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PloS One 2024The Global Investment Report 2023 revealed that after a sharp decline in 2020 and a strong rebound in 2021, global foreign direct investment (FDI) declined by 12 percent...
The Global Investment Report 2023 revealed that after a sharp decline in 2020 and a strong rebound in 2021, global foreign direct investment (FDI) declined by 12 percent to $1.3 trillion in 2022. However, in developing countries, FDI increased by 4% to $916 billion, a record share of more than 70% of global flows. The number of greenfield investment projects in developing countries increased by 37 percent and international project finance transactions by 5 percent. Foreign investment from China, the second largest recipient of foreign investment globally, increased by 5 percent. The service industry has become the mainstream industry in the global FDI structure. The global industry is accelerating its transformation to a "service-based economy," international FDI in productive service industries has become an essential means of industrial transfer in developed countries and a meaningful way to upgrade the industrial structure and high-quality development in emerging economies. As a representative province in central China, Hubei Province has unique advantages in human capital, factor cost, and market potential, which provide preferential conditions to attract foreign investment. This paper first introduced the concept of the productive service industry, based on the relevant statistical data from 2011 to 2022, focused on the current situation of foreign investment utilization in five major sub-sectors of the productive service industry in Hubei Province in the past ten years, and empirically investigated the impact of foreign investment utilization in five major sub-sectors of the productive service industry on the economic growth of Hubei Province, and obtained that the level of foreign investment attraction varied significantly among the regions in Hubei Province. The three productive service industries, namely transportation, storage and postal services, information transmission, software and information technology services, and financial services, played a significant role in the active attraction and optimal utilization of foreign capital and the economic development of Hubei Province. Based on this, it was proposed to build a market-oriented rule of law and internationalized business environment, improve the infrastructure construction in different regions of the province, focus on the training of professional talents for the development of productive service industries, and pay attention to the improvement of independent innovation capacity.
Topics: China; Investments; Industry; Humans; Developing Countries; Economic Development
PubMed: 38900766
DOI: 10.1371/journal.pone.0302494 -
Annales D'endocrinologie Feb 2024Diagnosis announcement of a chronic disease is a crucial moment for patients as well as for their families and an important step in the management of severe conditions...
CONTEXT
Diagnosis announcement of a chronic disease is a crucial moment for patients as well as for their families and an important step in the management of severe conditions such as rare endocrine diseases. Little is known of how diagnosis is communicated to patients and families. The FIRENDO network was created by the third French Plan for Rare Diseases, to promote autonomy, care and research on rare endocrine diseases.
OBJECTIVES
The aim of this study was to characterize, for the first time, the experience and needs of patients and/or their parents around the announcement of diagnosis to ensure optimal quality of care.
METHODS
A quantitative self-administered survey on diagnosis announcement procedures in rare endocrine diseases was launched in April 2017 by the ad hoc FIRENDO thematic working group in collaboration with its 11 partnering patient associations and support groups. The questionnaire was designed and revised by patient support group representatives, adult and pediatric endocrinologists, psychologists and biologists, all expert in rare endocrine diseases. It was made available on the FIRENDO network website and distributed mainly by email with electronic links on their respective websites to members of all affiliated patient support groups.
RESULTS
Questionnaires were filled out by 391 patients and 223 parents (median age of patients: 39 years). The following conditions were associated with at least 30 answers: Addison's disease, classical forms of congenital adrenal hyperplasia (CAH), Russell-Silver syndrome, Cushing's syndrome, acromegaly and craniopharyngioma. Overall, some announcement modalities were judged favorably by patients: physician's empathy, availability and use of clear terms, and presence of family at the time of announcement. However, a lack of psychological care and information documents was reported, as well as some inadequate procedures such as postal mail announcements.
CONCLUSION
This work suggests that better knowledge of the patient's experience is useful for improving the diagnosis announcement of rare endocrine disorders. The main recommendations derived from the survey were the need for several announcement visits, information on patient support groups and reference centers, imperatively avoiding impersonal announcement, and the usefulness of a written accompanying document.
