The needs for digital health and eHeath literacy of cancer patients, caregivers, and healthcare providers: A multicenter, descriptive correlational study.

PURPOSE: Digital health is an indispensable tool, but its use depends on the eHealth literacy (eHL) of end-users. This study aimed to understand the need for digital health and eHL among cancer patients, caregivers, and healthcare providers and to identify differences in digital health needs related to the eHL of cancer patients. METHODS: A multicenter, descriptive correlational study was conducted and included a total of 209 patients, 150 caregivers and 150 healthcare providers. Digital health needs were identified, and eHL was measured using the Korean version of the eHealth Literacy Scale. Differences in digital health needs in relation to the eHL of patients were analyzed. RESULTS: The most necessary digital health functions among cancer patients and caregivers were 'information and education on symptom management after cancer treatment' and 'education on coping methods for each type of cancer' (87.1-94.0%). Healthcare providers reported the need for a digital health function for 'medication information' and assisting in 'medical appointments' (96.7-98.0%). The preferred types of digital health were telemonitoring, mobile services, and telemedicine by telephone (81.3-90.5%). The mean eHL score of the cancer patients was 28.84 ± 6.75. Differences existed in the need for digital health functions and preferences for digital health types between cancer patients with high and low eHL. CONCLUSIONS: Cancer patients and caregivers expressed strong needs for digital health that provide information and education about symptom management and coping with cancer. Digital health interventions for cancer care need to be developed to reflect the identified needs and preferences and eHL of end-users.

Prevalence of unmet supportive care needs reported by individuals ever diagnosed with cancer in Australia: a systematic review to support service prioritisation.

PURPOSE: Improved health outcomes for individuals ever diagnosed with cancer require comprehensive, coordinated care that addresses their supportive care needs. Implementing interventions to address these is confounded by a lack of evidence on population needs and a large pool of potential interventions. This systematic review estimates the point prevalence of different supportive care needs stratified by the tool used to measure needs and cancer type in Australia. METHODS: We searched MEDLINE, Embase, and Scopus from 2010 to April 2023 to identify relevant studies published on the prevalence of supportive care needs in Australia. RESULTS: We identified 35 studies that met the inclusion criteria. The highest prevalent unmet need across all cancers was 'fear of cancer spreading' (20.7%) from the Supportive Care Needs Survey Short-Form 34 (SCNS-SF34), ranging from 9.4% for individuals ever diagnosed with haematological cancer to 36.3% for individuals ever diagnosed with gynaecological cancer, and 'concerns about cancer coming back' (17.9%) from the Cancer Survivors' Unmet Needs (CaSUN), ranging from 9.7% for individuals ever diagnosed with prostate cancer to 37.8% for individuals ever diagnosed with breast cancer. Two studies assessed needs in Aboriginal and Torres Strait Islander populations, reporting the highest needs for financial worries (21.1%). CONCLUSIONS: Point prevalence estimates presented here, combined with estimates of the costs and effects of potential interventions, can be used within economic evaluations to inform evidence-based local service provision to address the supportive care needs of individuals ever diagnosed with cancer. IMPLICATIONS FOR CANCER SURVIVORS: Local health services can use local evidence to prioritise the implementation of interventions targeted at unmet needs.

Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing.

Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.

Development of the traumatic brain injury Rehabilitation Needs Survey: a Veterans Affairs TBI Model Systems study.

PURPOSE: To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery. MATERIALS AND METHODS: RNS items were generated following a literature review (January - March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015-2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented. RESULTS: Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8-9, and number of unmet needs was 1-2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS. CONCLUSION: The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended.Implications for rehabilitationVeterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery.The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury.Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation.

