Medical Care Services Research Articles

Association of Geographic Distance and Hospital Characteristics With Use of Interhospital Transfer by Air: A Multicenter Retrospective Study

ObjectiveInterhospital transfer by air (IHTA) represents the majority of helicopter air ambulance transports in the United States, but the evaluation of what factors are associated with utilization has been limited. We aimed to assess the association of geographic distance and hospital characteristics (including patient volume) with the use of IHTA. MethodsThis was a multicenter, retrospective study of helicopter flight request data from 2018 provided by a convenience sample of 4 critical care transport medicine programs in 3 US census regions. Nonfederal referring hospitals located in the home state of the associated critical care transport medicine program and within 100 miles of the primary receiving facility in the region were included if complete data were available. We fit a Poisson principal component regression model incorporating geographic distance, the number of emergency department visits, the number of hospital discharges, case mix index, the number of intensive care unit beds, and the number of general beds and tested the association of the variables with helicopter emergency medical services utilization. ResultsA total of 106 referring hospitals were analyzed, 21 of which were hospitals identified as having a consistent request pattern. Using the hospitals with a consistent referral pattern, geographic distance had a significant positive association with flight request volume. Other variables, including emergency department visit volume, were not associated. Overall, the included variables offered poor explanatory power for the observed variation between referring facilities in the use of IHTA (r2 = 0.09). Predicted flights based on the principal component regression model for all referring hospitals suggested the majority of referring hospitals used multiple flight programs. ConclusionGeographic distance is associated with the use of IHTA. Unexpectedly, most basic hospital characteristics are not associated with the use of IHTA, and the degree of variation between referring facilities that is explained by patient volume is limited. The evaluation of nonhospital factors, such as the density and availability of critical care or advanced life support ground emergency medical services resources, is needed.

The change of healthcare service in Chinese patients with inflammatory bowel disease during the pandemic: a national multicenter cross-sectional study

The pandemic of COVID-19 was a major public health events and had a deeply impact on the healthcare acquired by patients with inflammatory bowel disease (IBD). The purpose of this study was to evaluate the long-term impacts on healthcare service in Chinese IBD patients under the dynamic zero-COVID strategy. The study was performed in the Inflammatory Bowel Disease Quality of Care Centers in mainland China in 2021. The data about the healthcare was collected by a 44-item questionnaire. Totally 463 were from ulcerative colitis (UC) patients and 538 from Crohn’s disease (CD) patients were included in the study. The pandemic impacted 37.5% patients on their treatment, and the biggest problem was unable to follow up timely (77.9%). There was a significant increase in healthcare costs in CD (P < 0.001) and no significant change in UC (P = 0.14) after the outbreak. Both UC and CD had an increase in the frequency of outpatient visits (UC 5.07 vs. 4.54, P = 0.001; CD 6.30 vs. 5.76, P = 0.002), and hospitalizations (UC 1.30 vs. 1.02, P < 0.001; CD 3.55 vs. 2.78, P < 0.001). The hospitalization rate in UC reduced slightly (40.2% vs. 42.8%, P = 0.423) after the outbreak, but it significantly increased in CD (75.8% vs. 67.8%, P = 0.004). The rate of biologics had significant increased (UC 11.2% vs. 17.7%, P = 0.005; CD 53.2% vs. 71.0%, P < 0.001). Besides, the proportion of people using telemedicine also increased from 41.6% to 55.1% (P < 0.001). However, 82.8% patients still preferred face-to-face visits. Recurrent outbreaks and the regular pandemic prevention and control policy had a long-term impact on medical care service for IBD patients. The preferred mode of healthcare was still face-to-face visit. It will be a long way to go in the construction of telemedicine in China.

Current Status, Challenges, and Recommendations for the Integration of Medical and Elderly Care Services in Chinese Urban Communities

Since the onset of the 21st century, China has been grappling with an aging population. The continuous increase in the number of individuals aged 65 and above in recent years has intensified this aging trend. To alleviate the challenges of an aging society and promote healthy aging in China, the development of integrated medical and elderly care services was formally proposed in 2013. This initiative has led to the establishment of four integrated service models, which have achieved commendable results over the past few years. However, China's foray into integrated medical and elderly care services began relatively late, and several challenges persist. These include a mismatch between the supply and demand of services, limited financing channels for these services, overlapping management by multiple government departments, and a shortage of specialized professionals in the field. Based on this analysis, this paper suggests enhancing the match between supply and demand for integrated services, diversifying financing channels, strengthening collaborative governance of these services, and actively recruiting and cultivating professionals specialized in integrated medical and elderly care.

Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk.

Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month. We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization. Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities. In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.

Making change: the new principles of the World organization of general medicine (Wonca 2022) and territorial medicine in Italy.

The new european declaration "Core values and principles of general practice and family medicine" (Wonca Europe 2022) has been recently issued: which contributions can it provide to the discussion on the future of primary health medicine? And what challenges and changes would it impose in its application to the contexts of medical training, care services and clinical research in Italy? We analyse here the seven principles and values of the new declaration: 1) person-centred care; 2) continuity of care; 3) cooperation in care; 4) community-oriented care; 5) equity in care; 6) science-oriented care; 7) professionalism in care; and through them we reflect on the announced reforms of primary health care (Phc) policy. Indeed, these provide an important basis for a critical discussion regarding the reform of the primary care model, the evolution of the medical training pathway (pre- and post-graduate and therefore towards an adjustment of the specialty pathway of future general practitioners) and research Phc. Considering that the Phc health policies are experiencing a condition of permanent and apparently uncontrollable change, it is well to ask ourselves how and if these values-principles, which are considered fundamental at an international level, will be able to come to life in order to build a new therapeutic trust, specific to general practice and family medicine, both in the professional and disciplinary sphere.

SPECIALIZED MEDICAL FORCE - FEM / SPECIALIZED MEDICAL CARE SERVICE – SAME

In light of the growing concerns related to public health in Brazil, from any perspective, in any scenario that can be projected for the future, there is a substantial increase in demands and, with this, the need for a larger, better workforce. qualified and with expanded skills. In that regard. Strategic prospecting studies are fundamental for planning public policies, especially with regard to the workforce for the Unified Health System. Therefore, this study aims to set up a Specialized FEM Medical Force, with a Specialized Medical Care Service - Nationwide SAME linked to the Brazilian Ministry of Health. This study will be carried out through the analysis of the legislation concerning the Federal Public Health Legislation in Brazil, in the analysis of the National Emergency Care Policy of the Unified Health System – SUS, as well as other national, state and municipal documents, as well as consultations on the official websites of these federative entities. The expected results, among other results, are: meeting the needs of the population with specialized care in all areas of medicine; compose a specialized assistance framework for the less favored population and considered vulnerable from a financial point of view and be a public utility service available to the population, with regard to national emergency care in situations of disasters and public calamities.

Longitudinal Association Between Perceived Availability of Home- and Community-Based Services and All-Cause Mortality Among Chinese Older Adults: A National Cohort Study

ABSTRACT Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.

Efficacy of a lifestyle intervention for elderly in long-term care: a randomized controlled trial

Abstract Background Long term care (LTC) services represent an important element of worldwide health systems, providing medical care and social services to thousands of elderlies. In this setting inadequate food consumption and lack of physical exercise represent major causes of mortality and morbidity due to malnutrition, sarcopenia, osteoporosis, and dehydration. While it has been acknowledged that these conditions are potentially reversible with proper lifestyle medicine interventions, the latter are rarely implemented and evaluated in LTC owing to their intrinsic complexity. Methods A randomized controlled trial was conducted to assess the effectiveness of a three-months combined food-physical exercise lifestyle intervention in elderlies living in an Italian LTC facility. The diet was designed to provide high levels of energy, proteins, leucine, and calcium. The physical exercise treatment was delivered two times per week, with a moderate to high effort requested to subjects. At baseline and at the end of the intervention subjects were evaluated using the Barthel Index, Activities of Daily Living, and Tinetti scales. Results 54 participants took part to the trial. At the end of the study the intervention group showed a significant improvement in all the scales. They burned 287 Kcal/week, significantly more than the control group. In contrast to the study protocol, they introduced 11% less calories than the control group. Conclusions This intervention has been proved effective in increasing functionality, with the beneficial effect that might be primarily attributed to the physical exercise, considering the low adherence to diet in the intervention group. This evidence supports the hypothesis that these interventions, despite the effectiveness, are complex to be powerfully implemented. While our results encourage the efficacy of lifestyle interventions in LTC, more studies are needed to deeply understand barriers and facilitators for an effective implementation. Key messages • This lifestyle intervention proved effective in improving functionality in institutionalized elderlies. • The low adherence to diet highlights challenges and complexities of lifestyle interventions in LTC.

