Inadequate Access To Health Care Research Articles

Maternal Malnutrition and Its Associated Adverse Pregnancy Outcomes and Childbirth in Dadu District, Sindh, Pakistan

Background: Maternal malnutrition poses serious risks to both mother and child, contributing to adverse pregnancy outcomes such as anemia, pre-eclampsia, and low birth weight. Addressing maternal malnutrition is essential for promoting healthy pregnancies and favorable birth outcomes. Methodology: The study involved 660 third-trimester pregnant women at a tertiary care hospital in Dadu district, Sindh, Pakistan. The aim was to identify the association patterns of maternal nutrition on birth outcomes to inform future programming. Data were collected using a mixed-methods approach with a snowballing technique. Bivariate and multivariate analyses were performed using R-Studio and Canvas software to analyze associations and differences related to maternal nutrition. Results: The majority of rural participants (84%) intended to deliver at DHQ Dadu, with 81% facing inconsistent family income sources, impacting food security and healthcare access. Maternal education positively correlated with healthcare service utilization, while maternal counseling had a weaker influence. Early pregnancies were prevalent, with 29% of women reporting their first pregnancy before age 20 and 6.7% before age 16. Iron and folic acid utilization was suboptimal (20.4%), and access to healthcare was hindered by distance, cost, and inconsistent coverage, particularly in rural areas. Maternal malnutrition was a significant concern, with 15.4% identified as acutely malnourished. Conclusion: The study highlights significant challenges, including socioeconomic disparities, early pregnancies, inadequate healthcare access, and poor maternal nutrition status. Targeted interventions such as improving healthcare infrastructure, enhancing maternal education, promoting early prenatal care, strengthening community-based nutrition programs, and leveraging social safety net programs can help mitigate adverse birth outcomes.

Socioeconomic Disparities in Healthcare Access and Implications for All-Cause Mortality among US Adults: A 2000-2019 Record Linkage Study.

The United States (US) has witnessed a notable increase in socioeconomic disparities in all-cause mortality since 2000. While this period is marked by significant macroeconomic and health policy changes, the specific drivers of these mortality trends remain poorly understood. In this study, we assessed healthcare access variables and their association with socioeconomic status (SES)-related differences (exposure) in US all-cause mortality (outcome), since 2000. Our research drew upon cross-sectional data from the National Health Interview Survey (NHIS, 2000-2018), linked to death records from the National Death Index (NDI, 2000-2019) (n=486,257). The findings reveal that the odds of a lack of health insurance and unaffordability of needed medical care were over two-fold higher among individuals with lower education, compared to those with high education, following differential time trends. Moreover, elevated mortality risk was associated with lower education (up to 77%), uninsurance (17%), unaffordability (43%), and delayed care (12%). Uninsurance and unaffordability accounted for 4-6% of the disparities in time to mortality between low- and high-education groups. These findings were corroborated by income-based sensitivity analyses, emphasizing that inadequate healthcare access partially contributed to socioeconomic disparities in mortality. Effective policies promoting equitable healthcare access are imperative to mitigate socioeconomic disparities in mortality.

Measles Outbreak in Socioeconomically Diverse Sections: A Review.

Measles outbreaks among socioeconomically weaker sections constitute a significant public health challenge.The objective is to highlight the specific vulnerabilities and contributing factors that make these communities more susceptible to measles outbreaks. Socioeconomically weaker sections, often characterized by poverty, inadequate healthcare access, overcrowding, and suboptimal immunization rates, face heightened risks of measles outbreaks. These outbreaks occur due to various interrelated factors, including limited healthcare infrastructure, low vaccine coverage, a lack of awareness about vaccination benefits, and difficulties in accessing healthcare services. The effects of measles outbreaks in socioeconomically disadvantaged areas are critical. Particularly among vulnerable groups, including newborns, expectant mothers, and malnourished people, measles increases morbidity and mortality. There is also a considerable financial impact on the healthcare system and the afflicted families. Measles outbreaks in these populations must be addressed using a diversified strategy. In order to improve vaccine coverage through targeted immunization programs, raise community vaccination awareness, and address social determinants of health, efforts should concentrate on bolstering the healthcare infrastructure. Effective epidemic control and prevention depend on coordinated efforts by healthcare practitioners, legislators, local leaders, and public health groups. Healthcare systems can lessen the impact of measles in socioeconomically disadvantaged areas and strive toward attaining equitable health outcomes for all populations by addressing the socioeconomic variables that lead to the vulnerability of measles.

