Access Challenges Research Articles

The Survival and Medical Dilemma of Rare Disease Patients in the Greater Bay Area

The population of rare disease patients in China faces many difficulties in disease diagnosis and treatment, medical security, economic burden, quality of life, social assistance, employment opportunities, mental health, and other aspects. It is of great significance to identify the common problems faced by this group and try to propose possible solutions, calling on all sectors of society to pay attention to the rare disease minority group, help them solve their survival and security difficulties, and enable more patients to return to society. This paper investigates and addresses the survival and security challenges faced by rare disease minority patients in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) of China. Through a survey of 223 rare disease patients in the Greater Bay Area, the study reveals that these patients face many challenges in diagnosis, treatment, drug access, and economic support. The conclusion emphasizes the necessity of improving diagnostic efficiency, accelerating drug development, and improving the medical insurance system. Thus, it further puts forward practical suggestions.

Utilization Digital Health: Opportunities and Challenges in Enhancing Tuberculosis Treatment

Digital health interventions hold promise for patient-centered care, as they enable remote monitoring of patients and can be used to easily remind patients to take their medications. This study used a literature review technique with research collecting 30 research publications related to the use, opportunities and challenges of digital health in the treatment of tuberculosis. The literature review technique aims to evaluate and analyze previous research to provide context, show gaps in research, and support arguments for the research to be conducted. Several conclusions from this literature review research include: (1) Digital health has a significant role as an intervention in the management of tuberculosis patients. (2) Digital health offers great opportunities to improve the management and treatment of tuberculosis patients. The opportunity for digital health as an intervention for tuberculosis patients is very promising and can have a significant impact on various aspects of managing this disease. (3) Although digital health offers many opportunities for managing tuberculosis, there are also various challenges that must be faced in its implementation, including: challenges of technology access, patient compliance and engagement, data security and privacy, integration with traditional health systems, costs and funding, quality content and information as well as cultural and language barriers.

'It's designed for someone who is not me': A reflexive thematic analysis of the unmet healthcare support needs in UK autistic adults aged 65 years and over.

Autistic people often face both physical and mental health challenges throughout their lives, which can lead to a higher risk of premature death due to health inequalities. However, we know very little about the healthcare experiences of autistic older adults. In this study, we talked with 19 autistic adults aged 65 years or above living in the United Kingdom. We found these main themes: (1) A lifetime of being misunderstood; (2) Autistic people falling between the gaps; (3) Processing autism diagnosis in later life; (4) Concerns about service pressures and scarce resources; (5) Lack of continuity of care, empathy and understanding; (6) Anxiety, alexithymia and sensory overload; and (7) Reduced social support and concerns for the future. Themes show that autistic older adults face unique healthcare access challenges because services don't consider their lifelong experiences of social exclusion. Participants also worried about age-related decline coupled with reduced social support, which makes it harder for them to get support. To address these challenges, healthcare services should provide more targeted support, make policies and funding consistent, and improve healthcare provision by providing staff training. Importantly, they must also speak with autistic older adults so they can advocate for their current and future care.

Digital Literacy Among Migrants in Portugal: Access, Usage, and Trust in Health Information

Abstract Background Digital literacy is crucial for effective utilization of health-related services and information. This study evaluates digital literacy among migrants in Portugal, focusing on three key components: access to digital services, usage of these services for health information, and trust in online health resources. Methods A cross-sectional survey was conducted to assess migrants’ access to digital devices such as smartphones and computers, their ability to use these devices for health-related purposes, and their perceptions of the credibility of online health information. Data were analyzed across various sociodemographic and migration-related factors. Results 1,048 migrants were included, of which 90.3% had access to digital services, and 64.9% reported ease in using these services to obtain health information. Despite widespread access and usability, about 45.6% of migrants doubted the reliability of online health information. Access and usage varied significantly with age, education, income, employment status, and region of origin. Older, less educated, lower-income, and African migrants faced more significant challenges in access and usage. Additionally, trust issues were predominantly reported by females, those with lower education levels, recent arrivals, and non-Portuguese speakers. Conclusions The study highlights significant disparities in digital literacy among migrants, influenced by socio-economic and demographic factors. While access to digital tools is high, challenges in usage and trust present barriers to effective health communication. Key messages • High access to digital services among migrants, yet significant disparities affect older, less educated, and lower-income groups. • Usage difficulties combined with low trust in online health info highlight the need for targeted digital literacy interventions.

