Search Results (1,059)

Background: Patients with cystic fibrosis frequently require repeated courses of intravenous antibiotic therapy, resulting in cumulative vascular injury, progressive depletion of peripheral venous access, and increasing complexity in long-term vascular access management. Integrating structured vascular access planning into multidisciplinary care pathways has become increasingly important for preserving venous capital, optimising vascular access decision-making, and ensuring continuity of care. Objective: To describe the development and implementation of an Advanced Practice Nursing-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. Methods: A practice-based descriptive analysis of a multidisciplinary vascular access pathway was conducted, incorporating ultrasound vascular assessment, structured clinical decision-making, and coordinated care across the Emergency Department, Cystic Fibrosis Unit, Vascular Access and Infusion Team, Hospital Pharmacy Service, and Hospital-at-Home Programme. An illustrative patient example was used to demonstrate pathway implementation in routine clinical practice. Results: Pathway implementation illustrated the feasibility of integrating ultrasound-guided vascular assessment, evidence-informed selection of vascular access devices, and coordinated home-based intravenous therapy within a multidisciplinary care model. Ultrasound-guided vascular assessment identified a suitable upper-arm basilic vein despite severe peripheral venous depletion. An Advanced Practice Nurse successfully performed ultrasound-guided midline catheter insertion, achieving first-attempt cannulation and no immediate complications. The illustrative patient completed four weeks of home-based intravenous antibiotic therapy without observed catheter-related infection, thrombosis, occlusion, catheter dysfunction, or unplanned hospital readmissions. The patient reported satisfaction with the treatment experience and the ability to maintain daily activities throughout treatment. Conclusions: This study describes and clinically contextualises an APN-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. The illustrative patient demonstrated the feasibility of applying the pathway in routine clinical practice. Further prospective multicentre studies are required to evaluate its effectiveness, safety, reproducibility, and broader applicability. Full article

Background: Emergency services in urban areas are overcrowded due to a rise in mild-to-moderate acuity consultations, and physician-led home visits are less common. In response, a home-based urgent care model in an urban setting (Docadom) was developed. Consultation requests via a dedicated mobile application or phone call are triaged by a trained emergency nurse. Physicians travel to the patient via an electric cargo bike that has storage for medical equipment. During home visits, physicians perform testing/diagnosis and advanced procedures (e.g., intravenous medication delivery) and prescribe treatment (if needed). This descriptive analysis reports activities during the first 12 months of Docadom. Methods: Data from all patients seen during the first 12 months of Docadom activity (1 May 2023–30 April 2024) were analysed. Outcomes analysed included: age, sex, diagnosis, and whether the patient was referred to the hospital. Patient satisfaction (from 1 [worst] to 5 [best]) is also reported. Each outcome was analysed in two subgroups based on patient age (<75 or ≥75 years) because the Swiss health insurance system distinguishes between these two age groups, using Wilcoxon or chi-square tests as appropriate. Results: A total of 1736 patients requested a consultation (66% female; median age 70 years [interquartile range 36, 84]; 43% aged ≥75 years). The five most frequent clinical presentations were: ear, nose and throat infection, epistaxis and bronchitis (25.7%); soft tissue trauma (7.8%); acute cervical or lower back pain syndrome (5.6%); gastroenteritis and dehydration (5.0%); and cancer and general decline in the elderly (4.6%). Only 4.7% of the patients were referred to the hospital. The mean satisfaction score was 4.97 (response rate: 207/422 patients [49%] who requested a consultation via the app). Conclusions: These data highlight the feasibility and acceptability of a home-based urgent care model in an urban setting. The service effectively addressed a wide range of acute conditions, especially in elderly patients. The low hospital referral rate and high patient satisfaction are encouraging, but as a single-arm descriptive analysis without post-consultation outcome data or a comparator group, this study cannot establish clinical safety or an effect on emergency department use; these questions require a future comparative study. Full article

