Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.

In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1-2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion. METHODOLOGY: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6-12 July 2020 and 23-29 November 2020. The interactive digital platform is openly available. PRIMARY AND SECONDARY OUTCOMES: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1-2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion. RESULTS: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali's urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6-12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1-2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.

Dynamic measurements of geographical accessibility considering traffic congestion using open data: a cross-sectional assessment for haemodialysis services in Cali, Colombia.

Background: Many cities with traffic congestion lack accessibility assessments accounting for traffic congestion and equity considerations but have disaggregated georeferenced municipal-level open data on health services, populations, and travel times big data. We convened a multistakeholder intersectoral collaborative group that developed a digital, web-based platform integrating open and big data to derive dynamic spatial-temporal accessibility measurements (DSTAM) for haemodialysis services. We worked with stakeholders and data scientists and considered people's places of residence, service locations, and travel time to the service with the shortest travel time. Additionally, we predicted the impacts of strategically introducing haemodialysis services where they optimise accessibility. Methods: Cross-sectional analyses of DSTAM, accounting for traffic congestion, were conducted using a web-based platform. This platform integrated traffic analysis zones, public census and health services datasets, and Google Distance Matrix API travel-time data. Predictive and prescriptive analytics identified optimal locations for new haemodialysis services and estimated improvements. Primary outcomes included the percentage of residents within a 20-min car drive of a haemodialysis service during peak and free-flow traffic congestion. Secondary outcomes focused on optimal locations to maximise accessibility with new services and potential improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective. The study in Cali, Colombia, used geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for two weeks in 2020. Findings: There were substantial traffic variations. Congestion reduced accessibility, especially among marginalised groups. For 6-12 July, free-flow and peak-traffic accessibility rates were 95.2% and 45.0%, respectively. For 23-29 November, free-flow and peak traffic accessibility rates were 89.1% and 69.7%. The locations where new services would optimise accessibility had slight variation and would notably enhance accessibility and health equity. Interpretation: Establishing haemodialysis services in targeted areas has significant potential benefits. By increasing accessibility, it would enhance urban health and equity. Funding: No external or institutional funding was received.

Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, Colombia.

This protocol proposes an approach to assessing the place of residence as a spatial determinant of health in cities where traffic congestion might impact health services accessibility. The study provides dynamic travel times presenting data in ways that help shape decisions and spur action by diverse stakeholders and sectors.  Equity assessments in geographical accessibility to health services typically rely on static metrics, such as distance or average travel times. This new approach uses dynamic spatial accessibility measures providing travel times from the place of residence to the health service with the shortest journey time. It will show the interplay between traffic congestion, accessibility, and health equity and should be used to inform urban and health services monitoring and planning. Available digitised data enable efficient and accurate accessibility measurements for urban areas using publicly available sources and provide disaggregated sociodemographic information and an equity perspective. Test cases are done for urgent and frequent care (i.e., repeated ambulatory care). Situational analyses will be done with cross-sectional urban assessments; estimated potential improvements will be made for one or two new services, and findings will inform recommendations and future studies. This study will use visualisations and descriptive statistics to allow non-specialized stakeholders to understand the effects of accessibility on populations and health equity. This includes "time-to-destination" metrics or the proportion of the people that can reach a service by car within a given travel time threshold from the place of residence. The study is part of the AMORE Collaborative Project, in which a diverse group of stakeholders seeks to address equity for accessibility to essential health services, including health service users and providers, authorities, and community members, including academia.

Presence and impact of Stockholm Convention POPs in gull eggs from Spanish and Portuguese natural and national parks.

The aim of the present work was to comparatively assess the occurrence and impact of persistent organic pollutants (POPs) in nine natural and national parks from Spain and Portugal using gull eggs (Larus michahellis and L. audouinii) as bioindicators of environmental contamination. Sampling was performed during the breeding season of 2016. Compounds studied include polychlorinated biphenyls (PCBs), organochlorinated pesticides (OC pesticides), perfluorooctane sulfonic acid (PFOS) and polybrominated diphenyl ethers (PBDEs), and were analyzed using mass spectrometric based techniques. The results showed a high contamination by PCBs in all colonies, with total levels ranging from 59 to 1278ng/g wet weight (ww), despite their use is not currently authorized. OC pesticides were also present in all colonies, with a high incidence of 4,4'-DDE in gull eggs at levels up to 218±50ng/g ww in L. michahellis and 760±412ng/g ww in L. audouinii from the Ebro Delta natural park. PBDEs and PFOS were also detected at levels up to 91.7±21.3ng/g ww, which can be attributed to a more recent use. Except for PBDEs, the POP levels in eggs from L. audouinii were higher than in L. michahellis, presumably associated to the fish-based diet of the former. Finally, the effect of POP levels on eggshell parameters (volume, eggshell thickness and desiccation index) were investigated for each colony and gull species in order to evaluate the egg viability and, therefore, the reproduction success.

Sindrome de friccion coracoideo: tecnica de tratamiento combinada artroscopica - mini abierto asistida / Coracoid impingement syndrome: arthroscopic mini-open technique

El proposito de este trabajo es transmitir la experiencia obtenida en el diagnostico, tratamiento incruento y quirurgico del infrecuente sindrome de friccion coracoideo. Entre septiembre de 1995 y septiembre de 2003 se trataron 10 pacientes con diagnostico de sindrome de friccion coracoideo. El tratamiento incruento fue efectivo en 4 pacientes, sometiendo a tratamiento quirurgico a los 6 pacientes que persistieron con sintomas. Se describe la tecnica quirurgica combinada artroscopica mini abierto asistida, que incluye la coracoplastia, asi como el tratamiento de las lesiones asociadas: reseccion de ganglion en el espacio coracohumeral, reparacion artroscopica del intervalo rotador, plastica de ruptura parcial del subescapular y total del supraespinoso. No fue necesario realizar acromioplastia en ningun paciente. El seguimiento fue de 1 a 8 años, observandose la remision de los sintomas con valoracion segun la escala de la UCLA de 32 a 35 puntos. Se concluye que es imprescindible considerarlo en los diagnosticos diferenciales del hombro doloroso y que la tecnica descripta es facil de realizar, permitiendo obtener buenos resultados.

Sindrome de friccion coracoideo: tecnica de tratamiento combinada artroscopica - mini abierto asistida / Coracoid impingement syndrome: arthroscopic mini-open technique

El proposito de este trabajo es transmitir la experiencia obtenida en el diagnostico, tratamiento incruento y quirurgico del infrecuente sindrome de friccion coracoideo. Entre septiembre de 1995 y septiembre de 2003 se trataron 10 pacientes con diagnostico de sindrome de friccion coracoideo. El tratamiento incruento fue efectivo en 4 pacientes, sometiendo a tratamiento quirurgico a los 6 pacientes que persistieron con sintomas. Se describe la tecnica quirurgica combinada artroscopica mini abierto asistida, que incluye la coracoplastia, asi como el tratamiento de las lesiones asociadas: reseccion de ganglion en el espacio coracohumeral, reparacion artroscopica del intervalo rotador, plastica de ruptura parcial del subescapular y total del supraespinoso. No fue necesario realizar acromioplastia en ningun paciente. El seguimiento fue de 1 a 8 años, observandose la remision de los sintomas con valoracion segun la escala de la UCLA de 32 a 35 puntos. Se concluye que es imprescindible considerarlo en los diagnosticos diferenciales del hombro doloroso y que la tecnica descripta es facil de realizar, permitiendo obtener buenos resultados.(AU)

Fricción interna del hombro: actualización / Shoulder impingement

La mejor interpretacion de la biomecanica del hombro ha permitido introducir el concepto de impingement glenoideo como causa de sintomas en el hombro de deportistas jovenes (lanzadores), asi como de no deportistas con antecedente traumatico unico o multiples a repeticion, con igual mecanismo de injuria. Los elementos anatomicos involucrados pueden ser: el rodete glenoideo posterosuperior, la cara articular del manguito rotador, el ligamento G-H inferior, el troquiter y el reborde glenoideo oseo. La presencia de dolor posterosuperior del hombro, con test de relocacion positivo, en pacientes de riesgo, debe sugerirlo. El tratamiento kinesico busca fortalecer los rotadores y estabilizadores de la escapula. Puede ser necesario el debridamiento artroscopico, y aun el retensado capsular cuando la cronicidad del caso lleva a la inestabilidad por elongacion del ligamento G-H inferior

Fricción interna del hombro: actualización / Shoulder impingement

La mejor interpretacion de la biomecanica del hombro ha permitido introducir el concepto de impingement glenoideo como causa de sintomas en el hombro de deportistas jovenes (lanzadores), asi como de no deportistas con antecedente traumatico unico o multiples a repeticion, con igual mecanismo de injuria. Los elementos anatomicos involucrados pueden ser: el rodete glenoideo posterosuperior, la cara articular del manguito rotador, el ligamento G-H inferior, el troquiter y el reborde glenoideo oseo. La presencia de dolor posterosuperior del hombro, con test de relocacion positivo, en pacientes de riesgo, debe sugerirlo. El tratamiento kinesico busca fortalecer los rotadores y estabilizadores de la escapula. Puede ser necesario el debridamiento artroscopico, y aun el retensado capsular cuando la cronicidad del caso lleva a la inestabilidad por elongacion del ligamento G-H inferior