Access To Care Services Research Articles

Sociodemographic and Geographic Disparities in End-of-Life Health Care Intensity Among Medicare Beneficiaries With Parkinson Disease.

Current studies of end-of-life care in Parkinson disease (PD) do not focus on diverse patient samples or provide national views of end-of-life resource utilization. We determined sociodemographic and geographic differences in end-of-life inpatient care intensity among persons with PD in the United States (US). This retrospective cohort study included Medicare Part A and Part B beneficiaries 65 years and older with a qualifying PD diagnosis who died between January 1, 2017, and December 31, 2017. Medicare Advantage beneficiaries and those with atypical or secondary parkinsonism were excluded. Primary outcomes included rates of hospitalization, intensive care unit (ICU) admission, in-hospital death, and hospice discharge in the last 6 months of life. Descriptive analyses and multivariable logistic regression models compared differences in end-of-life resource utilization and treatment intensity. Adjusted models included demographic and geographic variables, Charlson Comorbidity Index score, and Social Deprivation Index score. The national distribution of primary outcomes was mapped and compared by hospital referral region using Moran I. Of 400,791 Medicare beneficiaries with PD in 2017, 53,279 (13.3%) died. Of decedents, 33,107 (62.1%) were hospitalized in the last 6 months of life. In covariate-adjusted regression models using White male decedents as the reference category, odds of hospitalization was greater for Asian (AOR 1.38; CI 1.11-1.71) and Black (AOR 1.23; CI 1.08-1.39) male decedents and lower for White female decedents (AOR 0.80; CI 0.76-0.83). ICU admissions were less likely in female decedents and more likely in Asian, Black, and Hispanic decedents. Odds of in-hospital death was greater among Asian (AOR 2.49, CI 2.10-2.96), Black (AOR 1.11, CI 1.00-1.24), Hispanic (AOR 1.59; CI 1.33-1.91), and Native American (AOR 1.49; CI 1.05-2.10) decedents. Asian and Hispanic male decedents were less likely to be discharged to hospice. In geographical analyses, rural-dwelling decedents had lower odds of ICU admission (AOR 0.77; CI 0.73-0.81) and hospice discharge (AOR 0.69; CI 0.65-0.73) than urban-dwelling decedents. Nonrandom clusters of primary outcomes were observed across the US, with highest rates of hospitalization in the South and Midwest (Moran I = 0.134; p < 0.001). Most persons with PD in the US are hospitalized in the last 6 months of life, and treatment intensity varies by sex, race, ethnicity, and geographic location. These group differences emphasize the importance of exploring end-of-life care preferences, service availability, and care quality among diverse populations with PD and may inform new approaches to advance care planning.

Who cares about Aboriginal Aged Care? Evidence of home care support needs and use in rural South Australia.

To assess awareness, needs and use of Australian Government-funded home aged care services among Aboriginal and Torres Strait Islander Peoples from rural and remote South Australia. Mixed-method study. Four rural and remote communities with a higher proportion of Aboriginal populations (Ceduna, Port Augusta, Port Lincoln and Whyalla). Fifty Aboriginal peoples aged 50-89 years (68% females) interviewed between August 2020 and October 2021. Participant awareness, needs and unmet needs. 88% of the participants indicated they needed home care support with daily activities (median number of needs = 3; interquartile range 2-6 needs), especially housework (86%) and transportation (59%). However, only 41% of those reporting current needs were receiving home care services. The most prevalent unmet needs were allied health (87%), housework (79%), help with meals/meals preparation (76%), shopping (73%) and personal care (73%). Overall, 62% of the participants were unaware of the Commonwealth Home Support Programme, and 54% were unaware of the Home Care Packages program. Qualitative data showed participants felt there is insufficient information and public consultation about these services for older Aboriginal adults. Regular communication in group activities was the preferable approach to becoming aware of these services rather than websites, posted materials or phone calls. Further work is needed to increase home aged care service access for Aboriginal and Torres Strait Islander Peoples living in rural and remote settings. Promotion of these programmes through local group activities could facilitate access to these services and facilitate community engagement in decision-making.