Although esports-themed hotels have rapidly emerged as a technology-driven segment of smart hospitality, empirical research on their customer experience and satisfaction formation remains limited. Drawing on schema theory and expectancy violations theory (EVT), this study adopts a mixed-methods approach to examine the thematic attributes of esports-themed hotel experiences and their effects on customer satisfaction. Study 1 applied BERTopic and aspect-based sentiment analysis (ABSA) to 225,318 online reviews of 1601 esports-themed hotels. The results show that customer experience encompasses not only conventional hotel attributes, such as service, environment, and cleanliness, but also esports-specific attributes centered on gaming facilities, technological configurations, and esports-related social activities. ABSA results further reveal generally positive sentiment across most attributes, with service attitude and cleanliness receiving the strongest approval, whereas room facilities and comfort were the main sources of dissatisfaction. Study 2 employed hierarchical linear modeling to further examine the effects of six experience-related sentiments on customer satisfaction. The results indicate that all six sentiment dimensions significantly influence satisfaction and that hotel type moderates these relationships. Compared with professional esports-themed hotels (PETHs), the effects of experience-related sentiments on satisfaction are stronger in non-professional esports-themed hotels (NPETHs). This study extends schema theory and EVT to the esports-themed hotel context and offers practical implications for customer experience design and service management in this emerging hospitality segment. Full article

As small and medium enterprise organisations (SMEs) grapple with competing demands, decision-making is affected when faced with cost and regulatory uncertainties in response to sustainability obligations. Organisations adapt differently, focusing their resources to the most efficient use to optimise resources and enhance productivity. Qualitative interviews were carried out with 22 SME leaders spanning multiple sectors, including manufacturing, retail, services, construction, logistics, and hospitality, enabling examination of cross-sector variation while maintaining a shared regional context. The interviews lasted 45–65 min and captured managerial cognition, tacit knowledge, and informal strategic processes. The analysis reveals that SMEs do not respond uniformly to sustainability pressures. Instead, their responses are shaped by the interaction between cost pressures and regulatory uncertainty, producing distinct but overlapping strategic patterns. Three dominant mechanisms emerged across cases: cost filtering, temporal disruption under regulatory uncertainty, and strategic response variation. These mechanisms collectively explain how SMEs balance economic viability with environmental performance under constraint. The paper contributes to debates on sustainability transitions, resilience, and SME sustainability transitioning and growth strategies by identifying pathways that balance economic viability with environmental performance. Full article

Objectives: The aging population problem caused by low fertility intentions has already emerged worldwide and is expected to become more severe in the future. Despite the gradual implementation of welfare policies, there has been no substantial improvement in individuals’ intentions to have more children. It has therefore become increasingly important to examine the factors that correlate with individuals’ intentions in relation to fertility policy. Methods: The data used in this study were drawn from the 2023 Health Life Satisfaction Survey of the Yangtze River Delta Phase II conducted by Shanghai Jiao Tong University. The primary analysis employed binary logistic regression to examine the association between medical insurance type and fertility intentions, with healthcare accessibility operationalized as a moderating variable. Gender and parity-stratified analyses were conducted as pre-specified exploratory secondary analyses to examine potential heterogeneity in these associations. Results: A total of 8789 citizens were included in the analysis, of whom 18.42 percent reported fertility intentions. Individuals enrolled in the Basic Medical Insurance System for Urban Employees exhibited significantly higher odds of having fertility intentions compared with those enrolled in the Basic Medical Insurance System for Urban and Rural Residents (OR = 1.2154, 95% CI = 1.0626–1.3901, p < 0.001). Moreover, individuals covered by the Basic Medical Insurance System for Urban Employees and residing near secondary hospitals showed significantly higher odds of fertility intentions (OR = 1.6727, 95% CI = 1.1273–2.4821, p < 0.05) than those covered by the Basic Medical Insurance System for Urban and Rural Residents and living near primary hospitals. Conclusions: Medical insurance benefit levels, as well as the quality and accessibility of healthcare resources, are positively associated with individuals’ fertility intentions, suggesting that welfare design and service delivery may jointly shape the institutional context for reproductive decision-making. Full article

Objective: Extracorporeal Membrane Oxygenation (ECMO) has long been used in the treatment of acute respiratory and circulatory failure by providing time for damaged organs to recover. The aim of this study was to evaluate the safety and feasibility of interhospital transport of pediatric patients with acute respiratory failure who had undergone venovenous extracorporeal membrane oxygenation (VV ECMO) initiated at the referring facilities. Subjects and methods: Because of the critical condition of these patients, the high risk associated with transport, and the failure of conventional therapies, ECMO was initiated at the referring center. After cannulation, the patients were transported by ground ambulance to the Pediatric Intensive Care Unit in Poznań for further treatment. Results: Fourteen patients aged 2 months to 11 years with acute respiratory failure were transferred to our ECMO center. The mean time from decision to departure was 7.62 h, and the mean ICU stay before transfer was 4.14 days. The mean transport distance was 157.5 km. No mortality occurred during transport, and no serious adverse events were reported. Two technical complications were noted. Conclusions: Interhospital transport of pediatric patients on VV ECMO initiated at referring centers was feasible and safe, with favorable outcomes in patients who have exhausted conventional intensive care options. Effective collaboration between referring hospitals, ECMO centers, and emergency medical services was essential for optimal results. Full article

Smart cities (SCs) use the Internet of Things (IoT) to collect and process data to communicate with their infrastructure and assets in real time. A great deal of techniques, such as encryption protocols, Random Forest-based AI-driven threat detection, and blockchain architectures, have been developed to address cybersecurity challenges in smart cities (SCs). These techniques, however, have limitations such as their scalability, high computational expenses, and energy inefficiency. Therefore, in this study, to overcome these challenges, we propose a blockchain-based infrastructure called BlockSafeNet. This uses artificial intelligence, big data, and blockchain to enhance cybersecurity in SCs. The effectiveness of the proposed BlockSafeNet framework was evaluated using responsiveness, computational time, encryption quality score, detection rate, false positive rate, latency, throughput, and energy consumption as the primary cybersecurity performance metrics. These metrics were selected to assess communication efficiency, threat detection capability, privacy preservation, scalability, and overall security performance within smart-city IoT environments. To ensure secure data transactions, robust threat detection, and efficient communication. The system’s high calculation speed and detection rate show potential for managing sensitive maternal health data collected by IoT devices. The platform also shows how IoT may be used by healthcare services to monitor public health in real time, allowing hospitals, emergency services, and public health agencies to securely share data. This aids in resource optimization, improving service delivery, and preserving data privacy and trust in SCs. Data was obtained from the UCI Machine Learning Repository on Kaggle to validate the developed framework. By evaluating the effectiveness of BlockSafeNet in tackling cybersecurity challenges, we establish its practical relevance and usability in SCs. The proposed BlockSafeNet framework achieved a responsiveness of 24 s, an encryption quality score of 0.89, computational time of 85 s, and a detection rate of 91%, demonstrating significant improvements in secure IoT communication, privacy preservation, and AI-driven cyber threat detection within smart city infrastructures. shows that SC IoT security has significantly improved through the adoption of new data protection methods and better measures of security, providing a positive impact on the SC ecosystem. Full article

This empirical study positions hotel-based sport wellness programs as structured physical activity offerings embedded in co-created guest experiences in luxury hotels in Saudi Arabia. It examines how the quality of wellness sports programs relates to guests’ satisfaction with the program, loyalty intentions toward the hotel, and self-reported physical activity orientation and intention. The construct is operationalized as guests’ perceived increase in activity during the stay and their stated intention to maintain or increase activity afterward. The study also tests the mediating roles of perceived health benefits and enjoyment, as well as the moderating role of staff health communication. Drawing on service quality and expectancy disconfirmation perspectives, together with health belief and motor learning insights, a cross-sectional survey was conducted with 412 guests who had participated in structured sport-based wellness sessions during their stay in Saudi Arabian luxury hotels. Data were analyzed using partial least squares structural equation modeling (PLS SEM). Wellness sport program quality was positively associated with perceived health benefits, enjoyment, and program satisfaction, and both perceived health benefits and enjoyment partially mediated the quality satisfaction relationship, indicating parallel cognitive and affective pathways in the guest experience. Program satisfaction, in turn, was positively associated with guests’ loyalty intentions and their self-reported orientation toward maintaining healthier physical activity routines after their stay, while staff health communication significantly strengthened the association between program quality and perceived health benefits. These results contribute to wellness tourism and hospitality research by integrating sport pedagogy and health communication into an experience-centric framework and by clarifying how hotel-based sport wellness offerings can support satisfaction, loyalty, and self-reported physical activity orientation in an emerging tourism destination. Practical implications are offered for hotel managers seeking to design human-centered, health-oriented wellness services aligned with Vision 2030 and global physical activity promotion agendas, recognizing that the findings represent perception-based associations that are a promising foundation for future longitudinal and behavioral research. Full article