Health needs of mothers of children with Congenital Zika Syndrome: an integrative review / Necesidades de salud de las madres de niños con Síndrome Congénito por el virus del Zika: una revisión integradora / Necessidades de saúde de mães de crianças com Síndrome Congênita pelo vírus Zika: revisão integrativa

ABSTRACT Objectives: to evidence and analyze the health needs of mothers of children with Congenital Zika Syndrome. Methods: a total of 44 articles published between October/2015 and March/2021 on PubMed, LILACS, Scopus, Web of Science and Science Direct were included. The RTI bank and CASP score were applied to classify the methodological quality of the studies. Reflective content analysis and Cecílio and Matsumoto's taxonomy were used for analysis. Visual map was used as a technique for presenting the results. Results: mothers need access to social protection, family-centered, multi-professional empathetic monitoring, cultivating bonds and affection by professionals, sharing of care between health network services, strengthening the social support network and fostering coexistence groups between them. Final Considerations: intersectoral initiatives must be implemented for better housing conditions, fighting stigma, holding parents accountable and resuming life project.

RESUMEN Objetivos: demostrar y analizar las necesidades de salud de las madres de niños con Síndrome Congénito causado por el virus del Zika. Métodos: se incluyeron 44 artículos publicados entre octubre/2015 y marzo/2021 en PubMed, LILACS, Scopus, Web of Science y Science Direct. Se aplicó el puntaje RTI bank y CASP para clasificar la calidad metodológica de los estudios. Para el análisis se utilizó el análisis de contenido reflexivo y la taxonomía de Cecílio y Matsumoto, y se utilizó el mapa visual como técnica para presentar los resultados. Resultados: las madres necesitan acceso a protección social, centrado en la familia, multidisciplinar, seguimiento empático, cultivar vínculos y afectos por parte de los profesionales, compartir la atención entre los servicios de la red de salud, fortalecer la red de apoyo social y fomentar grupos de convivencia entre ellas. Consideraciones Finales: se deben implementar iniciativas intersectoriales para mejorar las condiciones de vivienda, combatir el estigma, responsabilizar al padre y retomar el proyecto de vida.

RESUMO Objetivos: evidenciar e analisar as necessidades de saúde de mães de crianças com Síndrome Congênita pelo vírus Zika. Métodos: foram incluídos 44 artigos publicados, entre outubro/2015 e março/2021, na PubMed, LILACS, Scopus, Web of Science e Science Direct. Foram aplicados o RTI bank e escore CASP, para classificar a qualidade metodológica dos estudos. A análise de conteúdo reflexiva e a taxonomia de Cecílio e Matsumoto foram utilizadas para análise, e o mapa visual, enquanto técnica de apresentação dos resultados. Resultados: as mães necessitam de acesso à proteção social, acompanhamento multiprofissional empático centrado na família, cultivo de vínculo e afeto por parte dos profissionais, compartilhamento de cuidados entre serviços da rede de saúde, fortalecimento da rede de apoio social e fomento de grupos de convivência entre elas. Considerações Finais: devem ser implementadas iniciativas intersetoriais para melhores condições de moradia, enfrentamento do estigma, responsabilização do genitor e retomada do projeto de vida.

Family Caregiver Suffering in Caring for Patients with Amyotrophic Lateral Sclerosis in Korea.

The purpose of this study was to describe the meaning of the suffering experience of Korean ALS family caregivers. This is a descriptive phenomenological study that included ten participants using convenience sampling with maximum variation in a tertiary hospital in Seoul, South Korea. Colaizzi's data analysis method was used to inductively determine themes and formulate meanings. The three main themes derived from analysis were: "frustration with seeing a patient suffering", "burnout at the cost of a life of dedication", and "desperate need for help". Caregivers experience high levels of suffering, which can come in various forms depending on the circumstances of the particular patient and family. Especially, distress from seeing a loved one suffering was another aspect of suffering in Korean ALS caregivers, reflecting strong family ties. At the same time, patients are in desperate need of help and support from their families. Thus, it is essential to provide care to lessen the causes of distress and meet the needs of not only patients, but also caregivers through family-centered care to improve overall quality of life for all involved.

