% (95% CrI: 88%-92%). By 2040, 24,088 (95% CrI: 22,764-25,648) individuals with a history of childhood cancer (diagnosed in Ontario or elsewhere) are projected to reside in the province. The model accurately reproduced historical trends in incidence, survival, and prevalence when validated. The rising incidence and prevalence of childhood cancer will create increased demand for both acute cancer care and long-term follow-up services in Ontario. The POSIM-Prev model can be used to support long-range health system planning and future health technology assessments in jurisdictions that have access to similar model inputs. This article describes the development of a population-based, discrete-time microsimulation model that can simulate incident and prevalent cases of childhood cancer in Ontario, Canada, until 2040.Use of an open cohort framework allowed for estimation of the potential impact of net migration on childhood cancer prevalence.In addition to supporting long-term health system planning, this model can be used in future health technology assessments, by providing a demographic profile of incident and prevalent cases for model conceptualization and budget impact purposes.This modeling framework is adaptable to other jurisdictions and disease areas where individual-level data for incidence and survival are available.

In Case You Haven't Heard…

The online therapy industry has grown significantly in recent years, driven by the increasing demand for accessible mental health care. BetterHelp, the world's largest online therapy platform, has surpassed 5 million people across over 100 countries worldwide who have trusted its therapy services on their mental health journey, according to a Jan. 22 news release. Courtesy of BetterHelp's network of 35,000 licensed and vetted therapists, 72% of BetterHelp clients experienced a reduction in symptoms in their first 12 weeks of therapy on the platform. “As this milestone and report both demonstrate, BetterHelp is doing something that has never been done before: providing access to high‐quality mental health care at a massive scale,” said Fernando Madeira, president and CEO of BetterHelp. “Over 5 million people have trusted us with their mental health journeys at sensitive moments in their lives, and we're proud to be able to provide this transparency about our platform and clinical outcomes in return.” In 2024, BetterHelp eradicated barriers to wellness across the globe, with 40% of new members experiencing the benefits of therapy for the first time ever, and met over 93% of client preferences when matching with a therapist, the release stated.

The inclusion of sex and gender in research methodology, funding, and publication: A systematic review.

Gender inequity in access to and outcomes of orthopedic care demands research that properly analyses data based on sex and gender. Orthopedic surgeons have an obligation to mitigate gender inequity in the provision of care by addressing the sex and gender bias in orthopedic research methodology, grant funding, and publication demonstrated by this review. This study aimed to review the literature on known gender inequities in orthopedic care, as well as sex and gender bias in orthopedic research methodology, funding, and publication; and to then to outline mitigating strategies. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published in English between 2000 and 2024. The databases searched included MEDLINE, PubMed, EMBASE, Scopus and Cochrane, and Scopus. A total of 70 studies were identified that met inclusion criteria. Women often have poorer access to care and poorer outcomes than men for many common orthopedic procedures. Sex-specific analysis reached a maximum of 34% for combined basic science, translational and clinical research in major orthopedic journals. Women were less likely than men to be study participants. Orthopedic outcome measures do not adequately account for the epidemiological factors that predominantly affect women including pregnancy and care of the (often extended) family or differences in factors such as pain and return to work or sport. The probability of sex-related reporting was higher in papers with women as first and authors last, often in journals with lower impact factors. Women orthopedic researchers received only 55.2% of the funding of men orthopedic researchers. While women's first authorship increased statistically significantly from 1995 to 2020 (6.70%-15.37%, P​<​0.001) manuscripts submitted by women were less likely to be published, and those with a woman first author demonstrated a lower citation rate. Mitigating strategies to address biases in research methodology and publication include adopting evidence-based Gender Specific Analysis (GSA) methods into the orthopedic research process, considering GSA as a prerequisite for research grants and manuscript publication, increasing the diversity of orthopedic editorial boards, and supporting the careers of women in the orthopedic academic community through a more gender equitable environment and career-long mentorship and sponsorship. There are well-documented gender inequities in orthopedic care. Addressing the identified sex and gender bias in orthopedic research methodology, funding, and publication is a public health imperative. Mitigating strategies include education and the integration of sex and gender analysis in each step of the research to publication pathway, and increasing women in academic orthopedics through mentorship, sponsorship, and more inclusive department culture and policies. IV.

