International Health Services Research Articles

Medical Events Encountered at a Major International Airport and Health Services Provided.

INTRODUCTION: Travel by airline starts and ends at airports. Thousands of people consisting of passengers, relatives of passengers, and employees gather at airports every day. In this study, medical events (MEs) encountered at Istanbul Atatürk Airport (IAA) and health services provided were analyzed.METHODS: The MEs encountered in IAA between January 1, 2016, and December 31, 2018, and health services provided by the private medical clinic in the airport terminal building were retrospectively analyzed.RESULTS: During the study period, 192,500,930 passengers traveled from the IAA and a total of 11,799 patients were seen at the clinic. There were 4898 (41.5%) male patients. The median age of the 9466 (80.2%) patients whose age was recorded was 34 (28-51) yr. Of 11,799 patients included in the present study, 9228 (78.21%) patients had medical complaints, 1122 (9.5%) patients had trauma complaints, 1180 patients (10%) were transferred to the hospital, and 269 (2.27%) patients required a certificate of preflight fitness. The most common medical complaint was gastrointestinal (1515 patients, 12.84%). The most common trauma was soft tissue injury (345 patients, 2.92%).DISCUSSION: MEs in airports can be as various and also critical as health conditions seen in emergency departments. It is important to provide medical services with an experienced medical team trained in aviation medicine and adequate medical equipment at airports.Ceyhan MA, Demir GG, Cömertpay E, Yıldırımer Y, Kurt NG. Medical events encountered at a major international airport and health services provided. Aerosp Med Hum Perform. 2024; 95(5):259-264.

Assessment of universities that provide education in the field of health tourism in Türkiye in the light of current data

Introduction: Health tourism, defined as travels aimed to improve the physical and mental health of individuals, is growing day by day in parallel with developing technology and transportation. Factors influencing the preference of Türkiye in health tourism include cost, tourism opportunities, and cultural characteristics, as well as health facilities, staff, doctors, and the quality level of service. Due to the focus of human health, the service delivery which is very sensitive should be carried out by qualified workforce. With their role in protecting patients from unnecessary tests and treatments and facilitating effective participation in clinical decision-making processes, family physicians are also involved in the health tourism process and advocate. It is aimed to improve the service provision both qualitatively and quantitatively to meet the predicted increase in the health tourism sector in our country. In line with the realization of these goals, education and training activities offered by higher education institutions come into prominence. It’s aimed in our study to quantitatively investigate the adequacy of education in the field of health tourism in our country and to assess it in light of current data. Methods: The data of the cross-sectional and descriptive study were collected during the 2023-2024 academic years. Education programs and the number of students in the field of health tourism between 2018-2023 at 18 institutions under the Council of Higher Education (YOK) and The Measuring, Selection and Placement Center (OSYM) were examined. Obtained data were brought together with health tourism data published by the Turkish Statistical Institute (TUIK), the International Health Services Inc. (USHAS), and the Association of Turkish Travel Agencies (TURSAB). Results: In Türkiye, for the first time in 2014, associate degree education started to be provided in the " Health Tourism Business" department within the Vocational School. This department, which is available in 9 universities today, has the highest percentage among associate degree preferences. Master's degree program level trainings in health tourism continue in 9 universities across 3 different departments: "Health Tourism", " Health Tourism Business " and "Health Tourism Management". Doctoral level education is provided in 1 university in the department of "Health Tourism". It is observed that the number of students and graduates enrolled in education programs in the field of health tourism is increasing every year. On the other hand, there is still no undergraduate program in this field in Türkiye. According to the data published by TUIK and USHAS, the number of visitors coming to our country for health tourism and the value of income is increasing every year. On the contrary, the number of students and graduates has not increased at the same rate in recent years. Conclusions: The number of programs and quotas in the field of health tourism opened in universities is gradually increasing. However, when evaluated together with the increase in the number of visitors coming to our country for health tourism over the years, it has been revealed that the number of qualified staff trained to meet the increasing need is still not at the desired level.