"Studi Kualitatif tentang Tingkat Kepuasan Pasien Home Care di Jawa Barat: Evaluasi Layanan, Tantangan, dan Harapan ke Depan"

This study aims to evaluate the level of patient satisfaction with home care services in West Java. The research method used is qualitative study with survey and face-to-face techniques on 10 home care patients and 10 patient families in West Java. The results of the study showed that patients and patient families were very satisfied with the home care services because they provided comfort and fulfilled patient needs. In addition, healthcare workers who worked in the field of home care felt connected and useful in providing personal care focused on the patient. However, the study also identified several challenges in home care services, such as coordination between healthcare workers and families, as well as accessibility and quality of home care services. Therefore, support and cooperation from various parties, such as patient families, the community, and the government, are needed to improve the quality of home care services and ensure that patients receive the best care at home.

Navigating the challenges of neuro-oncology in Africa: addressing diagnostic and treatment barriers in the region: a correspondence

Navigating the challenges of neuro-oncology in Africa: addressing diagnostic and treatment barriers in the region: a correspondence

Availability of Maternal, Newborn care and Child Health Services at Primary Health Care Unit during COVID-19 Outbreak in Ethiopia.

The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.

A 3-UK-nation survey on dementia and the cost of living crisis: contributions of gender and ethnicity on struggling to pay for social care

Objectives The aim of this 3-UK-nation online survey was to explore the impact of the cost of living crisis on the lives of people with dementia and their carers, specifically on their ability to access social care and support services, and the contributions of gender and ethnic background. Methods A 3-UK-nation (England, Wales, Northern Ireland) 31-item online survey was conducted in October 2022 asking people with dementia, carers, and people knowing but not caring for someone with dementia about social care and support service access, cost of living crisis, and changes due to the cost of living crisis. Frequency analysis and Chi-square analysis were employed to assess whether forms of payment for services varied by gender. Pearson correlation analysis and binary logistic regression were used to assess whether gender and ethnicity were associated with struggling to pay for care since the crisis. Results A total of 1,095 people with dementia, unpaid carers, and people who knew but not cared for someone with dementia participated. Of those, 745 people with dementia were utilising community-based social care and support services. Twenty percent of those with complete data had reduced their spending on care services since the crisis. Men and those from non-white ethnic backgrounds were at significantly increased odds of struggling to pay for care services. Conclusions The cost of living crisis has led to exacerbated inequalities in accessing and using dementia care. Men and those from non-white ethnic backgrounds in particular need to receive greater support in accessing care.

LEVELS OF ACCESSIBILITY OF PRIMARY MEDICAL SERVICES IN THE CONDITIONS OF THE REFORM OF THE MEDICAL INDUSTRY: A MARKETING APPROACH

The reform of the primary medical care link of the health care system became an indicator of changes in the health care system of Ukraine. Considering the fact that the primary link of the medical system was reformed as a priority, the feedback of the population, its assessment of the availability of quality medical care, is important, which will allow determining the consequences and prospects of the reform. The marketing analysis conducted in the article of such three criteria (levels) of the availability of primary medical care services as quality, financial and territorial or temporal availability of medical services in their dynamics for 2018-2020 made it possible to find out positive and negative development trends based on surveys of respondents units of primary medical care. In particular, it was established that during the specified period there is a general tendency to improve the quality of medical services, combined at the same time with an insufficient level of ensuring their financial and territorial or temporal availability. The marketing analysis of the respondents' opinions regarding the main indicators of quality criteria, financial and territorial or time availability made it possible to more objectively assess the consequences of the reform of the primary medical care link. The increase in the quality of medical services, which respondents attributed mainly to the improvement of the attitude of medical staff doctors to patients and the material conditions for the provision of medical services, is actually explained by the socio-psychological factors of the establishment of the "doctor-patient" interaction and the positive effect of the financial independence of medical institutions. The positive trend of increasing the financial availability of medical services, expressed in the survey by indicators of the ability to purchase drugs and receive effective treatment, is due to the practical implementation of the "Affordable Medicines" program, the availability of a significant range of free medical services (under the contract with the National Health Service) and the optimal pricing policy for additional medical services. In the end, the criterion of territorial or temporal availability of medical services, having received a wide range of evaluations (from positive to negative among respondents, testifies, on the one hand, to the positive consequences of the increase in temporal availability and opportunities for patients to choose a doctor, and on the other hand, it demonstrates the unresolved issue of territorial convenience placement of primary care facilities, especially in the conditions of reduction of their network in rural areas. We consider the development of practical recommendations for primary and secondary specialized health care institutions to improve individual indicators of quality, financial and territorial or temporal availability of medical services as a perspective for the study of the problem.

Trend, Pattern and Presentation of Visual Impairment and Blindness among Students of Schools for the Blind in South-East Nigeria

Introduction: The prevalence and distribution of major causes of blindness in children vary based on the availability of primary health care and eye care services, and under-5 mortality rates amongst others. Irrespective of the aetiology, blind children have a lifetime to live with the disability and this places enormous pressure on the family unit and the society.&#x0D; Data on the magnitude of blindness is usually gotten from schools for the blind.&#x0D; This study aimed to identify the recent trend, and presentation of visual impairment and blindness among students in schools for the blind located in southeast Nigeria.&#x0D; Methods: This was a cross sectional descriptive study conducted among visually impaired students in schools for the blind in southeast, Nigeria. A total of 92 students were examined from three randomly selected schools out of the six schools in this region.&#x0D; Results: There was a male to female ratio of 1.3:1, an age range of 8-32 years with a mean age of 18.4 6.4 years. Majority of the students (85.9%) were blind with visual acuity &lt;3/60, and 14.1% had visual impairment.&#x0D; Glaucoma was the leading cause of blindness followed by cataract and most known causes of blindness occurred in childhood.&#x0D; Conclusion: Most of the causes of blindness were from preventable and treatable causes. Increasing the availability of specialized eye care services for children, and improving primary health services will reduce the prevalence of blindness due to avoidable causes.

End of life in patients attended by pediatric palliative care teams: what factors influence the place of death and compliance with family preferences?

Each year, more than 8 million children worldwide require specialized palliative care, yet there is little evidence available in pediatrics on the characteristics of the end of life in this context. Our aim is to analyze the characteristics of patients who die in the care of specific pediatric palliative care teams. This is ambispective, analytical observational, multicenter study conducted between 1 January and 31 December 2019. Fourteen specific pediatric palliative care teams participated. There are 164 patients, most of them suffering from oncologic, neurologic, and neuromuscular processes. The follow-up time was 2.4 months. The parents voiced preferences in respect of the place of death for 125 of the patients (76.2%). The place of death for 95 patients (57.9%) was at the hospital and 67 (40.9%) was at home. The existence of a palliative care team for over 5 years is more likely to be related to families voicing preferences and their fulfillment. Longer follow-up times by pediatric palliative care teams were observed in families with whom preferences regarding the place of death were discussed and in patients who died at home. Patients who did not receive home visits, when the pediatric palliative care team did not provide full care and when preferences regarding the place of death were not discussed with parents, were more likely to die in the hospital. Conclusions: Advance planning of end-of-life care is one of the most important aspects of pediatric palliative care. The provision of services by the teams and the follow-up time are related to parents’ expressed preferences and the place of death.What is Known:• Various studies have shown how the availability of pediatric palliative care services improves the quality of life of patients and their families while reducing costs.• The place of death is an important factor influencing the quality of end-of-life care for dying people. The increase in palliative care teams increases the number of deaths in the home and having this care available 24/7 increases the probability of dying at home.What is New:• Our study identifies how a longer follow-up time of patients by palliative care teams is significantly associated with death at home and with express and comply with the preferences expressed by families.• Home visits by the palliative care team increase the likelihood that the patient will die at her home and that the preferences expressed by the palliative care team families will be cared for.

Accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic: A rapid review.

Control measures for the COVID-19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub-Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life-threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID-19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID-19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID-19 pandemic included movement restrictions, limited transport access, fear of contracting COVID-19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post-COVID-19 so that services may be able to better withstand future public health emergencies.

