The 2015 hospital treatment choice reform in Norway: continuity or change?

In several European countries, including Norway, polices to increase patient choice of hospital provider have remained high on the political agenda. The main reason behind the interest in hospital choice reforms in Norway has been the belief that increasing choice can remedy the persistent problem of long waiting times for elective hospital care. Prior to the 2013 General Election, the Conservative Party campaigned in favour of a new choice reform: “the treatment choice reform”. This article describes the background and process leading up to introduction of the reform in the autumn of 2015. It also provides a description of the content and discusses possible implications of the reform for patients, providers and government bodies. In sum, the reform contains elements of both continuity and change. The main novelty of the reform lies in the increased role of private for-profit healthcare providers

Temporal and spatial assessment of four satellite rainfall estimates over French Guiana and North Brazil

Satellite precipitation products are a means of estimating rainfall, particularly in areas that are sparsely equipped with rain gauges. The Guiana Shield is a region vulnerable to high water episodes. Flood risk is enhanced by the concentration of population living along the main rivers. A good understanding of the regional hydro-climatic regime, as well as an accurate estimation of precipitation is therefore of great importance. Unfortunately, there are very few rain gauges available in the region. The objective of the study is then to compare satellite rainfall estimation products in order to complement the information available in situ and to perform a regional analysis of four operational precipitation estimates, by partitioning the whole area under study into a homogeneous hydro-climatic region. In this study, four satellite products have been tested, TRMM TMPA (Tropical Rainfall Measuring Mission Multisatellite Precipitation Analysis) V7 (Version 7) and RT (real time), CMORPH (Climate Prediction Center (CPC) MORPHing technique) and PERSIANN (Precipitation Estimation from Remotely-Sensed Information using Artificial Neural Network), for daily rain gauge data. Product performance is evaluated at daily and monthly scales based on various intensities and hydro-climatic regimes from 1 January 2001 to 30 December 2012 and using quantitative statistical criteria (coefficient correlation, bias, relative bias and root mean square error) and quantitative error metrics (probability of detection for rainy days and for no-rain days and the false alarm ratio). Over the entire study period, all products underestimate precipitation. The results obtained in terms of the hydro-climate show that for areas with intense convective precipitation, TMPA V7 shows a better performance than other products, especially in the estimation of extreme precipitation events. In regions along the Amazon, the use of PERSIANN is better. Finally, in the driest areas, TMPA V7 and PERSIANN show the same performance

The intensification of thermal extremes in west Africa

International audienceThis study aims in filling the gap in understanding the relationship between trend and extreme in diurnal and nocturnal temperatures (Tx and Tn) over the Gulf of Guinea area and the Sahel. Time-evolution and trend of Tx and Tn anomalies, extreme temperatures and heat waves are examined using regional and station-based indices over the 1900–2012 and 1950–2012 periods respectively. In investigating extreme temperature anomalies and heat waves, a percentile method is used. At the regional and local scales, rising trends in Tx and Tn anomalies, which appear more pronounced over the past 60 years, are identified over the two regions. The trends are characterized by an intensification of: i) nocturnal/Tn warming over the second half of the 20th century; and ii) diurnal/Tx warming over the post-1980s. This is the same scheme with extreme warm days and warm nights. Finally annual number of diurnal and nocturnal heat waves has increase over the Gulf of Guinea coastal regions over the second half of the 20th century, and even more substantially over the post-1980s period. Although this trend in extreme warm days and nights is always overestimated in the simulations, from the Coupled Model Intercomparison Project Phase 5 (CMIP5), those models display rising trends whatever the scenario, which are likely to be more and more pronounced over the two regions in the next 50 years

Effects of a soluble dietary fibre NUTRIOSE® on colonic fermentation and excretion rates in rats

The resistant dextrin NUTRIOSE®, developed from starch, is expected to act as a prebiotic. The aim of this study was to determine the effects of NUTRIOSE® on cecal parameters, short-chain fatty acid (SCFA) concentrations, and fecal excretion in rats. In an initial experiment, twenty-four male Fischer F344 rats were randomly assigned to one of the following four treatments for 14 days: G0 (control diet), G2.5 (control diet + 2.5% of dextrin), G5 (control diet + 5% of dextrin), and G10 (control diet + 10% of dextrin). After 14 days, total cecal weight, cecal content, and cecal wall weight were significantly increased in G5 and G10 compared to G0. At the same time, cecal pH was significantly lower in G10 compared to G0. Total SCFA concentration was significantly higher in G10 than in G5, G2.5, and G0, and significantly higher in G5 than in G0. Acetate, butyrate, and propionate concentrations were significantly increased in G5 and G10 compared to the controls. In a second trial based on a similar design, eighteen male Fischer F344 rats were treated with a control diet supplemented with 5% of dextrin or 5% of fructo-oligosaccharide. The results obtained with NUTRIOSE® were similar to those obtained with the fructo-oligosaccharide. In a third experiment, two groups of 5 Fischer F344 rats were orally treated with 100 and 1,000 mg/kg NUTRIOSE®, respectively, and from 18% to 25% of the dextrin was excreted in the feces. The results of these three studies show that the consumption of NUTRIOSE®, by its effects on total cecal weight, cecal content, cecal wall weight, pH, and SCFA production, could induce healthy benefits since these effects are reported to be prebiotic effects

Are waiting times for hospital admissions affected by patients' choices and mobility?

Background Waiting times for elective care have been considered a serious problem in many health care systems. A topic of particular concern has been how administrative boundaries act as barriers to efficient patient flows. In Norway, a policy combining patient's choice of hospital and removal of restriction on referrals was introduced in 2001, thereby creating a nationwide competitive referral system for elective hospital treatment. The article aims to analyse if patient choice and an increased opportunity for geographical mobility has reduced waiting times for individual elective patients. Methods A survey conducted among Norwegian somatic patients in 2004 gave information about whether the choice of hospital was made by the individual patient or by others. Survey data was then merged with administrative data on which hospital that actually performed the treatment. The administrative data also gave individual waiting time for hospital admission. Demographics, socio-economic position, and medical need were controlled for to determine the effect of choice and mobility upon waiting time. Several statistical models, including one with instrument variables for choice and mobility, were run. Results Patients who had neither chosen hospital individually nor bypassed the local hospital for other reasons faced the longest waiting times. Next were patients who individually had chosen the local hospital, followed by patients who had not made an individual choice, but had bypassed the local hospital for other reasons. Patients who had made a choice to bypass the local hospitals waited on average 11 weeks less than the first group. Conclusion The analysis indicates that a policy combining increased opportunity for hospital choice with the removal of rules restricting referrals can reduce waiting times for individual elective patients. Results were robust over different model specifications

Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme