Comprehensive Health Care Services Research Articles

A comprehensive epidemiological assessment of female rape in São Paulo State, Brazil: trends, patterns, and implications for public health.

Sexual violence against women remains a global challenge, with Brazil exemplifying persistent issues despite legislative advancements. This study examined sexual violence within São Paulo state, Brazil's largest and economically affluent state, focusing on prevalence, patterns, forensic evidence, and health consequences. We analyzed 40,757 medical reports of alleged cases of rape against women available from the São Paulo Medical Legal Institute from 2014 to 2017. An increase in female rape cases was observed, reflecting broader societal trends, but underreporting, prevalent due to fear and stigma, underscored the need for multifaceted interventions. We also explored correlations between rape prevalence and the Human Development Index, highlighting disparities between urban and rural areas. Additionally, the study revealed concerning proportions of cases involving vulnerable victims, emphasizing the imperative for tailored interventions and legislative reforms. Furthermore, we demonstrated that only a small portion of medicolegal examinations were able to find evidence of sexual violence or recent sexual acts, necessary for conducting the criminal investigation of the alleged act. Therefore, despite challenges in forensic evidence collection, efforts to enhance medical examination protocols and awareness among professionals are crucial. Moreover, findings underscored the significant health consequences of rape, including unwanted pregnancies and sexually transmitted infections, necessitating comprehensive healthcare services for survivors. In conclusion, we reinforced that addressing sexual violence demands coordinated action, including legislative reforms, community engagement, and survivor-centered approaches, to create safer and more resilient communities.

A Holistic Harm Reduction Center Model: A Commentary

Substance addiction is a chronic, relapsing disorder characterized by compulsive drug seeking, loss of control over consumption, and a negative emotional state when access to the drug is restricted. Substance Use Disorders (SUDs) are associated with severe health issues including suicide and co-occurring diseases like HIV and hepatitis C, and mental health problems. Although the present SUD treatment models prioritize abstinence, achieving abstinence during a treatment episode is challenging as majority of individuals with SUDs continue using drugs during treatment. To address this challenge in the current SUD treatment model, harm reduction has emerged as a strategy that focuses on interventions such as naloxone distribution, syringe services, safe drug use education and other strategies that reduce harmful outcomes such as substance-related overdose death and disease transmission while improving quality of life. This commentary proposes a Holistic Harm Reduction Model that can be incorporated by harm reduction centers aimed at reducing risky drug use behavior and overdose deaths, and ultimately improving public health outcomes in the community. The proposed holistic model includes new components such as trauma-informed care and referral and a brief mindfulness intervention along with the already existing harm reduction approaches such as Licensed Practical Nurses (LPNs) and harm reduction managers to provide comprehensive healthcare services, distribution of supplies; education; referral and linkage to other services, including medications for substance use disorder; and participant data collection and analysis.

Dental impact on daily life and oral health in alcohol use disorder patients

ObjectivesIndividuals with Alcohol Use Disorder (AUD) are at a higher risk of developing dental problems. The present study assessed the dental impact on daily performances among AUD patients seeking treatment in a de-addiction centre and correlated it with their clinical dental status using the WHO oral health assessment form (2013). Materials and methodsThis research took place from January to May 2022. A cross-sectional study was carried out to collect data from 103 subjects among alcohol dependents taking treatment in a de-addiction centre of Dakshina Kannada district, Karnataka state. The Dental Impact on Daily Living Questionnaire (DIDL) assessed patients' satisfaction with their teeth, while the WHO Oral Health Assessment Form for Adults was used for dental caries (DMFT) and periodontal status. Data analysis was performed using the jamovi open-source software (version 2.3), employing t-test, chi-square test, hierarchical regression analysis, and Spearman correlation coefficient. ResultsThe study found low yet significant correlations between clinical oral health and dimensions of the DIDL scale. Social class and the number of decayed teeth emerged as significant predictors of the total DIDL score. ConclusionOral health conditions can adversely affect patient satisfaction, emphasizing the need for healthcare providers to consider these findings when offering comprehensive oral healthcare services. Clinical relevanceThis study underscores the necessity of integrating oral healthcare into the overall treatment regime for individuals with Alcohol Use Disorders (AUDs) to improve their quality of life and satisfaction.

