bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining medical deserts—an international consensus-building exercise
Authors: Brînzac M G , Kuhlmann E , Dussault G , Ungureanu M I , Chereches R M , Baba C O 
Published: October 2024

Abstract

Background
Medical deserts represent a pressing public health and health systems challenge. The COVID-19 pandemic further exacerbated the gap between people and health services, yet a commonly agreed definition of medical deserts was lacking. This study aims to define medical deserts through a consensus-building exercise, explaining the phenomenon to its full extent, in a manner that can apply to countries and health systems across the globe.

Methods
We used a standard Delphi exercise for the consensus-building process. The first phase consisted of one round of individual online meetings with selected key informants; the second phase comprised two rounds of surveys when a consensus was reached in January 2023. The first phase-the in-depth individual meetings-was organized online. The dimensions to include in the definition of medical deserts were identified, ranked and selected based on their recurrence and importance. The second phase-the surveys-was organized online. Finally, external validation was obtained from stakeholders via email.

Results
The agreed definition highlights five major dimensions: ‘Medical deserts are areas where population healthcare needs are unmet partially or totally due to lack of adequate access or improper quality of healthcare services caused by (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services or (v) other socio-cultural barriers’.

Conclusions
The five dimensions of access to healthcare: insufficient human resources in health or; facilities; long waiting times; disproportionate high costs of services and; other socio-cultural barriers, ought to be addressed to mitigate medical deserts. The term medical deserts might not be the most appropriate term for defining areas with insufficient access to health services as it excludes essential domains, such as access to public health and preventive services.

Key messages
• Medical deserts directly and negatively impact the health outcomes of the people living in it.
• Medical deserts might not be the most appropriate term for defining areas with insufficient access to medical services, as it excludes public health and preventive services.
Healthcare in police custody: a conceptual framework for measuring and improving quality of care
Authors: Zinger N D , Slev V N , Verheij R A , Bos I , Kringos D S 
Published: October 2024

Abstract

Background
Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands.

Methods
We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework.

Results
The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement.

Conclusions
The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings.

Key messages
• The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody.
• This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.
A systematic review of cancer overdiagnosis in multimorbid patients
Authors: Slight S P , Abdalla H , Hassan N , Wilson S , Slight R 
Published: October 2024

Abstract

Background
Cancer screening looks for early signs of cancer in people who do not currently exhibit symptoms. However, screening can also identify abnormalities that do not progress to produce symptoms or death. This could include the identification of tumours, which stop growing or grow very slowly; patients usually die with them rather than from them. We systematically reviewed the literature to investigate the harmful consequences of cancer overdiagnosis in multi-morbid patients.

Methods
We followed the PRISMA reporting guidelines and registered the review with PROSPERO (CRD42024475175). A Population, Intervention, Comparator, Outcome and Study design (PICOS) framework was used as an organising framework. Peer-reviewed studies were included except case series, case report reviews and conference abstracts. Four large databases (Medline, Embase, APA Psych INFO and Scopus) were searched in Nov23 using appropriate keywords grouped into categories: multimorbidity, overdiagnosis, patient harms, cancer screening. Titles were screened according to the eligibility criteria and their quality assessed. Studies needed to have investigated the extent of harm caused by overdiagnosis (e.g., overtreatment).

Results
A total of 200 articles were retrieved, with seven meeting our inclusion criteria. All included studies were based in the US. Breast and prostate cancer overdiagnosis was reported to be 15% higher in multimorbid populations compared to the average-risk population. Multimorbid individuals were more vulnerable to the harms of cancer overdiagnosis, with psychological, physical and financial harms reported.

Conclusions
These findings contribute valuable insights into the intricate interplay between comorbidities, cancer overdiagnosis, and associated harms. Radical treatment interventions in multi-morbid patients can carry greater risk of complications. Current screening guidelines only address average-risk populations; future guidelines need to reflect these findings.

Key messages
• Cancer overdiagnosis was found to be higher in multimorbid populations compared to the average-risk population.
• Multimorbid individuals are also more vulnerable to the harms of cancer overdiagnosis.
Experiences with paediatric hospital health care: a cross-sectional study among paediatric patients
Authors: Murko E , Kralj M , Poldrugovac M , Zaletel M , Ropret N 
Published: October 2024

Abstract

Background
The measurement of patient experiences is gaining importance in many healthcare systems, including the Slovenian one. The need for a national survey on patient experiences in the paediatric inpatient settings emerged recently.

