Equitable Access Research Articles

Community utilization of a co-created COVID-19 testing program in a US/Mexico border community

BackgroundThe COVID-19 pandemic exposed several health disparities experienced by underserved and Latino/a communities, including inequitable access to COVID-19 testing.Objective and GoalsTo describe the utilization of a community-driven and culturally-tailored testing model on COVID-19 testing in an underserved Latino/a community in San Diego.MethodsThe Community-driven Optimization of COVID-19 testing to Reach and Engage Underserved Areas for Testing Equity (CO-CREATE) project implemented a community co-designed COVID-19 testing program in partnership with a Federally Qualified Health Center in a US/Mexico border community.ResultsBetween May 2021 and March 2023, 24, 422 COVID-19 PCR tests were administered to 13,253 individuals, among whom 93% percent identified as Latino/a, 57% spoke Spanish in the home, and 38% resided in our target community adjacent to the US/Mexico border, San Ysidro. Based on a subset of available county testing data, CO-CREATE accounted for nearly 12% of all COVID-19 tests reported for San Ysidro residents. Over the course of the project, we estimated that nearly 17% of all San Ysidro residents were tested for COVID-19 through the CO-CREATE project.ConclusionThese findings highlight the success and reach of this culturally responsive and community co-designed COVID-19 testing program, within a Latino/a border community. Future public health interventions should focus on identifying testing barriers and design appropriate strategies to ensure equitable access to resources and testing uptake for all community members.

Analyzing the Supply and Demand Dynamics of Urban Green Spaces Across Diverse Transportation Modes: A Case Study of Hefei City’s Built-Up Area

With the increasing demands of urban populations, achieving a balance between the supply and demand in the spatial allocation of urban green park spaces (UGSs) is essential for effective urban planning and improving residents’ quality of life. The study of UGS supply and demand balance has become a research hotspot. However, existing studies of UGS supply and demand balance rarely simultaneously improve the supply side, demand side, and transportation methods that connect the two, nor do they conduct a comprehensive, multi-dimensional supply and demand evaluation. Therefore, this study evaluates the accessibility of UGS within Hefei’s built-up areas, focusing on age-specific demands for UGS and incorporating various travel modes, including walking, cycling, driving, and public transportation. An improved two-step floating-catchment area (2SFCA) method is applied to evaluate the accessibility of UGS in Hefei’s built-up areas. This evaluation combines assessments using the Gini coefficient, Lorenz curve, location entropy, and local spatial autocorrelation analysis, utilizing the ArcGIS 10.8 and GeoDa 2.1 platforms. Together, these methods enable a supply–demand balance analysis of UGSs to identify areas needing improvement and propose corresponding strategies. The research results indicate the following: (1) from a regional perspective, there are significant disparities in the accessibility of UGS within Hefei’s urban center, with the old city showing more imbalance than the new city. Areas with high demand and low supply are primarily concentrated in the old city, which require future improvement; (2) in terms of travel modes, higher-speed travel (such as driving) offers better and more equitable accessibility compared to slower modes (such as walking), highlighting transportation as a critical factor influencing accessibility; (3) regarding population demand, there is an overall balance in the supply of UGS, with local imbalances observed in the needs of residents across different age groups. Due to the high specific demand for UGS among older people and children, the supply and demand levels in these two age groups are more consistent. This study offers valuable insights for achieving the balanced, efficient, and sustainable development of the social benefits of UGS.

Integrating Artificial Intelligence in Autonomous Cashier Systems: A Study on Functional Schema Design and Its Impact on Supermarket Operations

This integrative literature review (ILR) explores the transformative potential of artificial intelligence (AI) in optimizing in-store logistics, a crucial aspect for retail environments striving to meet growing consumer demands for convenience and quick product availability. It aims to provide retail managers and logistics specialists with actionable insights on AI-driven tools that enhance competitiveness by improving inventory management and space utilization in retail settings. The conceptual framework is framed by functional schema design, user acceptance and experience, operational efficiency, data security and privacy, and equitable access, emphasizing the ethical and inclusive implementation of technology. Key findings suggest that AI improves demand accuracy, reduces inventory mismatches, and enables adaptable store layouts that respond dynamically to real-time consumer behavior, creating a more efficient, responsive, and customer-centered retail environment. Additionally, this study examines the adoption of AI in cashier systems as a response to evolving consumer expectations for efficient digital shopping experiences, revealing that AI-enabled cashier systems significantly reduce wait times and operational costs while providing personalized experiences through real-time analytics. However, challenges such as robust data security protocols, inclusive design for diverse user groups, and employee reskilling remain critical as automation progresses. Recommendations focus on privacy-enhancing data practices, user-friendly interfaces, and hybrid solutions combining human support with automation to foster inclusivity and consumer trust. Future research should address the long-term impacts of AI in retail, cultural adaptability, customer engagement, and secure data handling to support a balanced, customer-centered approach to automation in the retail sector.

