Major City Residents Research Articles

Remoteness-attributable financial inequality in dental service utilization in Australian older adults: A Blinder-Oaxaca decomposition.

Oral health is often overlooked in ageing health issues, despite its impact on overall health and quality of life. Older Australians, especially those in rural and remote areas, face difficulties accessing oral health services. The aim of the study was to investigate the factors that contribute to financial barriers to accessing dental services among the ageing population in Australia in relation to their residential location. The study included a weighted sample of Australian adults aged 65 years and over from a population-based survey called the National Study of Adult Oral Health (NSAOH) conducted in 2017-18. Descriptive analysis was conducted and generated cross-tabulation tables to investigate the distributions of the outcome, exposure and covariates, including Sex, Education level (the highest level of education), Equivalised household income, Dental insurance, Concession card ownership, Difficulty paying a dental bill and last dental visit. Blinder-Oaxaca decomposition counterfactual analysis was used to explore the potential impact of a person's residence on their financial difficulty accessing dental services. The findings showed that 26.2% (95% CI: 24.3-29.3) of major city residents and 30.1% (95% CI: 26.9-33.3) of rural residents avoided or delayed dental visits due to cost. The decomposition analysis indicated that 53.8% of the disparities in the prevalence of avoided or delayed dental visits due to cost were explained by the selected variables, while 46.2% remained unexplained. The explanatory variable with the largest contribution was difficulty paying a $200 dental bill, accounting for 62.4% of the differences, followed by dental insurance, last dental visit and equivalised household income, which explained 42.1%, 20.8% and 14.9% of the differences, respectively. Regional/remote populations experience more financial barriers to accessing dental care than major city populations and the identified factors explain a significant proportion of these disparities. Based on the study findings, recommendations include expanding public dental service coverage, evaluating concession card mechanisms and advocating for regular dental visits to mitigate disparities in dental care access.

The importance of public participation in framing air pollution policy: outcome of a judicial review in New Delhi, India

SETTING: Air pollution, including particulate matter, causes health problems for residents of major cities around the world, including New Delhi, India. Public participation is important in framing policies related to such public health issues.OBJECTIVE: To study how the public’s comments on air pollution, which had been collected on the orders of the Indian Supreme Court, influenced air pollution policy in New Delhi.DESIGN: We filed a Right to Information Act, 2005 application with the Commission for Air Quality Management (CAQM) to obtain a copy of the comments. These were compiled and compared with key major areas identified in the policy released by the regulatory authority.RESULTS: There were a wide range of comments from experts, residents and resident associations. In total, 115 comments were compiled and studied, and several recurring themes were found to have been incorporated into the policy. This included the need to switch to green public transport and cycling, the use of alternative fuels and reduced agricultural crop residue burning.CONCLUSION: Our study revealed that the public and experts have indeed influenced the CAQM air pollution policy. This is important, as it highlights a democratic, inclusive and stakeholder-based approach. Nonetheless, a future concern lies in how this policy is translated into actionable regulations with effective implementation in the field.

Impact of pay-for-performance for stroke unit access on mortality in Queensland, Australia: an interrupted time series analysis