Epidemiology, Sociodemographic Characteristics, Symptoms Assessment and Outcome of COVID-19 Epidemic among Residents of Niger State, Nigeria (March 2020 – March 2021)

Nigeria recorded the first case of COVID-19 infection on Feb 27, 2020. Thereafter, National response was imposed with different curtailing measures including travel bans, closure of schools, markets and limiting the number of persons that could congregate in a place. The objective of this study was to evaluate the epidemiological situation of COVID-19 in Niger state, Nigeria using the data collected during the outbreak, describing the sociodemographic characteristics and epidemiological behavior and clinical symptoms of those tested and confirmed COVID-19 cases. We conducted a state wide population based analysis of the epidemiology of COVID-19 using data reported from all the 25 Local Government Areas of the state from March 2020 to March 2021 for the first, second and third waves of the epidemic. We calculated the overall incidence, case fatality rate, association of sociodemographic variables and the outcome of COVID-19 cases, frequency of different symptoms and drew an epidemic curve. A total of 1128 cases and 20 deaths were included in the analysis with sex distribution of 63.9% males and 36.1% females. The overall incidence rate was 20 cases per 100,000 populations. Commonest symptoms were cough (62.5%), Fever (54.2%) and difficulty in breathing (42%). We found that age was an important determinant of death in COVID-19 cases and health care workers were significant contributors of morbidity and mortality. We recommend strengthening of the health care system especially emergency response, availability of intensive care services, improvement of laboratory services, community surveillance and contact tracing capacities to prevent and control future epidemics.

Proposal for improving access to palliative care by enhancing primary care services in an upper middle-income country.

Primary care doctors play an important role in providing palliative care as they are often the first point of contact for most healthcare needs in the community. This mixed-method study aims to 1) determine the accessibility of palliative care services in Malaysia, an upper middle-income country with universal health coverage, 2) explore the knowledge, challenges and opportunities faced by primary care doctors in providing palliative care and 3) identify if minimum standards for palliative care service are clearly defined, available and achieved in primary care facilities. Data on availability of palliative care services will be sourced from governmental and non-governmental databases and reports. Accessibility will be examined by estimating the distance, travel time and cost to the nearest facility offering palliative care services from various locations throughout Malaysia. In-depth interviews will be conducted with primary care doctors to explore their knowledge, challenges and opportunities in providing palliative care. Alongside, a survey will be conducted to evaluate whether components of palliative care services are available in primary care facilities using the Minimum Standard Tool for Palliative Care from India, which covers all the domains recommended by the World Health Organization. All findings will be inductively analysed and integrated, followed by a strengths, weaknesses, opportunities and threats analysis and a threats, opportunities, weaknesses and strength analysis with relevant stakeholders. The mapping study will provide empirical data on availability and accessibility of palliative care services in Malaysia. The qualitative inquiry will provide insights on the experiences and concerns of primary care physicians in providing palliative care in the community settings. The survey meanwhile will provide real-world data on availability of basic palliative care service components in the primary care facilities. Findings will facilitate development of framework and policies aiming to optimise provision of sustainable palliative care services at the primary care level in local settings.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN STIGMA TENAGA KESEHATAN TERHADAP ORANG DENGAN HIV/AIDS DI RSUD MGR. GABRIEL MANEK,SVD ATAMBUA 2022

The HIV control strategy carried out in Indonesia in 2020-2024 is to create a supportive environment for key populations of HIV and PLWHA to improve the quality of life of PLWHA. One of the factors that hinders access, availability and utilization of HIV testing and care services is HIV stigma. Stigma is not only carried out by the general public, but also by health workers. This study aims to identify factors associated with prejudice among health care workers against people living with HIV. This type of study is a cross-sectional investigation that considers quantitatively. The location of the study was carried out at the Mgr. Gabriel Manek, SVD Atambua, Belu Regency, which was held in September 2022. The population of this study was 429 health workers with a total of 203 respondents. The sample technique used is simple random sampling and the data analysis technique used is the chi-square test with a significance level of =0.05. This study resulted that there was a significant relationship between knowledge, perception and stigma against PLWHA and also no relationship between length of work, information exposure and interaction with PLWHA with stigma against PLWHA. The suggestion of this research is that health workers must increase their understanding and increase information about HIV and AIDS so that there is no stigma against PLWHA

Barriers to access and unmet needs to neuromyelitis optica spectrum disorders care in an Argentinean cohort.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare but severe neuroimmunological condition associated with a significant financial burden. NMOSD is also associated with increased health care utilization, including neurology outpatient visits, magnetic resonance imaging (MRI) use, long-term medication, among others. We aimed to evaluate real-world patient experiences in access to care and NMOSD burden in an Argentinean cohort. This cross-sectional study used a self-administered survey and was conducted in Argentina (2022). Patients with NMOSD were divided into three groups: private health insurance (PHI), social health insurance (SHI), and public health insurance (PHI, Ministry of Public Health). Differences in access and health care barriers were assessed. One hundred patients with NMOSD (74 women) with a mean age at diagnosis of 38.7 years were included. Their EDSS was 2.8 and they were followed for 5.2 years. Of them, 51%, 11%, and 13% were employed (full-time: 57.5%), currently unemployed and retired by NMOSD, respectively. 55% of them visited between 2-3 specialists before NMOSD diagnosis. Aquaporin-4-antibody and/or myelin oligodendrocyte glycoprotein-antibody testing was requested in 91% (health insurance covered this partially in 15.3% and 32.9% of the time the test was entirely paid by patient/family). Patients with NMOSD receiving private medical care reported greater access to MRI, outpatient visits, and fewer issues to obtain NMOSD medications compared to those treated at public institutions. A longer mean time to MRI and neurology visit was found in the PHI group when compared with the other two subgroups. Regression analysis showed that private insurance (OR=3.84, p=0.01) was the only independent factor associated with appropriate access to NMOSD medications in Argentina. These findings suggest that barriers to access and utilization of NMOSD care services in Argentina are common. NMOSD patients experienced problems to receive NMOSD medication properly, especially those from the public sector.

Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families.

International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark. The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n=8), family caregivers (n=11), healthcare professionals (n=10); and three workshops with migrants (n=5), social and healthcare professionals (n=6). The study took place in six different settings in two regions across Denmark. The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care. This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.

The prevalence and county-level socioeconomic correlates of visual impairment and glasses ownership among rural students in Western China.

Vision health has been a major issue in public health care. The vision problems of children in rural China are of particular concern. Effective policies for children's vision health should consider the heterogeneity of individual health levels and regional differences in healthcare services. This study systematically explored the relationship of student visual impairment and glasses ownership with county-level socioeconomic status (namely, county-level per capita GDP, population density and industrial structure) in rural China. The study sample included 99,670 students in grades 4-9 from 445 schools in 13 counties in Shaanxi Province. From 2014 to 2020, students took school-based vision screening tests and completed sociodemographic questionnaires. Multivariate regressions were used for empirical analysis. The prevalence of visual impairment was 30.4% in the total sample, and the rate of visual impairment in girls (34.3%) was higher than that in boys (27.0%). Among visually impaired students, the rate of glasses ownership was only 39.7%, with girls (40.6%) higher than boys (38.8%). The study also found that the visual impairment was significantly correlated with county-level average income, population density and industrial structure, and the glasses ownership was significantly correlated with population density and industrial structure (all p < 0.001). The study found that the county-level socioeconomic status was positively and significantly correlated with visual impairment and glasses ownership, respectively. The vision health management services for students should be jointly carried out by the education, medical and public health departments, and additional investment is needed to increase the accessibility and affordability of vision care services, with special focus on poor regions and disadvantaged groups, so as to narrow the gap in vision health services.

Understanding the drivers of preferential migration of people living with HIV to fishing communities of Lake Victoria in Uganda

ABSTRACT Fishing communities around Lake Victoria have among the highest burdens of HIV globally. Growing evidence suggests that high HIV prevalence is partially due to selective migration of people living with HIV to fishing communities. However, the reasons for this preferential migration are unclear. We recruited 60 men and women for qualitative in-depth interviews (30% living with HIV; 70% recent migrants of unknown HIV status) from seven Ugandan fishing communities. Interviews discussed mobility histories and the social context surrounding migration. Interviews were audio-recorded, transcribed, and translated. A version of the ‘Push-Pull’ theory of migration helped structure a conceptual thematic framework for data analysis. Unfavourable conditions related primarily to stigma, social discrimination, humiliation, rejection or HIV labelling, and violence, induced individuals to leave their home communities. Factors which eventually resulted in migration to fishing communities included anticipating less HIV-related stigma and a safe, friendly environment that accommodates all people. Access to healthy food (fish) and the perceived availability of community-based HIV care services were also attractions. We found that stigma is the major social phenomenon shaping preferential migration to fishing communities in Uganda.