8.D. Scientific session: Equitable Immunization: Leveraging Prisons for Vaccination Equity in Europe

Abstract Addressing low vaccine coverage is a pressing public health concern in Europe, where pockets of unvaccinated individuals persist despite ongoing efforts. The European region sees an estimated 1.4 million individuals detained on any given day, with a significantly higher number passing through prisons annually due to high turnover rates. Those experiencing incarceration often come from socially marginalized and disadvantaged groups, facing a multitude of health challenges including non-communicable diseases, infectious diseases, mental illness, cognitive disabilities, and substance dependence. Despite their elevated health needs, individuals in prison frequently encounter barriers to accessing healthcare services, including preventive measures such as vaccination. Available but limited data suggest that individuals entering the prison system are often under-immunized, particularly against Hepatitis B Virus (HBV), influenza, measles, mumps, rubella (MMR), and pneumococci. Unfortunately, vaccination services within prisons are often insufficient, typically being provided according to national schedules or in response to outbreaks of vaccine-preventable diseases (VPDs). It’s crucial to distinguish between the availability of vaccination services and actual coverage, as the modalities of vaccination offerings vary across the region. While individuals in prison are recognized as a target group for HBV vaccination, the methods of offering vaccines may differ based on factors such as age or risk group. Nevertheless, systematic implementation of HBV vaccination in prisons has shown clear benefits for both incarcerated individuals and the wider community. Given the significance of vaccinations in preventing diseases like HBV and human papillomavirus (HPV), which are linked to cancer, initiatives like the Europe Beating Cancer Plan and the European Council Recommendation on vaccine-preventable cancer emphasize their importance. Prisons can serve as a strategic point for delivering comprehensive healthcare and vaccination services to incarcerated individuals, yet routine data on vaccination coverage at entry and uptake during incarceration are often lacking, hindering effective health planning. To address this public health challenge, the ‘Reaching the hard-to-reach: Increasing access and vaccine uptake among prison population in Europe’ (RISE-Vac) project consortium has been formed. This collaborative effort brings together diverse expertise and established networks in the field of prison health, reflecting the varied epidemiological and structural landscapes across Europe. The objective of this workshop is to showcase recent research findings, evidence-based practices, and policy recommendations aimed at enhancing vaccination equity in the European region. By sharing insights and best practices, we aim to bolster efforts to improve vaccine access and uptake among incarcerated populations, ultimately contributing to broader public health goals. Key messages • Prison health is public health: vaccination services in prison are essential to achieve immunization targets in Europe. • Maximizing inter-sectoral collaboration is crucial for bridging the gap in vaccination access and uptake among people living in prison in Europe.

Impacts of chronic diseases and multimorbidity on health-related quality of life among community-dwelling elderly individuals in economically developed China: evidence from cross-sectional survey across three urban centers

ObjectiveAs the ageing process in China further accelerates and the average life expectancy increases, chronic disease prevalence and multimorbidity rates are constantly rising, especially among elderly individuals. However, few previous studies have explored the impacts of chronic diseases and multimorbidity on health-related quality of life (HRQoL). This study aimed to investigate this association among community-dwelling elderly individuals in China.MethodsA cross-sectional study was conducted in communities in three cities (Suzhou, Qingdao, and Guangzhou). The basic characteristics, chronic diseases and HRQoL of participants were collected, and HRQoL was measured by the EuroQol 5-Dimensions 3-Level version (EQ-5D-3L). Logistic regression, Tobit regression and generalized linear models were used to assess the impacts of chronic diseases and multimorbidity on HRQoL.ResultsApproximately 83.2 percent of the 1,218 respondents had chronic conditions, with 30 percent having multimorbidity. After controlling for sociodemographic and health behaviour factors, patients with stroke were more likely to report problems in all five dimensions of the EQ-5D and had a lower EQ-5D utility index (UI) (b = -0.342) than patients with other chronic conditions. Patients with chronic pulmonary obstruction had a lower EuroQol Visual Analog Scale (EQ-VAS) (b = -11.169) than patients with other chronic conditions. Furthermore, patients with multimorbidity had worse HRQoL (P < 0.001).ConclusionsBoth chronic condition probability and multimorbidity rates were high among Chinese community-dwelling elderly individuals. Different disease types had varying degrees of impact on HRQoL, and patients with multimorbidity had worse HRQoL. This study proposes that the government enhance the quality of life of community-dwelling elderly individuals with multimorbidity by establishing long-term care insurance and expanding comprehensive community-based home health care services.