Methods
The survey took into account various aspects of inpatient healthcare such as admission, hospital staff, safety, food and discharge from hospital. As part of the study, children/parents were able to give praise and suggestions for improvements. We used three different questionnaires adapted to the cognitive abilities of children - a child questionnaire for the age group 9-13 years in paper form, an online adolescent questionnaire for the age group 14-18 years, and an online parent questionnaire for the age group 0 (1 month)-8 years. The questionnaires were cognitively tested and piloted before national rollout.

Results
The national survey was conducted between September 2023 and March 2024 and included paediatric patients who spent at least one night in an acute paediatric hospital ward. The survey included 25 paediatric wards and totally 1965 questionnaires were valid for analysis. The rough response rate was 17,6 %. The first preliminary results of the qualitative analysis suggest that surveyed paediatric patients and their parents rate highly inpatient health care services received, however they point out also to areas that need improvement such as environmental factors (noise, temperature), food, infrastructure (outdated facilities & equipment) and in some cases attitude of hospital staff.

Conclusions
National institute of public health carried out the first national survey on paediatric patient reported experience measures in acute hospitals in Slovenia. The results of this survey will be used to improve the quality of inpatient health care services in paediatric wards, as well renew focus on the requirements of European charter of children rights and United Nations Convention on the Rights of the Child.

Key messages
• National institute of public health carried out the first national survey on paediatric patient reported experience measures in hospitals in Slovenia.
• The results of this survey will be used to drive hospital quality improvements.
Time-dependent networks for the treatment of acute coronary syndrome in South East Tuscany
Authors: De Luca A , Limaj S , Capitani E , Taddeini F , Limbruno U , Turillazzi R , D’Amato M G , Quercioli C , Nante N , D’Urso A 
Published: October 2024

Abstract

Introduction
The importance of timely reperfusion therapy in Cardiovascular diseases is crucial, leading to the creation of time-dependent networks for Acute Coronary Syndrome treatment. The ACS-STEMI treatment network in Tuscany operates across three health authorities (LHAs),including South-East Tuscany. The network ensures ACS-STEMI treatment in 12 hospitals integrating new territories such as Piombino and Elba into the network. Aim of the study is to assess the impact of an analytical monitoring system of the times to reperfusion treatment and the actions to improve the performance of the network.

Methods
In this retrospective study an analytical evaluation of the network’s performance was conducted. We utilized data on patient transport, symptom onset to medical contact times, and outcomes from the National Outcomes Program (PNE).Analytical evaluations in 2021 measured the network’s performance, identifying main delay causes. The treatment process is divided into periods from symptom onset to coronary reperfusion, and interventions like public campaigns, ECG transmission and fast-track transfers have been implemented.

Results
South East Tuscany LHU had the lowest 30-day mortality rate for ACS patients in Italian hospitals with 300 cases annually in 2020 and 2021.Improvements continued into 2022 and 2023, further reducing mortality rates in patients initially admitted to SPOKE hospitals. For Piombino and Island of Elba residents,30-day mortality decreased from 8.8% (2017-2020) to 5.7% in 2022. The Grosseto hub treated 80% of STEMI patients within 90 minutes in 2022.

Conclusions
The establishment of a well-organized time-dependent network for ACS-STEMI treatment in Tuscany has significantly improved patient outcomes, demonstrating the critical role of timely and efficient care pathways. The network’s success is attributed to several factors, including improved accessibility, enhanced coordination among healthcare facilities, and effective use of technology and resources.

Key messages
• Treatment networks for ACS/STEMI can improve health outcomes in peripheral areas.
• Structured clinical-care pathways in delivering high-quality care for ACS patients reduces ACS mortality.
Chronic Illness and visiting clinic before hospitalization at the onset of Stroke: Shiga Registry
Authors: Kiyohara M , Miyamatsu N , Harada A , Takashima N , Ogawa N , Shitara S , Urushitani M , Yoshida K , Miura K , Nozaki K 
Published: October 2024

Abstract

Background
Prompt action at stroke onset is required to improve prognosis. Some previous studies indicated that visiting local clinics may initially delay access to specialized care. We examined the relationship between the presence of chronic diseases known as risk factors for stroke and visiting a local clinic before admission to the hospital for acute stroke care.

