Improve Access To Health Care Research Articles

Rural ambulatory care pharmacists providing in-clinic and home visit services improve adherence to long-acting injectable antipsychotics.

Patients with schizophrenia often experience symptoms such as poor insight and disorganized thought, which limit their ability to seek and receive care consistently. In rural settings, systemic factors, including limited resources and transportation, further contribute to difficulties in health care access. Long-acting injectable antipsychotics (LAIs) can improve medication adherence and reduce hospitalizations from relapse. Opportunities exist for pharmacists to provide individualized care and improved health care access. The pilot service took place in ambulatory care clinics and home care settings. Pharmacists performed weekly reviews of patients with active orders for LAIs, coordinated care with nonadherent patients, and offered follow-up appointments in the Patient Centered Medical Home (PCMH). For patients unable to be reached, outreach pharmacists provided psychiatric assessment and LAI medication administration at home visits. There were 10 patients with LAI prescriptions in the past year selected for review. The period reviewed was 90 days before and after start of service. Pharmacist interventions resulted in 4 patients reestablished with care who were previously lost to follow-up. The percentage of days covered by LAI fills increased from an average 26% to 67% of days covered (P = .06). Total emergency room visits related to mental health episodes decreased from 11 to 2 visits (P = .03). Four patients who did not have metabolic lab monitoring in more than 1 year received lab monitoring as indicated. PCMH pharmacy services, including home visits by outreach pharmacists, may improve access and bridge care gaps for patients on LAIs by providing community-based services in addition to traditional clinic-based care.

Rectal cancer: Demographics and healthcare outcomes in a minority-rich community hospital.

e13735 Background: Rectal cancer (RC) has seen a decreasing incidence and mortality due to national screening guidelines, innovative therapies and new technology. In recent years, however, we have noted shifts in its demographics pertaining to variation in stage at diagnosis and mortality rates amongst various ethnic groups. Minority populations, namely Hispanic (H) and Black (B) patients (pts), continue to see higher incidence, diagnosis at more advanced stages and poorer survival than White (W) pts. In B pts, mortality rates are higher with an increased likelihood of distant-stage RC creating a significant survival disparity. Current studies involving H and Asians(A) show similar disparities. Compared to other malignancies, RC has improved survival for pts when diagnosed in a timely fashion and therefore, we seek to identify potential patterns within the diverse population we care for. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017- 2023. Pts were treated at our cancer center. We assessed age and stage at diagnosis and demographics such as age, sex and ethnicity. Results: We reviewed 59 pts with the following ethnic distribution: 22 H, 21 W, 11 B and 5 A pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W 71. More males were diagnosed in all groups except A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III, 45% at Stage IV. W pts also saw a similar trend with 33% at Stage III and 24% at Stage IV. Our H pts had comparatively fewer distant stage diagnoses: 23% at Stage III, 18% at Stage IV. Common sites of metastasis in B: liver 27%, lung 27%, locoregional lymph nodes 9%. In W pts: liver 24%, locoregional lymph nodes 24%, lung 10% and brain 5%. In H pts, 10 of 22(45%) were diagnosed without metastatic disease, though of the 10 who did, 2 had brain involvement. Mortality was highest in B pts at 55%, 33% for W, 20% for A and 18% for H pts. Conclusions: In our study, we note H pts being diagnosed at an earlier median age, at earlier stages of disease, with higher survival rates. Our B pts were diagnosed younger than W pts, at later stages of disease, with higher mortality rates. Brain involvement, which usually is rare, was seen in both H and W upon recurrence. Despite having a multi specialized cancer center, we note limitations in our access to screening resources and the availability of colorectal surgical expertise to enhance care for our underserved population. The challenge of disentangling disparities within RC will benefit from improved healthcare access and availability of multimodality resources in this disease state where cure is the ultimate goal.

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections.

Alcoholic hepatitis (AH) is a serious complication of alcohol consumption with high morbidity and mortality, particularly in the United States where alcohol-related liver diseases rank as one of the leading causes of preventable death. Our study aims to analyze the morbidity and mortality of AH across racial groups and project hospitalization trends up to 2028, thereby informing public health initiatives. We conducted a cross-sectional study utilizing data from the Nationwide Inpatient Sample (NIS) spanning 2012 to 2021. The study population comprised hospitalizations identified using specific ICD-9-CM and ICD-10-CM codes for AH. We assessed hospitalizations, in-hospital mortality rates, length of stay (LOS), and morbidities related to alcoholic hepatitis adjusting for sociodemographic factors and hospital characteristics. Statistical analyses were performed using Stata and R software, employing logistic and linear regression analyses, and SARIMA models for forecasting. Our results indicated a predominantly White cohort (68%), with a notable increase in AH hospitalizations among Hispanics (129.1% from 2012 to 2021). Racial disparities were observed in inpatient mortality, liver transplant accessibility, and the occurrence of in-hospital complications. The study forecasts a continued rise in hospitalizations across all racial groups, with Hispanics experiencing the sharpest increase. Our study reveals a disproportionate rise in the AH burden among Hispanics with projections indicating a persistent upward trend through 2028. These findings highlight the need for targeted public health strategies and improved healthcare access to mitigate the increasing AH burden and address disparities in care and outcomes.

Factors affecting quality of life in hepatitis B patients in Herat, Afghanistan: A case-control study.

Hepatitis B virus is a global health concern with a high death rate in Afghanistan. Limited data exist on the disease's impact on quality of life in low-resource settings. This case-control study aims to identify potential risk factors and assess the quality of life among hepatitis B patients in Herat, Afghanistan, with a focus on sex differences. Understanding these factors can inform prevention, care, and sex-specific interventions. A cross-sectional study conducted at Herat Regional Hospital examined hepatitis B patients above 18 years old, between October 2020 and February 2021. The control group consisted of age and sex-matched individuals without a history of hepatitis B. Data were collected through a structured questionnaire covering socio-demographic characteristics, signs and symptoms of hepatitis B, and the SF-36 questionnaire for measuring the quality of life of study participants. Statistical analysis was performed using multivariate General Linear Models, and logistic regression. We identified several potential risk factors for hepatitis B infection, including male sex, younger age groups, tobacco use, lower education levels, rural residence, family history, weak social networks, specific family structures and underlying chronic diseases (p < .05). The study found that hepatitis B cases had significantly lower mean scores across all SF-36 components, indicating an overall reduced quality of life (p < .05). These differences were more pronounced in males, although females had lower scores in most components. Role limitations due to physical and emotional health were particularly affected. These findings highlight the urgent need for targeted interventions, sex-specific strategies, improved healthcare access and comprehensive policies. These findings can inform prevention efforts to improve the overall quality of life of people with hepatitis B in Afghanistan.

The impact of the 2014 Medicaid expansion on the health, health care access, and financial well-being of low-income young adults.

Prior to the 2014 Affordable Care Act (ACA) expansion, 37% of young adults ages 19-25 in the United States were low-income and a third lacked health insurance coverage-both the highest rates for any age group in the population. The ACA's Medicaid eligibility expansion, therefore, would have been significantly beneficial to low-income young adults. This study evaluates the effect of the ACA Medicaid expansion on the health, health care access and utilization, and financial well-being of low-income young adults ages 19-25. Using 2010-2017 National Health Interview Survey data, I estimate policy effects by applying a difference-in-differences design leveraging the variation in state implementation of the expansion policy. I show that Medicaid expansion improved health insurance coverage, health care access, and financial well-being for low-income young adults in expansion states, but had no effect on their health status and health care utilization. I also find that the policy was associated with larger gains in health coverage for racial minorities relative to their Non-Hispanic White counterparts. With the continued health policy reform debates at the state and federal levels, the empirical evidence from this study can help inform policy decisions that aim to improve health care access and utilization among disadvantaged groups.

Unravelling the Hurdles of Health Services Research (HSR): Staff Perception at a Teaching Hospital

This research explores the challenges encountered by staff at King Abdulaziz University Hospital (KAUH) in conducting health services research (HSR). A descriptive-analytical approach was employed, utilizing a structured questionnaire adapted from Karimian et al. [1]. A total of 334 staff members from an array of careers at King Abdulaziz University Hospital (KAUH) were involved in this study, representing diverse professional backgrounds. Among the 188 respondents with prior research experience, the study found that 83.5% of 188 respondents with prior research experience had conducted health services research, with 79.8% encountering difficulties. 52.1% had applied research outcomes in their practice, which was seen as an instrumental aspect of HSR. Findings revealed that the major obstacles included; administrative issues such as limited integration of research outcomes into practice and unfair evaluations (78%), followed, respectively, by professional challenges such as job burden, financial challenges with funding and budgeting, facility-related issues like outdated research databases, and obstacles related to research skills. Additionally, the findings revealed a significant difference (P&lt;0.05), with academic staff facing fewer professional obstacles than non-academic staff, and Saudi researchers reporting more professional obstacles than non-Saudis. The findings emphasize the importance of addressing financial and facility-related obstacles to facilitate the practical utilization of HSR in health policy and community health services. Enhancing funding processes, clarifying budgeting regulations, and improving the research ecosystem are essential to overcoming these challenges and harnessing HSR's potential to improve healthcare access, quality, and cost-effectiveness.

A review of the challenges and opportunities in implementing health informatics in rural healthcare settings

This paper reviews the challenges and opportunities associated with implementing health informatics in rural healthcare settings. It examines the unique barriers rural communities face, such as infrastructure limitations, workforce shortages, and financial constraints, which can impede the adoption and utilization of health informatics solutions. However, it also explores the promising opportunities afforded by health informatics, including telemedicine, electronic health records (EHRs), and mobile health technologies, to overcome these challenges and improve healthcare access, quality, and efficiency in rural areas. By addressing these challenges and leveraging the opportunities presented by health informatics, stakeholders can work towards achieving equitable healthcare outcomes for rural populations. By addressing these challenges and leveraging the opportunities presented by health informatics, stakeholders can work towards achieving equitable healthcare outcomes for rural populations. Health informatics holds immense potential to revolutionize healthcare delivery, particularly in rural settings where access to quality care is often limited Health informatics holds immense potential to revolutionize healthcare delivery, particularly in rural settings where access to quality care is often limited. Health informatics holds immense potential to revolutionize healthcare delivery, particularly in rural settings where access to quality care is often limited. Telemedicine, for instance, enables remote consultations and diagnostic services, breaking down geographic barriers and providing rural patients with access to specialists and healthcare expertise they may not have locally. Electronic Health Records (EHRs) streamline administrative processes, improve care coordination, and enhance patient safety by ensuring that vital health information is readily accessible to healthcare providers regardless of location. Mobile health technologies, including smartp hone apps and wearable devices, empower rural residents to monitor their health, track chronic conditions, and engage in self-management activities from the comfort of their homes.By embracing these innovations and overcoming infrastructure challenges, stakeholders in rural healthcare can significantly improve healthcare access, quality, and efficiency. Additionally, leveraging health informatics can help address workforce shortages by enabling healthcare providers to deliver more effective and integrated care, even in remote areas. Ultimately, by harnessing the opportunities presented by health informatics while addressing the unique challenges of rural healthcare, stakeholders can work towards achieving equitable healthcare outcomes for rural populations. Keywords: Health Informatics, Rural Healthcare, Electronic Health Records (EHRS), Mobile Health, Challenges.

Influence of Procurement Process on Availability of Essential Drugs in Public Health Facilities in Mombasa County, Kenya

Purpose: Procurement process and practices are crucial components in the successful realization of universal healthcare and in particular the availability of essential drugs. Despite multifaceted efforts and inputs to promote the quality of the procurement process challenges still exists in the availability of essential drugs. This study aimed to establish the influence of procurement planning, supplier selection, procurement financing and needs assessment on availability of essential drugs in the public health facilities in Mombasa County, Kenya. This was a cross-sectional descriptive study design which targeted level 4 and 5 health facilities in Mombasa County. The study target population was 1216 health workers who included medical laboratory personnel, clinical officers and medical officers, nurses, pharmacists and pharmaceutical technologists. The study sample was 301. Methodology: Stratified sampling approach was used to distribute the sample among the cadre and random sampling method was used to select the respondents from each strata. Quantitative data was collected using a structured questionnaire. Findings: The study found that procurement planning, supplier selection, procurement, financing and needs assessment were significant factors in influencing the availability of essential drugs with P&lt;0.05. Unique Contribution to Theory, Policy and Practice: The study recommended that counties conduct a comprehensive and regular need assessment of essential drugs in public health facilities, that they develop a robust procurement planning strategy that aligns with the identified needs and available financing, that there should be a transparent and competitive supplier selection process, and to establish strategic partnerships with international organizations, non-governmental organizations, or donor agencies that are committed to improving healthcare access.

Charting the course: India’s health expenditure projections for 2035

ObjectivesUnderstanding past trends and forecasting future changes in health spending is vital for planning and reducing reliance on out-of-pocket (OOP) expenses. The current study analyzed health expenditure patterns in India and forecasted future trends and patterns until 2035. MethodsData on health expenditure in India from 2000 to 2019 was collected from the Organisation for Economic Co-operation and Development (OECD) iLibrary and National Health Accounts 2019 databases. Gross domestic product (GDP) data from the World Bank was also utilized. Descriptive statistics analyzed the composition and pattern, while the exponential smoothing model forecasted future health expenditures. ResultsThe findings revealed that expenditure made by OOP is the primary health financing source, followed by government and pre-paid private spending. The percentage of GDP allocated to total health expenditure remains stable, while the per capita health expenditure fluctuates. Variations in expenditure among states are observed, with Karnataka relying heavily on pre-paid private coverage. Future projections suggest a decline in per capita and total health expenditure as a share of GDP, with a slight increase in the government’s share. Pre-paid private expenditure per capita and OOP health expenditure as a share of the total is projected to remain relatively constant but still high in absolute terms. ConclusionThe study highlights variations in health spending in India, characterized by high OOP spending, limited public coverage, and a need for investments, and reforms to improve healthcare access and equity.

Working towards a paradigm shift in mental health: stakeholder perspectives on improving healthcare access for people with serious mental illnesses and chronic physical illnesses in Jamaica

The Jamaican public health system has incorporated mental health services into community-based primary care to improve healthcare access for people with serious mental illnesses (PWSMI), especially given global concerns about the high rate of comorbidity of chronic physical illnesses (CPI) among this population. Although it has been over twenty years since this strategy was implemented, there is a dearth of research into the views and experiences of stakeholders relating to this health system response. The current study sought to explore stakeholders’ perspectives and recommendations for improving the Jamaican public health system's response to healthcare access for PWSMI & CPI. A constructivist grounded theory approach was used to collect and analyse data from fifty-seven participants across six participant groups: health policymakers, primary care physicians, psychiatrists, mental health nurses, PWSMI & CPI and, their caregivers. The findings of the study identified one overarching category, “a paradigm shift in mental health” supported by six subthemes: (1) prioritise mental health, (2) reduce stigma and discrimination, (3) fill gaps in policies and practice, (4) address workforce issues, (5) improve health infrastructure and operations, and (6) respond to social needs. Findings highlighted a need for strategies that address social determinants of health inequalities such as stigma and discrimination as well as poverty to improve healthcare access. The paradigm shift in mental health will require greater financial and human resource investment in responding to these comorbid conditions and increased involvement of PWSMI and other stakeholders in strategies aimed at improving healthcare access and outcomes.

Perspectives on telehealth implementation in Australia: An exploratory qualitative study with practice managers and general practitioners

BackgroundThere is a lack of understanding regarding the impact of telehealth on clinical delivery and the feasibility of sustained implementation by health services. The COVID-19 pandemic provided an ideal opportunity to identify factors related to the implementation of telehealth. This study assessed factors that influenced telehealth implementation during COVID-19 in the Western region of Victoria, Australia, from the perspectives of practice managers and general practitioners (GPs). MethodsEmploying a qualitative approach, we conducted semi-structured interviews with 14 GPs and 11 practice managers across metropolitan and rural settings in the Western region of Victoria, Australia. Interviews were conducted between December 2021 to June 2022, which included periods during and beyond the peak of the COVID-19 pandemic. Themes were synthesised using the Consolidated Framework for Implementation Research, which comprised five domains: innovation, inner setting, outer setting, individuals and implementation process. An additional domain related to billing and finances was added. ResultsThe innovation domain revealed that telehealth was identified by both stakeholder groups as a critical tool for improving healthcare access for vulnerable patients. GPs highlighted the role of telehealth in follow-up care and the need for extended telephone consultation services. For the implementation process, both stakeholder groups identified a shift in attitudes among GPs from reluctance to acceptance of telehealth. In terms of outer setting, constant changes in regulations posed challenges to administrative staff. Practice managers faced difficulties in acquiring information on changes, but those with robust professional networks were well supported. Initial loss of incentive funding and government-imposed billing methods posed hurdles for clinics. Both stakeholder groups highlighted the need for education around videoconference and a standardised telehealth platform. ConclusionEvolving telehealth regulations during the emergence of COVID-19 posed financial, operational and administrative challenges to primary care clinics. To ensure sustainability, policymakers should improve stakeholder communication, set interoperability standards, and ensure sustainable funding for telehealth.

“She Resolved My Doubts, and I Was a Little Calmer”: A Qualitative Analysis of the HoPE Community-Based Doula Care Program in an Urban Public Hospital [ID 2683480

INTRODUCTION: Doula care, or trained lay birth support, represents an evidence-based and cost-effective strategy to improve maternal and child health. However, limited studies have focused on implementing doula care, especially in racial and ethnic minoritized communities. This study assessed HoPE (Helping Promote Birth Equity through Community-Based Doula Care), an intervention within two Queens, New York, public hospitals. METHODS: This qualitative analysis is part of a mixed-methods evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation science framework (IRB 21-01571). We conducted interviews in English or Spanish with HoPE doula clients (n=13), doulas (n=10), and health care providers (n=8) to assess acceptability, feasibility, and satisfaction. Interviews were audio-recorded, transcribed, and translated (if needed). Multiple coders analyzed themes and developed an analytical narrative. RESULTS: Preliminary findings suggest that HoPE serves a population in critical need of the support offered by community-based doulas. Regarding reach, doula clients were primarily immigrants and first-time mothers with limited social support and financial resources. We observed doula effectiveness in health care navigation, communication with providers, emotional, mental health, and physical support, infant care, health education, and referrals to social resources. Doula clients, doulas, and providers were generally satisfied with the program and found it acceptable and feasible. Implementation challenges, including language capability and timely client matching, hindered reach and effectiveness. CONCLUSION: These preliminary findings demonstrate how community-based doula support can improve health care access and quality of care in diverse, underserved communities. Ongoing evaluation will be used to improve HoPE and contribute to the knowledge of community-centered interventions promoting equity in obstetric care.

Colon and lung cancer classification from multi-modal images using resilient and efficient neural network architectures

Automatic classification of colon and lung cancer images is crucial for early detection and accurate diagnostics. However, there is room for improvement to enhance accuracy, ensuring better diagnostic precision. This study introduces two novel dense architectures (D1 and D2) and emphasizes their effectiveness in classifying colon and lung cancer from diverse images. It also highlights their resilience, efficiency, and superior performance across multiple datasets. These architectures were tested on various types of datasets, including NCT-CRC-HE-100K (set of 100,000 non-overlapping image patches from hematoxylin and eosin (H&E) stained histological images of human colorectal cancer (CRC) and normal tissue), CRC-VAL-HE-7K (set of 7180 image patches from N = 50 patients with colorectal adenocarcinoma, no overlap with patients in NCT-CRC-HE-100K), LC25000 (Lung and Colon Cancer Histopathological Image), and IQ-OTHNCCD (Iraq-Oncology Teaching Hospital/National Center for Cancer Diseases), showcasing their effectiveness in classifying colon and lung cancers from histopathological and Computed Tomography (CT) scan images. This underscores the multi-modal image classification capability of the proposed models. Moreover, the study addresses imbalanced datasets, particularly in CRC-VAL-HE-7K and IQ-OTHNCCD, with a specific focus on model resilience and robustness. To assess overall performance, the study conducted experiments in different scenarios. The D1 model achieved an impressive 99.80 % accuracy on the NCT-CRC-HE-100K dataset, with a Jaccard Index (J) of 0.8371, a Matthew's Correlation Coefficient (MCC) of 0.9073, a Cohen's Kappa (Kp) of 0.9057, and a Critical Success Index (CSI) of 0.8213. When subjected to 10-fold cross-validation on LC25000, the D1 model averaged (avg) 99.96 % accuracy (avg J, MCC, Kp, and CSI of 0.9993, 0.9987, 0.9853, and 0.9990), surpassing recent reported performances. Furthermore, the ensemble of D1 and D2 reached 93 % accuracy (J, MCC, Kp, and CSI of 0.7556, 0.8839, 0.8796, and 0.7140) on the IQ-OTHNCCD dataset, exceeding recent benchmarks and aligning with other reported results. Efficiency evaluations were conducted in various scenarios. For instance, training on only 10 % of LC25000 resulted in high accuracy rates of 99.19 % (J, MCC, Kp, and CSI of 0.9840, 0.9898, 0.9898, and 0.9837) (D1) and 99.30 % (J, MCC, Kp, and CSI of 0.9863, 0.9913, 0.9913, and 0.9861) (D2). In NCT-CRC-HE-100K, D2 achieved an impressive 99.53 % accuracy (J, MCC, Kp, and CSI of 0.9906, 0.9946, 0.9946, and 0.9906) with training on only 30 % of the dataset and testing on the remaining 70 %. When tested on CRC-VAL-HE-7K, D1 and D2 achieved 95 % accuracy (J, MCC, Kp, and CSI of 0.8845, 0.9455, 0.9452, and 0.8745) and 96 % accuracy (J, MCC, Kp, and CSI of 0.8926, 0.9504, 0.9503, and 0.8798), respectively, outperforming previously reported results and aligning closely with others. Lastly, training D2 on just 10 % of NCT-CRC-HE-100K and testing on CRC-VAL-HE-7K resulted in significant outperformance of InceptionV3, Xception, and DenseNet201 benchmarks, achieving an accuracy rate of 82.98 % (J, MCC, Kp, and CSI of 0.7227, 0.8095, 0.8081, and 0.6671). Finally, using explainable AI algorithms such as Grad-CAM, Grad-CAM++, Score-CAM, and Faster Score-CAM, along with their emphasized versions, we visualized the features from the last layer of DenseNet201 for histopathological as well as CT-scan image samples. The proposed dense models, with their multi-modality, robustness, and efficiency in cancer image classification, hold the promise of significant advancements in medical diagnostics. They have the potential to revolutionize early cancer detection and improve healthcare accessibility worldwide.

Empowering Expecting Women to Obtain High-Quality Healthcare in Pakistan: An Evaluation of Khyber Pakhtunkhwa's Conditional Cash Transfer Program.

Maternal mortality, largely stemming from complications during pregnancy and childbirth, impacts poor expecting women with limited healthcare access in rural Pakistan. Conditional Cash Transfers (CCTs), commonly implemented in developing nations, are designed to improve the well-being of vulnerable populations by focusing on health and education. A CCT initiative named Chief Minister's Special Initiative for Mother and Child Health (CM-SIMCH) was launched in Khyber Pakhtunkhwa (KP), one of the less-developed provinces of Pakistan, to empower expecting women to access quality healthcare. This study investigates the factors influencing CM-SIMCH program participation and assesses its impact on the health of expecting women by analyzing health-seeking hospital visits in KP, Pakistan. The study utilizes the Propensity Score Matching (PSM) technique to analyze cross-sectional data obtained from 303 expecting women residing in the Nowshera district of KP. The PSM allows for a balanced comparison of participants who received the CM-SIMCH transfers with those who did not, assessing its impact on maternal healthcare access and outcomes. Empirical results show that factors such as education and family system positively influence the participation of expecting women in the CM-SIMCH program, whereas travel costs exert a negative effect. The intervention leads to a notable increase in hospital visits among these women, contributing to improved health outcomes in KP. This underscores the program's potential effectiveness in addressing maternal healthcare challenges and enhancing healthcare access for vulnerable women in less-developed areas. Therefore, empirical evidence supports the CM-SIMCH program's potential to promote maternal health and improve healthcare access in KP. The study recommends government intervention in health sector as a strategic imperative to empower women and enhance infant health.

Delays in presentation, diagnosis, and treatment in Sudanese women with breast cancer: a cross-sectional study.

The poor prognosis of breast cancer in Sudan could be due to delayed treatment and diagnosis at an advanced stage. Our study aimed to assess the extent of delays from onset of symptoms to treatment in Sudanese women with breast cancer, as well as identify factors contributing to these delays. We conducted a multi-center cross sectional study between March and April 2023. Data were collected from the medical records and interviews with women with breast cancer in the two main oncology centers in Sudan. Linear regression was used to identify the predictors of delayed presentation. We interviewed 601 women with breast cancer. The majority of women (50.1%) were diagnosed at locally advanced or metastatic disease. The median interval from the onset of symptoms to receiving oncologic treatment was 221 days (IQR = 92, 496). The longest delay was the presentation delay 61 (31 244) days. The median duration for diagnosis delay and treatment delay was 21 (10.57) days and 27 (10.64) days, respectively. Predictors of early presentation included, being young (β = -5.3; 95% CI = 0.06 to 10), married (β = -264; 95% CI = -427 to -101), divorced (β = -306; 95% CI = -549 to -63), or widowed (β = -320; 95% CI = --543 to -97), urban residence (β = -107; 95% CI = -213 to -2.3), and seeking traditional healer (β = -204; 95% CI = -383 to -26). Most Sudanese women with breast cancer experience significant patient delays, often presenting at advanced stages. Factors like being single, older, and living in rural areas contribute to these delays. Increasing breast cancer education, improving healthcare access and addressing sociodemographic barriers can potentially expedite diagnosis and improve outcomes.

Unveiling the Complex Facets of Poverty: Unidimensional and Multidimensional Insights from Rural Areas of Suri Sadar Sub-Division, Birbhum District, Eastern India

Poverty, particularly in developing regions, is a complex, multifaceted issue deeply embedded in various interrelated factors. It extends beyond mere financial insufficiency, encompassing limited access to essential services such as healthcare, education, and overall living standards. This study examines both the unidimensional and multidimensional aspects of rural poverty in Suri Sadar Sub-Division, located in Eastern India. For the unidimensional aspect, this study employs the poverty headcount ratio and the Poverty Gap Index to gauge the incidence and intensity of poverty. In contrast, the multidimensional approach utilized three dimensions and 12 indicators to assess the incidence, severity, and multidimensional poverty index utilizing the Alkire–Foster (AF) methodology. The unidimensional analysis, focusing on income and consumption, highlights significant economic disparities, particularly in the western Community Development Blocks, namely, Khoyrasole, Md. Bazar, and Rajnagar. The highest levels of multidimensional poverty are generally consistent with the unidimensional findings, particularly in the western blocks. These results underscore the need for comprehensive poverty reduction strategies that address both economic and broader aspects of poverty. In areas like the western blocks, where both income-based and multidimensional poverty rates are high, strategies should integrate economic development, improved healthcare access, enhanced educational quality, and living standards improvement. Therefore, this study serves not only as an academic endeavor but also as a vital tool for informed policymaking in poverty alleviation, providing planners, administrative officials, and researchers with essential insights to develop effective, localized, and sustainable poverty reduction strategies.

Rural and urban differences in the prevalence and determinants of Type-2 diabetes in Bangladesh.

To estimate the prevalence of Type 2 Diabetes (T2D) in urban and rural settings and identify the specific risk factors for each location. We conducted this study using data from the 2017-18 Bangladesh Demographic and Health Survey (BDHS), sourced from the DHS website. The survey employed a stratified two-stage sampling method, which included 7,658 women and 7,048 men aged 18 and older who had their blood glucose levels measured. We utilized chi-square tests and ordinal logistic regression to analyze the association between various selected variables in both urban and rural settings and their relationship with diabetes and prediabetes. The prevalence of T2D was 10.8% in urban areas and 7.4% in rural areas, while pre-diabetes affected 31.4% and 27% of the populations in these respective settings. The study found significant factors influencing diabetes in both urban and rural regions, particularly in the 55-64 age group (Urban: AOR = 1.88, 95% CI [1.46, 2.42]; Rural: AOR = 1.87, 95% CI [1.54, 2.27]). Highly educated individuals had lower odds of T2D, while wealthier and overweight participants had higher odds in both areas. In rural regions, T2D risk was higher among caffeinated drink consumers and those not engaged in occupation-related physical activity, while these factors did not show significant influence in urban areas. Furthermore, urban participants displayed a significant association between T2D and hypertension. Our study outlines a comprehensive strategy to combat the increasing prevalence of T2D in both urban and rural areas. It includes promoting healthier diets to control BMI level, encouraging regular physical activity, early detection through health check-ups, tailored awareness campaigns, improving healthcare access in rural regions, stress management in urban areas, community involvement, healthcare professional training, policy advocacy like sugary drink taxation, research, and monitoring interventions. These measures collectively address the T2D challenge while accommodating the distinct features of urban and rural settings.

Socioeconomic Determinants of Maternal and Child Healthcare Utilization and Infant Survival: A Case Study of Kijumo Village, Uganda

This study examines the socioeconomic determinants of maternal and child healthcare utilization and its impact on infant survival in Kijumo Village, Uganda. Through a survey of 70 mothers, data was collected on demographic characteristics, healthcare service utilization, and infant survival. Regression analyses were conducted to explore the relationship between socioeconomic factors, healthcare utilization, and infant survival. Results indicate a significant association between maternal education, household wealth, and infant survival. Moreover, healthcare service utilization was influenced by factors such as distance to healthcare centers and economic constraints. The findings underscore the need for targeted interventions to improve healthcare access and utilization in underserved communities like Kijumo Village. Keywords: Maternal and child healthcare, healthcare utilization, socioeconomic determinants and infant survival.

Area-based disparities in non-small-cell lung cancer survival.

In the Nordic countries, universal healthcare access has been effective in reducing socioeconomic disparities in non-small-cell lung cancer (NSCLC) management. However, other factors, such as proximity to healthcare facilities, may still affect access to care. This study aimed at investigating the influence of residential area on NSCLC survival. This population-based study utilized hospital records to identify NSCLC patients who underwent their initial treatment at Vaasa Central Hospital between January 1, 2016, and December 31, 2020. Patients were categorized based on their postal codes into urban areas (≤50 km from the hospital) and rural areas (>50 km from the hospital). Survival rates between these two groups were compared using Cox regression analysis. A total of 321 patients were included in the study. Patients residing in rural areas (n = 104) exhibited poorer 12-month survival rates compared to their urban counterparts (n = 217) (unadjusted Hazard Ratio [HR]: 1.38; 95% Confidence Interval [CI]: 1.01-1.89; p = 0.042). After adjusting for factors such as performance status, frailty, and stage at diagnosis in a multivariate Cox regression model, the adjusted HR increased to 1.47 (95% CI: 1.07-2.01; p = 0.017) for patients living in rural areas compared to those in urban areas. The study findings indicate that the distance to the hospital is associated with increased lung cancer mortality. This suggests that geographical proximity may play a crucial role in the disparities observed in NSCLC survival rates. Addressing these disparities should involve strategies aimed at improving healthcare accessibility, particularly for patients residing in rural areas, to enhance NSCLC outcomes and reduce mortality.

AI Enabled MED Drone for Healthcare Application

The project proposes the development of an AI-enabled MedDrone for medication delivery, introducing an innovative and efficient solution to enhance healthcare logistics. The MedDrone, equipped with artificial intelligence capabilities, aims to revolutionize the process of medication delivery by leveraging autonomous aerial technology. The system integrates advanced algorithms to optimize route planning, ensuring timely and accurate delivery of medications to designated locations. The AI component enables the drone to adapt to real-time variables such as weather conditions and traffic, enhancing the reliability and responsiveness of the delivery process. This project addresses the challenges of traditional medication distribution, offering a futuristic and intelligent approach to healthcare logistics through the deployment of AI-enabled autonomous drones for efficient and timely medication delivery. The proposed system integrates AI algorithms for real-time route optimization, obstacle avoidance, and decision-making, enabling the drone to autonomously navigate complex environments and deliver essential medical supplies such as first aid kits, defibrillators, and medications to the point of need. Through the utilization of machine learning techniques, the drone continuously learns from its interactions with the environment, enhancing its adaptability and performance over time. Additionally, the system incorporates advanced communication technologies to enable seamless coordination with emergency responders and healthcare professionals, ensuring timely delivery and proper utilization of resources. The efficacy of the proposed AI-based medical drone system is demonstrated through simulations and real-world trials, highlighting its potential to revolutionize emergency response efforts and improve healthcare accessibility, particularly in challenging or resource-constrained environments.