Healthcare under pressure: modelling COVID-19 fatalities with multiscale geographically weighted regressions

Kybernetes ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Zizi Goschin ◽  
Gina Cristina Dimian
Keyword(s):  
Local Level ◽  
Age Distribution ◽  
Case Fatality ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Content Type ◽  
Case Fatality Ratio ◽  
Factors Of Influence ◽  
The Impact ◽  
Local Healthcare

PurposeThe paper aims to disentangle the factors behind territorial disparities in the coronavirus disease 2019 (COVID-19) case fatality ratio, focusing on the pressure put by the pandemic on healthcare services and adopting a spatial perspective.Design/methodology/approachMultiscale geographically weighted regression (MGWR) models have been used for uncovering the spatial variability in the impact of healthcare services on COVID-19 case fatality ratio, allowing authors to better capture the real spatial patterns at local level. The authors proved that this approach yields better results, and the MGWR model outperforms traditional regression methods. The selected case studies are two of the biggest UE countries, among the first affected by a high incidence of COVID-19 cases, namely Italy and Germany.FindingsThe authors found sizeable regional differences in COVID-19 mortality rates within each of the analysed countries, and the stress borne by local healthcare systems seems to be the most powerful factor in explaining them. In line with other studies, the authors found additional factors of influence, such as age distribution, gender ratio, population density and regional development.Originality/valueThis research clearly indicated that COVID-19 related deaths are strongly associated with the degree of resilience of the local healthcare systems. The authors supply localized results on the factors of influence, useful for assisting the decision-makers in prioritizing limited healthcare resources. The authors provide a scientific argument in favour of the decentralization of the pandemic management towards local authorities not neglecting, however, the necessary regional or national coordination.

Does an impaired capacity for self-care impact the prevalence of social and emotional loneliness among elderly people?

2018 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Irena Canjuga ◽  
Danica Železnik ◽  
Marijana Neuberg ◽  
Marija Božicevic ◽  
Tina Cikac
Keyword(s):  
Health Care ◽  
Elderly People ◽  
Age Distribution ◽  
Self Care ◽  
The Elderly ◽  
The Self ◽  
Content Type ◽  
Care Assessment ◽  
Significant Difference ◽  
The Impact

Purpose The purpose of this paper is to explore the impact of self-care on the prevalence of loneliness among elderly people living in retirement homes and older people living in their homes/communities. Design/methodology/approach The research was conducted through standardized SELSA-L assessment loneliness questionnaires and the Self Care Assessment Worksheet for self-care assessment. The results were processed using the Kruskal–Wallis test. Findings The obtained results have shown that impaired self-care ability affects the prevalence of loneliness among the elderly almost the same in both groups of participants. However, regarding the relationship between the state of health and self-care, only a statistically significant difference in the prevalence of loneliness is found in the case of the participants living in their homes, with the worst health condition affecting the poorer psychological care. Research limitations/implications It is necessary to point out the limitations of the research, primarily sample limitations and the selected design of the study. The sample consisted of two different and relatively small groups of participants which could adversely affect the representativeness of the sample and reduce the possibility of generalising the results. The next limiting factor is the age distribution the authors used in the research, where the age of the participants as a very important variable was collected by age range and not precisely which consequently resulted in inequality in subgroup sizes. Thus, the middle age (75–85) covers up to ten years, which is a huge range at an older age and can mean major differences in functional ability, and can impact the self-care assessment. Practical implications Nurses are indispensable in care for the elderly and they need to promote and encourage self-care of the elderly through health care. Elderly people living in retirement homes should be allowed to participate equally in health care in order to preserve their own autonomy and dignity. However, to benefit those who live in their homes, nurses should be connected to the local community and thus stimulate various forms of preventative (testing blood sugar levels, blood pressure and educating on the importance of preventive examinations) or recreational activities in the environment of elderly people with the goal of preserving their functional abilities. Originality/value The impact of self-care on loneliness was not sufficiently researched, and this paper contributed to understanding the complexity of loneliness phenomena among the elderly with the aim of developing a model of prevention.