O itinerário da famílias na atenção às necessidades da criança preterma no primeiro ano de vida / Families' itinerary in attention to the needs of the preterm child in the first year of life

A continuidade dos cuidados de crianças nascidas prematuras egressas da Unidade de Terapia Intensiva Neonatal faz-se necessária para o atendimento às necessidades de saúde apresentadas por essas crianças relacionadas à prematuridade. As trajetórias para o cuidado em saúde de seus filhos pode ser mediada por aspectos sócio-econômicos e culturais Objetivo geral: Analisar o itinerário de cuidados de famílias para o atendimento às necessidades de saúde de suas crianças nascidas prematuras no primeiro ano de vida. Objetivos específicos: verificar as ações de cuidado realizadas pelas famílias no domicílio e identificar subsistemas utilizados pelas famílias para o cuidado de suas crianças no primeiro ano de vida. Método: Trata-se de um Estudo de Caso Coletivo, longitudinal, de abordagem qualitativa. O Modelo de Sistemas de Cuidados em Saúde e o Modelo das Necessidades Essenciais das Crianças foram os referenciais teóricos desse estudo. Utilizamos a observação, a entrevista com roteiro semiestruturado, o genograma e o ecomapa para a produção de dados em campo. Oito famílias de crianças nascidas com menos de 32 semanas e egressas de três Unidades de Terapia Intensiva Neonatal de Belo Horizonte foram acompanhadas ao longo do primeiro ano de vida. Os dados foram coletados, inicialmente, no domicílio e, posteriormente, por via telefônica devido à pandemia da covid-19. A análise dos dados foi orientada pela técnica de Análise de Conteúdo Direcionada e apoiada pelo software MaxQDA versão 18.0 para organização e tratamento dos dados. Resultados: Os itinerários de cuidados de crianças prematuras foram mediados pelos três subsistemas do Modelo de Sistemas de Cuidados em Saúde em maior ou menor intensidade. Eles também influenciaram as ações de cuidado das famílias das crianças nascidas prematuras no primeiro ano de vida. As necessidades de saúde foram atendidas por meio dos subsistemas destacando o potencial atendimento à necessidade de proteção física, segurança e regulamentação. Entretanto para o atendimento à necessidade de estabelecimento de limites, organização e expectativas e de experiências individuais precisam ser mais exploradas pelo subsistema profissional. Conclusões: As famílias de crianças nascidas prematuras necessitam de apoio para a continuidade do cuidado após a alta da Terapia Intensiva. O subsistema profissional deve constituir-se como um apoio tanto para o fortalecimento do subsistema informal acessado pelas mães como para a construção do itinerário no primeiro ano de vida. Considerações para a enfermagem: a enfermagem como uma profissão do cuidado necessita encontrar caminhos para realizar ações do campo de conhecimento que lhe é próprio como se fazer reconhecer como rede de apoio para o fortalecimento das competências familiares para o cuidado de seus filhos prematuros no domicílio favorecendo o atendimento às necessidades de saúde dessas crianças e de suas famílias.

The continuity of care for children born prematurely and exiting the Neonatal Intensive Care Unit is necessary to meet the health needs presented by these children related to prematurity. The health care trajectories of their children may be mediated by socio-economic and cultural aspects General objective: To analyze the care itinerary of families to meet the health needs of their children born prematurely in the first year of life. Specific objectives: to verify the care actions performed by families at home and to identify subsystems used by families to care for their children during the first year of life.Method: This is a longitudinal Collective Case Study with a qualitative approach. The Health Care Systems Model and the Children's Essential Needs Model were the theoretical references of this study. We used observation, semi-structured interviews, the genogram and the ecomap to produce data in the field. Eight families of children born at less than 32 weeks and exiting three Neonatal Intensive Care Units in Belo Horizonte were followed during the first year of life. Data were collected, initially, at home and, later, by telephone due to the covid-19 pandemic. Data analysis was guided by the Directed Content Analysis technique and supported by MaxQDA software version 18.0 for data organization and treatment. Results: The care itineraries of premature infants were mediated by the three subsystems of the Health Care Systems Model to a greater or lesser extent. They also influenced the care actions of the families of children born prematurely in the first year of life. Health needs were met through the subsystems highlighting the potential meeting of the need for physical protection, safety and regulation. However for meeting the need for limit setting, organization and expectations and individual experiences need to be further explored by the professional subsystem. Conclusions: Families of prematurely born children need support for the continuity of care after discharge from intensive care. The professional subsystem must be a support for both the strengthening of the informal subsystem accessed by the mothers and for the construction of the itinerary in the first year of life. Considerations for nursing: nursing as a profession of care needs to find ways to perform actions in its own field of knowledge as to be recognized as a support network for the strengthening of family competences for the care of their premature children at home, favoring the care of the health needs of these children and their families.