Topics: Adult; Child; Humans; Rare Diseases; Endocrine System Diseases; Cushing Syndrome; Adrenal Hyperplasia, Congenital; Surveys and Questionnaires
PubMed: 37951412
DOI: 10.1016/j.ando.2023.10.008 -
The Journal of Adolescent Health :... Dec 2023The COVID-19 pandemic highlighted the need for innovative approaches to delivering care. Self-collect, mail-in sexually transmitted infection (STI) testing could address...
Utilizing Digital Health Technology to Increase Sexual Health Care Access: Youth Preferences on Self-Collect, Mail-In Sexually Transmitted Infection Testing in a High Sexually Transmitted Infection Prevalence Area.
PURPOSE
The COVID-19 pandemic highlighted the need for innovative approaches to delivering care. Self-collect, mail-in sexually transmitted infection (STI) testing could address barriers to in-person STI testing, particularly for youth, who bear a disproportionate burden of STIs. This study sought to obtain youth input on the development of a free self-collect, mail-in STI testing program.
METHODS
Focus group discussions (n = 5, 45-60 minutes each) were conducted with 28 youth ages 14-19 years old living in Baltimore, Maryland. Focus group discussions were based on a conceptual framework of patient-centered health-care access, and a prototype online program was discussed. Transcribed data were coded thematically. Memos were written to synthesize findings and identify representative quotes.
RESULTS
Participants noted existing barriers to in-person STI testing barriers including individual-level (e.g., lack of knowledge), interpersonal-level (e.g., stigma), and structural-level (e.g., financial). Although participants expressed concerns about self-collect, mail-in STI testing (e.g., accuracy of self-swabbing), there was overall acceptance of the program, and many felt it would address current barriers to testing. Opportunities to improve the testing program included all four steps of testing process: kit ordering, receipt of the kit and swabbing, post-testing experience, and communication of results and treatment. Specifically, participants desired expanded shipping options to schools, and mail drop-off points such as lockers and local convenience stores; more transparency about testing and treatment; and hearing directly from health-care providers to assuage any concerns.
DISCUSSION
Self-collect, mail-in STI testing was favorable among youth, and could be a viable option for increasing youth access to STI testing.
Topics: Humans; Adolescent; Young Adult; Adult; Prevalence; Pandemics; Postal Service; Sexually Transmitted Diseases; Health Services Accessibility
PubMed: 37676195
DOI: 10.1016/j.jadohealth.2023.07.002 -
PloS One 2023In the United States, increasing access to the internet, the increasing costs of large-scale face-to-face data collections, and the general reluctance of the public to...
In the United States, increasing access to the internet, the increasing costs of large-scale face-to-face data collections, and the general reluctance of the public to participate in intrusive in-person data collections all mean that new approaches to nationally representative surveys are urgently needed. The COVID-19 pandemic accelerated the need for faster, higher-quality alternatives to face-to-face data collection. These trends place a high priority on the evaluation of innovative web-based data collection methods that are convenient for the U.S. public and yield scientific information of high quality. The web mode is particularly appealing because it is relatively inexpensive, it is logistically flexible to implement, and it affords a high level of privacy and confidentiality when correctly implemented. With this study, we aimed to conduct a methodological evaluation of a sequential mixed-mode web/mail data collection protocol, including modular survey design concepts, which was implemented on a national probability sample in the U.S. in 2020-2021. We implemented randomized experiments to test theoretically-informed hypotheses that 1) the use of mail and increased incentives to follow up with households that did not respond to an invitation to complete a household screening questionnaire online would help to recruit different types of households; and 2) the use of modular survey design, which involves splitting a lengthy self-administered survey up into multiple parts that can be completed at a respondent's convenience, would improve survey completion rates. We find support for the use of mail and increased incentives to follow up with households that have not responded to a web-based screening questionnaire. We did not find support for the use of modular design in this context. Simple descriptive analyses also suggest that attempted telephone reminders may be helpful for the main survey.
Topics: Humans; United States; Postal Service; Pandemics; COVID-19; Surveys and Questionnaires; Data Accuracy; Internet
PubMed: 37540678
DOI: 10.1371/journal.pone.0289695 -
BMC Health Services Research Oct 2023Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and...