Inequalities in access to healthcare for older adults during COVID-19 pandemics in Lithuania

Abstract Background During COVID-19 pandemic, healthcare systems experienced unprecedented shock. Older adults were the most vulnerable group of Lithuanian society, facing distinctive health challenges and highest mortality rates. The aim of the study was to examine perceived inequalities and challenges in access to healthcare of Lithuanian population over 65 years old during COVID-19 pandemic. Methods Representative sample of Lithuanian population over 65 years old (1503 individuals) was involved in the anonymous questionnaire survey, performed in January, 2024. Results 22 % of respondents reported not using healthcare services during COVID-19 pandemics. Among them, 76% did not have any need for healthcare services, while 13.6% did not approach healthcare due to fear of getting infected by Covid-19, and the other 10.4% had various accessibility challenges. 15.8% reported frequent problems in registering with family doctors, and 20.0% - with the specialist appointment. There was a clear social gradient observed among those underserved: it was associated with educational level and place of residence. Those with lower education and living in smaller towns and rural areas reported more common healthcare accessibility problems. Higher education, income and better self-perceived health correlated with higher satisfaction with travel time reaching health care services and registering for the appointment (p < 0.05). Conclusions Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters and protection of the vulnerable groups of the society. Key messages • Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. • Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters.

Advancing mammography uptake among vulnerable groups: a systematic review of intervention strategies

Abstract With over 2 million cases diagnosed annually, breast cancer is a leading cause of cancer-related disability and mortality. Despite global efforts to implement mammography screening programs, uptake rates vary widely across settings due to socioeconomic factors and accessibility challenges. To improve participation, targeted interventions addressing barriers faced by underserved groups are essential for promoting inclusive screening and early detection. As part of the ENTER project, which aims to address disparities in breast cancer screening participation among women with low socioeconomic status (SES) in Flanders, Belgium, we conducted a systematic review and meta-analysis on the effectiveness of interventions to enhance mammography uptake. To explore the differential impact of interventions on mammography uptake among vulnerable groups, including individuals with low SES, underinsured, with immigrant background or part of an ethnic minority, subgroup analyses were performed. 7 databases were searched, resulting in the inclusion of 54 out of 9,366 papers for analysis. 14 types of interventions were identified. The meta-analysis showed significant pooled effects of interventions that increased mammography uptake [OR 1.8 (95%CI 1.6-2.2)], particularly among vulnerable populations [OR 2.2 (95%CI 1.7-2.8)]. The most effective interventions were educational interventions [OR 3.03 (95%CI 2.2-4.9); in vulnerable groups OR 2.7 (95%CI 1.9-3.9)]. As expected, interventions adapted to linguistic needs and culturally sensitive approaches showed a significant effect among vulnerable target groups [OR 2.9 (95%CI 1.1-7.9) and OR 2.5 (95%CI 1.1-5.6), respectively]. Reminders were also highly effective [OR 1.8 (95%CI 1.5-2.1); in vulnerable groups OR 2.5 (95%CI 1.9-3.1)]. This review underscores the critical role of targeted interventions in augmenting screening mammography uptake, particularly among vulnerable populations, where odds of participation can increase by up to 2-3 times. Key messages • Interventions adapted to the linguistic needs of the target population and culturally sensitive approaches, aligned with values and beliefs of a specific community, can greatly enhance screening rates. • Considering costs, practicality and impact, reminder letters with culturally and linguistically adapted content emerged as the most promising option for implementation in the ENTER project.

An Innovative Public Health Solution with European Features for an American Problem

Abstract Problem The Eastern Shore of Maryland is a beautiful region that boasts a multicultural community of 455,000 year-round residents. Despite its rural location, the coastal lifestyle attracts retirees, making it the state’s oldest population. Unfortunately, the region also has the highest socioeconomic disparities in the state, which creates difficulties in accessing healthcare. This is a significant public health issue that results in costly barriers to preventive care and timely, accounting for $320 billion in unnecessary healthcare spending. Description of the problem Maryland’s healthcare funding formulas favor larger health systems in urban areas, leading to health inequities. To address this, we propose an innovative scenario analysis model partially based on European public health approaches. This model will adjust funding formulas based on each region’s specific needs and challenges, promoting fairness and equity in healthcare funding. Results Adopting this population health management approach would have built-in efficiencies: In the United States, healthcare spending tends to be higher among underserved populations due to delayed care, access challenges, missed diagnoses, and limited access to the latest scientific advances as well as proper preventive services. Lessons The proposed scenario-based public health funding approach targeting the needs of the underserved population on the Eastern Shore of Maryland could yield significant positive health outcomes and health savings generating a ripple effect across the state, and perhaps even the country. The lessons learned in how other countries handle public health funding could lead to global collaboration. Key messages • Our approach aims to provide a practical solution to unnecessary healthcare spending. • We must adapt to the changing tides to stay on course.

Exploring the health challenges of affected people in the 2023 Khoy earthquake: a content analysis

BackgroundAn earthquake has significant effects on health and livelihood of people. It is important to identify health needs and challenges of earthquake victims and use them to prepare for other possible earthquakes. Therefore, the purpose of this study is to explain the challenges and health needs of earthquake victims in Iran.MethodsThis was a qualitative study with 25 participation who were affected by the earthquake in Khoy City, and were selected using purposive sampling by snowball method technique in 2023. The study data was collected through open and semi-structured interviews. To analyze the data, the conventional content analysis with an inductive approach was used.ResultsThe results show two main categories. The main categories “Management as a missing link in unexpected events” includes 9 subcategories: “The challenge of access to emergency resources and health facilities”, “Feeling of abandonment in medical personnel”, “Weakness in the structural safety and infrastructure of the health system”, “Logistical challenges”, “Risk management training”, “Crisis response management challenges”, “Weakness in the intelligent relief system”, “Management of secondary incidents”, and “Need to provide medical services and disease prevention”. Also, the main categories “Emotional actions of people in crisis” consist of 5 subcategories: “Overexcitement”, “Psychological vulnerability of children”, “Physical complaints caused by stress”, “Confusion caused by the lack of reliable information sources” and “Negative effects of living together with several families”.ConclusionTo help deal with threats and other challenges in the earthquake crisis, countries should try to improve their capacity to manage natural disasters.

Racial group differences and export market access challenges in agricultural value chains and supply networks of SMEs in South Africa

ABSTRACT Although previous studies provide an insightful and categorised nature of internal and external export barriers experienced by agricultural SMEs in general; there is little, if any, strategic insights on the racial nuances in value chain barriers for most agricultural SMEs that target global export markets. This study posits that export barriers are not uniform and differ based on race and the context in which the agricultural SME is based. Hence, we specifically explore the nature of export barriers per race within the agro-value chains in South Africa and juxtapose these with the dynamic market and historical conditions of the South African market environment. In this multi-case study, we focused mainly on the differences between black and white-owned agricultural SMEs riding on their different supply networks’ capabilities to navigate the export barriers they face. The findings serve to develop seminal knowledge to enhance export capabilities and opportunities for minority groups globally and more importantly to highlight the underlying drivers for racial imbalances in agro-supply chains. Although the findings are geographically skewed to South Africa, the market dynamics are relevant across countries with similar demographic characteristics and provide a platform for future research.

Redefining Teacher-Student Interaction in the Digital Era: A Case Study of Hybrid Learning Models in Primary Education

This study aims to explore the dynamics of teacher-student interactions in the context of hybrid learning in elementary schools. Data were collected through classroom observations, interviews with teachers, and analysis of digital platforms used through a case study approach. Findings indicate that although digital technology provides flexibility in time and space and a variety of interactive tools, student engagement in online sessions tends to be low. Non-verbal communication is also limited, affecting the quality of interpersonal interactions. Digital literacy is key; teachers who can utilize technology well can improve student interaction and engagement, and the challenge of unequal access to technology widens the gap in learning. The implications of this study emphasize the need to improve digital literacy for teachers and students, as well as solutions to overcome technological barriers to support effective hybrid learning in the future.

Unveiling Cervical Cancer Inequities Among Georgia Immigrant Latinas: A Robust Qualitative Examination of the Facilitators and Barriers to Prevention, with Emphasis on the Impact of Community-Based Organizations.

This qualitative study delves into the facilitators and barriers surrounding cervical cancer prevention among Latina women in Georgia, with a specific focus on the impact of community-based organizations (CBOs). Employing semi-structured interviews with healthcare providers and representatives from CBOs, faith-based organizations, and other key stakeholders, the study uncovers key themes and subthemes shaping cervical cancer disparities. Themes such as challenges in cross-cultural healthcare access, difficulties due to lack of US citizenship, and limited mobility emerge as significant barriers, while community and family support stand out as crucial facilitators to cancer prevention. Additionally, the study examines community intervention methods from CBOs to target cervical cancer disparity, highlighting the importance of public awareness campaigns, building trust within the Latina community, and providing medical support tailored to immigrant populations. Through this comprehensive examination, the study not only offers invaluable insights into the intricate web of issues surrounding cervical cancer prevention but also endeavors to serve as a catalyst for targeted interventions and evidence-based policies aimed at ameliorating cervical cancer disparities among immigrant Latinas in Georgia and beyond.

Social Inclusion for People with Intellectual Disability and on the Autism Spectrum through Assistive Technologies: Current Needs and Future Priorities

Context Contemporary technologies, such as mainstream and specialised Assistive Technologies (ATs), are seen as effective. However, there is a noticeable gap between technological progress and the ability to customise these technologies to meet the unique needs and characteristics of neurodivergent individuals, particularly those on the Autism Spectrum and people with Intellectual Disability (pwID). Purpose The goal of this study is to investigate the present requirements and future priorities acknowledged by specialists in the field regarding the progress of social inclusion for this population, making use of ATs. Methods and results A qualitative survey involving 24 international experts, and its respective thematic analysis reveals challenges in social inclusion, emphasizing communication and physical accessibility, awareness gaps, and stigma. Concurrently, issues surrounding ATs include limited access, insufficient training, and a lack of awareness and skills, with individuals, and families being inadequately involved. Conclusion and implications The study proposes strategies for overcoming these challenges, with a focus on accessibility, awareness, skills, family involvement, and customization. Identified research needs encompass scientific development, inclusive approaches, and changes in technological development paradigms.

Social Aspects of the Demographic Situation in Uzbekistan

This article investigates the sociocultural dimensions of the demographic landscape in Uzbekistan, with a particular emphasis on population expansion, urbanization processes, and transformations in familial structures. The demographic populace of Uzbekistan has exhibited consistent growth, surpassing 36 million individuals in the year 2023, characterized by an annual increase rate of 1.5%. Current urbanization patterns indicate that half of the populace now inhabits urban locales, thereby engendering challenges in educational access, healthcare provision, and employment opportunities. The research employs data derived from national censuses alongside academic investigations to scrutinize these dynamics and offers policy recommendations aimed at alleviating their societal repercussions. Also, in this article, an attempt was made to predict the demograqfic state of birth, marriage, employment, urbanization and its prospective state in Uzbekistan.

Delving the depths of 'terra incognita' in the human intestine - the small intestinal microbiota.

The small intestinal microbiota has a crucial role in gastrointestinal health, affecting digestion, immune function, bile acid homeostasis and nutrient metabolism. The challenges of accessibility at this site mean that our knowledge of the small intestinal microbiota is less developed than of the colonic or faecal microbiota. Here, we summarize the features and fluctuations of the microbiota along the small intestinal tract, focusing on humans, and discuss physicochemical factors and assessment methods, including the technical challenges of investigating the low microbial biomass of the proximal small bowel. We highlight the essential protective mechanisms of the small intestine, including motility, the paracellular barrier and mucus, and secretory immunity, to show their roles in limiting excessive exposure of host tissues to microbial metabolites. We address current knowledge gaps, particularly the variability among individuals, the effects of dysbiosis of the small intestinal microbiota on health and how different taxa in small intestinal microbiota could compensate for each other functionally.

A scoping review on barriers and facilitators to harm reduction care among youth in British Columbia, Canada

BackgroundProgressive harm reduction policies have been implemented in British Columbia, Canada. However, youth who use drugs face barriers to receiving harm reduction care, resulting in increasing opioid-related hospitalizations and drug toxicity deaths. This scoping review collates peer-reviewed evidence to understand the barriers and facilitators faced by youth who use drugs when accessing harm reduction programming in British Columbia, Canada.MethodsThis scoping review entailed conducting a systematic search of relevant databases to identify relevant articles. Articles were included if they: (i) contained youth falling between the ages of 12 and 26 years old; (ii) explored accessibility, barriers, and/or facilitators to harm reduction care or related topics; (iii) were empirical research articles using primary data (i.e., reviews, grey literature, theoretical or conceptual papers, books, etc. were excluded); and (iv) were available in the English language, given the geographic focus on British Columbia.ResultsA total of 398 sources were identified and ultimately, data from 13 sources were charted and extracted. When investigating barriers to harm reduction care among youth, four themes emerged: self-stigma, service navigation, service delivery, and negative provider interactions. Furthermore, in exploring factors that facilitate harm reduction care for youth, four themes surfaced: ability to meet basic needs, positive provider interactions, social networks, and risk mitigation guidance.ConclusionsThe expansion of harm reduction services in 2016 did not fully address accessibility challenges faced by youth who use drugs. Barriers continue to hinder harm reduction engagement, while supportive networks, positive provider interactions, and the ability to meet basic needs facilitated sustained access. Tailored policy interventions rooted in equity are crucial to improving access to harm reduction services for youth who use drugs.

