Provision Of Health Care Services Research Articles

Between worlds: Cis-and trans-identifying diaspora Middle Eastern and North African (MENA) women in Ontario, Canada on the intersections of gender, sexuality and sexual health

Youth Sexual Health and HIV/STI Prevention in Middle Eastern and North African Communities (YSMENA) is the first community-based research study in Canada to explore key determinants of sexual health among diaspora Middle Eastern and North African (MENA) women living in Canada. Our objectives were to identify the factors influencing sexual health for MENA youth and grow an evidence base to strengthen the sexual health response for MENA communities. Using mixed- method design, data were gathered through a quantitative socio-demographic survey and qualitative focus groups with 24 women-identifying MENA youth (16–29 years) living in Ontario, Canada. Six (6) focus groups were held virtually via Zoom, with heterosexual, lesbian, bisexual and queer (LBQ), and trans women. Members of each group participated in two sessions as per the sequential critical dialogical method and transcripts were coded in NVIVO. While participants identified with diverse sexual orientations and across the trans-feminine gender spectrum, key commonalities surfaced, namely the pressures to conform to familial expectations and the barriers faced when accessing healthcare. The trans group experienced compounded levels of exclusion given their unique positioning. Although the challenges faced by the group were deeply entrenched in patriarchy, heteronormativity and internalized shame, many participants demonstrated resilience and self-acceptance that enabled them to forge pathways to health. Findings have important and valuable implications for community-based health programs targeting MENA women as well as healthcare practitioners and service providers.

RELAKA: Robust ECC based Privacy Preserving Lightweight Authenticated Key Agreement protocol for healthcare applications

With the advancement of cutting-edge technologies, the Internet of Medical Things (IoMT) has assisted the healthcare sector by facilitating interaction between healthcare service providers and patients in remote areas. In IoMT, wearable or implantable sensors collect the patient’s record and share the information through a public network. Health-related information about the patient must be protected from a variety of attacks by the adversary since it is sensitive and extremely vulnerable to attacks. The sensor equipment that is implanted in the patient is also resource-constrained and has a low power capacity. The entities involved in the communication must be authenticated with one another in order to protect patients’ health information, anonymity, and reliability. While several authenticated key agreement protocols have been proposed, many suffer from high computational costs and storage cost, making them unsuitable for lightweight applications. This paper proposes a secure three-factor robust Elliptic Curve Cryptography (ECC) based mutually authenticated and key agreement protocol known as RELAKA for the IoMT environment, utilizing the benefits of one-way hash function. In proposed scheme, all entities, including the healthcare service providers and wearable sensors, are authenticated by the medical server. Subsequently, a secret key is established for each communication session and shared between all the entities. Additionally, mechanism for appropriate user revocation and re-registration is integrated to provide additional security in cases where a user’s QR code is tampered with by the attacker. The privacy of the proposed protocol is investigated by the potential use of zero knowledge proof. Furthermore, the efficacy of the authentication is examined by challenge and response mechanism. The informal security analysis demonstrates its resistance to threats such as DoS, impersonation, message modification, password guessing, and so on. The performance evaluation of RELAKA protocol indicates that the execution, communication, and storage costs is reduced by 87.59%, 43% and 60.71% respectively. Moreover, the outcomes of the AVISPA simulation illustrate that the RELAKA successfully evades both active and passive attacks. In addition, real-world testbed environment is developed with Raspberry pi 4 model B and the experimental results verifies the robustness of the proposed protocol. According to theoretical analysis and experimental evaluation, the RELAKA scheme is more secure and efficient than the existing protocols.

Adoption of quick response codes as a digital microlearning tool among clinical nurses: a quasi-experimental study.

The rapid growth of technology forced enormous changes in the provision of healthcare services. Different strategies are used to keep nurses up to date with rapid changes in health systems. Microlearning is one of the new methods of teaching professional skills to health workers. This method is effective in care settings that have many limitations in terms of time and place. However, it is very important to test the acceptability of this method among nurses before practical measures are taken for its widespread use. This study aimed to determine nurses' acceptance rate of quick response code as a microlearning tool in workplace. This is a cross-sectional study was conducted in medical and surgical wards in hospitals affiliated to Guilan University of Medical Sciences. 185 nurses participated in the study. A number of selected medical devices were labeled with quick response codes containing educational content. The eligible nurses were instructed how to use the QR codes. After two months, they were asked to complete a questionnaire adapted from the technology acceptance model 3. SPSS 21 software was used to analyze the data. 166 nurses and 19 head nurses with mean age of 34.26 ± 8.17 years and mean work experience of 10.46 ± 7.64 years completed the questionnaires. Most participants were female, married, with a bachelor's degree, worked on rotating shifts, in medical wards. The findings showed that the acceptance of the quick response code as a learning tool was at a moderate level (M = 66.1, SD = 16.6). Statistically, there was no significant relationship between nurses' demographic characteristics and the total acceptance rate (P > 0.05). However, the analyses at the multivariate level, using multiple linear regression, showed a significant superiority of the total acceptance score in head nurses compared to nurses (b = 7.97, P = 0.047) and in nurses who had previous experience of using quick response codes, compared to colleagues without such experience (b = 5.18, P = 0.036). Based on the coefficient of determination, only 6.1% of the changes in the total acceptance score of quick response codes of nurses are explained by their personal-occupational characteristics (R2 = 0.061). The provision of QR code requirements such as necessary infrastructure and training by the health authorities could increase the acceptance of this tool as a microlearning measure.

Pandemic COVID-19 as a challenge for telemedicine in the Czech Republic.

The COVID-19 Pandemic contributed to accelerating the process of using information and communication technologies and digital technologies in healthcare management and delivery within healthcare systems. At that time, the Czech healthcare system faced the same problems as other European systems and struggled with a temporary limitation of direct provision of healthcare services. It was solved by switching to telemedicine. The Czech healthcare system used telemedicine to a minimal extent until then. Despite adopting the law on healthcare digitisation, it is still one of the countries with a lower level of digitisation of healthcare processes. The article presents the results of an exploratory expert investigation focused on the implementation and development of telemedicine in the Czech Republic. The conducted research aimed to identify problems related to the implementation of telemedicine in practice, place them in the broader framework of the healthcare system and structure them, propose possible solutions, and identify the future challenges of telemedicine in the Czech Republic. We based our study on the results of a three-phase QUAL-QUAN-QUAL research. Data collection in the first phase took the form of individual semi-structured interviews with patients (25) with practical experience in the field of telemedicine, followed by the second quantitative phase of the questionnaire survey with patients (650). The third qualitative phase included semi-structured interviews with experts (17) with practical experience in telemedicine. The introduction and expansion of telemedicine require several fundamental changes. These include adjustments to the legislative environment and changes to the technological infrastructure, organisation of care and work. Several barriers have been identified at the healthcare system level, healthcare providers, healthcare professionals and patients.

Hybrid multi-criteria decision-making model for assessing perceived significance of 23 potentially modifiable cancer risk factors among senior nursing officers

BackgroundPotentially modifiable cancer risk factors have been increasingly recognized among the Chinese population. In this study, we aimed to investigate the perceived significance of these risk factors among senior nursing officers, who play a crucial role in providing healthcare services. We also sought to determine senior nursing officers’ performance in reducing these risk factors.MethodsA questionnaire survey regarding 23 potentially modifiable cancer risk factors was conducted in November 2023 with 58 senior nursing officers at Taizhou Hospital in Zhejiang Province, China. The consistent fuzzy preference relation method and importance–performance analysis were used to determine the attribute weights and performance levels.ResultsThe senior nursing officers considered diabetes, ultraviolet radiation exposure, PM2.5 exposure, excess body weight, physical inactivity, alcohol consumption and secondhand smoking significant. However, performance in reducing secondhand smoking, physical inactivity, excess body weight, PM2.5 exposure, and ultraviolet radiation exposure required improvement.ConclusionsThe proposed hybrid multiple-criteria decision-making model enhances our understanding of the perceived significance of 23 modifiable cancer risk factors and performance in reducing them, which could facilitate improvements in health education efforts.