Background/Objectives: Ischemic heart disease (IHD) is a major cause of cardiovascular mortality, and emergency medical service (EMS) crews often make the first decision on whether an IHD-coded patient should be transported to hospital or managed at the scene. Evidence from Central Asian EMS systems is sparse, and it remains unclear whether routinely coded comorbidity information adds decision-relevant information beyond acute presentation. We aimed to identify predictors of the EMS hospitalization/transport decision among IHD calls in Astana, Kazakhstan. Materials and Methods: We conducted a retrospective call-level cohort study of 9985 consecutive EMS calls coded as IHD (ICD-10 I20-I25) over a five-year period. The endpoint was field disposition—hospitalization/transport versus being left at the scene—and should not be interpreted as confirmed ACS, mortality, clinical appropriateness or any other patient outcome. Group comparisons used the Mann–Whitney U and Pearson chi-square tests, and independent associations were estimated using explanatory multivariable logistic regression. Results: Overall, 2676 calls (26.8%) resulted in hospitalization/transport. The strongest independent predictors were cardiogenic shock (aOR 15.06), acute/unstable IHD versus chronic I25 (aOR 8.52) and heart failure (aOR 2.46). Other arrhythmias (aOR 1.84), atrial fibrillation (aOR 1.60), male sex (aOR 1.65) and age <45 years (aOR 1.88) were also associated with higher transport odds, whereas age ≥75 years (aOR 0.61), specialized crews (aOR 0.84) and high dispatch urgency (categories 1–2; aOR 0.84) were associated with lower odds. Model discrimination was moderate (AUC 0.69; optimism-corrected AUC 0.69), plausibly reflecting the absence of ECG findings, vital signs, symptom severity and hospital outcome data. Conclusions: The expected acuity markers dominated EMS transport decisions, but routinely coded cardiac comorbidities were independently associated with disposition in this understudied setting. The model is not deployable for individual triage; these variables should be considered candidate inputs for future models that incorporate richer clinical data, outcome linkage and prospective validation. Full article

Background: Despite substantial progress in prevention of mother-to-child transmission (PMTCT) programmes and widespread access to antiretroviral therapy (ART), maternal HIV infection remains associated with adverse maternal and neonatal outcomes in many high HIV-burden settings. This study compared maternal and perinatal outcomes among women living with HIV and HIV-negative women delivering at a tertiary referral hospital in the Eastern Cape Province, South Africa. Methods: A retrospective comparative cohort study was conducted using routinely collected clinical records of 600 women (300 HIV-positive and 300 HIV-negative) who delivered at Nelson Mandela Academic Hospital between January and December 2019. Maternal, obstetric, and neonatal characteristics were compared according to maternal HIV status. Associations were evaluated using chi-square tests, multivariable logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards regression models. Results: Women living with HIV were older, had higher parity, and were more likely to have documented anaemia and delayed antenatal care attendance than HIV-negative women. HIV-exposed pregnancies had higher frequencies of preterm birth (26.3% vs. 20.3%) and low birthweight (LBW). In adjusted analyses, maternal HIV-positive status remained independently associated with increased odds of LBW (AOR = 1.88; 95% CI: 1.18–3.00; p = 0.008). LBW was independently associated with neonatal intensive care unit (NICU) admission (AOR = 2.45; 95% CI: 1.46–4.11; p < 0.001) and an increased hazard of in-hospital neonatal mortality (HR = 2.40; 95% CI: 1.55–3.70; p < 0.001). Maternal HIV-positive status (HR = 1.75; 95% CI: 1.12–2.71; p = 0.015) and unsuppressed maternal viral load (HR = 2.05; 95% CI: 1.13–3.73; p = 0.018) were also associated with increased hazards of neonatal mortality. However, these findings should be interpreted cautiously, given the limited number of neonatal mortality events (n = 32). Among HIV-exposed infants with documented HIV test results, the observed mother-to-child transmission rate was 1.7%. However, incomplete infant follow-up and HIV testing data limited the precision of this estimate. Among women living with HIV, birthweight did not differ significantly according to the timing of ART initiation. Conclusions: In this tertiary referral hospital cohort, maternal HIV infection was associated with adverse maternal and neonatal outcomes, particularly anemia, preterm birth, and LBW. LBW emerged as an important predictor of neonatal morbidity and mortality. These findings support continued efforts to strengthen integrated HIV and maternal healthcare services, promote early antenatal care engagement, maintain maternal viral suppression, and improve monitoring and care of high-risk neonates. Given the retrospective observational design, incomplete follow-up for selected outcomes, limited numbers of neonatal mortality events, and the tertiary referral setting, the findings should be interpreted as associations rather than evidence of causal relationships and may not be generalizable to lower-level healthcare facilities or community-based obstetric populations. Full article