Anemia among Medical Students from Jakarta: Indonesia-Iron Deficiency or Carrier Thalassemia?

Anemia, a global health concern, affects one-fourth of the global population, particularly women. In Indonesia, its prevalence is 23.7%, with 32.0% among 15-24 year-olds. Factors include poor nutrition, infectious diseases, chronic diseases, inherited disorders, and inadequate healthcare access. This study aimed to investigate anemia prevalence and its etiology among medical students from Jakarta. This study was a descriptive research with a cross-sectional approach. Undergraduate students aged 18-23 years old were selected and consented to participate by a consecutive nonrandom sampling methods. Laboratory blood data were evaluated (including Hb, MCV, MCH, HbA2, and ferritin levels) and DNA was isolated to confirm the type of thalassemia carrier. In total, 140 medical students, mainly female, were recruited. Anemia was found in 13.6% (11.4% had low MCV and/or MCH), and 16.5% had low MCV and/or MCH without anemia. Hb electrophoresis revealed high HbA2 values, suggesting the HbE variant (2.1%), and β-thalassemia carrier (0.7%). DNA analysis confirmed the cd26 mutation and heterozygous IVS1nt5. Among those without anemia, 5% had α-deletion, while in the group with anemia, 1.4% had α-deletion (with coexistent IDA), 3.6% had α-deletion, and 0.7% had β-mutation. DNA analysis can identify specific mutations associated with alpha-thalassemia, distinguishing between iron deficiency anemia and the alpha-thalassemia trait. Thalassemia screening should involve low MCV and/or MCH values as the first step (stage 1), followed by Hb analysis (stage 2) and DNA analysis (stage 3). In common areas, a combination of Hb and DNA testing is best. However, healthcare professionals must diagnose and treat thalassemia, as proper management relies on accurately identifying the underlying condition.

LEADERSHIP IN GLOBAL HEALTH: NAVIGATING CHALLENGES AND OPPORTUNITIES FOR IMPACTFUL OUTCOMES IN AFRICA AND SRI LANKA

Effective leadership is paramount in addressing the complex challenges and harnessing the opportunities in global health, particularly in regions such as Africa and Sri Lanka. This review explores the multifaceted dimensions of leadership within the context of global health, highlighting the unique challenges and opportunities faced by these regions. In Africa, leadership in global health is confronted with a myriad of challenges including limited resources, political instability, and infrastructural deficiencies. The burden of infectious diseases, inadequate healthcare access, and socio-economic disparities further exacerbate the complexities. However, amidst these challenges lie opportunities for transformative leadership. Visionary leaders can leverage partnerships, innovative technologies, and community engagement to strengthen health systems, promote preventive healthcare, and address the root causes of health inequities. Similarly, in Sri Lanka, leadership in global health faces its own set of challenges and opportunities. Despite notable achievements in healthcare infrastructure and disease control, the country grapples with emerging health threats, non-communicable diseases, and disparities in healthcare access. Effective leadership is essential in mobilizing resources, fostering intersectoral collaboration, and implementing evidence-based interventions to ensure equitable health outcomes for all segments of the population. In both regions, transformative leadership in global health necessitates a multidisciplinary approach that integrates political commitment, scientific innovation, and community participation. Leaders must possess strong communication skills, cultural competence, and a deep understanding of local contexts to navigate the intricate socio-political landscapes. Furthermore, fostering leadership capacity at all levels of the healthcare system is crucial for sustainability and resilience in the face of evolving health challenges. By examining the challenges and opportunities for leadership in global health within the contexts of Africa and Sri Lanka, this review underscores the importance of visionary leadership in driving impactful outcomes. Empowering leaders to navigate complexities, foster collaboration, and innovate solutions is essential for advancing the global health agenda and achieving health equity on a global scale.
 Keywords: Leadership, Global Health, Africa, Sri Lanka, Healthcare, Review

Mental health, depressive disorder and its management: A review

Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. India's mental health struggles are largely due to societal stigma and inadequate healthcare access. Depression is a major cause of disability worldwide and contributes greatly to the global disease burden. Depression is characterized by persistent sadness, hopelessness, irritability, guilt, loss of interest, fatigue, difficulty concentrating, sleep disturbances, changes in appetite, physical aches, and thoughts of death or suicide. Symptoms can also include increased anger, restlessness, withdrawal, impulsivity, alcohol or drug use, isolation, and difficulties with sexual desire and performance. Major depressive disorder (MDD) is one of the most common types of depression. It is characterized by changes in neuronal structure and function, which are accompanied by several biochemical changes. It is caused by a variety of biological, psychological, and environmental factors. This review will cover depression, its signs and symptoms, risk factors, mechanisms, and management. The management of depression includes various types of medication, therapies, counselling, stimulation, and strategies to combat depression.

