Changeability of transport behaviour in a large city from the perspective of working days and Sundays: The case of Lodz, Poland

The transport behaviour of Lodz residents with a view to constructing a balanced traffic model to include both private and public transport is examined in this paper. A survey was conducted among 6,000 Lodz citizens using mixed-mode techniques: CAWI and CATI: respondents were asked to complete a travel log for the previous day and the previous Sunday. This served as a basis for further analyses, performed with PTV simulation software, following a four-step model. The main results of the study are presented, including the mobility rate of Lodz residents, the motivations and duration of journeys, and the division of transport tasks into workdays and Sundays, indicating that a higher private carload is typical for home-other and other-home trips on Sundays compared to working days. The number of home to work and work-home trips via private cars is higher for working days compared to Sundays. Furthermore, the simulated traffic load of the public transport system is much higher for working days compared to Sundays. A higher percentage of non-motorised trips and longer trip duration are found to be common for Sundays as well.

COMPARISON OF PATIENT SATISFATCION SCORES BETWEEN TELEMEDICINE AND IN-PEROSN VISITS AT AN ACADEMIC PRIMARY CARE PRACTICE

BACKGROUND: Telemedicine, in various forms, has existed for over 100 years. Increased bandwidth and emergence of easily accessible video communication over the last 15-20 years has led to video health or “telemedicine” gaining momentum. In the COVID pandemic there was an accelerated uptake of telemedicine at Academic Medical Centers (AMCs). There has been debate over this rapid implementation and the quality of care delivered by video visits. To examine this issue, we looked at our own academic primary care practice patient satisfaction scores to see if people were less satisfied with their interaction with medical providers during video visits versus in person medical visits. METHODS: Mount Sinai Health System uses a private vendor called Q reviews to evaluate patient satisfaction with 24 hours of a health care visit. With-in minutes post-visit patients receive a text-based message to their mobile phone with a link to the review site. A 5-point Likert Scale is used for all questions. We performed a retrospective study to compare the patient experience in a primary care practice at Mount Sinai Beth Israel. RESULTS: We reviewed all patient responses (1821) for in-person or video visits from June 1, 2020 to April 30, 2021. We compared responses for the three questions on the physician role (see table) Overall, patient satisfaction did not differ statistically on these questions. Response rates were similar;1,427/ 7,913 (18%) for in-person visit and 394/2,543 (15%) for telemedicine visits. CONCLUSIONS: We found no statistically significant difference found in patient satisfaction between video visits and in-person visits on the provider specific questions we reviewed. Many worry, about this rapid transition to video visits driven by the COVID-19 pandemic and propose a return to the majority or entirety of health care visits being in person, when possible. Prior to the pandemic new companies were entering the health care market place providing telehealth or video visits and taking patients from traditional office-based practices. Many AMC patients face significant social and financial hurdles to attending in person visits. This retrospective data shows that AMC based practices can and do provide a high level of engagement for patients whose visits are appropriate for a video visit. While this cohort may have had some self-selection biases, as patients could choose which type of visit, they would attend, it does show a proof of concept that we should maintain video visits as an option for patients seen at AMC practices. Future studies should focus on if telemedicine can improve healthcare disparities and which types of cases are not appropriate for telehealth visits.

UNPLANNED HOPSITAL ADMISSION AND EMERGENCY ATTENDANCE FOLLOWING TWO-DOSE OF BNT162B2 AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY

Background: Real-world population-based safety data about the COVID-19 mRNA vaccine is lacking in patients with various immunocompromised conditions, including inflammatory bowel disease (IBD). Aim: To determine the incidence rates of unplanned IBD-related hospital admission and all-cause emergency attendance following BNT162B2 vaccination in IBD patients. Methods: Through the Government commissioned, territory-wide active COVID19 safety surveillance, we linked population-level vaccination records and health outcome data, between March 10 (1st day of vaccination program) and September 30, 2021, to assess the association between two-dose of BNT162b2 and unplanned IBD-related hospitalization and all-cause emergency attendance. We used inverse probability treatment weightingbased cohort study design to balance the baseline characteristics between vaccinated and unvaccinated IBD patients. Poisson regression model was fitted to estimate the adjusted incidence rate ratio (IRR) of unplanned IBD hospital admission and 28-day emergency room attendance following the vaccination, using the unvaccinated group as the reference. Results: Among more than 4.1 million citizens with successful vaccine and health record-linkage, we identified 941 IBD patients (age: 46.0 ± 15.0 years, male: 64.2%) who completed twodose of BNT162b2 and 1196 age-sex matched unvaccinated IBD patients as control (age: 49.3 ± 18.3 years, male: 58.9%). After inverse propensity weighting, all baseline demographic and clinical characteristics were well balanced (standard mean difference < 0.1;Table 1). During a median follow-up of 59-60 days (181.2 person-years for BNT162b2 group;253.6 person-years for the unvaccinated group), there was no significant difference in the risk of unplanned IBD-related hospital admission [3.31 versus 5.13 per 100 person-years, IRR: 0.75 (0.38, 1.47)] and 28-day all-cause emergency room attendance [39.1 vs 47.5 per 100 person-years, IRR: 1.08 (0.76-1.53)] between BNT162b2 recipients and unvaccinated individuals. Series of stratified analyses, including patients with Crohn’s disease (N= 378) or ulcerative colitis (N=553), who received immunosuppressants (N=454) or biologics (N= 192), all showed that receiving two-dose of BNT162b2 vaccine was not associated with a higher risk of unplanned IBD-admission and 28-day emergency attendance when compared to their counterparts without vaccination (Figure 1). Conclusion: Results from this populationbased study showed no increase in risk of unplanned IBD-related hospitalization and allcause emergency attendance following two-dose of BNT162b2 Covid-19 vaccination in patients with IBD. This observation potentially reassures the medium-term safety of mRNA vaccine in patients with IBD, although there is still possible self-selection bias in receiving the vaccine. (Table Presented) (Figure Presented)

Allowance for School Graduate Practice Performance in Slovakia: Impact Evaluation of the Intervention

This study aims to evaluate the impact of a selected active labour market policy measure that has been applied in Slovakia—Allowance for school graduate practice performance—on the employability of young jobseekers and their sustainability in the labour market, and thus, it will also empirically contribute to the field of relevant literature. The policy targets unemployed school graduates, and it enables them to acquire professional skills and practical experience that corresponds with their level of education, work habits, and possible direct contact with potential employers. At the same time, this measure addresses a long-standing gap in the Slovakian education system, namely, the insufficient linkages between the educational process, the practices in the field, and the requirements of the labour market. Using fiscal resources to finance this policy, it provides a natural and logical platform to investigate the relevance of the outcome of this measure in the context of its proclaimed objectives. In light of this, we employed a counterfactual approach to compare the results of the participants who were affected the measure (recipients;treated group) and non-participants, as their counterparts (comparison/control group), using an instrumental variable to mitigate self-selection and selection-bias problems. Our findings show that this policy intervention has a short- or medium-term impact on the employability of unemployed school graduates and the sustainability of their careers. In addition, a positive impact on their monthly wages was observed. We also came to the conclusion that, assuming the measure is linked to other labour market policy interventions, which is aimed at employers that are willing to hire young unemployed people, it would be possible to improve the functionality and effectiveness of support for the unemployed through indirect measures.

Risk Self-Selection and the Concept of Equilibrium in a Competitive Insurance Market

The purpose of this paper is an analysis of the presence of self-selection mechanisms on the market that could bring the market closer to the separating equilibrium state, in line with the Rothschild–Stiglitz equilibrium model and its subsequent modifications. An example is the Polish market of compulsory third-party liability insurance of vehicle owners. This paper describes this market in terms of both its structure and its financial results. The main focus is on describing the assumptions of the Rothschild–Stiglitz model for markets operating under the conditions of information asymmetry and based on the self-selection mechanism, allowing for an unequivocal determination of the insured’s profile without the need to actually observe the insured’s behaviour. Finally, we show that thanks to the self-selection induced by the possibility of driving behaviour monitoring, the industry can minimise the negative effect information asymmetry has on the motor insurance market. This can be achieved, for example, by observing the choices made by the insured after being offered a new voluntary contract with a premium based on telematics data. Our analysis was carried out with the use of three selected characteristics that can determine the insured’s risk profile, i.e., distance covered, self-assessment, and insurance premium paid;the significance of the latter—although it may be intuitive—is questionable at commonly accepted significance levels. Therefore, the main result is that although there is some evidence on the disputed matter, there can be no definitive conclusion—especially in terms of risk as measured by insurance premium.

Accuracy of self-assessment of gestational duration among people seeking abortion.

BACKGROUND: Mifepristone, used together with misoprostol, is approved by the United States Food and Drug Administration for medication abortion through 10 weeks' gestation. Although in-person ultrasound is frequently used to establish medication abortion eligibility, previous research demonstrates that people seeking abortion early in pregnancy can accurately self-assess gestational duration using the date of their last menstrual period. OBJECTIVE: In this study, we establish the screening performance of a broader set of questions for self-assessment of gestational duration among a sample of people seeking abortion at a wide range of gestations. STUDY DESIGN: We surveyed patients seeking abortion at 7 facilities before ultrasound and compared self-assessments of gestational duration using 11 pregnancy dating questions with measurements on ultrasound. For individual pregnancy dating questions and combined questions, we established screening performance focusing on metrics of diagnostic accuracy, defined as the area under the receiver operating characteristic curve, sensitivity (or the proportion of ineligible participants who correctly screened as ineligible for medication abortion), and proportion of false negatives (ie, the proportion of all participants who erroneously screened as eligible for medication abortion). We tested for differences in sensitivity across individual and combined questions using McNemar's test, and for differences in accuracy using the area under the receiver operating curve and Sidak adjusted P values. RESULTS: One-quarter (25%) of 1089 participants had a gestational duration of >70 days on ultrasound. Using the date of last menstrual period alone demonstrated 83.5% sensitivity (95% confidence interval, 78.4-87.9) in identifying participants with gestational durations of >70 days on ultrasound, with an area under the receiver operating characteristic curve of 0.82 (95% confidence interval, 0.79-0.85) and a proportion of false negatives of 4.0%. A composite measure of responses to questions on number of weeks pregnant, date of last menstrual period, and date they got pregnant demonstrated 89.1% sensitivity (95% confidence interval, 84.7-92.6) and an area under the receiver operating curve of 0.86 (95% confidence interval, 0.83-0.88), with 2.7% of false negatives. A simpler question set focused on being >10 weeks or >2 months pregnant or having missed 2 or more periods had comparable sensitivity (90.7%; 95% confidence interval, 86.6-93.9) and proportion of false negatives (2.3%), but with a slightly lower area under the receiver operating curve (0.82; 95% confidence interval, 0.79-0.84). CONCLUSION: In a sample representative of people seeking abortion nationally, broadening the screening questions for assessing gestational duration beyond the date of the last menstrual period resulted in improved accuracy and sensitivity of self-assessment at the 70-day threshold for medication abortion. Ultrasound assessment for medication abortion may not be necessary, especially when requiring ultrasound could increase COVID-19 risk or healthcare costs, restrict access, or limit patient choice.

Impact of Two Different Recruitment Procedures (Random vs. Volunteer Selection) on the Results of Seroepidemiological Study (SARS-CoV-2).

The proper recruitment of subjects for population-based epidemiological studies is critical to the external validity of the studies and, above all, to the sound and correct interpretation of the findings. Since 2020, the novel coronavirus SARS-CoV-2 pandemic has been a new factor that has been, additionally, hindering studies. Therefore, the aim of our study is to compare demographic, socio-economic, health-related characteristics and the frequency of SARS-CoV-2 infection occurrence among the randomly selected group and the group composed of volunteers. We compare two groups of participants from the cross-sectional study assessing the seroprevalence of SARS-CoV-2 coronavirus, which was conducted in autumn 2020, in three cities of the Silesian Voivodeship in Poland. The first group consisted of a randomly selected, nationally representative, age-stratified sample of subjects (1167 participants, "RG" group) and was recruited using personal invitation letters and postal addresses obtained from a national registry. The second group (4321 volunteers, "VG" group) included those who expressed their willingness to participate in response to an advertisement published in the media. Compared with RG subjects, volunteers were more often females, younger and professionally active, more often had a history of contact with a COVID-19 patient, post-contact nasopharyngeal swab, fewer comorbidities, as well as declared the occurrence of symptoms that might suggest infection with SARS-CoV-2. Additionally, in the VG group the percentage of positive IgG results and tuberculosis vaccination were higher. The findings of the study confirm that surveys limited to volunteers are biased. The presence of the bias may seriously affect and distort inference and make the generalizability of the results more than questionable. Although effective control over selection bias in surveys, including volunteers, is virtually impossible, its impact on the survey results is impossible to predict. However, whenever possible, such surveys could include a small component of a random sample to assess the presence and potential effects of selection bias.