Disparities in access and three-year survival of patients with ST-elevation myocardial infarction treated in percutaneous coronary intervention-capable hospitals within the Brazilian public and private healthcare systems: The VICTIM extended registry.

Oral health is fundamental to overall well-being, as it influences physical health, social confidence, mental stability, and daily functioning. Public Health Dentistry (PHD) addresses oral health at the population level by developing strategies to improve access and outcomes. This narrative review examines the current state, challenges, and opportunities in PHD in India. It incorporates peerreviewed literature as well as policy documents and strategic reports from relevant government health agencies and professional dental organisations to ensure contextual relevance and completeness. The review highlights key areas, including workforce distribution, oral health awareness, mobile dental services, and community outreach. However, persistent challenges such as insufficient manpower, limited funding and a lack of integrated policies continue to pose significant obstacles. Disparities in access to dental care between urban and rural areas underscore the need for targeted interventions to address these inequities. The review emphasises the importance of a robust national oral health policy, integrating oral health care into general health services, and fostering interdisciplinary collaboration. Newer techniques, such as teledentistry and mobile health applications, have the potential to address service deficiencies, particularly in remote or isolated areas. Enhancing community-based oral health education and targeted prevention can lead to lasting improvements in population oral health. Coordinated action among government agencies, academic institutions, and local health systems is crucial to maintain service delivery that is reliable, accessible, and sustainable. A community-centered and equitable approach is essential for reducing the prevalence of oral illnesses in India. Overall, aligning public health priorities with oral health needs can contribute to meaningful and long-term improvements in national health outcomes.

Glycaemic control remains central in type 2 diabetes mellitus management: key learnings from the latest International Diabetes Federation guidelines.

The Indonesia pre-eclampsia study (INAPRES): Pregnancy outcomes in pregnancy with pre-eclampsia in Indonesia.

Alzheimer's disease presents a public health challenge, with disparities in dementia literacy and resource access, particularly in rural communities. This study examines Extension professionals' perceptions of the adequacy, availability, and awareness of clinical and non-clinical dementia resources, focusing on potential urban-rural and role-based differences. Using an existing dataset (N = 132), ordinal logistic regression assessed associations between resource ratings and county rurality as well as professional role. Results indicate professionals in rural counties reported significantly lower ratings for the adequacy (OR = 0.47, p < .05), availability (OR = 0.42, p < .05), and awareness (OR = 0.49, p < .05) of clinical dementia resources compared to urban counterparts. No significant differences emerged for non-clinical resources. Findings highlight geographic and professional disparities in clinical dementia resources.

The realisation of the right to health in Nigeria, aimed at achieving universal health coverage, is increasingly obstructed by various factors, such as considerable financial risks, inadequate healthcare service delivery and disparities in healthcare access. The Nigerian government's efforts to tackle these issues have led to the implementation of the National Health Act in 2014, aimed at improving access to healthcare services for all citizens and reinforcing protections against financial strain through the Basic Health Care Provision Funds, which serve as the primary healthcare insurance framework. Nonetheless, the execution remains considerably far from achieving the goal of ensuring the right to health. This study employs a scoping review methodology to investigate a broader spectrum of perspectives on the systemic challenges that impede the achievement of the right to health in Nigeria. Insufficient healthcare funding, a lack of political will and commitment and capacity constraints were found to be the primary challenges hindering the advancement of the right to health in Nigeria. Also, cultural and religious nuances were notably identified as contributing factors to unmet health rights in the North, which are absent in the South. Likewise, it has been observed that lived experiences often clash with established rights frameworks, intensifying the challenges related to the right to health within primary health centres. This study critically mapped out key issues and gaps in literature that would form the bedrock of future studies as well as serve as a guide to policymaking.

Defining Quality Metrics for Telemedicine in Surgery: A Critical Examination.

This study evaluates associations between school-level disadvantage (i.e., relative socioeconomic circumstances of student populations) and the accessibility of unhealthy food vendors near secondary schools across Ontario, Canada. It also examines how vendor distribution would change following the implementation of new distance-based regulations. We identified and summed all unhealthy food vendors within successive 100m network buffers around secondary schools up to 1600m, and applied inverse distance weighting, giving greater weight to vendors located closer to schools than those farther away. We used the Jonckheere-Terpstra test to determine significant differences and negative binomial regression to evaluate the association between the accessibility of unhealthy food vendors in school neighbourhoods and school-level disadvantage, defined by the percentage of immigrant, non-English-speaking, and low-income students. We investigated five regulatory scenarios across the entire province and by level of urbanicity, removing food vendors within 100m, 200m, 300m, 400m, and 500m of schools, and repeating our analyses for the broader neighbourhood food environment (i.e., 1600m from school). Adjusted models show that unhealthy food vendors were inequitably distributed across school neighbourhoods, with more disadvantaged schools having significantly more unhealthy food vendors within most buffer zones than the least disadvantaged schools. Also, these inequities would persist following the implementation of hypothetical distance-based regulations. Distance-based regulations which restrict retail locations around all schools may not be an effective tool for ameliorating socioeconomic disparities in unhealthy food accessibility across school neighbourhoods or, by extension, addressing broader concerns related to adolescents' dietary behaviours.

It remains unclear whether driver licensing pathways between young drivers in urban and rural areas differ when considering differences in financial status. Using a database of young new drivers in Ohio, we found that young rural drivers obtained their first licenses earlier and showed only small differences in licensing age and GDL-training completion across poverty levels, whereas low-poverty young urban drivers were licensed much earlier and completed GDL training at higher rates than their high-poverty counterparts. Our findings inform strategies to reduce disparity in access to licensure and reduce the urban/rural mobility gap for young drivers.

ABSTRACT This article examines the way Bangladeshi identity is constructed relationally amongst British Bangladeshi Muslims by studying their diasporic self-organization on the basis of ‘Sylheti’ and ‘non-Sylheti’ identity. By centring A) region, B) language and C) religion that emerge from in-depth interviews as key constituents of British Bangladeshi identity, this paper follows from works on class distinction and ‘appropriate’ identity to demonstrate aspirations and competitions for respectability amongst British Bangladeshi Muslims, such as through disparate access of Sylhetis and non-Sylhetis to cultural capital via education. By conceiving this identity negotiation as invisible labour, rather than assuming antagonism, this article demonstrates how British Bangladeshi communities negotiate their own and others’ regional, linguistic and religious identities and practices to put forth an identity perceived relationally as authentically and appropriately ‘Bangladeshi’. Through this, the article illustrates the dual labour and agency of British Bangladeshi Muslims.

ABSTRACT Using secondary data from the Annie E. Casey Foundation's OPPS JCYOI, we examined the relationship between financial capability and mental health outcomes among 2635 young people aged 14–26 with current or prior out‐of‐home care experience. Key findings indicated that financial capability was a protective factor for mental health, whereas owing money and holding multiple jobs were linked to worse mental health and higher unmet service needs. While 69% reported that their health insurance covered mental health services, 15% did not. Over half (54%) had a paid job, and 44% were enrolled in school. Notably, female and LGBTQIA+ individuals, along with those facing financial hardship, reported lower mental health ratings and greater unmet service needs. The results underscore the urgent need for financial education and support programs for this population, suggesting that economic stability can safeguard against mental health challenges. Integrating financial capability education and resources into transition services and postcare supports could improve mental health outcomes and decrease disparities in service access.

The digital transformation of university education has shown the importance of digitalization in influencing the world system by finding relevance at the pinnacle of education. The equitable access to digital infrastructure by stakeholders within the university system, therefore, becomes a thing of concern for the certainty of quality education. This study explores the accessibility to digital infrastructure resources by one of the stakeholders in the University of Education, the academics, and their job performance. The study hinges on three indices basically: digital infrastructure accessibility, financial investment in digital infrastructure, and job performance of academics. By using stratified random sampling techniques, questionnaires were administered and responses analyzed using descriptive and inferential statistics such as linear regression. The finding exposes the disparities in digital access of the academics and recommendations that would assist the institution to better harness institutional digitalization, such as the need to have policy reforms to ensure sustainable digital infrastructure in the university system, were suggested.

The transformation of legal services through the implementation of the E-Court system is part of judicial modernization aimed at realizing effective and inclusive access to justice. This study seeks to analyze the regulation of cross-regional jurisdiction under Supreme Court Regulation (PERMA) Number 1 of 2019 and to examine the challenges of digital infrastructure in providing access to justice for civil litigants in remote areas. The research employs a normative juridical method with statutory and conceptual approaches. The findings indicate that PERMA Number 1 of 2019 enables the implementation of e-summons and electronic hearings without eliminating the court’s authority based on territorial jurisdiction. However, its effectiveness still depends on the consent of the parties and technical readiness. On the other hand, limitations in internet connectivity, technological devices, and digital literacy in underdeveloped, frontier, and outermost (3T) regions create disparities in access to justice. This study concludes that the transformation of legal services through E-Court requires regulatory strengthening, the development of digital infrastructure, and the implementation of a hybrid service model to ensure that the principles of justice, legal certainty, and utility are equitably realized for all people across Indonesia.

