What patients with cancer think about the dehospitalization. A survey of Cipomo.

اهداف: کیفیت زندگی، مفهومی پیچیده و چندبعدی است که تحت تأثیر مولفه هایی چون زمان و مکان، ارزش‌های فردی و اجتماعی از سوی متفکران علوم شهری و سایر اندیشمندان علوم مختلف مطرح و مورد پژوهش قرار گرفته است. تحقیق حاضر با هدف بررسی شاخص‌های کیفیت زندگی و سنجش آن در شهر مرکزی زرین دشت (حاجی‌آباد) بر مبنای 4 گروه شاخص‌های اقتصادی، اجتماعی، خدماتی و کالبدی صورت گرفته است. روش: روش تحقیق، در این مقاله توصیفی- تحلیلی و ابزار آن پرسش‌نامه می‌باشد. روایی پرسش‌نامه با استفاده از نظرات متخصصان و پایایی آن با استفاده از محاسبه آلفای کرونباخ (72%) تعیین شد. جامعۀ آماری در این پژوهش7 محله از شهر حاجی‌آباد (20000نفر) می‌باشد که با استفاده از فرمول کوکران 377 نمونه انتخاب گردید و به‌صورت تصادفی در هر محله پرسش‌نامه توزیع شد. تجزیه و تحلیل پرسش‌نامه با استفاده ازآمار توصیفی، همبستگی و رگرسیون چندگانۀ خطی انجام شد و در نهایت از روش آنتروپی شانون جهت وزن‌دهی شاخص‌ها و تکنیک پرومتی جهت رتبه‌بندی محلات به‌کار گرفته شد. یافته‌ها/نتایج: یافته‌های پژوهش نشان داد که در شهر حاجی‌آباد، محلۀ فرهنگیان بالاترین سطح کیفیت زندگی شهری و محلۀ حسین‌آباد، پایین‌ترین سطح کیفیت را در بین محلات دارد. همچنین در بررسی ابعاد چهارگانۀ شاخص کیفیت زندگی همبستگی مستقیم و معناداری وجود داشته و هر یک از این ابعاد همبستگی معناداری با رضایتمندی نهایی از کیفیت زندگی دارند و از بین شاخص‌های کیفیت زندگی، شاخص اقتصادی بیشترین تأثیر را در کیفیت محلات دارد.

The accessibility to healthcare facilities is closely linked to people's health and quality of life, which is especially evident in densely populated metropolises, such as Shanghai, China. Access to healthcare facilities is determined by various spatial and nonspatial factors, such as population, transportation modes, travel time, and the reputation of hospitals. In this research, with the consideration of all these factors mentioned above, a new approach based on the two‐step floating catchment area method and multi‐source datasets was proposed to measure the accessibility to these hierarchical healthcare facilities in Shanghai, China, including secondary hospitals and tertiary hospitals. In addition, a web mapping Application Programming Interface (API) was employed in this research to retrieve the traffic cost for different transportation modes and the analytic hierarchy process approach was also employed to help calculate the comprehensive accessibility in Shanghai considering both different types of hospitals and different modes of transportation. The results show that depending on modes of transportation, significant differences can be seen in accessibilities to different types of healthcare facilities. The calculated comprehensive accessibility reflects that the central regions in the research area have higher accessibility compared to the surrounding areas in Shanghai in general and more detailed spatial patterns could also been seen from the accessibility map. The research findings can also be utilized to support the better allocation of healthcare facilities at various levels.

ObjectivesTo investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.DesignThe study is a cross-sectional spatial interaction analysis...

AIMS OF THE PAPERThe aim of this study is to examine the association between smart city development and residents’ qualityof life in Budapest. This includes evaluating urban consumers’ perceptions and attitudes towards existingsmart solutions in the city across various aspects of their life. METHODOLOGYThe research employed a trilingual questionnaire (English, Hungarian and Mandarin Chinese) to accommodateBudapest’s diverse population of resident consumers. The data collection yielded 453 valid responses.Distribution occurred through both electronic platforms (web-based interfaces, QR codes, DistrictForums, expatriate networks) and paper-based instruments, which were completed by interviewers in variousdistricts of the city. MOST IMPORTANT RESULTSRespondents generally have a positive image of Budapest, and they find the city relatively safe. Budapest’surban environment is rated quite positively, especially the city’s atmosphere. Consumers find public transportefficient, easy to use and easy to navigate. Smart transportation-related services (mobile apps, ticketing,electronic information boards) were rated highly. However, respondents are not so happy with theparking situation and overall traffic management. They are least happy with the quality and cost of housing,followed by healthcare and low salaries compared to the cost of living. Also, they do not see Budapest asa very clean or sustainable city. RECOMMENDATIONSIt is important to build on the city’s strengths (e.g., efficient transport system, cultural attractions, goodatmosphere) and to address apparent weaknesses (e.g., cleanliness, lack of parking). The city should bemade safer for certain groups of residents (e.g., women) and the number of local green spaces should beincreased for older residents who might find it harder to access central locations. Sustainability needs tobe communicated more prominently, and residents, especially those less confident (e.g., older residents),should be encouraged to use smart tools.