Background: Pre-analytical errors account for the majority of failures across the total testing process. This study evaluated pre-analytical performance in a tertiary-care biochemistry laboratory in Riyadh, Saudi Arabia, using IFCC-aligned Quality Indicators (QIs), Six Sigma metrics, and structured Root Cause Analysis (RCA). Methods: A retrospective analysis of all biochemistry tests processed between January and December 2024 at a tertiary-care hospital was conducted. Rejected tests were classified into seven IFCC-aligned QI categories. Sigma metrics assessed process capability, Pareto analysis identified the vital few contributors, and RCA using the Ishikawa framework identified human, equipment, environmental, and process-related factors. Rejection patterns were described by department and work shift. Results: Of 845,647 tests performed, 10,783 (1.28%) were rejected, yielding an overall process capability of 3.89σ (Minimum Acceptable). Hemolysis was the leading cause (8186 tests; 75.92%) at 3.97σ, the only indicator classified as High against the IFCC WG-LEPS registry. The remaining six indicators demonstrated Good to Very Good performance (4.59σ–5.33σ). Pareto analysis identified hemolysis and inappropriate tube use (7.60%) as the vital few, jointly responsible for 83.52% of rejections. RCA implicated venipuncture technique, needle gauge selection, workload pressure, and prolonged tourniquet application as key contributors. The Emergency Department generated the highest inpatient rejection burden (38.7%). Conclusions: Although the overall rejection rate compared favorably with international benchmarks, hemolysis was the principal process vulnerability, with inappropriate tube selection as a secondary target. Recommended quality improvement strategies include structured phlebotomy training, real-time hemolysis index feedback, and Emergency Department-specific initiatives; structural solutions such as dedicated inpatient phlebotomy services warrant prospective evaluation alongside training-based interventions. Full article

Background/Objectives: Community psychiatric care aims to support recovery, autonomy, and lower reliance on inpatient services, but co-occurring substance use may reduce these gains. This study examined associations between psychiatric care pathway, non-tobacco substance-use severity, recovery-related patient-reported outcomes, clinical instability, and direct mental health cost in adults with severe mental illness in Romania. Methods: This cross-sectional observational study included 128 adults receiving psychiatric hospital care, long-term residential care, or protected community housing within one regional psychiatric care network. Participants had at least 12 months of uninterrupted care in their current setting. Substance use was assessed with the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), excluding tobacco from the analytic severity score. Outcomes included SF-36 physical and mental scores, brief service-experience ratings of autonomy and perceived coercion, emergency department visits, relapse, readmission, inpatient days, outpatient visits, and annual direct mental health cost. Results: Any non-tobacco substance use was most common in hospital care, intermediate in residential care, and least common in community housing. Mental quality of life was lowest among hospital participants with substance use and highest among community participants without substance use. In multivariable models, ASSIST-derived severity was independently associated with a lower SF-36 mental score and a higher direct cost, while autonomy was independently associated with better mental quality of life and lower direct cost. The cost outcome was modeled primarily with a gamma generalized linear model with a log link because costs were positive and right-skewed. Because pathway allocation was clinically determined rather than randomized, and because autonomy, perceived coercion, and mental quality of life were all self-reported at a single assessment, every multivariable and path estimate is exploratory. Conclusions: Community psychiatric pathways were associated with more favorable recovery indicators, but non-tobacco substance use remained an important marker of poorer outcomes and greater service burden. The findings support addiction-sensitive community psychiatric care and routine monitoring of autonomy and perceived coercion as service-quality indicators. Because the design was cross-sectional and the care pathways were non-equivalent at baseline, these results are hypothesis-generating and do not establish that care pathway, substance use, or autonomy exerts a causal effect on any outcome measured. Full article

Background/Objectives: Socioeconomic inequalities continue to shape health service use in low- and middle-income countries. This study aimed to quantify socioeconomic inequalities in formal health service utilization among Peruvian adults using nationally representative data. Methods: A cross-sectional analytical study was conducted using the 2023 National Household Survey (ENAHO). The sample included 77,793 adults aged 18 years or older. Formal health service utilization was defined as self-reported use of outpatient, emergency, or hospitalization services during the preceding 12 months. Survey-weighted Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Overall, 15.94% of adults reported using formal health services in the previous year. In the adjusted model, utilization was higher among women (aPR: 1.47; 95% CI: 1.41–1.55) and adults aged 60 years or older (aPR: 1.74; 95% CI: 1.57–1.92). Compared with uninsured adults, service utilization was higher among those covered by SIS (aPR: 2.59; 95% CI: 2.29–2.93), EsSalud (aPR: 2.90; 95% CI: 2.56–3.29), Armed Forces/Police insurance (aPR: 3.04; 95% CI: 2.36–3.91), and private insurance (aPR: 2.32; 95% CI: 1.77–3.03). Non-extreme poverty (aPR: 0.72; 95% CI: 0.67–0.78) and extreme poverty (aPR: 0.68; 95% CI: 0.59–0.78) were associated with lower utilization. Conclusions: Formal health service utilization remains low and unequal in Peru. Insurance coverage was strongly associated with greater service use, whereas poverty was associated with lower utilization. Full article

Background: The COVID-19 pandemic profoundly disrupted healthcare utilization patterns at both primary care (PC) and hospital emergency department (ED) levels. This study aimed to assess the impact of the pandemic on referral patterns from PC to a hospital ED and on the resource consumption associated with those referrals. Methods: A descriptive, retrospective, longitudinal comparative study with multivariable sensitivity analyses was conducted at a first-level hospital of Madrid (Spain). All consecutive PC-to-ED referrals received during two observation windows were included: a pre-pandemic period (1 June–31 December 2019; $n=946$) and a Later-Pandemic period (1 January–30 June 2022; $n=1797$). Sociodemographic characteristics, referral form quality, diagnostic specialty, and in-ED resource utilization variables were collected and compared using ${\chi }^2$, Student’s t-test, and Mann–Whitney U tests as appropriate. To assess seasonal confounding, multivariable logistic and ordinal regression models adjusting for calendar season, age, and sex were performed for the primary resource-utilization outcomes. Results: A total of 2743 referrals were analyzed. The monthly referral rate increased by approximately 122% between periods (135/month vs. 300/month). A statistically significant but clinically negligible difference in mean age was observed ($53.1\pm 18.3$ vs. $54.9\pm 19.0$ years; $p=0.015$); no significant sex differences were found. Referral form completion improved significantly for clinical history (94.5% vs. 98.2%; $p<0.001$). Orthopedics referrals nearly tripled (5.8% vs. 18.4%), while respiratory/COVID-19-related referrals represented 22.0% of the 2022 caseload. ED length of stay between 3 and 6 h increased from 13.0% to 42.8% ($p<0.001$), while the need for urgent blood tests fell from 68.9% to 56.0% ($p<0.001$), hospital admission from 68.4% to 10.9% ($p<0.001$), and referral to another center from 12.3% to 0.9% ($p<0.001$). In multivariable sensitivity analyses, the period effect remained statistically significant after adjustment for calendar season, age, and sex for hospital admission (adjusted OR $=0.062$; 95% CI: 0.037–0.106; $p<0.001$) and urgent blood test utilization (adjusted OR $=0.470$; 95% CI: 0.326–0.678; $p<0.001$), although study period and season remain partly confounded by the non-overlapping design. Conclusions: During the later-pandemic period, PC-to-ED referrals increased substantially while being associated with fewer complementary investigations and fewer hospital admissions. This study documents between-period differences in referral patterns and ED resource utilization rather than causal effects; the differences persisted after adjustment for seasonality but cannot be definitively attributed to the pandemic. Future multi-center longitudinal studies are needed to confirm these trends and clarify their underlying mechanisms. Full article

Objective: This study aimed to identify priority areas, social vulnerability, and healthcare capacity and networks while considering hospitalization and mortality rates due to Severe Acute Respiratory Syndrome (SARS) caused by COVID-19 during the public health emergency period. Materials and Methods: A spatiotemporal analysis was performed to assess hospitalization, mortality, and case fatality rates among hospitalized patients due to severe COVID-19 across the municipalities of the Metropolitan Region of Belo Horizonte (MRBH), Brazil, between 2020 and 2022. The findings were contextualized by considering the social vulnerability of the population as well as the healthcare infrastructure and organizational characteristics of municipalities and health regions. Results: Municipalities located in the central area of the MRBH showed higher hospitalization rates, corresponding to areas with a greater concentration of healthcare infrastructure. However, mortality and case fatality rates among hospitalized patients were higher in municipalities with more limited healthcare infrastructure and greater social vulnerability. Conclusion: The spatiotemporal disparities in hospitalization and mortality risks suggest health inequities that seem to be influenced by social determinants and healthcare system vulnerabilities. These findings emphasize the imperative for public health emergency responses to prioritize the strengthening of health system organization and the establishment of effective care pathways to enhance access and service delivery, particularly in municipalities exhibiting higher levels of social vulnerability. Full article