Improve Access To Health Care Research Articles

Artificial Intelligence-Enabled Transformation in Bangladesh: Overcoming Challenges for Socio-Economic Empowerment.

This research paper delves into Bangladesh's AI landscape, focusing on socio-economic empowerment. Despite notable AI strides, critical gaps persist, necessitating deeper investigation. It addresses impact assessment, policy evaluation, skill development, and community engagement, vital for actionable insights. Bangladesh grapples with socio-economic challenges—widespread poverty, healthcare disparities, and educational hurdles—highlighting the urgency for innovative solutions. The paper outlines ongoing AI initiatives across agriculture, healthcare, education, and governance, backed by government policies like the "AI Strategy 2030" and substantial investments. However, integrating AI faces multifaceted barriers—infrastructural limitations, skill shortages, ethical concerns, and financial constraints—demanding collaborative efforts. A mixed-methods approach, incorporating interviews, surveys, and case studies, revealed insights. Policymakers acknowledged significant government investment in AI infrastructure, regulatory support, collaboration, education, and funding's impact. Industry experts emphasized high AI adoption, positive productivity impacts, data security efforts, and workforce integration. A survey revealed workforce interest in AI education but a gap in practical proficiency and access barriers. Graphical representations depicted varied AI usages, global adoption trends, and market projections, highlighting AI's transformative potential. Case studies showcased successful AI implementations in agriculture, healthcare, finance, education, and governance, yielding increased yields, improved healthcare access, fraud reduction, enhanced learning, and efficient service delivery. Policy analysis highlighted existing strengths and areas for improvement, stressing robust ethical guidelines, capacity-building, resource allocation, and enhanced coordination for effective implementation. In conclusion, this paper provides insights guiding stakeholders in leveraging AI for sustainable socio-economic development in Bangladesh.

Impact of Socioeconomic Factors on Life Expectancy in Pakistan

Purpose: The aim of the study was to examine the impact of socioeconomic factors on life expectancy in Pakistan
 Methodology: The study adopted a desktop methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library
 Findings: Socioeconomic factors have a significant impact on life expectancy in Pakistan. Higher education, greater access to healthcare, and higher income levels are associated with longer life expectancies. Gender disparities exist, with women generally having longer life expectancies than men due to differences in healthcare access and lifestyles. Urban areas tend to have higher life expectancies compared to rural areas due to better healthcare facilities and resources. These findings highlight the need for targeted policies and interventions to address disparities and improve overall population health in Pakistan.
 Unique Contribution to Theory, Practice and Policy: The socioeconomic development theory, the well-being theory & the social ecology theory may be used to anchor future studies on the examining impact of socioeconomic factors on life expectancy in Pakistan. Invest in the expansion and improvement of primary healthcare services, especially in rural and underserved areas. Develop policies that specifically aim to reduce health inequalities, such as initiatives to improve healthcare access in remote areas and interventions to address disparities in nutrition and sanitation.

Stigma and infectious diseases in Africa: examining impact and strategies for reduction

Stigma poses a significant barrier to accessing care, managing, and preventing infectious diseases in Africa. The authors conducted an extensive search across Scopus, PubMed, ScienceDirect, and Google Scholar to identify relevant English-language articles, with no constraints on publication dates, using the keywords “Stigma,” and “Infectious Disease,” in conjunction with “Africa.” This article explores the multifaceted nature of stigma associated with infectious diseases, highlighting its impact on healthcare access and public health outcomes. It delves into the current situation of infectious disease-related stigma in Africa, emphasizing the various diseases and contexts affected. The article identifies drivers of stigma, including negative attitudes, misinformation, and institutional practices, and discusses their role in perpetuating discrimination. Importantly, it provides recommendations for addressing infectious disease stigma in Africa through comprehensive strategies encompassing health education, contact-based interventions, professionalized counselling and peer support services, and community engagement. The article calls for collaboration among governments, healthcare organizations, NGOs, and community leaders to implement holistic strategies that prioritize inclusivity and stigma reduction. Ultimately, it underscores the urgent need to combat stigma to improve healthcare access and outcomes for individuals affected by infectious diseases in Africa.

