Patterns of care for brachytherapy in Japan

This study aimed to assess the current state of brachytherapy (BT) resources, practices and resident education in Japan. A nationwide survey was undertaken encompassing 177 establishments facilitating BT in 2022. Questionnaires were disseminated to each BT center, and feedback through online channels or postal correspondence was obtained. The questionnaire response rate was 90% (159/177), and every prefecture had a response in at least one center. The number of centers in each prefecture ranged from 0.6 to 3.6 (median: 1.3) per million population. The annual number of patients in each center ranged from 0 to 272 (median: 31). While most prefectures provided intracavitary (IC) BT for gynecological cancers and interstitial (IS) BT for prostate cancer, only one-third of the prefectures provided IS BT for cancer sites other than the prostate. The institutional image-guided BT implementation rate was 71%. IC and IS BT was performed for 15.4% of IC BT cases of gynecological cancer. Only 47% of the BT training centers answered that they could provide adequate training in BT for residents. The most common reason for this finding was the insufficient number of patients in each center. The results show that, although BT has achieved uniformity in terms of facility penetration, new technologies are not yet widespread enough. Furthermore, IS BT, which requires advanced skills, is limited to a few BT centers, and considerable number of BT training centers do not have sufficient caseloads to provide the necessary experience for their residents.

The Impact of Broadband Infrastructure Construction on Medical Resource Mismatch: Quasi-Natural Experiment From the Broadband China Policy

BACKGROUND

Whether the construction of broadband infrastructure can alleviate the problem of mismatched medical resources is crucial to the national information strategy, residents' well-being, and social equity. However, the academic community lacks a comprehensive theoretical analysis and rigorous empirical research on this issue.

OBJECTIVE

This study aims to construct a preliminary theoretical framework to scientifically assess the effects of broadband infrastructure development on the mitigation of health care resource mismatch from both theoretical and empirical perspectives, to explore the potential mechanisms of influence, and ultimately to develop several practical policy recommendations.

METHODS

We first used a theoretical analysis to propose testable theoretical hypotheses and establish a preliminary theoretical framework. Then, based on balanced panel data from 300 cities from 2010 to 2021, a 2-way fixed effects difference-in-differences model was used for empirical testing. Mechanism tests, robustness analyses, and heterogeneity analyses were further conducted.

RESULTS

The research findings demonstrate that the Broadband China Policy significantly reduces the degree of mismatch in medical resources by primarily using innovation effects and integration effects, resulting in a reduction of 13.2%. In addition, the heterogeneity analysis reveals that the central and eastern regions, cities with large populations, and areas with a high proportion of young people benefit more significantly.

CONCLUSIONS

This study fully confirms, both theoretically and empirically, that broadband infrastructure construction can effectively reduce the mismatch of medical resources not only by expanding the existing literature on the impact of broadband on public services but also by providing valuable opportunities for policy makers to optimize the allocation of medical resources.

Applications of Clinical Decision Support Systems in Diabetes Care: Scoping Review

BACKGROUND

Providing comprehensive and individualized diabetes care remains a significant challenge in the face of the increasing complexity of diabetes management and a lack of specialized endocrinologists to support diabetes care. Clinical decision support systems (CDSSs) are progressively being used to improve diabetes care, while many health care providers lack awareness and knowledge about CDSSs in diabetes care. A comprehensive analysis of the applications of CDSSs in diabetes care is still lacking.

OBJECTIVE

This review aimed to summarize the research landscape, clinical applications, and impact on both patients and physicians of CDSSs in diabetes care.

METHODS

We conducted a scoping review following the Arksey and O'Malley framework. A search was conducted in 7 electronic databases to identify the clinical applications of CDSSs in diabetes care up to June 30, 2022. Additional searches were conducted for conference abstracts from the period of 2021-2022. Two researchers independently performed the screening and data charting processes.

RESULTS

Of 11,569 retrieved studies, 85 (0.7%) were included for analysis. Research interest is growing in this field, with 45 (53%) of the 85 studies published in the past 5 years. Among the 58 (68%) out of 85 studies disclosing the underlying decision-making mechanism, most CDSSs (44/58, 76%) were knowledge based, while the number of non-knowledge-based systems has been increasing in recent years. Among the 81 (95%) out of 85 studies disclosing application scenarios, the majority of CDSSs were used for treatment recommendation (63/81, 78%). Among the 39 (46%) out of 85 studies disclosing physician user types, primary care physicians (20/39, 51%) were the most common, followed by endocrinologists (15/39, 39%) and nonendocrinology specialists (8/39, 21%). CDSSs significantly improved patients' blood glucose, blood pressure, and lipid profiles in 71% (45/63), 67% (12/18), and 38% (8/21) of the studies, respectively, with no increase in the risk of hypoglycemia.

CONCLUSIONS

CDSSs are both effective and safe in improving diabetes care, implying that they could be a potentially reliable assistant in diabetes care, especially for physicians with limited experience and patients with limited access to medical resources.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.37766/inplasy2022.9.0061.

Telehealth Use Across Time and Regional Medical Resources During the COVID-19 Pandemic: Evidence from China

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created lots of difficulties for individuals to seek medical help offline. Telehealth is considered as a potential approach to solve this issue. During the COVID-19 pandemic, although the use of telehealth has increased in the short term, it still remains unknown whether the use of telehealth can maintain a high level of development in the long term. The purpose of this article is to investigate the impact of COVID-19 pandemic on telehealth use across time and regional medical resources. Materials and Methods: Our research used the Internet search index from Baidu Index Platform in 31 provinces of China as the proxy of telehealth use. A total of 2,119,486 times of searching behaviors from January 2018 to December 2021 are included in our dataset. Changing plots, the method of analysis of variance and empirical models are applied to reveal the relationship between COVID-19 pandemic and telehealth use. Results: Baidu Index counts increased (p < 0.01) at the beginning of COVID-19 pandemic (2020) but started to decline (p < 0.01) during the period of regular epidemic prevention and control (2021). Moreover, the counts of Baidu Index in regions with rich medical resources are higher than those in other regions in 2020. Comparing Baidu Index counts in 2020, the COVID-19 pandemic has higher positive effects on telehealth use during the period of 2021 in regions with average and poor medical resources. Conclusions: COVID-19 pandemic has a positive effect on telehealth use in 2020 but has a negative effect in 2021. During the epidemic, telehealth use differs in regions with rich, average, and poor medical resources. Our findings indicate that the use of telehealth should be promoted with different measures in regions with different medical resources, thereby contributing its healthy development in the long term.

The Correlation Between the Attended Deaths at Home and Medical Resources in Osaka City

Introduction Most people would prefer end-of-life care to be provided at home. Although Japan has tried to promote home care and end-of-life care, very few people die at home in Japan. On the other hand, deaths at home are not necessarily attended deaths at home by end-of-life care because they include many deaths, such as deaths from external causes and solitary deaths. We obtained the data on the number of postmortem examinations at home in the main areas of Osaka City and calculated the estimated number of attended deaths at home by subtracting the number of postmortem examinations at home from the number of total deaths at home. We analyzed the contribution of medical resources to end-of-life care from a forensic perspective for a closer analysis of the actual situation. Methods The data about the population, the number of total deaths, deaths at home, and medical resources related to home care in Osaka City was obtained from the website of a public institution in Japan. The data about the number of postmortem examinations in Osaka City was obtained from the Osaka Medical Examiner's Office. The estimated number of attended deaths at home was calculated by subtracting postmortem examinations at home from total deaths at home. We conducted univariate and multivariate analyses between the number of medical resources and the prevalence of attended deaths at home. Results In the univariate analysis of the prevalence of attended deaths at home, a high positive correlation was observed in "doctors," "total clinics," "clinics except HCSC," and "general beds." A high negative correlation was observed in "long-term care beds." In the multivariate analysis, a positive coefficient was observed in "clinics except HCSC," and a negative one was observed in "HCSC or HCSH." Conclusion The policy of shifting general clinics and hospitals to HCSC and HCSH may not be as effective for end-of-life care because the criteria do not include any restrictions on the number or use of beds. However, general clinics may have played an important role in end-of-life care, even if they were not HCSC.

What factors affect Beijing residents' contracts with family doctors? A comparative study of Beijing's urban and suburban areas

Objective

To improve the health of residents and promote hierarchical diagnosis and treatment to achieve an orderly pattern of medical treatment, Beijing implemented family doctor contract services (FDCSs) in 2011. The aims of this study were to analyze the current status of Beijing residents' contracts with family doctors (FDs), compare the differences in contracting between urban and suburban residents, and explore the factors that affect residents' contract behavior.

Methods

From August 2020 to October 2020, a stratified sampling method was adopted to select residents from community health centers (CHCs) in districts D (urban area) and S (suburb) of Beijing to conduct a questionnaire survey. Chi-square tests, rank sum tests and logistic regression analyzes were used to analyze the current status and influencing factors of residents' contracting with FDs.

Results

A total of 4,113 valid questionnaires were included in the final analysis. District D was rich in medical resources, and the FD contract rate of residents there (93.09%) was significantly higher than that of residents in district S (78.06%; p < 0.05). Residents' district (OR = 1.55, 95% CI = 1.18-2.05), understanding of FDCS policies (OR = 4.13, 95% CI = 3.63-4.69), preferred medical institutions (OR = 0.58, 95% CI = 0.42-0.79 for tertiary hospitals in the district; OR = 0.36, 95% CI = 0.22-0.59 for urban medical institutions in Beijing), age, education level, average annual medical expenses and medical insurance type were factors that influenced residents' contracts with FDs (p < 0.05).

Conclusion

This study shows that residents who are located in districts with rich medical resources, prefer CHCs as their first choice, have a better understanding of FDCS policies, and are more inclined to contract with FDs than other residents. It is recommended that the number and quality of FDs in suburban areas be increased and that medical staff strengthen publicity about FDCSs and actively encourage residents to contract with FDs.

The Effect of Offline Medical Resource Distribution on Online Physician-Patient Interaction: Empirical Study With Online and Offline Data

BACKGROUND

The relationship between online health communities (OHCs) and offline medical care is unclear because both provide physician-patient interaction services and channels. Taking advantage of information and communication technology, patients have been using OHCs widely. However, some physical medical resources (such as hospital beds and medical devices) cannot be replicated by information and communication technologies. Therefore, it is worth studying how offline medical resources affect physician-patient interactions in OHCs and how OHCs help to solve resource scarcity and the uneven distribution of traditional medical treatment.

OBJECTIVE

This study aimed to support the notion that physician-patient consultations in OHCs are influenced by the objective distribution of offline health care capital (accessibility and availability) and to provide suggestions for the allocation of medical resources in practice through the judicious use of offline and online channels.

METHODS

The empirical data in this study were collected from both online and offline channels. The offline data include 9 years (2006-2014) of medical resource statistics of 31 provincial administrative regions in mainland China. Moreover, data regarding the geolocation-based physician-patient interaction network in the OHC were also collected. The online data come from one of China's largest OHCs. We obtained 92,492 telephone consultation records of 6006 physicians using an automatic web crawler program. Social network analysis was used to visualize the descriptive statistics of the offline geolocation-based physician-patient interaction network in the OHC. A regression model with a squared variable was applied to analyze online and offline empirical data to further test our hypothesis. Two types of robustness tests were used to increase the reliability of the test results of the initial model.

RESULTS

The results of our social network analysis show that there is a uniform geographic distribution of patients who use OHCs, whereas the physician relies more on geographic advantage (eg, a higher medical resource capability). Moreover, the empirical results of the regression model support the notion that physician-patient telephone consultations are positively influenced by physicians' online contributions (β_contribution=.210; P<.001) and capital availability (β_bed=.935; P=.07), and, interestingly, spatial accessibility has an inverted U-shaped effect (β_distance=.199; P<.001 and β_distance²=-.00449; P=.008). The results indicate that the use of OHCs, although constrained by offline medical resources, provides a channel for offline resources to flow from areas with high availability to those with low availability.

CONCLUSIONS

This study explores the relationship between online and offline channels by investigating online physician-patient interactions and offline medical resources. In particular, this study analyzes the impact of offline channels on online channels and verifies the possibility of OHC capital use shifting from a high-availability area to a low-availability area. In addition, it provides a theoretical and practical basis for understanding the interaction of online and offline channels of medical care.

How individual social capital affects residents' satisfaction with medical services: Based on the evidence from urban residents in China

Introduction

Residents' satisfaction with medical services has commonly been treated as both a medical and psychosocial process. The influence of psychosocial factors on residents' satisfaction with medical treatment is generally considered as important as that of medical factors. However, the effect of individual social capital on residents' satisfaction after medical treatment-an important psychosocial variable that may influence health status and access to medical services-has not received sufficient attention.

Methods

This study used the questionnaire survey data of urban residents in eight Chinese cities in 2014 to investigate how individual social capital affects residents' satisfaction with medical services over the past year.

Results

The results revealed a negative impact of individual social capital on residents' overall satisfaction with medical services. In addition, the use of individual social capital significantly improved residents' satisfaction with medical resources and significantly reduced residents' satisfaction with the medical system. Moreover, the negative impact of individual social capital on residents' overall satisfaction with medical services was greater for individuals with a lower likelihood of using this capital, which may lead to unequal allocation of medical resources and long-term life satisfaction.

Discussion

The heterogeneous impact and mechanism of individual social capital on residents' satisfaction with medical services was confirmed under the premise of self-selection bias.

Incorporating Exercise Efficiency to Evaluate the Accessibility and Capacity of Medical Resources in Tibet, China

Accessibility and capacity of medical resources are key for the health care and emergency response, while the efficiency of the medical resources is very much limited by hypoxia in Tibet, China. Through introducing exercise efficiency, this study explores the accessibility of township residence to county-ship medical resources in Tibet using weighted mean travel time (WMT), and evaluates the medical capacity accordingly. The results show that: 1) the average travel time of township residence to county-level hospital is around 2 h by motor vehicle in Tibet. More than half of the population can not reach the county-ship hospital within 1 h, 33.24% of the population can not reach within 2 h, and 3.75% of the population can not reach within 6 h. 2) When considering the catchment of the medical resources and the population size, the WMT of the county-ship medical resources ranges from 0.25 h to 10.92 h. 3) After adjusted by travel time and exercise efficiency, the county-ship medical capacity became more unequal, with 38 out of 74 counties could not meet the national guideline of 1.8 medical beds per 1000. 4) In total, there are 17 counties with good WMT and sufficient medical resources, while 13 counties having very high WMT and low capacity of medical resources in Tibet. In the end, suggestions on medical resources relocation and to improve the capacity are provided. This study provides a method to incorporate exercise efficiency to access the accessibility and evaluate medical capacity that can be applied in high altitude ranges.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available in the online version of this article at 10.1007/s11769-022-1321-1.

Identifying Spatial Matching between the Supply and Demand of Medical Resource and Accessing Carrying Capacity: A Case Study of Shenzhen, China

Previous Studies, such as the evaluation of the supply of and demand for regional medical resources and carrying capacity assessments, require further development. This paper aims to evaluate the carrying capacity and spatial distribution of medical resources in Shenzhen from the perspective of supply and demand, and to conduct a time-series variation of the coupling coordination degree from 1986 to 2019. The two-step floating catchment area method was employed to quantify the carrying capacity and coupling coordination degree method and spatial autocorrelation analysis were applied to analyze spatial distribution between supply and demand. The results were as follows. (1) The carrying capacity index in more than 50% of the districts was classified as low-grade. The percentage of regions with good grades was 8.27%. The regions with a high carrying capacity were distributed in the central and southeastern areas. (2) The coupling coordination continued to rise, increasing from 0.03397 in 1986 to 0.33627 in 2019. (3) The level of supply and demand for medical resources in Shenzhen increased from 1986 to 2019, and the highest degree of compatibility between the supply and the population size was largely concentrated in the western and eastern regions. This research can provide a theoretical reference for Shenzhen to rationally plan medical resources and improve the carrying capacity of medical resources.

Operation and management of a community treatment center using telemedicine for foreign patients with mild COVID-19 symptoms

South Korean studies on coronavirus disease-2019 (COVID-19) treatment have described the use of community treatment centers (CTCs), which combine elements of the home and hospital, to isolate and treat mild COVID-19 patients. While the number of South Koreans diagnosed with COVID-19 cases has varied greatly by season, the number of confirmed cases in foreign nationals has shown no seasonality, with an average of around 25 to 30 per day. For foreign patients, accommodation arrangements and travel routes may be difficult; they may also have difficulty accessing medical care, so require careful management.We discuss our experience in operating and managing a CTC for foreign COVID-19 patients arriving in South Korea with mild symptoms. We also propose guidelines for efficient use of resources with respect to treating these patients in CTCs.We present the clinical findings of patients treated at the CTC between 7 October and 22 November 2020, and make some recommendations. We quarantined and treated foreign patients with mild symptoms of COVID-19 at the Ansan CTC. Discharge is determined based on clinical symptoms rather than polymerase chain reaction results. Medical and administrative staff use building A, while building B is used for isolating patients. Medical rounds are in the form of twice-daily video calls. Three kinds of foods with medication are served according to the patient's country of origin.In total, 315 patients were admitted to the Ansan CTC between 7 October and 22 November 2020; 145 of them were discharged from the CTC and 26 were transferred to other hospitals.To utilize medical resources efficiently during the pandemic, it is desirable to reserve CTCs exclusively for foreign patients.

The Structural Characteristics of Economic Network and Efficiency of Health Care in China

With the rapid development of the economy of China, the interactivity between provinces and the mobility of the population is increasing. Some patients who could have received the same treatment in their residential areas still choose to receive services in areas with higher economic development and concentrated high-quality medical resources, resulting in a huge waste of medical resources. Blindly increasing medical resources everywhere does not necessarily increase the output effectively. In this study, the data envelopment analysis (DEA) model, social network analysis (SNA), cluster analysis, and regression analysis are used to analyze the structural characteristics of the economic network structure and efficiency of health care in China. The results show that indegree and eigenvector centrality have a significant positive correlation with the efficiency of health care, and the clustering coefficient has a significant negative correlation with the efficiency of health care in China. This study uses a k-means algorithm to classify 31 provinces into three groups and extract their characteristics. As for the supply of health care resources, the government should command and dispatch the resources in the whole country through a top-down design based on the characteristics of each province.

Health Shocks and Unbalanced Growth of Medical Resources: Evidence From the SARS Epidemic in China

Since the outbreak of the SARS epidemic in 2003, the Chinese government has increased inputs to bolster the health care system. However, the COVID-19 pandemic has exposed the geographic maldistribution of health resources in China. We examine the spatial and temporal variation of the SARS epidemic using a difference-in-differences strategy. Our empirical results show that, compared with cities without SARS case reports, exogenous health shocks significantly increased the affected cities' medical resources supply. We provide multiple robustness tests to examine the validity of the main findings. Further study shows that the mechanism is because the SARS event increased the financial autonomy of the epidemic-affected cities, thus providing an incentive for local governments to increase health resources. Meanwhile, health shocks have little influence on the regions with only imported cases than the infected area. These findings provide a possible explanation for the inequality in the distribution of health resources.

Construction of a Medical Resource Sharing Mechanism Based on Blockchain Technology: Evidence from the Medical Resource Imbalance of China

Health equity is a very important part of social equity. The outbreak of the novel coronavirus pneumonia (COVID-19) in a short period of time exposed the problems existing in the allocation of medical resources and the response to major public health emergencies in China. By using Kernel density estimation and Data envelopment analysis (DEA), it is found that the allocation and imbalance of medical resources in China are greatly different among regions, and the polarization phenomenon is obvious. As an important part of the information technology system, blockchain technology is characterized by decentralization and non-tampering. It can realize sharing of medical resources through a mechanism of resource storage, circulation, supervision, and protection. The construction of a medical resource sharing mechanism under the condition of blockchain technology will greatly improve the degree of medical resource sharing, will narrow the differences in resource allocation between regions, and can effectively respond to an outbreak of major public health emergencies.

Doctor-Patient Relationship in the Eyes of Medical Professionals in China During the COVID-19 Pandemic: A Cross-Sectional Study

Background: Doctor-patient relationship (DPR) is very important for patient outcomes, especially during a public health emergency like the COVID-19 pandemic. However, few studies have evaluated DPR and related sentiments from medical professionals' perspectives. Thus, the aim of the study is to provide a better understanding of DPR from medical professionals' perspectives during the COVID-19 pandemic in China. Methods: A total of 979 medical professionals, including doctors, nurses, technicians, and other workers have completed a series of questionnaires to evaluate their attitudes toward DPR, trust, violence against doctors, factors that affected and improved DPR, and the importance of these factors on DPR. Analyses of variances (ANOVA) and linear regressions were used to analyze the effects of the pandemic, demographic variables, and various elements on DPR. Results: One-way ANOVA revealed a significant effect of education on recent DPR [F _{(2, 976)} = 6.17, p < 0.001 and trust at F _{(2, 976)} = 9.54, p < 0.001], indicating that individuals with higher level of education (bachelor's degree, Master's degree and above) showed poorer recent DPR and lower level of trust. The level of hospital also showed a significant effect on trust [F _{(5, 973)} = 3.79, p = 0.0021]. Cochran's Q test revealed a significant difference in factors that affected [Q₍₁₁₎ = 3,997.83, p < 0.001] and improved [Q₍₈₎ = 3,304.53, p < 0.001] DPR. Backward stepwise linear regressions revealed predictors for changes during [F _{(9, 969)} = 21.17, p < 0.001, R ² = 0.16], shortly after [F _{(7, 971)} = 54.98, p < 0.001, R ² = 0.28], and long after [F _{(10, 968)} = 37.83, p < 0.001, R ² = 0.29] the pandemic. Conclusions: Medical professionals' perceptions of DPR is important as they provide basis for the improvement in working environment of medical professionals and hospital visiting experience of patients, as well as healthcare policy making and preparation for future public health emergencies.

Ambulatory Orchidopexy Is a Potential Solution to Improve the Rate of Timely Repair in Cryptorchid Boys: An 8 Year Retrospective Study of 4,972 Cases

Background: Cryptorchidism is the most common congenital anomaly in pediatric urology. Although early surgery on cryptorchid boys is recommended by pediatric urologists worldwide, the actual age at orchidopexy is often older than the recommended age. Our medical center has started performing ambulatory orchidopexy since March 2016 at the ambulatory surgery center. We aimed to investigate whether ambulatory orchidopexy can improve the timely repair rate. Methods: A retrospective analysis was conducted from 2012 to 2019 at our medical center. Ambulatory orchidopexy was started at our medical center on March 24, 2016. Boys born on or after September 24, 2015 were classified into the "with ambulatory medical resource" group, and boys born before September 24, 2014, were classified into the "without ambulatory medical resource" group. The timely repair rates were calculated and compared. Results: A total of 4,972 cryptorchidism cases were included in the final study. Approximately 33.0% of cryptorchid boys received timely surgery (orchidopexy by the age of 18 months), and only 6.8% of all cryptorchid boys underwent surgery before the age of 1 year. After the performance of ambulatory orchidopexy, the timely repair rate increased from 25.7 to 37.0% (P < 0.001), and the percentage of patients receiving surgery before the age of 1 year increased significantly from 3.5 to 8.6% (P < 0.001). The proportion of timely repair in patients with ambulatory medical resources was significantly higher than that in patients without ambulatory medical resources (15.6% vs. 58.2%, P < 0.001). Significant changes in the rate of surgery before 12 months of age were also found between the two groups (2.4% vs. 14.8%, P < 0.001). Conclusions: After the performance of ambulatory orchidopexy in our medical center, the rates of both timely repair and receiving surgery before the age of 1 year increased significantly. Ambulatory orchidopexy is a potential solution to improve the rate of timely repair in cryptorchid boys, and it is worthy of promotion in developing countries and regions.

Characterization of Esophageal Cancer and ItsAssociation with Influencing Factors in GuangzhouCity, China

Epidemiological features of esophageal cancer (EC), as well as their associations withpotential influencing factors in a city, have seldom been seldom explored on a fine scale. The ECdeath cases in Guangzhou city during 2012-2017 were collected to describe the epidemiologicalcharacteristics such as EC mortality rate (ECMR) and health-seeking behaviors of deaths. Potentialinfluencing factors, including socioeconomic conditions (population density, gross domesticproduct density), medical resources, and ageing degree were also gathered for exploring theirrelationships with the epidemiological characteristics of EC. A total of 2,409 EC deaths werereported during 2012-2017 in Guangzhou with an age-standardized ECMR of 3.18/105. Theprevalence of EC in Guangzhou was spatially featured and was divided into three regions withobvious differentiated ECMR (ECMR of 6.41/105 in region A, ECMR of 5.51/105 in region B, ECMRof 2.56/105 in region C). The street/town-level ECMR was spatially clustered in Guangzhou city,especially two clusters of streets/towns with high ECMR were highlighted in region A and Brespectively. Meanwhile, demographic features including gender gap, death age, temporal intervalbetween diagnosis and death, health-seeking behaviors were remarkably different among the threeregions. Moreover, health-seeking behaviors (e.g., the proportion of hospital deaths) of the ECdeaths were obviously influenced by medical institution occupancy rate and socioeconomicconditions at street/town level. In addition, the street/town-level ECMR was significantly associatedwith ageing degree across Guangzhou city (r = 0.466, p < 0.01), especially in region A (r = 0.565, p <0.01). In contrast, the ECMR in region B was closely related to population density (r = -0.524, p <0.01) and gross domestic product density (r = -0.511, p < 0.01) when the ageing degree was controlled,while these associations were weak in region C. The epidemiological characteristics of EC inGuangzhou city were spatially featured and potentially associated with socioeconomic conditions,medical resources and ageing degree on a fine scale across Guangzhou city. This study couldprovide scientific basis for local authorities to implement more targeted EC interventions.

Regional Disparity of Medical Resources and Its Effect on Mortality Rates in China

Objectives: The purpose of this study was two-fold. First, to empirically study the effects that medical resources (i.e., hospital, doctors, beds) have on the mortality rate in China. Second, to divide China into east, middle, and west regions, and empirically study the regional disparity of medical resources and its effect on mortality rates in China. Methodology and Data: This study utilized a panel data regression model to explore the effect medical resources have on the age-standardized mortality rate in China. The data came from the 2003-2017 China Statistical Yearbook compiled by the National Bureau of Statistics of China. Results: Nationwide, hospitals, doctors, and beds had a significant negative correlation with the mortality rate. In the western region, hospitals, beds, and doctors had a significant negative correlation with the mortality rate. In China's middle and eastern regions, hospitals, beds, and doctors had no significant effect on the mortality rate. In China, increased hospitals, doctors, and beds significantly reduced the mortality rate. The distribution of medical resources in eastern, middle, and western China was unequal. More hospitals, beds, and doctors in the less developed western regions can more effectively alleviate the local mortality rate. In the middle and east regions, hospitals, beds, and doctors had no significant impact on the local mortality rate. Conclusion: First, China's overall medical resources are still inadequate and improving medical resources throughout the country could reduce the mortality rate. Second, due to the imbalanced distribution of medical resources in China, the Chinese government should implement more supportive policies for medical resources in the western region. At the same time, we should also actively develop the western region by improving local per capita GDP and reducing unemployment, so as to fundamentally reduce the local mortality rate.

Lack of medical resources and public health vulnerability in Mongolia's winter disasters

INTRODUCTION

Many countries face the need to address medical resource shortages following various disasters. The dzud is a winter disaster that occurs in Mongolia following drought in dryland areas, and it leads to high livestock mortality. Affected provinces suffer increased mortality rates for children aged under 5 years. Using various factors, including medical resources, the present study aimed to evaluate the health risks for children during the dzud.

METHODS

Data from all of Mongolia's 21 provinces and the capital of Ulaanbaatar were analyzed. The change in child mortality (CCM) was defined as the difference in the under-five mortality rate from 2009 to 2010. To determine the correlations, the CCM was compared with the urbanization rate (proportion of urban population), number of physicians and nurses (per 1000 residents), average temperature, total precipitation (October 2009 to February 2010), and declining rate in livestock numbers for 2009-10 (percentage livestock loss) in each province.

RESULTS

The correlation coefficients between the CCM and each factor were as follows: number of physicians (r=&minus;0.506, p=0.016), urbanization rate (r=&minus;0.467, p=0.029), and percentage livestock loss (r=0.469, p=0.028). In the multiple regression analysis, the number of physicians was significantly negatively related to the CCM (standardizing coefficient &minus;0.492, p=0.020).

CONCLUSION

These results suggest that increased medical resources and infrastructure development have positive effects on child health - even in the setting where the dzud causes considerable damage to livestock.

The increase in total knee replacement surgery in Taiwan: A 15-year retrospective study

Total knee replacement (TKR) is considered as one of the most success among clinical interventions for patients with who suffering from knee osteoarthritis (OA). We sought to estimate the incidence of TKR using demographics, incidence rates, lengths of hospital stay, and costs from 1996 to 2010 by analyzing Taiwan's National Health Insurance Research Database. A total of 154,553 patients obtained primary TKR surgery between 1996 and 2010. The diagnosis code for knee OA and the procedure code for TKR were selected from the records. To compare the rate of TKR between covariables, we calculated the TKR risk ratios and 95% confidence interval (CI) of these variables (gender, age, age group, and primary diagnoses). A 2-tailed P-value of .05 was considered statistically significant. The statistical package SPSS version 20.0 (SPSS, Chicago, IL) was used to conduct all the statistical analyzes. We analyzed 154,553 TKRs performed by surgeons in Taiwan from 1996 to 2010. The overall crude incidence increased from 26.4 to 74.55 TKR per 100,000 inhabitants from 1996 to 2010. TKR incidence for the 70 to 79 years age group increased from 227 to 505 per 100,000 people from 1996 to 2010. The age-standardized rate ratios for TKR of women to men ranged from 2.5 to 3.0. The mean average length of stay in hospital was 15 days in 1996 and decreased to 8 days in 2010. During the study period, the adjusted mean cost per patient decreased from US$7485 to US$4827. Health expenditures for TKR were 5% of total National Health Insurance expenditure every year. Over the 15-year period, Taiwan's TKR incidence tripled, which is consistent with population ageing. Arthritis will be a major public health issue in the ageing population in the future.

[Ethical Debates Related to the Allocation of Medical Resources During the Response to the Mass Casualty Incident at Formosa Fun Coast Water Park]

Disasters are unpredictable and often result in mass casualties. Limited medical resources often affect the response to mass casualty incidents, undermining the ability of responders to adequately protect all of the casualties. Thus, the injuries of casualties are classified in hopes of fully utilizing medical resources efficiently in order to save the maximum possible number of people. However, as opinions on casualty prioritization are subjective, disagreements and disputes often arise regarding allocating medical resources. The present article focused on the 2015 explosion at Formosa Fun Coast, a recreational water park in Bali, New Taipei City, Taiwan as a way to explore the dilemma over the triage and resource allocation for casualties with burns over 90% and 50-60% of their bodies. The principles of utilitarianism and deontology in Western medicine were used to discuss the reasons and rationale behind the allocation of medical resources during this incident. Confucianism, a philosophical mindset that significantly influences Taiwanese society today, was then discussed to describe the "miracles" that happened during the incident, including the acquisition of assistance from the public and medical professionals. External supplies and professional help (social resources) were provided voluntarily after this incident, which had a profound impact on both the immediate response and the longer-term recovery efforts.

Development and examination of a rubric for evaluating point-of-care medical applications for mobile devices

The rapid development and updates of mobile medical resource applications (apps) highlight the need for an evaluation tool to assess the content of these resources. The purpose of the study was to develop and test a new evaluation rubric for medical resource apps. The evaluation rubric was designed using existing literature and through a collaborative effort between a hospital and an academic librarian. Testing found scores ranging from 23% to 88% for the apps. The evaluation rubric proved able to distinguish levels of quality within each content component of the apps, demonstrating potential for standardization of medical resource app evaluations.

Impact of continuous glucose monitoring on quality of life, treatment satisfaction, and use of medical care resources: analyses from the SWITCH study

To investigate the impact of continuous glucose monitoring (CGM) on health-related quality of life (HRQOL), treatment satisfaction (TS) medical resource use, and indirect costs in the SWITCH study. SWITCH was a multicentre, randomized, crossover study. Patients with type 1 diabetes (n = 153) using continuous subcutaneous insulin infusion (CSII) were randomized to a 12 month sensor-On/Off or sensor-Off/On sequence (6 months each treatment), with a 4-month washout between periods. HRQOL in children and TS in adults were measured using validated questionnaires. Medical resource utilization data were collected. In adults, TS was significantly higher in the sensor-On arm, and there were significant improvements in ratings for treatment convenience and flexibility. There were no clinically significant differences in children's HRQOL or parents' proxy ratings. The incidence of severe hypoglycaemia, unscheduled visits, or diabetes-related hospitalizations did not differ significantly between the two arms. Adult patients made fewer telephone consultations during the sensor-On arm; children's caregivers made similar numbers of telephone consultations during both arms, and calls were on average only 3 min longer during the sensor-On arm. Regarding indirect costs, children with >70 % sensor usage missed fewer school days, compared with the sensor-Off arm (P = 0.0046) but there was no significant difference in the adults days of work off. The addition of CGM to CSII resulted in better metabolic control without imposing an additional burden on the patient or increased medical resource use, and offered the potential for cost offsets.

Prevalence and Assessment of Malingering in Homicide Defendants Using the Mini-Mental State Examination and the Rey 15-Item Memory Test

This study surveyed malingering prevalence in pretrial homicide defendants and assessed the usefulness of the Mini-Mental State Examination (MMSE) and the Rey 15-Item Memory Test (FIT) in detecting malingering among them. Malingering prevalence was 17%. MMSE and FIT scores were positively correlated. The MMSE and FIT had modest positive predictive value (67% and 43%), but reasonably good negative predictive value (93% and 89%), for malingering. Overall, the MMSE outperformed the FIT, with no advantage to combined use of the MMSE and FIT over the MMSE. The widely used MMSE, traditionally a bedside test of cognition, may have a role in malingering assessment.