Current trends and ethical considerations in gene therapy

Abstract. This paper explores the advancements, applications, and ethical challenges associated with gene therapy, a transformative approach to treating genetic disorders. Gene therapy corrects genetic defects at the molecular level, offering potential cures for diseases previously considered intractable. Techniques like CRISPR-Cas9 have revolutionized this field by enabling precise genetic editing. We discuss both ex vivo and in vivo methods, highlighting their applications in treating diseases such as sickle cell disease and inherited blindness. However, the implementation of gene therapy raises significant ethical and safety concerns, including the risks of germline modifications and the high costs limiting access. Safety concerns associated with viral vectors, such as potential oncogenesis and immune reactions, are also examined. The paper calls for evolved regulatory frameworks to ensure safe, ethical, and equitable access to gene therapy, underscoring the need for ongoing public engagement and education to navigate the complex landscape of genetic medicine. This study concludes that while gene therapy holds great promise, it requires evolved regulatory frameworks to ensure safe, ethical, and equitable access. Ongoing public engagement and education are essential to navigating the complex landscape of genetic medicine.

Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study.

Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure. This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home. This study used a mixed methods approach involving two key stakeholders-patients with chronic obstructive pulmonary disease and HCPs-across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The research indicated a notable difference in app usability perceptions: 66% (8/12) of HCPs found tasks "very easy," compared to only 22% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non-native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation. Most HCPs (11/12, 91%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care.

Telework Beyond the COVID-19 Pandemic: Exploring Residential Density and Travel Behavior

The COVID-19 pandemic was a teleworking catalyst, but less is known about the implications for the built environment, travel behavior, and social equity following the pandemic. Using three rounds of survey data ( n = 474) in Flanders, Belgium—at the onset of the pandemic (April–May 2020), 1 year into the pandemic (April–May 2021), and after a return to normal (October–November 2022)—this research investigates teleworking profiles using residential population densities, necessary trip behavior and satisfaction, and sociodemographic characteristics. Four profiles are evaluated: not teleworking; teleworking during the pandemic and continuing afterward; teleworking during the pandemic but returning to work physically; and teleworking before, during, and after. Results indicate a negative relationship between teleworking and residential population density, so teleworking options might contribute to equitable access to employment. Alternatively, beginning to telework might prompt a residential movement to less dense areas with more space. Non-teleworkers were generally more mobile (frequency, distance, and duration) in regard to necessary trips than teleworkers. Women were more likely to return to work physically, indicating challenges in work–life balance that might benefit from the structure and separation that comes with commuting. Finally, experienced teleworkers were older and full-time employed, indicating that skill and job competence might relate to flexible contracts that include teleworking alongside employer trust. Increases in and the normalization of teleworking following the COVID-19 pandemic are related to work–life balance, equity, the urban form, and travel patterns, and understanding these relationships can aid in predicting teleworking trends and informing supportive policy.

Managing the challenges of paying for gene therapy: strategies for market action and policy reform in the United States.

Gene therapies delivered through a single administration have revolutionized treatment possibilities for many patients living with serious or fatal conditions such as spinal muscular atrophy, hemophilia and sickle cell disease. However, shadowing the excitement about the transformational potential of many gene therapies has been widespread concern about the combination of uncertainty in the durability of their benefits over the long term and the short-term financial shock of high prices. As the healthcare payment ecosystem prepares for the growing number of gene therapies entering the market, three key interconnected challenges must be addressed: determining a fair price, managing clinical uncertainty and managing short-term budget impacts. This paper identifies specific policy reforms and market-based tools to help the US health system address these challenges to achieve more equitable and affordable access for patients to the growing number of gene therapies expected to be approved in the coming years.