Evaluating Rural Health Disparities in Colombia: Identifying Barriers and Strategies to Advancing Refugee Health.

Health disparities within rural communities, notably those affecting migrant and refugee populations, are well-documented. Refugees often grapple with high disease burdens and mortality rates due to limited access to primary healthcare and their vulnerable socio-economic and political situations. This issue is particularly acute in the rural areas around Medellin, Colombia, where the refugee influx exacerbates the existing public health challenges. Studies highlight a substantial gap between community needs and public health policies, resulting in inadequate healthcare access. Our study, utilizing the Delphi technique, aimed to identify common barriers and strategies to enhance rural healthcare for refugees. Through consensus-building with community leaders, we identified six primary barriers to healthcare access and five barriers to healthcare quality. Community leaders endorsed five strategies to address the access barriers and eight strategies to improve healthcare quality. This research provides valuable insights for optimizing resource allocation and designing effective support programs for these vulnerable populations.

Journey for a cure: Illness narratives of obstetric fistula survivors in North Central Nigeria.

Obstetric fistula is a life transforming event resulting in embodied biographical disruption. Survivors suffer myriad long-term physical and emotional consequences. This paper is an account of a narrative inquiry, conducted with 15 fistula survivors in North-central, Nigeria, who described how their identities had been transformed by their condition. A narrative therapeutic approach, using Frank's 'chaos, restitution and quest' typology, was used to map their recovery narratives. 'Chaos', described by Frank as the opposite of restitution, dominated, with women losing hope of recovery. Women's shift towards 'restitution' began with treatment, but inadequate health-care access often delayed this process. In their quest narratives, women's life and identify changes enabled them to derive meaning from their experience of obstetric fistula within the context of their own lives. The findings highlight socio-structural factors raising the risk of obstetric fistula, which in turn causes biographical disruption and hampers sufferers' treatment and recovery. Rehabilitation should include income-generating skills to bring succour to survivors, particularly those whose incontinence persists after repairs.

Health disparities in COVID-19: immune and vascular changes are linked to disease severity and persist in a high-risk population in Riverside County, California

BackgroundHealth disparities in underserved communities, such as inadequate healthcare access, impact COVID-19 disease outcomes. These disparities are evident in Hispanic populations nationwide, with disproportionately high infection and mortality rates. Furthermore, infected individuals can develop long COVID with sustained impacts on quality of life. The goal of this study was to identify immune and endothelial factors that are associated with COVID-19 outcomes in Riverside County, a high-risk and predominantly Hispanic community, and investigate the long-term impacts of COVID-19 infection.Methods112 participants in Riverside County, California, were recruited according to the following criteria: healthy control (n = 23), outpatients with moderate infection (outpatient, n = 33), ICU patients with severe infection (hospitalized, n = 33), and individuals recovered from moderate infection (n = 23). Differences in outcomes between Hispanic and non-Hispanic individuals and presence/absence of co-morbidities were evaluated. Circulating immune and vascular biomarkers were measured by ELISA, multiplex analyte assays, and flow cytometry. Follow-up assessments for long COVID, lung health, and immune and vascular changes were conducted after recovery (n = 23) including paired analyses of the same participants.ResultsCompared to uninfected controls, the severe infection group had a higher proportion of Hispanic individuals (n = 23, p = 0.012) than moderate infection (n = 8, p = 0.550). Disease severity was associated with changes in innate monocytes and neutrophils, lymphopenia, disrupted cytokine production (increased IL-8 and IP-10/CXCL10 but reduced IFNλ2/3 and IFNγ), and increased endothelial injury (myoglobin, VCAM-1). In the severe infection group, a machine learning model identified LCN2/NGAL, IL-6, and monocyte activation as parameters associated with fatality while anti-coagulant therapy was associated with survival. Recovery from moderate COVID infection resulted in long-term immune changes including increased monocytes/lymphocytes and decreased neutrophils and endothelial markers. This group had a lower proportion of co-morbidities (n = 8, p = 1.0) but still reported symptoms associated with long COVID despite recovered pulmonary function.ConclusionThis study indicates increased severity of COVID-19 infection in Hispanic individuals of Riverside County, California. Infection resulted in immunological and vascular changes and long COVID symptoms that were sustained for up to 11 months, however, lung volume and airflow resistance was recovered. Given the immune and behavioral impacts of long COVID, the potential for increased susceptibility to infections and decreased quality of life in high-risk populations warrants further investigation.