The impact of compensation upon urban village residents satisfaction with the land expropriation process

2019 ◽  
Vol 11 (3) ◽  
pp. 186-216
Author(s):  
Ning Chai ◽  
Rob Stevens ◽  
Xiaozhen Fang ◽  
Chun Mao ◽  
Ding Wang
Keyword(s):  
Local Governments ◽  
Family Income ◽  
Local Level ◽  
Urban Redevelopment ◽  
National Standard ◽  
Land Expropriation ◽  
Content Type ◽  
Urban Village ◽  
Monthly Family Income ◽  
The Impact

Purpose The purpose of the paper is to investigate compensation and related welfare issues in the case of the expropriation of land for urban redevelopment in China. Design/methodology/approach A mixed methods quantitative and qualitative approach was selected to undertake the research. This involved a wide ranging qualitative review of the academic and policy literature to explore the relevant arguments and issues, combined with a quantitative regression analysis of survey data collected from research subjects. Findings The research identified the complex and changeable phenomena of urban village redevelopment in China, and the variable compensation arrangements used. The research found that monthly family income before land expropriation, monthly family expense before expropriation, the location of the housing expropriation and family unit size are important determinants for the property holders chosen methods of compensation. It also found that an increase in family size leads to a decreasing probability that the expropriated farmers choose the single monetary compensation relative to the alternative option of housing compensation. The degree of satisfaction with compensation, changes in monthly family income and expense are found to be significant determinants for changes in life satisfaction. Research limitations/implications The research made the following four recommendations based upon the qualitative and quantitative analysis: that local governments should pay closer governance/ political attention to changes in the welfare of the farmers/ villagers whose property has been expropriated; that central and local government should aim to improve the compensation system for rural land and property expropriation, to make the compensation policy be perceived as fairer and more reasonable by citizens; that a broad National standard of compensation be used within a pragmatic locally focussed regime; that the Chinese Central, Provincial and Local governments can devise improved policy tools and make more effective policy interventions by learning from the experiences (both successes and failures) of other countries approaches to this topic. It also suggested that further research be undertaken investigating the multitude of local level policy experiments, as a way of developing better National compensation standards based upon those compensation standards that appear to be working – and have citizen support – at the local level. Originality/value The literature review identified recent developments in Chinese urban studies and originally synthesised both recent and longstanding work on the issue of urban villages in China. The research also suggested changes to the National and Local legal and policy framework for compensation cases in urban redevelopment expropriation scenarios.

India’s rural healthcare systems: structural modeling

2018 ◽  
Vol 31 (7) ◽  
pp. 757-774 ◽  
Author(s):  
Dinesh Kumar
Keyword(s):  
Structural Model ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Climatic Conditions ◽  
Healthcare Management ◽  
Driving Factors ◽  
Rural Healthcare ◽  
Content Type ◽  
Rural Health Center ◽  
Interpretive Structural Model

Purpose The purpose of this paper is to identify factors related to rural healthcare services and establish a hierarchical model for the effective rural healthcare management in India. Design/methodology/approach A questionnaire survey identified and correlated numerous factors related to the Uttarakhand rural healthcare systems. Experts opinion were translated into a reachability matrix and an interpretive structural model. A fuzzy matriced impacts croises-multiplication applique and classment (FMICMAC) analysis arranged the factors as hierarchical stages using their driving power. Findings The interpretive structural and FMICMAC hierarchical models suggest four key driving factors: diseases, climatic conditions, population growth and political pressure. Practical implications Despite numerous issues, rural healthcare services can be improved by considering key driving factors that could be used as a prediction tool for policy makers. Originality/value Results demonstrate that population control, coordinating services with local bodies and rural health center annual maintenance can be game changers toward better healthcare services.

