Availability Of Healthcare Resources Research Articles

Healthcare Provider Narratives of the Impacts of the COVID-19 Pandemic on Pregnant and Parenting Youth in Canada: A Qualitative Study

The COVID-19 pandemic led to significant challenges for healthcare providers working with pregnant and parenting youth. However, the impacts of the pandemic on this population and healthcare services from the perspective of healthcare providers are not well documented in Canada. We examined the narratives and experiences of healthcare providers regarding these impacts and explored the challenges to service provision. Using a qualitative interpretative description (ID) approach, we recruited 25 health and service providers from Alberta, Ontario, and British Columbia for individual qualitative interviews. Our analysis resulted in three themes: complexities of health service provision during COVID-19, healthcare providers’ accounts of impacts on pregnant and parenting youth, and leveraging challenges into opportunities for service provision. Participants described the influence of pandemic policies and distancing measures on accessibility of health services, availability of healthcare resources and personnel, and well-being of their clients. They also reported increased mental health issues, isolation, and exacerbation of inequities within this population. Providers highlighted the role of telemedicine in ensuring some degree of continuity of care. Additionally, they commented on service adaptations to address the evolving needs of their clients. Our findings underline the need for a resilient and adaptable healthcare system that can better support the needs of vulnerable populations during crises.

Impact of Chronic Disease Shocks on Household Consumption in China: The Role of Multi-Level Health Insurance

Expanding and enhancing the quality of consumption is crucial to satisfy the increasing demand for a higher standard of living. However, the rising risk of chronic diseases impacts not only the level of consumption but also impedes the optimization of consumption patterns. This research utilizes Staggered Difference-in-Differences (DID) and Difference-in-Differences-in-Differences (DDD) models to evaluate the effects of chronic disease shocks on both the levels and structures of household consumption, leveraging data from the China Family Panel Studies (CFPS) across four survey waves from 2012 to 2018. Additionally, the study examines the effects and mechanisms of the multi-level health insurance system in mitigating the impact of chronic disease shocks. The study discerns a significant decrease in household consumption expenditure, obstruction in the enhancement of consumption structures, and a constriction of consumption diversity attributable to chronic disease shocks. Heterogeneous analysis reveals that the impact of chronic shocks varies across factors such as age, capital endowment, urban versus rural residence, and the availability of healthcare resources. Moreover, the analysis highlights the heterogeneous mitigating effects of the multi-level health insurance system, particularly through diminishing out-of-pocket medical expenses and the propensity for precautionary savings. The findings accentuate the imperative for the enhancement and equalization of the multi-level health insurance system to fortify household consumption, offering significant policy insights for the realization of the “Healthy China” vision. JEL Classification: P36, D12.

O45 INDIVIDUAL VS. HEALTH SYSTEM FACTORS IN HYPERTENSION CONTROL PERFORMANCE: DISTRICT-LEVEL CARE CASCADE ANALYSIS

Background: High-quality health systems are crucial for achieving optimal health outcomes, particularly in managing chronic conditions like hypertension. Effective hypertension control reduces the risk of cardiovascular diseases (CVD). This study examines the relative importance of individual factors (social determinants of health, SDOH) versus health system factors in influencing the stages of the hypertension care cascade in Indonesia, focusing on the controlled rate as the endpoint. This study aims to analyze which factors impact the hypertension care cascade. Methods: The performance of 514 districts in Indonesia was analyzed using multivariate regression. Dependent variables included the percentages of individuals ever tested, diagnosed, treated, and controlled for hypertension. Independent variables encompassed healthcare resource availability, socioeconomic factors, and demographic factors. Results: The regression analysis revealed several key findings: The physician ratio positively and significantly impacted all stages of the care cascade, with coefficients increasing from 0.087 in testing to control 0.356 (p<0.01 for all). The midwife ratio positively influenced testing (0.072), diagnosis (0.135), and treatment (0.160) but not control (0.016, p>0.1). Conversely, Average years of schooling positively correlated with testing (0.111, p<0.05). GNI PPP per capita was positively associated with testing (0.235, p<0.01), diagnosis (0.189, p<0.05), and treatment (0.228, p<0.05), but not control (-0.253, p>0.1). Median age showed a strong positive association across all stages, with coefficients of 1.212 for testing, 1.443 for diagnosis, 1.509 for treatment, and 1.274 for control (p<0.01 for all). Regression shows a pattern that while individual SDOH significantly influenced the early stages of the care cascade (testing and diagnosis), these factors had minimal impact on the control rate. Instead, health system performance was particularly critical for achieving control. Conclusion: Individual SDOHs are more influential in the early stages of the care cascade, while health system factors are crucial for controlling hypertension. Efforts to improve hypertension management should focus on enhancing health system resources to achieve better control rates and reduce CVD risks.