Disparities in early intervention (EI) use are well documented. We sought to determine the effects of family navigation (FN) on EI services use and child development among low-income, racially diverse children with suspected developmental delays. We conducted a randomized controlled trial at 6 pediatric practices in a large urban community. Children who were aged younger than 30 months, had a gestational age of more than 35weeks, had parents who spoke English or Spanish, and were referred to Part C EI were eligible. Children were randomized to FN or usual care and followed for 12 months. The main outcome measures were multidisciplinary evaluation (MDE) and EI service initiation and duration obtained from county EI program administrative files and Bayley-3 developmental scores. We examined differences among groups using intention-to-treat logistic and Cox regression models. We randomized 358 eligible children and followed 305 (85%) for 12 months. Children were predominantly Black with family incomes of less than $55 000. Overall, 257 (72%) completed an MDE, and 195 (54%) initiated services. Children who received FN had greater odds of MDE completion (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) and greater EI service initiation (64.4% vs 54.7%; P = .02) than children who received usual care. The average duration of EI services and Bayley-3 scores did not differ among groups. We found that an FN program improved EI referral completion and services initiation but not EI duration or child development among a population of predominantly low-income urban Black children. Implementation of FN programs in similar minoritized communities may reduce disparities in access to EI services.

ABSTRACT Education is a cornerstone of sustainable development, yet large disparities in access persist across and within countries—particularly in Africa, where millions remain underserved. Among several factors influencing educational participation, physical accessibility to schools (in terms of travel time) is not comprehensively understood, especially in data‐scarce contexts. This study presents 90‐m resolution maps of school accessibility in Africa, offering a detailed and systematic view of spatial variability. Leveraging advances in geospatial data and modeling, the analysis highlights substantial inequalities, especially in rural areas where many live more than a 3‐h walk from the nearest school. Comparisons with national statistics reveal substantial gaps in existing school datasets, while model validations demonstrate the results' rigor. A case study in Malawi illustrates how accessibility intersects with wealth and educational attainment, and elucidates model sensitivities. The results provide tools to inform evidence‐based planning, prioritize interventions, and advance progress toward equitable and inclusive education.

This study aims to address gaps in understanding healthcare accessibility inequality in rural China, where traditional distance-based assessments and urban-centric biases are insufficient. By integrating real-time travel data from Amap and the two-step floating catchment area (2SFCA) method, we conducted a high-resolution (1 km grid) analysis across transportation modes, administrative scales, and time-sensitive populations. Results reveal that driving enables more stable, equitable access (characterized by higher supply–demand ratios and lower variability) than public transport, which distorts ratios due to limited coverage. Accessibility disparities are most pronounced at the county scale, with eastern rural counties (e.g., Yangtze River Delta) showing far higher accessibility (log10(A-value) &gt; 5.0) than remote western counties (log10(A-value) &lt; 1.5). High time-sensitive populations (urgent care) face extreme accessibility gaps, with only 15% of counties providing optimal access. In contrast, low time-sensitive groups benefit from extended travel time thresholds, achieving 62% coverage of optimal access. Targeted interventions—investing in rural high-tier hospitals, enhancing transit frequency, and county-specific policies—are needed to advance health equity. The findings of this study provide the first nationwide high-resolution healthcare accessibility map for rural China, improve assessment accuracy via real-time data, and identify county-level gaps—offering data-driven insights for targeted policies to advance health equity and support rural revitalization.