Work Environment and Socio-Demographic Factors of Psychiatric Nurses: A Cross-Sectional Study in Hospitals of Eastern Saudi Arabia

The work environment in healthcare institutions, especially in psychiatric hospitals, plays a crucial role in shaping the experiences and efficacy of nurses’ performance. This environment is influenced by various factors such as facility design, resource availability, workplace culture, support systems, and interpersonal dynamics. Understanding the intricate dynamics of the work environment in psychiatric hospitals is essential for ensuring the provision of high-quality mental healthcare services and enhancing the overall quality of life for both patients and healthcare providers, including nurses. However, the work environment of psychiatric nurses in the eastern region of Saudi Arabia is still inadequately understood. Objective: This study aimed to examine the work environment of nurses working in psychiatric hospitals in the eastern region of Saudi Arabia. Method: A cross-sectional research design was employed on a sample of 346 nurses using a non-probability convenience sampling technique. The survey method was adopted with the Practice Environment Scale of the Nursing Work Index (revised, Arabic version). Results: The study found a significant association between psychiatric nurses’ work environment and their socio-demographic characteristics. Demographic factors, such as age and years of experience, were identified as influencing factors of nurses’ perceptions of their work environment. Younger nurses and those with fewer years of experience reported greater job satisfaction when their work environment was positive. Conclusions: This study underscores the critical importance of maintaining a supportive work environment for psychiatric nurses due to its possible direct influence on their job satisfaction, work performance, quality of life, and overall well-being. Tailoring interventions to address demographic variations in perceptions of the work environment can enhance the well-being of nurses and improve the quality of care provided to psychiatric patients. These findings contribute to the body of knowledge on psychiatric nursing and have clinical implications for healthcare institutions that aim to optimize their work environments and retain a skilled and satisfied nursing workforce.

Provision of Digital Primary Health Care Services: Overview of Reviews.

Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary health care (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence. This study aims to provide policy makers, health managers, and researchers with a summary of evidence on digital interventions used in PHC. This overview of reviews searched the Web of Science and MEDLINE databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC published from January 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or health care providers (HCPs) were included. A total of 236 records were identified from the search strategy, of which 42 (17.8%) full-text papers were selected for analysis, and 18 (7.6%) reviews met the eligibility criteria. In total, 61% (11/18) of the reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine, provider-to-provider telemedicine, health worker decision support systems, systems for tracking patients' health status, client participation and self-care platforms, and provision of education and training to health workers), and 39% (7/18) of the reviews focused on specific topics related to PHC (preventive care, chronic disease management, behavioral health disorders, the COVID-19 pandemic, multicomponent PHC interventions, and care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and apps developed without involving end users, the lack of training of HCPs and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients' clinical conditions and behavior changes. Research in digital health applied to PHC is still concentrated in high-income countries, mainly in North America and Europe. The mixed results related to health service quality and patients' clinical conditions or behavior changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal relationship among implementation, health service quality, and clinical condition outcomes to support the spread of digital health in PHC settings.

Talking about practice: agency and its structural context in regional healthcare practice change

ABSTRACT Ageing societies and rising instances of non-communicable diseases require changes in public healthcare service provision. Despite a plethora of propositions, most innovations never become practically applied. In understanding innovation as a place- and path-dependent change process which depends on actors’ agency to reconfigure routinised practices and their structural context, we show how actors create, perceive and act upon opportunities for change while tracing the development trajectories of two networks in the regions of Murcia (Spain) and Örebro (Sweden), respectively. The cases illustrate the role intermediary actors play in creating opportunities and shaping organisational and institutional context.

Healthy design strategies to promote Urban Public Mental Health, according to the contemporary cities’ climate resilience and the SDGs’ challenges

Abstract According to the “Urban Health Rome Declaration” at European meeting “G7 Health” that defines the strategic aspects and actions to improve Public Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about “Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable”, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): “Health is the precondition of urban sustainable development and the first priority for urban planners”. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of health protection and promotion, but an individual and collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The “Health in All Policies” strategy, clearly underlines how health doesn’t depend only on the supply of healthcare services, but also, on the quality of outdoor and indoor living environments. Aim of the Presentation 3 is the share the findings of a literature review about the link between the urban contexts’ morphological and functional features; the results are divided into: 14 Health Outcomes, representing the main Non-Communicable Diseases (NCDs) whose come from the urban environment’s quality and by the adoption of healthy lifestyles; 8 types of Environmental Risk Factors (Urban Heat Island Effect; soil/air/acoustic/light pollution; vehicular traffic; Safety & Security; weak attractiveness of places); and 14 Healthy Urban Planning Strategies (green/blue/grey infrastructures; biodiversity protection; adverse meteoric events management; public transport systems; vehicular traffic reduction; pedestrian and cycling paths; social and functional mix; urban solid waste’s management; renewable energy and efficiency; outdoor spaces lighting; Design for All).

COVID-19 premature mortality in Serbia: Does the place of death matter?

Abstract Background The COVID-19 pandemic has significantly impacted healthcare services provision in Serbia and globally. Many people did not seek or reach healthcare due to various reasons, and a significant number of COVID-19 deaths were not confirmed by laboratory testing. Within the project of the Laboratory for Strengthening Capacity and Performance of Health System and Workforce for Health Equity, we assessed the differences in years of life lost (YLL) of COVID-19 death cases according to the place of death. Methods The Statistical Office of the Republic of Serbia provided average life expectancy and anonymous individual mortality data of the Serbian population in 2020, 2021, and 2022, where COVID-19 was the underlying cause of death (ICD-X codes: laboratory confirmed - U07.1 and clinically diagnosed - U07.2), also disaggregated by the place of death (at home or in a hospital). Analytical statistics and nonparametric tests were used to assess the differences in premature mortality by place of death with a significance level set at p < 0.05. Results In all observed years, a total of 45,632 death cases due to COVID-19 occurred (94.3% in hospital and 5.7% at home). Most COVID-19 deaths were coded as U07.1 (93.8% in hospital, 91.3% at home). An average of 12.12±7.50 YLLs was estimated per death, with a median of 11.50. There was a significant difference (p < 0.001) in the median number of YLLs between those who died in the hospital (11.50) and those who died at home (6.78). Furthermore, deaths occurring at home had fewer YLLs but were more frequently coded as U07.2 (p < 0.001). Conclusions The place of death is relevant when assessing the impact of COVID-19 on premature mortality in Serbia. On average, persons who died at home due to COVID-19 had a lower number of YLLs compared to those who died in a hospital. More research is necessary on the other factors contributing to premature mortality and inequalities in the COVID-19 burden in Serbia. Key messages • During the first three years of the COVID-19 pandemic in Serbia, 5.7% of COVID-19 deaths occurred at home, resulting in an average of 9.89 years of life lost. • The COVID-19 pandemic highlights the need to investigate deaths that occur at home and improve pandemic preparedness.

Factor Influencing Unmet Healthcare Needs among the disabled

Abstract Background The unmet Healthcare needs (UHNs) of the disabled are not only detrimental to their quality of life but also can lead to serious health outcome including death. A variety of factors including socioeconomic, personal, environmental factors affect UHNs for the disabled. Methods We analyzed the UHNs status and influencing factors among 4,326 adult the disabled using Korea disability Life Data. Chi-square analysis was conducted to identify differences in UHNs according to characteristics of general, disability, environmental of the disabled. Logistic regression analysis was conducted to determine factors affecting UHNs. Results Those with low educational level (aOR=1.23, 95% CI = 1.02-1.48), those enrolled in private insurance (aOR=1.23, 95% CI = 1.02-1.50), those need help with daily living (aOR=1.30, 95% CI = 1.06-1.59), those who rarely go out (aOR=1.57, 95% CI = 1.27-1.92), those who use taxis (aOR=1.41, 95% CI = 1.05-1.89) or call taxi for the disabled when going to the hospital (aOR=1.37, 95% CI = 1.01-1.88), the communication disabled (aOR=1.30, 95% CI = 1.03-1.65), those with poor subjective health status (aOR=1.25, 95% CI = 1.04-1.49), those felt the explanation of treatment results was insufficient (aOR=4.04, 95% CI = 1.37-11.93), and those dissatisfied with healthcare services (aOR=3.52, 95% CI = 2.74-4.51) were more likely to experience UHNs. Conclusions Effective healthcare service provision for the disabled requires not only financial assistance but also social support, along with education for healthcare staff, policies with the characteristics of disabilities. Funding: This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165) and by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2024-00394642) Key messages • The disabled need not only financial support when using healthcare services, but also support from society, such as accompanying them to the hospital and providing transportation. • Education for healthcare staff who communicate with the disabled and provision policy to provide appropriate healthcare services according to the characteristics of disabilities are needed.

