Health Cooperative Research Articles

Moncloa University HLA Hospital: the Health Cooperative Contributing to Generating Value for Stakeholders

Moncloa University HLA Hospital: the Health Cooperative Contributing to Generating Value for Stakeholders

Wild bird mass mortalities in eastern Canada associated with the Highly Pathogenic Avian Influenza A(H5N1) virus, 2022

AbstractIn 2022, a severe outbreak of disease caused by clade 2.3.4.4b Highly Pathogenic Avian Influenza (HPAI) H5N1 virus resulted in unprecedented mortality among wild birds in eastern Canada. Tens of thousands of birds were reported sick or dead, prompting a comprehensive assessment of mortality spanning the breeding season between April 1 and September 30, 2022. Mortality reports were collated from federal, Indigenous, provincial, and municipal agencies, the Canadian Wildlife Health Cooperative, and other nongovernmental organizations, universities, and citizen science platforms. A scenario analysis was conducted to refine mortality estimates, accounting for potential double counts from multiple sources under a range of spatial and temporal overlaps. Correcting for double counting, HPAI is estimated to have caused 40,391 wild bird mortalities in eastern Canada during the spring and summer of 2022; however, this figure underestimates total mortality as it excludes unreported deaths on land and at sea. Seabirds and sea ducks, long‐lived species that are slow to recover from perturbations, accounted for 98.7% of estimated mortalities. Our study provides estimates of bird mortality, with Northern Gannets (Morus bassanus; 25,669), Common Murres (Uria aalge; 8133), and American Common Eiders (Somateria mollissima dresseri; 1894) exhibiting the highest mortality figures. We then compare these mortality estimates with recent population estimates and trends and make an initial assessment of whether biologically meaningful population‐level impacts are possible. Specifically, we focus on the Northern Gannet, a species that has suffered significant global mortality, and two harvested species, Common Murre and American Common Eider, to inform management decisions. Our analysis suggests population‐level impacts in eastern Canada are possible for Northern Gannets and American Common Eiders, but are unlikely for Common Murres. This study demonstrates a comprehensive approach to assessing mortality and underscores the urgent need for further research to understand the broader ecological ramifications of the HPAI outbreak on wild bird populations.

Disease and Mortality in Free-Ranging Leporids in Canada, 1990-2019: A Retrospective Study.

Passive surveillance of wildlife disease is a valuable tool for the identification of emerging and changing disease patterns. Free-ranging leporids play an important role in their ecosystem and in the culture and diet of Canadians; however, little is known about their health status and the zoonotic pathogens they may carry. We summarized major causes of mortality and morbidity, as well as incidental infections and lesions, of free-ranging leporids submitted to the Canadian Wildlife Health Cooperative (CWHC) between 1990 and 2019. We identified Canadian leporids as competent hosts for several zoonotic pathogens, most notably Francisella tularensis (20/569; 3.5%). Trauma was the most frequent cause of mortality or morbidity among leporids, accounting for 46.0% of cases submitted to the CWHC, followed by bacterial infections (13.7%) and emaciation (5.1%). Human-mediated mortalities, such as those involving machines (23.7%), were the most common trauma case type, with apparently healthy individuals overrepresented within this mortality group. Harvesters proved to be a valuable resource for the monitoring of diseased and infected animals, as more than half (69.6%) of the animals submitted by this group had an incidental infection or lesion. The results from this study provide a scientific understanding the cause of mortality in free-ranging leporids in Canada with relevance to public health, wildlife biologists, veterinarians, and potential future surveillance programs.

Effectiveness of Home Health Care Services in the Qassim Region

This study aimed to assess the effectiveness of home healthcare services provided by both governmental and private sectors in the Qassim Region, Saudi Arabia, during 2021. A survey was conducted involving 210 participants, comprising 2,304 patients from 20 governmental home health care (HHC) sections in hospitals and 199 patients from one private home health care section in private hospitals in the Qassim Region. The majority of respondents were married Saudi men who preferred home visits and faced literacy challenges. Home health care (HHC) was found to be a viable and cost-effective alternative to hospital care, with an average visit duration of approximately 65 minutes and costs amounting to about $400.5 for the private sector and $1,622.694 for the government sector per patient monthly. Despite higher perceived costs, home healthcare remained more economical than hospital-based care. Noteworthy is the continued cost difference between governmental and private sectors on a per-patient monthly basis, indicating potential non-financial factors influencing service delivery. Participants rated HHC services as effective, particularly in assisting with transitions and identifying nutritional deficiencies, although patient deterioration and re-admission received lower ratings. In conclusion, home healthcare services in the Qassim Region were effective across both sectors, highlighting HHC as a cost-effective alternative despite variations in costs between governmental and private providers. It is essential to note the exclusion of home health care coverage from the Council of Cooperative Health Insurance (CCHI) policy. Keywords: Home health care, Care systems, Quality, Costs

