Improve Access To Health Care Research Articles

Effect of a Comprehensive School-Based Health Center on Academic Growth in K-8th Grade Students

ObjectiveSchool-based health centers (SBHCs) improve health care access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over 4 school years versus nonenrolled students. We also explored changes in absenteeism. MethodsParticipants were students enrolled in 2 co-located Title I schools from 2015–19 (1 elementary, 1 middle, n = 2480). Analysis of math and reading was limited to students with baseline and postbaseline scores (math n = 1622; reading n = 1607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pretrends. ResultsMore than 70% of SBHC-enrolled students had math (1194 [73.6%]) and reading 1186 [73.8%]) scores. Enrollees were more likely than nonenrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded nonenrollees by 3.5 points (95% confidence interval [CI]: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (incident rate ratio 0.772 [95% CI: 0.623, 0.956]) than nonenrollees (incident rate ratio 0.865 [95% CI: 0.696, 1.076]). ConclusionsSBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than nonenrollees.

Doctor Appointment System

Abstract: In today's fast-paced world, efficient healthcare services are essential for maintaining the well-being of individuals. This abstract introduces a Doctor Appointment Booking System, designed to streamline the process of scheduling medical appointments. This system leverages technology to improve healthcare access, reduce patient waiting times, and enhance overall patient experience. The Doctor Appointment Booking System incorporates user-friendly web and mobile applications, allowing patients to conveniently browse through a list of available doctors, view their profiles, and select suitable appointment slots. It also provides a user-friendly interface for healthcare providers to manage their schedules and update their availability in real-time. Additionally, it features an integrated notification system to send appointment reminders, thus reducing no-show rates and ensuring optimal resource utilization. Furthermore, this system offers secure and confidential storage of patient data, ensuring compliance with relevant healthcare regulations, such as HIPAA. Data analytics capabilities enable the generation of valuable insights for both healthcare providers and administrators to improve resource allocation and optimize the patient experience

INVEST IN WOMEN

Investing in women can accelerate progress across various sectors, including economic growth, education, healthcare, political participation, technology, and gender equality. Supporting women entrepreneurs stimulates job creation and innovation, while investing in girls' education leads to long-term societal benefits. Improved healthcare access for women enhances maternal and child health outcomes, and promoting women's involvement in politics fosters inclusive decision-making. In STEM fields, investing in women drives innovation, and initiatives for gender equality address issues like discrimination and violence. Ultimately, investing in women is not only a matter of social justice but also a strategic investment for economic and social advancement

The clinical use of remote parameter testing during cardiac implantable electronic devices implantation procedures: a single center, randomized, open-label, non-inferiority trial.

A novel non-contact system for remote parameter testing and reprogramming offers an alternative method for assessing device parameters during cardiac implantable electronic devices (CIEDs) implantation without the need for physical contact with the manufacturer's clinical service technician. The safety and feasibility of using this system in CIEDs implantation procedures remains to be determined. Evaluate the safety and feasibility of remote parameter testing in CIEDs implantation procedures. A single center, randomized, open-label, non-inferiority trial (ChiCTR2200057587) was conducted to compare the two approaches for interrogating CIEDs during implantation procedures: routine interrogation performed by on-site technicians or remote interrogation performed by technicians using the 5G-Cloud Technology Platform. Patients aged ≥18 years and elected to receive CIEDs were eligible for inclusion. The primary endpoint was the completion rate of the parameter test. Safety and efficiency were evaluated in all randomly assigned participants. A total of 480 patients were finally enrolled and were randomly assigned to routine group (n = 240) or remote group (n = 240). The primary endpoint was achieved by 100% in both groups (P = 0.0060 for noninferiority). The parameters of sensing, threshold, and impedance regarding the right atrium, right ventricle, and left ventricle had no statistical significance between the two groups (P > 0.05). Procedure time, parameter testing time, and both duration and dose of x-ray irradiation were not significantly different between the two groups (P > 0.05). Shut-open door frequency was significantly higher in the routine group than the remote group [6.00 (4.00, 8.00) vs. 0, P < 0.0001]. Notably, no clinical or technical complications were observed in the remote group. Remote parameter testing is safe and feasible across various devices implantation procedures. The utilization of remote parameter testing and reprogramming could represent an innovative approach to improve healthcare accessibility and unlock the full potential of secondary centers in managing CIEDs. ChiCTR2200057587.

Dissecting Alzheimer's Disease Risk in Asian American Elders: A Classification and Regression Tree Approach.

Alzheimer's disease (AD) poses a growing public health challenge, particularly with an aging population. While extensive research has explored the relationships between AD, socio-demographic factors, and cardiovascular risk factors, a notable gap exists in understanding these connections within the Asian American elderly population. This study aims to address this gap by employing the Classification and Regression Tree (CART) approach to investigate the intricate interplay of socio-demographic variables, cardiovascular risk factors, sleep patterns, prior antidepressant use, and AD among Asian American elders. Data from the 2017 Uniform Data Set, provided by the National Alzheimer's Coordinating Center, were analyzed, focusing on a sample of Asian American elders (n = 4,343). The analysis utilized the Classification and Regression Tree (CART) approach. CART analysis identified critical factors, including levels of independence, specific age thresholds (73.5 and 84.5 years), apnea, antidepressant use, and body mass index, as significantly associated with AD risk. These findings have far-reaching implications for future research, particularly in examining the roles of gender, cultural nuances, socio-demographic factors, and cardiovascular risk elements in AD within the Asian American elderly population. Such insights can inform tailored interventions, improved healthcare access, and culturally sensitive policies to address the complex challenges posed by AD in this community.

Acceptability and Satisfaction of Patients and Providers With Telemedicine During the COVID-19 Pandemic: A Systematic Review.

COVID-19, also known as coronavirus disease 2019, is an extremely contagious viral sicknesscaused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After the first cases of this primarily respiratory viral illness were recorded in Wuhan, Hubei Province, China, in late December 2019, SARS-CoV-2 rapidly disseminated across the globe. Consequently, on March 11, 2020, the World Health Organization (WHO) declared it a global pandemic. The rapid spread of the COVID-19 virus, coupled with subsequent lockdowns and social distancing measures, profoundly disrupted traditional healthcare delivery systems. Amidst the COVID-19 pandemic, telemedicine emerged as a pivotal solution for delivering healthcare services while minimizing exposure to the virus. This study aims to assess patient and provider satisfaction with telemedicine during this unprecedented period. A systematic literature search was conducted on PubMed and Google Scholar using specific MeSH terms and Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) guidelines to summarize patient and provider satisfaction concerning telemedicine using all the facts, evidence, and published literature. The analysis showed that although providers were generally satisfied with telemedicine, they were less satisfied than patients due to technical issues and difficulties transmitting documents. Patients reported high satisfaction with telemedicine, citing convenience and cost savings as major benefits. However, a lack of provider compensation was identified as a potential barrier to adoption. Most providers believed that telemedicine was only necessary in emergencieswhile a few recognized its potential for routine care. The study concludes that telemedicine has the potential to improve healthcare access and efficiency, but more research is needed to address technical and reimbursement issues and to determine the appropriate scope of telemedicine use. Overall, the findings of this study can inform future healthcare policies and regulations to ensure that telemedicine is used effectively and to the satisfaction of both patients and providers.

Black Alaskans Health Needs Assessment during COVID-19 Pandemic: Implications for Social Work.