Analysis of Environmental Footprints of Health Centers in Kangra District, Himachal Pradesh, India

The experiment was conducted during December, 2020 to June, 2021 at Kangra district of Himachal Pradesh, India to evaluate the ecological footprint of 15 hospitals that were chosen at random. The purpose of this study was to assess the ecological impact of these medical facilities-which included both government and private hospitals—across five blocks of district. The ecological footprint framework was utilized to analyze factors such as food waste, solid waste, water consumption and energy consumption and material use, determining their impact on biocapacity. The average ecological footprints of the hospitals ranged from 116.5 to 271.4 global hectares (g ha). The ecological footprints varied across different blocks as follows Jawalamukhi (349.7 g ha), Dharamshala (535.6 g ha), Nurpur (698.3 g ha), Palampur (722.3 g ha), and Kangra (814.0 g ha). Notably, the hospitals in the Jawalamukhi block were the most sustainable, exhibiting the lowest ecological footprint. These results underscore the significant environmental impact of hospitals and the urgent need for initiatives to reduce their ecological footprint, particularly in the Kangra block. The results emphasize the importance of sustainable resource utilization in healthcare institutions to minimize their ecological footprint and promote environmental sustainability. To achieve a balance between providing healthcare services and protecting the environment, the research recommends extensive actions to enhance the effectiveness of resource utilization, waste management, and energy consumption in hospitals.

Reconstructing legal protection for the medical profession in the face of medical disputes during the COVID-19 pandemic from the dignified justice perspective

BACKGROUND: Healthcare involves various stakeholders, including hospitals, healthcare professionals, such as doctors, nurses, and others, as well as patients. The direct relationship typically occurs between doctors and patients. In carrying out their duties, doctors always adhere to standard operating procedures, medical records, and informed consent. The COVID-19 pandemic in Indonesia has led to a surge in the number of COVID-19 patients requiring treatment by doctors. On the one hand, doctors and other healthcare professionals face numerous challenges in providing healthcare services, potentially failing to ensure legal certainty for them. AIM: This study aimed to reconstruct legal protection for the medical profession in medical disputes during the COVID-19 pandemic from a Dignified Justice perspective. MATERIALS AND METHODS: This research is a legal study based on the Dignified Justice Theory to understand the concept of legal protection for healthcare professionals, particularly doctors, during the COVID-19 pandemic. The research methodology includes a legislative, conceptual, and case approach. RESULTS: The research results are subsequently analyzed. Based on the research, it is evident that legal protection is derived from regulations related to recognition, protection of rights, and other relevant legal provisions. Legal protection for the medical profession during the COVID-19 pandemic is also framed within the framework of Pancasila, integrated with the Dignified Justice Theory. CONCLUSION: Legal protection for doctors in the COVID-19 rapid response task force is evident because healthcare professionals have received legal protection through supervision and guidance provided by local governments and their employing institutions in handling COVID-19.

Artificial Intelligence in Radiology, Emergency, and Remote Healthcare: A Snapshot of Present and Future Applications

This paper critically examines artificial intelligence in the healthcare sector and aims to identify concrete points of challenges and business value propositions first in radiology and then across healthcare more broadly. It discusses current applications in radiology and future uses of AI in healthcare, focusing on three main areas: (i) emergency incidents handling, (ii) intensive care unit treatment and (iii) augmented telemedicine, to which emergency radiology is a critical success factor. Despite some risks and compliance issues that need to be taken care of, this paper clearly shows that AI has the potential (a) to reengineer the business processes of the healthcare sector, using AI-assisted radiology as a driver and (b) to improve the effectiveness of the healthcare system as well as (c) to increase the quality provision of healthcare services. Despite its slow adoption, AI-assisted healthcare can indeed offer business/operational solutions that benefit all healthcare stakeholders.

