Good Access Research Articles

Changes in Instructional Formats: Which Learning Format is More Convenient for Postgraduate Students?

Changes in learning format between face-to-face, online, and blended learning impact learning convenience. Based on changes in learning formats, this research aims to reveal and explore information regarding the learning formats that postgraduate students feel is most convenient based on their experiences and conditions. This research used a phenomenological design to obtain comprehensive and in-depth data regarding the convenience of various learning formats and that are at the beginning of the transition between various instructional formats. Data sources were obtained from postgraduate study participants at various universities in Jawa, Indonesia, who had experienced changes in learning formats during their studies. Data was collected through direct observation and in-depth face-to-face and online interviews of 13 participants to capture real experiences and feelings. The data was then analysed using thematic qualitative analysis techniques with the help of the Atlas.Ti programme. The research results showed that all learning formats can optimise learning success if the resources are available and students are serious and focused on learning. For postgraduate students with good internet access, online learning was the most desired and convenient, both for those who were very busy and those who were just focused on studying. Ultimately, the choice of learning format should be based on carefully examining all available options to maximise their success in achieving their educational goals.

Relationship between Family Income and Access to Primary Care of Senior Citizens in Kaytapos, Indang Cavite

The research investigates the relationship between family income and access to primary care among senior citizens in Kaytapos, Indang Cavite. A combined self-administered survey and an in-person interview was conducted to analyze the multifaceted factors shaping the accessibility of primary care for seniors. The study examined the socio-economic status, health conditions, and the extent of their access to primary healthcare services. The study mainly aimed to assess the relationship between family income and access to primary care of senior citizens in Kaytapos, Indang. This study further seeks to identify the respondents' socio-demographic profile and determine senior citizens' access to primary care in terms of awareness, accessibility, affordability, availability, acceptability, and accommodation. Based on the findings, it was revealed that senior citizens have good access and high awareness of primary care. The affordability and accessibility of related goods and services were also moderate. Additionally, primary care providers and healthcare institutions were deemed moderately accessible, very acceptable, and highly accommodating to senior patients. Moreover, the existing relationship between family income and senior citizens' access to primary care was statistically significant, yet there was a weak positive correlation. Hence, these findings could aid the government in policy-making planning to promote a more equitable and inclusive healthcare system. Overall, it was recommended that the government address the insufficient access to primary care by proposing free monthly check-ups, medicines, food, and allowances, especially for senior citizens in the lower income bracket.

"Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi.

The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not. We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi. Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting. Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred. Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.

"Technology has allowed us to do a lot more but it's not necessarily the panacea for everybody": Family physician perspectives on virtual care during the COVID-19 pandemic and beyond.

Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice. We conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach. We interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward. The move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.

Spatial accessibility and travel to pharmacy by type in the Detroit region

BackgroundCommunity pharmacies are a critical part of the health care provision system. Yet less is understood about the spatial accessibility to pharmacies and how people travel to reach these services. ObjectivesThis study compared spatial accessibility and actual travel to different types of pharmacies among selected neighborhoods in the Detroit region. MethodsThree types of neighborhoods were selected and compared, including two lower income Black urban neighborhoods of high-density and four upper income White suburbs (two of low density and two of high density). Spatial accessibility was computed by pharmacy type and compared among neighborhoods using ANOVA. Pharmacy trips reported in a travel survey were geocoded and linked with community pharmacies in a list generated from ReferenceUSA business data. Destination choices were mapped and the relationship between spatial accessibility and actual distance traveled was examined using ordinary least squares regressions. ResultsOn average, urban residents in Detroit had higher access to local independent pharmacies (0.74 miles to the nearest one) but relatively lower access to national chains (1.35 miles to the nearest one), which most residents relied on. Urban residents also tended to shop around more for services even among national chains. In fact, they bypassed nearby local independent pharmacies and traveled long distances to use farther pharmacies, primarily national chains. The average trip distance to pharmacy was 2.1 miles for urban residents, but only 1.1 miles and 1.5 miles for residents in high-density suburbs and low-density suburbs, respectively. ConclusionSupposedly good spatial access considering all pharmacies together may mask excessive burden in reaching the pharmacy services needed in low-income minority urban communities, as shown in the case of Detroit. Thus, when mapping pharmacy deserts, it is important to distinguish spatial accessibility among different pharmacy types.

Access to advanced healthcare services and its associated factors among patients with cervical cancer in Addis Ababa, Ethiopia.