The Danish Gynecological Cancer Nursing Database- implementation of ERAS principles in surgery care demands systematic monitoring of data

The Danish Gynecological Cancer Nursing Database- implementation of ERAS principles in surgery care demands systematic monitoring of data

Examining social support, psychological resilience and general wellbeing of newly employed nurses at quezon city general hospital

Caring professions, such as nursing, can be emotionally draining, resulting in high stress levels and career burnout. Nurses face multiple and complex challenges in a profession characterized by work intensification, increased accountability, and demands for high-quality patient care. Nurse stress and burnout are growing concerns, but resilience in nursing has been linked to positive outcomes such as improved care quality, enthusiasm, and commitment, as well as positive outcomes for patients. Research suggests that social support can significantly predict coping strategies (Kong et al., 2019). Nurses with a high level of social support demonstrate better social adaptation skills and use positive coping strategies to address challenges. This study aimed to examine social support, psychological resilience, and general well-being among newly employed nurses at Quezon City General Hospital. The findings of this study will greatly benefit these nurses by providing insights into how social support and resilience can enhance their well-being and professional performance. The study employed a descriptive research method, collecting data through a survey questionnaire. Close-ended questions were used to gather actionable, qualitative data, which were then interpreted into visual insights such as graphs, charts, and concept maps. The researcher utilized the descriptive survey method within a quantitative research design.

Use of the structured emergency nursing framework HIRAID® improves patient experience: A stepped-wedge cluster randomised control trial in rural, regional and metropolitan Australia.

Emergency departments have high levels of uncertainty, long wait times, resource shortages, overcrowding and a constantly changing environment. Patient experience and patient safety are directly linked, yet levels of patient experience are stagnant. To improve emergency nursing care and patient experience, an emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) was implemented in 29 Australian emergency departments. To evaluate HIRAID® on patient experience in the emergency department. This modified stepped-wedge cluster randomised control trial was conducted in 29 Australian rural, regional and metropolitan emergency departments and involved over 1300 emergency nurses. A total 2704 (1456 control, 1248 intervention) surveys were completed. We hypothesised implementation of HIRAID® would result in an at least 5% increase in patient experience per Schmidt's Perceptions of Nursing Care Survey and Australian Hospital Patient Experience Question Set. Patients (of all ages) and/or their carers completed a phone interview. Data were analysed using descriptive statistics and Generalized Estimating Equations approaches. Median (IQR) participant age was 54 (31-67) years. The most common presenting problems were abdominal, chest and respiratory issues. Greater than 5% improvement in all categories of the Schmidt's Perceptions of Nursing Care Survey, and 10 out of 12 Australian Hospital Patient Experience Question Set was achieved. The implementation of the HIRAID® emergency nursing framework in Australian emergency departments significantly improved patient experience with emergency care. Demand for emergency care is increasing. Evaluating what methods work to effectively translate evidence to emergency practice, improve patient experience in the complex emergency setting is crucial. We present how a behaviour change informed implementation strategy enabled maximum, sustained uptake of an intervention that improved patient experience in a variety of emergency settings despite the COVID-19 pandemic and catastrophic flooding. ANZCTR, ACTRN12621001456842. 25.10.2021.

