Healthcare Capacity Research Articles

Balancing privacy and public health: The impact of South Africa's cannabis legalization

The Cannabis for Private Purposes Act, enacted in South Africa in 2024, marks a significant shift in national drug policy by legalizing private cannabis use while aiming to balance individual privacy rights with public health and safety. This paper examines the Act’s impacts on socioeconomic dynamics, public health, and crime within South Africa, a context shaped by poverty, inequality, and strained healthcare resources. The study highlights potential economic benefits, such as job creation and formal market opportunities, alongside risks, including increased pressure on mental health services and complex implications for crime and gender-based violence. Drawing from government reports, recent studies, and international case comparisons, the analysis reveals how legalization might reduce the burden on the criminal justice system while also introducing challenges in public safety and healthcare capacity. The findings emphasize the need for robust governance frameworks that prioritize health system preparedness, social protections, and crime prevention. The discussion provides targeted policy recommendations for government agencies, healthcare providers, and law enforcement, addressing the importance of public education, regulatory oversight, and mental health support. This study offers valuable insights into the nuanced consequences of cannabis legalization in an emerging economy, contributing to global discussions on drug policy. By aligning policy with the realities of public health and safety, South Africa can leverage the potential benefits of legalization while mitigating its social costs.

Geospatial Analysis of COVID-19 Death Rate and Influencing Factors in the Middle East and North Africa Region

Introduction: This study uses advanced geospatial modeling to analyze key determinants of COVID-19 death cases across the Middle East and North Africa (MENA) region, aiming to reveal spatial patterns and inform targeted interventions for enhanced public health response. Methods: This study employs GIS and geostatistical models, including OLS, SLM, SEM, GWR, and MGWR, to analyze spatial and demographic determinants of COVID-19 mortality across MENA. By examining socioeconomic, medical, and demographic factors, it identifies key drivers and explores spatially non-stationary relationships impacting death rates. Results: The study found that hospital bed allocation, unemployment rate, and vaccination doses positively correlate with COVID-19 death cases in MENA, likely due to better reporting and healthcare access. The OLS model (R² = 0.7346) highlighted spatial autocorrelation, prompting the use of SLM and SEM, which confirmed predictor significance. GWR (R² = 0.8140) and MGWR (R² = 0.8187) revealed spatially non-stationary relationships, with hospital beds impacting the northwest (GWR) and southwest (MGWR). Unemployment was significant in the northeast (Iran, Turkey) and northwest (Morocco), while vaccination doses were notably influential in Iran and Somalia. Conclusion: This study emphasizes the significant roles of healthcare capacity, socioeconomic factors, and vaccination coverage in influencing COVID-19 mortality across MENA. It highlights the vulnerability of healthcare systems in developing countries and underscores the need for targeted resource allocation. Using spatial models like GWR and MGWR, the research reveals regional variations, especially in the northwest, advocating for tailored, region-specific interventions. By integrating GIS and geostatistical models, this analysis lays a foundation for future research on COVID-19 dynamics, providing crucial insights to inform policy measures for better public health crisis management

Viability and control of a delayed SIR epidemic with an ICU state constraint

This paper studies viability and control synthesis for a delayed SIR epidemic. The model integrates a constant delay representing an incubation/latency time. The control inputs model non-pharmaceutical interventions, while an intensive care unit (ICU) state-constraint is introduced to reflect the healthcare system's capacity. The arising delayed control system is analyzed via functional viability tools, providing insights into fulfilling the ICU constraint through feedback control maps. In particular, we consider two scenarios: first, we consider the case of general continuous initial conditions. Then, as a further refinement of our analysis, we assume that the initial conditions satisfy a Lipschitz continuity property, consistent with the considered model. The study compares the (in general, sub-optimal) obtained control policies with the optimal ones for the delay-free case, emphasizing the impact of the delay parameter. The obtained results are supported and illustrated, in a concluding section, by numerical examples.

Measuring healthcare professionals’ perceptions of their ability to adopt shared decision making: Translation and psychometric evaluation of the Danish version of the IcanSDM questionnaire

BackgroundShared decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices. It was developed in Canada with French and English versions, and recently translated into German. This study aims to adapt the IcanSDM measure for Danish-speaking healthcare professionals, and evaluate its psychometric properties.MethodsCultural adaptation and translation based on Beaton et al.'s approach was applied. A forward translation by ten people and a backward translation by two people were performed. To assess comprehensibility, cognitive interviews were conducted with 24 healthcare professionals. Eighty healthcare professionals who were trained in shared decision making for either one hour (n = 65) or one day (n = 15) participated in the psychometric evaluation. The evaluation concerned acceptance, item characteristics, skewness, item difficulties, corrected item-total correlations, inter-item correlations, factorial structure, internal consistency, and responsiveness.ResultsThe forward and backward translation revealed few discrepancies, and participants understood the items well. The psychometric evaluation showed a high completion rate and acceptable item difficulties and discrimination values. Both the factor analysis and the internal consistency showed a 2-factor structure: 1) healthcare professionals' capacity to implement shared decision making; and 2) healthcare professionals' capacity to practise shared decision making. The IcanSDM_Danish obtained a Cronbach’s alpha coefficient of 0.74. The evaluation of responsiveness showed improvement, but was not statistically significant.ConclusionThe IcanSDM_Danish has good cross-cultural validity and internal consistency, and a 2-factor structure. The IcanSDM_Danish is capable of providing reliable and valid measurement when evaluating constructed knowledge about shared decision making, and may be able to support the implementation of shared decision making training and evaluation of its impact.

103. The Impact of COVID-19 restrictions on Open Fracture Emergency Fixation Procedures in eight institutions around South and Southeast Asia

Introduction: Around the time COVID-19 was declared a global pandemic, various restrictions and measures were implemented at all levels to limit disease spread and preserve healthcare capacity. Data is lacking in many low and middle-income countries on how these measures impact healthcare utilization and outcomes. This study aims to determine the impact of COVID-19 restrictions on volumes of the open fracture emergency fixation procedures in South and Southeast Asia. Methods: This was a retrospective cohort study of patients who underwent open fracture fixation from 1 January 2018 to 31 December 2021 at one of 8 institutions in Singapore, Malaysia, Indonesia, India and Vietnam. We compared the weekly volumes, baseline characteristics and outcomes of each procedure across different time periods in each institution defined by different level of COVID-19 restrictions using selected indicators from a city-level and hospital-level response index. Results: A total of 74 (AMH) to 299 (SGH) open fracture fixations were performed over the 4-year period. Weekly volumes decreased significantly at GNRC (p = 1.33 x 10-5), AMH (p = 1.68 x 10-6) and UGH. At UGH there was a drop in the proportion of males during HR1 (66.7%) and HR3 (46.7%) compared to pre-COVID (83.0%) and HR2 (82.4%) (p = 2.02 x 10-4). None of the outcomes were significantly different in any of the institutions. Conclusions: COVID-19 restrictions on the city and hospital level were associated with a decrease in surgical volumes of the open fracture fixation emergency procedures in some of the institutions. There was some suggestion of surgical capacity limitations in UGH and MH175 during periods of more stringent COVID-19 restrictions.

Public health communication and multi-disciplinary NHS workload relating to Group A Streptococcus: a retrospective observational study

BackgroundBy December 2nd, 2022, five child deaths in England were linked to invasive Group A Streptococcus (iGAS) and cases were higher than average, prompting the UK Health Security Agency (UKHSA) to release public health advice for parents. This study aims to describe the relationship between public health messaging and Streptococcus A-related NHS activity in children aged 0–14-years in England. MethodsA retrospective observational study was conducted using GAS-related internet search analytics, NHS and GP surveillance, and UKHSA notifications. FindingsIn the week following the first public health announcement, GP pharyngitis appointments rose by 111% compared to any previous peak observed since 2017. Strep throat and peritonsillar GP attendances rose by 1742%, and Penicillin V prescriptions by 134% compared to mean winter levels. Emergency department attendances for paediatric respiratory infections rose by 68%, 111 calls and online submissions for children with fevers increased by 20% and 311% respectively, and sore throats by 397% and 748%. For each paediatric invasive GAS case, 2250 111 contacts for sore throat or fever and nearly 1200 GP appointments for pharyngitis or scarlet fever occurred. InterpretationThis study highlights the significant impact of Streptococcus A-related workload on the healthcare system during the winter of 2022. Strengthening interdisciplinary collaboration between public health bodies and frontline healthcare providers could help to optimise the content and targeting of messaging and prepare the system for future outbreaks. The findings also point to the necessity of establishing mechanisms for scaling healthcare capacity during periods of increased demand. FundingNone.