Promoting Workplace Health, Safety, and Well-Being Among Essential Agricultural Workers Through Vaccine-Preventable Infectious Diseases Training in the Rio Grande Valley

ABSTRACT Introduction Health, safety, and well-being training programs provide essential education on anticipating, identifying, and mitigating exposures like infectious diseases. Gaps in infectious diseases awareness and education became especially apparent during the COVID-19 pandemic and subsequently were exacerbated by mis- and disinformation. Methods Vaccine-preventable infectious diseases training (influenza, hepatitis A and B, and tetanus infections, including COVID-19) was developed, delivered, and evaluated among 1,043 farmworkers, bodega workers, and production management in the Rio Grande Valley using mobile-learning technologies. The Kirkpatrick Four-Level Training Evaluation Model was utilized to evaluate training satisfaction (Level 1), effectiveness (Level 2), and effect on behavior (Level 3). Results The mean score on the pretest before training was 67.8% (SD 17.5), and the mean score on the same test immediately after the video training was 77.2% (SD 17.9). A paired t-test revealed that knowledge improved significantly from pre- to post-training (p < .05). We observed a difference between mean pre- and post-test scores relative to the pooled standard deviation, resulting in an effect size estimate of 0.53 indicative of a medium learning effect. Conclusion There is no “silver bullet” for training migrating bodega and farmworkers. Our findings suggest that the utilization of m-learning techniques continues to be a successful mechanism for delivering health, safety, and well-being awareness training content to agricultural workers in remote and challenging work environments. There is a long overdue need for offline capable software with features that allow equitable access to training, even in remote farming regions.

Assessing Students’ Perceptions of Moodle Usage for Teaching and Learning: A Case of College of Business Education, Dar es Salaam Campus, Tanzania

The advancement of Information Communication Technologies (ICT) has stimulated the development of new learning experiences through using software applications or platforms that deliver, manage and track educational or training programs in the universities. Through the use of blended learning, e-learning platforms like moodle have improved learning experience by integrating virtual classes, video conferencing, presentations, and testing in education delivery. This study aims to show how students perceive the use of moodle for teaching and learning at the College of Business Education (CBE) Dar es Salaam Campus in Tanzania. The study was guided by was guided by the Connectivism Theory (CT). The study adopted a case design because it used a short period of time and constructed at a single case study at College of Business Education (CBE). The target population was 11,924 students from the College of Business Education (CBE) who used moodle as their learning platform. Probability sampling specifically simple random sampling was used to attain the sample size of 374 respondents. Both qualitative and quantitative approaches were employed in the study.The quantitative data was collected through the Likert scale questionnaire was processed through coding, tabulating and analysis using MS excel. Further, the processed and analyzed results for research questions two and three were produced statistically using tables and figures. Apparently, the qualitative data were recorded and immediately transcribed, shared with the respondents for collection in case there were mistakes made, edited, summarized, tabulated and presented in the narrative. Also, the thematic-content analysis was undertaken to analyze the qualitative data obtained through the semi-structured interview and then presented using Tables of summaries and narratives. In addition, the presentation and discussion of the findings were triangulated during the presentation of the responses for each research question. The findings revealed that the integration of moodle into the learning process has enhanced the overall quality of teaching and learning and blended learning through moodle has improved understanding of the course materials. The study recommended that the curriculum designers and policymakers at the college should develop policies that promote the effective use of technology in education including guidelines for implementing moodle in blended learning environments to ensure equitable access to quality education for all students.

Hurdling obstructions on instructional management of science teachers in schools with challenging laboratory resources

Lacking the resources for hands-on scientific experimentation could impact both students' educational experiences and their long-term proficiency. Without access to laboratories, students miss out on crucial opportunities to engage in practical applications of theoretical concepts, hindering their ability to comprehend scientific principles fully. The purpose of this exploratory study was to analyze the experiences of science teachers (n=20) from last-mile schools in the Philippines. Narratives from science teachers were the primary data in this study being collected through one-on-one interview. Thematic analysis revealed that the science teachers were challenged by insufficient resources available in their laboratories while others conduct experiments only in their classrooms while having class. Adapting to their concerns, teachers were able to maintain their instructional competence through hands-on demonstrations, visual and audio-visual presentations, interactive activities, and printout instruction. For science teachers, addressing these challenges requires concerted efforts from policymakers, educational institutions, and stakeholders to ensure equitable access to resources and professional development opportunities for teachers. The study emphasized the need for sustainable solutions to bridge the gap between resource-rich and resource-poor schools, ultimately enhancing students' educational experiences and long-term proficiency in science.

Supply and Geographic Distribution of Geriatric Physicians and Geriatric Nurse Practitioners

The rapidly growing population of older adults and their concomitant high prevalence of chronic health conditions require an increased supply in the specialized geriatric workforce to meet increasing health care demands. Understanding trends and geographic disparities in the supply of the geriatric workforce is essential for developing effective policies. To examine temporal and geographic trends in the supply of geriatric physicians (GMDs) and geriatric nurse practitioners (GNPs) from 2010 to 2020 and to assess potential disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study used annual county-level data from 2010 to 2020, encompassing all counties in the 50 US states and Washington, DC. Statistical analysis was performed from June 2023 to March 2024. The primary outcomes were the numbers of GMDs, GNPs, and the combined number of GMDs and GNPs per 100 000 older adults. The secondary outcome included the proportion of counties with or without any GMDs or GNPs. From 2010 to 2020, the national per capita supply of GMDs decreased by 12.7%, from 13.4 per 100 000 older adults in 2010 to 11.7 per 100 000 older adults in 2020, while GNPs increased by 125.0%, from 4.4 per 100 000 older adults in 2010 to 9.9 per 100 000 older adults in 2020. The combined GMD and GNP workforce increased by 21.3%, from 17.8 per 100 000 older adults in 2010 to 21.6 per 100 000 older adults in 2020. The distributions of older adults, GMDs, and GNPs closely resembled the distribution of metropolitan and nonmetropolitan counties, with GMDs and GNPs highly concentrated in metropolitan counties where the number of older adults was greatest. Throughout the study period, 63.9% of counties (2008 of 3142 in 2010-2019; 2009 of 3143 in 2020), predominantly small and nonmetropolitan counties, had no GMDs or GNPs, which was associated with the disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study found that from 2010 to 2020, the overall national supply of GMDs and GNPs kept pace with the growth of the older population, largely due to the rapid growth in the number of GNPs. However, significant geographic disparities persisted, particularly in small and nonmetropolitan counties. Future efforts should focus on increasing the availability of GMDs and GNPs in underserved small and nonmetropolitan counties to ensure equitable access to geriatric care.

Assessing language barriers in health facilities in Malawi

BackgroundLanguage barriers in healthcare lead to miscommunication between professionals and patients, thereby reducing the quality of and equitable access to healthcare. In African countries, the recognition and formal study of these barriers is severely limited despite Africa having more languages than any other continent. Our study investigates language barriers in healthcare facilities in Zomba district in Malawi, where three major local languages are spoken.MethodsWe employed a mixed methods approach and conducted a questionnaire-led study. Data were gathered at 22 health facilities, from 79 healthcare professionals and 312 outpatients using a semi-structured questionnaire. Findings were corroborated using document analysis to review legislation and policies, curriculum documents and patient notes.ResultsLanguage discordance emerged as a problem for professionals and patients. Both faced challenges due to vocabulary limitations for medical terms in English and Chichewa. Professionals did not receive training on how to effectively communicate medical concepts in local languages. Most patients did not speak English, which was used for all written records. Patient understanding of the information given to them verbally during consultations or in written health notes was very low, and this diminished their confidence in the diagnosis or treatment they received. Social factors including gender, age or patient experience, as well as patient literacy or perceived low literacy, poor rapport between healthcare professionals and patients, and a lack of privacy during consultations all exacerbated communication issues. Consequences of language barriers included unsatisfactory care experiences and compromised exchanges of health information. Strategies used by professionals to cope with these challenges were flexibility in the choice of language, reliance on physical checks and non-verbal communication indicators and the occasional use of ad-hoc interpretations.ConclusionLanguage barriers in healthcare facilities in Malawi have serious implications on the quality of healthcare provided. We propose solutions such as the development of dictionaries with phrases for symptoms and conditions, sensitisation courses that incorporate language considerations for both professionals and patients. Policies such as the provision of interpreters and staff allocation are discussed. We recognise that coordinated efforts at national and international levels are key to securing significant funding for effective interventions.

Addressing Lean and Safety Readiness Assessment in Territorial Ambulatory Healthcare

Within the international healthcare landscape, it is incumbent upon all organisations to proactively address individual patient needs by offering a wide range of services. In this context, Territorial Ambulatory Healthcare (TAH) is critical to promote equal access to care as the primary point of contact between National Healthcare Systems and individuals. To achieve this goal, the adoption of Lean and Safety Management (L&amp;SM), a managerial approach to proactively reduce clinical risk and process inefficiencies, can support organisations in pursuing high quality care objectives. Despite the positive benefits associated with the adoption of this approach, the feasibility of guaranteeing a sustainable care quality over time may encounter several challenges. Among these, key contributors to failure include the lack of tailored tools and practices suitable for the healthcare environment, insufficient readiness of the context for implementation, and the absence of a comprehensive system-wide performance strategy. Recent studies in literature address these issues presenting theoretical and practical models to assess readiness levels, highlighting opportunities for future developments of these topics. The current empirical study contributes to the existing knowledge by creating a framework to assess the level of readiness for L&amp;SM implementations within TAH. While this context is essential for ensuring high-quality care and equitable access to care services, successfully implementing L&amp;SM initiatives within TAH is challenging due to the organizational complexity and the involvement of multiple, fragmented stakeholders and care providers. Addressing weak Critical Readiness Factors (CRFs) before starting a project can significantly contribute to successfully implement L&amp;SM and sustain improvement over time. This study will be conducted within the TAH setting of a healthcare organisation in Northern Italy and aims 1) to evaluate the specific care setting readiness for L&amp;SM implementations and 2) to develop practical guidelines to support the organisation in increasing its actual readiness level. The theoretical framework will be grasped integrating prior research on Lean readiness assessment, along with specific literature on L&amp;SM sustainability implementation factors within TAH. Once refined and tested with the purpose of developing a practical assessment tool, the framework will be applied within the selected setting, leading to the identification of practical guidelines to facilitate project success and improvements sustainability. Overall, this research will contribute to enrich the knowledge about L&amp;SM implementation within TAH, supporting health organisations, managers, and clinical leadership to sustainably improve care quality, enhancing the role of territorial care to foster social well-being.

Equitable Access to Disease-Modifying Therapies for Canadian Children with SMA and Four SMN2 Copies.

Equitable Access to Disease-Modifying Therapies for Canadian Children with SMA and Four SMN2 Copies.

Capacity Planning in Paediatric Palliative and Hospice Care: An Italian Case

Although the growing demand for healthcare services has enhanced the occurrence of inefficiencies in care provision, healthcare systems should ensure safe, timely and equitable access to care. In particular, the long waiting lists, the lack of beds, and the shortage of healthcare workforce have highlighted the necessity to effectively manage and strategically plan the available resources. Capacity Planning (CP) contributes to determine what, when, where and how much product or service to deliver, with the goal of analysing and optimizing the use and allocation of human and material resources (e.g., physical spaces, equipment, beds, workforce) based on the demand. CP demonstrates to be extremely relevant for hospital units to schedule appointments, diagnostics, surgeries and admissions. Complex contexts and broader healthcare networks could benefit even more from this approach, helping to coordinate multiple care providers and aligning the available resources with the demand pace. The current research presents the implementation of CP in the context of Paediatric Palliative and Hospice Care (PPHC), delivered in an Italian facility. PPHC provides long-term, interdisciplinary and coordinated care between territorial, ambulatory and hospice services. It encompasses follow-up activities, parental training, end-of-life and respite care. In the Italian case analysed, the shortage of beds affects the quality of care delivered to these patients, in terms of accessibility to the service, effectiveness and timeliness of care. Hence, a CP analysis has been performed to pursue a twofold objective: a) to understand if the current capacity of the facility meets the demand for care; b) to improve productivity through an optimized allocation of resources, particularly the available beds and the healthcare workforce. The expected results involve a more effective use of resources, an increased bed occupancy rate and a reduction in rescheduled admissions due to inadequate planning. Optimizing capacity in this specific setting can serve as a pilot project for other similar contexts, aiming to improve patients’ access to healthcare services, their quality of life and supporting the workforce involved in PPHC. This research offers new insights from both the academic and managerial point of view, providing evidence about the implementation of CP in complex healthcare settings.

The Role Of Machine Learning In Transforming Healthcare: A Systematic Review

This systematic review explores the transformative role of machine learning (ML) in healthcare, focusing on its applications in disease diagnosis, personalized medicine, healthcare operations, and patient monitoring. By analyzing 167 peer-reviewed studies published between 2015 and 2024, the review highlights how ML algorithms have significantly improved early disease detection, treatment personalization, and operational efficiencies in healthcare settings. Findings reveal that ML-powered diagnostic tools, especially deep learning models, demonstrate accuracy levels comparable to human experts in areas like cancer detection. Additionally, ML models tailored for personalized medicine have shown promise in optimizing treatment protocols based on genetic profiles, reducing adverse reactions and improving patient outcomes. In healthcare operations, ML applications have streamlined hospital resource management, enhanced workflow efficiency, and reduced administrative burdens through predictive analytics and natural language processing (NLP). Moreover, ML-driven remote patient monitoring systems have enabled proactive interventions for chronic disease management. Despite these advancements, challenges related to data privacy, algorithmic transparency, and regulatory compliance persist. Addressing these barriers is critical for realizing the full potential of ML in healthcare, ensuring ethical deployment and equitable access. The review concludes by emphasizing the need for robust regulatory frameworks and further research to enhance the integration of ML technologies into clinical practice.

Abstract 4139135: Trends in Stroke Related Mortality in Atrial Fibrillation Patients Aged 25 and Older in the United States: Insights from the CDC WONDER Database

Background: Stroke associated with atrial fibrillation (AF) is a significant cause of mortality. This CDC analysis delves into mortality trends due to stroke in AF patients aged ≥ 25 years, from 1999 to 2020. By analyzing extensive datasets we scrutinized how factors such as gender, race, region of residence, and level of urbanization intersect with mortality rates. Methods: Death data from 1999 to 2020 was analyzed using the Centers for Disease Control and Prevention database, employing ICD codes I48 for AF and I64 for stroke. Age-adjusted mortality rate (AAMR) per 100,000 people with 95% confidence intervals was calculated for the total population, stratified by gender, race, urban/rural status, and census region. The Joinpoint regression software was used to calculate annual percentage change (APC) trend for each stratification. Results: In the U.S. between 1999 and 2020, total of 331,106 deaths occurred among adults due to AF associated with stroke. Deaths occurred predominantly in medical facilities (43.2%). The overall AAMR for AF associated stroke decreased from 26.8 per 100,000 in 1999 to 18.4 in 2020, with an AAPC of -2.05 (p value &lt; 0.000001). Additionally, AAMR declined significantly from 1999 to 2018 (APC: -2.65, p value = 0.012398), followed by an increase from 2018 to 2020 (APC: 3.90, p value = 0.220356). Women had slightly higher AAMRs compared to men (men: 6.6; women: 7.1). The AAMR for women reduced substantially from 1999 to 2020 than for men. AAMRs varied among racial/ethnic groups, with White patients having the highest AAMR (7.4), followed by Blacks (5.4), American Indian or Alaska Natives (4.6), Asian or Pacific Islanders (4.5), and Hispanic population (4.1). AAMRs decreased for all races except for Black population. Geographically, AAMRs ranged from 4.3 in Nevada to 11.9 in Vermont, with the Western region showing the highest mortality (AAMR: 7.9). Nonmetropolitan areas had slightly higher AAMRs than metropolitan areas, with both experiencing a decrease over the study period. Conclusion: This analysis depicts significant disparities in mortality rates attributed to stroke associated with AF and underscores the need for larger population-based studies to further understand the primary factors influencing the observed geographical, racial, and gender differences. Targeted interventions and equitable healthcare access are crucial to mitigate these disparities and improve outcomes for this population.

Recognising and responding to the community needs of gay and bisexual men around mpox.