Change over time in migrantś self-assessed unmet health care need in Finland

Abstract Background Previous studies have shown that people of foreign background (PFB) often experience barriers in accessing and utilizing medical care services. This study examines the potential change in unmet health care need among PFB living in Finland in two time points: 2018 and 2022. Furthermore, we study the potential factors (age, sex, education, treason for migration and country of origin) associated with the unmet health care need. Methods We used two nationally representative cross-sectional data sets: the Survey on well-being among foreign-born population (FinMonik, n = 6836; response rate 53.1%) in 2018-2019 and the National survey on health, well-being and service use among foreign-born population (MoniSuomi, n = 7838; response rate 44.1%) in 2022-2023. The analyses were limited to those aged 20-64-years. Our indicator for unmet health care need was based on the question: “Do you feel that you have adequately received primary care services during the past 12 months?'' Results Unmet health care need among PFB has increased significantly between the years 2018 and 2022 (p = 0.005). The prevalence of unmet health care need among PFB was 24.9% in 2018 and 33.7% in 2022. Preliminary results show that younger age, those who moved to Finland from Middle East and Africa, refugees and Ingrains Finns reported more frequently unmet health care need. Conclusions The increase of unmet health care need among PFB is alarming. More studies are needed to investigate the reasons behind the high rates of unmet health care need. Key messages • Unmet health care need is an indicator of problems in access to care. • Actions are needed to improve access to care among the migrant population in Finland.

Differences in the healthcare needs of older adults attending primary health centers in urban and rural areas of Taiwan

PurposeAs the older adult population in Taiwan continues to increase, primary health centers (PHCs) play a crucial role in geriatric care. This study explored the differences in the PHC experiences and usage needs of older adults in urban versus rural areas.MethodsA qualitative study was conducted. Twenty-one older adults were recruited from PHCs in northern, central, southern, and eastern Taiwan. Semistructured interviews were used to collect data, and the interview guidelines included their reasons for visiting PHCs, the health-care services they received, their evaluation of the services, and the advantages and disadvantages of these centers. The data were analyzed using thematic content analysis.ResultsThe PHC usage needs of older adults in urban areas differ from those of older adults in rural areas in the following 3 aspects: (1) Medical services: older adults in rural areas demand clinics specializing in various medical domains, mobile and home medical care, and case management, whereas those in urban areas demand mobile health examinations. (2) Environment and transportation: older adults in rural areas demand diverse medical equipment, shuttle services, and accessible facilities, whereas those in urban areas demand recreational facilities. (3) Active aging: older adults in rural areas demand health education courses, and those in urban areas demand diverse senior citizen courses as well as opportunities to volunteer and build interpersonal relationships.ConclusionThe older adults in urban and rural areas had different PHC usage needs. The older adults in rural areas generally focused on medical care and transportation services in PHCs, whereas those in urban areas generally focused on health promotion as a means of social participation and active aging.

Prediction of Maternity Recovery Rate of Group Long-Term Disability Insurance Using XGBoost

To help insurers determine insurance rates incorporating maternity factors, it is crucial to understand the maternity recovery rate, which was a metric used by insurance companies to understand how much of the expenses associated with maternity care and related medical services are covered by their policies. This paper employed Extreme Gradient Boosting (XGBoost), a powerful method for handling complex data relationships and preventing overfitting, on North American Group Long-Term Disability dataset obtained from the Society of Actuaries, which listed maternity as one of its categories, to predict the maternity recovery rate. In comparison, other machine learning methods such as Gradient Boosting Machine (GBM) and Bayesian Additive Regression Tree (BART) were used, with Root Mean Squared Error (RMSE) values calculated the difference between predicted and observed maternity recovery rates. Four datasets, 3 imbalanced and 1 fairly-balanced, were created out of the original dataset to test each method’s predictive prowess. The study revealed that XGBoost performed exceptionally well on the imbalanced datasets, while BART showed slight superiority in fairly-balanced data. Furthermore, the model identified the duration, exposures, and age of participants in both predicting maternity recovery rates and the underwriting process.

Fair Healthcare Practices in Orthopedics Assessed with a New Framework.