Which glaucoma patients should be monitored at home and exploration of clinician perceptions on home monitoring? a survey of glaucoma specialists in the UK

ObjectivesTo identify suitable patients for glaucoma home monitoring and explore clinicians’ perceptions of the possible benefits and risks of home monitoring within the National Health Service.DesignAn online survey composed of open-ended and closed-ended questions.SettingSecondary care.ParticipantsGlaucoma specialists registered with the UK and Eire Glaucoma Society.Outcome measuresAgreement with clinical scenarios.ResultsThe estimated response rate was 68% (n=49). Of 49 participants, 92% (n=45) were consultant ophthalmologists and 71% (n=35) had over 10-year experience. There was a poor agreement regarding an ideal glaucoma patient for home monitoring, with only one scenario achieving over 60% agreement. Most participants believed that home monitoring would be most suitable for low-risk scenarios, rather than high-risk, due to fear of missing progression. In relation to acceptability, key facilitators included the potential to increase healthcare capacity and promote patient safety. However, low clinician trust in equipment reliability and fear of patient harm were reported as concerns.ConclusionsThere was no clear consensus on which patients would benefit most from glaucoma home monitoring. While many clinicians believe home monitoring may enhance healthcare, there were also many concerns about the technologies themselves. Further work to address clinician concerns is warranted.Research Registry registration number6213.

Loading Self-Assembly Siliceous Zeolites for Affordable Next-Generation Wearable Artificial Kidney Technology.

The global demand for dialysis among patients with end-stage kidney disease has surpassed the capacity of public healthcare, a trend that has intensified. While wearable artificial kidney (WAK) technology is seen as a crucial solution to address this demand, there is an urgent need for both efficient and renewable toxin-adsorbent materials to overcome the long-standing technological challenges in terms of cost, device size, and sustainability. In this study, we employed screening experiments for adsorbent materials, multimodal characterization, and Monte Carlo adsorption simulations to identify a synthetic self-assembly silicalite-1 zeolite that exhibits highly ordered crystal arrays along the [010] face (b-axis) direction, demonstrating exceptional adsorption capabilities for small molecular toxins such as creatinine and urea associated with uremia. Moreover, this metal-free, cost-effective, easily synthesized, and highly efficient toxin adsorbent could be regenerated through calcination without compromising the performance. The simulated toxin adsorption experiments and comprehensive biocompatibility verification position it as an auxiliary adsorbent to reduce dialysate dosages in WAK devices as well as a potential adsorbent for small-molecule toxins in dialysis. This work is poised to propel the development of next-generation WAK devices by providing siliceous adsorbent solutions for small-molecule toxins.

Burden of cardiovascular disease attributable to metabolic risks in 204 countries and territories from 1990 to 2021.

To evaluate the global cardiovascular disease (CVD) burden attributable to metabolic risks in 204 countries and territories from 1990 to 2021. Following the methodologies used in the Global Burden of Disease Study 2021, this study analyzed CVD deaths and disability-adjusted life-years (DALYs) attributable to metabolic risks by location, age, sex, and socio-demographic index (SDI). In 2021, metabolic risks accounted for 13.59 million CVD deaths (95% UI 12.01 to 15.13) and 287.17 million CVD DALYs (95% UI 254.92 to 316.32) globally, marking increases of 63.3% and 55.5% since 1990, respectively. Despite these increases, age-standardised mortality and DALY rates have significantly declined. The highest age-standardised rates of metabolic risks-attributable CVD mortality and DALYs were observed in Central Asia and Eastern Europe, while the lowest rates were found in High-income Asia Pacific, Australasia, and Western Europe, all of which are high SDI regions. Among the metabolic risks, high systolic blood pressure emerged as the predominant factor, contributing to the highest numbers of CVD deaths [10.38 million (95% UI 8.78 to 12.03)] and DALYs [14.52 million (95% UI 180.42 to 247.57)] in 2021, followed by high LDL cholesterol. Our study highlights the persistent and significant impact of metabolic risks on the global CVD burden from 1990 to 2021, emphasizing the need of designing public health strategies that align with regional healthcare capacities and demographic differences to effectively reduce these effects through enhanced international collaboration and specific policies.