A multiscale examination of heat health risk inequality and its drivers in mega-urban agglomeration: A case study in the Yangtze River Delta, China

Increased frequency of extreme urban heat and its exposure to urban populations is one of the challenges presented by climate change, especially in urban clusters. Due to the rapid but unequal development, heat exposure disproportionately increased in the underdeveloped regions compared to the developed regions in urban agglomeration. To address this issue, it is crucial to clarify the spatial pattern of heat health risk (HHR) inequality for urban heat resilience. However, analyses for the disparity of HHR inequality often used a single scale, neglecting important spatial context effects at other scales. Moreover, the rationale of HHR inequality remains unclear. Here, we took the well-developed and highly urbanized Yangtze River Delta (YRD) region as a case study and employed multiscale approaches to examine how and why the HHR inequality varied at and within the regional scale. We first assessed HHR using a comprehensive assessment framework at a 1 km grid level. Then, we quantified the inequality between regions using local Moran's I and KS distance. Therefore, we utilized the Gini coefficient and Bayes quantile regression to quantify inequality and identify its drivers within the regional scale. Finally, we proposed a conceptual framework to inform policymaking in regions with different patterns of multiscale equality. Our results found that the HHR in YRD exhibited significant spatial inequality at the regional scale (Moran's I = 0.562, P < 0.001) and within the regional scale (Gini coefficient: 0.27–0.54). Higher population concentrations and building densities often led to higher HHR. In high HHR areas, intra-regional inequality was often lower due to high and coordinated socioeconomic levels (Gini coefficient: 0.27–0.34). Additionally, in areas with low and medium levels of risk, healthcare resource availability and local temperatures had a greater impact on intra-regional inequities, which varied at different levels of inequality. This study contributes to a better understanding of multiscale HHR inequality, which helps optimize heat risk management strategies and regional sustainable development.

Abstract 800: Spatial accessibility of gynecologic oncologists and time to surgery in a diverse cohort of women with ovarian cancer in Northern California