Background: In Ghana, a blood group and rhesus type test is one of the essential recommended screening tests for women during antenatal care since blood transfusion is a key intervention for haemorrhage. We estimated the spatial accessibility to health facilities for blood group and type point-of-care (POC) testing in the Upper East Region (UER), Ghana. Methods: We assembled the attributes and spatial data of hospitals, clinics, and medical laboratories providing blood group and rhesus type POC testing in the UER. We also obtained the spatial data of all the 131 towns, and 94 health centres and community-based health planning and services (CHPS) compounds providing maternal healthcare in the region. We further obtained the topographical data of the region, and travel time estimated using an assumed tricycle speed of 20 km/h. We employed ArcGIS 10.5 to estimate the distance and travel time and locations with poor spatial access identified for priority improvement. Findings: In all, blood group and rhesus type POC testing was available in 18 health facilities comprising eight public hospitals and six health centres, one private hospital, and three medical laboratories used as referral points by neighbouring health centres and CHPS compounds without the service. Of the 94 health centres and CHPS compounds, 51.1% (48/94) and 66.4% (87/131) of the towns were within a 10 km range to a facility providing blood group and rhesus type testing service. The estimated mean distance to a health facility for blood group and rhesus POC testing was 8.9 ± 4.1 km, whilst the mean travel time was 17.8 ± 8.3 min. Builsa South district recorded the longest mean distance (25.6 ± 7.4 km), whilst Bongo district recorded the shortest (3.1 ± 1.9 km). The spatial autocorrelation results showed the health facilities providing blood group and rhesus type POC testing were randomly distributed in the region (Moran Index = 0.29; z-score = 1.37; p = 0.17). Conclusion: This study enabled the identification of district variations in spatial accessibility to blood group and rhesus type POC testing in the region for policy decisions. We urge the health authorities in Ghana to evaluate and implement recommended POC tests such as slide agglutination tests for blood group and rhesus type testing in resource-limited settings.

Hub networks have always been acriticalissue in locating health facilities. Recently, a study has been investigated by Cocking et al. (2006)in Nouna health district in Burkina Faso, Africa, with a population of approximately 275,000 people living in 290 villages served by 23 health facilities. The travel times of the population to health services become extremely high during the rainy season, since many roads are unusable. In this regard, for many people, travelling to a health facility is a deterrent to seeking proper medical care. Furthermore, in real applications of hub networks, the travel times may vary due to traffic, climate conditions, and land or road type.To handle this challenge this paper considers the travel times are assumed to be characterized by trapezoidal fuzzy variables in order to present a fuzzy green capacitated single allocation p-hub center system (FGCSApHCP) with uncertain information. The proposed FGCSApHCP is redefined into its equivalent parametric integer nonlinear programming problem using credibility constraints. The aim is to determine the location of pcapacitated hubs and the allocation of center nodes to them in order to minimize the maximum travel time in a hub-and-center network in such uncertain environment. As the FGCSApHCP is NP-hard, a novel algorithmcalledoppositionbiogeography based optimizationis developed to solve that. This algorithm utilizes a binary oppositionbased learning mechanism to generate a diversity mechanism. At the end, both the applicability of the proposed approach and the solution methodologies are demonstrated using GAMS/BARON Software under severalkind of problems. Sensitivity analyses on the number of hubs and center nodes are conducted toprovide more insights as well.