Impact of football matches on number of visits to an emergency department. / Impacto de los partidos de fútbol en la frecuentación de pacientes a un servicio de urgencias.

OBJECTIVES: To analyze the impact of a local football team's matches on patient demand for hospital emergency department care in Bilbao, in the Spanish province of Biscay. MATERIAL AND METHODS: Retrospective analysis. We retrieved the number of patients coming to the emergency department on the days and hours of matches played by Bilbao's Athletic Club during the 2017-2019 and 2018-2019 seasons and compared the caseloads with those on the same days of the weeks before and after the matches (control days). RESULTS: Ninety-five match days were studied. Nineteen of the matches were considered key events. Visits by adults to the emergency department fell by a statistically significant 7.5% (95% CI, 4.6%-11.6%) when matches were being played in Bilbao. The decrease was 8.4% (95% CI, 5.3%-12.6%) when matches were played away. The decrease in pediatric emergencies was 32.7% (95% CI, 7.4%-68.3%) in the hours while important matches were played outside the city. CONCLUSION: The impact of football on the number of visits to our hospital emergency department was modest, except during important away matches.

OBJETIVO: Analizar el impacto que tienen los partidos de fútbol del equipo local en la frecuentación de pacientes al servicio de urgencias hospitalario (SUH) de Bilbao (Bizkaia). METODO: Estudio analítico retrospectivo. Se comparó la afluencia al servicio de urgencias durante los días y horas de partido del Athletic Club de Bilbao de las temporadas 2017/18 y 2018/19 con la de los mismos días de las semanas previas y posteriores a los eventos deportivos (controles). RESULTADOS: Fueron estudiadas 95 días de partido celebrados, donde 19 fueron considerados de alta relevancia. En pacientes adultos, cuando el partido se jugó en Bilbao se registró una disminución estadísticamente significativa del 7,5% (IC95% 4,6-11,6) en el número de urgencias y del 8,4% (IC95% 5,3-12,6) cuando el partido se celebró en otra ciudad. En pacientes pediátricos, se halló un descenso de la afluencia del 32,7% (IC95% 7,4-68,3) en las horas correspondientes al desarrollo del partido cuando este era relevante y se jugaba fuera de la ciudad. CONCLUSIONES: El fútbol tiene una limitada capacidad moduladora de la frecuentación de pacientes al SUH tan solo cuando se trata de partidos de alta relevancia.

Patient, Rheumatologist and Therapist Perspectives on the Implementation of an Allied Health Rheumatology Triage (AHRT) Initiative in Ontario Rheumatology Clinics.

PURPOSE: The objective of this qualitative study was to explore patient, rheumatologist, and extended role practitioner (ERP) perspectives on the integration of an allied health rheumatology triage (AHRT) intervention in Ontario rheumatology clinics. Triage is the process of identifying the urgency of a patient's condition to ensure they receive specialist care within an appropriate length of time. This research explores the clinical/logistical impact of triage by occupational and physical therapists with advanced arthritis training (ERPs), including facilitators and barriers of success, and recommendations for future application. PARTICIPANTS AND METHODS: Semi-structured telephone interviews were held with participating rheumatologists, ERPs, and a sample of patients from each clinical site (4 community, 3 hospital) in five Ontario cities. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using basic qualitative description. Two independent researchers compared coding and achieved consensus. RESULTS: Patients (n=10), rheumatologists (n=6), and ERPs (n=5) participated in the study and reported reduced wait-times to rheumatology care, diagnosis, and treatment for those with inflammatory arthritis (IA). Rheumatologists and ERPs perceived that the intervention improved clinical efficiency and quality of care. Patients reported high satisfaction with ERP assessments, valuing early joint examination/laboratory tests, urgent referral if needed, and the provision of information, support, and management strategies. Facilitators of success included: supportive clinical staff, regular communication and collaboration between rheumatologist and ERP, and sufficient clinical space. Recommendations included extending ERP roles to include stable patient follow-up, and ERP care between scheduled rheumatology appointments. CONCLUSION: Findings support the integration of ERPs in a triage role in the community and hospital-based rheumatology models of care. Future research is needed to explore the impact of utilizing ERPs for stable patient follow-up in rheumatology settings.

The needs of patients with post-intensive care syndrome: A prospective, observational study.

BACKGROUND: The needs of critical illness survivors and how best to address these are unclear. OBJECTIVES: The objective of this study was to identify critical illness survivors who had developed post-intensive care syndrome and to explore their use of community healthcare resources, the socioeconomic impact of their illness, and their self-reported unmet healthcare needs. METHODS: Patients from two intensive care units (ICUs) in Western Australia who were mechanically ventilated for 5 days or more and/or had a prolonged ICU admission were included in this prospective, observational study. Questionnaires were used to assess participants' baseline health and function before admission, which were then repeated at 1 and 3 months after ICU discharge. RESULTS: Fifty participants were enrolled. Mean Functional Activities Questionnaire scores increased from 1.8 out of 30 at baseline (95% confidence interval [CI]: 0-3.5) to 8.9 at 1 month after ICU discharge (95% CI: 6.5-11.4; P = <0.001) and 7.0 at 3 months after ICU discharge (95% CI: 4.9-9.1; P = < 0.001). Scores indicating functional dependence increased from 8% at baseline to 54% and 33% at 1 and 3 months after ICU discharge, respectively. Statistically significant declines in health-related quality of life were identified in the domains of Mobility, Personal Care, Usual Activities, and Pain/Discomfort at 1 month after ICU discharge and in Mobility, Personal Care, Usual Activities, and Anxiety/Depression at 3 months after ICU discharge. An increase in healthcare service use was identified after ICU discharge. Participants primarily identified mental health services as the service that they felt they would benefit from but were not accessing. Very low rates of return to work were observed, with 35% of respondents at 3 months, indicating they were experiencing financial difficulty as a result of their critical illness. CONCLUSIONS: Study participants developed impairments consistent with post-intensive care syndrome, with associated negative socioeconomic ramifications, and identified mental health as an area they need more support in.

Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea.

BACKGROUND: In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. METHODS: Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. RESULTS: Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval -0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. CONCLUSION: The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers' preferences toward girls.

Daily volume of cases in emergency call centers: construction and validation of a predictive model.

BACKGROUND: Variations in the activity of emergency dispatch centers are an obstacle to the rationalization of resource allocation. Many explanatory factors are well known, available in advance and could predict the volume of emergency cases. Our objective was to develop and evaluate the performance of a predictive model of daily call center activity. METHODS: A retrospective survey was conducted on all cases from 2005 to 2011 in a large medical emergency call center (1,296,153 cases). A generalized additive model of daily cases was calibrated on data from 2005 to 2008 (1461 days, development sample) and applied to the prediction of days from 2009 to 2011 (1095 days, validation sample). Seventeen calendar and epidemiological variables and a periodic function for seasonality were included in the model. RESULTS: The average number of cases per day was 507 (95% confidence interval: 500 to 514) (range, 286 to 1251). Factors significantly associated with increased case volume were the annual increase, weekend days, public holidays, regional incidence of influenza in the previous week and regional incidence of gastroenteritis in the previous week. The adjusted R for the model was 0.89 in the calibration sample. The model predicted the actual number of cases within ± 100 for 90.5% of the days, with an average error of -13 cases (95% CI: -17 to 8). CONCLUSIONS: A large proportion of the variability of the medical emergency call center's case volume can be predicted using readily available covariates.