From hope to dystopia

2016 ◽  
Vol 15 (1) ◽  
pp. 35-50
Author(s):  
Ngambouk Vitalis Pemunta ◽  
Tabi Chama James Tabenyang
Keyword(s):  
Participant Observation ◽  
Investment Decision ◽  
Local Level ◽  
Group Discussion ◽  
Development Project ◽  
Dark Side ◽  
Content Type ◽  
Wide Range ◽  
Petroleum Development ◽  
The Impact

Purpose This paper aims to examine the dark flip side of the heightened dreams and wild expectations of development as a bright picture that accompanied the discovery of petroleum in politically unstable and donor-dependent Chad. Design/methodology/approach Data were elicited through local-level ethnography–participant observation, individual surveys and focus group discussion sessions with stakeholders on the impact of the Chad–Cameroon pipeline and petroleum development project. Findings While the “discourse of development” is about a better and new future, this new future, however, has a dark side: un/under-development, “backwardness”, corruption and patronage, leading to deeply entrenched poverty. Petroleum has become a discursive site where the competing discourses about development personified as the provision of material resources are played out. Originality/value The failure of petro-dollar-inspired development in Chad speaks to the mutually reinforcing nature of development decisions. Although firms need workers with specialized skills, workers will not acquire those skills in anticipation of employment opportunities. This disjuncture highlights the need for strategic complementarity in investment decision and coordination among economic agents. More than a decade later, the utopic dream of petro-dollar-inspired development as an aspiration is now characterized by a disconnect–environmental degradation, food insecurity, gendered and deeply entrenched poverty. This disjuncture demonstrates the need for a holistic impact assessment that involves different adaptive approaches and focus on a wide range of livelihood issues. Holistic evaluation on all programmes, plans, projects, policies and interventions will lead to the achievement of sustainable people-centred development that conserves the stewardship of nature.

Building a learning health system using clinical registers: a non-technical introduction

2016 ◽  
Vol 30 (7) ◽  
pp. 1105-1118 ◽  
Author(s):  
John Ovretveit ◽  
Eugene Nelson ◽  
Brent James
Keyword(s):  
Health Systems ◽  
Computer Literacy ◽  
Patient Empowerment ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Digital Data ◽  
Content Type ◽  
Daily Work ◽  
Effective Use ◽  
Unpublished Research

Purpose The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems. Design/methodology/approach Case description and comparison of the development and use of clinical registries, drawing on participants’ experience and published and unpublished research. Findings Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users’ daily work appears to be the key to effective use of the potential afforded by digital data. Research limitations/implications The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness. Practical implications The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research. Social implications Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities. Originality/value The paper shows three real examples of clinical registers which have been developed as part of their host health systems’ strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for clinicians, managers, policy-advisors and improvers of what is possible and the challenges, and highlights the need to shape the design and implementation of digital infrastructures in healthcare services to serve users.

Healthcare facilities maintenance management: a literature review

2017 ◽  
Vol 15 (4) ◽  
pp. 352-375 ◽  
Author(s):  
Zahra Yousefli ◽  
Fuzhan Nasiri ◽  
Osama Moselhi
Keyword(s):  
Literature Review ◽  
Healthcare Services ◽  
Facility Management ◽  
Maintenance Management ◽  
Future Research ◽  
Content Type ◽  
Healthcare Facilities ◽  
And Performance ◽  
Management Functions ◽  
The Impact