Nurse management of minor problems in primary care emergencies: a non-randomized controlled trial

BackgroundHealth systems must implement strategies to adapt to the high demand in primary care caused by social changes. Since 2009, the Catalan Institute of Health has been expanding the Nurse Demand Management programme through which nursing autonomously addresses minor health problems. This study aims to analyse whether this programme is a factor in improving the efficiency and quality of care in a primary care emergency centre. The results come from a non-randomised controlled experimental study that tested the implementation of the programme applied to an experimental group treated by nurses versus a control group treated by doctors. The study was approved on 14 July 2022 by the Research Ethics Committee of the Jordi Gol University Institute following the guidelines of the TREND statement.ResultsA total of 312 patients were included in the study, all of whom came to the emergency centre with five types of minor problems. Exactly half (156) were seen by nurses and half were seen by doctors. The experimental group had an average waiting time of 15.1 min and the control group 33.25 min. There was no significant difference in the assessment of the quality of care received and there were no differences in the total number of consultations for the same problem. There were fewer prescriptions given out by nurses, with an average of 1.79 medicines per participant versus 2.26 medicines prescribed by doctors. The results of the study suggest that the Nurse Demand Management programme was a factor in improving the efficiency and in the emergency centre. Nurse resolution capacity, after applying algorithms, offered quality care, with fewer prescriptions and good patient satisfaction without increasing the total number of consultations due to the same problem.Trial registrationThe protocol for the current study was registered at Clinicaltrials.gov, with identification NCT06298240, retrospectively registered February 29, 2024.

Perceived costs and benefits of companion dog keeping based on a convenience sample of dog owners

The increasing trend of dog ownership is often linked to its perceived benefits for human physical and mental well-being. However, the psychological and practical demands of caring for a dog can significantly impact the owner’s quality of life and the long-term success of the dog-owner relationship. This study aimed to provide a comprehensive overview of both the advantages and disadvantages of dog ownership, as perceived by a convenience sample of Hungarian dog owners (N = 246), who were assumed to be generally satisfied with their dogs. The study employed both quantitative (a Cost/Benefit scale consisting of 33 neutrally-phrased statements rated on a seven-point scale, from − 3 to + 3) and qualitative methods (two open-ended questions). Quantitative results showed that owners rated the short lifespan of dogs as the most negative aspect, while the belief that dogs brighten their lives was rated most positively. On average, positive statements were rated significantly higher (2.06) than negative ones (−0.66), supporting the prediction from social exchange theory that dog owners in a voluntary sample tend to perceive more advantages than disadvantages in dog ownership. Qualitative findings revealed six ‘benefit’ and three ‘cost’ themes. 61% of owners considered the meaningful relationship with their dog as the greatest benefit, frequently mentioning the dog’s constant presence, love, and support. Additionally, 15% highlighted the relationship with another species and the dog’s intrinsic qualities, indicating the biophilia effect of dog ownership. Regarding the costs, 95% of respondents identified financial, particularly health-related expenses, as the most significant drawback, and only 4–5% mentioned emotional or practical burdens. In the quantitative data, principal component analysis revealed three core components of the dog ownership experience: (1) emotional, physical, and social benefits, (2) negative emotions and practical challenges, and (3) time and emotional commitment. Overall, the results suggest clear costs and benefits, though some aspects, such as daily care, holiday arrangements, and training, were seen as both beneficial and disadvantageous, depending on the owner. Even within a convenience sample, the diversity in dog and owner characteristics was sufficient to explain why certain facets of dog ownership are experienced differently.

Variables in the projection of physician demand and supply in primary care

Primary care services improve healthcare outcomes and limit unnecessary specialty care. Thus, it is essential to monitor primary care physician demand and supply projections to suggest evidence-based healthcare reforms and promote better healthcare delivery. This study evaluates 28 demand variables, 50 supply variables, and 26 additional variables associated with the demand and supply projections of physicians by reviewing scenarios from other countries, including Taiwan, Singapore, Japan, and the United States of America. The results indicate that Korea uses less diverse demand and supply indicators and suggest the need to implement variables used in the other four countries to improve projection modeling.

Advances in 3D correction of adolescent scoliosis: The superiority of scoliocorrector fatma-UI in rotational realignment.