The escalating use of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is reshaping pharmaceutical consumption patterns and posing unprecedented challenges to healthcare systems worldwide. This study analyzes the landscape of GLP-1 RA consumption, safety monitoring and regulatory oversight in Brazil. A retrospective regulatory surveillance study was carried out triangulating data from three official sources: (1) national sales covering 2020-2024, classifying according to Anatomical Therapeutic Chemical (ATC) system; (2) adverse event reports submitted to Vigimed, the national pharmacovigilance platform integrated with global VigiBase; and (3) official alerts of falsified products. Sales data were sourced from industrial reports and the National System for the Management of Controlled Products (SNGPC). Semaglutide emerged as the predominant GLP-1 RA in the Brazilian market. Consumption was markedly concentrated in regions with higher Gross Domestic Product (GDP), revealing a disconnect between medication use and regional diabetes prevalence. Pharmacovigilance analysis uncovered a significant proportion of reports involving off-label use, pointing to potential clinical and regulatory gaps. Furthermore, documented cases of counterfeit products underscore critical supply chain vulnerabilities. The convergence of escalating demand, widespread off-label use and product falsification requires a coordinated and agile regulatory response. The observed trends suggest significant access disparities driven by economic factors rather than epidemiological need.

Lung cancer is one of the leading causes of mortality in the United States. Despite overall declines in incidence and mortality nationwide, rural communities continue to experience higher rates of lung cancer incidence and mortality than their urban counterparts, a disparity that has persisted over recent decades. This review synthesizes evidence from epidemiologic and clinical studies evaluating rural-urban differences in lung cancer incidence, mortality, diagnostic stage, access to screening, and treatment outcomes. Factors influencing these differences-tobacco use and environmental exposures, socioeconomic inequities, access to healthcare, and psychosocial and spiritual support-are examined as well. The review highlights the importance of increasing access to lung cancer screening and suggests interventions to improve early detection, access to treatment, and enhance psychosocial and spiritual support for patients and caregivers residing in rural areas. In this review, we have followed the urban-rural classification designated by the United States Census Bureau as a rural area consisting of populations, housing, and territory not included within an urban-classified area.

This study examines the integration of social media platforms into teaching and learning within Ghanaian higher education. Guided by an interpretive phenomenological approach, the study explored instructors’ lived experiences across different institutional and disciplinary contexts. A purposive sampling technique was used to select 12 instructors from the University of Education, Winneba (UEW) and Ghana Communication Technology University (GCTU). Findings reveal that social media adoption is uneven and shaped by institutional digital capacity, course requirements, and instructors’ pedagogical orientations. Platforms such as WhatsApp, YouTube, and Facebook are used to support collaborative discussions, extend communication beyond classroom boundaries, and enhance student engagement; however, concerns persist regarding access disparities, workload demands, and blurred professional boundaries. The study highlights that effective integration depends not only on platform availability but also on intentional pedagogical design, institutional support, and capacity-building. It recommends targeted professional development, clear policy direction, improved digital infrastructure, and the establishment of communities of practice to sustain meaningful and context- sensitive use of social media in instruction. The study contributes to ongoing discussions on digital transformation in Ghanaian higher education, offering insights into how social media can enrich teaching and learning when integrated thoughtfully and systematically.

Access to hearing health care remains a major issue for people with hearing and balance disorders across the lifespan. University audiology clinics are in a unique position to address these disparities in access, as they serve as training programs for future clinicians and health care centers. This study examined the accessibility of university audiology clinics in various domains including financial barriers, LGBTQ+-inclusive facilities, physical access, scheduling, transportation, financial assistance, and communication. Data on accessibility domains were collected via structured phone calls with clinic reception staff at university audiology clinics and websites. Distances between the nearest bus stop or rail station and the university audiology clinic were calculated and categorized based on the frequency of service. Responses and public transportation data were analyzed using descriptive statistics. University audiology clinics had a range of accessibility features, including ways to schedule an appointment, services for patients with limited English proficiency, financial assistance, disability accommodations, availability of gender-neutral restrooms, and extended clinic hours. Most offered standard scheduling by phone, written visit summaries, and accessible physical facilities, but fewer clinics provided services for extended hours, disability accommodations, or language support. Gaps identified include gender-inclusive restrooms, bilingual staffing, and financial assistance options for patients. The mean distance from the university clinic to the nearest bus stop was 0.206 mi, and the mean distance from the university clinic to the nearest rail station was 0.488 mi. Clinics are located in slightly more socially disadvantaged areas compared to the national average. The findings provide data on the accessibility of university audiology clinics for patients from various backgrounds with differing needs (e.g., financial assistance, language support). Gaps in hearing health care access and areas for improvement of accessibility across areas such as language services, physical facilities, scheduling, and transportation for university audiology clinics are identified and discussed. Recommendations include asking about transportation options, scheduling considerations around transit schedules, installing clear signage, providing staff training, and offering tele-audiology appointments. https://doi.org/10.23641/asha.31235929.