Efforts Implemented for Developing Health Management Workforce in the Asia Pacific: A scoping review

Background and objective: A strong and effective health management workforce (HMW) is essential to underpin the comprehensive health care services provided by health care organizations. The fast-growing nature of healthcare systems suggests the required competencies for HMW continue to evolve. The objective of this scoping review is to identify and confirm the key strategies that have been used in developing the health management workforce in the Asia Pacific region. Materials and Methods: A scoping review of the literature was conducted between May and August 2022 using the following databases: Medline, Ovid Emcare, CINAHL, Scopus, and Web of Science, to retrieve original research articles demonstrating development efforts for HMW in the Asia Pacific regions. The review was guided by the PRISMA-ScR (2018) checklist [23]. Results: The scoping review identified four different development strategies for HMW in Asia Pacific region: i) Organisational informal professional development programs, ii) Competency assessment and identification of gaps in knowledge and skills of HMW, iii) Confirming competencies and developing competency framework and iv) Formal education and training. Among these four development strategies, organisational informal professional development programs and competency assessment and the identification of gaps in knowledge and skills of HMW were the main strategies implemented for HMW in the Asia Pacific region. Conclusion: The review concluded that the existing development strategies and efforts for HMW are not evenly implemented within the Asia Pacific region. Political will and policy direction are important and plays a vital role in the competency development of HMW. It is also critical to provide multilevel commitment from system and organisational level together with identifying and addressing the bottlenecks in the development strategies by considering organisation types, management levels and positions, practical training methods, motivation of participants, and other contextual factors.

Assessing the Dietary Practices and Anthropometric Outcomes of Students Consuming Mid-day Meals Versus Home-Cooked Meals.

Early childhood and adolescence are prime years that people spend in school. These formative years give the school ample opportunities to impart certain aspects of lifestyle and healthcare to the student, in addition to academics. School health programs are vital in providing comprehensive education and healthcare services. The objectives of the study are to enlist the socio-demographic factors affecting the nutritional level between students who enrolled for the mid-day meal scheme and those who did not. This is a cross-sectional questionnaire-based study, which was carried out between children who enrolled in the mid-day meal program and home-cooked meals for students from 3rdto 12thgrade in Faridabad. The study was conducted by the Department of Public Health Dentistry, Faridabad, from January to June 2024. It was determined that 162 (53.6%) males and 222 (74.9%) females were obese. 332 (55.3%) believed that social media had an impact on their dietary decisions, while 268 (44.7%) disagreed. When asked to rate how many healthy food alternatives were available at their school, 53 (8.8%) of them said it was great, 194 (32.3%) said it was good, 196 (32.7%) said it was fair, and 157 (26.2%) said it was poor. 236 (78.7%) parents of the mid-day meal group never had dietary supplemental education, which is why children have indigent nutritional status. The mean waist-to-hip ratio (WHR) was calculated as 0.92 ± 0.43 and 0.88 ± 0.69 with significant values of 0.00 (p≤0.05) in the home-cooked and mid-day meal-consuming groups respectively. Students consuming home-cooked meals showed a better WHR for age than those consuming mid-day meals. Children of parents with high education levels have good nutritional status and are healthier as compared to children with parents who have low education levels. Thus, there is a dire need to include school health programs to provide healthy and nutritious food to children, in need.

Performance of health and wellness centre in providing primary care services in Chhattisgarh, India

IntroductionPrimary health care has regained its importance in global policy making. In 2018, the Government of India initiated the Ayushman Bharat - Comprehensive Primary Health Care (AB-CPHC) programme. It was based on upgrading the existing primary health facilities into Health and Wellness Centers (HWCs). The current study aimed to assess the readiness and performance of HWCs in providing comprehensive primary health care services in India’s Chhattisgarh state.MethodsWe conducted a cross-sectional health facility assessment with a state-representative sample of 404 HWCs. A standardized health facility survey tool was used to collect information on essential inputs and service outputs of HWCs. The expected population healthcare needs were estimated using secondary sources. The performance of HWCs was assessed by comparing the volume of services provided against the expected population need for outpatient care.ResultsOn an average, 358 outpatients including 128 non-communicable disease (NCD) patients were treated monthly at an HWC. HWCs were able to cover 31% of the total population’s health need for outpatient care, 26% for hypertension, and 21% for diabetes care. In addition to services for reproductive and child health, HWCs provided services for common acute ailments (cold, cough, fever, aches and pains); infections of skin, eye, ear, and reproductive tract, and minor injuries. HWCs were also contributing significantly to national disease control programmes. Acute ailments followed by NCDs and communicable diseases had the largest share among services provided. The key gaps were in coverage of mental illnesses and chronic respiratory diseases. Most of the HWCs showed adequate readiness for the availability of required human resources, supplies, and infrastructure.ConclusionHWCs were able to provide a comprehensive range of primary care services and able to cater to a sizable portion of the rural population’s acute and chronic health care needs. The performance was made possible by the adequate availability of medicines, staff, training programmes and tele-consultation linkages. If HWCs in other states are able to reach a similar level of performance, the initiative will prove to be a game changer for equitable primary care in India.

Women's Health Care Delivery and Coordination After Transitioning From One Electronic Health Record to Another: Perspectives From Staff in the Veterans Health Administration

ObjectivesThe Veterans Health Administration (VA) is transitioning its 1,300 health care facilities from one electronic health record (EHR) to another. The transition aims to improve care delivery and interoperability; however, specific effects on women veterans, who comprise only 7.5% of the patient population, may be obscured without focused evaluation. We aimed to characterize the perspectives of VA staff regarding the impact of transitioning EHRs on women's health care delivery. MethodsWe conducted semistructured interviews with VA staff members involved in delivering or coordinating care for women at three sites that had transitioned EHRs within the past year. Interviews were audio-recorded and transcribed. We used a rapid, templated qualitative analytic approach to identify salient themes in the data. ResultsWe interviewed 16 staff members across VA departments and roles. Although some participants felt the new EHR held promise, most identified challenges with the EHR rollout and implementation (e.g., insufficient training) and the EHR product (e.g., system inefficiencies and latency). Participants highlighted several ways the EHR transition disproportionately affected care delivery for women veterans, including via backlogs of community care referrals, insufficient opportunities for providers to gain proficiency with sex-specific workflows in the new EHR, and outdated listings for veterans who have changed their names. Participants reported that these issues affected their morale and contributed to decreases in productivity and delayed care. ConclusionsMany of our findings reflect challenges that affect VA staff broadly, whereas others may be compounded among women veterans and the VA staff who serve them. To achieve the goal of delivering timely, equitable, high-quality, comprehensive health care services to women veterans, continued efforts to monitor and address the impacts of the EHR transition on this population are needed.

“Diabetes among tuberculosis patients in Bengaluru is alarming: Time to tackle it efficiently!”

ContextTuberculosis (TB) remains a major health challenge in India, with the country bearing the highest global burden. Co-existing with this epidemic is the surge in diabetes mellitus (DM) cases, earning India the title of "Diabetes Capital." AimThis study investigates the association between TB and DM, focusing on the feasibility and outcomes of screening TB patients for diabetes. It also explores the challenges and opportunities for integrated care of TB-DM comorbidities. Settingsand Design: This cross-sectional study was conducted in 32 tuberculosis units in the BBMP district of Bengaluru, Karnataka, India. Materials and methodsData were collected from TB laboratory registers and through interviews with National Tuberculosis Elimination Program (NTEP) healthcare providers. The study assessed the implementation of diabetes screening, challenges in the process, and suggestions for improvement. ResultsAs part of the Quantitative data, of the 17,052 presumptive TB cases examined, 41% were aware of their diabetes status. Diabetics constituted 14.61% of the presumptive cases. Of the diagnosed TB patients, 25.2% were found to be positive for DM as well. Qualitatively, healthcare providers highlighted operational challenges, mainly concerning the timing of blood sugar testing and the need for referral to higher-level facilities. They also emphasized the importance of generating awareness among communities and training healthcare workers for on-the-spot diabetes screening. ConclusionThe findings highlight the urgent need for improved screening of TB patients for diabetes, timely initiation of anti-diabetic treatment, and comprehensive healthcare services under one roof. Advocacy, communication, and social mobilization strategies should be intensified to create awareness of TB-DM comorbidities in the general population.

Non-alcoholic fatty liver disease (NAFLD) integration into India's NCD program - Obstacles and solutions for the implementation of guidelines at the national level.

Individuals who have non-alcoholic fatty liver disease (NAFLD) are at high risk of metabolic comorbidities and can put a significant strain on healthcare systems. If not managed in a timely manner, NAFLD can lead to sustained healthcare costs, economic losses, and reduced health-related quality of life. In India, the Ministry of Health and Family Welfare recognized the need for a comprehensive approach to prevent NAFLD and integrated public health measures into the existing National Program for Prevention and Control of Non-Communicable Diseases (NP NCD). However, 3 years after the integration, there is no clear measure of the extent of implementation of this program, and the exact facilitators and barriers to implementing the program are yet to be determined. The next step toward providing comprehensive and effective healthcare services to those affected by NAFLD is the implementation of NAFLD guidelines under the NP NCD. The article emphasizes the importance of replacing old reporting formats with updated ones that incorporate NAFLD. It also highlights the need for healthcare personnel and community health workers to receive multiple trainings. While measuring waist circumference (WC) and identifying patients who need referral poses challenges, we can overcome them by updating the Non-Communicable Disease (NCD) application to include NAFLD, recording WC in registers, and using up-to-date reporting formats.

Prevalence of Psychiatric Morbidity, Physical Illness, and Coping Strategies in Residents at Old Age Homes: A Cross-Sectional Study

Abstract Background: Older adults living in long-term care facilities, such as old age homes, often face a range of physical and mental health challenges that can significantly impact their overall well-being. Objectives: This study investigated the prevalence of psychiatric morbidity, physical illness, and coping strategies in old age home residents in Visakhapatnam, India. Methods: A cross-sectional study recruited 300 consenting residents. Standardized tools, namely the Mini-Mental Status Examination (MMSE), the six-item version of Goldberg's General Health Questionnaire (GHQ-6), and the Mini International Neuropsychiatric Interview (MINI) for diagnosing psychiatric disorders as per DSM-V criteria, were used to assess mental health. The Coping Checklist by Kiran Rao was also used. Results: Significant psychiatric morbidity was found in 15.33% of residents, with depression being the most prevalent disorder. Females, widowed individuals, those from urban backgrounds, and residents of nuclear families were more likely to report depressive symptoms. Physical illness was identified in 70% of the participants. Conclusion: This study highlights a considerable burden of psychiatric illness and physical health problems among residents of old age homes. Furthermore, it suggests that specific demographic factors are associated with an increased risk of depression. These findings emphasize the need for comprehensive mental and physical healthcare services within old age homes, with tailored interventions for vulnerable populations.

Perception of healthcare workers and patients about the impact of health facility infrastructure on healthcare services in eThekwini Municipality, KwaZulu-Natal, South Africa