(Data-) Cooperatives in health and social care: a scoping review

Abstract Aim To gather information about the structure of cooperatives in health and social care, in general, and data cooperatives, in particular, to derive implications for their future implementation. Subject and methods Health and social care systems are currently under pressure due to rising costs and demands. Many hopes lie on digitization, digitalization, and the potentials of health data. A scoping review was conducted searching nine databases and grey literature. Data on information about aim, type, and structure of the cooperatives, member structure, founding process, and their way of financing were extracted. Results All searches resulted in 9080 articles and websites. Overall, we included 26 cooperatives and categorized them as follows: (1) worker cooperatives with focus on workers’ rights and service provision to clients, (2) consumer cooperatives, (3) consumer and worker cooperatives, (4) cooperatives of institutions, (5) general practitioner (GP) cooperatives, (6) cooperatives as health insurance models, and (7) health data cooperatives. Conclusions Information provided on (data) cooperatives differed greatly in detail. Their common goal is to tackle and overcome existing barriers in their field such as working conditions or unequal health care. We identified five challenges: (1) salary structures; (2) cooperating with other providers and surrounding institutions; (3) building an identity and recruiting potential members; (4) motivation of members to participate actively; and (5) distinction from other types. Benefits are: (1) improvement of conditions; (2) being stronger together; (3) support of research; and (4) data governance. When successful and competent, (data) cooperatives can be powerful tools on public, scientific, and political levels.

Validity and responsiveness of EQ-5D-Y in children with haematological malignancies and their caregivers.

The psychometric properties of the EQ-5D-Y have not been widely tested in severely ill children. The aim of this study was to assess and compare the validity and responsiveness of the EQ-5D-Y-3L and EQ-5D-Y-5L in paediatric inpatients with haematological malignancies and caregivers. Respondents completed the interviewer-administered self-complete or proxy version of the EQ-5D-Y-3L and EQ-5D-Y-5L and an overall health assessment twice on different days. Known-groups validity was assessed by comparing patients who differed in overall health and Eastern Cooperative Oncology Group (ECOG) performance. Responsiveness to worsened health was assessed using standardised effect size (SES) for patients with worsened ECOG grade, self-reported rating, or chemotherapy initiation. Ninety-six dyads completed the baseline questionnaires. A smaller proportion of patients reported "no problems" on the EQ-5D-Y-5L compared to EQ-5D-Y-3L for most of the five dimensions. Patients in poor health reported more problems in all dimensions and had higher EQ-5D-Y-5L level sum score, lower EQ VAS and EQ-5D-Y-3L index scores (Cohen's d ES: 0.32-1.38 for patients; 0.50-2.05 for caregivers). There was a mild to good responsiveness to worsened health condition based on ECOG (SES: 0.14-0.61 for patients; 0.40-0.96 for caregivers), suggesting the proxy version was slightly responsive than the self-complete version of both instruments. The results demonstrated validity and responsiveness for both the self-complete and proxy versions of the EQ-5D-Y-3L and EQ-5D-Y-5L. The proxy and 5-level versions of the instrument were more sensitive than the self-complete and 3-level versions in this patient group.

Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021.

Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

Taxa e custos médicos diretos de cesáreas em beneficiárias da saúde suplementar no estado de São Paulo, Brasil: 2015 a 2021

Abstract Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

OVERVIEW OF THE DEVELOPMENT OF HEALTH COOPERATIVES IN THE TERRITORY OF SERBIA AND MODERN ASPECTS

Health cooperatives were initiated in Serbia in the late 19th century, while a fully developed model of modern health cooper atives was in 1921, providing a model for other countries. Today, there are currently very few health cooperatives in Serbia. An initiative was submitted in 2020 to promote their re-establishment and recommend that the government consider public-cooperative partnership forms to enhance healthcare accessibility and quality. Health coop eratives could address challenges in organizing preventive activities, health education, services not covered by health insurance or expensive in private practice, rural health development, reduction of emigration of health personnel, profiling and complication of health services, and development of medical research, among other sectors.