Sociocultural adjustment and social support as predictors for international medical sciences students’ anxiety during COVID-19

BackgroundThe prevalence of anxiety is high among international medical sciences students and it increased even more during the COVID-19 pandemic due to different restrictions and social isolation. Successful sociocultural adjustment and social support could be important factors in overcoming those challenges, however, there is a lack of studies which would investigate the role of those factors among inter- national medical students. This study aimed to assess the role of sociocultural adjustment and social support as predictors for international medical students’ anxiety during COVID-19.MethodsTwo measurements were conducted via self-reported questionnaires which consisted of three scales - SCAS, MSPSS and GAD-7. In total, 82 international medical students participated in both measurements in this longitudinal study.ResultsThe findings indicated that 37% of international students had symptoms of moderate or severe anxiety during their first year of studies at university. In the second year, during the COVID-19 pandemic and an official lockdown, 35% of international students had symptoms of moderate or severe anxiety. In addition, this study showed that gender and sociocultural adjustment did not play a role as predictors of students’ anxiety during the second year of studies. However, this study revealed that social support provided by family during the first year of studies, as well as having friends or family members who had been ill with COVID-19 predicted higher levels of anxiety at second measurement, while sociocultural adjustment was an even stronger predictor of anxiety in the second year of studies of international medical students.ConclusionsThis knowledge can help to better understand how international medical students felt during the COVID-19 pandemic and what role the above- mentioned factors played in the students’ anxiety. As the anxiety level is quite high among international medical students, universities and mental health service providers should take it into consideration and help them to overcome those challenges.

Patient experiences during the planned perioperative care pathway: An integrative review.

This integrative review aimed to synthesize evidence about the patients' experiences during the planned perioperative care pathway. Integrative review. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline Ovid, Scopus, and American Psychological Association (APA) PsychINFO. Original, peer-reviewed studies published in English between 2012 and 2023 exploring patient experiences during the planned perioperative care pathway were reviewed. This review was guided by the Whittemore and Knafl method and followed PRISMA guidelines to search the literature. Twenty-two articles were selected for the final study. Three themes emerged: Sharing of information is empowering; interpersonal relationships are valued by patients, and hospital systems and care co-ordination influence the patient experience. The quality and consistency of the information patients receive can both support and undermine patient confidence in health professionals. The quality of relationships that participants experience and effective communication with health professionals can support or compromise the quality of the patients' perioperative experience. The nature of the hospital systems and care co-ordination in hospital has implications for the quality of recovery from surgery. This review evaluates whether national and international health services and organizations, adhering to the WHO guidelines, have developed and implemented intentionally focused perioperative care with the aims to achieving effective and sustainable surgical outcomes through increased patient satisfaction. This article is an integrative review and does not include patient or public contribution.

The World Health Organization and Global Health Inequality: Strategies and Results Analysis under the Socio-economic Background

Nowadays, the overall health status of countries has greatly improved with economic development, but health inequality has become a global health problem. With the continuous acceleration of globalization and the deepening of China's participation in international affairs, and through rapid development in recent years, China's position as an economic powerhouse has gradually been recognized and consolidated. China's role and influence in the development of international health services have also become increasingly evident, fully reflecting the status and responsibility of a major country. This article attempts to analyze the strategies and outcomes of the WHO(World Health Organization) in the context of global health inequality in the socio-economic context. In the significant adjustment of the WHO's policy towards member states from "assistance" to "cooperation", the connotation has undergone extremely profound changes. Under the coordination of WHO, we will strengthen cooperation in research, knowledge dissemination, capacity building, technology development, and policy support on social determinants of health issues, share experiences, and continuously strive to improve social determinants of health worldwide.

Development of indicators for avoidable emergency medical service calls by mapping paramedic clinical impression codes to ambulatory care sensitive conditions and mental health conditions in the UK and Canada

ObjectiveParamedic assessment data have not been used for research on avoidable calls. Paramedic impression codes are designated by paramedics on responding to a 911/999 medical emergency after an assessment of...

Disaster Response and Management: The Integral Role of Rehabilitation.