ABSTRACT Background: Although there are several health facilities with infrastructure to cater to healthcare services, there are still healthcare facilities with inadequate infrastructure in eThekwini Municipality, KwaZulu-Natal Province, South Africa, to provide comprehensive healthcare services. This study investigates the perceptions of healthcare workers and patients about the impact of health facility infrastructure on the provision of healthcare services in KwaZulu-Natal. Objectives: This study aims to determine the perception of healthcare workers and patients about the impact of health facility infrastructure on healthcare services at Goodwins Clinic in eThekwini Municipality, KwaZulu-Natal, South Africa. Method: This qualitative study applied a phenomenological design by conducting in-depth interviews with individual patients (n = 20) and healthcare workers (n = 10) purposively selected in 2022. Data were analysed using Colaizzi’s phenomenological analysis framework. Results: Participants reported that health facility infrastructure affects healthcare services. Furthermore, old facility structures, scattered structures and limited working spaces were found to be the leading factors affecting healthcare services in the facility. Conclusion: The facility’s structural design factors need to be considered to ensure that the health facility structure is adequate to deliver healthcare services and motivate radical transformation in measuring and managing healthcare facilities.

Ayushman Bharat Yojana – A Beneficiary Level Study

Ayushman Bharat Yojana, a nationwide public health insurance initiative administered by the Indian government, aims to provide free health insurance coverage to low-income individuals in the country. It is also referred to as PMJAY or Pradhan Mantri Jan Arogya Yojana. Launched on September 23, 2018, this program is designed to achieve the Sustainable Development Goals (SDGs) and their underlying commitment. Under the Ayushman Bharat scheme, approximately 100 million impoverished and vulnerable families in India will be covered, offering up to Rs. 5lakhs per family per year for secondary and tertiary care hospitalizations. Additionally, the initiative proposes the establishment of 150,000 health and wellness centers nationwide, providing comprehensive primary healthcare services. Both public and privately affiliated medical facilities are eligible to offer healthcare services to beneficiaries of the insurance program. This program stands as one of the largest publicly funded health insurance initiatives globally. This paper is based on a combination of primary and secondary data sources. Primary data was collected from selected respondents in the study village of Parakuchi in the Kamrup Rural District of Assam. Secondary data was obtained from various online reports and articles. Among the 80 sample respondents, 38 individuals have already received their Ayushman Bharat cards, while 42 are still awaiting theirs. However, none of the respondents have utilized their cards yet, as they have recently received them and do not currently experience any major health issues.

Examining Factors Related to Medical Home Attainment for Youth in Working Poor Households

The medical home model has been recognized as an effective approach for promoting comprehensive primary health care services. Even though income-related disparities have been highlighted as a barrier for equal access to health care, within pediatrics, youth in working poor households have been vastly understudied regarding risk factors for medical home attainment. To address this gap, this study uses conceptual guidance from the Andersen Health Care Utilization Model and applies hierarchical logistic regression methods to examine factors related to medical home attainment for youth in working poor homes. Results indicate that race, parental education, insurance coverage, English language proficiency, and health status are all significant predictors of medical home attainment, yielding important implications for policy and program planning.

Transforming Lives Through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY): A Review

Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) program was created in line with the global goal of Universal Health Coverage (UHC), and aims to ensure everyone has access to quality healthcare services without suffering financial difficulties. In India, over 60% of healthcare spending is still borne by households, and a significant portion of the population lacks any form of health protection coverage. Discussion: The High-Level Expert Group (HLEG) recommended a shift from supply-side healthcare financing to demand-side financing, leading to the introduction of government-sponsored health insurance schemes. To achieve Universal Health Coverage (UHC), the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched following the recommendations of the National Health Policy 2017. The PMJAY program is the world's largest publicly sponsored social health insurance program, delivering comprehensive healthcare services covering primary, secondary, and tertiary care levels. The scheme covers approximately 12 crore households, including more than 50 crore beneficiaries, offering healthcare coverage of up to Rs. 5 lakh per family annually. PMJAY operates nationwide in India, covering all states and union territories except for a few.. Conclusion: To move forward, PMJAY can play a transformative role in the healthcare landscape, integrate with primary healthcare, contribute to economic development, and expand its scope to include more healthcare services.