This letter compares the clinical efficacy and economic feasibility of the scoliocorrector fatma-UI (SCFUI) with direct vertebral rotation (DVR) in treating adolescent idiopathic scoliosis (AIS). SCFUI has shown promising results in three-dimensional spinal correction, providing superior rotational alignment compared to DVR and achieving significant improvements in coronal and sagittal planes. Additionally, SCFUI's advanced design reduces risks associated with AIS surgeries and enhances overall patient outcomes. Economic analysis reveals SCFUI as a cost-effective option, potentially lowering long-term healthcare costs by minimizing complications and revisions. Our findings suggest that SCFUI is a viable, innovative approach in AIS treatment, meeting clinical and economic demands in orthopedic care.

Review on application of silk fibroin hydrogels in the management of wound healing.

Wounds are regarded as disruptions in the integrity of human skin tissues, and the process of wound healing is often characterized as protracted and complex, primarily due to the potential infection or inflammation caused by microorganisms. The quest for innovative solutions that accelerate wound healing while prioritizing patient safety and comfort has emerged as a focal point. Within this pursuit, silkworm silk fibroin-a natural polymer extracted from silk cocoons-exhibits a distinctive combination of properties including biocompatibility, biodegradability, superior mechanical strength, water absorption, and low immunogenicity, which align closely with the demands of contemporary wound care. Its remarkable biocompatibility facilitates seamless integration with host tissues, thereby minimizing the risk of rejection or adverse reactions. Furthermore, its intrinsic degradability permits controlled release of therapeutic agents, promoting an optimal microenvironment conducive to healing. This review investigates the multifaceted potential of silk fibroin specifically as a wound dressing material and examines the intricate nuances associated with its application in hydrogels for wound healing, aiming to furnish a thorough overview for both researchers and clinicians. By scrutinizing underlying mechanisms, current applications, and prospective directions, we aspire to cultivate new insights and inspire innovative strategies within this rapidly evolving field.

Differences in the structure and prevalence of oral mucosal diseases across age groups

Relevance. In the Russian Federation, the population is witnessing a notable increase in the absolute number and proportion of elderly and senile individuals. Aging is recognized as a complex process involving multiple functional transformations in tissues and organs, often accompanied by a decline in the body’s adaptive capacities. With the growing proportion of older adults, the demand for dental care has significantly increased. Internal organ pathologies can alter the presentation of existing dental diseases or serve as triggers for the onset of oral conditions. A steady rise in oral mucosal diseases has been observed, linked to aging, environmental issues in specific regions, harmful habits, occupational hazards, and a tendency toward malignant transformation. Despite existing literature, the structure and prevalence of oral diseases, particularly mucosal pathologies in individuals over 60 years of age, remain underexplored. A personalized approach to diagnosing oral mucosal diseases (OMD) requires a comprehensive assessment of the clinical progression of primary, comorbid, and past conditions, while accounting for the patient’s age and sex.Materials and Methods. A primary examination was conducted at the Department of Therapeutic Dentistry and Periodontology of Pavlov First Saint Petersburg State Medical University to identify oral mucosal lesions. The study included 512 patients aged 18 to 89 years, comprising 167 men and 345 women. The assessment involved gathering patient complaints, medical histories, and general health status based on consultations with medical specialists. Visual evaluation of the oral mucosa was performed, along with autofluorescent stomatoscopy using the "AFS-D" device (Politron, Russia).Results. The study revealed a high prevalence of oral mucosal lesions among the adult population. Lesions were observed in 40.8% of the 512 patients, with their frequency and types varying by age and sex. The most common conditions included denture-related stomatitis, traumatic lesions, periodontal diseases, and leukoplakia.Conclusion. The analysis of data from primary patient examinations demonstrated a significant increase in oral mucosal lesions with age. While periodontal diseases and traumatic lesions were more prevalent in younger individuals, older adults showed a rise in oral mucosal conditions associated with internal organ pathologies. Additionally, there was a notable increase in precancerous oral mucosal diseases among elderly and senile patients

Association between nursing workload and staff size with the occurrence of adverse events and deaths of patients with COVID-19: A retrospective cohort study.