Spatiotemporal evolution and development path of healthcare services supply in China

ObjectPromoting the accessibility and equity of healthcare services, as well as enhancing service capacity, are crucial for building a sound healthcare system. Particularly in the past two years of the normalized COVID-19 situation, this issue has garnered widespread attention in the academic community. This study aims to investigate and analyze the characteristics and trends of the spatial-temporal evolution of healthcare service supply levels in China. It also seeks to explore the influencing factors and pathways for development, with the goal of optimizing the allocation of healthcare resources.MethodsThis article uses the entropy weight TOPSIS method combined with Dagum Gini coefficient and Kernel density to evaluate the supply level of healthcare services in 31 provinces and cities in China from 2012 to 2020, and explores its development and spatial pattern characteristics. Then, through Moran index, panel regression model and spatial econometric testing, the spatial correlation problem and its influencing factors are further analyzed, and targeted policy recommendations are proposed based on it, laying the foundation for further promoting the balanced development of healthcare service supply capacity.Results(1) Healthcare services supply levels in various provinces and cities in China have significantly increased, with a shift in spatial distribution from ‘higher in the east and lower in the west’ to ‘convergence between east and west, with lower levels in the central regions.’ (2) Relative differences among regions are narrowing annually, primarily due to interactions between the four regions rather than within each region, with expanding impact of overlapping regions. (3) Absolute differences among regions are also decreasing, moving towards uniformity with a contraction of extension and a restraint on the trend towards multipolarization. (4) Spatial correlation between adjacent regions is weakening, eventually becoming non-significant, with fading spatial effects. (5) The correlation between local economic development, population factors, institutional arrangements, and the current state of supply is significant, and the research design and conclusions remain robust even after thorough consideration of spatial effects. The study explores the development pathways based on the objective existence of regional development and the controllable government actions.ConclusionThe overall level of healthcare service supply in China has improved, but regional differences still exist. The objective level of regional development and the subjective behavior of local governments have a significant impact on the supply of healthcare services. Therefore, it is recommended that each region adapt to local conditions, identify its own strengths and weaknesses, coordinate resource supply and demand, consider the impact of key factors, and optimize the allocation of healthcare development resources.

SPATIAL DISTRIBUTION AND ACCESSIBILITY OF HEALTHCARE FACILITIES IN NIGER STATE, NIGERIA

The provision of adequate basic healthcare services is becoming increasingly difficult due to rapid population growth and lack of available resources. One of the imperatives of healthcare provision is a concern for both social and spatial justice. This study examines the spatial distribution and accessibility of healthcare facilities in Niger State. Secondary data were collected from the Niger State Ministry of Health and the National Population Commission. ArcGIS 10.4.1 software was used to create distribution maps of healthcare facilities throughout the state. The results of the study indicated that healthcare facilities in Niger State were not evenly distributed across the state. Niger East had the most accessible healthcare facilities, followed by Niger South. Despite having a sufficient number of healthcare facilities that meet the minimum global average recommended by the World Health Organization (WHO) in-terms of population ratio, the distribution of these facilities per population ratio were also not evenly distributed across the State with Niger North having the least healthcare facilities per population ratio which needs to be addressed to meet the WHO-recommended threshold. Moreover, several local government areas, including Muya, Agwara, Mashegu, Edati, Gbako, and Katcha, had no secondary healthcare facilities, indicating that healthcare accessibility in Niger North and Niger South was significantly limited. The study highlights the need for more well-equipped general hospitals in currently inadequate areas and the provision of primary healthcare facilities, particularly in rural areas throughout the State. Overall, the findings suggest that healthcare accessibility in Niger State is a critical issue that requires immediate attention.

Antibiotic prescription, dispensing and use in humans and livestock in East Africa: does morality have a role to play?

Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to "misuse" and "overuse", particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice "proper" use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics. This reflection is anchored on Jarrett Zigon's morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania's National Action Plans on antimicrobial resistance was conducted. Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with "inappropriate" behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery. Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur.

Impact of telehealth implementation on medical non-consultant hospital doctors training experience

Telehealth is defined as the provision of health care services over a distance. Major health systems, including outpatient clinics and check-ups alike, turned to telehealth and teleconsultation amid the COVID19 pandemic. There are many recognized advantages of telehealth and its increasing implementation, however, not much is known about the specific impact of remote consultation on the quality of non-consultant hospital doctors (NCHD) training experiences in medicine. This study aimed to gain rich descriptive insights into the specific impact of remote consultation on the quality of medical NCHD training experiences and their perceptions, through purposeful sampling. Data was collected via semi-structured virtual interviews of fifteen NCHD participants. The interviews were recorded, transcribed and analysed using thematic analysis. The collective transcripts were analysed using NVIVO data software for common themes. The themes identified suggested that there were both advantages and disadvantages to telehealth and its impact on training across a spectrum of entities including; doctor-patient relationships, peer relationships, service provision, work morale, working hours, clinical skills experience and general feedback as a trainee. NCHD perspectives expressed were mixed across all themes. Further research is recommended to advance understanding of the potential impact of telehealth on current and prospective doctors in training. With a greater understanding of general insights, future changes, including telehealth training programmes, could be implemented to build confidence and familiarity with telehealth utilization and potentiate its conceivable benefits.

Physical health challenges faced by elders with severe mental illness: population-based retrospective cohort study.

Severe mental illness (SMI), which includes schizophrenia, schizoaffective disorder and bipolar disorder, has profound health impacts, even in the elderly. To evaluate relative risk of hospital admission and length of hospital stay for physical illness in elders with SMI. To construct a population-based retrospective cohort observed from April 2007 to March 2016, data from a case registry with full but de-identified electronic health records were retrieved for patients of the South London and Maudsley NHS Foundation Trust, the single secondary mental healthcare service provider in south-east London. We compared participants with SMI aged >60 years old with the general population of the same age and residing in the same areas through data linkage by age-, sex- and fiscal-year-standardised admission ratios (SARs) for primary diagnoses at hospital discharge. Furthermore, we compared the duration of hospital stay with an age-, sex- and cause-of-admission-matched random group by linear regression for major causes of admission. In total, records for 4175 older people with SMI were obtained, relating to 10 342 admission episodes, showing an overall SAR for all physical illnesses of 5.15 (95% CI: 5.05, 5.25). Among the top causes of admission, SARs ranged from 3.87 for circulatory system disorders (ICD-10 codes: I00-I99) to 6.99 for genitourinary system or urinary conditions (N00-N39). Specifically, the diagnostic group of 'symptoms, signs and findings, not elsewhere classified' (R00-R99) had an elevated SAR of 6.56 (95% CI: 6.22, 6.90). Elders with SMI also had significantly longer hospital stays than their counterparts in the general population, especially for digestive system illnesses (K00-K93), after adjusting for confounding. Poorer overall physical health and specific patterns were identified in elders with SMI.

Overview of Finnish national patient data repository for research on medical risk assessment

The Kanta Patient Data Repository (PDR) contains healthcare data from the population of Finland for more than a decade. The repository is a continuously expanding real world dataset produced by many information systems and healthcare service providers. Kanta data has been available for secondary uses such as scientific research since 2019. The data can be requested from the Finnish authority Findata. However, before a request has been accepted, it is difficult to assess if the accumulated data allows answering a specific research question. Publicly available descriptions of data structures in the Kanta PDR do not tell how much they are used in practice. This publication enables future data use cases by providing a view on the overall availability of types of structured health data in the Kanta PDR based on a sample of 96 200 medical histories of over 18-year-old patients. We conclude that the Kanta PDR is a promising source of real world data for development and evaluation of medical risk calculators within the Finnish population. The wide coverage of the Finnish population and timeliness of the data are its strengths as a source of research data also outside of Finnish context. However, the limitations on data availability in variable level need to be considered on a case-by-case basis. Main challenges in the use of data in the Kanta PDR are multiple code systems for laboratory results, short durations of recorded data for specific data types, and missing or very rarely used structured format e.g., in cases of tobacco and alcohol use.