Gender Identity Disclosure and Healthcare Services Uptake Among Chinese Transgender Individuals in China: Results from a Cross‐Sectional Study

Purpose Culture and stigma-relevant issues discourage transgender individuals in China from gender identity disclosure, which may limit their access to comprehensive health care services. This study evaluates how gender identity disclosure to healthcare professionals would facilitate healthcare services in China. Methods A cross-sectional study was conducted in nine cities across mainland China from December 2019 to June 2020 among transgender individuals. Participants completed questions covering socio-demographic information, Human Immuno-Deficiency Virus and Sexually Transmitted Infections (HIV/STI) testing habits, sexual risk behaviors, and access to medical and mental health services for the past 3 months. Results A total of 277 eligible transgender individuals with a mean age of 29 ± 8 years old completed the survey. Overall, 56.0% (155/277) had disclosed their gender identity to health professionals. 83.9% had ever tested for HIV (with HIV prevalence of 12.9%), 54.2% had tested for STIs, 62.6% had used hormone therapy, and 12.3% had undergone gender-affirming surgery. Multivariable logistic regression showed that participants who had ever disclosed their gender identity to healthcare professionals were more likely to have tested for STIs (aOR = 1.94, 95%CI: 1.12–3.39) and HIV (aOR = 1.72, 95% CI 0.82–3.39), received hormone intervention therapy (aOR = 2.81, 95%CI: 1.56–5.05), and used pre-exposure prophylaxis (PrEP) (aOR= 3.51, 95%CI: 1.12–10.97) compared to non-disclosers. Conclusions Our study demonstrated strong correlations between gender identity disclosure and healthcare services usage among Chinese transgender individuals. Facilitating the gender identity disclosure of transgender individuals to healthcare professionals with caution would be useful for improving their access to care.

How Primary Healthcare Sector is Organized at the Territorial Level in France? A Typology of Territorial Structuring.

Most the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and cost-effective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring. A sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA). A total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%). Interest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.

A critical need for the concept of matrescence in perinatal psychiatry.

The concept of matrescence, akin to adolescence but for mothers, has gained increasing attention in perinatal psychiatry, marking a paradigm shift towards understanding the holistic development of mothers. Matrescence encompasses the myriad psychological, social, cultural, and existential changes which occur as women transition into motherhood. Despite advances in maternal mental health, a bias towards pathologizing maternal experiences persists in research and practice. This commentary advocates for the integration of matrescence into perinatal psychiatry, drawing from the work of Dana Raphael and contemporary scholarship. Matrescence offers a strengths-based framework that acknowledges both the challenges and opportunities of motherhood, emphasizing the normative aspects of a mother's self-development. By adopting matrescence terminology and nosology, clinicians and researchers can enhance traditional psychiatric classifications. Additionally, matrescence underscores the importance of considering ecological systems and historical factors in maternal well-being, highlighting the need for comprehensive and compassionate healthcare services. Embracing matrescence as a fundamental concept in perinatal psychiatry holds promise for improving maternal mental health outcomes and promoting the flourishing of mothers worldwide.

Building Resilience: A SWOT and TOWS Analysis of LPPKN's Role in Enhancing Population Quality and Family Well-being in Malaysia

The National Population and Family Development Board (LPPKN) plays a crucial role in shaping Malaysia's demographic landscape, but there are challenges to be tackled. This article conducts a thorough SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of LPPKN, exploring its impact and effectiveness in promoting population and family well-being. Additionally, a TOWS (Threats, Opportunities, Weaknesses, Strengths) analysis refines our understanding of LPPKN's strategic positioning. The research employs a dual-method approach, combining web-based desk review and structured interviews. Seven central themes emerge from the SWOT analysis, including legislative framework and policy environment; integrated educational programs; comprehensive reproductive healthcare services; innovative research; information sharing and public awareness; skilled and dedicated personnel; technological innovation and digitalization. The TOWS matrix identifies 28 potential key strategies aligning internal strengths and weaknesses with external opportunities and threats. The study identifies Malaysia's legislative frameworks and policies as strengths in promoting family well-being and population management, despite ongoing challenges from evolving societal demands and international integration. Opportunities in leveraging technology for education and establishing a National Subfertility Centre are noted, countered by threats from rapid socio-economic-political changes and governance issues, requiring strategic adaptation. By integrating SWOT and TOWS analyses, this study provides recommendations for LPPKN's strategic development, aiming to foster a resilient environment that supports Malaysia's population well-being and family dynamics.