Abstract Introduction: To expand our understanding of factors contributing to racial and ethnic disparities in ovarian cancer outcomes, we examined the association between spatial accessibility of gynecologic oncologists and time from cancer diagnosis to surgery in the KPROCS Study, a diverse cohort of women diagnosed with ovarian cancer between 2000-2018 at Kaiser Permanente Northern California (KPNC). Spatial medical accessibility is a component of healthcare access that captures the proximity and availability of healthcare resources in the area. Methods: Ovarian cancer cases were identified through the KPNC Cancer Registry. Demographic and clinical information was extracted from KPNC databases. Neighborhood characteristics from the California Neighborhoods Data System were linked to the residential addresses of cases at the time of diagnosis. Spatial medical accessibility was measured using the 2-step floating catchment area method based on the location of the infusion centers where KPNC gynecologic oncologists practice and the residence location of cohort members. We used generalized estimating equations with independent correlation structure and robust standard errors to examine the association between spatial accessibility of gynecologic oncologists and time to ovarian cancer surgery, adjusting for year and age at diagnosis, stage, histotype, race, ethnicity, neighborhood socioeconomic status (nSES), and receipt of neoadjuvant chemotherapy. Results: The cohort comprised 4,910 women with ovarian cancer, of whom 3,304 had surgery at KPNC. Of this group, 13% were Hispanic, 14% were non-Hispanic (NH) Asian American women, 5% NH Black women, and 67% NH White women. The proportion of women residing in areas of the lowest spatial accessibility of gynecologic oncologists was highest among NH White women (26%) and women residing in the highest quintile of nSES (29%). The median time from diagnosis to surgery was 4 days (interquartile range 22 days). In adjusted analyses, not including the information on spatial accessibility, the time from diagnosis to surgery was 5.1 days longer (95% CI 1.5, 8.7) for NH Black women than NH White women. After adding information on spatial accessibility, this time did not considerably change, resulting in a 5.3-day (95% CI 1.7, 8.9) difference. In this model, the lowest quintile of spatial accessibility of gynecologic oncologists was associated with a longer time from diagnosis to surgery, but this association was not statistically significant (0.4 days difference, 95% CI -1.3, 2.0). Summary: In our preliminary analyses, spatial accessibility of gynecologic oncologists was not found to be a contributing factor to the disparity in time from diagnosis to surgery between NH Black and NH White women. Further analyses will examine time from diagnosis to chemotherapy overall and stratified by racial and ethnic groups. Citation Format: Ekaterina Chirikova, Pushkar P. Inamdar, Valerie McGuire, Salma Shariff-Marco, Valerie S. Lee, Lindsay J. Collin, Carola T. Sanchez-Diaz, Juraj Kavecansky, C Bethan Powell, Jennifer A. Doherty, Lawrence H. Kushi, Elisa V. Bandera, Scarlett L. Gomez. Spatial accessibility of gynecologic oncologists and time to surgery in a diverse cohort of women with ovarian cancer in Northern California [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 800.

Geographic variation in inpatient medical expenditure among older adults aged 75 years and above in Japan: a three-level multilevel analysis of nationwide data.

In Japan, a country at the forefront of population ageing, significant geographic variation has been observed in inpatient medical expenditures for older adults aged 75 and above (IMEP75), both at the small- and large-area levels. However, our understanding of how different levels of administrative (geographic) units contribute to the overall geographic disparities remains incomplete. Thus, this study aimed to assess the degree to which geographic variation in IMEP75 can be attributed to municipality-, secondary medical area (SMA)-, and prefecture-level characteristics, and identify key factors associated with IMEP75. Using nationwide aggregate health insurance claims data of municipalities for the period of April 2018 to March 2019, we conducted a multilevel linear regression analysis with three levels: municipalities, SMA, and prefectures. The contribution of municipality-, SMA-, and prefecture-level correlates to the overall geographic variation in IMEP75 was evaluated using the proportional change in variance across six constructed models. The effects of individual factors on IMEP75 in the multilevel models were assessed by estimating beta coefficients with their 95% confidence intervals. We analysed data of 1,888 municipalities, 344 SMAs, and 47 prefectures. The availability of healthcare resources at the SMA-level and broader regions to which prefectures belonged together explained 57.3% of the overall geographic variance in IMEP75, whereas the effects of factors influencing healthcare demands at the municipality-level were relatively minor, contributing an additional explanatory power of 2.5%. Factors related to long-term and end-of-life care needs and provision such as the proportion of older adults certified as needing long-term care, long-term care benefit expenditure per recipient, and the availability of hospital beds for psychiatric and chronic care and end-of-life care support at home were associated with IMEP75. To ameliorate the geographic variation in IMEP75 in Japan, the reallocation of healthcare resources across SMAs should be considered, and drivers of broader regional disparities need to be further explored. Moreover, healthcare systems for older adults must integrate an infrastructure of efficient long-term care and end-of-life care delivery outside hospitals to alleviate the burden on inpatient care.

Event-independent resilience assessment of the access to care network at the pre-disaster stage using a spatio-temporal analysis

Providing timely access to healthcare is one of the main components of resilient cities and communities. Even without the occurrence of a disaster, the need to access healthcare and the availability of healthcare resources change over time in different areas, so it is crucial to assess the resilience of the access to care network. Previous research on urban infrastructure resilience focused mainly on considering a disaster and its consequences for the performance of systems. This approach limits the generalizability of modeling and assessing resilience to a specific event with considered uncertainties. This research presents a framework to assess the inherent resilience of the access to care network as a complex system at the pre-disaster stage, including the hospital network, population city blocks, access road network, and their interconnections. To conduct this assessment, the availability and accessibility of healthcare resources have been incorporated to establish spatial accessibility, which is compared to the level of need for healthcare. The framework is used for optimizing the system's upgrade decisions under normal operating conditions to improve adaptive static resilience. The methodology and case study illustrate the application of the framework in prioritizing hospitals for upgrading and retrofitting and in urban planning to allocate a location for a new hospital.

Impact of COVID-19 pandemic on thyroidectomy for malignant diseases in high-volume referral centers.

The COVID-19 pandemic has limited the availability of healthcare resources for non-COVID patients and decreased elective surgeries, including thyroidectomy. Despite the prioritization of surgical procedures, it has been reported that thyroidectomy for thyroid cancer (TCa) was adversely impacted. We assessed the impact of the pandemic on the surgical activities of two high-volume referral centers. Patients operated at two National Referral Centers for Thyroid Surgery between 03/01/2020 and 02/28/2021 (COVID-19 period) were included (P-Group). The cohort was compared with patients operated at the same Centers between 03/01/2019 and 02/29/2020 (pre-COVID-19 pandemic) (C-Group). Overall, 7017 patients were included: 2782 in the P-Group and 4235 in the C-Group. The absolute number of patients with TCa was not significantly different between the two groups, while the rate of malignant disease was significantly higher in the P-Group (1103/2782 vs 1190/4235) (P < 0.0001). Significantly more patients in the P-Group had central (237/1103 vs 232/1190) and lateral (167/1103 vs 140/1190) neck node metastases (P = 0.001). Overall, the complications rate was significantly lower (11.9% vs 15.1%) and hospital stay was significantly shorter (1.7 ± 1.5 vs 1.9 ± 2.2days) in the P-Group (P < 0.05). The COVID-19 pandemic significantly decreased the overall number of thyroidectomies but did not affect the number of operations for TCa. Optimization of management protocols, due to limited resource availability for non-COVID patients, positively impacted the complication rate and hospital stay.

A Post-Acute COVID-19 Syndrome (PACS) Clinic in Rural New England.

This article explores the demand and utilization of a rural post-acute COVID syndrome clinic. Electronic health records were used to identify referrals between April 2021 and April 2022 and to describe characteristics of referred patients and referrals generated to specialty services. Of the 747 referrals received, 363 (48.6%) met the criteria for an appointment and were seen, the vast majority (89.6%) via Telehealth. Most patients resided in rural communities (63.1%) and were female (75.2%); mean age was 49, and 17% were hospitalized during their acute illness. Nearly half of patients (49%) had at least one pre-existing mental health diagnosis. Referrals to specialty care for further evaluation and/or intervention were most commonly to occupational therapy (27.3%), physical therapy (24.8%), psychiatry (19.8%), and neurology (17%). Telehealth expanded the availability of health care resources. Additional research on how to meet care needs, ameliorate symptoms, and aid recovery in rural communities is warranted.

Old problems, new solutions: harnessing technology and innovation in Parkinson's disease-evidence and experiences from Thailand.

The prevalence of Parkinson's disease (PD) is increasing rapidly worldwide, but there are notable inequalities in its distribution and in the availability of healthcare resources across different world regions. Low- and middle-income countries (LMICs), including Thailand, bear the highest burden of PD so there is an urgent need to develop effective solutions that can overcome the many regional challenges associated with delivering high-quality, and equitable care to a diverse population with limited resources. This article describes the evolution of healthcare delivery for PD in Thailand, as a case example of a LMIC. The discussions reflect the author's presentation at the Yoshikuni Mizuno Lectureship Award given during the 8th Asian and Oceanian Parkinson's Disease and Movement Disorders Congress in March 2023 for which he was the 2023 recipient. The specific challenges faced in Thailand are reviewed along with new solutions that have been implemented to improve the knowledge and skills of healthcare professionals nationally, the delivery of care, and the outcomes for PD patients. Technology and innovation have played an important role in this process with many new tools and devices being implemented in clinical practice. Without any realistic prospect of a curative therapy in the near future that could halt the current PD pandemic, it will be necessary to focus on preventative lifestyle strategies that can help reduce the risk of developing PD such as good nutrition (EAT), exercise (MOVE), good sleep hygiene (SLEEP), and minimizing environmental risks (PROTECT), which should be initiated and continued (REPEAT) as early as possible.

Stoma care: the role of community nurses.

There are many benefits of standardised care but often this is not possible due to variations in the availability of healthcare resources in the UK. Within stoma care, there is evidence to guide care but with limited standardisation, particularly for community nurses. Stoma care is provided inconsistently, possibly due to variations in training and experience of the nurse. It is known that patients have greater needs in the first few months after stoma formation and this need for support is compounded if there are stoma complications. Community nurses can provide practical support and information, as well as psychological support and encouragement to help people become independent with stoma care and adapt to life with a stoma.

The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023.

The 2023 update of the Chinese Society of Clinical Oncology (CSCO) Clinical Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China, reflecting the latest advancements in evidence-based medicine, healthcare resource availability, and precision medicine. These updates address the differences in epidemiological characteristics, clinicopathological features, tumor biology, treatment patterns, and drug selections between Eastern and Western gastric cancer patients. Key revisions include a structured template for imaging diagnosis reports, updated standards for molecular marker testing in pathological diagnosis, and an elevated recommendation for neoadjuvant chemotherapy in stage III gastric cancer. For advanced metastatic gastric cancer, the guidelines introduce new recommendations for immunotherapy, anti-angiogenic therapy and targeted drugs, along with updated management strategies for human epidermal growth factor receptor 2 (HER2)-positive and deficient DNA mismatch repair (dMMR)/microsatellite instability-high (MSI-H) patients. Additionally, the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer. The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice, particularly in the heterogeneous healthcare landscape of China, while maintaining a commitment to scientific rigor, impartiality, and timely revisions.

Analysing Boons &amp; Banes of COVID 19 Pandemic: A Perspective from Healthcare Services &amp; Policy Standpoint

Background: The myriad effects of COVID 19 pandemic on health and beyond are getting being recognized with the passing time. Aims &amp; Objective: We attempted to compile a general assessment of the various positive and negative impacts of COVID 19 on health and healthcare services, drawing on global and Indian experiences, as well as incorporating a contemporary viewpoint of India's health policy. Methodology: A comprehensive search through PubMed, Google Scholar, news articles, and official documents was conducted to gather evidence on pandemic's impacts (March 2020 - April 2022). Policy capacity framework and health policy studies were analysed without time constraints. Results: The COVID-19 pandemic has heightened the demand for emergency services, affecting the availability of healthcare resources for both communicable and non-communicable disorders. Initially, maternal and child health services experienced a decline, but later rebounded. Telemedicine and community-based care emerged as valuable assets during the pandemic. From a health policy perspective, the crisis prompted a shift from a curative to a prevention-oriented approach. Conclusion: Strengthening and refining rules and regulations governing the implementation of public-private partnerships (PPPs) in health, as well as systematic investment in preventive programmes such as WASH and nutrition were identified as possible areas of health reforms.