Unveiling patterns in pediatric appendectomy: A comparative study on healthcare resource capacity and surgical decisions in Brazil.

Appendicitis is the most prevalent surgical emergency in children. This study examined hospital infrastructure, surgical techniques, patient demographics, and hospitalization parameters to assess the provision of safe and adequate care within the Brazilian public healthcare system. Pediatric hospitalizations for acute appendicitis in 2022 were extracted from the Brazilian national database. We included all hospitalizations for patients aged 0-16years with a primary ICD-10 diagnosis of acute appendicitis who underwent an operation. Parameters of interest were the type of surgical approach, mortality, and total cost of hospitalization. Facilities were defined as basic-facility, full-facility, and pediatric according to the level of pediatric resources available. In 2022, there were 29,983 pediatric appendectomies due to acute appendicitis. Of these, 90.2% were open appendectomies. Most occurred in basic-facility general hospitals (53.0%), followed by full-facility (35.2%) and pediatric hospitals (11.8%). Full-facility hospitals had a higher median cost (USD126.3, IQR 99.5-154.4) compared to basic (USD96.8, IQR 87.6-130.1) and pediatric hospitals (USD103.0, IQR 91.9-117.5), though the cost difference between basic and pediatric was not significant (p=0.367). Death was a rare event across all levels of hospital infrastructure and for all types of procedures performed. The majority of hospitalizations for acute appendicitis occurred in hospitals with minimal pediatric infrastructure. Open appendectomies remain the most predominant procedure across all hospital types.

Healthcare capacity strengthening in conflict settings through virtual emergency medical training and outreach: Ukraine and Sudan case studies.

The use of digital learning in healthcare is expanding in a range of contexts including for settings of armed conflict. Humanitarian emergencies and war often lead to a surge of traumatic injuries, emotional distress, and disruption to health systems risking neglect and exacerbations of chronic illness, and acute infectious disease outbreaks, often requiring an international response. On the ground humanitarian response is often essential though logistical and security challenges can delay these responses, and the reliance on an international workforce unfamiliar with local cultures can create challenges in response efforts. In crises where local healthcare workers have limited training, or experience in emergency care, digital health care education can augment in-person response and training efforts. In recent years digital emergency care education programs have been deployed to both Ukraine and Sudan. A review of each of these programs demonstrates successes in and potential utility of remote healthcare capacity strengthening through digital education in settings of war. These programs provide important lessons in strengths of and challenges in developing and delivering just in time learning programs to settings of active armed conflict suggesting similar potential utility in a variety of humanitarian emergency contexts.

Key Determinants of SARS-CoV-2 Testing Among Symptomatic Individuals During the Second Wave in Uttar Pradesh, India: An Analysis From Two Districts.

