Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Welfare Law and the Construction of Social Citizenship

The paper is written as a part of the research project «Judicialisation and Social Citizenship», funded by the Norwegian Research Council (the Welfare, Work and Migration programme (Vam)). It was presented at the conference «Challenging Citizenship», Coimbra Portugal, 3–5 June 2011The paper elaborates on the relationship between social citizenship and juridification. Departing from a Marshallian understanding of social citizenship, juridification processes concern the institutional construction of social citizenship by combining collective political obligations on the one hand and individual rights and duties on the other. One important intention of the paper is to elaborate on how social citizenship is constructed in the possible tension field between political, administrative and legal institutions. How does welfare law affect the relationship between welfare administration/professions and individuals (e.g. social and civil rights) and between law and politics (e.g. social and political rights)? The institutionalization of social citizenship has to be studied on the basis of different areas of welfare law. This is exemplified by two empirical cases: the legal development in the field of work and welfare on the one hand and health services on the other. In the field of health services it seems reasonable to say that a juridification process has taken place in Norway - implying a reinforcement of individual patients’ rights and thus a strengthening of social citizenship. The expansion of rights within the sector encompasses claims to certain services and through the legislation patients are granted procedural rights and an increased opportunity to decide on questions concerning medical examination and treatment. In the field of social policy individual legal rights to social benefits have increasingly been comprehended as to render people passive, leading to a stronger coupling between individual rights and duties expressed through the establishment of quasi-contractual legal arrangements. It may be argued that contractualism implies de-juridification in the way that it emphasizes tailor-made services and increased local discretion in the preparation of the content of welfare policies (weak legal control).Dette paperet retter søkelyset mot forholdet mellom rettsliggjøring og sosialt medborgerskap. Med utgangspunkt i et Marshalliansk perspektiv kan rettsliggjøringsprosesser sies å berøre den institusjonelle konstruksjonen av sosialt medborgerskap gjennom å kombinere kollektive politiske forpliktelser på den ene siden og individuelle rettigheter og plikter på den andre. Et viktig mål med dette arbeidet er å undersøke hvordan sosialt medborgerskap konstrueres i spenningsfeltet mellom politiske, administrative og rettslige institusjoner. Hvordan påvirker velferdsretten relasjonen mellom velferdsadministrasjon/profesjon og den enkelte borger og mellom rett og politikk? Institusjonaliseringen av sosialt medborgerskap må studeres med utgangspunkt i konkrete deler av velferdsretten. I paperet er dette eksemplifisert gjennom to empiriske case: rettsutviklingen på områdene helse og arbeid/velferd. På helseområdet er det rimelig å si at det har foregått en rettsliggjøringsprosess i Norge hvor individuelle pasientrettigheter har stått sentralt. Utviklingen omfatter både en utvidet rett til bestemte tjenester, nye prosedurale rettigheter og en større rett til å velge når det gjelder beslutninger som angår medisinske undersøkelser og behandling. På området velferd/arbeid har retten til velferdsytelser i større grad blitt sett på som passiviserende i forhold til den enkeltes deltakelse i arbeidsmarkedet. Dette har resultert i en sterkere kopling mellom individuelle rettigheter og plikter blant annet uttrykt gjennom en økt bruk av kvasi-kontraktuelle arrangementer i iverksettingen av velferdspolitikken. Det kan argumenters for at en slik kontraktualisme innebærer en materiell avrettsliggjøring i den forstand at den innebærer økt individualisering (skreddersøm) og større rom for lokal skjønnsutøving i utformingen av velferdstjenester (svakere rettslig kontroll)

Welfare Law and the Construction of Social Citizenship

The paper elaborates on the relationship between social citizenship and juridification. Departing from a Marshallian understanding of social citizenship, juridification processes concern the institutional construction of social citizenship by combining collective political obligations on the one hand and individual rights and duties on the other. One important intention of the paper is to elaborate on how social citizenship is constructed in the possible tension field between political, administrative and legal institutions. How does welfare law affect the relationship between welfare administration/professions and individuals (e.g. social and civil rights) and between law and politics (e.g. social and political rights)? The institutionalization of social citizenship has to be studied on the basis of different areas of welfare law. This is exemplified by two empirical cases: the legal development in the field of work and welfare on the one hand and health services on the other. In the field of health services it seems reasonable to say that a juridification process has taken place in Norway - implying a reinforcement of individual patients’ rights and thus a strengthening of social citizenship. The expansion of rights within the sector encompasses claims to certain services and through the legislation patients are granted procedural rights and an increased opportunity to decide on questions concerning medical examination and treatment. In the field of social policy individual legal rights to social benefits have increasingly been comprehended as to render people passive, leading to a stronger coupling between individual rights and duties expressed through the establishment of quasi-contractual legal arrangements. It may be argued that contractualism implies de-juridification in the way that it emphasizes tailor-made services and increased local discretion in the preparation of the content of welfare policies (weak legal control)