Impact of the 2023 armed conflict on Sudan's healthcare system

AbstractThe armed conflict in Sudan erupted in mid‐April 2023, resulting in many casualties, internal displacement, and refugees. Sudan's health system was severely affected by multiple attacks on healthcare facilities and workers, closure of hospitals, and occupation of medical facilities by armed groups. Critical services such as immunization, nutrition, and emergency care have been suspended, disrupting health services in conflict states and increasing strain on neighboring states' healthcare facilities. The conflict also caused shortages of essential medical supplies, looting of healthcare facilities and humanitarian supplies, and destruction of infrastructure, affecting the supply chain and availability of healthcare resources. The deployment and distribution of the health workforce have become challenging and may lead to a further brain drain of healthcare professionals. The financial challenges in healthcare financing are expected to worsen due to the conflict's economic impact on fiscal space and fiscal capacity. The health system's governance has been affected by a leadership vacuum, and decision‐making may shift to the state level. The conflict has also exacerbated the burden of diseases, including communicable diseases, malnutrition, and mental health issues, with potential outbreaks of dengue fever, measles, and spikes of gender‐based violence reported. In response to the conflict, the restoration and maintenance the health system is pivotal via coordinating efforts between the Sudanese Ministry of Health and international partners. The safety of healthcare workers and the delivery of essential supplies need to be restored via strengthening compliance with international humanitarian law, pooling of funds, and services at primary care level. This commentary discusses the impact of the 2023 conflict on Sudan's health and health system, particularly on different building blocks of Sudan's health system as well as the burden of disease and humanitarian response priorities.

Realities and challenges of head and neck free flap reconstruction in sub-Saharan Africa.

With an increased need to decentralize and train more head and neck ablative and reconstructive surgeons in sub-Saharan Africa, we assess the realities and challenges of free flap reconstruction in sub-Saharan Africa to provide context of its use as a reconstructive option. Head and neck free flap reconstruction has been performed by local teams as well as visiting teams in Sub Saharan Africa with good results. Free flap success rates are similar to high income regions at 89% vs. 85-100%. However, flap salvage rates are significantly lower (45% compared to 64.1% reported in high income regions). This has been attributed to resource constraints. With increasing efforts to increase free flap reconstructive capacity in sub-Saharan Africa, these efforts need to be in the context of available healthcare resources including infrastructure and workforce outside of the surgical team. As training of head and neck ablative and reconstructive surgeons is expanded, reconstructive training needs take the healthcare resource availability into account.

Deferring Postoperative Follow‑Up Visits up to 4 Weeks After Uneventful Cataract Surgery in a Tertiary Level Eye Hospital: Protocol for a Prospective, Quantitative, Experimental Control Study.

Routine examination after cataract surgery, including a refraction test 4 to 6 weeks after surgery, is mandatory in most hospitals. In recent years, there has been growing interest in exploring alternative approaches to postoperative follow-up in cataract surgery patients due to the increasing number of cataract surgeries being performed, the limited availability of health care resources, and the need to optimize the use of health care services. We aim to compare postoperative visual outcomes after a day 0 examination in patients with 2 follow‑ups, one on day 7 and other on day 30, and patients with a single ophthalmic follow‑up between days 25 to 30. A prospective, quantitative, experimental control study will be carried out in Reiyukai Eiko Masunaga Eye Hospital, located in Banepa, Kavrepalanchok, Nepal. All patients undergoing cataract surgery meeting the inclusion and exclusion criteria irrespective of the type of surgery (small-incision cataract surgery or phacoemulsification) will be included in the study. The patients will be randomly assigned to 1 of 2 groups. Patients in group 1 will be examined on day 1, day 7, and day 30, whereas patients in group 2 will be examined on day 1 and once between days 25 to 30. The minimum clinically important difference (MCID) in our study will be set according to the improvement in the Snellen visual acuity chart. The study is expected to be completed within 6 to 8 months from the start of the project. Data analysis and report writing will be carried out in a 2-month period. Best-corrected visual acuity will be compared between the 2 groups to determine if the MCID is achieved. The cost-effectiveness of the new approach will also be analyzed. We aim to conclude that we can safely defer the 1-week postoperative follow-up visit in patients undergoing uncomplicated cataract surgery and that, moreover, we can reduce the patient load at the hospital and decrease patient expenses by decreasing the frequency of hospital visits. PRR1-10.2196/48616.

E33 Identifying and understanding JDM in Africa: a survey of rheumatology care providers from Africa

Abstract Background It is estimated that millions of children in Africa suffer from pediatric rheumatic diseases (PRD). Despite this, as of 2021, there were just 28 pediatric rheumatologists in only 10 of the 54 African countries. With ∼700 million children living in Africa, this number falls far short of the recommended minimum 1750 pediatric rheumatologists needed for ideal care. Rheumatic and musculoskeletal diseases are the second leading cause of disability globally. However, there is a paucity of data on PRD in low and middle-income countries (LMIC) due to limited diagnostic capacities, scarcity of pediatric rheumatologists, and limited awareness of PRD. We have much to learn about the prevalence of PRD as well as clinical manifestations, optimal treatments, and outcomes in African children with PRD. Juvenile dermatomyositis (JDM) can cause significant morbidity and irreversible damage when inadequately treated, resulting in medical, social, and economic burden on patients, families, and healthcare systems, particularly in LMIC. The few studies of JDM in Africa suggest high rates of severe manifestations, including calcinosis, vasculitis, and pulmonary involvement. The objective of this survey is to better understand the scope of JDM burden in Africa by obtaining an overview of JDM and comparing this to data in previously published work. Methods A survey was distributed to members of the African League of Associations for Rheumatology (AFLAR; n = 233) and Paediatric Society of the African League Against Rheumatism (PAFLAR; n = 130) via WhatsApp groups. Respondents were queried about the total number of JDM patients seen currently or within the last 10 years; morbidities and clinical outcomes, including calcinosis, interstitial lung disease (ILD), clinically inactive disease, remission, and death; and availability and accessibility of diagnostic tools and medications. Results A total of 43 (12%) individuals started the survey, with 4 (9%) partially and 16 (37%) fully completing it, describing 216 JDM patients. One general pediatrician participated; the remainder were adult (n = 10; 50%), pediatric (n = 7; 35%), or adult/pediatric (n = 2; 10%) rheumatologists. Respondents represented the 5 regions of Africa, primarily Northern Africa (n = 12; 60%). Mortality was reported at 14% and 29% in Kenya and Zambia, respectively (Table 1). Many respondents identified limited availability of medications (56%), unfamiliarity with JDM by caregivers (69%) and other medical providers (44%), and delayed presentation to care (75%). Access and/or cost limited use of diagnostic tools and medications. Of the 27 queried diagnostic tools and medications, 13 were reported to be accessible to only 50% or fewer of respondents, the majority (69%) of whom were from Northern or Southern African countries. Despite the lack of cost or other apparent access barriers, disease assessment tools are used by only 53% of respondents. Conclusion This is the first study to explore JDM on a broad scale across the African continent. We identified 216 African children with JDM within the past 10 years, exceeding the previously published reports of 196 JDM patients seen in the last 25 years and likely still underestimating prevalence. Our results suggest substantially higher rates of severe disease, with mortality rates in some countries vastly different from the 1–3% reported in high-income countries. Many respondents were limited in their capacity to diagnose and treat JDM, but there was a wide range across African regions that seemed to parallel known disparities in healthcare resource availability in Africa. This survey highlighted important possible differences in disease manifestations and outcomes that warrant further study. Future collaboration with our African colleagues is critical to raise awareness of JDM to ultimately improve disease severity and outcomes. Ethics Institutional review board approval was obtained with waiver of informed consent.