Purpose The complexity and criticality of healthcare services highlight the importance of maintenance management function in healthcare facilities. The purpose of this paper is to review the literature on maintenance management of healthcare facilities and hospital buildings to provide an organized literature review and identify gaps from the perspective of research and practice. Design/methodology/approach The paper categorizes the literature and adopts a review hierarchy according to maintenance management functions in hospital buildings. It explores the impact of those functions on the performance of maintenance activities in hospitals. Furthermore, it examines the role of information technology and automated decision support systems in facilitating hospital maintenance management functions and performance. Findings Literature on maintenance management in healthcare facilities and hospital buildings has so far been very limited. Recently published literature focusing on healthcare facilities management and its maintenance management functions is classified into various areas and sub-areas. The paper highlights gaps in the literature and suggests avenues for future research and improvements. Originality/value The paper contains a comprehensive listing of publications and their classifications according to various attributes. It will be useful for researchers, maintenance managers, practitioners and stakeholders concerned with facility management of hospital buildings.

scholarly journals The role of age distribution, time lag between reporting and death and healthcare system capacity on case fatality estimates of COVID-19

2020 ◽  
Author(s):  
Patrizio Vanella ◽  
Christian Wiessner ◽  
Anja Holz ◽  
Gerard Krause ◽  
Annika Moehl ◽  
...  
Keyword(s):  
Time Lag ◽  
Age Distribution ◽  
Case Fatality ◽  
System Capacity ◽  
Time Lags ◽  
Cross Country ◽  
The Difference ◽  
Case Fatality Risk ◽  
The Impact

European countries report large differences in coronavirus disease (COVID-19) case fatality risk (CFR). CFR estimates depend on demographic characteristics of the cases, time lags between reporting of infections and deaths and infrastructural characteristics, such as healthcare and surveillance capacities. We discuss the impact of these factors on the CFR estimates for Germany, Italy, France, and Spain for the COVID-19 pandemic from early March to mid-April, 2020. We found that, first, a large proportion of the difference in CFRs can be attributed to different age structures of the cases. Second, lags of 5-10 days between day of case report and death should be used, since these provide the most constant estimates. Third, for France, Italy, and Spain, intensive care beds occupied by COVID-19 patients were positively associated with fatality risks of hospitalized cases. Our results highlight that cross-country comparisons of crude CFR estimates can be misleading and should be avoided.

scholarly journals Enhanced comparisons of COVID-19 mortality across populations

2020 ◽  
Author(s):  
Chalapati Rao ◽  
Suhail A. Doi ◽  
Gail Williams
Keyword(s):  
Health System ◽  
Age Distribution ◽  
Case Fatality ◽  
The South ◽  
South Korean ◽  
Age Variations ◽  
Incidence And Mortality ◽  
System Factors ◽  
The Impact ◽  
Age Structures

AbstractBackgroundThe reported crude case fatality rate (CFR) for COVID-19 varies considerably across countries. Crude CFRs could by biased by larger proportions of older COVID-19 cases in population data, who are also at increased mortality risk. Such distorted age case structures are a common feature of selective COVID 19 testing strategies in many countries, and they potentially mask underlying differences arising from other important factors such as health system burden.MethodsWe used the method of direct case-age standardisation to evaluate the effects of age variations on CFRs. Data on cases and death by age from Italy, Spain, China, Australia and South Korea were analysed to derive standardised CFRs. Findings were compared across different case age distribution references as standards.ResultsUsing the South Korean case age distribution as a standard, the fivefold higher crude CFR for Italy is reduced to less than two-fold after adjustment, while the crude CFR difference for Spain is virtually eliminated. The adjusted CFR for Australia is the lowest among all countries.DiscussionMortality differences based on crude CFRs are exaggerated by age structures, which are effectively controlled by case age standardization. Residual CFR differences could be attributed to health and health system factors. The South Korean case age distribution is an appropriate reference standard, given its robust case detection and contact tracing program. Till reliable population level indicators of incidence and mortality are available, the age-standardized CFR could be a viable option for international comparison of the impact of the COVID 19 epidemic.SummaryThe knownThere are intense debates around the magnitude of and reasons for wide variations in observed case fatality rates (CFRs) from COVID 19 across countries. Age is commonly speculated as a reason, but this has not been technically quantified or explained.The newThe technique of direct standardization using reference distributions of case age structures eliminates the effects of age on CFR, thus enhancing the comparability as well as understanding of differentialsThe implicationsResidual differences between adjusted CFRs can be used to infer health and health system factors that influence mortality in COVID 19 cases in different populations

scholarly journals Eruption of COVID-19 like illness in a remote village in Papua (Indonesia)

2020 ◽  
Author(s):  
Elco van Burg ◽  
Wijnanda van Burg-Verhage
Keyword(s):  
Healthcare Workers ◽  
Age Distribution ◽  
Case Fatality ◽  
Medical Doctors ◽  
Young Population ◽  
Remote Areas ◽  
Resource Levels ◽  
The Impact ◽  
The Village ◽  
Village Population

Background The COVID-19 pandemic is creating significant challenges for healthcare infrastructure for countries of all development and resource levels. Low-and-middle resource countries face even larger challenges, as their resources are stretched and often insufficient under normal circumstances. A village in the Papuan highlands of Indonesia; small, isolated, accessed only by small plane or trekking has experienced an outbreak typical of COVID-19. Methodology/Principal Findings This description was compiled from patient care records by lay healthcare workers in M20 (a pseudonym) during and after an outbreak and from medical doctors responding to online requests for help. We assume that, for reasons given, the outbreak that has been described was COVID-19. The dense social structure of the village resulted in a rapid infection of 90-95% of the population. Physical distancing and isolation measures were used, but probably implemented suboptimal and too late, and their effect on the illness course was unclear. The relatively young population, with a majority of women, probably influenced the impact of the epidemic, resulting in only two deaths so far. Conclusions/Significance This outbreak pattern of suspected SARS-CoV-2 in a village in the highlands of Papua (Indonesia) presents a unique report of the infection of an entire village population over five weeks. The age distribution, common in Papuan highland villages may have reduced case fatality rate (CFR) in this context and that might be the case in similar remote areas since survival to old age is already very limited and CFR among younger people is lower.

scholarly journals Exploring primary care responses to domestic violence and abuse (DVA): operationalisation of a national initiative

2019 ◽  
Vol 21 (2) ◽  
pp. 144-154 ◽  
Author(s):  
Julie McGarry ◽  
Basharat Hussain ◽  
Kim Watts
Keyword(s):  
Primary Care ◽  
Domestic Violence ◽  
Care Setting ◽  
Primary Care Setting ◽  
Local Level ◽  
Team Approach ◽  
Content Type ◽  
The Uk ◽  
The Impact ◽  
Domestic Violence And Abuse

Purpose In the UK, the Identification and Referral to Improve Safety (IRIS) initiative has been developed for use within primary care to support women survivors of domestic violence and abuse (DVA). However, while evaluated nationally, less is known regarding impact of implementation at a local level. The purpose of this paper is to explore the effectiveness of IRIS within one locality in the UK. Design/methodology/approach A qualitative study using interviews/focus groups with primary care teams and women who had experienced DVA in one primary care setting in the UK. Interviews with 18 participants from five professional categories including: general practitioners, practice nurses, practice managers, assistant practice managers and practice receptionists. Focus group discussion/interview with seven women who had accessed IRIS. Data were collected between November 2016 and March 2017. Findings Five main themes were identified for professionals: Team role approach to training, Professional confidence, Clear pathway for referral and support, Focussed support, Somewhere to meet that is a “safe haven”. For women the following themes were identified: Longevity of DVA; Lifeline; Face to face talking to someone; Support and understood where I was coming from; A place of safety. Practical implications IRIS played a significant role in helping primary care professionals to respond effectively. For women IRIS was more proactive and holistic than traditional approaches. Originality/value This study was designed to assess the impact that a local level implementation of the national IRIS initiative had on both providers and users of the service simultaneously. The study identifies that a “whole team approach” in the primary care setting is critical to the effectiveness of DVA initiatives.

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