This study aimed to assess the extent of access to healthcare services, perception and associated factors among patients with cervical cancer in Addis Ababa, Ethiopia. A facility-based cross-sectional study was conducted from 01 July through 30 August 2023 at two tertiary hospitals. Cases with histopathologic and clinical confirmation of cervical cancer were enrolled using a consecutive sampling technique. Data was collected through a validated questionnaire administered by interviewers using the KoboCollect application. Subsequently, the collected data underwent analysis using Statistical Sciences for Social Sciences (SPSS) version 26.0. Bivariable and multivariable regression models were performed at p ≤ 0.2 and p<0.05 statistical significance, respectively. A total of 391 patients were enrolled in the study. Health facilities were accessible for obtaining general medical services (56.5%), drugs (57.3%), laboratory diagnosis services (57.0%), imaging diagnosis services (56.8%), and radiotherapy services (55.8%) of the patients. Cost of services was affordable only in 11.5% of the cases. Essential anticancer medicines were out of stock for 229 (58.6%) of the patients during the past three months. About two-thirds of the patients have a good perception of access to healthcare services. In multivariable binary logistic regression, admission to the inpatient (AOR: 0.20, 95% CI: 0.06-0.67), joblessness (AOR: 0.19, 95% CI: 0.08-0.46), lower level of income to the extreme poverty line (3567ETB)(64.9 USD) (AOR: 0.19, 95% CI: 0.10-0.35), no CBHI coverage (AOR: 4.16, 95% CI: 1.76-9.85), having social support (AOR: 3.80; 95% CI: 1.96-7.41), and poor dietary practice (AOR: 2.36, 95% CI: 1.28-4.35) were found to have a statistically significant association with perceived good access to healthcare services. Only close to a half of the patients with cervical cancer, in Addis Ababa, have adequate access to healthcare services. Nearly two-thirds of the patients reported perceived good access to the services. Many factors were found to show a statistically significant association with patients' perceived access to healthcare services.

Breastfeeding, first-food systems and corporate power: a case study on the market and political practices of the transnational baby food industry in Brazil.

The exploitative marketing of commercial milk formula (CMF) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the International Code of Marketing of Breast-Milk Substitutes (The Code) was adopted by WHO member states, many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, worldwide CMF markets have markedly expanded. In this paper, we adopt Brazil as a case study to understand the power of the baby food industry's marketing and corporate political activity, and how this influences the country's 'first-food system' in ways that promote and sustain CMF consumption. We used a case study design, drawing data from from documents and key informant interviews (N = 10). Breastfeeding rates plummeted in Brazil to a historic low in the 1970s. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national policy framework and breastfeeding protection law, resulting in-turn, from collective actions by breastfeeding coalitions, advocates, and mothers. Yet more recently, improvements in breastfeeding have plateaued in Brazil, while the industry grew CMF sales in Brazil by 750% between 2006 and 20. As regulations tightened, the industry has more aggressively promoted CMF for older infants and young children, as well as specialised formulas. The baby food industry is empowered through association with powerful industry groups, and employs lobbyists with good access to policymakers. The industry has captured the pediatric profession in Brazil through its long-standing association with the Brazilian Society of Pediatrics. Brazil illustrates how the baby food industry uses marketing and political activity to promote and sustain CMF markets, to the detriment of breastfeeding. Our results demonstrate that this industry requires much greater scrutiny by regulators.

Correlation between Knowledge and Attitude to Health-Seeking Behaviour among Madurese in Surabaya, Indonesia

Everyone should have good access toward health services where and when they need, therefore, various ways are used to seek treatment. In the Madurese, health-seeking behaviour is determined by many factors. The study aimed to analyze the relationship between the level of knowledge and attitudes of the Madurese related to health-seeking practice. The research was conducted on 50 Madurese living in Surabaya. This research was conducted to measure the behaviour of the Madurese in health-seeking. Behaviour is divided into knowledge, attitudes, and practice. The independent variables in this study are knowledge and attitudes, and the dependent variable is the practice or effort of health-seeking. The results showed that the level of knowledge is good (92%), and the attitude toward health-seeking behaviour is negative (78%). Most of the respondents choose self-medication when they are sick (70%). Statistical analysis showed that knowledge was not significantly related to health-seeking practice (p-value = 0,075), while attitudes were significantly related to health-seeking practice (p-value=0,001).