Enhancing healthcare access during disasters and emergencies: Recommendations from Nepali migrants in Japan.

Migrants in Japan often face difficulties accessing healthcare due to language barriers, lack of information, shortage of interpreters, amongst other barriers. With an increase in the number of foreigners in Japan, it is also expected that health and safety concerns for migrants will rise during times of crisis or disaster. The purpose of this article is to present recommendations from Nepali migrants themselves about various actions that stakeholders or policymakers could take to improve healthcare access during future disasters, emergencies, or crises in Japan. Recommendations from Nepali migrants in this study include mobilization of Nepali healthcare professionals, self-preparedness, a disaster information centre by the embassy, Nepali hotline services, telehealth services, and mutual help. By working together and leveraging available resources, it is possible to ensure that migrants are not left behind in the face of disasters and emergencies. Further research is required to determine the most effective ways to improve healthcare access for migrants in Japan during disasters, crises, or emergencies.

Lifestyle and socio-economic disparities in the prevalence of diabetes among the elderly population (aged 60+) in India: a decomposition analysis using longitudinal aging study in India data

Background: This study aimed to determine the prevalence of self-reported diabetes by sex and investigate the socio-economic, demographic, and lifestyle risk factors associated with diabetes. Additionally, it aimed to understand the coexistence of diabetes with other morbid conditions. Methods: The study design used in this research is a cross-sectional study design. This study utilized data from the longitudinal aging study in India (LASI), a nationally representative survey of older adults. The sample included 15,098 males and 16,366 females aged 60 years and above. Results: The prevalence of diabetes in India varies by state, zone, and rural/urban areas. Kerala has the highest prevalence among both men (33%) and women (28.5%). Urban areas have a higher prevalence (20%) compared to rural areas (8.5%). Hypertension and cancer are strongly associated with diabetes. Other morbid conditions like heart disease, high cholesterol, and vision problems also show significant links with diabetes. Conclusions: Diabetes in India is a significant health concern, with variations across regions and associations with comorbidities like hypertension, cancer, heart disease, high cholesterol, and vision problems. To address this, comprehensive preventive measures and health promotion campaigns are needed, targeting high-risk groups and improving healthcare access. Early detection, effective management, and promoting healthy lifestyles are crucial for diabetes prevention and control in India.

Analytic Approach in Accessing Trends and Impacts of Medicaid-Medicare Dual Enrollment in the United States

The landscape of Medicaid and Medicare enrollment in the United States is undergoing dynamic changes, driven by intricate policies, shifting demographic trends, and evolving healthcare access criteria. This publication serves as a beacon, illuminating the multifaceted terrain of Medicaid and Medicare dual enrollment and offering a comprehensive understanding of its complexities and challenges. The primary objective is to advocate for the adoption of a centralized data-driven decision support system, recognizing its transformative potential. By harnessing the power of data, we can revolutionize enrollment management, streamline administrative processes, and facilitate the timely adjustment of policies, ensuring more efficient and effective healthcare access. Empowerment is at the heart of our mission. We aim to equip all healthcare stakeholders, from government agencies and insurance providers to healthcare institutions and enrollees, with knowledge and insights. Informed decisions driven by data will lead to improved healthcare access, ultimately catalyzing positive change within the Medicaid and Medicare landscape. This publication represents a call to action, urging all players in the healthcare ecosystem to embrace data-driven solutions, adapt to the evolving landscape, and work collaboratively to advance the cause of accessible and effective healthcare for all.

Real World Outcomes of Black Americans with Mantle Cell Lymphoma

Introduction Mantle cell lymphoma (MCL) is a rare subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 6-8% of all NHL cases. MCL generally affects older, White, male patients, having a significantly lower incidence in Black patients. Thus, clinical outcomes of Black Americans with MCL are poorly characterized, though multiple sources have reported relatively poor survival outcomes when compared to their White counterparts. We aimed to evaluate the overall survival outcomes and explore potential factors contributing to poor survival outcomes for Black patients with MCL in the United States. Methods The National Cancer Database was used to identify MCL patients diagnosed from 2004-2020. Demographic and treatment characteristics were compared between White and Black MCL patients, by self-identified race. Patients of other races were excluded. Kaplan Meier and adjusted Cox regression survival analysis were used to compare overall survival (OS) by race, and stratified for age ≤ 65 or age > 65 years old. Finally, a propensity matched analysis was performed to compare OS in Black and White Americans matched by age, comorbidity burden, insurance status, and zip code income. Results A total of 34,872 patients with MCL were identified, of which 93.1% (N=32,407) were White, 4.2% (N=1,465) were Black, and 1.7% (N=942) identified as another race and were excluded from the dataset. Black patients were more likely to be female (34% Black vs. 29% White), have a younger age at diagnosis (mean age 65 years [SD ± 13] vs. 68 years [SD ± 12], p<0.001), more likely to have ≥1 co-morbidity (30% vs. 23%), and more likely to be uninsured (4% vs. 2%) when compared to White patients. Both Black and White patients had equal rates of stage IV disease (68% vs. 68%) and receipt of systemic therapy at diagnosis (84% vs. 84%), however White patients were more likely to receive stem cell transplant compared to Black patients (13% vs.11%). With a median follow-up of 40 months, the median OS for all MCL patients was 70 months (95% CI 66-71). Compared to White patients of the same age, Black patients age ≤ 65 years had worse median OS (116 months [95% CI 92-139] vs. 140 [95% CI 134-146] months for White patients) along with decreased 1-year (87% vs. 90%), 5-year (62% vs. 70%) and 10-year OS (38% vs. 55%), (all p <0.001). For MCL patients age > 65 years old, Black MCL patients had shorter median OS compared to their White counterparts (36 months [95% CI 28-43] vs. 43 months [95% CI 41-44]), and decreased 1-year (70% vs. 75%) and 5-year OS (40% vs. 41%) (all p=0.030), though by ten years there was no survival disparity. On age-adjusted cox regression, Black race was associated with increased hazard for all-cause death for MCL patients (hazard ratio [HR] 1.17, CI 1.08-1.26; p<0.001). However, when Black and White patients were 1:1 propensity score matched by age, co-morbidity score, insurance status, and income quartile of zip code, there was no significant difference in risk of death by race alone (HR 0.99, CI 0.91-1.08; p=0.61). Conclusion This is the largest study to-date evaluating outcomes among Black patients with MCL. Patients who are Black with MCL are more likely to present at a younger age, have female predominance, and have worse overall survival outcomes than White patients of similar age. Notably, we found that this survival difference was lost when controlling for surrogate markers of healthcare access, such as insurance and income. This study highlights existing disparities for Black patients with MCL, which appear to be related to socioeconomic disparities that may impact access to treatment, supportive care, and other vital aspects of care for MCL. Future studies may seek to evaluate the role of known high risk features for MCL such as TP53 status or blastoid/pleomorphic morphology in these populations. Interventions aimed at improving healthcare access for underserved populations, including racial minorities, are essential.