The safety of patients in the intensive care unit (ICU) is significantly impacted by inadequate staffing of nursing professionals to meet the demand for care of critically ill patients. COVID-19 patients increased nurses' workload, particularly in high-intensity care settings like the ICU. To evaluate the association of workload and number of patients per nursing professional with the occurrence of adverse events and death in critically ill patients with COVID-19 in the ICU. This is a retrospective cohort study. This study analysed patients with COVID-19, aged 12 years or older, admitted between 1 April 2020 and 31 May 2021 in the ICU of a hospital in Brazil. Nursing workload was measured by the Nursing Activities Score (NAS). The independent variables were the ratio of the NAS score per nursing professional (NNR) and the ratio of the number of patients per nursing professional (PNR). Dependent variables included adverse events (pressure injuries and health care-associated infections-HAIs) and death in the ICU. Of the 386 included patients, 59.59% were male and the median age was 60.5 years. The median NAS, NNR and PNR values were 72.81%, 128% and 1.64, respectively. The frequency of pressure injuries (31.09%) exceeded that of HAIs (16.06%), and 218 patients (56.48%) died. The NNR was associated with HAIs (OR 1.006; CI95% 1.001-1.012; p = .012), pressure injury (OR 1.005; CI95% 1.000-1.010; p = .033) and death (OR 1.010; CI95% 1.005-1.015; p < .001) in the ICU. There was no association between PNR values and the study's dependent variables. A high workload per nursing professional was associated with the occurrence of adverse events and deaths of patients with COVID-19 in the ICU, while the nursing staff sizing was not. The results reinforce the importance of evaluating the workload of nursing professionals to establish safety measures for the care of patients with infectious diseases.

Organizational strategies of eldercare work and health - Is the daily number of residents cared for over 14 months associated with back pain?

The growing care demands of an aging population and a smaller workforce is a big societal problem. Therefore, knowledge on how to organize eldercare work without hampering workers` health is needed. We aimed to investigate if workers` daily number of residents cared for over 14 months is associated with low-back pain in eldercare workers. We included 513 eldercare workers from 122 wards. In each ward, we gathered quarterly data over 14 months on the number of residents, workers, and work schedules and calculated the daily numbers of residents each worker cared for. Workers reported intensity and days with low-back pain via monthly text messages over 14 months. Using generalized linear mixed models adjusted for confounders, we investigated the association between the number of residents workers cared for daily and low-back pain among those workers. In 3-month periods over 14 months, caring for ≥1 resident per day was associated with a 4% [95% confidence interval (CI) 1.02-1.07] increased risk of more days with low-back pain, and a 2% (95% CI 1.00-1.03) increase in low-back pain intensity among workers. Eldercare workers are at a higher risk of experiencing low-back pain during periods when they care for a greater number of residents each day. Maintaining a consistent number of residents and workload for workers over a 14-month period could serve as an effective organizational strategy to prevent low-back pain.

The Earnings and Labor Supply of U.S. Physicians

Abstract Is government guiding the invisible hand at the top of the labor market? We use new administrative data to measure physicians’ earnings and estimate the influence of healthcare policies on these earnings, physicians’ labor supply, and allocation of talent. Combining the administrative registry of U.S. physicians with tax data, Medicare billing records, and survey responses, we find that physicians’ annual earnings average $350,000 and comprise 8.6% of national healthcare spending. Business income comprises one-quarter of earnings and is systematically underreported in survey data. Earnings increase steeply early in the career, and there are major differences across specialties, regions, and firm sizes. The geographic pattern of earnings is unusual compared with other workers. We argue that these patterns reflect policy choices to subsidize demand for physician care, amplified by restrictions on physician entry, especially in certain specialties. Health policy has a major impact on the margin: 25% of physician fee revenue driven by Medicare reimbursements accrues to physicians personally. Physicians earn 8% of public money spent on insurance expansion. These policies in turn affect the type and quantity of medical care physicians supply, retirement timing, and the allocation of talent across specialties.