Methods
This study utilized data from stroke patients aged 18 and older who were registered in the Shiga Stroke and Heart Attack Registry (SSHR) from January 2011 to December 2015. We excluded cases with onset during hospitalization or those with impaired consciousness assessed by the Japan Coma Scale (JCS &gt; =10). The presence of comorbid chronic diseases was determined based on the past history and medications presented at admission. Local clinics are defined as clinics or hospitals that are not equipped to provide acute stroke treatment. Multivariate logistic regression analyses, adjusting for sex, age, modified Rankin Scale score before onset, and stroke subtypes, were performed to calculate odds ratios and 95% confidence intervals for visiting a clinic before hospitalization according to the presence of chronic diseases such as hypertension, diabetes, dyslipidemia, and atrial fibrillation, respectively.

Results
Data from 11,111 out of 14,620 registered cases were analyzed. Among these participants, 5,774 had hypertension, 1,951 had diabetes, 2,111 had dyslipidemia, and 882 had atrial fibrillation. A total of 2,405 (21.6%) cases visited a local clinic at stroke on set. The adjusted odds ratios for visiting clinics by the presence of hypertension were (1.22, 95% CI: 1.11 -1.34), diabetes (1.14, 1.01-1.28), dyslipidemia (1.07, 0.95 -1.20), and atrial fibrillation (0.80, 0.67 -0.95).

Conclusions
The present study indicated that individuals with hypertension and/or diabetes are more likely to initially visit a local clinic at stroke onset, whereas those with atrial fibrillation were not.

Key messages
• Approximately 20% of mild stroke patients first consult local or primary care doctors at stroke onset. This trend was particularly observed in individuals with hypertension and diabetes.
• Emphasizing the need for direct access to specialized emergency care for individuals with chronic diseases is important to avoid delays in acute stroke care.
Data ecosystem using smart home technology to support healthy aging
Authors: Wang K , Cao S , Morita P 
Published: October 2024

Abstract

Background
Smart home technology has been widely used to mitigate the challenges that population aging brings. However, the lack of a centralized data ecosystem has prevented these technologies from realizing their full potential. This project aimed to construct a data ecosystem compatible with smart home sensors to monitor healthcare for seniors, improving their quality of life.

Methods
The infrastructure was constructed using a user-centered design approach, allowing smart devices such as motion, temperature sensors to operate independently and communicate through a Wi-Fi mesh network. API technology provides a reliable channel for real-time data collection. To ensure data privacy and security, extracted data is hosted in a cloud environment that provides comprehensive data protection, and cloud computing is utilized for high-performance computation tasks. Analytical models such as Machine Learning can be implemented to recognize indoor activities, achieving the goal of remote monitoring.

Results
This data ecosystem advances in privacy and security, interoperability, accessibility, and data-sharing. Unified authentication mechanism ensures data is transmitted among heterogeneous devices with minimal vulnerability. Additionally, the common communication protocol provides the foundation of interoperability between devices. With unobtrusive devices, inhabitants are not burdened with operation, ensuring their accessibility and improving their user experience. Lastly, the data is exchanged in a standardized JSON data format, enabling efficient data-sharing board data integration.

Conclusions
This project developed a data ecosystem based on existing smart home environments. The ecosystem is compatible with smart devices that families already have, effectively reducing additional healthcare costs. Implications of this study include helping health policy and decision makers to adopt more smart home ecosystems to keep older people healthy at home.

Key messages
• Study constructed a data ecosystem compatible with smart home sensors, achieving remote monitoring of indoor activities and improving the quality of life for seniors.
• The developed ecosystem offers promotion in privacy and security, interoperability, accessibility, and efficient data-sharing, reducing healthcare costs.
Youth mental health care use during COVID-19: Evidence from administrative data in Alberta, Canada
Authors: Hilario C , Russell M , Urichuk L , Agyapong V , Rittenbach K , Dyson M , Parker N , Babins-Wagner R 
Published: October 2024

Abstract

Background
The COVID-19 pandemic affected health care service delivery and accessibility. Our study examined how Canadian youth used mental health services before and during the COVID-19 pandemic, and whether youth access and use patterns differed for subgroups based on social determinants previously associated with health care access.

Methods
Cross-sectional population-based administrative health care data from the province of Alberta in Canada was used to examine youth (ages 15-24) mental health care use from 2018/19 to 2021/22. Data was analyzed using an interrupted time series design and segmented regression modeling on type of mental health care use. Outcome measures were mental health care use for: general physician visits, psychiatrist visits, emergency department, hospitalization, and different mental health diagnoses. We stratified by factors related to social determinants, including gender and socioeconomic status.

Results
The analysis indicates an overall increase in the proportion of youth that used mental health care from 2018/19 to 2021/22 (14.4% vs 17.5%, respectively). There was an immediate drop in use with the onset of the COVID-19 pandemic in Canada, followed by a steady rise during the pandemic years, which was largely due to an increase in general physician visits. This rise was seen for most mental health diagnoses of study (i.e., anxiety, adjustment, attention-deficit/hyperactivity disorder, schizophrenia, and self-harm disorders). Service use increased for young women/girls compared to young men/boys and for youth from wealthier neighborhoods.

Conclusions
This study provides evidence to support health services planning and delivery to respond to the mental health needs of youth and to prepare for future public health emergencies.

Key messages
• Our study findings indicate changes in health care use for mental health among Canadian youth (ages 15-24) during the COVID-19 pandemic, with use patterns differing for youth subgroups.
• Administrative health data can provide evidence to support health services planning and delivery to respond to the mental health needs of youth and to prepare for future public health emergencies.
The impact of diabetes pay-for-performance program on hyperglycemic hyperosmolar state (HHS)
Authors: Chen T-T 
Published: October 2024

Abstract

Background
To examine the effects of a diabetes pay-for-performance (P4P) program on the negative metabolic outcome: hyperglycemic hyperosmolar state (HHS) of patients in Taiwan.

Methods
Four years (2008∼2011) of data from the National Health Insurance Administration (NHIA) databases were examined. P4P patients included those who were newly enrolled in the P4P group in 2010, and consecutively included in 2011. Patients were never enrolled are defined as non-P4P group in these two years. The caliper matching method and a generalized estimating equation were used to estimate difference-in-differences models (baseline year 2009) and examine the effects of the P4P program on the count of the adverse outcome.

Results
The P4P program was associated with decreases in the incident of HHS (IRR 0.53, P = 0.02).

Conclusions
The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS.

Key messages
• The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS.
• The disease management component of the diabetes P4P program is important.
Data literacy in healthcare: A systematic collection and evaluation of OERs on data acquisition
Authors: Kempny C , Wahidie D , Dereli I , Yilmaz-Aslan Y , Brzoska P 
Published: October 2024

Abstract

Background
Data literacy is crucial in healthcare, as it allows healthcare professionals to recognize, collect, and use data for research efficiently. Teachers can use open educational resources (OERs) to increase data literacy among healthcare staff, covering the entire research process. This study focuses on examining existing OERs with a focus on data acquisition to identify the limitations of existing OERs and to develop new OERs for data collection based on these limitations.

Methods
The platforms ‘Twillo.de’, ‘Orca.nrw’, ‘Merlot.org’, ‘OER Commons’, ‘Serlo’, ‘VIMEO’, ‘Dailymotion’, ‘SlideShare’ and ‘YouTube’ were systematically searched for OERs focusing on quantitative and qualitative data acquisition. Only OERs published under a Creative Commons license were considered. A team of researchers then analyzed existing OERs with respect to production and content quality and sorted them into four competence levels of a learning objective matrix developed by Schüller (2020).

Results
Out of 4,383 search results, we identified 111 suitable OERs for qualitative data acquisition. Only 9 of these were related to health. For quantitative data acquisition, out of 4,415 search results, 145 suitable OERs were identified, 36 of which were health-related.

Conclusions
This study highlights the scarcity of suitable OERs for healthcare professionals to improve their health data literacy. This is for various reasons. Only a few OERs are specifically designed for healthcare professionals and, therefore, do not correspond to the lifeworld of learners in the explanatory examples. Additionally, the existing OERs are not sufficiently detailed in essential areas for learners and are customized to the competence level of the target group of healthcare professionals. Therefore, existing OERs must be adapted for healthcare professionals’ data literacy training.

Key messages
• The search for OERs on qualitative and quantitative data acquisition yields many results, but less than three percent of the results are suitable for training healthcare personnel.
• Few Open Educational Resources (OERs) for healthcare professionals provide sufficient detail and alignment with their competency levels, which necessitates adaptations for data literacy training.