The COVID-19 epidemic caused significant disruptions worldwide, particularly in healthcare systems. India's second wave, driven by the Delta variant in 2021, severely affected healthcare capacity, leading to resource shortages and healthcare service disruptions. In this context, understanding the factors influencing SARS-CoV-2 testingis crucial for improving public health responses. This study investigates testing determinants in Uttar Pradesh, India, using Andersen's Behavioral Model of Health Services Use. We chose Lucknow and Sitapur districts in Uttar Pradesh based on the number of SARS-CoV-2 tests conducted per million people during the second wave of the epidemic. We conducted a cross-sectional study and surveyed 675 consenting respondents aged 18 and above from both districts. These respondents reported experiencing at least three COVID-19 symptoms between March and June 2021 (the second wave in the state). The survey was conducted face-to-face using a structured questionnaire on an electronic device. We used multiple correspondence analysis (MCA) to identify underlying factors, which were then utilized in a logistic regression model to assess their impact on SARS-CoV-2 testing. The testing rate in Lucknow (281, 84.6%) washigher than in Sitapur (117, 34.1%) (P < 0.001). Urban residents had a higher likelihood of being tested (188, 75.8%) than rural residents (210, 49.2%) (P < 0.001). Males (213, 63.0%) were more frequently tested than females (185, 54.9%) (P = 0.032). Postgraduates had the highest testing rate (49, 89.1%) compared to those without formal education (73, 44.8%) (P < 0.001). Individuals in regular jobs were more likely to be tested (171, 67.1%) compared to homemakers (128, 51.2%) and laborers (72, 57.1%) (P = 0.004). Smaller households (<5 members) had higher testing rates (146, 69.9%) than larger ones (252, 54.1%) (P < 0.001). Those living closer to a facility were more frequently tested (90, 64.3%) compared to those farther away (61, 34.1%) (P < 0.001). Additionally, individuals with access to public transport had higher testing rates (294, 62.0%) compared to those without (104, 51.7%) (P = 0.013). Higher-income groups were more likely to be tested (14, 93.3%) than low-income individuals (39, 36.8%) (P < 0.001). Psychological factors such as ease of testing (285, 72.5%) vs. (71, 38.6%) and perceived likelihood of needing testing (312, 90.7%) vs. (78, 25.1%) were strong predictors (both P < 0.001). Logistic regression identified urban residency and education as key determinants (odds ratio [OR] = 2.00, P < 0.001). This study identifies key sociodemographic, logistical, and psychological factors influencing SARS-CoV-2 testing during the second wave of COVID-19 in Uttar Pradesh, India. Addressing disparities in healthcare infrastructure, improving health literacy, and reducing psychological barriers are essential to enhancing public health responses in future pandemics. Expanding healthcare access in rural areas and targeted public health campaigns could help bridge the gap in testing utilization. Further research is needed to explore these factors longitudinally and in different regional contexts.

Effect of a participatory whole-systems approach on mortality in children younger than 5 years in Jigawa state, Nigeria (INSPIRING trial): a community-based, parallel-arm, pragmatic, cluster randomised controlled trial and concurrent mixed-methods process evaluation

In 2019, Nigeria reported the highest mortality rate in children younger than 5 years globally. We aimed to assess a whole-systems approach to improving child mortality in northern Nigeria. We conducted a community-based, parallel-arm, pragmatic, cluster randomised controlled trial in Kiyawa local government area, Jigawa state, Nigeria, and a concurrent mixed-methods process evaluation using ethnography and quantitative implementation monitoring. Trial clusters were population catchment areas of 32 government primary health-care facilities. Compounds were randomly sampled, proportional to cluster size, and all women aged 16-49 years and children younger than 5 years who were permanent residents were eligible for inclusion and recruited as the evaluation population. Children younger than 7 days were recruited but excluded from analysis. Evaluation clusters were allocated to intervention or control via simple randomisation with a 1:1 ratio. Cluster names were written on paper, folded, and placed in a container by community representatives. Different community representatives took out names one by one, with the first half assigned to receive the intervention. The intervention consisted of three components: participatory learning and action (PLA) groups for men and women (including compound heads [ie, the member of the compound that residents deemed most senior]), partnership defined quality scorecard (PDQS), and health-care worker capacity building; it was delivered from March 1, 2021, to Dec 31, 2022. We could not mask participants, field staff, or intervention-delivery staff to cluster allocation but baseline, endline, and follow-up data excluded information on cluster allocation. PLA groups involved separate groups of up to 25 men or women from all villages in the intervention clusters. The primary outcome was all-cause mortality in children aged 7 days to 59 months between Oct 1, 2021, and Sept 20, 2022, referred to as the evaluation period. The trial was prospectively registered (ISRCTN 39213655) and the protocol has been published. We recruited 3800 compounds at baseline, with 12 893 children contributing to analysis of the primary outcome (7316 [56·8%] of 12 893 in the intervention group and 5577 [43·3%] in the control group). 6617 (51·3%) of 12 893 children were male, 6275 (48·7%) were female, and one (<0·1%) child had missing sex data. Sampled compounds randomly came from 388 (91·3%) of 425 villages in the 32 clusters. We conducted verbal autopsies for 1182 deaths, of which 369 (31·2%) were children aged 7 days to 59 months during the evaluation period. Of these 369, 91 (24·7%) were classified as pneumonia deaths. Children contributed a median 361 days (IQR 236-365) to the analysis, with 369 (2·9%) of 12 893 children censored on their date of death, 1545 (12·0%) on their 5th birthday, and 3392 (26·3%) on the date of the most recent follow-up in which their residence or survival status was known. We found no significant decrease in all-cause mortality (hazard ratio 0·95, 95% CI 0·68-1·33; p=0·79) or suspected pneumonia mortality (0·79, 0·43-1·46; p=0·46) in the intervention group. The process evaluation showed low coverage and issues in reach of the intervention, but qualitative data highlighted mechanisms for positive effects on health and relationships. Our intervention did not affect mortality. However, due to the high child mortality in this region, further efforts should be made to adapt our participatory whole-systems approach to use communities of action within compounds. GSK and Save the Children UK. For the Hausa translation of the abstract see Supplementary Materials section.