Financial Barriers to Expanded Birth Center Access in New Jersey: A Qualitative Thematic Analysis.

Birth centers are an underused care setting with potential to improve birth experience and satisfaction. Both hospital-based and freestanding birth centers operate with the midwifery model of care that focuses on safe, low-intervention physiologic birth experiences for healthy, low-risk pregnant people. However, financial barriers limit freestanding birth center sustainability and accessibility in New Jersey, especially for traditionally marginalized populations. This qualitative study explores the financial barriers faced by freestanding birth centers in order to expand access and choice for pregnant people in New Jersey. Semistructured interviews were conducted with participants from 4 sectors: (1) birth center or health system, (2) policy-adjacent philanthropy or research, (3) state departments, and (4) health insurance. Coding and analysis followed a reflexive thematic analysis process, resulting in the identification of 4 financial barriers to birth center access. Facility Medicaid reimbursement rates are a primary barrier for birth centers, along with startup and operating costs and, more indirectly, low supply of midwives and low patient demand for birth center care. New Jersey is well-positioned to enact critical policies and programs that can improve out-of-hospital birth center access, based on the findings and recommendations from this research. Other states can follow suit in pursuit of solutions to improve maternal health access and equitable birth center sustainability.

Malpractice Liability Exposure and the Sports Medicine Team Physician: Caring for Professional Athletes in the National Football League, Major League Baseball, and National Hockey League

Background: Orthopaedic surgeons play a critical role in ensuring the health and safety of professional athletes. Despite the privilege of treating elite athletes, there exists great financial exposure to individual physicians in the event of a malpractice lawsuit. Hypothesis/Purpose: The purpose of this study was to evaluate and model malpractice liability exposure of the sports medicine surgeon caring for athletes in the National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) with respect to player position and additional supplemental malpractice insurance needs. It was hypothesized that routine liability coverage cannot adequately address the demands of caring for elite athletes in professional sports leagues. Study Design: Economic and Decision Analysis; Level of evidence, 3. Methods: In total, 2447 NFL, 992 MLB, and 980 NHL player contracts from the 2022-2023 season were aggregated from a publicly available online database. Position, team, total contract value, and mean yearly salary were noted. Risk ratios were calculated with respect to 1 million US dollars (USD) and 3 million USD of annual occurrence-based malpractice liability awards and used to generate a “covered-to-treat” analysis. Supplemental malpractice liability insurance was quantified. Results: Assuming 1 million and 3 million USD occurrence-based awards covered by malpractice liability insurance, team physicians can fully treat 17.3% and 50.0% of NFL players, 43.2% and 59.7% of MLB players, and 13.6% and 41.0% of NHL players, without incurring additional personal financial risk, from a risk-based medicolegal model. Liability policies of 52.6 million, 108.1 million, and 64.1 million USD are required to treat 95% of NFL, MLB, and NHL players, respectively. Positions carrying the greatest risk ratios are quarterback (QB) (9.9) in the NFL, right field (15.1) in the MLB, and center (5.7) in the NHL. Conclusion: Sports medicine specialists caring for elite athletes face potential personal financial risk due to insufficient medicolegal coverage. While coverage may vary among different practice settings including private, academic, or public state institutions, medical malpractice risk is crucial in partnerships between sports franchises, hospitals, players, agents, and physicians to protect sports medicine physicians and offer the highest-quality care.

Effect of Inter-Generational Living Arrangement and Digital Exclusion on Unmet Healthcare Needs Among Older Adults: Findings From Two National Cohort Studies.

To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs. A prospective cohort study. The study reporting is conformed to the STROBE checklist. This longitudinal study utilised data from the 2018-2020 waves of the United States-based Health and Retirement Study and the 2013-2015 waves of the China Health and Retirement Longitudinal Study. Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline. A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort. Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure. These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction. This study using the STROBE CHECKLIST for reporting guideline. No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY: By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.