Stroke unit care provides substantial benefits for all subgroups of patient with stroke, but consistent access has been difficult to achieve in many healthcare systems. Pay-for-performance incentives have been introduced widely in attempt to improve quality and efficiency in healthcare, but there is limited evidence of positive impact when they are targeted at hospitals. In 2012, a pay-for-performance program targeting stroke unit access was co-designed and implemented within a clinical quality improvement network across public hospitals in Queensland, Australia. We assessed the impact on access to specialist care and mortality following stroke. We used interrupted time series analysis on linked hospital and death registry data to compare changes in level (absolute proportions) and trends in outcomes (stroke/coronary care unit admission, 6-month mortality) for stroke, and a control condition of myocardial infarction (MI) without pay-for-performance incentive, from 2009 before, to 2017 after introduction of the pay-for-performance scheme in2012. We included 23,572 patients with stroke and 39,511 with MI. Following pay-for-performance introduction, stroke unit access increased by an absolute 35% (95% CI 29, 41) more than historical trend prediction, with greater impact for regional/rural residents (41% vs major city 24%) where baseline access was lowest (18% vs major city residents 53%). Historical upward 6-month mortality trends following stroke (+0.11%/month) reversed to a downward slope (-0.05%/month) with pay-for-performance; difference-0.16%/month (95% CI-0.29,-0.03). In contrast, access to coronary care and mortality trends for MI controls were unchanged, difference-in-difference for mortality-0.18%, (95% CI-0.34,-0.02). This clinician led pay-for-performance incentive stimulated significant improvements in stroke unit access, reduced regional disparities; and resulted in a sustained decline in 6-month mortality. As our findings contrast with lack of effect in most hospital directed pay-for-performance programs, differences in design and context provide insights for optimal program design. Queensland Advancing Clinical Research Fellowship, National Health and Medical Research Council Senior Research Fellowship.

Hydrochemical Assessment and Characterizationof Selected Boreoles Water in Onopa, Azikoro and Agbura Axis of Atissa in Yenagoa Metropolis of Bayelsa State, Nigeria

Groundwater is now the major source of domestic, commercial and industrial source of water for residents of major cities all over the world. Residents in Yenagoa metropolis also depend heavily on boreholes water for their daily needs. The aim of this study was to assess the physicochemical and heavy metals characteristic of selected boreholes water in Onopa, Azikoro and Agbura communities of Attisa Clan in Yenagoa metropolis of Bayelsa State. Parameters analysed include: EC, TDS, TSS, TH, pH, TA, Cl, F, NO3, SO4, PO4, DO, COD, BOD, Ca. Heavy metals include Mg, Fe, Cd, Cr, Cu and Pb. Evaluation of WQI and HPI was also undertaken. Results show that all the physicochemical parameters were within the standard limit of (WHO). WQI evaluation revealed that all the water samples have excellent quality for drinking with respect to physicochemical qualities. However, HPI evaluation revealed that the waters are not safe for drinking with respect to heavy metal pollution significantly influenced by high Cadmium concentration in most of the samples. It is concluded that Cadmium is a heavy metal of concern in the study area and that regular monitoring of drinking water should be undertaken in order to protect public health and wellbeing.

Impact of using smart applications, “Sehaty Application”, on health care at primary care center in Al-Qurayyat Region

The research aimed to investigate the impact of using smart applications, specifically the "Sehhaty" application, on healthcare in primary care centers in the Al Qurayyat province. The study used a descriptive-analytical methodology and relied on an electronic questionnaire as a tool for data collection. The study sample consisted of 213 residents of Al Qurayyat and 211 individuals from major cities. The study found that the most common method used to obtain healthcare services inside and outside the province was through the "Sehaty" application, but the residents of Al Qurayyat were the least likely to use it. The study also found that the level of knowledge and ease of use of the application was slightly lower among residents of the province. Additionally, the study found that residents of the province benefited more from the services of the application and that residents of major cities were more satisfied with the application's services. The most significant problem encountered by both residents of the province and major cities when using the application was the need for a high-speed internet connection. The study recommended several measures to optimize the use of the application.

A review of experimental informal urbanism initiatives and their implications for sub-Saharan Africa's sustainable cities’ agenda