Factors Associated with Transgender and Gender Diverse People's Experience of Sexual Coercion, and Help-Seeking and Wellbeing Among Victims/Survivors: Results of the First Australian Trans and Gender Diverse Sexual Health Survey.

Purpose: Our study examined factors associated with transgender and gender diverse ("trans") people's experience of sexual coercion, as well as the factors associated with help-seeking and wellbeing among victims/survivors. Methods: We analyzed cross-sectional data from the first Australian Trans and Gender Diverse Sexual Health Survey, conducted in 2018. Logistic regressions were undertaken to identify factors associated with sexual coercion, help-seeking, and wellbeing. Results: Of the sample of 1448 participants, 53.4% had been sexually coerced, which was associated with older age, Aboriginal or Torres Strait Islander descent, nonbinary gender, being presumed female gender at birth, currently living publicly some or all the time as their affirmed gender, having regular sex, and use of drugs to enhance or alter sexual experiences. Protective factors included having a higher income and access to gender affirming care. Help-seeking was reported among 49.5% of victims/survivors and was associated with having more trans friends. Wellbeing among victims/survivors was associated with being older, residing in regional/remote areas, having higher levels of education and annual income, being presumed female gender at birth, having stronger satisfaction with one's sex life, and good health care access. Wellbeing was not associated with help-seeking. Conclusion: Sexual coercion was prevalent among participants, but help-seeking behavior was low. Protective factors identified underscore the importance of socioeconomic supports, access to health and gender affirming care, and peers. Accessible peer-led and culturally safe preventive and trauma-focused supports should also be considered for trans people who experience sexual coercion.

Triumphs and trials with the UK abortion law: The power of collaboration in abortion reform.

The UK is usually viewed as having liberal abortion regulations, providing good access to abortion care within a publicly funded health service. However, the underlying laws are authoritarian, dating from an era when public executions drew large crowds and 67 years before women were able to vote. Abortion is only legal when two doctors certify it meets the permitted grounds, and the penalty for self-managed abortion is up to life imprisonment for both the woman and any accomplice. These laws had prevented the use of mifepristone and misoprostol at home. Changes to the regulations for misoprostol in 2018 and mifepristone in 2020 permitted home use, but the government announced they were rescinding the approval for mifepristone in 2022. This article discusses how, despite the opposition of government, significant progressive changes to the abortion laws were achieved. Early medical abortion at home is now protected in law, and safe access zones protect patients and staff from harassment and intimidation from protesters. Despite this progress, increasing numbers of women are facing criminal investigation and face long prison sentences if convicted. The need for decriminalization and for abortion care to be regulated like all other health care is the next pressing issue.

Need for Care in Old Age: Characterization of Informal Caregivers and the Care Situation with Regard to Care Levels in Home Care

In Germany, people in need of care can be supported by benefits from care insurance. Prerequisite is an official assessment of the need for care, which is carried out by assigning care levels (1 to 5) according to the Second Care Strengthening Act. One of the reasons for introducing care levels was to pay more attention to the needs of people with dementia. In this article, characterization of care levels were based on characteristics of care recipients, their relatives, and the care situation. The aim was to map the current state of health care and providing practical suggestions to improve health care. Data was collected as part of the cross-sectional study "Benefits of being a caregiver" by a written survey of informal caregivers throughout Bavaria on aspects of the caregiving situation as well as on current and desired future use of 15 care services. To compare care levels, group differences were analyzed using χ2-tests and one-factor analysis of variance. The effect size measures odds ratio and Cohen's d were reported for significant group differences comparing care levels 1 and 4. The sample consisted of 958 cases of people in need of care aged 65 and above. The proportion of people with dementia increased significantly with care level. For informal caregivers, subjective burden, functional coping strategies, and the caregiving motive of not wanting to place the care recipient in a nursing home increased with care level. Informal caregivers of those with higher care levels spent significantly more time on supporting activities of daily living and supervision; they received more informal help, and more often lived together with the care recipient in a household. For 9 of the 15 care services surveyed (e. g. 24-h care), current use increased significantly with increasing care level. However, we recorded a low overall utilization rate of care services across all care levels (M=2.20; SD=1.90). As a result of the Second Care Strengthening Act, people with dementia get good access to care insurance benefits. The increasing amount of time required for assisting in activities of daily living and supervision is reflected by care levels. Despite the increasing caregiving burden, care services are rarely used. Therefore, we recommend that measures to increase the use of support and counselling services be expanded.