Effect of air pollution on health service demand of the elderly and middle-age patients with hypertension,cardiovascular and cerebrovascular diseases:based on analysis of data from CHARLS / 北京大学学报(医学版)

Objective:To study the association of air pollution with health service demand of the elderly and middle-age patients with cardiovascular and cerebrovascular diseases,and to provide a scientific ba-sis for development of environmental protection policy and health service policy of the Chinese govern-ment.Methods:This study included survey data on self-evaluated health,outpatient service demand and inpatient service demand of the patients with hypertension,heart disease and stroke in 62 cities of 1 7 provinces from China Health and Retirement Longitudinal Study(CHARLS)in 201 1 and 201 3,and com-bined it with the data on the annual concentrations of inhalable particulate matter(PM1 0 ),sulfur dioxide (SO2 )and nitrogen dioxide(NO2 )of those provinces and cities.Conditional Logistic regression was car-ried out to assess the possible effects of air pollutants on self-evaluated health and health service utiliza-tion.Results:The results showed that turning points existed in the effects of concentrations of NO2 and SO2 on the health service demand of the patients with hypertension,heart disease and stroke.The inpa-tient service demand of the hypertension patients increased with NO2 concentration when it was lower than 35.1 μg/m3 and decreased with NO2 concentration for higher value.Self-evaluated health of the patients with heart disease and stroke decreased with SO2 concentration when it was lower than 63.8 μg/m3 and increased with SO2 concentration for higher value.In addition,no evidence was found for the association between PM1 0 and health service demand.Conclusion:Air pollution may have effects on health service demand of the patients with hypertension,cardiovascular and cerebrovascular diseases,and different air pollutants at high or low concentration may have different health effects.

Determinants of H1N1 vaccination uptake in England.

OBJECTIVE: This study aims to investigate which individual characteristics influenced the uptake of the 2009 H1N1 vaccination in England. The vaccination was provided for free to a specified target group who also received invitation letters, but the coverage rate was still far from universal among them. METHODS: Data from the 2010 edition of the Health Survey for England are used (size of the estimation sample: 7211). In order to partial out the effect of unobservable time costs, attitudes or access to vaccinations, immunisations against the seasonal and pandemic influenza are jointly estimated. RESULTS: Health risks, health behaviours and preferences, and exposure to various information help explain the immunisation decision. Receiving the seasonal flu vaccine increases the probability of H1N1 vaccination uptake by 20 percentage points. CONCLUSIONS: The widespread refusal of the vaccination can be worrying for the control of potential future pandemics. Providing clear, well targeted information, ensuring that high risk groups are contacted, and raising the level of health consciousness can increase the coverage rate with vaccinations.

The Relationship Between the Time-distribution of EMS Demands and the Transport Time of 119 Ambulances

PURPOSE: As the prevalence of emergency diseases such as cardiac, cerebrovascular and respiratory disease has increased, the demands on the emergency medical service (EMS) system have also increased. But the resource of the EMS can't be expanded to meet the increased demands. So, due to the limited resources and the increased EMS call volume, the efficacy of EMS has decreased. In this study, we analyzed the relationship between the call volume and EMS transport time with respect to the EMS efficacy. METHODS: We retrospectively reviewed the computerized log data of the EMS ambulances in a metropolitan city of Korea. During the period from January 2008 to December 2008, a total 74,349 EMS calls developed and in 50,661 cases an EMS ambulance was dispatched to transport patients to a hospital. The time-distribution of the EMS demands and the time of EMS ambulance transport were analyzed according to the date, time and location of the calls to the EMS. Other characteristics of the EMS such as triage and disease or injury were analyzed. The transport time of the dispatched ambulance was compared between within the jurisdiction and outside the jurisdiction for evaluating the efficacy of the EMS system. RESULTS: During dawn (00:00-08:00) the frequency of EMS calls was low, as compared with that of the day and night (08:00-24:00). During dawn, 12,098 (23.88%) patients were developed, but 38,563 (76.12%) patients were developed during the day and night. On comparison according to jurisdiction, the response time and total transport time of the ambulance dispatched within the jurisdiction were faster than that outside the jurisdiction (p<0.001). During day and night, more ambulances were dispatched outside the jurisdiction that that during dawn (p<0.001). CONCLUSION: In a situation that there are many simultaneous demands for EMS in the same area, insufficient EMS resources can't quickly and effectively service all the demands. So, the time-distribution of EMS calls can assessed according to the dispatched EMS ambulances. Using our data, EMS resources can be redistributed to increase the efficiency of EMS.