Longitudinal Sleep Patterns and Cognitive Impairment in Older Adults

Sleep disturbances and clinical sleep disorders are associated with all-cause dementia and neurodegenerative conditions, but it remains unclear how longitudinal changes in sleep impact the incidence of cognitive impairment. To evaluate the association of longitudinal sleep patterns with age-related changes in cognitive function in healthy older adults. This cross-sectional study is a retrospective longitudinal analyses of the Seattle Longitudinal Study (SLS), which evaluated self-reported sleep duration (1993-2012) and cognitive performance (1997-2020) in older adults. Participants within the SLS were enrolled as part of a community-based cohort from the Group Health Cooperative of Puget Sound and Health Maintenance Organization of Washington between 1956 and 2020. Data analysis was performed from September 2020 to May 2023. The main outcome for this study was cognitive impairment, as defined by subthreshold performance on both the Mini-Mental State Examination and the Mattis Dementia Rating Scale. Sleep duration was defined by self-report of median nightly sleep duration over the last week and was assessed longitudinally over multiple time points. Median sleep duration, sleep phenotype (short sleep, median ≤7 hours; medium sleep, median = 7 hour; long sleep, median ≥7 hours), change in sleep duration (slope), and variability in sleep duration (SD of median sleep duration, or sleep variability) were evaluated. Of the participants enrolled in SLS, only 1104 participants who were administered both the Health Behavior Questionnaire and the neuropsychologic battery were included for analysis in this study. A total of 826 individuals (mean [SD] age, 76.3 [11.8] years; 468 women [56.7%]; 217 apolipoprotein E ε4 allele carriers [26.3%]) had complete demographic information and were included in the study. Analysis using a Cox proportional hazard regression model (concordance, 0.76) showed that status as a short sleeper (hazard ratio, 3.67; 95% CI, 1.59-8.50) and higher sleep variability (hazard ratio, 3.06; 95% CI, 1.14-5.49) were significantly associated with the incidence of cognitive impairment. In this community-based longitudinal study of the association between sleep patterns and cognitive performance, the short sleep phenotype was significantly associated with impaired cognitive performance. Furthermore, high sleep variability in longitudinal sleep duration was significantly associated with the incidence of cognitive impairment, highlighting the possibility that instability in sleep duration over long periods of time may impact cognitive decline in older adults.

OP5 Multistakeholder Healthcare Cooperative: A New Paradigm for Healthcare Delivery

OP5 Multistakeholder Healthcare Cooperative: A New Paradigm for Healthcare Delivery

SAT288 Development Of CAH-specific Patient Reported Outcome (PRO) Instrument To Assess Health-related Quality Of Life (HRQoL)

Abstract Disclosure: M.E. Flokas: None. L. Yang: None. K. Middleton: None. R.W. Persky: None. S. Kollender: None. M. Parker: None. D.P. Merke: Grant Recipient; Self; Diurnal, received unrelated research funds through the National Institutes of Health Cooperative Research and Development Agreement., D.P.M. received unrelated research funds from Neurocrine Biosciences through the National Institutes of Health Cooperative Research and Development Agreement. Objectives: Measuring health-related quality of life (HRQoL) is a crucial and often required process of evaluating health care outcomes. The aim of our study is to develop a disease-specific patient reported outcome (PRO) instrument to evaluate the HRQoL of patients >16 years old with classic congenital adrenal hyperplasia (CAH). Methods: Following the FDA guidelines for developing PRO instruments, we developed a conceptual framework for the instrument. The process involved interviewing a representative sample of the CAH population and along with expert feedback and review of the literature. We are assessing the instruments’ validity and reliability with the assistance of patient participation. Internal consistency of the instrument is being evaluated using Cronbach’s alpha. We are also assessing the validity by comparing the scores of our instrument with scores from widely used instruments for HRQoL namely, Short Form Health Survey-36 (SF-36), AddiQol, Tuebingen CD-25 and Female Sexual Functioning Index. Furthermore, we collected data regarding the clinical outcomes, symptoms and patient characteristics to investigate the correlation between patient-reported and provider- observed outcomes. Results: Twelve patients with CAH, aged between 16 to 68 years old were interviewed and provided insight on the CAH - related health outcomes that were most relevant to them. A preliminary instrument was developed and subjected to validity testing in the form of cognitive interviewing. The edited instrument consisting of 73 questions covering 9 preliminary domains (General Health, Adrenal Insufficiency, Glucocorticoid Excess, Androgen Excess, Physical Functioning, Sexual Functioning and Fertility, Mental Health and Cognition, Social Functioning and CAH Management). Sixty-nine participants aged 16 to 75 years old participated in validating our preliminary instrument. Forty- six participants (67%) had salt-wasting CAH while 23 (33%) had simple virilizing CAH. Fifty-one percent of participants identified as male, 46% female, while 3% as other gender. Preliminary results show mostly acceptable (>0.7) Cronbach’s alpha, showing reliability in most domains. Further data analysis is underway. Conclusion: This is the first PRO instrument to capture the HRQoL outcomes in the CAH population. In addition to its anticipated use in the clinical setting, the instrument could be used to assess the efficacy of novel treatments in development. The final instrument is currently under development. Presentation: Saturday, June 17, 2023