Background and Objectives: Healthcare systems are supported by the European ideology to develop their egalitarian concerns and to encourage the correct and fair behavior of medical staff. By integrating fair healthcare practices into sustainability, this requirement is addressed. In this research, our objective is to develop and validate, in the current activity of healthcare facilities, a new instrument for evaluating fair healthcare practices as a component of social responsibility integrated into sustainability. Materials and Methods: The research methods consist of deciding the domains of a new framework that integrates fair healthcare practices; the collection of the most recent fair healthcare practices reported by healthcare facilities around the world; elaboration of the contents and evaluation grids of the indicators; the integration of indicators related to fair healthcare practices in the matrix of the new framework for sustainable development; validation of the theoretical model at an orthopedic hospital. Results: The theoretical model of the new framework is composed of five domains: organizational management, provision of sustainable medical care services, economic, environmental, and social. The last domain is developed on the structure of the seven subdomains of the social responsibility standard ISO 26000. The seven indicators that describe fair healthcare practices are attitudes of the profession towards accreditation, effective intervention application, promoting a culture of patient safety, characteristics that affect the effectiveness of transfers, effective healthcare practices, feedback to medical staff, safety checklists. The new reference framework was implemented and validated in practice at an emergency hospital with an orthopedic profile. Conclusions: The practical implementation highlighted the usefulness of the new reference framework, its compatibility, and the possibility of integration with the reference frameworks for the evaluation of European hospitals, with the national legislation for the accreditation of hospitals and outpatient units, as well as with the ISO 9001 standard regarding the implementation of quality management systems. Its added value consists in promoting sustainable development by orienting staff, patients, and interested parties towards sustainability.

Examining healthcare needs and decisions to seek health services among Venezuelan migrants living in Trinidad and Tobago using Andersen's Behavioral Model.

Beginning in 2016, Trinidad and Tobago experienced increasing flows of migrants and refugees from Venezuela. Through a Government Registration Exercise in 2019, followed by a Re-registration Exercise in 2020, migrants and refugees benefitted from access to publicly available primary care and emergency medical services. By applying Andersen's Behavioral Model for Health Service Use, our study examined the non-communicable disease care needs of migrants, and factors influencing their decision to seek public and private health services. Between September and December 2020, a health questionnaire was administered via telephone to n = 250 migrants from Venezuela. Descriptive statistics summarized the constructs of Andersen's Behavioral Model. The model comprised of predisposing factors including migrants' social characteristics; enabling factors namely monthly earnings, education level and most trusted source of information on medical needs; need for care factors such as migrants self-reported health status, presence of non-communicable health conditions and having visited a doctor in the past 12 months; and the outcome variables which were migrants' decisions to seek public and private health services. Pearson χ2 tests, odds ratios and multivariable logistic regression with backward elimination examined the factors influencing a migrant's decision to seek health services. Overall, 66.8% of migrants reported they would seek public health services, while 22.4% indicated they would seek private health services. Predisposing factors namely length of time residing in Trinidad and Tobago (p = 0.031) and living with family/friends (p = 0.049); the enabling factor of receiving information from publicly available sources (p = 0.037); and the need for care factor of visiting a doctor for a physical health problem (p = 0.010) were significant correlates of their decision to seek care in the public sector. Predisposing factors namely living with family/friends (p = 0.020) and the enabling factor of having difficulty accessing healthcare services (p = 0.045) were significant correlates of their decision to seek care from private providers. Our findings demonstrated the positive association between social networks and a migrant's decision to use public and private health services, thus underscoring the importance of family and friends in facilitating health service use, promoting proper health practices and preventing diseases. Overall, the use of Andersen's Behavioral Model aided in identifying the factors associated with the use of health services by Venezuelan migrants in Trinidad and Tobago. However, further studies are needed to better understand their need for ongoing care, to inform policy, and to plan targeted health interventions for addressing the gaps in health service access, barriers and use.

Trends in all-cause mortality and leading causes of death from 2009 to 2019 among older adults in China