Spatiotemporal evolution and influencing factors of flood resilience in Beibu Gulf Urban Agglomeration

In the context of global climate change and rapid urbanization, enhancing flood resilience is essential for mitigating urban flood risk. However, few studies have conducted long-term, cross-scale dynamic evaluations of flood resilience and analyzed its influencing factors and mechanisms. Taking the Beibu Gulf urban agglomeration as the study area, a long-term, cross-scale dynamic evaluation index system based on the “Robustness-Resistance-Recovery” (3Rs) framework was developed to assess the spatiotemporal evolution of flood resilience from 2000 to 2020. Furthermore, the optimal parameters-based geographical detector model is employed to identify the key influencing factors and mechanisms. The results reveal that pre-flood robustness is lower in coastal areas and higher in inland areas. In the during-flood stage, cities with greater comprehensive power exhibit stronger resistance. Post-flood recovery is higher in city centers and marginal mountainous areas, while coastal and inland low-lying areas show lower recovery. The flood resilience of urban agglomerations has improved in recent years, largely due to the enhancement of urban flood control infrastructure and healthcare capacity. However, disparities between cities persist. From 2000 to 2020, economic factors have been the primary drivers of improved flood resilience, while ecological factors have gained increasing importance over the past decade. These findings provide valuable insights for flood prevention, mitigation, and resilience management in urban agglomerations. The developed dynamic evaluation index system offers a reference framework for evaluating flood resilience in other regions.

Factors influencing nursing students' willingness to volunteer during wartime emergencies: A cross sectional study in Israel