A Cardiac Deep Learning Model (CDLM) to Predict and Identify the Risk Factor of Congenital Heart Disease.

Congenital heart disease (CHD) is a critical global public health concern, particularly when it comes to newborn mortality. Low- and middle-income countries face the highest mortality rates due to limited resources and inadequate healthcare access. To address this pressing issue, machine learning presents an opportunity to develop accurate predictive models that can assess the risk of death from CHD. These models can empower healthcare professionals by identifying high-risk infants and enabling appropriate care. Additionally, machine learning can uncover patterns in the risk factors associated with CHD mortality, leading to targeted interventions that prevent or reduce mortality among vulnerable newborns. This paper proposes an innovative machine learning approach to minimize newborn mortality related to CHD. By analyzing data from infants diagnosed with CHD, the model identifies key risk factors contributing to mortality. Armed with this knowledge, healthcare providers can devise customized interventions, including intensified care for high-risk infants and early detection and treatment strategies. The proposed diagnostic model utilizes maternal clinical history and fetal health information to accurately predict the condition of newborns affected by CHD. The results are highly promising, with the proposed Cardiac Deep Learning Model (CDLM) achieving remarkable performance metrics, including a sensitivity of 91.74%, specificity of 92.65%, positive predictive value of 90.85%, negative predictive value of 55.62%, and a miss rate of 91.03%. This research aims to make a significant impact by equipping healthcare professionals with powerful tools to combat CHD-related newborn mortality, ultimately saving lives and improving healthcare outcomes worldwide.

Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study

Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30–65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.

Does race influence the attainment of the principles of oncologic surgical resection in colon adenocarcinoma? A retrospective cohort analysis from the national cancer database.

The authors performed a retrospective cohort study of all cases of resectable colon adenocarcinoma who underwent surgical resection in the National Cancer Database between 2004 and 2018. The postoperative lymph node count and margins were grouped as 'principles of oncologic surgical resection'. A multivariate logistic regression analysis was performed to assess race and other demographic variables as independent factors influencing the attainment of the principles of oncologic resection. A total of 456746 cases were included. From this cohort, 377344 (82.6%) achieved an adequate oncologic resection and 79402 (17.4%) did not. On logistic regression, African American and Native American patients were less likely to attain an adequate oncologic resection. Similarly, patients with an elevated Charlson-Deyo score (2 or above), stage I cancer, and patients who underwent extended resection were less likely to achieve adequate oncologic resection. Resections performed in metropolitan areas, patients with private insurance, high-income quartiles, and patients diagnosed in more recent years were more likely to achieve adequate oncologic resection. There are significant racial disparities regarding the attainment of the principles of oncologic resection in colon cancer, which could be explained by unconscious biases, social discrepancies, and inadequate healthcare access. Early introduction and conscientization of unconscious biases are required in surgical training.

Telehealth Challenges for California Rural Hospitals in Reaching Latino Populations During COVID-19

Background Rural and remote communities were especially vulnerable to the COVID-19 pandemic due to the availability and capacity of rural health services. Research has found that key issues surrounded (1) the lack of staff, (2) the need for coordinated health services, and (3) operational and facility issues. Similarly, research also confirms that irrespective of hospital capacity issues existing during crisis, compared to urban communities, rural communities typically face poorer access to health services. Telehealth programs have long held promise for addressing health disparities perpetuated by inadequate health care access. In response to the current COVID-19 pandemic, Adventist Health Saint Helena Hospital, a rural hospital in northern California, urgently worked to expand telehealth services. However, as Adventist Health Saint Helena Hospital is the longest-serving rural hospital in the state of California, administrators were also able to draw on experiences from the pandemic of 1918/1919. Understanding their historically rural and heavily Latino populations, their telehealth approach was coupled with cultural approaches for prioritizing socially responsive and equitable access to health services. Objective This study aimed to present one rural community’s holistic sociotechnical response to COVID-19 in redesigning their health care delivery approach. Redesign efforts included the expansion of digital health services coupled with county-wide collaborations for nondigital mobile health centers, testing, and vaccination clinics to meet the needs of those with limited digital access and language barriers. Methods We present data on telehealth services for maintaining critical care services and a framework on the feasibility of private-public partnerships to address COVID-19 challenges. Results In this paper, we provide a critical review of how a rural hospital adapted its health care approach to incorporate telehealth services and distance services to meet the needs of a diverse population. Conclusions This paper contributes empirical data on how rural communities can use telehealth technologies and community partnerships for a holistic community approach to meet health needs during a natural disaster. Conflicts of Interest None declared.