BACKGROUND
Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system.
OBJECTIVES
The aim of the study was to determine whether having a named GP is associated with hospital service use.
METHODS
The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register).
RESULTS
A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis.
CONCLUSION
A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.
Topics: Humans; General Practitioners; Follow-Up Studies; Delivery of Health Care; Hospitals; Social Work
PubMed: 37898748
DOI: 10.1186/s12913-023-10184-5 -
Clinical Orthopaedics and Related... Oct 2023Advanced practice professionals, including physician assistants (PAs) and nurse practitioners (NPs), play an important role in providing high-quality orthopaedic care....
BACKGROUND
Advanced practice professionals, including physician assistants (PAs) and nurse practitioners (NPs), play an important role in providing high-quality orthopaedic care. This role has been highlighted by projections of nationwide shortages in orthopaedic surgeons, with rural areas expected to be most affected. Given that approximately half of rural counties have no practicing orthopaedic surgeons and that advanced practice professionals have been shown to be more likely to practice in rural areas compared to physicians in other medical disciplines, orthopaedic advanced practice professionals may be poised to address orthopaedic care shortages in rural areas, but the degree to which this is true has not been well characterized.
QUESTIONS/PURPOSES
(1) What percentage of rural counties have no orthopaedic caregivers, including surgeons and advanced practice professionals? (2) Is the density of advanced practice professionals greater than that of orthopaedic surgeons in rural counties? (3) Do orthopaedic advanced practice professionals only practice in counties that also have practicing orthopaedic surgeons? (4) Are NPs in states with full practice authority more likely to practice in rural counties compared with NPs in restricted practice authority states?
METHODS
We identified orthopaedic surgeons and advanced practice professionals using the 2019 Medicare Provider Utilization and Payment Data, as this large dataset has been shown to be the most complete source of claims data nationwide. Each professional's ZIP Code was matched to counties per the US Postal Service ZIP Code Crosswalk Files. The total number and density of physician and advanced practice professionals per 100,000 residents were calculated per county nationwide. Counties were categorized as urban (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) or rural (micropolitan and noncore) using the National Center for Health Statistics Urban-Rural Classification Scheme. Comparisons between rural and urban county caregivers were conducted with the chi-square test and odds ratios. Population densities were compared with the Wilcoxon rank sum test. A bivariate density map was made to visualize the nationwide distribution of orthopaedic caregivers and determine the percentage of rural counties with no orthopaedic caregivers as well as whether orthopaedic advanced practice professionals practiced in counties not containing any surgeons. Additionally, to compare states with NP's full versus restricted practice authority, each NP was grouped based on their state to determine whether NPs in states with full practice authority were more likely to practice in rural counties. We identified a group of 31,091 orthopaedic caregivers, which was comprised of 23,728 physicians, 964 NPs, and 6399 PAs (7363 advanced practice professionals). A total of 88% (20,879 of 23,728) of physicians and 87% (6427 of 7363) of advanced practice professionals were in urban counties, which is comparable to nationwide population distributions.
RESULTS
A total of 39% (1237 of 3139) of counties had no orthopaedic professionals (defined as orthopaedic surgeons or advanced practice professionals) in 2019. Among these counties, 82% (1015 of 1237) were rural and 18% (222 of 1237) were urban. The density of advanced practice professionals providing orthopaedic services compared with the density of orthopaedic surgeons was higher in rural counties (18 ± 70 versus 8 ± 40 per 100,000 residents; p = 0.001). Additionally, 3% (57 of 1974) of rural and 1% (13 of 1165) of urban counties had at least one orthopaedic advanced practice professional, but no orthopaedic surgeons concurrently practicing in the county. There was no difference between the percentage of rural counties with an NP in states with full versus restricted practice authority for NPs (19% [157 of 823] versus 26% [36 of 141], OR 1.45 [95% CI 0.99 to 2.2]; p = 0.08).