Persepsi Kelompok Tani Alfa Omega Terhadap Penerapan Pertanian Organik Di Kelurahan Rurukan Kecamatan Tomohon Timur Kota Tomohon

The aim of the research was to determine the perception of the Alfa Omega farmer group regarding the implementation of organic farming in Rurukan Village, East Tomohon District, Tomohon City. This research lasted for three months from May to July 2023. The data used in primary data was obtained through interviews with 13 respondents from the Alfa Omega farmer group, which were taken by census and secondary data was obtained from agencies related to the research conducted. Data analysis used is descriptive. The results of the research show that the perception of the Alfa Omega farmer group regarding the implementation of organic farming is relative profit, namely profit if sold to shops that collaborate with the Alfa Omega farmer group, having good quality plants. The perception of suitability of plants is that they are suitable because of fertile soil, high soil moisture and good water access. The perception regarding the ease of trying it is that it is easy to implement organic farming and easy to get raw materials. The perception of complexity is that it takes a long time to neutralize the soil and it is difficult to get a clear price comparison on the market between organic agricultural products and non-organic products. There needs to be outreach so that the Alfa Omega farmer group implements organic farming. It is also hoped that the Department of Agriculture will provide financial assistance to be able to switch to organic farming.

SURVEY AND ROAD MEASUREMENT TECHNIQUES IN POJA VILLAGE, SAPE SUB-DISTRICT.

The development of road access is currently a very important thing in infrastructure development in a country. Good road access can facilitate community mobility and support economic growth. Currently, the government is trying to improve road access in every region and village through the construction of new roads, repairing existing roads. The implementation method of measuring new roads is an important process in infrastructure development. This method involves the use of specialized equipment such as distance measuring devices and angle measuring devices. The purpose of this service activity is to determine the length, width, elevation and slope of the new road terrain. The location of the activity is Poja Village, Sape District, Bima Regency, West Nusa Tenggara. The results of the road terrain slope analysis on the Poja Village road section, Sape District, Bima Regency, were calculated at each STA with a distance of 500 meters for each STA. Obtained road terrain slope STA 00+000 - STA 00+500 is 0.2%, STA 00+0500 - STA 01+000 is 0.8%, STA 01+000 - STA 01+500 is 0.4%, STA 01+500 - STA 02+000 is 0.6, STA 02+00 - STA 02+500 is 1.8%, STA 02+500 - STA 03+00 is 1.2%. And the road section of Poja Village, Sape District, Bima Regency is included in the Flat (D) road terrain category, because all segments every 500 meters have a value smaller than 3%.

Can infrastructure, built environment, and geographic factor negate weather impact on Strava cyclists?

Cycling participation is context-sensitive and weather condition is reportedly a significant factor. How weather affects cyclists with different demographics, trip purposes, and in the context of cycling infrastructure, built environment and geographic factors is less well understood by existing literature. This paper applies autoregressive models to explain difference in Strava cycling volume from the same hour of the previous day as a function of change in weather conditions, and day of the week; the contextual effect of cycling infrastructure, built environment and geographic factors is accounted for using interaction terms. We use Strava crowdsourced cycling data in Sydney, Australia, as a case study; commute and leisure cyclists, male and female, young and older cyclists are modeled separately. We find weather conditions have a statistically significant effect on cycling participation; rain, rainfall in the last 2 hours and wind are general deterrents to cycling. Physically separated cycling lanes reduce the adverse effect of precipitation on leisure cyclists and male cyclists but have little effect in retaining commute cyclists and female cyclists. The adverse effect of precipitation and wind on commute cycling is amplified in areas with good access to jobs, possibly due to the availability of better alternative modes of transport. Inland locations generally attenuate effects of windy conditions, except for young adults. This paper sheds light on factors attenuating adverse weather effects on cycling participation and provides useful guidance for future cycling infrastructure.