Protein biomarkers in cervicovaginal lavages for detection of endometrial cancer

BackgroundRates of endometrial cancer (EC) are increasing. For a definitive diagnosis, women undergo various time-consuming and painful medical procedures, such as endometrial biopsy with or without hysteroscopy, and dilation and curettage, which may create a barrier to early detection and treatment, particularly for women with inadequate healthcare access. Thus, there is a need to develop robust EC diagnostics based on non- or minimally-invasive sampling. The objective of this study was to quantify a broad range of immuno-oncology proteins in cervicovaginal lavage (CVL) samples and investigate these proteins as predictive diagnostic biomarkers for EC.MethodsOne hundred ninety-two women undergoing hysterectomy for benign or malignant indications were enrolled in this cross-sectional study. Classification of women to four disease groups: benign conditions (n = 108), endometrial hyperplasia (n = 18), low-grade endometrioid carcinoma (n = 53) and other EC subtypes (n = 13) was based on histopathology of biopsy samples collected after the surgery. CVL samples were collected in the operating room during the standard-of-care hysterectomy procedure. Concentrations of 72 proteins in CVL samples were evaluated using multiplex immunoassays. Global protein profiles were assessed using principal component and hierarchical clustering analyses. The relationships between protein levels and disease groups and disease severity were determined using Spearman correlation, univariate and multivariate receiver operating characteristics, and logistic regression analyses.ResultsWomen with EC and benign conditions exhibited distinctive cervicovaginal protein profiles. Several proteins in CVL samples (e.g., an immune checkpoint protein, TIM-3, growth factors, VEGF, TGF-α, and an anti-inflammatory cytokine, IL-10) discriminated EC from benign conditions, particularly, when tested in combinations with CA19–9, CA125, eotaxin, G-CSF, IL-6, MCP-1, MDC, MCP-3 and TRAIL (sensitivity of 86.1% and specificity of 87.9%). Furthermore, specific biomarkers (e.g., TIM-3, VEGF, TGF-α, TRAIL, MCP-3, IL-15, PD-L2, SCF) associated with histopathological tumor characteristics, including histological type and grade, tumor size, presence and depth of myometrial invasion or mismatch repair protein status, implying their potential utility for disease prognosis or monitoring therapies.ConclusionsThis proof-of-principle study demonstrated that cervicovaginal sampling coupled with multiplex immunoassay technology can offer a minimally to non-invasive method for EC detection.

Health Services Utilization Barriers for Rural Elderly Women in Bangladesh: Narratives of Clinicians, Pharmacists and Public Health Assistants.

Bangladesh has the third largest population of poor older adults in the world and 73% of them live in rural areas. Disparity in the country's health services is evident that creates a substantial pressure, especially on rural elderly women who live in a compromised socio-cultural atmosphere. This is true that we know about rural elderly women's self-reported health and service use barriers, but no studies captured the views of health staff. This study presents a qualitative exploration of the views held by rural health staff whose role is to provide care to local elderly women. We conducted 11 interviews with clinicians, pharmacists and public health assistants in Sylhet district, Bangladesh. A critical thematic discourse analysis, using the critical social constructs of Habermas and Honneth, of the data informed the women's inadequate healthcare access and associated barriers that were complex and overlapping but had explicit institutional, subjective and material consequences. Five major themes emerged including: unequal distribution of health services; marginalization in patient-staff relationships; living with poverty; social relegation; and mistrust of clinical treatment. Rural areas were viewed with inequitably distributed health services and traditionally a large proportion of elderly women living in poverty who lacked social support and demonstrated a mistrust towards healthcare system. No recognition of the women and power differences were underpinned by economic factors and cultural societal values. The findings suggest a need for health policy solutions and education of healthcare staff and elderly women regarding accessing healthcare.

IMPACT OF TELEHEALTH VISITS ON OUTCOMES AMONG BLACK AND LATINX PATIENTS WITH MODERATE-SEVERE ASTHMA

<h3>Introduction</h3> Black and Latinx patients bear a disproportionate burden of asthma-related morbidity partly due to inadequate healthcare access. Telehealth could improve access, but its impact on asthma outcomes compared to in-person visits in these populations is unknown. <h3>Methods</h3> Black and Latinx adults with moderate-severe asthma were recruited from US clinics, including Puerto Rico for the PREPARE trial. For this ancillary study, 7/19 sites had available EMR data on asthma care appointment setting (telehealth vs. in-person). Participants whose asthma care included telehealth (<b>TH</b>) vs. those with exclusively in-person visits (<b>IP</b>) starting at COVID-19 pandemic onset (3/2020, greater telehealth prevalence) through 4/2021 (last PREPARE exit) were included if 2+ monthly PREPARE surveys were available for the post-index visit period. Asthma control (<b>ACT</b>®) and asthma-related quality of life (<b>ASUI</b>) were compared between TH vs. IP. <h3>Results</h3> Data were available for n=62 TH and n=36 IP participants, with comparable duration of follow-up (6.36 vs. 6.42 months, respectively). TH were more likely Latinx, from the Northeast, employed, only use inhaled corticosteroids as controller therapy, lower BMI, and lower self-reported asthma therapy adherence compared to IP. Before and after adjustment for these baseline differences and for PREPARE treatment assignment and baseline ACT and ASUI scores, TH and IP had comparable follow-up asthma control (ACT 18.43 vs. 18.93, respectively, p=0.519) and asthma-related quality of life (ASUI 0.79 vs. 0.84, respectively, p=0.163). <h3>Conclusion</h3> Asthma control and asthma-related quality of life were comparable between TH and IP after adjustment. TH may represent a valuable asthma care option for Black and Latinx patients.

Using Nomogram to Predict the Hospitalization Forgone Among Internal Migrants in China: A Nationally Representative Cross-Sectional Secondary Data Analysis.

BackgroundMigrants are one of the most vulnerable populations facing many health issues. Inadequate health care access and unequal insurance are the most challenging. This study aimed to construct a nomogram to predict the risk of hospitalization forgone among internal migrants in China.MethodsWe analyzed the 2014 Mobile Population Social Integration and Mental Health Survey (MPSIMHS) launched by National Health and Family Planning Commission. Using the Probability Proportionate to Size Sampling method (PPS), MPSIMHS sampled from eight cities (districts) with a total sample size of 15,999. Of total 589 patients who were diagnosed with hospitalization requirement, 116 forwent their hospitalization, 473 had no forgone. Demographics, socioeconomic status, and health conditions were analyzed using univariate analysis and multivariate logistic regression. A nomogram was built and validated by applying bootstrap resampling.ResultsAfter model selection, gender, age group, marital status, migration range, insurance (having NRMI), and self-evaluated health were chosen into the nomogram to predict the risk of hospitalization forgone. The nomogram that predicted the risk of hospitalization forgone was validated for discrimination and calibration using bootstrap resampling. The calibration curves illustrated optimal agreement between the actual and predicted probabilities of the nomogram. The value of C-index from bootstrap was 0.80 (95% CI: 0.76–0.85).ConclusionThis study identified some possible factors contributing to migrant’s hospitalization forgone: being single, male and middle-aged, having fixed health insurance, and having bad or great self-evaluated health. By integrating significant and easy-to-get prognostic factors, a nomogram was developed to estimate an individual patient’s risk of hospitalization forgone, which might have practical utility and the potential to assist clinicians in making hospitalization recommendations.

Confronting Disparities: Race, Ethnicity, and Immigrant Status as Intersectional Determinants in the COVID-19 Era.

The COVID-19 (coronavirus disease-2019) pandemic has exposed long-standing inequalities in U.S. health care. Historically, racial and ethnic minorities have been the most likely to suffer from inadequate health care access and insurance coverage. With the spread of COVID-19, these disparities have dramatically increased. Focusing on native and foreign-born racial/ethnic minorities, this article discusses how entrenched health inequities and structural discrimination have led to COVID-19 morbidities and mortalities. Considering that "essential" frontline workers are disproportionately native and foreign-born racial/ethnic minorities, this work evaluates the impact(s) of social exclusion and the lack of support systems for these workers. Using the framework of intersectionality, this work also examines how race and immigrant status affect COVID-19 spread in prisons and immigration detention centers-facilities that often lack effective health and sanitary conditions and where inmates are also likely to be racial/ethnic minorities.

Healthcare for migrant workers in destination countries: a comparative qualitative study of China and Malaysia

ObjectivesThis paper explores policies addressing migrant worker’s health and barriers to healthcare access in two middle-income, destination countries in Asia with cross-border migration to Yunnan province, China and international migration...

Improving Health Equity for Women Involved in the Criminal Legal System.

Improving Health Equity for Women Involved in the Criminal Legal System.