BackgroundThis study aimed to determine long-term variations in mortality trends and identify the leading causes of death among older adults in China from 2009 to 2019 so as to propose interventions to further stabilise the mortality rate among older adults and facilitate healthy ageing.MethodsWe extracted data from the China Death Surveillance database from 2009 to 2019 for all-cause mortality and cause-specific death among individuals aged ≥ 65 years. A joinpoint regression model was used to estimate mortality trends by calculating the annual percentage change (APC). A trend chi-square test was used to estimate sex differences in mortality, and descriptive analysis was used to estimate the leading causes of death. Semi-structured expert interviews were conducted to examine health interventions for older adults.ResultsWe observed an overall declining trend in age-adjusted mortality rates among older adults aged ≥ 65 years in China from 2009 to 2019 (APC, -2.44; P < 0.05). In this population, the male mortality rate was higher than the female mortality rate during this period (P < 0.05). However, the mortality rate among older adults aged ≥ 85 years increased since 2014, particularly among females. Cardiovascular disease (CVD) was the leading cause of death among older adults aged 65–84 years, whereas ischaemic heart disease was the leading cause of death among individuals aged ≥ 85 years, especially among females. The majority of injuries resulting in death were caused by falls, showing an increasing trend.ConclusionsCVD is a major cause of death among older adults aged ≥ 65 years in China, and relevant health intervention strategies should be implemented from the perspectives of physiology, psychology, and living environment. The change in the mortality trend and the distribution of cause of death among older adults aged ≥ 85 years is noteworthy; a diagnostic and management model centred around females aged ≥ 85 years should be implemented. Additionally, a multidimensional fall prevention strategy involving primary medical institutions and care services needs to be implemented to reduce the risk of falls among older adults.

Influence of medical care tasks on subjective burden and gain among older adults’ family caregivers: structural equation modeling for testing the role of formal and informal support

BackgroundThe number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers’ appraisals of caregiving differed based on the support received.MethodsInterview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan’s long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses.ResultsApproximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients’ physical and cognitive difficulties; caregivers’ age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers’ sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain.ConclusionsThese results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.

Visual Impairment and Its Associated Factors Among Hypertensive Patients in Amhara Region Referral Hospitals, Ethiopia.

Visual impairment is one of the most common long-term effects of high blood pressure. It affects one's quality of life, independence, and mobility. There is a paucity of information regarding the prevalence of visual impairment due to hypertension in Ethiopia. Therefore, this study aimed to determine the prevalence of visual impairment and its associated factors among hypertensive patients in referral hospitals of the Amhara region, Ethiopia, 2021. An institution-based cross-sectional study was conducted among 423 study participants, which were selected by systematic random sampling technique. Data were collected by using an interviewer-administered structured questionnaire and physical measurements. The collected data were entered into Epi-data version 4.6. Then, exported into SPSS Version 26 for analysis. The crude and adjusted odds ratios and 95% Confidence intervals were calculated. Both bivariable and multivariable logistic regression analyses were done. Variables with a p-value of ≤0.05 were stated as significantly associated with visual impairment. The overall prevalence of visual impairment among hypertensive patients was 32.4% (95% CI: 27.9-37.9). Duration of hypertension ≥ 5 years (AOR =3.06, 95% CI: 1.86-4.95), history of ocular trauma (AOR =2.50, 95% CI: 1.3-4.73), and ever alcohol drinking (AOR = 2.72, 95% CI: 1.32-5.62) were significantly associated with visual impairment. Nearly one-third of hypertensive patients were visually impaired from the study participants. Duration of hypertension ≥5 years, history of ocular trauma, and ever alcohol drinking was significantly associated with visual impairment among hypertensive patients. Therefore, in addition to providing medical care and follow-up services for hypertension patients, health education is needed for early and proper management of visual impairment, and to decrease their level of alcohol consumption. Furthermore, better to do this study by prospective cohort study design to identify cause-and-effect relationships.

Privatization of Medical Services and Revenue Development Project: A Cross-Sectional Survey of Staff Perceptions at the University of Jeddah Medical Center.

This study aimed to assess the perceptions of staff working at the University of Jeddah (UJ) Medical Center on the possibility of finding new financing methods for the administration and privatization of the primary and specialized medical care services it provides. A questionnaire link was sent online targeting all staff at the UJ Medical Center (n = 141). The questionnaire comprised 17 items under the following sections: demographic information, staff perceptions about the current status of the services provided by the UJ Medical Center and the possibility of finding new financing methods and additional sources of revenue for the administration. Of the 101 questionnaires returned, the majority were filled by males (n = 71; 70.3%). One-third of the participants (n = 39; 38.6%) have between 5 and 9 years of working experience in Medical Administration, and most of them (n = 42; 41.6%) reported that they have a background in the concept of revenue development/privatization/self-resources/paid treatment. Most were satisfied with the current status of the services provided (average rating = 3.39/5). However, most participants (n = 72; 71.3%) reported that the UJ Medical Center is not ready for the Revenue Development Project of privatization. The survey respondents demonstrated satisfaction with the medical services provided by the UJ Medical Center and the potential application of the Revenue Development Project. However, streamlining the privatization process according to the governmental structures is crucial for it to be implemented properly at the UJ Medical Center.

Barriers to Seeking Medical Care Among Youth Victims of Sexual Violence

PurposeYouth victims of sexual violence often experience physical health problems but are unlikely to receive medical care. However, victims' reasons for not accessing medical care have been understudied. We examined barriers to seeking medical care among youth victims who contacted the National Sexual Assault Online Hotline. MethodsWe used archival data about one-on-one chat sessions with youth victims between June 2018 and February 2020. Hotline staff described victims' reasons for not accessing medical care via an online assessment. We coded and qualitatively examined these reasons using data about 520 victims with physical health concerns who had not received medical care. ResultsVictims' barriers were rooted in individual beliefs and contextual realities reflected in three categories: (1) perception that medical care was not needed, (2) anticipated consequences of seeking medical care, and (3) inability to physically access medical care. Victims who perceived care as unnecessary did not understand the health implications of abuse or minimized their need for care. Anticipated consequences included privacy and control over disclosure, stigmatization, retaliation from the perpetrator, family disruptions, and retraumatizing medical treatment. Victims unable to physically access care were uncertain how to access care independently, lacked social support, or were prevented from care by the perpetrator. DiscussionMedical treatment can ameliorate acute health concerns and increase safety, but youth victims perceived numerous barriers to care. Several barriers implied unintended consequences of child maltreatment policies, including mandatory reporting. Trauma-informed policy and practice are critical for improving victims' access to medical care and other support services.

Home/Community-Based Medical and Elderly Care Services Utilization in China: A Cross-Sectional Study from the Middle-Aged and Elderly Population.

Few studies have analyzed the acceptance of home/community-based medical and elderly care services in China. Therefore, we conducted a cross-sectional study to describe the acceptance of five services among people aged ≥ 45 years in the China mainland, and their influencing factors. The data were obtained from the database China Health and Retirement Longitudinal Study 2018. For each service, a binary logistics regression was adopted. A total of 9719 people were included, of whom 20.12% received services. The numbers of recipients (acceptance rates) of the five services, namely, comprehensive aged care services, regular physical examinations, onsite visits, health management, and entertainment, were 107 (1.10%), 1640 (16.87%), 323 (3.32%), 156 (1.61%), and 245 (2.52%), respectively. About 4% of people had received two or more services. The elderly aged 65-74 and those who were satisfied with the local medical services had higher acceptance of services. Urban hukou having health insurance, two or more chronic diseases, provincial economic welfare, and social welfare were positively associated with the acceptance of regular physical examination services. It is suggested that the government should gradually improve satisfaction with local medical services, and pay more attention to the needs of elderly people aged 65-74 for all kinds of home/community-based medical and elderly care services.

A Provably Secure,Privacy-Preserving Lightweight Authentication Scheme for Peer-to-Peer Communication in Healthcare Systems based on Internet of Medical Things

The Internet of Medical Things (IoMT) is a novel paradigm that plays a significant role in healthcare applications. The Patient’s healthcare information is gathered, and remotely monitored through these IoMT systems. Hence, patients will get proper medical care and other emergency services to enhance survival and control morbidity. However, the patient’s data which is transferred between the devices through an insecure channel should be prevented against security threats and attacks. Therefore, secure authentication and key management schemes play an important part in IoMT communications. On the other hand, while considering the resource-constrained devices used in IoMT systems it is necessary to propose lightweight authentication schemes. In this paper, we have proposed a secure lightweight authentication scheme (LAS) for IoMT based healthcare systems. According to LAS, all the devices have to be registered and should approved by a central authority but in the authentication and communication phases, the devices can establish peer-to-peer communication without the intervention of a central authority. Furthermore, the privacy of the communicating parties is preserved by implementing hash based pseudo-identification method. In this paper, we have done the formal security analysis using BAN logic, the ROR model, and the Scyther tool. The informal security analysis is also shown proof of the resilience capabilities of LAS on various other well-known threats and attacks. Moreover, the proposed LAS is implemented using NS3 simulator to analyze its network performance such as End-to-End delay, Packet Loss Rate, and throughput. Lastly, the performance of the proposed scheme is also evaluated in terms of computational and communication costs. As per the result, the proposed LAS outperformed well when compared with other lightweight authentication schemes.