Survival Outcomes of Rural Patients with Mantle Cell Lymphoma

Background Mantle cell lymphoma (MCL) is a rare and aggressive malignancy, representing approximately 6-8% of all non-Hodgkin lymphomas, and is generally associated with poor outcomes. Patients (pts) with MCL often require intensive up-front treatment with consideration for stem cell transplant consolidation. Due to geographic limitations, pts living in rural areas with MCL may not have access to specialized treatment centers experienced in managing this rare disease. There is a paucity of data available evaluating the impact of rurality in MCL, and it is unknown how population density and access to major metropolitan centers and their healthcare systems may impact survival outcomes. Methods The National Cancer Database was used to identify MCL pts diagnosed from 2004-2020. Demographic and treatment characteristics were compared by county level measures of rurality and urban influence, categorized into metropolitan (metro), non-metropolitan urban (urban), and non-metropolitan rural (rural) counties. These data are provided from the 2013 Department of Agriculture Economic Research service data Rural-Urban Continuum Codes which uses population, population density, and commuting distance to determine these codes. Pts without rurality data or who were not treated at the reporting facility were excluded. Kaplan Meier and adjusted Cox regression survival analysis were used to compare overall survival by rural-urban codes. Results Of the 29,464 pts with MCL identified, 83.4% (N= 24,849) resided in metro counties, 14.6% (N=4,356) resided in urban counties, 1.9% (N=573) resided in rural counties. Non-metro pts were more likely to be male (70.7% male metro vs 73.0% and 72.1% for urban and rural counties, respectively), with similar age at diagnosis across county types (median age of 68 for metro pts and 69 for rural pts). Rural pts had a higher burden of comorbidities, as determined by the Charlson-Deyo comorbidity index (11.3% of rural pts with a score of 2 or greater, compared to 8.7% urban, and 7.9% of metro pts). Pts from metro counties were more likely to have private insurance (38.5% metro vs. 32.4% for urban and 28.6% for rural pts), where non-metro pts were more often uninsured (3.3% of rural, vs 2.4% of metro) or Medicare insured (61.6% rural vs 53.4% of metro pts). Notably, pts were less likely to be managed with active surveillance if they were from a rural county (4.8% vs 6.9% of metro pts), and were more likely to receive systemic disease related therapy at diagnosis (90.6% rural vs 85.2% metro). With a median follow up of 42 months, pts from metro counties had a median overall survival (OS) of 70.6 months (95% confidence interval (CI) 68.6-72.7), which was significantly longer than those from urban (61.1 months [95% CI 56.4-65.9], p<0.001) and rural counties (59.8 months [95% CI 54.0-65.6], p<0.001). The survival disparity was persistent for metro, urban, rural pts at 1-year (81%, 80%, and 78% respectively, p<0.001), 5-years (54%, 50%, 50% respectively, p<0.001) and 10-years (36%, 30%, 29% respectively, p=0.066). When referenced to pts from metro counties on Cox regression, non-metro counties had a greater risk of all-cause mortality, with hazard ratio (HR) of 1.13 (95% CI 1.08-1.18; p<0.001) for urban and 1.14 (95% CI 1.02-1.28; p=0.024) for rural pts. When adjusted for age and Charlson-Deyo comorbidity score this survival disparity persisted, with a HR of 1.12 (95% CI 1.07-1.17), p<0.001 for urban pts and HR 1.05 (95% CI 0.94-1.18), p=0.408, for rural pts, when referenced to pts from metro counties. Discussion We demonstrate a population density-based survival disparity in MCL pts, finding that pts living in more rural counties have worse survival outcomes. Rural pts had a higher comorbidity burden and were more likely to be underinsured. Additionally, they received less active surveillance, which may indicate delays in diagnosis and/or consultation with an oncologist. Given the rapidly evolving treatment landscape of MCL, these data support the need for efforts to improve healthcare access for MCL pts, such as earlier referrals to academic centers with expertise in MCL management, expanded access to telehealth, rural partnerships with academic medical centers, and programs that support patient and family travel.

Determinants of Unsupervised Medical Termination of Pregnancy Pill Usage Among Women: A Cross-Sectional Study From North India.

Background Medical termination of pregnancy (MTP) pills, primarily comprising mifepristone and misoprostol, have proven highly effective and safe under medical supervision. However, unsupervised MTP pill use is on the rise, posing serious health risks. Unsafe abortions remain a global public health concern, with a high incidence in developing countries like India. Methods We conducted a cross-sectional study at a tertiary healthcare center in India from February to April 2023. We enrolled 150 women with a history of unsupervised MTP pill use. Data were collected using structured questionnaires, including demographic information, awareness, sources of information, reasons for self-medication, and knowledge of complications. Results The majority of participants (50%) were aged 25-29 years. Low-income women (<3000pc) constituted 46.66% of the sample. Husbands played a significant role in advocating MTP pill use (57.33%). Ninety percent of pills were obtained directly from pharmacies. Shockingly, 97.3% of women were unaware of MTP pill complications, and 84% did not follow the recommended regimen. Significant associations were found between income, religion, education, age, parity, and reasons for self-medication, as well as recommendations for MTP pill use. Conclusion Our study revealed a diverse demographic of women seeking unsupervised MTP pill intake. Low-income women were disproportionately affected, emphasizing the need for improved healthcare access and education. Husbands played a crucial role in advocating MTP pill use, highlighting the importance of including men in reproductive health discussions. Lack of awareness and non-adherence to recommended regimens posed substantial risks. To combat unsafe abortions, a multifaceted approach is needed. Reproductive health education, regulatory measures, improved healthcare accessibility, and tailored interventions are essential.

Addressing racial differences in the management of atrial fibrillation: Focus on black patients

Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.

Strengthening Primary Healthcare in Jordan for Achieving Universal Health Coverage: A Need for Family Health Team Approach.

Achieving Universal Health Coverage (UHC) is a strategic objective of the Jordanian government and has been prioritized in its strategies and plans. However, there are several challenges affecting primary healthcare in Jordan and the health system in general that prevent Jordan from achieving UHC. This paper highlights the importance of team-based care in the form of Family Health Teams (FHTs) to realize Jordan's goal of achieving UHC. FHTs are a team-based approach that brings together diverse professionals to provide a comprehensive, efficient, patient-centered primary care system that meets the changing needs of Jordan's population and refugees. However, the implementation of FHT may encounter obstacles, including individual, organizational, institutional, and external barriers. To overcome such obstacles, several actions and processes need to be taken, including political commitment and leadership, implementing good governance and policy frameworks, allocating resources and funding, multisectoral collaboration, and engagement of communities and stakeholders. The successful implementation of FHTs requires participation from government officials, parliamentarians, civil society, and influential community, religious, and business leaders. A strategic policy framework, effective oversight, coalition building, regulation, attention to system design, and accountability are also essential. In conclusion, adopting the FHT approach in Jordan's Primary Healthcare system offers a promising path towards achieving UHC, improving healthcare access, quality, and efficiency while addressing the unique challenges faced by the country's healthcare system.

The impact on the elapsed time to care and outcomes of a clinician-to-clinician electronic consultation program in patients diagnosed or suspected atrial fibrillation in primary care

Abstract Background An early diagnosis and early initiation of oral anticoagulants (OAC) are main determinants for outcomes in patients with atrial fibrillation (AF). Clinician-to-clinician electronic consultations (e-consultations) program as the first step in the ambulatory care organization for the general practitioner (GPs) referrals to cardiologist may improve health care access by reducing the elapsed time for cardiology care compared with a face-to-face consultation for all the referrals. Objective To evaluate the effect on outcomes of a reduced elapsed time to care after a clinician-to-clinician e-consultations program implementation (2013–2019) in comparison with previous in-person consultation (2010–2012) in the outpatient health care management in a Cardiology Department. Methodology We included 10,488 patients referred by general care practitioners for cardiology consultation with confirmed or suspected AF from 1 January 2010, to 31 December 2019. Until 2012, all patients were attended with an in-person consultation (2010–2012). In 2013, we instituted an e-consult program (2013–2019) for all primary care referrals to cardiologists that preceded patient's in-person consultation when considered. The shared electronic patient dossier (EPD) was available between GP and cardiologist, and any clinical comment and change in therapy advice from cardiologist was directly implemented in this EPD. Results During the e-consultation period (2013–2019) were referred 6627 patients by GPs to cardiology versus 3861 during the in-person consultation (2010– 2012). The e-consultation implementation was associated with a reduction in the elapsed time to anticoagulation prescription (177.6 ±8.9 vs. 22.5 ±8.1 days,p &amp;lt; .001) (Figure 1, A), and an increase of OAC use (61% [95% IC: 19.6%–102.4%], p &amp;lt; .001) (Figure 1, B). The e-consult program implementation was associated with a reduction in the 1-year CV mortality (.48 [95% CI: .30–.75]) and all-cause mortality (.42 [95% CI: .29– .62]). The OAC reduces the stroke mortality (.15 [95% CI: .06–.39]) and CV mortality (.43 [95% CI: .29–.62]) and all-cause mortality (.23 [95% CI: .17–.31]) (Figure 2). Conclusion A shared EPD-based clinician-to-clinician e-consultation program significantly reduced the elapsed time for cardiology consultation and initiation of OAC. The implementation of this program was associated with a lower risk of stroke, cardiovascular and all-cause mortality.