Utilization of Information Communication and Technology Among Students in St Philomena Catholic Hospital, Benin City

In today’s society, information and communication technologies (ICT) play an important part in almost every area. This descriptive cross-sectional study assessed utilization of information communication and technology among students in St. Philomena Catholic Hospital, Benin City. Convenience sampling approach was used to recruit the 212 participants. The instrument for data collection was structured questionnaire with reliability of 0.786. SPSS version 22 was used to analyze the data. The result shows that the mean ± SD age of the respondent is (22.7 + 4.6 years). Only 29(14.5%) have good access to information communication and technology and 171(85.5%) have poor access information communication and technology. High utilization of information communication and technology was 133(66.5%) while low usage was 67(33.5%). perceived factors affecting utilization of information communication and technology among the respondents include faulty equipment/lack of maintenance 180(90.0%), lack of technical support 178(89.0%), and inadequate computers 165(82.5%), and unavailability of IT equipment in the school 150(75.0%). It is concluded that there is good utilization but poor access to information communication and technology among the students. Therefore, nursing institutions (academic/clinical) should continue to invest in professional development with student-centered ICT labs to encourage students to use modern technology.

Food environment trajectories: a sequence analysis from the CARTaGENE cohort.

The purpose of this study was to create a typology of longitudinal exposure to food environment based on socio-economic context. Food environment trajectories were modelled using a sequence analysis method, followed by a logistic regression to describe those trajectories. The study took place in Quebec, Canada, using food environment data from 2009, 2011 and 2018 merged with participants' demographic and socio-economic characteristics. At recruitment, 38 627 participants between the ages of 40 and 69 years from six urban areas in Quebec were included in the CARTaGENE cohort study. The cohort was representative of the Quebec urban population within this age range. Our study revealed five trajectories of food access over time: (1) limited access to food stores throughout the study period, (2) limited access improving, (3) good access diminishing, (4) good access throughout the period and (5) low access throughout the period. Logistic regression analysis showed that participants who were unable to work (OR = 1·42, CI = 1·08-1·86), lived in households with five or more persons (OR = 1·69, CI = 1·17-2·42) and those living in low-income households (OR = 1·32, CI = 1·03-1·71) had higher odds of experiencing a disadvantaged food environment trajectory. Additionally, the level of education and age of participants were associated with the odds of experiencing a disadvantaged food environment trajectory. The study demonstrates that people facing socio-economic disadvantage are more likely to experience a disadvantaged food environment trajectory over time.

Investigating the Relationship between Medication Adherence Behaviors and the Achievement of Sustained Viral Load Suppression among People Living with HIV (PLHIV) on Antiretroviral Therapy (ART) in Akwa Ibom State, from 2018 - 2022

Background: Nigeria is still endemic for Human Immuno-Deficiency Virus (HIV), and currently among the top five countries with the highest burdens of HIV infection. For a successful HIV program, there should be good access to antiretroviral therapy (ART) and record of viral load suppression (VLS). This study aimed at investigating the relationship between medication adherence behavior (MAB) and sustained VLS among people living with HIV (PLHIV) receiving ART in Akwa Ibom State. Methods: This was a retrospective cohort study of the medical records of 1,763 PLHIV receiving ART services from January 2018 to December 2022, in selected ten health facilities in Akwa Ibom State. Relevant demographic, clinical, immunological, viral load (VL) information were obtained from the patients’ medical records and databases. The proportion of VLS and associated variables were then analyzed. Results: Out of the 2,550 PLHIV whose medical records were accessed, data for 1,763 PLHIV was accepted for analysis. A total of 795 (45.1%) male and 968 (54.9%) female participated in the study, with a mean age of 38.4 ± 5 years. While 23.8% (n = 420) have unsuppressed VL of &gt;1,000 copies/mL; 76.2% (n = 1,343) of participants achieved VLS of &lt;1,000 copies/mL. 90.4% (n = 1,213) of the virally suppressed participants recorded moderate to high medication adherence levels (X2 = 94.977, df = 2, p-value = 2.2 x 10-16). CD4 counts and HAART regimen have significant impact on VLS (p &lt; 0.05), while pregnancy status, TB Infection, duration on HAART, and WHO disease stage do not have significant effects on VLS (p &gt; 0.05). Conclusion: There was a strong evidence to reject the null hypothesis, which states that there is no positive association between MAB and sustained VLS among PLHIV on ART (p &lt; 0.05). The VLS rate in this study indicates a good HIV epidemic control. Good medication adherence level, high baseline CD4 count, and being on first line HAART regimen were strongly associated with VLS.