In May 2022, a global surge in mpox cases, typically endemic to Western and Central Africa, particularly affected gay, bisexual, and other men who have sex with men (gbMSM). This study examines gbMSM communities' experiences and perceptions around Ireland's public health response to the outbreak. A cross-sectional mixed-methods online survey was conducted. Qualitative data were analysed using reflexive thematic analysis informed by critical realism. A total of 163 gay and bisexual men took part in the survey. Participants accessed information from diverse sources, reporting varying levels of trustworthiness. Overall, participants were well-informed. Four themes were developed from the qualitative data: (1) Perceptions of the mpox response: divergence in urgency, priority, and care; (2) The mpox outbreak as a sign of otherness for gbMSM; (3) The potential for othering through mpox prevention practices; and (4) mpox, memory and fear. While community-led initiatives were effective, significant challenges included stigmatisation, discrimination, and mistrust towards public health institutions, influenced by institutionalised homophobia. The study underscores the need for inclusive, culturally sensitive, and transparent public health strategies. The mpox outbreak highlights the importance of robust community collaboration in public health interventions. Future strategies must ensure equitable access to information, vaccination, and care, and address broader structural inequalities to foster trust and engagement within affected communities.

Abstract 4143217: Gender Disparities in Clinical Outcomes Following Transcatheter Aortic Valve Replacement: Insights from the National Inpatient Sample

Background: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis, offering a less invasive alternative to surgical valve replacement, particularly for high-risk patients. While TAVR has demonstrated efficacy and safety in various patient populations, there is growing recognition of gender-specific differences in clinical outcomes post-procedure.Understanding gender-related variations in TAVR outcomes is crucial for optimizing patient care and ensuring equitable access to this life-saving therapy. Methods: Using the National Inpatient Sample (2017-2020), we analyzed the characteristics and comorbidities of male and female patients undergoing TAVR. We then assessed the incidence of clinical outcomes between genders, including in-hospital mortality, mechanical ventilation, length of stay, hospital charges, vasopressor requirement, heart block, pacemaker insertion, stroke, acute kidney injury (AKI), vascular complications, and discharge disposition. Multivariate analysis was performed to evaluate mortality risk among congestive heart failure (CHF) patients. Results: Among 234,860 total admissions, females comprised 44.5% (104,365) of the population. Females were slightly older (mean age 79.4 vs. 78.5 years, p &lt; 0.001) and had a lower mean Charlson Comorbidity Index (2.8 vs. 3.1, p &lt; 0.001) compared to males. After adjusting for confounding factors, females had a higher odds ratio for in-hospital mortality (OR 1.48, 95% CI 1.37-1.60, p &lt; 0.001), mechanical ventilation (OR 1.14, 95% CI 1.07-1.20, p &lt; 0.001), stroke (OR 1.55, 95% CI 1.46-1.65, p &lt; 0.001), and vascular complications (OR 1.24, 95% CI 1.19-1.31, p &lt; 0.001). Length of stay (mean difference 0.37 days, 95% CI 0.32-0.42, p &lt; 0.001) and hospital charges (mean difference $3,795, 95% CI 2,488-5,102, p &lt; 0.001) were also significantly higher in females (p &lt; 0.001 for both). Conclusion: The divergent clinical profile and poorer outcomes observed among females undergoing TAVR, characterized by elevated in-hospital mortality, stroke, and vascular complications compared to males, may emphasize the need for gender-specific approaches in TAVR management.

Women's Acceptability of and Satisfaction With Self-Monitoring Blood Pressure During Pregnancy.

The aim of this study was to evaluate the acceptability and satisfaction of pregnant women at risk of hypertensive disorders with self-monitoring their blood pressure. A prospective cross-sectional study. Women at risk of hypertensive disorders during pregnancy were recommended to self-monitor their blood pressure at the study site to reduce hospital visits. Women who purchased a subsidised blood pressure monitor through the hospital were invited to participate in a survey about acceptability of and satisfaction with self-monitoring their blood pressure between hospital visits. Data were analysed with descriptive statistics and content analysis. Thirty women completed the survey. Most women were highly satisfied with self-monitoring their blood pressure and the support provided from hospital staff for responding to high readings experienced at home. The reassurance of monitoring their health and the convenience of reduced hospital visits were reported benefits of self-monitoring blood pressure. Inaccuracy of readings, anxiety associated with high readings, and cost of purchasing the machine were described as concerns by a small number of women. The findings suggest that self-monitoring blood pressure may be a useful addition to antenatal care for women at risk of hypertensive disorders. Ensuring that antenatal care providers adequately test machines for accuracy and educate women about proper use is essential. Promoting equitable access to self-monitoring by providing free or very low-cost machines to women experiencing financial disadvantage is warranted. Self-monitoring blood pressure during pregnancy has the potential to improve the detection of hypertensive disorders and reduce hospital visits and associated healthcare system costs. The authors have nothing to report.