Within European cross-border health care, recent studies have identified several types of international patients. Within the Anglo-Saxon setting, the specific terminology of medical tourism is used. The analytical purpose of the paper is to resolve this semantic difference by suggesting an alternative terminology, 'transnational health care' that is understood as a 'context-controlled and coordinated network of health services'. For demand-driven trans-border access seekers and cross-border access searchers, there is a need to opt for regional health-policy strategies. For supply-driven sending context actors and receiving context actors, there would be organizational benefits to these strategies.Applying the terminology of trans-border access seekers, cross-border access searchers, sending context and receiving context actors results in a transnational patient mobility typology of twelve types of international patients, based on the criteria of geographical distance, cultural distance and searching efforts, public/private/no cover and private/public provision of health services. Finally, the normative purpose of the paper is to encourage the use of this terminology to promote a policy route for transnational health regions. It is suggested that the development of transnational health regions, each with their own medical and supportive service characteristics, could enhance governmental context-controlled decision power in applying sustainable health destination management.
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Executive Summary - Temperatures across the Middle East region are predicted to increase by 3°C by 2050 - Warming will be felt more in cities because of the urban heat island (UHI) effect, causing heat-related health problems - City planning and management regimes are often disconnected from disaster risk and resilience building and legislation is lacking - Lacking data and information sharing across multiple levels of governance hamper heatwave warning systems - Urban building projects lead to a soaring demand for cooling systems - Traditional adaptations such as street grid design, wind catchers and mashrabiya screens could be used more - Policy response should include national Heat Health Action Plans that are translated into Local Heat Plans, coordinated and implemented by local governments
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Background: Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective: Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods: This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results: The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions: All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication.
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Purpose: Inter-professional collaboration and adaptation of e-health are necessary to implement innovative exercise and nutrition interventions in health practice. The aims of this qualitative study were 1) determine the relevant factors related to successful inter-professional collaboration, and 2) determine the relevant factors for implementation and susceptibility of our blended interventions in older adults, by allied health professionals in the Amsterdam metropolitan region.Methods: This explorative qualitative study was the next step in implementation, subsequent to the VITAMIN RCT. We combined fourteen semistructured interviews with dietitians with two focus-groups of mixed exercise and physiotherapists. After each focus group and interview, the two researchers evaluated and discussed the statements, factors and common beliefs in relation to the research questions. Transcripts were analyzed with MAXQDA software and open, axial and selective coding was adapted.Results: In current practice inter-professional collaboration is not common, mainly due to lacking knowledge about the other profession. Location is a facilitator, as well is previous experience. External factors as higher financial compensation to implement inter-professional work meetings, were defined as possible facilitator to collaboration. Main encouraging factors related to blended interventions were timesaving consults, ability to reach immobile older adults and cost saving healthcare. Main barrier was a lack of e-health literacy in older adults.Conclusions: This study shows that the exercise and nutrition professionals have a positive attitude towards future implementation of these types of blended and combined interventions for older adults. Furthermore, inter-professional collaboration is a point of attention in our regional allied healthcare system.
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Purpose: Interprofessional collaboration and adaptation of e-health are necessary to implement innovative exercise and nutrition interventions in health practice. The aims of this qualitative study were 1) determine the relevant factors related to successful interprofessional collaboration, and 2) determine the relevant factors for implementation and susceptibility of our blended interventions in older adults, by allied health professionals in the Amsterdam metropolitan region.Methods: This explorative qualitative study was the next step in implementation, subsequent to the VITAMIN RCT. In total 45 physiotherapy and 27 dietician practices were selected for recruitment. We combined fourteen semistructuredinterviews with dieticians with two focus-groups of mixed exercise- and physiotherapists. After each focus-group and interview the two researchers evaluated and discussed the statements, factors and common believes in relation to the research questions. Transcripts were analyzed with MAXQDA software, and open, axial and selective coding was adapted by two independent researchers. A third researcher was available if consensus could not be reached.Results: In current practice interprofessional collaboration is not common, mainly due to lacking knowledge about the other profession. Location is a facilitator, as well is previous experience. External factors as higher financialcompensation to implement interprofessional work meetings were defined as possible facilitator to collaboration. The professionals defined a shared electronic patient database as necessity to interprofessional collaboration,especially due to the privacy regulations. Main encouraging factors related to blended interventions were timesaving consults, ability to reach immobile older adults, and cost saving healthcare. Main barrier was lacking e-health literacyof older adults.Conclusions: This study shows that the exercise and nutrition professionals have a positive attitude towards future implementation of these types of blended and combined interventions for older adults. Furthermore, interprofessional collaboration is a point of attention in our regional allied healthcare system. Several external factors related to implementation, like financial compensation, make the adaptation of combined interventions with e-health for older adults challenging.
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Background and Objective: To develop a health care value framework for physical therapy primary health care organizations including a definition. Method: A scoping review was performed. First, relevant studies were identified in 4 databases (n = 74). Independent reviewers selected eligible studies. Numerical and thematic analyses were performed to draft a preliminary framework including a definition. Next, the feasibility of the framework and definition was explored by physical therapy primary health care organization experts. Results: Numerical and thematic data on health care quality and context-specific performance resulted in a health care value framework for physical therapy primary health care organizations—including a definition of health care value, namely “to continuously attain physical therapy primary health care organization-centered outcomes in coherence with patient- and stakeholder-centered outcomes, leveraged by an organization’s capacity for change.” Conclusion: Prior literature mainly discussed health care quality and context-specific performance for primary health care organizations separately. The current study met the need for a value-based framework, feasible for physical therapy primary health care organizations, which are for a large part micro or small. It also solves the omissions of incoherent literature and existing frameworks on continuous health care quality and context-specific performance. Future research is recommended on longitudinal exploration of the HV (health care value) framework.
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Post-war urban neighbourhoods in industrialised countries have been shown to negatively affect the lifestyles of their residents due to their design. This study aims at developing an empirical procedure to select locations to be redesigned and the determinants of health at stake in these locations, with involvement of residents’ perspectives as core issue. We addressed a post-war neighbourhood in the city of Groningen, the Netherlands. We collected data from three perspectives: spatial analyses by urban designers, interviews with experts in local health and social care (n = 11) and online questionnaires filled in by residents (n = 99). These data provided input for the selection of locations to be redesigned by a multidisciplinary team (n = 16). The procedure yielded the following types of locations (and determinants): An area adjacent to a central shopping mall (social interaction, traffic safety, physical activity), a park (experiencing green, physical activity, social safety, social interaction) and a block of low-rise row houses around a public square (social safety, social interaction, traffic safety). We developed an empirical procedure for the selection of locations and determinants to be addressed, with addressing residents’ perspectives. This procedure is potentially applicable to similar neighbourhoods internationally.
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Background: Urban slums are characterised by unique challenging living conditions, which increase their inhabitants’ vulnerability to specific health conditions. The identification and prioritization of the key health issues occurring in these settings is essential for the development of programmes that aim to enhance the health of local slum communities effectively. As such, the present study sought to identify and prioritise the key health issues occurring in urban slums, with a focus on the perceptions of health professionals and community workers, in the rapidly growing city of Bangalore, India. Methods: The study followed a two-phased mixed methods design. During Phase I of the study, a total of 60 health conditions belonging to four major categories: - 1) non-communicable diseases; 2) infectious diseases; 3) maternal and women’s reproductive health; and 4) child health - were identified through a systematic literature review and semi-structured interviews conducted with health professionals and other relevant stakeholders with experience working with urban slum communities in Bangalore. In Phase II, the health issues were prioritised based on four criteria through a consensus workshop conducted in Bangalore. Results: The top health issues prioritized during the workshop were: diabetes and hypertension (non-communicable diseases category), dengue fever (infectious diseases category), malnutrition and anaemia (child health, and maternal and women’s reproductive health categories). Diarrhoea was also selected as a top priority in children. These health issues were in line with national and international reports that listed them as top causes of mortality and major contributors to the burden of diseases in India. Conclusions: The results of this study will be used to inform the development of technologies and the design of interventions to improve the health outcomes of local communities. Identification of priority health issues in the slums of other regions of India, and in other low and lower middle-income countries, is recommended.
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It is unclear to what extent self-employed choose to become self-employed. This study aimed to compare the health care expenditures-as a proxy for health-of self-employed individuals in the year before they started their business, to that of employees. Differences by sex, age, and industry were studied. In total, 5,741,457 individuals aged 25-65 years who were listed in the tax data between 2010 and 2015 with data on their health insurance claims were included. Self-employed and employees were stratified according to sex, age, household position, personal income, region, and industry for each of the years covered. Weighted linear regression was used to compare health care expenditures in the preceding (year x-1) between self-employed and employees (in year x). Compared with employees, expenditures for hospital care, pharmaceutical care and mental health care were lower among self-employed in the year before they started their business. Differences were most pronounced for men, individuals ≥40 years and those working in the industry and energy sector, construction, financial institutions, and government and care. We conclude that healthy individuals are overrepresented among the self-employed, which is more pronounced in certain subgroups. Further qualitative research is needed to investigate the reasons why these subgroups are more likely to choose to become self-employed.
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