Allied health professional-physician collaboration to enhance guideline-directed medical therapy of heart failure: expanding therapeutic opportunities

Abstract Background Guideline-directed medical therapy (GDMT) is the cornerstone of treatment for heart failure patients with reduced ejection fraction (HFrEF). Optimization of GDMT at a targeted allied professional medication titration clinic represents a key opportunity to provide greater access to care and further refine patient care models, leading to improvements in clinical outcomes. Purpose To evaluate the effectiveness of an allied health practitioner optimization clinic model in HFrEF as indicated by changes in rates of triple and quadruple GDMT therapy (see associated table). Methods Qualified patients were either: proactively screened from clinic lists, having demonstrated a diagnosis of heart failure, reduced ejection fraction, and not receiving triple or quadruple therapy, or were physician-referred after initial optimization during 2021-2022. Participants subsequently underwent medication review and optimization by an allied health professional, involving introduction, up-titration, down-titration, or withdrawal of medications across relevant medication classes as tolerated. Results 52 (78.8% male) patients with a mean age of 70.3 (11.4) years and mean ejection fraction of 30.1 (6.7) percent underwent medication optimization. Along with HFrEF, all patients exhibited cardio-metabolic multi-morbidity (2-3 cardio-metabolic diagnoses), including hypertension (59.6%), dyslipidemia (71.2%), coronary artery disease (61.5%), atrial fibrillation (42.3%), and type 2 diabetes (21.2%). Pre-optimization prescription rates ranged from: 53.8% for ACEi/ARB, 30.8% for ARNI, 80.8% for beta-blockers, 59.6% for MRA, 40.4% for diuretics, and 13.5% for SGLT2i. Medication review and optimization spanned an average of 2.8 (1-7) meetings, and lead to an average of 1.9 (range 0-4) medication changes. Among 49 patients considered for ARNI optimization, there were 43 (87.7%) successful introductions and progressive dose adjustments, including 12 (27.9%) dose adjustments among those already prescribed. Additional changes involved optimizations in: beta-blockers (5 introductions, 5 dose-changes), MRA (8 introductions, 4 dose-changes, 2 withdrawals), diuretics (1 introduction, 7 dose-changes, 2 withdrawals), and SGLT2i (17 introductions). Collaboration between allied health professionals and physicians in optimization demonstrated significant improvements in rates of triple (42.3% vs 63.5%, P= 0.003) and quadruple (5.8% vs 26.9%, P= 0.001) therapy post-optimization. Discussion A Collaborative approach to medication optimization increased the use of GDMT in ambulatory patients with HFrEF. Collaboration presents both clinicians and health systems with greater opportunities to improve healthcare access, therapeutic inertia, and disease management.Pre-post Changes in GDMT Rates

Abstract 14874: Trends and Disparities in Cardiovascular Death in Colorectal Cancer: A Population-Based Retrospective Study in the United States From 1999 to 2020

Background: Overlap between cardiovascular diseases and colorectal cancer(CRC) has become more prominent with enhanced life expectancy. The data on cardiovascular deaths (CVDs) among those patients is not well-established. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVDs with comorbid CRC by race, sex, and region. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid CRC among patients aged 18 and above. Diseases of the circulatory system were listed as the underlying cause of death, and colorectal cancer as contributing cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and determined the trends by using the Joinpoint Regression Program. Results: In the 22-year study period, 77,094 CVDs with comorbid CRC were identified between 1999 and 2020. The AAMR from CVDs with comorbid CRC decreased significantly from 29.73 per 1,000,000 individuals in 1999 to 9.65 per 1,000,000 individuals in 2020 (p&lt;0.05). The most common CVDs reported were ischemic heart disease (56%) and cerebrovascular disease (14%). Males had a higher AAMR compared to females (21.51 vs 12.53 per 1,000,000 individuals, p&lt;0.05). African Americans had the highest AAMR (18.12 per 1,000,000 individuals), while the AAMRs for White populations, American Indian, and Asian populations were 16.28, 9.09, and 9.06 respectively. Rural areas had a higher AAMR than urban areas (18.25 vs 15.76 per 1,000,000 individuals, p&lt;0.05). Conclusion: The CVDs in patients with CRC have decreased significantly over the past two decades, with disparities seen in African Americans and rural regions. This highlights the importance of early screening among high-risk populations, and the importance of improving healthcare access in underserved populations.

Self-medication and medication storage practices among Lira University students in Lira city, Northern Uganda.

Self-medication (SM) is a global public health concern, particularly prevalent in developing nations. It involves the consumption of drugs without professional guidance, encompassing both over-the-counter and prescription medicines. Responsible SM can alleviate healthcare burdens, reduce costs, and empower individuals to manage minor ailments independently. However, improper SM practices can lead to adverse effects, contribute to antimicrobial resistance, and pose various health risks. This study aimed to evaluate the prevalence of SM and related practices of storing medications among students at Lira University, located in Lira City West Division, Northern Uganda. This study adopted a quantitative cross-sectional design, focusing on students from various faculties. The sample size comprised 422 students, determined using the Kish Leslie formula. Data collection involved the administration of self-administered questionnaires, and subsequent data analysis was performed using SPSS version 25. The study involved participants from Lira University, primarily women (51.2%) with an average age of 23.82. A majority were Christians (59.7%) and single (87.9%). Most were from the Faculty of Health Sciences (63.7%), with third-year students being the largest group (48.3%). Regarding SM, 74.2% practiced SM, with antibiotics (69.2%) and tablets (69.2%) being commonly self-administered. In terms of medication storage, 93.4% kept medicines at home, mostly in cupboards (76.5%), but many were unsure about proper storage practices. Participants exhibited good knowledge of SM's risks and measures to reduce them. There was a significant association between the faculty of study and SM practices (p = 0.015), while other demographic factors showed no significant associations. This study sheds light on the prevalent SM practices among students at Lira University in Northern Uganda. Notably, antibiotics were frequently self-medicated, raising concerns about antibiotic resistance. Additionally, medication storage practices emphasize the need for proper education on storage guidelines. However, the participants exhibited good knowledge of the risks associated with SM, suggesting the potential for effective awareness campaigns. The study recommends targeted health education programs, stricter regulations on medication sales, improved healthcare access, proper medication disposal, further research on the factors driving SM, collaborative efforts, and monitoring of antibiotic use to address this public health issue effectively.

HEMA: A Proposed Robot for Improving Healthcare Access in Underserved Communities

HEMA: A Proposed Robot for Improving Healthcare Access in Underserved Communities

Smart city healthcare delivery innovations: a systematic review of essential technologies and indicators for developing nations

BackgroundIn recent times, the concept of smart cities has gained remarkable traction globally, driven by the increasing interest in employing technology to address various urban challenges, particularly in the healthcare domain. Smart cities are proving to be transformative, utilizing an extensive array of technological tools and processes to improve healthcare accessibility, optimize patient outcomes, reduce costs, and enhance overall efficiency.MethodsThis article delves into the profound impact of smart cities on the healthcare landscape and discusses its potential implications for the future of healthcare delivery. Moreover, the study explores the necessary infrastructure required for developing countries to establish smart cities capable of providing intelligent health and care services. To ensure a comprehensive analysis, we employed a well-structured search strategy across esteemed databases, including PubMed, OVID, EMBASE, Web of Science, and Scopus. The search scope encompassed articles published up to November 2022, resulting in a meticulous review of 22 relevant articles.ResultsOur findings provide compelling evidence of the pivotal role that smart city technology plays in elevating healthcare delivery, forging a path towards improved accessibility, efficiency, and quality of care for communities worldwide. By harnessing the power of data analytics, Internet of Things (IoT) sensors, and mobile applications, smart cities are driving real-time health monitoring, early disease detection, and personalized treatment approaches.ConclusionSmart cities possess the transformative potential to reshape healthcare practices, providing developing nations with invaluable opportunities to establish intelligent and adaptable healthcare systems customized to their distinct requirements and limitations. Moreover, the implementation of smart healthcare systems in developing nations can lead to enhanced healthcare accessibility and affordability, as the integration of technology can optimize resource allocation and improve the overall efficiency of healthcare services. It also may help alleviate the burden on overburdened healthcare facilities by streamlining patient care processes and reducing wait times, ensuring that medical attention reaches those in need more swiftly.

Financial burden of coronary artery bypass grafting in India: implications for catastrophic health expenditure and healthcare access.

Cardiovascular diseases (CVD) have become a leading cause of mortality in India. High costs of coronary artery bypass grafting (CABG) impose a financial burden in patients often resulting in catastrophic health expenditure (CHE). CHE and distressed financing have significant microeconomic and macroeconomic implications. CHE depletes savings, forces asset disposal, and perpetuates poverty. At a macroeconomic level, the burden of CVD impacts gross domestic product, economic productivity, healthcare budgets, and social welfare. Addressing these challenges requires a multifaceted approach. Prioritizing accessible and affordable healthcare systems with robust financial risk protection is essential. Widespread adoption of health insurance, including government-sponsored schemes, can provide financial protection. Expanding public healthcare infrastructure, implementing price regulations, promoting generic medicines, and encouraging preventive measures for coronary artery disease (CAD) are crucial steps to reduce the burden of CABG costs and improve healthcare access.

Impact of Telemedicine on No-Show Rates in an Ambulatory Gastroenterology Practice.

Background: Studies suggest that telemedicine worsens health care disparities in certain groups, partly owing to a lack of access to appropriate technology or poor technological literacy. Our aim was to use clinic no-show data to determine the impact of telemedicine on patient access to care in the ambulatory gastroenterology setting. Methods: Single-center retrospective study of ambulatory in-person and telemedicine clinic appointments comparing the 15-month prepandemic (PP) with the first 15 months during the pandemic (DTP) using an administrative database. Statistical analysis was performed using univariate and multivariable logistic regression. Results: About 9,746 and 12,808 patient-encounters were scheduled PP and DTP respectively. The no-show rate decreased from 9.8% to 6.9% DTP (p < 0.001). The no-show rate decreased for Black (p = 0.02) and non-Hispanic White patients (p = 0.018). The no-show rate increased for LatinX (p < 0.001) and Asian (p = 0.007) patients. In multivariate analysis, older patients and patients identifying as Black, Asian, or LatinX all had higher odds of no-show DTP (p < 0.05 for all). Patients from high-income counties were 43% less likely to no-show than those in the lowest income counties. Conclusions: The transition to telemedicine improves health care access by decreasing the overall no-show rate. Some groups have been negatively affected, including the older, lower income, LatinX, and Asian populations. Future studies should aim to identify the risk factors within these populations that can be modified to increase health care participation, including targeted application of in-person visits, and improved technology to drive engagement.

Healthcare providers’ insights on enhancing health literacy and access for Arab Bedouin in Israel

Abstract Background The Arab Bedouin minority is considered as one of the most vulnerable populations in Israel due to socio-cultural factors that affect their healthcare utilization patterns. This study investigates continuity of care and health literacy within the Bedouin community, aiming to identify gaps and barriers to healthcare services (HS) utilization for Bedouins, as perceived by healthcare providers serving this community. Methods A qualitative study was conducted June 2019 and January 2022, involving in-depth semi-structured interviews with 32 healthcare providers from community health centers/clinics in Bedouin villages and towns in Southern Israel, as well as Soroka Medical Center. Thematic analysis was used to analyze the collected data, and trustworthiness was ensured through audit, reflexivity, and peer debriefing. Results Healthcare providers identified factors that hinder HS utilization and the absence of various healthcare options for Bedouin patients. Interviews revealed discontinuity in treatment due to insufficient health literacy and unaffordability of medications. Additionally, many Bedouins choose to forgo or delay their visits to the community health services and visit the Emergency Department directly, because of physical, cultural, and gender barriers. Elderly Bedouins are a particularly vulnerable subgroup, susceptible to complications from chronic diseases such as diabetes and hypertension. Conclusions This study highlights the necessity of targeted interventions to improve healthcare access for Bedouin minority population, particularly tailoring HS to elderly subgroups. Potential interventions comprise health education programs designed to enhance health literacy, address medication affordability, and confront cultural and gender barriers obstructing access to primary care services. These findings hold implications for public health policies and initiatives addressing healthcare disparities among minority groups worldwide. Key messages • Health literacy is a key barrier for the Bedouin minority in Israel, with global implications for addressing healthcare disparities in minority groups. • Targeted interventions, like health education programs, are needed to improve healthcare access for Bedouin minority, especially the elderly subgroup.