BackgroundThe World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) currently have no benchmarks or ‘norms’ for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Our objective was to understand which systematic reviews had addressed the following norms in the last five years: number of SSN beds per live births in a district or similar administrative unit (admission beds); space requirements for SSN units, including mother-infant dyads (space); health workforce ratios in SSN units (workforce); and travel time to health facilities with SSN units (travel time).MethodsWe searched for systematic reviews of admission beds, space, workforce and travel time norms for SSN under 28 days of age and their mothers in all health facilities and countries, regardless of infant gestational age and birth weight, that had been published in the previous five years (2018–23). For beds, space, and workforce norms, we searched for reviews of prevalence, incidence, mean and median estimates. For the travel time norm, we searched for reviews of estimates of effect, i.e. dichotomous (e.g. relative risks) or continuous measures (e.g. mean differences).ResultsWe identified 9110 records and included eight systematic reviews published in the last five years: two related to space, five to workforce, and one to travel time norms. We found no reviews for admission bed norms. Two reviews included high income countries only, while three included tertiary neonatal intensive care units only. The reviews provided estimates of mean space requirements in SSN units, health workforce ratios of doctors and nurses, and optimal travel time to health facilities for SSN. Seven of the eight reviews had high risk of bias.ConclusionsDespite the high burden of SSN in LMICs and the need to scale up hospital care, there have been few systematic reviews into this topic, and rigorous syntheses of evidence are lacking. The WHO and the UNICEF have now commissioned four systematic reviews. The next steps will be to analyse real-world country-level data and develop implementation guidance.RegistrationPROSPERO: CRD42023417847, CRD42023451302, CRD42023478512, CRD42023453644.

Relevance: This study analyzes the health status of women diagnosed with ovarian cancer, with a particular focus on identifying factors that influence their quality of life and evaluating their access to healthcare services and the level of disease-related awareness. Ovarian cancer remains one of the most prevalent oncological conditions affecting women, and its frequent late-stage diagnosis significantly contributes to poor prognostic outcomes. It is important to understand how different aspects of a patient’s life affect their emotional and physical well-being. The study aimed to investigate the impact of socio-economic and psychological factors on the quality of life of women diagnosed with ovarian cancer in the Abay Region, and to evaluate the existing relationships between factors within the framework of a multicenter study. Methods: The study included 35 women with a verified ovarian cancer. Data was collected using a questionnaire comprising items related to travel time to healthcare facilities, educational attainment, marital status, financial circumstances, caregiving responsibilities, and the range of symptoms experienced by participants. Both quantitative and qualitative analytical methods were applied to interpret the collected data. Results: A total of 68.6% of participants reported a travel time of 30 to 60 minutes to reach a healthcare facility, a factor that may negatively influence their overall well-being. Regarding educational attainment, 54.3% of the women had completed secondary vocational education. Similarly, 54.3% of respondents were married, suggesting the presence of a potential source of social support. In terms of economic status, 48.6% rated their income as average, which may have implications for their ability to access timely and comprehensive treatment. Additionally, 68.6% of participants reported having no caregiving responsibilities, potentially reducing their emotional burden. The most frequently reported symptoms were general weakness (48.6%) and abdominal enlargement (57.1%). Notably, the majority of respondents (42.9%) sought care from gynecologic oncologists. Conclusion: The study found that socio-economic factors such as education level and financial status have a significant impact on the quality of life of women with ovarian cancer. A considerable proportion of participants reported reasonable travel times to healthcare facilities and access to medical specialists, underscoring the critical role of timely diagnosis and appropriate treatment in managing the disease. However, there is a need to increase awareness of the disease and access to psychological support.

Relevance: This study analyzes the health status of women diagnosed with ovarian cancer, with a particular focus on identifying factors that influence their quality of life and evaluating their access to healthcare services and the level of disease-related awareness. Ovarian cancer remains one of the most prevalent oncological conditions affecting women, and its frequent late-stage diagnosis significantly contributes to poor prognostic outcomes. It is important to understand how different aspects of a patient’s life affect their emotional and physical well-being. The study aimed to investigate the impact of socio-economic and psychological factors on the quality of life of women diagnosed with ovarian cancer in the Abay Region, and to evaluate the existing relationships between factors within the framework of a multicenter study. Methods: The study included 35 women with a verified ovarian cancer. Data was collected using a questionnaire comprising items related to travel time to healthcare facilities, educational attainment, marital status, financial circumstances, caregiving responsibilities, and the range of symptoms experienced by participants. Both quantitative and qualitative analytical methods were applied to interpret the collected data. Results: A total of 68.6% of participants reported a travel time of 30 to 60 minutes to reach a healthcare facility, a factor that may negatively influence their overall well-being. Regarding educational attainment, 54.3% of the women had completed secondary vocational education. Similarly, 54.3% of respondents were married, suggesting the presence of a potential source of social support. In terms of economic status, 48.6% rated their income as average, which may have implications for their ability to access timely and comprehensive treatment. Additionally, 68.6% of participants reported having no caregiving responsibilities, potentially reducing their emotional burden. The most frequently reported symptoms were general weakness (48.6%) and abdominal enlargement (57.1%). Notably, the majority of respondents (42.9%) sought care from gynecologic oncologists. Conclusion: The study found that socio-economic factors such as education level and financial status have a significant impact on the quality of life of women with ovarian cancer. A considerable proportion of participants reported reasonable travel times to healthcare facilities and access to medical specialists, underscoring the critical role of timely diagnosis and appropriate treatment in managing the disease. However, there is a need to increase awareness of the disease and access to psychological support.