Renewable energy: A way out for South Sudan’s electricity crisis

South Sudan is one of the least electrified countries in the world, despite having abundant renewable energy resources that could be exploited to generate electricity. The country relies on imported diesel for electricity generation, besides having limited focus on renewable energy development. This policy brief sheds light on the potential of renewable energy as a solution to South Sudan’s ongoing electricity crisis. It examines the key factors hindering the development of renewable energy resources for electricity generation in the country. The brief also provides recommendations to the Government of South Sudan, policymakers, experts, and funding institutions on how to improve electricity access in the country. It is stressing on the importance of prioritising the development of diverse renewable energy resources, such as solar, wind, and small hydropower, as an immediate solution to the electricity access challenges in the country.

Enabling gender responsive low-carbon transport in India using SDG5 framework

<p>Gender and mobility are strongly related and address challenges of safety and accessibility for women. Studies worldwide highlight the need to create more gender-responsive transport systems that maximize women’s mobility, civic participation, and safety. Gender inequality in urban transport is evident in Indian cities in terms of women’s longer walking trip lengths, longer time spent in commute and hence time poverty, impoverished health, and compromised personal safety. Even the public transport systems, often perceived as more gender-equal, overlook women’s needs and mobility concerns such as affordability and scheduling. This article presents transportation challenges faced by women (recorded through primary surveys and focus-group discussions) and further investigates how low-carbon urban transport, as perceived under the Paris Agreement and Sustainable Development Goals (SDGs), can be delivered with gender-equitable outcomes. For a more holistic perspective, the assessment is grounded in two Indian cities, Surat (4.5 million population), a fast-growing industrial metropolis, and Udaipur (0.5 million population), a small but important tourist destination in the nation.</p>

Mitigating household air pollution exposure through kitchen renovation

Globally, over three billion people rely on traditional solid fuels for cooking and heating, leading to significant household air pollution and critical public health concerns. While transitioning to clean energy carriers faces challenges of accessibility and affordability—especially among low-income, rural populations—alternative strategies like kitchen layout modifications and the use of ventilation fans may effectively reduce exposure to pollutants. Here, we analyze factors influencing the adoption of separated kitchens and mechanical ventilation and evaluate changes in human exposure to PM2.5 under different kitchen renovation scenarios by conducting a nationwide survey of household kitchen characteristics in rural China. We found that although 82% of rural households have kitchens separated from other rooms, only 34% use mechanical ventilation. The adoption of ventilation fans is significantly influenced by income and education levels. We estimate that widespread implementation of ventilation fans and separated kitchen designs could prevent approximately 67400 premature deaths annually, resulting in a health benefit of about USD 19 billion per year—substantially exceeding the costs involved. These findings suggest that cost-effective kitchen renovations offer enormous potential for substantial health benefits and present a practical solution compared to the challenges of clean energy transitions in rural areas.

Growing Old in the City: Challenges of Access to and Control of Urban Houses among Older Women in Low-income Suburbs of Bulawayo, Zimbabwe

This study addresses the struggles for housing among older women, including the meaning attached to ownership and control of urban houses among low-income households. It analyses the extent to which older women in low-income suburbs of Bulawayo, Zimbabwe, can age-in-place. I explain how the ideal of ageing in place for the nineteen women in this research (ages 60 – 90) is dependent on factors such as access to and control of one’s housing situation, which are impacted by whether or not they have good sibling and intergenerational family relationships. Family conflicts and unpleasant interactions with siblings, adult children, nephews, nieces, and grandchildren affect their chances of ageing well in their place of choice forcing some of them to begrudgingly retrace their steps back to the rural areas. These older women are poor and do not have reliable sources of income to look after themselves and the children under their care.

Designing Hand Orthoses: Advances and Challenges in Material Extrusion

The intricate structure of human hands requires personalized orthotic treatments, especially with the growing aging population’s demand for accessible care. While traditional orthoses are effective, they face challenges of cost, customization time, and accessibility. Additive manufacturing, particularly material extrusion (MEX) techniques, can effectively address challenges in orthotic device production by enabling automated, complex, and cost-effective solutions. This work aims to provide engineers with a comprehensive set of design considerations for developing hand orthoses using MEX technology, focusing on applying design for additive manufacturing principles, to enhance rehabilitation outcomes. This objective is achieved by establishing design requirements for hand orthoses, reviewing design choices and methodologies across conventional and state-of-the-art MEX-based devices, and proposing an innovative approach to orthotic design. Hand orthosis design requirements were gathered through workshops with occupational therapists and categorized into engineer-, medical-, and patient-specific needs. A review of 3D-printed hand orthoses using MEX analyzes various design approaches, providing insights into existing solutions. The study introduces a modular design concept aimed at improving rehabilitation by enhancing customizability and functionality. It highlights the potential of MEX for creating personalized, cost-effective orthoses and offers recommendations for future research, to optimize designs and improve patient outcomes.