WILLINGNESS TO PAY FOR HEALTH INSURANCE: THE CROSS-SECTIONAL STUDY IN SAUDI ARABIA

Due to rapid changes in disease pattern, demand for advance healthcare services has been increased extensively in Saudi Arabia. In Saudi Arabia, health facilities are provided free to general public. This has increased the burden of communicable and non-communicable diseases expenditure on ministry of health. On other hand, to private sector employee cooperative health insurance program is established. Saudi Government plan to extend this program to the public sector as well. In this study willingness to pay for health insurance opinion was taken from general public as they are main stakeholder. In case if government extend this private employer cooperative insurance program to other sectors whether people are willing to pay for private insurance or not. Non-probability convenience sampling technique was used to select sample size. Findings revealed that majority of people in Saudi Arabia have no chronic disease and likewise they have no private insurance ownership as well. On the basis of gender, education, income, insurance ownership, family size, chronic disease and obstacles people are significantly willing to pay for health insurance. Policy makers, & MoH can take benefits from findings of the current study and it would help them to formulate insurance premiums & provide additional source of funding for healthcare in Saudi Arabia.

USING WILDLIFE REHABILITATION AND POSTMORTEM DATA TO IDENTIFY KEY CAUSES OF MORBIDITY AND MORTALITY IMPACTING THE HEALTH AND WELFARE OF FREE-LIVING WILD ANIMALS IN CANADA.

The health and welfare of wild animals are of increasing concern, yet there are very few large-scale data syntheses examining how causes of wildlife morbidity and mortality vary across time, space, and taxa. Records for 18,540 animals submitted to the Canadian Wildlife Health Cooperative (CWHC) (2009-19) and 144,846 animals admitted to 19 wildlife rehabilitation centers (WRCs) (2015-19) were evaluated to 1) identify the main causes of morbidity and mortality for Canadian wildlife and 2) assess the utility and complementarity of these two data sources to further our understanding of wildlife health. The CWHC cases (mortality) were examined by pathologists and grouped by the presence or absence of five diagnostic categories: trauma, emaciation, infection or inflammation, toxicity, and other. These CWHC animals were also classified as "killed due to real or perceived human-wildlife conflict" based on finder history. The WRC admissions were categorized by health issue (according to intake records) and based on reported or observed situational reasons for admission: parental loss, unsafe or unsuitable location, nest or habitat disturbance, illegal possession, and abnormal behavior. For both datasets, the main reason for submission or admission was trauma (44 and 48%, respectively), especially vehicle collisions (7 and 11%) and window or building strikes (5 and 7%). Many other WRC admissions were due to parental loss (28%), cat attacks (6%), and immature animals being found in unsafe or unsuitable locations (6%). Most other CWHC mortalities were caused by infections (27%) and emaciation (23%). Relatively few birds, amphibians, and reptiles submitted to CWHC were killed due to human-wildlife conflict, but 22% of mammals were killed for this reason, highlighting the taxonomic differences in the perceived threat of wildlife to finders, and therefore their response. Together, these data sources highlight key issues impacting the health and welfare of wild animals in Canada.

Remembering Ruth Milligan Ballweg, MPA, PA-C Emeritus.

Remembering Ruth Milligan Ballweg, MPA, PA-C Emeritus.

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care.

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care.

사회적경제조직의 학습활동 분석을 통한 학습관리장치 개념의 탐색

Health Cooperatives are one of the Social Economy (SE) organizations that carry out various health care and educational activities for the realization of community medical welfare. As a Learning Management Apparatus (LMA), which is a network of verbal and non-verbal elements that intervene in human learning activities, Health Cooperatives produce the subject (‘activist members’) through the management of their members' learning activities. This paper aims to capture the dispositif that manages learning activities at the group level and to specify the concept of LMA. For this purpose, this study selected a Health Cooperative as a case study and inductively derived the elements of a LMA. The results of this study are as follows: the elements that make up the LMA are divided into spatial, content, practical and discursive elements. Also the two essential attributes of the dispositif are the process of subjectification and the emergence of new subjectivity. In addition, the LMA functions as a space that resonated through competition between the two essential attributes and various elements of the dispositif. Finally, this study suggested various empirical follow-up case studies to refine the concept of the LMA

COVID-19 Vaccination Coverage among 42,565 Adults Amid the Spread of Omicron Variant in Beijing, China.

Vaccines against coronavirus disease 2019 (COVID-19) have been in use for over two years, but studies that reflect real-world vaccination coverage and demographic determinants are lacking. Using a multistage stratified random cluster sampling method, we planned to directly explore vaccination coverage and the demographic determinants of different doses of COVID-19 vaccines in Beijing, especially in older populations. All 348 community health service centers in 16 districts were involved. We performed multivariable logistic regression analyses to identify demographic determinants of different coverage rates via adjusted odds ratios (aORs) and 95% CIs. Of the 42,565 eligible participants, the total vaccination coverage rates for ≥1 dose, ≥2 doses, ≥3 doses, and 4 doses were 93.3%, 91.6%, 84.9%, and 13.0%, respectively, but decreased to 88.1%, 85.1%, 76.2%, and 3.8% in the older population. Among all participants, younger (aOR = 1.77, 95% CI: 1.60-1.95), male (aOR = 1.15, 95% CI: 1.06-1.23), and better-educated residents (high school and technical secondary school aOR = 1.58, 95% CI: 1.43-1.74; bachelor's degree aOR = 1.53, 95% CI: 1.37-1.70) were more likely to be fully vaccinated. People who lived in rural areas (aOR = 1.45, 95% CI: 1.31-1.60) and held the new rural cooperative health insurance (aOR = 1.37, 95% CI: 1.20-1.57) established a higher rate of full vaccination coverage. No history of chronic disease was positively associated with a higher coverage rate (aOR = 1.81, 95% CI: 1.66-1.97). Occupation also affected vaccination coverage. Demographic factors influencing the rate of vaccination with at least one or three doses were consistent with the results above. Results remained robust in a sensitivity analysis. Given the highly transmissible variants and declining antibody titers, accelerating the promotion of booster vaccination coverage, especially in high-risk groups such as the elderly, is a top priority. For all vaccine-preventable diseases, rapidly clarifying vaccine-hesitant populations, clearing barriers, and establishing a better immune barrier can effectively safeguard people's lives and property and coordinate economic development with epidemic prevention and control.

The Impact of Covid-19 Pandemic on Islamic Health Insurance Market Returns: Empirical Evidence from Saudi Arabia

This study aims to identify the impact of COVID-19 on the Cooperative Health Insurance (CHI) Market in Saudi Arabia by applying Event Study Methodology. The health event identified in this study is the announcement of the first positive case of COVID-19 in Saudi Arabia, which the Ministry of Health announced on March 2, 2020. For this study, the daily price of 24 cooperative health insurance companies listed on the Saudi Stock Market (Tadawul) and the market index (TASI) for the same period (June 05, 2018 - March 30, 2020) were collected. The abnormal returns are calculated using the Capital Asset Pricing Model (CAPM). The study found a negative effect of the COVID-19 pandemic on the health insurance companies in Saudi Arabia during the first week of the anticipation period that continued until the event day. Negative abnormal returns persisted until the end of the total study period but were not statistically significant except on only three days during the post-event window (March 05, 08, and 09, 2020). This means the Saudi cooperative insurance market experienced a period of anticipation and anxiety before the announcement of the first case of Covid-19; however, the information was insufficient and unconfirmed. During the adjustment window, the market tried to adjust itself and react to the event efficiently, but it could not do so. The results of this study are useful to takaful investors, operators, and regulators in the Islamic insurance markets and to researchers and academicians.

The influence of sociodemographic and environmental factors on wildlife carcass submissions in urban areas: Opportunities for increasing equitable and representative wildlife health surveillance

Wildlife health surveillance is important in rapidly expanding urban areas, where wildlife live in close association with humans and face unique health risks. Urban areas are not homogeneous, and social and environmental factors may affect the distribution of surveillance data we receive from these environments. The Canadian Wildlife Health Cooperative (CWHC) operates a national wildlife surveillance programme that receives carcass submissions for diagnostic evaluation. Our objective was to evaluate sociodemographic and environmental factors associated with CWHC submissions within two cities in Ontario, Canada. Submissions were mapped at two geographic scales and linked with census and environmental data. The results of mixed multivariable Poisson and negative binomial regression analyses suggest that natural (e.g., percent parkland) and anthropogenic environmental (e.g., presence of a zoo) and social variables (e.g., low income) are associated with submissions at both administratively relevant scales. Associations that are common across scales may represent robust intervention points and inform surveillance methodology/messaging. Surveillance data may influence public health policy, wildlife management, and other decision-making regarding the benefits/risks associated with coexistence with wildlife. This study highlights gaps in surveillance methodology that may prevent equal opportunity for participation in wildlife health surveillance and enable equal opportunity to benefit from the associated outputs.