Using laws, common sense, and statistical approaches to design indicators for 'medical desertification'. An application on the Romanian case

The study of spatial accessibility to healthcare services is key to health policy (Pförtner et al., 2019; Vergier et al., 2017). Terms such as 'rurality' or 'medical desertification' were employed to stress the relevance of the topic. Within the existing literature, there is little (if any) concern with the legitimacy of the existing ways to measure inequality. Expert systems were assumed to be in place, and discrepancies or consistency with existing regulations or to views of relevant stakeholders were not considered. This paper discusses spatial accessibility of medical services in three distinct approaches: normative, that is following what national regulations consider as standard; relative, that is what statistical approaches reveal; consensual, which adjusts the indexes based on representations of stakeholders. The three approaches are compared for the case of Romania, an EU country with low population density, ideal to inspect geographical discrepancies. For the relative and the consensual approach, population is adjusted according to different demand expressed by age groups, and also including population and providers from the nearby localities. The normative approach follows official regulations. The refinements in the consensual model are based on survey data from stakeholders and consider distances to neighbouring localities and adjustments according to the age structure of the population in the catchment area. The results reveal high consistency between the consensual and the relative approach. Both are more permissive with respect to detecting medical desertification as compared to the normative approach but prove to be more effective in directing policy when resources are scarce. The normative approach, however, is relevant in depicting the state of the system as contrasted to a desired standard. The relative approach also overlaps with the consensual one. Therefore, to fully characterize spatial accessibility to general practitioners (GPs) and pharmacies, one needs to consider at least the normative and the relative approaches.

Embedding Attitudes Toward Immigrants in Solidarity Contexts: A Cross-European Study

This article aims to retrospectively investigate the embeddedness of attitudes toward immigrants (ATI) in cultures of solidarity seen as general orientations toward solidarity measured at a country level. We predict individual-level ATI with country-level aggregated indicators of solidarity that were observed decades earlier. The latter measure local, social, and global solidarity and are explained by a general, overall orientation toward solidarity. For computing the indicators, we combine aggregate data from the European Values Study (EVS) 1999 and 2008 and individual-level data from the spring 2015 Eurobarometer to show that the effect of country-level solidarity on individual-level ATI is strong and stable. The findings reveal that cultures of solidarity have a long-term effect and are the strongest contextual determinant for individual-level ATI. Both 1999 and 2008 data proved to be related to 2015 individual-level attitudes, having a positive effect. In particular, local solidarity positively affects attitudes toward both European Union (EU) and (to a smaller extent) non-EU immigrants. General solidarity remains the most relevant, and it should be used for boosting positive views about immigrants.

Observing many researchers using the same data and hypothesis reveals a hidden universe of uncertainty

This study explores how researchers' analytical choices affect the reliability of scientific findings. Most discussions of reliability problems in science focus on systematic biases. We broaden the lens to emphasize the idiosyncrasy of conscious and unconscious decisions that researchers make during data analysis. We coordinated 161 researchers in 73 research teams and observed their research decisions as they used the same data to independently test the same prominent social science hypothesis: that greater immigration reduces support for social policies among the public. In this typical case of social science research, research teams reported both widely diverging numerical findings and substantive conclusions despite identical start conditions. Researchers' expertise, prior beliefs, and expectations barely predict the wide variation in research outcomes. More than 95% of the total variance in numerical results remains unexplained even after qualitative coding of all identifiable decisions in each team's workflow. This reveals a universe of uncertainty that remains hidden when considering a single study in isolation. The idiosyncratic nature of how researchers' results and conclusions varied is a previously underappreciated explanation for why many scientific hypotheses remain contested. These results call for greater epistemic humility and clarity in reporting scientific findings.

Minilaparotomy as surgical approach for aortoiliac occlusive disease -- single center initial experience

PURPOSE

The purpose of this study was to emphasize the benefits and indications of performing minilaparotomy as surgical approach for occlusive aortoiliac disease.

MATERIAL AND METHOD

From January 2011 to July 2012, a total of 23 patients (19 men and 4 women), with a median age of 60 years (range 49-75) diagnosed with aortoiliac occlusive disease(n=22) or abdominal aneurysm (n=1), were included in a retrospective non-randomized clinical study. Among these patients 11 underwent aortic bypass procedure by minila parotomy approach (ML group) and 12 patients by standard laparotomy(SL group). Demographic and clinical data, operative data, postoperative recovery data and complications were analysed according to these two groups of patients. Follow-up consisted of clinical examination and duplex scanning at 1, 3,6 and 12 months postoperatively.

RESULTS

There were no significant differences between the minilaparotomy and standard laparotomy control groups concerning clinical and demographical data. Two surgical conversions to standard laparotomy were necessary (18.18%) in the ML group due to technical difficulties. The mean operative time was shorter in the ML group (124 ± 22 minutes) and the mean aortic clamping time was similar between the two groups.Major differences between the two lots were observed postoperatively;mean blood loss was more important in the SL group (550 ml) than in the ML group (350 ml) (statistical significance p=0.001, Student test). Patients who have undergone standard laparotomy required more fluids (10000 Â+-2000 ml) in comparison to the other group (6000 ± 1000 ml) p value=0.0001, while the duration of nasogastric suction and period before resuming a liquid diet was both shorter in the ML group (1.1 ± 0.5 days) than those from the SL group (2.5 ± 0.6 days) p value=0.001. The period spent in the ICU was significantly shorter for the ML lot of patients and the median hospitalization time was 5.6 days for patients in ML group,whereas in the SL group the median hospitalization time was 8.9 days (Student test - p value 0.01). We had no 30-day mortality in any of the groups included in the study. One patient from the ML group was readmitted in postoperative day 43 and re-operated on for a prosthetic limb graft thrombosis.Two patients were lost to follow-up and the mean follow-up was 9 ± 1.5 months.

CONCLUSIONS

Minilaparotomy as surgical approach for aortic diseases is a feasible, safe procedure on selected patients.

Ionizing radiation--understanding and acceptance

A written survey about perceived radiation risks was conducted among three groups of a total of 400 individuals. Seventy-seven (26%) of the respondents were radiation workers, 35 (12%) were medical doctors without professional exposure, and 177 (68%) belonged to the general population. Even if the sample is not representative of the Romanian population as a whole, some interesting conclusions can be made. The level of anxiety toward radiation, expressed as a hazard perception index, is significantly lower in radiation workers when compared to medical doctors and the general population (0.81 +/- 0.94, 1.42 +/- 1.21, and 1.72 +/- 1.34, respectively, p < 0.001). Hazard perception index values also varied with the education status, with lowest values among medical university graduates and highest among public school graduates (p < 0.001). Both university-graduated groups significantly differ from the non-university groups (p < 0.05). Knowledge about radiation and emergency plans for nuclear accidents/incidents was also correlated with hazard perception, with the results confirming the hypothesis that better knowledge is associated with lower radiation hazard perception. The extent to which people accept civilian nuclear power is also related to hazard perception and knowledge. The way people perceive the radiation risk differed among the three groups. Different levels of risk perception were associated with radiation from nuclear energy and diagnostic x rays. It is important that radiological protection authorities develop new plans and materials for communicating with the general public in order to improve knowledge of ionizing radiation, radiation risks, and the safety of civilian nuclear energy employment.