BackgroundDuring wartime emergencies, the Ministry of Health in Israel faces workforce shortages, prompting consideration of nursing students as auxiliary support. Understanding the factors influencing nursing students' willingness to volunteer, is essential for effective crisis preparedness. AimThe research seeks to identify how self-efficacy, positive attitudes, institutional support, knowledge, age, gender, prior experience, and familial obligations impact nursing students' readiness to volunteer during mass casualty events in wartime. DesignThis study employed a descriptive, cross-sectional research approach. SettingsNursing schools in Israel. ParticipantsA convenience sample of 300 nursing students who had commenced their studies for at least one month. The study targeted nursing students across Israel, regardless of their specific school affiliation. Recruitment was conducted through various channels, including face-to-face recruitment, emails, and synchronous chat groups. MethodsData were collected using a structured self-report questionnaire based on Bandura's self-efficacy theory and adapted from existing literature. Statistical analyses, included t-tests, Pearson correlation, and linear rand logistic regressions. ResultsThe study found high levels of intent (M = 3.33, SD = 0.83), perceived self-efficacy (M = 3.25, SD = 0.54), and positive attitudes towards volunteering during wartime (M = 3.57, SD = 0.54) among nursing students towards volunteering during wartime. Significant correlations were observed between students' willingness to volunteer during wartime and factors such as positive attitudes to volunteer during wartime (r = 0.543, p < 0.01), perceived self-efficacy (r = 0.313, p < 0.01), institutional support (r = 0.313, p < 0.01), knowledge (r = 0.138, p < 0.05), age (r = 0.179, p < 0.01), and previous volunteering experience (r = 0.158, p < 0.01). Regression analyses indicated that positive attitudes towards wartime volunteering, perceived self-efficacy, institutional support, and prior volunteering were significant predictors of the intention to volunteer. ConclusionsNursing students in Israel demonstrate a high willingness to volunteer during wartime, influenced by factors such as perceived self-efficacy, positive attitudes towards volunteering, and institutional support. While these findings suggest potential areas for enhancing volunteerism, further research is needed to assess the effectiveness of targeted training and support interventions. Nonetheless, fostering these key factors could strengthen the healthcare system's capacity to respond to wartime emergencies.

A New Hospital-At-Home Model for Integrated Geriatric Care: Data from a Preliminary Italian Experience

ObjectiveHospital-at-home (HaH) has emerged as an alternative to conventional in-hospital care in older adults, possibly reducing hospital admissions and related complications. This study aimed to describe the characteristics and outcomes of patients referred to “Gruppo di Intervento Rapido Ospedale-Territorio” (GIROT), a HaH service based on comprehensive geriatric assessment, developed in Florence, Italy, during the postpandemic period. DesignRetrospective longitudinal study. Setting and ParticipantsGIROT provided home-based care to patients with acute or exacerbated chronic diseases and a high risk of hospital-related complications (ie, patients with moderate-to-severe disability and/or dementia), referred from primary care, emergency departments, or in-hospital units. MethodsAll-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated. ResultsAmong 391 patients (mean age, 88.4 years; 62.4% female) referred from emergency departments (58.6%), primary care (27.9%), and acute medical units (13.6%), the main diagnoses were respiratory failure (28.4%), acute heart failure (25.3%), and delirium (13.6%). Patients referred from primary care were older and showed a higher prevalence of severe disability and hypomobility. After 1, 3, and 6 months, mortality rates were 34.5%, 45.6%, and 53.8%, and hospitalization rates 7.2%, 21.5%, and 37.9%, respectively. Predictors of 6-month mortality included age [odds ratio (OR), 1.039], severe disability (OR, 3.446), impossible/assisted walking (OR, 4.450) and referral from primary care (OR, 2.066). High global satisfaction with the service was reported. Conclusions and ImplicationsThe GIROT model may help expanding acute health care capacity for older adults at high risk of hospital-related complications. Customized care plans are needed in patients with severe disability/hypomobility, considering also simultaneous palliative care.

A new performance evaluation indicator for the LEE Jong-wook Fellowship Program of Korea Foundation for International Healthcare to better assess its long-term educational impacts: a Delphi study.

The Dr. LEE Jong-wook Fellowship Program, established by the Korea Foundation for International Healthcare (KOFIH), aims to strengthen healthcare capacity in partner countries. The aim of the study was to develop new performance evaluation indicators for the program to better assess long-term educational impact across various courses and professional roles. A 3-stage process was employed. First, a literature review of established evaluation models (Kirkpatrick’s 4 levels, context/input/process/product evaluation model, Organization for Economic Cooperation and Development Assistance Committee criteria) was conducted to devise evaluation criteria. Second, these criteria were validated via a 2-round Delphi survey with 18 experts in training projects from May 2021 to June 2021. Third, the relative importance of the evaluation criteria was determined using the analytic hierarchy process (AHP), calculating weights and ensuring consistency through the consistency index and consistency ratio (CR), with CR values below 0.1 indicating acceptable consistency. The literature review led to a combined evaluation model, resulting in 4 evaluation areas, 20 items, and 92 indicators. The Delphi surveys confirmed the validity of these indicators, with content validity ratio values exceeding 0.444. The AHP analysis assigned weights to each indicator, and CR values below 0.1 indicated consistency. The final set of evaluation indicators was confirmed through a workshop with KOFIH and adopted as the new evaluation tool. The developed evaluation framework provides a comprehensive tool for assessing the long-term outcomes of the Dr. LEE Jong-wook Fellowship Program. It enhances evaluation capabilities and supports improvements in the training program’s effectiveness and international healthcare collaboration.