A dominant narrative in conventional literature is that informality is a barrier against sustainable city development. However, in recent times, some scholars argue that informal urbanism has positive implications for the attainment of the sustainable city development goals. Following this view, this study investigates the experimental projects (referred to as Experimental Informal Urbanism – EIU) developed by slum dwellers in sub-Saharan Africa (SSA) in response to their deprivations and discusses their implications for the region's sustainable city development agenda. The study relied solely on secondary data (both scholarly and grey literature) that were extracted using search engines and data repositories such as Scopus, Web of Science, Google, Google Scholar, and the Mendeley Literature search function. The results indicate that slum residents in major cities in SSA have engineered innovative solutions to their deprivations. Some of the initiatives are: a) greenspace development on refuse dumpsites, b) solar-powered cars, c) productive reuse of plastic waste, organic waste, and electronic waste (e-waste), d) water sharing and e) plastic and sandbag housing. These innovative initiatives promote resilience and have positive implications for the sustainable city development agenda of SSA cities. However, some of these initiatives could have adverse health and environmental consequences. We therefore call on states and city authorities to consciously take stock of innovative initiatives of slums and research ways to harness, replicate, and integrate them into their sustainable city development agenda.

Gun violence in Australia, 2002-2016: a cohort study.

To describe the burden, geographic distribution, and outcomes of firearm-related violence in New South Wales during 2002-2016. Population-based record linkagstudy of people injured by firearms in NSW, 1 January 2002 - 31 December 2016. Frequency, proportion, and rate of firearm-related injuries and deaths by intent category (assault, intentional self-harm, accidental, undetermined/other) and socio-demographic characteristics; medical service use (hospitalisations, ambulatory mental health care) before and after firearm-related injuries; associations between rates of firearm-related injury and those of licensed gun owners, by statistical area level 4. Firearm-related injuries were recorded for 2390 people; for 849 people, the injuries were caused by assault (36%), for 797 by intentional self-harm (33%), and for 506 by accidents (21%). Overall rates of firearm injuries were 4.1 per 100000 males and 0.3 per 100000 females; the overall rate was higher in outer regional/rural/remote areas (3.8 per 100000) than in major cities (1.6 per 100000) or inner regional areas (1.8 per 100000). During 2002-2016, the overall firearm-related injury rate declined from 3.4 to 1.8 per 100000 population, primarily because of declines in injuries caused by assault or accidental events. The rate of self-harm injuries with firearms were highest for people aged 60 years or more (41.5 per 100000 population). Local rates of intentional self-harm injuries caused by firearms were strongly correlated with those of licensed gun owners (r=0.94). Rates of self-harm with firearms are higher for older people, men, and residents in outer regional and rural/remote areas, while those for assault-related injuries are higher for younger people, men, and residents of major cities. Strategies for reducing injuries caused by self-harm and assault with firearms should focus on people at particular risk.

Variations between major and regional Australian cities in physically active and sedentary travel behaviors

Promoting active travel is a public health priority. However, existing studies on active travel tend to focus on major cities: little is known about travel in regional cities. This study examined differences in the prevalence of walking, cycling, public transport use, and car use among adult residents of major, satellite, and regional cities in Queensland, Australia. Logistic regression analyses were used to examine the odds of travel behaviors according to city type. Overall, 14.8% of participants reported any walking, 7.3% walking at least 30 min/d, 1.9% cycling, 4.7% using public transport, and 42.3% using cars over 1 h/d. Compared with residents of major city, residents of satellite and regional cities had significantly lower odds of participating in any walking, walking ≥30 min/d, and using public transport; and residents of regional cities had a significantly higher odds of cycling and lower odds of using a car ≥1 h/d. Differences in travel behaviors between city type were more pronounced for working-age adults (18–64 years) than older adults (65–84 years). Our findings suggest that working-age residents of satellite cities are the least active for transport. Initiatives to promote active travel in Australia may need to prioritize areas outside of major cities.

Would customers be willing to use an alternative (chargeable) delivery concept for the last mile?

B2C e-commerce is still one of the fastest growing marketing channels in almost all product categories yielding to less bundled direct-to-consumer deliveries. Last mile deliveries cause costs and emissions especially in urban areas with a high density of e-customers. Therefore, stakeholders in the context of last mile parcel deliveries are interested in implementing efficient, innovative and ecological last mile concepts. Additionally, such concepts must fulfill the requirements and expectations of online customers as parcel recipients because last mile delivery is the critical link between an online purchase and the delivery to the address stated by the customer. In our customer-driven central last mile micro depot (CMD) project a potential analysis was carried out for the implementation of a CMD with the aim of environmentally-friendly and bundled last mile delivery. Our paper tries to close a research gap by examining acceptance and willingness-to-pay for an alternative last mile delivery concept from the perspective of the customer. Our empirical results based on a survey among German major city residents indicate that city residential areas are potentially more suitable for the realization of a CMD-project than other areas. Furthermore, younger and employed inhabitants are most willing to use the CMD. Based on our statistical model we are able to predict values for the willingness to pay per parcel for a specific population of urban inhabitants. A high proportion of the population in cities (60%) would be interested in participating. However, only 36% are willing to pay in addition to the usual parcel delivery charges. 26% are willing to pay €1.00 or more.

Patterns in protein consumption in Ghanaian cities

Consumption of food of animal origin or animal proteins has been associated with many perceptions about the quantity and quality consumed and the related health effects on the consumer. Several investigative methods including a food frequency questionnaire have been used to confirm or disprove these perceptions. This study investigated the consumption patterns of animal proteins (beef, chicken, fish, egg, offal, sausage, and pork) of some residents in major cities in Ghana. A total of 688 participants were involved in this survey with an average age of 38.7±16; having religious makeup of 89.1% Christians, 10.32% Muslims, 0.44% non-religious, and 0.15% Traditionalists. The Akan ethnicity accounted for 55% of all participants followed by Ga-Adangbe, and Ewe with 20% and 12% respectively. The estimated protein consumptions were 657 g/person/day chicken, 412 g/person/day pork, 477 g/person/day fish, 410 g/person/day beef, 211 g/person/day egg and 148 g/person/day sausage. While boiled eggs were the most preferred protein form, the fried type was the most preferred for the other protein sources.

Exploring the Impact of Remoteness and Socio-Economic Status on Child and Adolescent Injury-Related Mortality in Australia

Injuries are a leading cause of harm for children. This study explores the impact of determinants of health on children (0–19 years) injury-related mortality (namely remoteness and socio-economic disadvantage, calculated using the index of relative socio-economic advantage and disadvantage (IRSAD)). Cause of death data from the Australian Bureau of Statistics were sourced for children in Australia between 1 July 2007 to 30 June 2017. Fifteen injury categories (ICD-10-AM external cause codes) were used. Burden and trends by injury mechanism were explored. A total of 5153 children died; with road traffic incidents (3.39 per 100,000 population), intentional self-harm (2.46) and drowning (0.72) being the leading mechanisms. Female fatality rates in very remote areas (8.73) were nine times higher than in major cities (Relative Risk [RR] = 8.73; 95% Confidence Interval [95% CI]: 4.23–18.00). Fatality rates increased with remoteness; very remote areas recording an injury-related fatality rated six times (RR = 5.84; 95% CI: 3.76–9.12) that of major city residents. Accidental poisoning and intentional self-harm fatalities were more likely in high IRSAD areas, while road traffic fatalities were more likely in low and mid socio-economic areas (X2 = 69.1; p < 0.001). People residing in regional and remote areas and from low socio-economic backgrounds already face significant health and lifestyle challenges associated with disadvantage. It is time to invest in injury prevention interventions for these populations, as well as upstream policy strategies to minimize any further preventable loss of life.

Effect of mammography screening and sociodemographic factors on stage of female breast cancer at diagnosis in New South Wales

Objective The aims of this study were to assess the effects of screening through BreastScreen NSW on the stage of cancer at diagnosis, and differences in cancer stage at diagnosis according to sociodemographic factors. Methods Using linked BreastScreen NSW screening attendance records and NSW Cancer Registry data, the effects of screening participation and sociodemographic characteristics on stage at diagnosis were investigated using Kruskal-Wallis analysis of variance or the Mann-Whitney U-test for the 2002-13 diagnostic period. Multivariate logistic regression was used to investigate predictors of stage at diagnosis. Results The association between BreastScreen NSW participation and earlier stage at diagnosis was strongest when the last screening episode occurred within 24 months of the cancer diagnosis, with an odds ratio of localised versus non-localised cancer of 1.61 (95% confidence interval 1.51-1.72). Women aged ≥70 years, Aboriginal women, residents of major cities and women living in areas of socioeconomic disadvantage were more likely to have distant than non-distant stage at diagnosis. A trend towards more distant stage in more recent diagnostic years was evident after adjusting for screening participation. Conclusions The strongest and most consistent predictor of earlier stage at diagnosis was BreastScreen NSW participation. Continued efforts to increase screening participation are important to achieve earlier stage at diagnosis, particularly for sociodemographic groups with more advanced disease. What is known about the topic? Earlier cancer stage at diagnosis is a prerequisite for mortality reduction from screening. Past research indicated that screening participation in New South Wales (NSW) was strongly associated with early stage at diagnosis and mortality reduction. More contemporary data are needed to monitor screening performance in NSW and assess differences in cancer stage across sociodemographic subgroups. What does this paper add? Using data linkage, this paper indicates associations between screening, sociodemographic factors and stage at diagnosis for the NSW population in 2002-13. Contrary to expectations, major city residents tended to have a lower proportion of early stage breast cancer at diagnosis, which may be indicative of lower screening coverage and barriers to screening. Compared with past research, similar effects of screening and other sociodemographic factors on the stage of breast cancer at diagnosis were observed. This paper compares screening histories across sociodemographic groups, indicating statistically significant differences. What are the implications for practitioners? Increasing screening participation is particularly important for sociodemographic groups who are diagnosed at more advanced stages, including women from lower socioeconomic areas, Aboriginal and Torres Strait Islander women and residents of major cities. In particular, the results reinforce the need to further develop targeted strategies to increase screening participation among NSW women from lower socioeconomic areas and Aboriginal and Torres Strait Islander women. Further investigation into screening coverage and barriers to screening for residents in major cities is needed.

Web Based Survey of Adult Population of West and Central Saudi Arabia about Cause and Management of Keratoconus

Background: Keratoconus (KC) causes visual disability in young adults. To improve its early detection and compliance, improving the awareness of patients and their relatives is crucial. We present the level of awareness about KC among the adult population of western Saudi Arabia and its determinants. Methods: This web-based survey was carried out from June to August 2020 in urban and semi-urban areas in western Saudi Arabia. Demographic and eye ailment profiles were collected. To generate responses on the presentation, causes, management and prevention of KC, a five-point Likert scale was used. The logit values were calculated and graded into good and poor awareness. Awareness was associated with other determinants. Results: We surveyed 420 Saudi adults. The median logit score of awareness about KC among participants was 2.86 (inter quartile range (IQR) 0.86; 2.95). The median score of knowledge about the causes and presentation of KC was 2.86 (IQR 1.1; 2.86) and for management, it was 0.00 (IQR 0.00; 0.18). The level of awareness was good in 286 participants (68.1%) and poor in 134 (31.9%). Residents of major cities (P < 0.04) and women (P < 0.001) had significantly better awareness about KC. Knowledge about KC mainly came from friends and reading about it. The mass media and social media were rarely used to seek knowledge. Conclusions: Awareness about the presentation, causes and management of KC was good in two-thirds of adults but with some variation. Strategies to involve the community and stress health education need to be urgently implemented. Campaigns should target the male and semi-urban population in western Saudi Arabia.

Mapping foreign residents in Japan’s major cities

Abstract. Japan’s population has been declining since it reached its peak in 2008, and the annual decrease is expected to expand gradually in the future. In this situation, improvement in the fertility rate and intake of foreigners have attracted great attention. However, since the total fertility rate (TFR) has remained stagnant between 1.40 and 1.45 in recent years, more attention is being paid to the role of foreigners as “replacement migration,” and the importance of this has even been highlighted by the United Nations (2001). Noteworthy trends in relation to this are the regional disparity of population decline and the distribution of foreign nationals in contemporary Japan. In particular, the issue of depopulation is serious in peripheral parts of the country because it has been occurring since the 1980s. Meanwhile, the monopolar concentration of population, including foreign residents, into Tokyo has also been a major issue.Keeping the above developments in mind, the first edition of Mapping Foreign Residents in Japan, which I edited, was published in 2011; thanks to its favourable reception, a revised edition was published in January 2019. Both editions were prepared especially for policy-makers of national and local government offices in charge of foreign residents. It includes more than 100 maps. This presentation aims to introduce the maps that visualize the status of foreign residents in Japan’s major cities and to outline the distinctive features of the differentiation in their residential distribution.The work’s chief sources are national government statistics such as population census (including microdata of foreign residents in the 2015 census), statistics on foreign residents, and vital statistics. The maps are arranged by six topics (distribution/changes, gender/age/nationality, status-of-residence, employment, life, and enclaves/migration), and each topic has several sub-topics. Maps of foreign residents in major cities are drawn on a municipality basis (city, ward, town, and village) or on a small-area unit basis (cho-cho and aza). Figure 1 shows an example from the second edition.Major findings obtained from the series of maps in the recently revised publication are summarized as follows.First, there are very few remarkably large enclaves composed of small-unit areas with a high ratio of foreign residents, suggesting that most foreign residents, even in such areas, tend to reside alongside Japanese residents. Second, major enclaves for ‘oldcomers’ (Korean and Chinese residents) are located in the inner-city areas of a few metropolises. Third, major enclaves for newcomers are confirmed to exist in four types of small-area units: downtown, public housing, around universities, and around factories.

Patterns of prostate-specific antigen testing by remoteness of residence and socio-economic status: An Australian population-based study.

Describes the variation in prostate cancer testing by the remoteness of residence and socio-economic status groups in Australia. A national population-based descriptive study using Medicare data extracted by the Department of Health (formerly the Department of Health and Ageing). Australia. All men, with a Medicare-reimbursed prostate-specific antigen test conducted in Australia between 2002 and 2017, were included. We focused on "screening and case finding" tests (Medicare Benefits Schedule item number 66655) from 1 April 2005 to 31 December 2009, to describe testing differences in subgroups. Groups were categorised into State and Territory, socio-economic status and region of residence. A negative binomial regression model was fitted to measure the incidence rate ratios of those who had a screening prostate-specific antigen test by group. Age-standardised testing rates and incidence rate ratios. Between 2002 and 2017, 11588775 screening prostate-specific antigen tests were reimbursed by the Department of Human Services. During 2005-2009, 52% of all Australian men, aged 40years and over, had a screening test. The incidence rate ratios differed by State and Territory. Men aged 40years and over, living in very remote areas, were 43% less likely to have had a screening test than residents of major cities. Prostate-specific antigen testing rates fell in all age groups between 2007 and 2009 and 2017. The prostate-specific antigen testing behaviour differs between community groups in Australia. Men were less likely to have had a screening prostate-specific antigen test the farther they lived from the major cities. This highlights the need for a more targeted approach to achieve an equitable and evidence-based prostate cancer care across all sectors of the community.

Cardiopulmonary resuscitation and first-aid training of river users in Australia: A strategy for reducing drowning.