Price Transmission of Ofada Rice in the South-West Geo-Political Zone of Nigeria

The study was conducted to examine price transmission of ofada rice in the south –west geo-political zone of Nigeria. Data on monthly prices of processed Ofada rice was collected from National Bureau of statistics from the period of January 2016- March 2021. Descriptive statistics was carried out to characterize the price pattern in the various States; this was done by the use of Eviews9 statistical software. The result showed that the price of ofada rice in Lagos and Ondo were stationary both at level I(0) and after first differencing I(I) while the other remaining States were stationary only after first differencing I(I). The maximum price of ofada rice was recorded in Ondo (₦900/kg) while the minimum price was recorded in Osun (₦250.11/kg). The result of the Jarque –Bera shows that the prices of Ofada rice were not normally distributed in Lagos, Ondo, and Osun State. Johansen test of co-integration was used to analyze the market co-integration and the test result shows that only 5 market links were co-integrated while the result of the granger-causality test shows that all the market links had Uni-directional price movement with 7 market links showing evidence of granger- causality. Therefore, it was recommended that there should be an efficient flow of information and good access to roads as these will help to improve market performance, and the activities of market intermediaries should be minimized.

The role of street network metrics in shaping distance distributions in a residential neighbourhood

Walkability studies often rely on physical proximity metrics for destination accessibility. However, some recent studies argue that configuration (topological) distance provides a more accurate reflection of the actual distances experienced by individuals. This study therefore aims to test the extent to which an association exists between network-metric proximity to several destinations and two main measures of space syntax – integration and choice – in a dendriform network structure such as Putrajaya city (Malaysia). Using GIS, multiple buffer-service areas were generated around each housing unit (N = 2,392). Interpolation and space syntax analyses were conducted to assess metric and topological distance at local and global levels for each buffer. The statistical analysis showed that distances to commercial areas, transportation and average distances to all destinations were strongly affected by the syntactical properties of the neighbourhood. Moreover, global measures were more powerful in detecting metric-distance changes compared to local measures. Aligned with natural movement theory, these results support the idea that the spatial properties of urban form have a significant impact on distance distributions within residential settings, specifically distances to commercial areas. Therefore, policies that promote mixed-use development, especially in areas with good transportation access, should consider the impact of syntactical accessibility of the network.

On track on the care pathway: Care coordination, information, and communication needs among Norwegian cancer patients.

Background: Cancer patients may have long-lasting and complex care pathways. These typically involve a wide range of care providers who must coordinate their actions, so that treatment and follow up is experienced as seamless and integrated. Good communication with patients and providing them with the 'right amount' of information is crucial to ensure that patients feel engaged and empowered along the pathway. &#x0D; The study: This paper reports from an ongoing research study ('Pathway') on the management of patient pathways in Norway, exemplified with cancer pathways. The project aims to give detailed descriptions of the unfolding of pathways, with an emphasis on patients' experiences and needs. These form the basis for the development of a theoretical pathway model and a visual multi-layered modeling language. This paper addresses the research question: What are cancer patients' information- and communication needs from care providers during their patient pathway?&#x0D; Methods: We conducted three workshops with cancer patients and next of kin (n=35), supplemented with individual interviews (n=6) in June 2022. Participants had various cancer diagnoses. Data collection was conducted on a digital platform. Study participants were asked i.e., about communication with the services, their information needs, and how they keep overview of their appointments and contacts with the services, as well as how they would like to stay informed and engaged. &#x0D; Results: A 'regular' cancer pathway was described to involve a wide range of providers, like regional and local public hospitals, private medical imaging centers, general practitioners, municipal care providers (i.e., physiotherapy, home care services), as well as the labour and welfare office. For the most complex cancers, and for multimorbid patients, the pathways could be even more complex. Study participants unanimously agreed that knowing as much as possible about the disease, its treatment, and follow up is critical to feel in control. Even though the participants mostly were satisfied with the cancer pathway, they all had experienced breakdowns in care coordination, missing and contradictory information, and providers lacking overview of their situation. Most participants had experience with taking on the task of collecting and aligning information and taking responsibility for coordinating their own follow up and care. Specifically, this was true when patients were discharged from hospital and from the standardized cancer patient pathway (CPP). The participants had invented various creative ways of keeping track of all the information they were given, and they frequently acted as messengers between providers. &#x0D; Learning and next steps: The study underscores the challenge of ensuring integrated care for patients. Cancer is among the diseases that has evidence-based treatment protocols, and in Norway diagnostics and treatment is organized in standardized care pathways. Nevertheless, also these patients struggled with keeping track of their 'simple' pathways. Such findings remind us about the need to keep on working for improving integration across disease specific pathways, and that good communication and access to information for all the involved actors are means for achieving this. The next step in our study is to map patients' touchpoints with the services over time, in detail.