Samarbeid arbeid og helse. Problemrepresentasjoner og blindsoner

Artikkelen stiller spørsmål om hvilke forståelser som ligger til grunn for myndighetenes problembeskrivelser og løsningsforslag på arbeid-helsefeltet. Den tar utgangspunkt i en pågående satsing mellom Helsedirektoratet og Arbeids- og velferdsdirektoratet om styrket samarbeid mellom helse- og velferdssektoren. Med utgangspunkt i Carol Bacchis «what is the problem represented to be»-tilnærming gir vi en analyse av satsingen. Strategiens forutsetninger om arbeid som helsefremmende, og at prioriteringskriterier og veiledere styrer atferd, vies særlig oppmerksomhet som illustrasjoner på at en bestemt problemrepresentasjon nødvendigvis skygger for andre forståelser og løsninger

Rettslig regulering og e-helse

The health services in Norway are subject to extensive legal regulation to ensure fair distribution of healthcare. In this chapter, we question whether the growing importance of e-health / digitalization of public services in general can support the legal regulation. Access to specialist health services requires interaction between the different organizational levels in the health service, as well as face-to-face health encounters between patients and physicians. The analytical concept «barriers to interaction» is used to discuss the relationship between legal regulation and e-health, more precisely how use of health-related information on Internet impact on these processes. Barriers are here understood in relation to making contact, to competency and efficiency in interaction between service users and services providers. Access to Internet and knowledge about digital health resources can change the impact of the barriers and affect access to specialist health services. E-health literacy are increasingly important, but varies with age, gender and education. The development of e-health may increase barriers for some, and lower them for others. E-health changes the organization of health care, and provide access to quality assured health-related information. Because the e-health field changes very quickly, researchers, patients and healthcare personnel must monitor and act upon wanted and unwanted consequences of e-health

Rettslig regulering og e-helse

The health services in Norway are subject to extensive legal regulation to ensure fair distribution of healthcare. In this chapter, we question whether the growing importance of e-health / digitalization of public services in general can support the legal regulation. Access to specialist health services requires interaction between the different organizational levels in the health service, as well as face-to-face health encounters between patients and physicians. The analytical concept «barriers to interaction» is used to discuss the relationship between legal regulation and e-health, more precisely how use of health-related information on Internet impact on these processes. Barriers are here understood in relation to making contact, to competency and efficiency in interaction between service users and services providers. Access to Internet and knowledge about digital health resources can change the impact of the barriers and affect access to specialist health services. E-health literacy are increasingly important, but varies with age, gender and education. The development of e-health may increase barriers for some, and lower them for others. E-health changes the organization of health care, and provide access to quality assured health-related information. Because the e-health field changes very quickly, researchers, patients and healthcare personnel must monitor and act upon wanted and unwanted consequences of e-health.publishedVersio

Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark

Objective: This article explores the implications of legal regulation for medical discretion and decision-making in Norway and Denmark. Methods: The article is based on a cross-national cross-sectional survey exploring cardiologists’ assessments of patient eligibility for specialist health care. Forty-two cardiologists in Norway and 48 in Denmark were presented with two standardized case vignettes in the form of patient referrals and were asked to assess whether the patient was eligible for treatment by a specialist, and if so, what waiting time would be assigned to the patient. Results: Primarily based on descriptive statistics, our findings indicate interesting similarities and variations. While there was only minor variation across the countries in cardiologists’ professional assessments about a patient with a more severe condition, judgements of eligibility for specialist treatment varied for a patient with a less severe medical condition. Moreover, Danish cardiologists distinguished between the more severe and less severe conditions to a much lesser extent when assessing eligibility for specialist treatment. For waiting times, there was considerable variation at the general level, from 1 week to 6 months. The assigned waiting times were on average double those for Norwegian cardiologists compared with their Danish counterparts. Denmark’s legal standardization of waiting times appears to lead to shorter waiting times than those prescribed by Norway’s legal regulations. Conclusion: For a single clear overall intention with a new policy, simpler legal regulations may be more effective than very detailed and specific requirements. If policymakers’ overall intention is for medical doctors to make complex decisions involving the prioritization of patients, then more individualized regulations seem to be a better tool