Background: The phenomenon in Indonesia is still the number of mothers giving birth does not use health facilities and with the help of non-health workers, which can affect the high maternal mortality rate. South Central Timor District is one of the regencies in East Nusa Tenggara province with the highest maternal mortality rate of 290/100,000 live births. In addition, the problem of access to health facilities is low, due to the affordability of locations where health services are difficult, the type and quality of service and affordability to information (WHO, 2008). Methods: observational analytic with a cross-sectional design. The number of sample of 95 respondents. Sampling technique is systematic random sampling. Data analysis using SPSS. Descriptive analysis to describe the frequency distribution of each variable, the chi-square test used for bivariate analysis is to assess the relationship between independent variables with a dependent. Statistical test with a 5% significance level. Result: labor guarantee has p-value 0,003 (OR 0,098, 95% CI: 0,019-0,509), distance of residence with p-value 0,498 (OR 1,822 95% CI 0,428-7,761), travel time with p-value 0,710 (OR 1,292 95% CI 0.299-5,583), community habits in choosing the birthplace with p-value 0.010 (OR 13.833 95% CI 2,282-83,861). Multivariate analysis showed that labor delivery and community habits in choosing delivery sites were the strongest determinants of the utilization of maternity sites compared to other variables. Conclusions: Guaranteed labor and community habits in choosing a delivery venue have a significant relationship with the utilization of delivery at health facilities. While the distance between the residence and the travel time is not significant to the utilization of delivery places in health facilities.

Background Rehabilitation has been shown to improve exercise capacity, quality of life and reduce hospital admissions in pulmonary and cardiac disease. These diseases may be complicated by obesity and comorbidities. Patients with complex chronic diseases may not be offered the opportunity to attend rehabilitation programs and therefore miss out. Aim To identify issues and implement changes to improve access to rehabilitation for people with chronic respiratory, cardiac and metabolism and obesity (MO CR at two hospitals; no MO lack of programs for MO family doctors unaware of ability to refer and lack of parking. Changes implemented were: long-term attendees discharged to community exercise programs to reduce waiting lists; new CR commenced; new MO referrals from family doctors and immediately following hospital discharge encouraged; disabled parking increased. Compared to the previous year, there was a 50% increase in number of CR programs, 56% increase in attendance at CR and 100% increase in M&O hydrotherapy program. No change to pulmonary rehabilitation attendance. Conclusion The chronic disease rehabilitation redesign project identified important access issues. Changes were implemented that have improved access to rehabilitation programs for people with chronic diseases.

1684PD_PR - Physical activity (PA) and patterns of quality of life (QOL) after adjuvant chemotherapy (CT) for breast cancer (BC)

Measuring the spatial accessibility and capacity of healthcare facilities is an important task to improve the quality of health services and reduce the pressure on them. This research assesses the current spatial accessibility and capacity of two-level of healthcare facilities (comprehensive healthcare centers and hospitals) in the Greater Irbid Municipality using the enhanced two-step floating catchment area (E2SFCA) method. To do this, Network analysis techniques including original-destination matrix (OD), service area, and location-allocation were employed for determining the travel time from residents' points towards every healthcare facility, the service coverage and capacity within travel time zones, and the number of served areas by every healthcare facility. Then, optimum locations for new healthcare facilities that improve the accessibility and capacity rates were determined. The results show that while all areas in the study area are located within a 30-minute drive from the hospital's locations, 18 out of 23 areas are within 15 minutes drive towards the comprehensive health centers. This means that 28.80% of the population needs more than 15 minutes of driving time to access the second level of healthcare services. In addition, the annual average of the actual patient-doctor ratio ranges from 1338 to 2900 patients per doctor in the hospitals, and 2676 to 8524 patients per doctor in the comprehensive healthcare centers, and thus, the health services are inadequate in the study area. Furthermore, the suggested new healthcare facilities in terms of the numbers and optimum location would improve the spatial accessibility and the capacity ratio.