Indications for Transfer and Care Pathways of Inuit Transferred to a Tertiary Centre for Childbirth in Québec, Canada: A Chart Review 2015–2019

ObjectivesChildbirth evacuation, the transfer of patients from rural and remote communities to urban centres for pregnancy care or childbirth, can be associated with numerous adverse health outcomes and contributes to widening health disparities between Inuit and non-Indigenous populations in Québec. We examined the indications and outcomes of childbirth evacuations among Inuit from Nunavik, Northern Québec transferred to a southern tertiary care centre. MethodsA 5-year retrospective chart review included 677 pregnancies of 597 Inuit with obstetric indications transferred to a tertiary care centre between 2015 and 2019. ResultsThe most common reasons for transfer were diabetes (70/677, 10.3%), hypertension (69/677, 10.2%), abnormal prenatal screen/soft markers (57/677, 8.4%), and threatened preterm labour (55/677, 8.1%). Of the 534 (78.9%) Inuit who gave birth at the tertiary centre, 84.1% (449/534) were vaginal births. Overall, 27.0% (144/534) had obstetric complications, with postpartum hemorrhage (58/534, 10.9%) and retained placenta (34, 6.37%) being the most common. Of the 549 neonates, 9 were stillbirths (1.6%), and 69 neonates (12.6%) required admission to the neonatal intensive care unit. Approximately 3.4% (18/534) had complications within the postpartum period, with the most common being retained products of conception (4/18, 22.2%) and postpartum preeclampsia (4/18, 22.2%). ConclusionsA relatively young and multiparous population, Inuit from Nunavik have unique health profiles and care needs. Further investment in health care capacity in Nunavik, alongside locally adapted, prevention-focused perinatal health programming, might improve perinatal health profiles and reduce the rates of childbirth evacuation.

Systems mapping: a novel approach to national lung cancer screening implementation in Australia.

Lung cancer screening with low-dose computed tomography has been started in some high-income countries and is being considered in others. In many settings uptake remains low. Optimal strategies to increase uptake, including for high-risk subgroups, have not been elucidated. This study used a system dynamics approach based on expert consensus to identify (I) the likely determinants of screening uptake and (II) interactions between these determinants that may affect screening uptake. Consensus data on key factors influencing screening uptake were developed from existing literature and through two stakeholder workshops involving clinical and consumer experts. These factors were used to develop a causal loop diagram (CLD) of lung cancer screening uptake. The CLD comprised three main perspectives of importance for a lung cancer screening program: participant, primary care, and health system. Eight key drivers in the system were identified within these perspectives that will likely influence screening uptake: (I) patient stigma; (II) patient fear of having lung cancer; (III) patient health literacy; (IV) patient waiting time for a scan appointment; (V) general practitioner (GP) capacity; (VI) GP clarity on next steps after an abnormal computed tomography (CT); (VII) specialist capacity to accept referrals and undertake evaluation; and (VIII) healthcare capacity for scanning and reporting. Five key system leverage points to optimise screening uptake were also identified: (I) patient stigma influencing willingness to receive a scan; (II) GP capacity for referral to scans; (III) GP capacity to increase patients' health literacy; (IV) specialist capacity to connect patients with timely treatment; and (V) healthcare capacity to reduce scanning waiting times. This novel approach to investigation of lung cancer screening implementation, based on Australian expert stakeholder consensus, provides a system-wide view of critical factors that may either limit or promote screening uptake.

Global Health Security in Vision Care: Health Systems Strengthening During Ebola Virus Disease Outbreak Responses.

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications.