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.

The Relationship between the Dominant Hand and the Occurrence of the Supracondylar Humerus Fracture in Pediatric Orthopedics.

It is known that during a fall, a child would rather protect their dominant hand by using the non-dominant one, although the role of handedness in upper limb fractures has not been studied in-depth. We carried out a retrospective, cross-sectional cohort study, including pediatric patients who presented to the emergency room with a supracondylar humerus fracture following an injury by falling from the same height. In total, 245 patients were selected and grouped according to age. In the 1-3 years group, no statistical significance was found between hand dominance and the side of fracture (p = 0.7315). During preschool years (4-6 years old), the non-dominant hand is more often involved (p = 0.03, odds ratio: 3.5). In the 7-14 years group this trend was maintained and actually increased (p = 0.052, odds ratio: 3.8). We might conclude that children tend to protect their dominant hand by falling on their non-dominant one. The main objective of this study is to highlight a link between handedness and the side of the body where the hand fracture will be identified in the pediatric population, regarding supracondylar humerus fracture.

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.