Coupling Relationship of Human Activity and Geographical Environment in Stage-Specific Development of Urban Coastal Zone: A Case Study of Quanzhou Bay, China (1954–2020)

Owing to the development of the social economy, the geographical environment and ocean utilization patterns of urban coastal zones have changed. This change, in turn, has influenced the socio-economic development of urban coastal zones. Based on the Geographic Information System technology, the area, coastline length, and shoreland use function of reclamation areas were obtained from the geographic charts (1954–2020) and remote sensing data (1988–2017) of Quanzhou Bay. In this study, we analyzed the geomorphologic change process and the relationship between land use patterns and economic development in Quanzhou Bay from the perspectives of hydrodynamics, sediments, and human activity. Our results indicated that over the past 70 years, the bay area has reduced by 21.5%. The length of the coastline decreased from 208.36 km in 1959 to 149.11 km in 1988, whereas the shape index of the bay (SIB) decreased from 3.09 to 2.41 during the same period. Between 1988 and 2017, the coastline increased to 162.91 km, causing the SIB to increase to 2.72. The artificial index of the bay increased from 0.28 in 1959 to 0.90 in 2017. The intensity of bay the development (IBD) first increased from 0.27 in 1959 to 0.77 in 2006. During the transition to a more modern society (2006 to present), the IBD slightly decreased to 0.73 in 2017. Affected by human activity, the transformation of the reclaimed land in Quanzhou Bay can be divided into four stages that are closely linked to the economic development in the region. In the early industrialization period, reclaimed land in the region was used for agricultural production, whereas in the mid-industrialization period, it was gradually transformed into a combination of industrial (29.8%) and agricultural (56.1%) lands. In the later period of industrialization, the reclaimed land was gradually converted into urban industrial and port lands. Finally, with further refinement and upgrading of economic and industrial structures, the socio-economic and environmental benefits from coastal reclamation projects have been increasing, whereas the proportion of economic benefits (in the total benefits) has been decreasing. The results of this study can provide decision-making references for the optimization of utilization patterns and the economic development of reclamation lands in coastal areas.

Profiles and predictors of healthcare utilization: using a cluster-analytic approach to identify typical users across conventional, allied and complementary medicine, and self-care

Introduction The identification of typologies of health care users and their specific characteristics can be performed using cluster analysis. This statistical approach aggregates similar users based on their common health-related behavior. This study aims to examine health care utilization patterns using cluster analysis; and the associations of health care user types with sociodemographic, health-related and health-system related factors. Methods Cross-sectional data from the 2012 National Health Interview Survey were used. Health care utilization was measured by consultations with a variety of medical, allied and complementary health practitioners or the use of several interventions (exercise, diet, supplementation etc.) within the past 12 months (used vs. not used). A model-based clustering approach based on finite normal mixture modelling, and several indices of cluster fit were determined. Health care utilization within the cluster was analyzed descriptively, and independent predictors of belonging to the respective clusters were analyzed using logistic regression models including sociodemographic, health- and health insurance-related factors. Results Nine distinct health care user types were identified, ranging from nearly non-use of health care modalities to over-utilization of medical, allied and complementary health care. Several sociodemographic and health-related characteristics were predictive of belonging to the respective health care user types, including age, gender, health status, education, income, ethnicity, and health care coverage. Conclusions Cluster analysis can be used to identify typical health care utilization patterns based on empirical data; and those typologies are related to a variety of sociodemographic and health-related characteristics. These findings on individual differences regarding health care access and utilization can inform future health care research and policy regarding how to improve accessibility of different medical approaches.

Healthcare Service Utilization Patterns and Patient Experience in Persons With High Healthcare Needs: A Comparison Across 22 Countries

BackgroundPersons with complex health conditions, e.g. spinal cord injury (SCI), frequently visit numerous clinical settings. Their service utilization and patient experience is a comprehensive indicator of how a system is functioning overall. This study compared the patient experience of persons with chronic SCI in relation to healthcare service utilization patterns in 22 countries, hypothesizing that primary-care oriented patterns would offer better experience.MethodsThis study was based on International Spinal Cord Injury Survey with 12 588 participants from 22 countries worldwide. Utilization clusters were identified by cluster analysis, experience score was attained by partial credit model. The association between the two was explored by regression analysis. ResultsHighest share of visits was to primary care physician (18%) and rehabilitation physician (16%). Utilization patterns had diverse orientation: from primary care to specialized and from inpatient to outpatient. The experience was reported as very good and good across different dimensions: 78% reported respectful treatment; 75% – clear explanations; 71% – involvement in decision making; 63% – satisfaction with care. Average experience score on 0-100-point scale was 64, highest – 74 (Brazil) and lowest – 52 (Japan, South Korea). Service utilization patterns were associated with patient experience, but no uniformly better patient experience was found for neither primary or specialized care-oriented systems. ConclusionWhile there are distinct utilization patterns between countries of how persons with chronic SCI use the healthcare system, neither the more primary care oriented nor the specialized care system leads to a uniformly better patient experience.

Emergency Department Utilization Patterns Among Physical Elder Abuse Victims in Comparison to Other Older Adults

Background Physical elder abuse is common and has serious health consequences. Little is known, however, about the patterns of health care utilization among these victims, including whether opportunities may exist for earlier identification and intervention. Our goal was to describe Emergency Department (ED) utilization known physical elder abuse victims compared with non-victims. Methods We used Medicare insurance claims to examine ED utilization patterns among a well-characterized cohort of 139 known physical elder abuse victims in the year before abuse was identified and compared this to control subjects matched on age, sex, race, and residential zip code. Results Physical elder abuse victims were significantly more likely than control subjects to visit the ED (47.5% vs. 35.9%, p=0.01) during the year before identification and to have at least one visit for an injury-related complaint (14.4% vs. 8.3%, p=0.03). Victims were also more likely to have multiple visits (18.7% vs. 14.6%, p=0.24), visit multiple EDs (7.9% vs. 6.7%, p=0.63), or be high frequency utilizers (≥4 visits, 3.6% vs. 2.7%, p=0.58), but differences did not reach statistical significance. The most common diagnoses in ED visits among victims were: open wound of knee/ankle, exacerbation of chronic bronchitis, pneumonia, and chest pain. Conclusion This work provides preliminary evidence that physical elder abuse victims use the ED more frequently and potentially have different patterns of utilization than other older adults. We plan to further characterize these different patterns to potentially to use them to develop tools for earlier identification.