Rivers are a leading location for fatal drowning worldwide, often geographically isolated from timely medical assistance. Cardiopulmonary resuscitation (CPR) benefits drowning victims and those who suffer cardiac arrests. This study explored CPR and first-aid training of river users in Australia. Adult river users (18+ years) were surveyed at four high-risk river drowning sites. Respondents were asked the last time they undertook CPR (responses converted into: "CPR ever undertaken"-yes/no; and "CPR training current"-yes/no (training undertaken ≤12 months ago). Responses were explored by demographics and social determinants of health. Of those surveyed (N = 688), 98.4% responded regarding CPR. Seventy-five percent (74.9%) had undertaken CPR training previously. Females and 35- to 44-year-olds were more likely to have undertaken training (P < 0.05). Males and older people (65+ years) were less likely to hold a current qualification (P < 0.05). Major city residents reported a longer mean time (5.4 years) since last trained than remote and very remote locations (2.0 years). People in low socio-economic areas had a shorter time since qualification current (5.8 years) than those in areas deemed high (7.2 years). Current CPR qualifications are important, particularly among those visiting high-risk river drowning locations. System-level, upstream strategies that should be explored include compulsory CPR training in secondary schools and linking CPR updates to motor vehicle licence renewals. SO WHAT?: Cardiopulmonary resuscitation is a vital component of multifaceted river drowning prevention. Social determinants of health, such as socio-economic disadvantage and geographical isolation, were not barriers to participation or currency of qualification.

Spatial Point Data Analysis of Geolocated Tweets in the First Day of Eid Al-Fitr 2017 in Java Island

Eid Al-Fitr is a worldwide Muslim feast day, which in Indonesia generally accompanied by tradition of going home (mudik). The demographic patterns at the time of the holiday are generally shifted, in which some urban residents will travel to their hometowns. The impact of this shifting is that there is a quite massive mobility of the population, which is generally accompanied by traffic congestion. The presence of location sensors on smartphone devices, open the opportunity to map the movement of the population in realtime or near-realtime. Especially now that social media applications have been integrated with the capability to include location information. One of the popular social media applications in Indonesia is Twitter, which provides microblogging facilities to its users. This study aims to analyze the pattern of Geolocated Tweets data uploaded by Twitter users on the first day of Eid Al-Fitr (1 Syawal 1438H). Geolocated Tweets data mining is done by using Streaming API (Application Programming Interface) and Python programming language. There are 13,224 Geolocated Tweets points obtained at the location of the study. Various point data analysis techniques applied to the data have been collected, such as density analysis, pattern analysis, and proximity analysis. In general, active Twitter users are dominated by residents in major cities, such as Jakarta, Bandung, Surabaya, Yogyakarta, Surakarta and Semarang. The results of the analysis can be used to determine whether the Geolocated Tweets data mined by the Streaming API method can be used to represent the movement of the population when mudik.

Emergency department attendance after telephone triage

ABSTRACTObjectivesTo measure compliance with telephone helpline advice to attend an emergency department (ED) and the acuity of patients who presented to ED following a call. ApproachPopulation based, observational cohort study of all calls (n=1.04 million) to the healthdirect helpline over four years made by residents of New South Wales (NSW), Australia, linked to records of ED presentations, hospital admissions and death registrations using probabilistic data linkage. Outcomes measured include: compliance with dispositions to attend an ED, self-referral to ED by patients given low urgency dispositions, predictors of compliance and self-referral, and triage levels at ED presentation. This helpline dataset had not been previously linked with clinical outcome data, and this is the largest population-based linkage of telephone triage data conducted internationally.Results67.2% of patients were compliant with dispositions to attend an ED and the great majority of these (95.2%) attended within four hours of the call. Compliance was highest in patients aged 10-14 years, in residents of major cities and inner regional areas, in middle socio-economic quintiles, in calls triaged after-hours by nurses, in patients who had not been frequent callers to the service, and in callers with an original intention matching the disposition. In patients receiving a low-urgency disposition, 6.2% attended ED within 24 hours of the call (50.4% of these within four hours). Predictors of self-referral included older patient age, and calls triaged after hours. Calls from remote areas and areas in high socio-economic quintiles and where the original intention was similar to the disposition, were less likely to self-refer to ED. After age-adjustment, healthdirect compliant patients who attended ED were significantly less likely (7.7%) to receive the least urgent triage category (Australasian Triage Scale [ATS] 5) compared to the general NSW ED population (16.9%). Compliant healthdirect ED attenders also included a significantly higher proportion of patients triaged as the more urgent ATS 3 (37.0%) compared to the general NSW population (30.0%).Conversely, patients who self-referred to the ED did not differ significantly from the general population in allocation to lower urgency categories. ConclusionThis large population-based data linkage study provides precise estimates of ED attendance following calls to a telephone triage service, and details the predictors of ED attendance. The findings with regard to triage categories at ED presentation indicate that the healthdirect helpline is not referring substantial numbers of low-urgency patients to EDs.

Examining dental expenditure and dental insurance accounting for probability of incurring expenses.

There are few studies of dental service expenditure in Australia. Although dental insurance status is strongly associated with a higher probability of dental visiting, some studies indicate that there is little variation in expenditure by insurance status among those who attend for care. Our objective was to assess the overall impact of insurance on expenditures by modelling the association between insurance and expenditure accounting for variation in the probability of incurring expenses, that is dental visiting. A sample of 3000 adults (aged 30-61 years) was randomly selected from the Australian electoral roll. Dental service expenditures were collected prospectively over 2 years by client-held log books. Questionnaires collecting participant characteristics were administered at baseline, 12 months and 24 months. Unadjusted and adjusted ratios of expenditure were estimated using marginalized two-part log-skew-normal models. Such models accommodate highly skewed data and estimate effects of covariates on the overall marginal mean while accounting for the probability of incurring expenses. Baseline response was 39%; of these, 40% (n = 438) were retained over the 2-year period. Only participants providing complete data were included in the analysis (n = 378). Of these, 68.5% were insured, and 70.9% accessed dental services of which nearly all (97.7%) incurred individual dental expenses. The mean dental service expenditure for the total sample (those who did and did not attend) for dental care was AUS$788. Model-adjusted ratios of mean expenditures were higher for the insured (1.61; 95% CI 1.18, 2.20), females (1.38; 95% CI 1.06, 1.81), major city residents (1.43; 95% CI 1.10, 1.84) and those who brushed their teeth twice or more a day (1.50; 95% CI 1.15, 1.96) than their respective counterparts. Accounting for the probability of incurring dental expenses, and other explanatory factors, insured working-aged adults had (on average) approximately 60% higher individual dental service expenditures than uninsured adults. The analytical approach adopted in this study is useful for estimating effects on dental expenditure when a variable is associated with both the probability of visiting for care, and with the types of services received.

Inaccurate ascertainment of morbidity and mortality due to influenza in administrative databases: a population-based record linkage study.

BackgroundHistorically, counting influenza recorded in administrative health outcome databases has been considered insufficient to estimate influenza attributable morbidity and mortality in populations. We used database record linkage to evaluate whether modern databases have similar limitations.MethodsPerson-level records were linked across databases of laboratory notified influenza, emergency department (ED) presentations, hospital admissions and death registrations, from the population (∼6.9 million) of New South Wales (NSW), Australia, 2005 to 2008.ResultsThere were 2568 virologically diagnosed influenza infections notified. Among those, 25% of 40 who died, 49% of 1451 with a hospital admission and 7% of 1742 with an ED presentation had influenza recorded on the respective database record. Compared with persons aged ≥65 years and residents of regional and remote areas, respectively, children and residents of major cities were more likely to have influenza coded on their admission record. Compared with older persons and admitted patients, respectively, working age persons and non-admitted persons were more likely to have influenza coded on their ED record. On both ED and admission records, persons with influenza type A infection were more likely than those with type B infection to have influenza coded. Among death registrations, hospital admissions and ED presentations with influenza recorded as a cause of illness, 15%, 28% and 1.4%, respectively, also had laboratory notified influenza. Time trends in counts of influenza recorded on the ED, admission and death databases reflected the trend in counts of virologically diagnosed influenza.ConclusionsA minority of the death, hospital admission and ED records for persons with a virologically diagnosed influenza infection identified influenza as a cause of illness. Few database records with influenza recorded as a cause had laboratory confirmation. The databases have limited value for estimating incidence of influenza outcomes, but can be used for monitoring variation in incidence over time.