At the peak of the COVID-19 pandemic it became clear that Black people were experiencing more severe symptoms and had higher rates of mortality from COVID-19 than White people. However, data on racial differences in death and hospitalization rates in Alaska were less clear. To address this, the Alaska Black Caucus initiated the first Black Alaskans health needs assessment to understand the health status, needs, and resources of the Black community of Alaska. This article reports on the design, implementation, and descriptive results from the survey portion of the first community health needs assessment of Black Alaskans. The findings indicate that a majority of Black Alaskans report being moderately healthy, having access to health insurance, owning their homes, and having a favorable view of their neighborhood. However, too many are unable to work due to poor physical or mental health challenges and are diagnosed with one or more chronic health diseases. In addition, Black Alaskans experience high rates of substance abuse, have untreated mental health conditions, consume tobacco products at a high rate, and are not screening for some cancers. The article will conclude by presenting additional strategies for improving healthcare access and responsiveness for Black Alaskans.

A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility.

Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.

Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia.

Scholars worldwide have defined the COVID-19 pandemic as a mass-disabling event of our time. The situation is grave for families experiencing financial hurdles while caring for young adults in recovery from addiction problems. Using semi-structured interviews with 30 purposively selected family caregivers (FCGs) of young adults with substance use disorders (SUDs) in Lusaka, Zambia, this study reveals several factors influencing forgone healthcare for this medically vulnerable group. Financial challenges and huge out-of-pocket bills; caregivers' perceived far-fetched recovery of the young adult; the cost of medication and transportation; the young adult's little perceived need for healthcare service use, their runaway and treatment elusive tendencies; caregiver concerns about contracting the virus, and the stigma associated with it; and a fragmented child and adolescent mental health system influenced forgone healthcare. The young adults were often unavailable for days and months, posing challenges to the continuity of care. Despite caregivers' acknowledgment of the availability of healthcare professionals, young adults with problematic substance use had limited access to SUD recovery services, resulting in adverse health outcomes. Results also show that most family caregivers encountered challenges in accessing and purchasing psychotropic medications, which were difficult to find during the lockdowns. Some family caregivers lost their sources of income by being laid off from work due to the pandemic and skipping work to attend to caregiving responsibilities. Most of those in self-employment had to close their business and stay home to look after their youth. Several caregivers kept their youth at home because they failed to access private residential SUD recovery services. Family caregivers mostly relied on outpatient public health services, alternative medicine from traditional healers, and faith-based healing, all of which some young adults rarely accessed because of their problematic behaviors of escaping healthcare. These identifiable risk factors, and their detrimental consequences highlight the need for interventions to improve healthcare access for this vulnerable population. Supporting FCGs of addicted young adults is crucial in ensuring the well-being of both the caregivers and care recipients. Further research is warranted to explore potential solutions, such as peer support programs, policy changes, and education initiatives for carers and recipients in the (post) pandemic era.

Co-located Heroin Assisted Treatment within primary care: A preliminary analysis of the implications for healthcare access, cost, and treatment delivery in the UK

BackgroundThe UK is experiencing its highest rate of drug related deaths in 25 years. Poor and inconsistent access to healthcare negatively impacts health outcomes for people who use drugs. Innovation in models of care which promote access and availability of physical treatment is fundamental. Heroin Assisted Treatment (HAT) is a treatment modality targeted at the most marginalised people who use drugs, at high risk of mortality and morbidity. The first service-provider initiated HAT service in the UK ran between October 2019 and November 2022 in Middlesbrough, England. The service was co-located within a specialist primary care facility offering acute healthcare treatment alongside injectable diamorphine. MethodsAnalysis of anonymised health records for healthcare costs (not including drug treatment) took place using descriptive statistics prior and during engagement with HAT, at both three (n=15) and six (n=12) months. Primary outcome measures were incidents of wound care, skin and soft tissue infections (SSTIs), overdose (OD) events, unplanned overnight stays in hospital, treatment engagement (general and within hospital care settings) and ambulance incidents. Secondary outcome measures were costs associated with these events. ResultsA shift in healthcare access for participants during HAT engagement was observed. HAT service attendance appeared to support health promoting preventative care, and reduce reactive reliance on emergency healthcare systems. At three and six months, engagement for preventative wound care and treatment for SSTIs increased at the practice. Unplanned emergency healthcare interactions for ODs, overnight hospital stays, serious SSTIs, and ambulance incidents reduced, and there was an increase in treatment engagement (i.e. a reduction in appointments which were not engaged with). There was a decrease in treatment engagement in hospital settings. Changes in healthcare utilisation during HAT translated to a reduction in healthcare costs of 58% within six months compared to the same timeframe from the period directly prior to commencing HAT. ConclusionThis exploratory study highlights the potential for innovative harm reduction interventions such as HAT, co-located with primary care services, to improve healthcare access and engagement for a high-risk population. Increased uptake of primary healthcare services translated to reductions in emergency healthcare use and associated costs. Although costs of HAT provision are substantial, the notable cost-savings in health care should be an important consideration in service implementation planning.

Advocacy in gender affirming care.

Healthcare advocacy is the duty and privilege of all healthcare providers, but especially for those who care for children. Intersex and gender diverse youth face significant barriers across many aspects of life, with access to competent gender affirming healthcare chief among them. Understanding the importance of both institutional and individual efforts in healthcare advocacy is paramount to improving healthcare access and outcomes for this population.

AI-Powered Online Symptom Checkers: Enhancing Accuracy and Guiding Users to Appropriate Medical Care

Online symptom checkers have emerged as valuable tools for individuals seeking health advice and guidance. Powered by artificial intelligence (AI) algorithms, these symptom checkers aim to provide more accurate and personalized health assessments, directing users to the appropriate level of medical care. This study presents an innovative architecture that combines Vector Database (VDB), Faiss similarity search algorithm, and GPT (Generative Pre-trained Transformer) API to analyze user inputs, identify intents, and generate tailored responses. The proposed system leverages the power of VDB to store symptom and test data as embeddings, enabling efficient similarity searches. The GPT model is employed to analyze user inputs, determining whether the user is seeking symptom analysis, test suggestions, booking details, booking help, or general health queries. Based on the identified intent, the Faiss algorithm searches for relevant tests and returns appropriate recommendations. The GPT model then generates personalized responses by considering the user's input, suggested tests, intent, and a summary of the chat history. The chatbot also incorporates a memory mechanism to store conversation summaries, providing context for subsequent interactions. Experimental results demonstrate the effectiveness of the proposed architecture in delivering accurate and context-aware health advice, guiding users to the most suitable medical care options. This study highlights the potential of AI-powered online symptom checkers in improving healthcare accessibility, reducing unnecessary medical visits, and empowering individuals to make informed decisions about their health.

Role of Community Based Organizations (CBOs) in Providing Health Care Services: A Case Study of Baloch Women Domestic Workers

This qualitative study delves into the complex dynamics of healthcare community-based organizations (CBOs) supporting Baloch women domestic workers in Garden West, Karachi City. The research aims to assess CBOs' efficiency in improving healthcare access, identify challenges these organizations face, evaluate their impact on Baloch women's health outcomes, and understand women's perceptions of CBO services. Semi-structured interviews were conducted with CBO heads, healthcare workers, and Baloch women domestic workers. Thematic analysis of the data reveals economic challenges faced by Baloch women, barriers to healthcare access, and the crucial role CBOs play in addressing these issues. Findings further advocate for dismantling barriers, fostering inclusivity, and amplifying voices often overlooked. The study advocates for tailored interventions to address economic and healthcare challenges, emphasizing the importance of context-specific solutions for sustainable community well-being.

Intersectional Model of Service Use: Understanding Transgender and Nonbinary Healthcare Access

Transgender and nonbinary (TNB) people often have difficulty accessing healthcare services because of the systemic forces of transphobia and cisgenderism. Despite this, there is little theory specifically designed to examine healthcare access among TNB people. We conducted a literature review to identify studies examining TNB healthcare access. We screened a total of 2,050 unique articles for inclusion, resulting in a final sample of 46 articles that met the review criteria. Theories used and key findings were coded to inform the development of the Intersectional Model of Service Use (IMSU) for TNB people. The IMSU builds upon current theoretical frameworks including the Behavioral Model for Vulnerable Populations (BMVP), which proposes that predisposing, enabling, and need factors drive healthcare utilization among vulnerable populations. The IMSU combines the predisposing, enabling, and need factors of the BMVP with TNB-specific healthcare access factors identified through this integrative review. The findings from this review suggest its effectiveness in informing research and interventions aimed at improving healthcare access among TNB people.

Frailty Syndrome in Rural Communities: A Narrative Review and Interviews With Rural Individuals.

Background With the global increase in aging populations, frailty syndrome, characterized by decreased strength, endurance, and physiological function, has become a critical issue. This study focuses on rural Japanese communities, where the prevalence of frailty syndrome can be notably high due to factors such as multimorbidity, polypharmacy, and a significant population of elderly individuals. This research addresses the gap in understanding frailty's manifestations and impacts in rural settings, considering unique challenges such as social isolation, limited healthcare access, and the broader social determinants of health. Methodology The study employs a narrative review with PubMed and a thematic analysis of semi-structured interviews with 21 elderly community workers in Unnan City. The analysis used the framework of frailty syndrome affected by physiological, social, psychological, and economic factors. The analysis focused on identifying themes related to the social determinants of health affecting frailty and potential solutions. Results The following five themes emerged from the analysis: Aging, Rural Contexts, Isolation, Lack of Knowledge of Frailty Syndrome, and Lack of Help-Seeking Behavior for Frailty Syndrome. Four solution-oriented themes were identified, namely, Public Dialogue and Educational Workshops, Frailty Syndrome Health Meetings, Social Engagement Activities, and Political Advocacy for Accessibility to Community Centers. These findings highlight the critical role of community engagement, education, and infrastructure improvements in addressing frailty syndrome in rural areas. Conclusions This study underscores the complexity of frailty syndrome in rural Japanese communities, emphasizing the need for targeted interventions that address the unique challenges faced by these populations. By fostering public dialogue, improving healthcare access, and enhancing social support, it is possible to mitigate the impacts of frailty syndrome and improve the quality of life for elderly residents in rural settings. This research contributes to a deeper understanding of frailty in aging societies and the importance of considering social determinants of health in developing effective solutions.

Enhancing Performance of Health Assistants through Technical and Vocational Education and Training for Better Healthcare Access

This is a review article exploring critical role of Technical and Vocational Education and Training (TVET) programs in advancing capacities of health assistants and consequently strengthening healthcare access to the rural population in Nepal. The review was planned in the wake of the existing literatures on the study area that lacks a comprehensive examination to explores the role of health assistants in Nepal's healthcare delivery and assess the importance of TVET on their performance. A methodical literature search was conducted using various electronic databases like Google scholar and PubMed applying specific keywords, such as “Health Assistant", "Health Care Access", "Technical Education", "Vocational Education and Training”. It encompassed the studies published in the English language without limiting publication date, while the involved two authors independently evaluated the published articles' eligibility. These authors also carried out data extraction, culminating in a narrative summary of the findings. Of the total 37 literatures, most of them reported health assistant trained through TVET, play a vital role in improvement of healthcare access, thereby addressing the challenges. They bridge gaps in medical access, provide essential care, and promote community well-being, particularly in the underserved areas. TVET programs enhance skills through practical experiences and comprehensive training, resulting into significant improvement in healthcare access, especially in rural regions. Integrating innovative teaching methods and collaborations further enhances health assistant preparedness. Challenges, such as funding limitations and rural-urban divides persist, but opportunities exist in e-learning initiatives, partnerships, and professional development to improve health assistant education. Improving healthcare in Nepal by inculcating better skills to health assistants can address many healthcare problems.

Does Medicare Insurance Mitigate Racial/Ethnic Disparities in Access to Lumbar Spinal Surgery When Compared to Commercial Insurance?

Retrospective cohort study. Compare disparities in lumbar surgical care utilization in Commercially insured versus Medicare patients. While disparities in spinal surgery have been previously described, less evidence exists on effective strategies to mitigate them. Theoretically, universal health care coverage under Medicare should improve health care access. Utilizing National Inpatient Sample data (2003-2018), we included inpatient lumbar discectomy or laminectomy/fusion cases in black, white, or Hispanic patients aged 18-74 years, with Commercial or Medicare insurance. A multivariable Poisson distribution model determined race/ethnicity subgroup-specific rate ratios (RRs) of patients undergoing lumbar surgery compared to their respective population distribution (using US Census data) based on race/ethnicity, region, gender, primary payor, and age (Commercially insured age subgroups: 18-39, 40-54, and 55-64y; Medicare age subgroup: 65-74y). Of the 2,310,956 lumbar spine procedures included, 88.9%, 6.1%, and 5.0% represented white, black, and Hispanic patients, respectively. Among Commercially insured patients, black and Hispanic (compared to white) patients had lower rates of surgical care utilization; however, these disparities decreased with increasing age: black (RR=0.37, 95% CI: 0.37-0.38) and Hispanic patients (RR=0.53, 95% CI: 0.52-0.54) aged 18-39 years versus black (RR=0.72, 95% CI: 0.71-0.73) and Hispanic patients (RR=0.64, 95% CI: 0.63-0.65) aged 55-64 years. Racial/ethnic disparities persisted in Medicare patients, especially when compared to the neighboring age subgroup that was Commercially insured: black (RR=0.61, 95% CI: 0.60-0.62) and Hispanic patients (RR=0.61, 95% CI: 0.60-0.61) under Medicare. Disparities in surgical care utilization among black and Hispanic patients persist regardless of health care coverage, and an expansion of Medicare eligibility alone may not comprehensively address health care disparities. Level III.

Patient Satisfaction with the Implementation of Telehealth in Ambulatory Care during the COVID-19 Pandemic: A Single Institution Experience.

COVID-19 has reduced the capacity for delivering essential health services due to lockdown restrictions. Telehealth is an effective alternative option to improve healthcare access. However, there remain implementation challenges to patient adoption in resource-limited settings such as Ethiopia. Therefore, the purpose of this study was to assess patient satisfaction following the implementation of telehealth in ambulatory settings during the COVID-19 pandemic. A cross-sectional study was conducted at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia. Patients who used the telehealth service were invited to participate in a patient satisfaction survey. All statistical analyses were performed using STATA Version 14.1. A total of 149 patients have participated in the survey. Out of the total participants, 129 (86.6%) found that telehealth is easy to understand and overall satisfaction for telehealth was 87.9%. About two-thirds of the patients (97, 65.1%) reported that the telehealth visit is just as good as a traditional visit. The vast majority of participants (148, 98.6%) stated that they would definitely or probably use telehealth again and would recommend it to others. The majority of respondents (137, 91.9%) followed the recommendations provided. Patients have a high level of satisfaction with the use of telehealth during the COVID-19 pandemic. About two-thirds of patients said the telehealth visit was just as good as a traditional visit. The majority of patients followed the recommendations given to them by the healthcare providers and stated that they would definitely or probably use telehealth in the future and would recommend it to others. This high level of patient satisfaction with telehealth implementation suggests that the service could be considered in low-income countries as well.

The challenges in rebuilding a quality public health in Brazil

In recent years, Brazil has grappled with a denialist approach to its healthcare system, the Unified Health System (SUS), especially during the COVID-19 pandemic. Influential figures, including public personalities, have cast doubt on science, leading to widespread uncertainty. Despite the challenges, Brazil boasts a strong National Immunization Plan (PNI) that has served as a global reference. The country faces the demographic transition, with an aging population requiring healthcare adaptation. Addressing chronic diseases becomes paramount, as does managing the economic implications of an older workforce supporting retirees. Inequalities in access to quality public healthcare persist due to socioeconomic disparities, a divided healthcare system, geographic disparities, ethnic and racial inequalities, education and cultural factors, and long wait times in the public healthcare system. Environmental issues, like deforestation, wildfires, climate change, water pollution, pesticide use, industrial pollution, and food security, impact public health. Sustainable policies and awareness are crucial. Health research in Brazil thrives in universities, institutions, and through international collaboration. Clinical research, epidemiology, public health research, and tropical medicine research are prevalent, but funding challenges and research misconduct persist. Combating infodemia and fake news is essential to ensure that public health decisions are based on reliable information. Fact-checking organizations, healthcare professionals, and education play a vital role. Expanding vaccination coverage is critical to protect against infectious diseases. Brazil employs campaigns, vaccination centers, home visits, school vaccination, partnerships, effective communication, vaccination records, education, and prioritizing high-risk groups. Strengthening the First Level of Health Care through the Family Health Strategy, coverage expansion, professional qualification, electronic health records, prevention programs, management strategies, specialized care, service integration, and community participation can improve healthcare access and coordination. Health education in Brazil focuses on health promotion, disease prevention, child and family health, sexual education, community engagement, school education, information accessibility, and trust in public health policies. The growth of health technology in Brazil can enhance care quality, access, resource management, disease prevention, cost savings, and innovation. However, ethical considerations, equitable access, and data privacy are vital. A democratic environment in public health promotes community participation, accountability, equity, evidence-based decision-making, individual and collective rights, anti-corruption efforts, conflict resolution, and long-term policy planning. SUS funding faces challenges of insufficient resources, budget predictability, dependence on unstable funding sources, regional inequalities, healthcare professional shortages, underfunding of complex services, lack of prevention investment, corruption, and an aging population. Addressing these challenges is vital to maintain SUS as an equitable and effective healthcare system. In conclusion, addressing these healthcare challenges and opportunities is crucial for Brazil's future. It requires ongoing investment in public policies, a multidisciplinary approach, and active community participation. Strengthening primary healthcare and combating misinformation are essential steps toward a healthier and more equitable Brazil.

The burden of dermatitis from 1990–2019 in the Middle East and North Africa region

BackgroundThere are several types of dermatitis, each capable of causing enduring changes that extend beyond physical discomfort. In severe cases, dermatitis can significantly affect mental health, social interactions, and the overall quality of life. This study reports the burden of dermatitis in the Middle East and North Africa (MENA) region from 1990 to 2019, according to sex, age category, and socio-demographic index (SDI).MethodsPublicly available data regarding the point prevalence, incidence, and years lived with disability (YLDs) were collected from the Global Burden of Disease 2019 study for both the MENA region and its constituent countries. The point prevalence, incidence, and YLDs of dermatitis were represented as counts and age-standardised rates with 95% uncertainty intervals (UIs).ResultsIn 2019, the age-standardised point prevalence of dermatitis was 2744.6 (2517.8–3003.1) per 100,000 population, which was 2.3% lower than in 1990. The YLD rate was 92.3 (55.6–143.4) per 100,000 population, which was 3.1% lower than in 1990. The largest point prevalence rates were observed among those aged 70–74, for both sexes. The 2019 MENA/Global DALY ratio was not above one in any age group for either sex. During the period 1990 to 2019, there was no clear correlation between the burden of dermatitis and the SDI level.ConclusionThe dermatitis burden in the MENA region remained relatively stable from 1990 to 2019. Future prevention efforts should focus on improving healthcare access, health education, and workplace safety regulations.