Optimizing access and configuration of trauma centre care in New South Wales

IntroductionGetting the right patient, to the right place, at the right time is dependent on a multitude of modifiable and non-modifiable factors. One potentially modifiable factor is the number and location of trauma centres (TC). Overabundance of TC dilutes volumes and could be associated with worse outcomes. We describe a methodology that evaluates trauma system reconfiguration without reductions in potential access to care. We used the mature trauma system of New South Wales (NSW) as a model given the perceived overabundance of urban major trauma centres (MTC).MethodsWe first evaluated potential access to TC care via ground and air transport through the use of geographic information systems (GIS) network analysis. Potential access was defined as the proportion of the population living within 60-min transport time from a potential scene of injury to a TC by ground or rotary-wing aircraft. Sensitivity analyses were carried out in order to account for potential pre-hospital interventions and/or transport delays; travel times of 15-, 30-, 45-, 60-, and 90-min were also analyzed. We then evaluated if the current configuration of the system (number of urban MTS in the Sydney basin) could be optimized without reductions in potential access to care using two GIS methodologies: location-allocation and individual removal of MTC.Results86% of the NSW population has potential access to a TC within 60 min ground travel time; potential access improves to 99% with rotary-wing transport. The 1% of the population without potential TC access lives in 48% of the land area (>384,000km2). Utilizing two different methodologies we identified that there was no change in potential access by ground transport after removing 1 or 2 MTC in the Sydney basin at the 30-, 45-, and 60-min transport times. However, 0.02% and 0.5% of the population would not have potential access to MTC care at 15 min after removing one and two MTC respectively.DiscussionRedistribution of the number of MTC in the Sydney basin could be achieved without a significant impact on potential access to care. Our approach can be utilized as an initial tool to evaluate a trauma system where overabundance of coverage is present.     

The geographic harmonisation of Scotland's small area census data, 1981 to 2011

Previous research in Scotland used a merging approach to combine census boundary data for geographies specific to 1981, 1991 and 2001 to create Consistent Areas Through Time (CATTs) for the analysis of health and social data for small areas. In this paper, we adopt the same methodology to integrate the 2011 Scottish Output Areas to the CATTs. First, we overlaid the 2001 Output Areas upon the 2011 Output Areas to create SUPER OAs, which were then combined with SUPER EDs, which represented a consistent small area geography for 1981 and 1991. This resulted in 8,548 CATTs providing a consistent geography for the 1981, 1991, 2001 and 2011 Censuses in Scotland. We demonstrate the utility of the CATTs by exploring the correlations between deprivation, the proportion of the population who were permanently sick and those with degree qualifications, across the 4 censuses, a research angle impossible without consistent geographies. We have provided a resource that enables users to deepen their understanding of small area social changes in Scotland between the 1981 and 2011 Censuses.     

The Impact of Socioeconomic Factors,Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis

Background:No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers.Objectives:To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil.Methods:An ecological study using secondary data from Brazilian Health Informatics Department between 2013–2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R² and lowest Akaike Information Criterion.Results:A total of 22,920 individuals died from IHD between 2013–2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran’s I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R²: 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05).Conclusion:Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil.Highlights

• The increase in ischemic heart disease mortality rates is related to geographical disparities.
• The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health.
• Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state.
• Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling.

     

Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

BackgroundAchieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports.MethodsThirteen Gavi-supported countries were purposively selected with emphasis on Gavi’s priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016–2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF’s coverage and equity assessment approach – an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard.ResultsIn total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity.ConclusionFindings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and ‘zero-dose’ vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.     

2004－2016年我国结核病流行的时空特征分析

目的 分析2004-2016年我国结核病登记病例的时空分布特征,探测聚集区域,为结核病防控提供理论依据。方法 利用ArcGIS 10.0软件作为数据管理和呈现的平台,建立我国2004-2016年结核病空间分析数据库,对结核病疫情进行空间自相关分析,采用SaTScan 9.6软件进行时空扫描分析。结果 2004-2016年全国共登记结核病病例13 157 794例,全国年均登记率为75.90/10万(27.95/10万~180.82/10万)。全局空间自相关结果显示结核病发病呈聚集性分布,局部Moran''s I自相关分析结果表明,新疆、西藏、贵州、广西和海南(省、自治区)为高-高聚集区域,北京、河北、天津、山东、江苏、上海(省、直辖市)为低-低聚集区域;局部G统计量热点分析结果显示,全国结核病疫情存在15个"热点"区域,其中3个"正热点"区域分别为新疆、西藏和海南(省、自治区), 12个"负热点"区域分别为北京、天津、辽宁、内蒙古、河北、山东、江苏、安徽、上海、山西、河南和吉林(省、自治区、直辖市)。利用SaTScan 9.6软件进行分阶段时空扫描分析,3个阶段共探测出12个聚集区域,每个聚集区域差异均有统计学意义(均P<0.05)。结论 2004-2016年我国结核病疫情呈现逐年下降的趋势,各省(自治区、直辖市)的年均登记率并非随机分布,呈明显的空间聚集性,分阶段时空扫描聚集区域逐渐减少,结核病防治工作取得一定进展,但高风险地区仍持续存在,需重点关注并采取针对性防控措施。     

Ramps remain a barrier to safe wheelchair user transit bus ingress/egress

Abstract

Background: Wheelchair users (WCUs) often rely on ramps for access to transit buses. Previous studies indicate WCUs have difficulty using ramps for bus ingress/egress and many transportation-related incidents occur on ramps. However, experiences of WCU ramp usage during ingress/egress have not been fully described.

Methods: Cross-sectional, internet-based survey of WCUs who ride transit buses was conducted. The participants were queried on frequency of bus usage, difficulty and incidents involving ramps, and factors contributing to difficulty and incidents. Wheelchair characteristics, primary condition, and whether participants received travel training were also captured. Chi-square was used to describe relationships between wheelchair type and frequency of difficulties and incidents, and odd ratios were used to determine likelihood of the incidents.

Results: The majority (55.7%) of 384 participants reported using public transportation ≥ 1 per week. Seventy-eight percent of WCUs had ≥ 1 ramp incident over the past 3?years, with an increased likelihood of incidents occurring during ingress (OR = 1.53; CI 1.21–1.86). Of those who had an incident, 22% were injured or had damage to their wheelchair. Over 60% of those who had an incident identified steep ramp slope as being the contributing factor. Steep ramp slope, exterior ramp thresholds and wet surfaces were the most common contributing factors to difficulty using ramps.

Conclusion: This is the first large-scale US study enabling WCUs to describe their experiences using transit bus ramps. Despite ADA guidelines, steep ramps remain the primary factor contributing to incidents and difficulty when using ramps to access transit buses.

• Implications for rehabilitation

• The discrepancy between ADA maximum allowable ramp slopes for the built environment and transit buses may require an increased level of effort that is a barrier to transportation accessibility for some wheelchair users.

• Wheelchair users who access transit buses should be made aware of, and trained, to navigate ramp configurations found in the environment.

• We suggest rehabilitation therapists provide skills training specific to navigating transit bus ramp slopes that may be steeper and narrower than building ramps.