Expectations and barriers to the utilization of specialist palliative care services among persons living with cancer in Ghana: an exploratory qualitative study.

The need for palliative care among patients living with cancer is increasing globally. This need is far greater in resource-constrained settings like Ghana where there is a high unmet need for palliative care services. Consequently, there are lapses in the current palliative care regime, thus, resulting in suboptimal utilization. The study aims to explore patients living with cancer's expectations of palliative care services and examine the barriers that impede palliative care utilization. Descriptive exploratory qualitative design. A total of 15 patients living with cancer and receiving treatment in a tertiary health facility were purposively sampled to participate in this study. Semi-structured interviews were conducted. The data were transcribed and inductively analysed following Collaizi's qualitative analysis framework. From the analysis, the findings were grouped under two main categories: perceived expectations and barriers to utilizing palliative care. The participants expected to receive meaningful communication about their condition and prognosis; they also expected to be actively involved in palliative care decision-making. Regarding the barriers, the following themes emerged: financial constraints, unfavourable health appointment schedules, problems with the distance to the health facility, poor referral and follow-up from oncology specialists and being unaware of the availability of palliative care services. In conclusion, there is a need to actively involve patients and their families in all decision-making along the continuum of palliative care service delivery. The study underscores the need for Ghana to implement an integration of palliative care services in primary healthcare facilities to avert the challenges that distance to tertiary healthcare facilities poses to palliative care utilization. Service providers must implement awareness programmes to enable patients to better comprehend palliative care services.

Association between socioeconomic contextual factor, dental care service availability, and prevalence of periodontitis in Brazil: a multilevel analysis.

This study aimed to examine the effect of dental care services on periodontitis cases in Brazilian municipalities. The sample comprised 3,426 individuals aged 35-44 years. Moderate to severe periodontitis with clinical attachment loss and probing depth was the dependent variable, both > 3mm. Its exploratory variables were grouped into four categories: (1) individual characteristics; (2) contextual development indicators; (3) health service and structural factors; and (4) dental care use. Data were collected using the SBBrasil 2010 Project, the Brazilian Institute of Geography and Statistics, the Brazilian Information System of Primary and Secondary Care, and the Program to Improve Access and Quality of Dental Specialization Centers (PMAQ-CEO). Multilevel logistic regression was used to assess associations of periodontitis with individual and context variables. Municipalities with > 1 CEO or > 1 of any centers were associated with periodontitis, with OR = 0.97 (95%CI: 0.55-1.71) and OR = 0.41 (95%CI: 0.17-0.97), respectively. Prevalence of periodontitis was more likely in older people, lower education levels, and individuals that sought dental visits for pain/extraction and periodontal treatment. Other dental care services availability were not associated with the prevalence of periodontitis.

Acceptability of HIV Test and Treat among Women and Men Seeking Health Care at Monze Mission Hospital

The HIV test and treat strategy removes many barriers that interrupt HIV intervention. The Test and Treat campaign is an important strategy such that it promotes the general public access various promotive, preventive and treatment services. The aim of the study was to determine the acceptability of HIV Testing and Treatment and factors that influence acceptance among women and men seeking health care at Monze Mission Hospital. A cross-sectional study design was used at Monze Mission Hospital in Monze district. The findings from 171 patients showed that 72% (12) participants knew the meaning of HIV test and treat policy compared to 28% (48) that seemed not to know. The general distribution of HIV test acceptability among participants shows that the majority of the participants in this study had accepted to be tested for their HIV status. The study shows that 87% of the study participants accepted to be tested for HIV. The study shows that acceptability for HIV test and treat as per UNAIDS 2020 target i.e achieving 90/90/90 has not been achieved. This could be due to less sensitization as 28% of participants never knew the meaning of the policy. Other factors could be lacking awareness, 31% of the participants were not aware of care, treatment, and support services availability for HIV positive people at the hospital. To achieve acceptability of HIV test and treatment, we need to consider educational programs to strengthen or increase sensitization on the meaning and benefits of the program. Keywords: Acceptability to HIV; test; treat; men and women.