Geographic Access Research Articles

Inequalities in the geographic access to delivery services in Brazil

BackgroundDespite Brazil’s recent social progress, access to health services is still unequal. This article analyzes the inter-municipal distances traveled by pregnant women to access delivery services, documenting their magnitude and relationship to socioeconomic and risk factors for over a decade in Brazil.MethodsUsing data between 2007 and 2017 from the Brazilian Information System of Live Births and a matrix of inter-municipal distances, we describe the evolution of (i) the share of pregnant women that traveled across municipalities and (ii) the average distance they traveled. Next, we assess which of the previous variables explains the changes in travel distance over time. Finally, we estimate the difference in the average travel distance by individual risk factors and use regression analysis to measure the association between this distance and municipal socioeconomic determinants from the Brazilian census.ResultsWe observe that, on average, (i) the share of women traveling for childbirth increased, reaching 31% in 2017, and (ii) distances got longer, approaching the 60-kilometer mark by 2017. The increase in distance is mainly due to more women traveling. Nevertheless, regional disparities persist, especially between the north/inland and coastal regions. Women with high-risk pregnancies or newborns with risks such as low birth weight tend to travel longer distances. However, those residing in higher-development municipalities tend to travel shorter distances.ConclusionLong distances remain an obstacle to accessing delivery facilities. This matter affects the most vulnerable disproportionately. Policymakers must consider the geographic accessibility of mothers when expanding birth-related services. Additionally, more research is required to understand the decision to travel and the distance effectively traveled as different accessibility facets.

Efficient and Selective Lithium Extraction from Brine Water Via a Photothermal Sandwich Sieve Structure

AbstractLithium is being recognized as a strategic resource on a global scale, mainly because of its growing importance in the production of lithium‐ion batteries for electric vehicles and energy storage systems. Due to its uneven geographical distribution and limited availability on Earth, extracting lithium from brines and seawater presents a sustainable supply pathway. However, conventional lithium extraction techniques are still challenging, necessitating significant costs and energy consumption. This study primarily employs a solar‐utilizing selective extraction strategy for efficient lithium harvesting by designing a solar‐thermal sandwich sieve structure. Herein, a portable solar‐driven lithium extraction device has been developed based on HKUST‐1 and LIG. Due to the sub‐nano channels provided by HKUST‐1, the hydrated Li+ can selectively pass through the MOF layer. The excellent solar heating of the layer enables the device an accelerate vapor escaping, it then facilitates the delivery of Li+, resulting in lithium accumulation at the interface for convenient collection. The maximum lithium extraction capacity in one cycle is 1467 mg m−2, demonstrating good Li+ selectivity absorption with a high Mg2+/Li+ ratio under 1 solar illumination. Moreover, the device shows excellent cycle stability. This work offers an integrated solar utilization for scalable and sustainable lithium extraction from brine water.

Application of Youth-Led Participatory Action Research to Examining Adolescent Sexual and Reproductive Health and Rights in Ontario: What Can We Learn?

Engaging adolescents and young people as partners in research is increasingly acknowledged as a vital strategy to ensure diverse voices are heard and to catalyze social change. This article, coauthored by adolescent and adult researchers, presents the methodological approach and outcomes of a youth-led participatory action research (YPAR) study in which three teams of youth researchers developed and implemented projects examining equity-related factors affecting adolescent sexual and reproductive health and rights (ASRHR) in Ontario, Canada. Teams of four assigned-female youth researchers aged 16-19 years were recruited from three priority regions through purposive sampling. Selected youth completed a paid 5-day virtual YPAR training. Each youth team, supported by adult research mentors, identified key ASRHR issues in their region and developed a related research question. Each team then determined their study's design, obtained institutional ethics approval, and conducted data collection, analysis, and interpretation. Based on their findings, teams proposed potential solutions and communicated results to multiple stakeholders. Methodologically, the YPAR process amplified youth voices through a social justice-framed approach to examining ASRHR. Centering the perspectives, values, and experiences of youth positively impacted the youth researchers themselves, while yielding results that were relevant, meaningful, adolescent-responsive, and culturally informed. Results from the youth-led projects identified multiple barriers to accessing sexual and reproductive health services and products. Policy and practice implications encompassed concerns related to geographical accessibility, equity, service provider competence, and content of sexuality education curricula.

Interpreting Context in Rural and Remote Aged Care Facilities in Readiness for a New Care Model: A Mixed Method Study.

Geographical isolation compounds limited access to healthcare services and skilled workforce for the provision of rural aged care. Residents have complex chronic disease management and end-of-life care needs. An undersupply of general medical practitioners due to retirement, attrition or unfilled training places in Australia has impacted recruitment to rural areas. Nurse practitioners have been identified as a potential solution. To describe and explore the inner (local and organisational) and outer (wider health system) contexts of healthcare, from the perspective of care staff and residents' families. This, in turn, aims to inform the planned implementation of a nurse practitioner model, in several aged care facilities, operating within rural and remote settings, in Queensland Australia. A convergent mixed methods design. Qualitative data were collected, in 2022-2023, using semistructured interviews with staff focusing on role, knowledge development, workplace culture and care relationships with local community. Resident's family's perspectives were obtained as a secondary analysis of organisational feedback data. Quantitative data were collected from direct care workers using the Alberta Context Tool for Long-Term Care. Data were analysed according to type and integrated. Relational care for residents and families is highly valued but provision of quality is challenging where time-poor staff are perceived to be doing the best they can. Scarce local healthcare services make it difficult to meet resident healthcare needs. Despite the supportive organisational culture, evolving policy requirements have impacted already difficult staff recruitment in rural settings. Identifying contextual needs of organisations in readiness for change highlights geographical and sectoral nuances influencing any future implementation. As government policy changes to improve the older adult care sector, rural and remote facilities are forced to increasingly adapt. Context-specific needs extend far beyond a nurse practitioner providing additional expertise in care provision. What problem did the study address? Nurse practitioners have been successfully implemented into residential aged care facilities in metropolitan and major regional centres but translating this role into rural and remote Australia requires being cognisant of the needs, unique challenges and context of this setting. What were the main findings? In an organisational culture of support, the importance of staff providing relational care and having connection with older adult residents and families was a central driver. It was challenging for staff to meet complex care requirements in the absence of local healthcare options and support. Time pressures, from inadequate staffing and changing structural aged care sector, force the prioritising of care requirements. Where and on whom will the research have an impact? Older adults, policy makers and aged care providers will benefit from understanding the context of rural and remote settings, particularly in identifying potential solutions when there are gaps in primary and secondary healthcare. The GRAMMS checklist was followed in reporting of this study. Two lived experience consumers were involved as research team members. One was involved during the development and submission of the funding application and another during project activities including data collection and analysis and the development of publications.

Barriers to accessing abortion care: an analysis from the perspective of unintended pregnant women-findings from the ELSA study

Barriers to accessing abortion care can delay access to services, which can lead to delayed abortion and health risks. Barriers include geographical accessibility, confidentiality, waiting times, stigmatization, poor or inaccessible information and the cost of abortion. This article examines barriers to accessing abortion care in Germany. This includes barriers in the availability and accessibility of care services, access to information, costs associated with abortion and organisational barriers. The analyses are based on data from an online cross-sectional survey of 594 women in Germany who had an unwanted pregnancy terminated, which was conducted as part of the ELSA Study in 2021 and 2022. The findings indicate that access to abortion care in Germany is associated with various barriers for many women. Of the respondents, 80.1% reported at least one barrier to accessing abortion, 65.5% reported more than two barriers and 40.5% reported three or more barriers. In particular, the non-disclosure of the procedure and the associated fear of stigmatisation represented hurdles for many participants. The results of the study underline the need to improve access to safe abortions. Reducing access barriers therefore includes the decriminalisation of abortion, acomprehensive care structure, financial support services, improved information services and the reduction of stigmatisation and discrimination.

Geographic Access to High-Volume Mechanical Thrombectomy Centers in Florida, 2019.

Mechanical thrombectomy (MT) improves outcomes for acute ischemic stroke (AIS) due to large vessel occlusion, but is time sensitive and requires specialized infrastructure. Professional organizations and certification bodies have promulgated minimum procedural volume standards for centers and for individual proceduralists but it is unclear whether enforcing these requirements would decrease geographic access to MT. Therefore, we sought to evaluate the potential impact of applying a minimum procedural volume threshold on geographic access to MT. We identified all hospital discharges for stroke where an MT procedure was performed at any nonfederal hospital in Florida in 2019 using statewide hospital discharge data. We then generated geographic service area maps based on prespecified ground transport distances for the subset of hospitals that performed at least 1 MT and for those that performed at least 15 MTs that year, the minimum volume threshold required for thrombectomy capable and comprehensive stroke centers by the Joint Commission. Then, using zip code centroids and patient-level discharge hospital data, we computed the proportion of patients with AIS who lived within each of the generated service areas. A total of 105 of 297 hospitals performed MT; of those, 51 (17%) were low-volume centers (1-14 MTs/year) and 54 (18%) were high-volume centers (≥15 MTs/year). High-volume centers accounted for nearly 95% of all MTs performed in the state. Most patients hospitalized with AIS (87%) lived within 20 miles (or an estimated as a 1-hour driving time) of a hospital that performed at least 1 MT, and all (100%) lived within 115 miles (or estimated as 3-hour driving time). Setting a minimum MT volume threshold of 15 would decrease the proportion of stroke patients living within 1-hour driving time of an MT center from 87% to 77%. In 2019, most Florida stroke patients lived within a 1-hour ground transport time to a center that performed at least 1 MT and all lived within 3-hour driving time of an MT center, irrespective of whether a minimum procedural volume threshold of 15 cases per year was applied or not.

Bacteriology testing and antimicrobial resistance detection capacity of national tiered laboratory networks in sub-Saharan Africa: an analysis from 14 countries

Accurate detection of antimicrobial resistance (AMR) depends on adequate laboratory capacity. We aimed to document key weaknesses hindering AMR detection at various tiers of laboratory networks in 14countries in sub-Saharan Africa, and analyse their significance in AMR surveillance and policies. In this analysis, we obtained retrospective data on AMR and antimicrobial consumption from 14countries participating in the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership between May 1, 2019, and June 30, 2020. We established the number, capacity for AMR detection, and other characteristics from all bacteriology laboratories within the national network from existing national health system compendiums, combined with a self-applied scored survey tool. We calculated AMR detection readiness scores at a facility and country level and analysed the pertinence of national strategies to address system gaps for AMR detection and surveillance. Of the 53 770listed laboratories, 675 (1%) were formally assigned to deliver bacterial testing and invited to complete the survey tool. Of the 504 (75%) facilities that returned the completed survey, 393 (78%) reported antimicrobial susceptibility testing (AST) capacity and collectively provided geographical access to less than 50% of the general population in seven countries. Continuous access to water was reported by 347 (88%) laboratories, power sources by 341 (87%) laboratories, and the presence of qualified laboratory scientist or technologist by 377 (96%) laboratories. By contrast, ISO15189 accreditation was reported by 90 (23%) laboratories and use of an electronic laboratory information system by 54 (13%). Reference laboratories were associated with higher AMR detection readiness scores than were district laboratories (odds ratio 4·7 [95% CI 1·3-10·2; p=0·014). Private, not-for-profit laboratories were associated with higher scores than were government-affiliated facilities (9·2 [1·6-53·8; p=0·014). Designated national AMR sentinel sites were associated with higher scores than were non-sentinel sites (5·8[2·9-11·8; p<0·001). Laboratories processing between 1001and 3000bacterial cultures annually were associated with higher scores than were those processing less than 200cultures annually (4·8 [1·7-13·7]; p=0·0040). Strengthening bacterial testing and capacity for AMR detection represented less than 20% of the proposed interventions in 12of the 14national AMR action plans. AMR action plans and other relevant national strategies should prioritise the scale-up of bacterial testing services to improve access to care and promote quality AMR surveillance. Interventions that democratise AST to lower laboratory tiers, formally designate AMR sentinel sites, and implement whole-of-network laboratory information and quality management systems are urgently needed. Fleming Fund, UK Aid, and US Centers for Disease Control and Prevention through the Training Programs in Epidemiology and Public Health Intervention Networks.

Inequalities in geographic barriers and patient representation in lymphoma clinical trials across England.

The distribution of trial site locations may lead to disparities in geographic access and affect patient representativeness in clinical trials. We utilised trial data covering 1993-2022 from the National Institute for Health and Care Research (NIHR) Open Data Platform, 2011 and 2021 English Census and geographic data and English individual-patient cancer registry data for patients diagnosed with lymphoma between 1997 and 2017. To assess representation, we compared patient age and sex between trial participants and the incident population. We mapped the distance and travel times of English lower layer super output areas (LSOAs) to their nearest research active NHS Trusts and assessed associations between distance and travel times and the geographic and sociodemographic characteristics of the LSOAs. Trial participants were younger than the incident population and more likely to be male. The closest NHS Trust to more than half of English LSOAs was not research active. Greater LSOA mean age, male percent, White British percent, rurality and coastal/border status were positively associated with distance and travel time (at prespecified p < 0.05 level), while greater deprivation was negatively associated. Female and older lymphoma patients in England are underrepresented in trials, with the latter facing a higher burden of geographic barriers.

The unexpected impact of geographic access on take-up of social benefits

Abstract Among the factors identified to account for non-take-up of social benefits, there has been limited research on ‘process costs’, particularly regarding the impact of geographic access. Using Israeli data on field office openings from 1993 to 2021, this paper investigates the impact of geographic access on the take-up of the five largest social security programs in Israel. Based on staggered openings and closings of social security field offices, we find that geographic access has no significant impact on the take-up of either automatic enrollment programs, such as child allowances, or non-automatic programs, such as disability benefits. These findings suggest that the effect of geographic access on the take-up of social benefits may have been overstated in previous studies. We propose the following hypothesis to explain the surprising findings: If enhanced geographic access is driven by political favoritism, opening of new service points may lead to the misallocation of resources and, in effect, increase administrative burdens, thereby undermining rather than improving the take-up of social benefits.

Enhancing geographical access to cardiovascular disease healthcare services in Lagos State, Nigeria

Abstract Cardiovascular diseases (CVDs) are the leading cause of global mortality, and three-quarters of the world’s deaths from CVDs occur in low- and middle-income countries. Improving spatial access to care facilities is a way of reducing the disease burden through early detection and treatment. Determining the number of facilities to provide and the locations in order to improve accessibility is central to healthcare facility planning. The maximal covering location problem (MCLP) was used in the identification and determination of where to place additional CVD treatment facilities in Lagos State for better accessibility. The primary objective of this study was to optimize the placement of CVD facilities to maximize coverage for both patients and non-patients alike. The optimization model utilized data on the population of Lagos State, the locations of CVD patients, the location of existing CVD care facilities, and the locations of general hospitals (GHs) within the state. The MCLP implementation was carried out using the maxcovr. The results of the models indicated that the addition of two facilities at the Isolo and Ile-Epo GHs would enhance CVD patient coverage from 70 to 87.4%, reducing the average travel distance from 9,038 to 6,466 m. Similarly, the introduction of two facilities at the Ikorodu and Ajegunle GHs improved population coverage from 40.3 to 70.8%, reducing the average travel distance of 18,788 m by over 5,000 m. These findings are expected to offer valuable insights for public health decision-makers who face the challenge of prioritizing limited budgets.

Understanding the health system drivers of delayed cancer diagnosis in public healthcare networks of Chile, Colombia and Ecuador: A qualitative study with health professionals, managers and policymakers

Although the greatest delays in cancer diagnosis in Latin America occur in the provider interval little is known about the related factors. This study aims to analyze factors influencing access to cancer diagnosis -from initial contact with health services to confirmation- from institutional stakeholders' perspective in public healthcare networks of Chile, Colombia, and Ecuador. A qualitative, descriptive-interpretative study was conducted in two networks per country, using semi-structured individual interviews (n = 118; 23 to 58, per country) with a criterion sample of health professionals and administrative personnel from primary care (PC) (n = 41) and secondary/tertiary care hospitals (n = 47), network managers and policymakers (n = 30). The final sample size was reached through saturation. Thematic content analysis was performed, segmented by country. The analysis reveals interacting factors that cause cumulative delays throughout the patient's diagnostic pathway within healthcare networks, with differences between countries. In all three, informants identify similar characteristics of the networks: structural (deficits in diagnostic resources; geographical accessibility), organizational factors (long waiting times, especially after referral), and the limited knowledge and experience of PC doctors, which all lead to delayed diagnosis. In Chile and Colombia, health policy barriers related to care rationing/prioritization policies that hampered access to tests, and in Chile, increased delays for non-prioritized conditions. Country-specific barriers related to the organization of healthcare system also emerge: in Chile, private services subcontracting and the voucher system for using them; in Colombia, the management of care by insurers (care authorizations; fragmented and short-term contracting of providers); and in Ecuador, underfunding of the system. The barriers most affect the elderly, those with low socioeconomic status, with limited support networks, and rural areas residents. The results reveal relevant barriers in access to timely cancer diagnosis which can and should be addressed with specific cancer diagnosis policies and general measures that strengthen public healthcare systems and networks.

Barriers and Facilitators to Patient Utilization of Non-Communicable Disease Services in Primary Healthcare Facilities in Nepal: A Qualitative Study.

Background The Nepalese government endorsed and implemented the Package of Essential Non-Communicable Disease Interventions (PEN) by the World Health Organization (WHO) to prevent and manage four major non-communicable diseases (NCDs): cardiovascular disease (CVD), diabetes, cancers, and chronic respiratory diseases. This study explored barriers and facilitators to patient utilization of NCD services at primary healthcare facilities in Nepal. Methodology: We conducted a qualitative study with a 35 purposive sample of patients living with one or more NCDs (hypertension, diabetes, chronic obstructive pulmonary disease (COPD/ asthma) who sought healthcare at primary healthcare facilities in 14 randomly selected districts in seven provinces in Nepal that implemented PEN. Trained qualitative researchers conducted in-depth interviews in-person in a private setting using a semi-structured interview guide developed based on the Health Belief Model in the local language. The interviews were audio-recorded, transcribed verbatim, coded inductively and deductively, and analyzed by a framework approach using Dedoose software. Results From the perspectives of patients, key facilitators of service utilization encompassed free medicines, low-cost services, geographical and financial accessibility, less waiting time, positive interactions with health service providers, experiencing improvements in their health conditions, and support from family and peers. Barriers to utilizing services included inadequate health services (e.g., lack of medications and equipment), inaccessibility and affordability, inadequate health-related information from health service providers, low knowledge of NCD care, and lack of reminders or follow ups. Conclusion Enhancing NCD service utilization is potentially attainable through interventions that address patients' knowledge, self-motivation, and misconceptions. Furthermore, strengthening the availability and accessibility of crucial services such as laboratory investigations, medications, equipment, and the patient-provider relationship is crucial for sustainable implementation of PEN.

Spatial Distribution of Public Lower Secondary School and its Impact on Students’ Enrolment in Ogun Central Senatorial District Ogun State, Nigeria

Given the quest for universal basic education, the large enrolments in the Nigerian secondary educational institutions has resulted in the problem of over-crowded classes, shortage of teachers and shortages of classroom, which portend enormous challenges to the development of the educational sector in Ogun state. Using Ogun Central as a case study, the study identified the spatial pattern of the schools; analyzing students’ enrolment trends in the area, and identifying the factors associated with the observed pattern. Spatial analysis tool in ArcGIS was used to analyze both the spatial accessibility index and the students’ annual enrolment trend of the lower secondary school in the area. The result of the nearest neighbor analysis for the spatial pattern of lower secondary schools in the study revealed a random pattern. This pattern implies that the lower secondary schools are located far from one another, which indicates, that for students to attend the schools, most of them need to cover long distances. The spatial distribution of junior secondary school is influenced by socioeconomic status, environmental factors, demographic characteristics, transportation infrastructure, and geographic accessibility, which are key determinants of educational equity. Linear regression analysis was employed to identify trends and predict future enrollments of students. Further, the results of the trend analysis of enrolments of students in the zone from 2020 – 2023 reveal a negative trend. This implies a decrease in students’ enrolment as the year increases. The four years (2020 – 2023) annual trend of enrolments in the zone is represented by the negative trend y = -3180.3x + 99400. This result suggests that the students’ enrolments in the zone would gradually keep decreasing as time goes on if quick remedial actions are not taken. However, factors such as shortage of teachers, shortage of classrooms, COVID-19, insufficient infrastructural facilities and fuel subsidy removal could be responsible for the negative enrolment trend

The Challenges of the Kurikulum Merdeka Implementation in 3T Area

This study investigates the challenges of implementing the Kurikulum Merdeka in the disadvantaged, remote, and outermost (3T) areas of Maluku. The significance of this research lies in addressing the geographic, infrastructural, and educational accessibility issues in these 3T areas, which can hinder the effective implementation of the Curriculum. The research employs a descriptive qualitative methodology. The study engaged 40 respondents, including school principals, teachers from both public and private schools, training facilitators, and assistant program implementers. Data were collected through questionnaires and interviews and were then analyzed to identify recurring patterns, problems, challenges, and obstacles faced during implementation. The results indicate that despite their dedication to implementing the curriculum, nearly all schools struggle with the execution of the Kurikulum Merdeka. The main challenge identified is the inadequacy of teachers in designing and carrying out learning activities as required by the curriculum. This issue arises from various factors, including limited access to technology, insufficient training for principals and teachers, shortcomings in the mentoring mechanisms, and a lack of digital literacy among educators. Consequently, the government's mandate to implement this curriculum in all schools should be preceded by comprehensive preparation. Emphasis should be placed on enhancing teachers' capabilities through training sessions and workshops focused on planning, executing, and evaluating learning activities. Additionally, providing sufficient facilities and fostering a supportive learning environment are essential aspects that must be addressed. Keywords: implementation, Kurikulum Merdeka, disadvantaged, remote area

Optimizing Agricultural Labour: An Examination of On-Demand Workforce Solutions for Seasonal Demands

To address the growing challenges in managing on-demand Labour within the agricultural sector, we introduce Agro Finder, an innovative application developed using Figma for design and flutter for frontend development and firebase for backend. This research presents a comprehensive overview of the current state of Labour management in agriculture and proposes Agro Finder as a solution tailored to the sector's unique needs. The app leverages real-time data and sophisticated algorithms to streamline the connection between farmers and Labourers, optimizing Labour allocation based on geographic location, skills, and availability. Further analysis reveals that Agro Finder significantly enhances Labour utilization efficiency, reducing downtime in agricultural operations. The app's intuitive design, supported by Figma, ensures a user-friendly experience, while the fronted, powered by Flutter, provides reliable performance. The integration of these technologies facilitates efficient Labour management, leading to increased productivity and operational efficiency in agriculture. The research findings underscore the potential of applying modern development tools and methodologies to solve traditional problems in agriculture. By harnessing the power of Figma and Flutter, Agro Finder sets a new standard in on- demand Labour management, offering valuable insights and practical solutions. This study provides a solid foundation for future advancements in agricultural Labour management and highlights the importance of technological innovation in enhancing agricultural productivity. Key Words: on-demand Labour, agricultural management, mobile application development, Figma, Flutter, Labour allocation, real-time data processing, Firebase.

The allocation and fairness of hospital pharmacist human resources in China: a time-series study

BackgroundTo address the rational use of medicines in healthcare institutions, the Chinese government enacted legislation for pharmacists in 2021, emphasizing the importance of pharmacists in medical services. The allocation and equity of pharmacist human resources in healthcare institutions directly affect people’s accessibility to pharmaceutical services. The study aims to analyze the supply and demand of pharmacist human resources in Chinese healthcare institutions and evaluate the equity of their distribution to provide a reference for the rational management of pharmacist resources.MethodsThis was a time-series study that was conducted using data obtained from Health and Health Statistical Yearbook that is performed every year by the National Health Commission of the People’s Republic of China. The study included 31 provinces, municipalities, and autonomous regions and 34,354 medical institutions in mainland China, which were classified into different economic regions based on their level of economic development. The study collected healthcare technicians and pharmacist data from national healthcare institutions between 2016 and 2020. The study evaluated the level of pharmacist human resource allocation using the health resource density index. The study explored the equity of pharmacist human resource allocation from two aspects: population and geographic area, using the Gini coefficient and Theil index.ResultsThe average annual growth rates of healthcare technical staff and pharmacists in Chinese medical institutions from 2016 to 2020 were 5.67% and 3.03%, respectively. The Gini coefficients of healthcare personnel resources based on population distribution were all below 0.119, while those based on geographical area were all above 0.655. The total Theil indexes of pharmacist human resources based on population distribution were all below 0.010, while those based on geographical area were all above 0.511. In addition, the contribution rates of the within-group Theil indexes of pharmacist human resources based on population and geographical area distributions to the total Theil index were all greater than or equal to 50%.ConclusionsThe allocation level of pharmacist human resources in China continues to improve, but there are differences in different economic development areas. Currently, allocation based on population shows equity, but allocation based on geographic area shows inequity. In the future, more attention should be paid to the geographic accessibility of pharmacist human resources, and resource allocation should consider both the population served and geographic area.

Impact of Mobile Health Interventions on HIV Testing Rates among At-Risk Youths: A Review

HIV remains a significant global public health challenge, particularly among at-risk youths aged 15–24, who accounted for over 30% of new infections in 2022. Barriers such as stigma, socioeconomic disparities, and limited access to healthcare contribute to low HIV testing rates within this demographic. Mobile health (mHealth) interventions, which leverage the widespread use of mobile devices, offer innovative solutions to address these barriers by providing confidential, accessible platforms for HIV testing and care. This review explored the impact of various mHealth interventions, such as SMS-based reminders, mobile apps, and telehealth platforms, on HIV testing rates among at-risk youths in different regions. Several studies demonstrate significant increases in testing rates, with mHealth tools reducing barriers related to confidentiality, stigma, and geographical access. However, challenges remain, including digital access disparities, privacy concerns, and the sustainability of interventions. A comprehensive literature review of studies on mHealth interventions targeting at-risk youth populations were utilized in compiling this educating paper. Future research should focus on refining mHealth strategies, incorporating emerging technologies like AI, and ensuring interventions are tailored to specific cultural and geographical contexts. mHealth has the potential to play a crucial role in combating the HIV epidemic by empowering at-risk youths to access testing and care. Keywords: Mobile health (mHealth), HIV testing, At-risk youths, Digital health interventions. HIV prevention.

Interventions to improve access to cancer care in underserved populations in high income countries: a systematic review.

Underserved populations both globally and in Canada face serious cancer inequities that result from systemic economic, environmental, and social conditions. These pose barriers in access to cancer care and lead to suboptimal cancer care experiences and outcomes. Knowledge of effective interventions to improve access to cancer care is needed to inform the design of tailored interventions for these populations. To identify interventions and programs to improve access to cancer care for underserved populations in high income countries with universal health coverage (UHC) and the United States (US) throughout the cancer care continuum. We conducted a systematic review following the PRISMA standards. We searched Medline, EMBASE, PsycINFO, CINAHL, Scopus, and the Cochrane Library. Inclusion criteria: quantitative and qualitative studies published in English in the last 10years (2013-2023), describing interventions/programs to improve access to cancer care for underserved populations (18years and over). We included studies in the US given the body of scholarship on equity in cancer care in that country. Screening, data extraction and analysis were undertaken by two independent reviewers. Our search yielded 7,549 articles, and 74 met the inclusion criteria. Of these, 56 were conducted in the US, 8 in Australia, 6 in Canada, and 4 in the United Kingdom. Most (90.5%) were quantitative studies and 47.3% were published between 2020-2023. Seven types of interventions were identified: patient navigation, education and counselling, virtual health, service redesign, financial support, improving geographical accessibility and multicomponent interventions. Interventions were mainly designed to mitigate language, distance, financial, lack of knowledge and cultural barriers. Most interventions focused on access to cancer screening, targeted rural populations, racialized groups and people with low socioeconomic status, and were conducted in community-based settings. The majority of interventions or programs significantly improved access to cancer care. Our systematic review findings suggest that interventions designed to remove specific barriers faced by underserved populations can improve access to cancer care. Few studies came from countries with UHC. Research is required to understand tailored interventions for underserved populations in countries with UHC.

Анализ транспортной доступности населенных пунктов Республики Мордовия с использованием геоинформационных технологий

The study is devoted to the analysis of transport accessibility of the settlements in the Republic of Mordovia, which is proposed by the authors as one of the indicators for assessing the level of the transport system development. Methods of spatial analysis and graph theory are used to create a transport network model. The selection of graph elements includes settlements in Mordovia with a population of 2 000 people or more, as well as all sections of highways that provide the shortest paths between them. The measure of distance is used as impedance. The article discusses the usability of geographic and potential accessibility, as well as the detour index to detect problematic elements of the transport network, and compares the indicators using the ranking and classification methods. Using web mapping services and network analysis tools in GIS, the selected indicators were calculated and a series of maps were created to display them, using natural breaks classification method and graduated symbols as a method of cartographic representation. During the study, it was found that some of the shortest paths between the considered settlements of the Republic of Mordovia pass through the Nizhny Novgorod Oblast, which indicates that the regional transport network goes beyond the borders of the federal subject. The problem of artificial barriers within one country at the level of municipal districts and federal subjects has been identified. The possibility of creating a project to improve transport accessibility of the region is being considered, and arguments in favor of the construction of missing direct connections between settlements of the Republic of Mordovia are given. The target indicators and limiting factors for improving the transport accessibility of settlements in the region are identified. The possibilities of further research using the obtained results for a comprehensive analysis of the regional transport system are considered.

Combining OpenStreetMap mapping and route optimization algorithms to inform the delivery of community health interventions at the last mile.

Community health programs are gaining relevance within national health systems and becoming inherently more complex. To ensure that community health programs lead to equitable geographic access to care, the WHO recommends adapting the target population and workload of community health workers (CHWs) according to the local geographic context and population size of the communities they serve. Geographic optimization could be particularly beneficial for those activities that require CHWs to visit households door-to-door for last mile delivery of care. The goal of this study was to demonstrate how geographic optimization can be applied to inform community health programs in rural areas of the developing world. We developed a decision-making tool based on OpenStreetMap mapping and route optimization algorithms in order to inform the micro-planning and implementation of two kinds of community health interventions requiring door-to-door delivery: mass distribution campaigns and proactive community case management (proCCM) programs. We applied the Vehicle Routing Problem with Time Windows (VRPTW) algorithm to optimize the on-foot routes that CHWs take to visit households in their catchment, using a geographic dataset obtained from mapping on OpenStreetMap comprising over 100,000 buildings and 20,000 km of footpaths in the rural district of Ifanadiana, Madagascar. We found that personnel-day requirements ranged from less than 15 to over 60 per CHW catchment for mass distribution campaigns, and from less than 5 to over 20 for proCCM programs, assuming 1 visit per month. To illustrate how these VRPTW algorithms can be used by operational teams, we developed an "e-health" platform to visualize resource requirements, CHW optimal schedules and itineraries according to customizable intervention designs and hypotheses. Further development and scale-up of these tools could help optimize community health programs and other last mile delivery activities, in line with WHO recommendations, linking a new era of big data analytics with the most basic forms of frontline care in resource poor areas.