CONCLUSION
As advanced practice professionals tended to only practice in counties which contain orthopaedic surgeons, our analysis suggests that plans to increase the number of advanced practice professionals alone in rural counties may not be sufficient to fully address the demand for orthopaedic care in rural areas that currently do not have orthopaedic surgeons in practice. Rather, interventions are needed to encourage more orthopaedic surgeons to practice in rural counties in collaborative partnerships with advanced practice professionals. In turn, rural orthopaedic advanced practice professionals may serve to further extend the accessibility of these surgeons, but it remains to be determined what the total number and ratio of advanced practice professionals and surgeons is needed to serve rural counties adequately.
CLINICAL RELEVANCE
To increase rural orthopaedic outreach, state legislatures may consider providing financial incentives to hospitals who adopt traveling clinic models, incorporating advanced practice professionals in these models as physician-extenders to further increase the coverage of orthopaedic care. Furthermore, the creation of more widespread financial incentives and programs aimed at expanding the experience of trainees in serving rural populations are longer-term investments to foster interest and retention of orthopaedic caregivers in rural settings.
Topics: Aged; Humans; United States; Medicare; Rural Population; Orthopedic Surgeons; Quality of Health Care; Surgeons
PubMed: 37043552
DOI: 10.1097/CORR.0000000000002649 -
Scientific Reports Apr 2024The presence of significant, unwarranted variation in treatment suggests that clinical decision making also depends on where patients live instead of what they need and...
The presence of significant, unwarranted variation in treatment suggests that clinical decision making also depends on where patients live instead of what they need and prefer. Historically, high practice variation in surgical treatment for lumbar degenerative disc disease (LDDD) has been documented. This study aimed to investigate current regional variation in surgical treatment for sciatica resulting from LDDD. We conducted a retrospective, cross-sectional analysis of all Dutch adults (>18 years) between 2016 and 2019. Demographic data from Statistics Netherlands were merged with a nationwide claims database, covering over 99% of the population. Inclusion criteria comprised LDDD diagnosis codes and relevant surgical codes. Practice variation was assessed at the level of postal code areas and hospital service areas (HSAs). Multivariable logistic regression analysis was employed to identify variables associated with surgical treatment. Among the 119,148 hospital visitors with LDDD, 14,840 underwent surgical treatment. Practice variation for laminectomies and discectomies showed less than two-fold variation in both postal code and HSAs. However, instrumented fusion surgery demonstrated a five-fold variation in postal code areas and three-fold variation in HSAs. Predictors of receiving surgical treatment included opioid prescription and patient referral status. Gender differences were observed, with males more likely to undergo laminectomy or discectomy, and females more likely to receive instrumented fusion surgery. Our study revealed low variation rates for discectomies and laminectomies, while indicating a high variation rate for instrumented fusion surgery in LDDD patients. High-quality research is needed on the extent of guideline implementation and its influence on practice variation.
Topics: Humans; Male; Female; Intervertebral Disc Degeneration; Middle Aged; Adult; Cross-Sectional Studies; Retrospective Studies; Netherlands; Lumbar Vertebrae; Diskectomy; Laminectomy; Aged; Hospitals; Practice Patterns, Physicians'; Spinal Fusion; Sciatica
PubMed: 38653739
DOI: 10.1038/s41598-024-59629-9 -
European Journal of Public Health Apr 2024We aimed to explore to the possibilities of utilizing automatically accumulating data on health-owned for example by local companies and non-governmental...
BACKGROUND
We aimed to explore to the possibilities of utilizing automatically accumulating data on health-owned for example by local companies and non-governmental organizations-to complement traditional health data sources in health promotion work at the local level.
METHODS
Data for the PUHTI study consisted of postal code level information on sport license holders, drug purchase and sales advertisements in a TOR online underground marketplace, and grocery sales in Tampere. Additionally, open population register data were utilized. An interactive reporting tool was prepared to show the well-being profile for each postal code area. Feedback from the tool's end-users was collected in interviews.
RESULTS
The study showed that buying unhealthy food and alcohol, selling or buying drugs, and participating in organized sport activities differed by postal code areas according to its socioeconomic profile in the city of Tampere. The health and well-being planners and managers of Tampere found that the new type of data brought added value for the health promotion work at the local level. They perceived the interactive reporting tool as a good tool for planning, managing, allocating resources and preparing forecasts.