Examining the Connection Between Health Outcomes, State Political Ideology, and Food Access in the United States.

To estimate the impact of county-level income, access to food, availability of health resources, socioeconomic factors, and state political ideology on population obesity and mental health in US counties. We compiled a county-level data set from the US Census, County Health Rankings, USDA Food Environment Atlas, the American Community Survey, and the State Ideology Database. We specify 2 multivariable regression models for county-level obesity rate and per capita poor mental health days and control for rurality, food access, income, availability of health care resources, state political ideology, and socioeconomic characteristics. We find that higher food access reduces obesity in counties; an increase in per capita full-service restaurants by 1 unit is associated with reduction in obesity rate by 1.24 points and an increase in per capita grocery stores reduces poor mental health days by 0.14. We also find that counties in liberal-leaning states tend to have lower obesity rates. Access to primary care providers (increase in primary care physicians by 1 is associated with decline in obesity rate by 1.18 points and poor mental health days by 0.11 days), and recreational facilities (increase in recreational facilities per 1000 by 1 is associated with reduction in obesity rate by 3.16 points and poor mental health days by 0.47 days) reduces obesity rates and poor mental health days. Median income is associated with decrease in obesity rate and poor mental health days. Increase in median household income by 1% is associated with reduction in obesity rate 4.75% and reduction in poor mental health days by 1.39 days. We find that access to food and health care at county level and state ideology through policy making affects health outcomes. Our analysis indicates that counties can improve access to food and health care by investing in these services thereby improving county-level health outcomes and save dollars in the process.

Comparison of Rare and Common Diseases in the Setting of Healthcare Priorities: Evidence of Social Preferences Based on a Systematic Review.

In light of the limited availability of healthcare resources, providing universal access to healthcare is a challenging task. As a result, prioritizing healthcare services has emerged as a crucial issue. This study aims to explore the preferences of the public regarding healthcare prioritization for rare and common diseases. By examining public attitudes, this study seeks to inform government decisions concerning resource allocation and distribution within healthcare. "Social preference" and "rare disease" were searched as MeSH terms in the electronic databases of Ovid Medline, Web of Science, Embase, and Econlit for articles published since their establishment, and the information on the characteristics of the articles and the results of social preferences for rare diseases were analyzed and summarized. The public held predominantly neutral views on the setting of healthcare priorities for rare and common diseases. The results of the included studies showed that with all else being equal, no social preference for rarity was found, but when the public considered the proportional advantage of rare diseases or when the respondents were young, a social preference for rarity existed. In addition, the public weighed attributes such as the health benefits of treatments, the effectiveness of treatment options, the safety of treatment, equity, unmet needs, and disease severity in the process of setting of treatment priorities for rare diseases. Furthermore, in consideration of equity, the public showed a willingness to pay for rare diseases in spite of the high medical costs. International studies on social preferences provide some evidence for the setting of healthcare priorities for rare diseases, and health policymakers should consider social preferences in an integrated manner in order to set healthcare priorities appropriately.

Asian Pacific Society of Cardiology Consensus Statements on the Diagnosis and Management of Chronic Heart Failure

In the Asia-Pacific region, heart failure (HF) is associated with significant health and socioeconomic burden. Given the differences in the epidemiology of HF, as well as the availability of healthcare resources between Asian and Western countries, an Asian Pacific Society of Cardiology (APSC) working group developed consensus recommendations on the management of chronic HF in the Asia-Pacific region. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Consensus recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were either ‘agree’ or ‘neutral’. The resulting statements provide guidance on the diagnosis, assessment and treatment of patients with HF with reduced, mildly reduced or preserved ejection fraction in the Asia-Pacific region.