ObjectivesModelling and assessing the loss of geographical accessibility is key to support disaster response and rehabilitation of the healthcare system. The aim of this study was therefore to estimate postdisaster...

Objective To compare the effect of different regimens (capecitabine plus docetaxel vs capecitabine plus vinorelbine) on the quality of life in anthracycline-resistant advanced breast cancer patients. Methods This was a prospective, open, single-centered, phase 3 randomized trial, including 206 anthracycline-resistant advanced breast cancer patients in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. They were treated by different regimens of chemotherapy (capecitabine plus docetaxel vs capecitabine plus vinorelbine) and divided into two groups accordingly: TX group received intravenous infusion of 75 mg/m2 docetaxel on day 1 and 1 g/m2 capecitabine twice per day on days 1-14, every 3 weeks; NX group received 25 mg/m2 vinorelbine on days 1 and 8 and 1 g/m2 capecitabine twice per day, on days 1-14, every 3 weeks. After the treatment of 6-8 cycles, the patients with clinical response continued the maintenance treatment of capecitabine. Totally 98 patients were evaluated by quality of life (QOL)scale and functional assessment of cancer therapy-breast cancer (FACT-B), including 48 patients in TX group and 50 patients in NX group. Using t test, QOL and FACT-B scores in two groups were compared before and after treatment. χ2 test was used to compare the number of cases. The rank sum test was used to analyze the rank data. Results In TX group, QOL score was 55.08±4.64 and 52.58±5.38 before and after chemotherapy, indicating a significant difference (t=4.417, P<0.001). In NX group, QOL score was 53.22±4.95 and 50.94±5.29 before and after treatment, indicating a significant difference (t=4.347, P<0.001). FACT-B scores showed no significant difference before and after treatment in TX group and NX group (95.94±17.54 vs 93.13±16.65, t=1.826, P=0.074, 94.28±14.60 vs 91.40±12.96, t=1.956, P=0.056). The score gap before and after treatment presented no significant difference between TX group and NX group (QOL: 2.50±4.18 vs 2.42±3.83, t=0.099, P=0.921; FACT-B: 2.40±10.45 vs 2.88±10.41, t=-0.230, P=0.819). According to QOL scores, the patients showed significant differences in the loss of appetite, fatigue, decreased mental status and affected sleep between TX and NX groups [58.33%(28/48) vs 36.00%(18/50), χ2=4.904, P=0.027; 54.17%(26/48) vs 34.00%(17/50), χ2=4.045, P=0.044; 33.33%(16/48)vs 16.00%(8/50), χ2=3.979, P=0.046; 31.25%(15/48) vs 14.00%(7/50), χ2=4.186, P=0.041). FACT-B scores showed that the proportion of nausea patients was 52.08%(28/48) in TX group and 22.00%(11/50) in NX group, indicating a significant difference (χ2=9.537, P=0.002); the proportion of patients with pain symptom was 29.17%(14/48) in TX group and 40.00%(20/50) in NX group, indicating no significant difference (χ2=1.269, P=0.260). According to the treatment outcome, 78 patients showed clinical response, the chemotherapy was ineffective in 20 patients and there was no significant difference in life quality between two groups(QOL: 2.32±4.05 vs 3.00±3.74, t=-0.679, P=0.499; FACT-B: 1.90±10.84 vs 5.55±7.90, t=-1.411, P=0.161). In 78 patients with clinical response, there was no significant difference between the patients with hand-foot syndrome and the patients without (QOL: 1.50±4.37 vs 2.53±3.98, t=-0.907, P=0.367; FACT-B: 0.25±7.52 vs 2.32±11.56, t=-0.679, P=0.499). None had hand-foot syndrome in 20 patients with no clinical response. Conclusions TX and NX regimens of chemotherapy may have little influence on life quality of advanced breast cancer patients. The chemotherapy efficacy and the occurrence of hand-foot syndrome produce no remarkable effect on life quality of pateints. Key words: Breast neoplasms; Quality of life; Capecitabine; Docetaxel; Vinorelbine