CONCLUSIONS
Traditional health data collection methods-administrative registers and health surveys-are the cornerstone of local health promotion work. Digital footprints, including data accumulated about people's everyday lives outside the health service system, can provide additional information on health behaviour for various population groups. Combining new sources with traditional health data opens a new perspective for health promotion work at local and regional levels.
PubMed: 38573194
DOI: 10.1093/eurpub/ckae053 -
Journal of Exposure Science &... Mar 2024Environmental epidemiologic studies using geospatial data often estimate exposure at a participant's residence upon enrollment, but mobility during the exposure period...
Environmental epidemiologic studies using geospatial data often estimate exposure at a participant's residence upon enrollment, but mobility during the exposure period can lead to misclassification. We aimed to mitigate this issue by constructing residential histories for participants in the California Teachers Study through follow-up (1995-2018). Address records have been collected from the US Postal Service, LexisNexis, Experian, and California Cancer Registry. We identified records of the same address based on geo-coordinate distance (≤250 m) and street name similarity. We consolidated addresses, prioritizing those confirmed by participants during follow-up questionnaires, and estimating the duration lived at each address using dates associated with records (e.g., date-first-seen). During 23 years of follow-up, about half of participants moved (48%, including 14% out-of-state). We observed greater mobility among younger women, Hispanic/Latino women, and those in metropolitan and lower socioeconomic status areas. The cumulative proportion of in-state movers remaining eligible for analysis was 21%, 32%, and 41% at 5, 10, and 20 years post enrollment, respectively. Using self-reported information collected 10 years after enrollment, we correctly identified 94% of movers and 95% of non-movers as having moved or not moved from their enrollment address. This dataset provides a foundation for estimating long-term environmental exposures in diverse epidemiologic studies in this cohort. IMPACT: Our efforts in constructing residential histories for California Teachers Study participants through follow-up (1995-2018) benefit future environmental epidemiologic studies. Address availability during the exposure period can mitigate misclassification due to residential changes, especially when evaluating long-term exposures and chronic health outcomes. This can reduce differential misclassification among more mobile subgroups, including younger women and those from lower socioeconomic and urban areas. Our approach to consolidating addresses from multiple sources showed high accuracy in comparison to self-reported residential information. The residential dataset produced from this analysis provides a valuable tool for future studies, ultimately enhancing our understanding of environmental health impacts.
PubMed: 38448681
DOI: 10.1038/s41370-023-00631-0 -
Environmental Monitoring and Assessment Sep 2023Climatic changes are known to affect CO intoxications. The purpose of this study was to examine childhood CO intoxications with the Beaufort wind scale (BWS)...
Climatic changes are known to affect CO intoxications. The purpose of this study was to examine childhood CO intoxications with the Beaufort wind scale (BWS) classification of wind speeds. The demographic data (age and sex) and information concerning the hour, day, and month of presentation to the emergency department for cases diagnosed with CO intoxication over a 7-year period between 2015 and 2021 in the pediatric emergency department of a tertiary training and research hospital in a rural area were examined. Wind speeds (m/s) measured on the days of presentation to the emergency department were recorded. The wind category on the BWS on the day of intoxication was then determined. Four hundred twenty-two patients, with a mean age of 95.12 ± 59.4 (1-215) months, 218 (51.7%) girls and 204 (48.3%) boys were diagnosed with CO intoxication over the 7-year study period. A comparison of wind speeds on the days of presentation to hospital revealed a significantly higher wind speed in 2020 than in the other years (p<0.001). A comparison of the groups in terms of the BWS revealed a significant difference between the years of presentation to hospital (p:0.001). This is the first study to investigate CO intoxications in the pediatric emergency department with the BWS. A significant association was observed between wind speed based on the BWS and childhood CO intoxications. Further studies evaluating wind in the rural setting and CO intoxications are now needed for protection against such intoxications.
Topics: Child; Female; Humans; Male; Carbon Monoxide; Emergency Service, Hospital; Environmental Monitoring; Hospitals; Wind; Infant; Child, Preschool; Adolescent
PubMed: 37702873
DOI: 10.1007/s10661-023-11748-y