With the increasing frequency of disasters and the significant upsurge of survivors with severe impairments and long-term disabling conditions, there is a greater focus on the importance of rehabilitation in disaster management. During disasters, rehabilitation services confront a greater load due to the influx of victims, management of persons with pre-existing disabilities and chronic conditions, and longer-term care continuum. Despite robust consensus amongst the international disaster response and management community for the rehabilitation-inclusive disaster management process, rehabilitation is still less prioritised. Evidence supports the early involvement of rehabilitation professionals in disaster response and management for minimising mortality and disability, and improving clinical outcomes and participation in disaster survivors. In the last two decades, there have been substantial developments in disaster response/management processes including the World Health Organization Emergency Medical Team (EMT) initiative, which provides a standardized structured plan to provide effective and coordinated care during disasters. However, rehabilitation-inclusive disaster management plans are yet to be developed and/or implemented in many disaster-prone countries. Strong leadership and effective action from national and international bodies are required to strengthen national rehabilitation capacity (services and skilled workforce) and empower international and local EMTs and health services for comprehensive disaster management in future calamities. This narrative review highlights the role of rehabilitation and current developments in disaster rehabilitation; challenges and key future perspectives in this area.

Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement.

Trypanosoma cruzi causes Chagas disease (CD), a potentially fatal disease characterized by cardiac disorders and digestive, neurological or mixed alterations. T. cruzi is transmitted to humans by the bite of triatomine vectors; both the parasite and disease are endemic in Latin America and the United States. In the last decades, population migration has changed the classic epidemiology of T. cruzi, contributing to its global spread to traditionally non-endemic countries. Screening is recommended for Latin American populations residing in non-endemic countries. The present study analyzes the epidemiological characteristics of 2,820 Latin American individuals who attended the International Health Service (IHS) of the Hospital Clinic de Barcelona between 2002 and 2019. The initial assessment of organ damage among positive cases of T. cruzi infection was analyzed, including the results of electrocardiogram (ECG), echocardiogram, barium enema and esophagogram. Among all the screened individuals attending the clinic, 2,441 (86.6%) were born in Bolivia and 1,993 (70.7%) were female. Of individuals, 1,517 (81.5%) reported previous exposure to the vector, which is a strong risk factor associated with T. cruzi infection; 1,382 individuals were positive for T. cruzi infection. The first evaluation of individuals with confirmed T. cruzi infection, showed 148 (17.1%) individuals with Chagasic cardiomyopathy, the main diagnostic method being an ECG and the right bundle branch block (RBBB) for the most frequent disorder; 16 (10.8%) individuals had a normal ECG and were diagnosed of Chagasic cardiomyopathy by echocardiogram. We still observe many Latin American individuals who were at risk of T. cruzi infection in highly endemic areas in their countries of origin, and who have not been previously tested for T. cruzi infection. In fact, even in Spain, a country with one of the highest proportion of diagnosis of Latin American populations, T. cruzi infection remains underdiagnosed. The screening of Latin American populations presenting with a similar profile as reported here should be promoted. ECG is considered necessary to assess Chagasic cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach given that it can detect cardiac abnormalities when the ECG is normal.

Методологические основы прогнозирования распространения заболеваний в мире (обзор)

In modern conditions, the prediction of the morbidity of the population is becoming one of the most urgent tasks of public health worldwide. For state and international health services, with the help of forecasting the possible incidence and prevalence of various diseases in the general population, it becomes necessary to improve the system of providing specialized care due to the possibility of an updated calculation of the necessary resources. Purpose of the study is to analyze the methodological basis for predicting the morbidity of the population based on the study and generalization of literary sources. Materials and methods. The materials for the analysis were scientific publications on the issues of forecasting and modeling of morbidity in various subgroups of the population and territories of the Russian Federation and other countries. In the course of the research, such methods as comparative analysis, study and generalization of experience, bibliographic were used. Results. Currently, there are a number of studies devoted to disease prediction, and the number of methodological approaches to predicting possible changes in the epidemiological situation in various territories is growing. The study provides an overview of existing methodological approaches to predicting the morbidity of the population in Russia and in the world community. Findings. Thus, the analysis of the experience of predicting morbidity made it possible to determine the features of the use of certain mixed methods of forecasting different classes, groups and types of diseases, especially when identifying new viruses and infectious diseases.

The ReCoN intervention: a co-created comprehensive intervention for primary mental health care aiming to prevent involuntary admissions

BackgroundReducing involuntary psychiatric admissions is a global concern. In Norway, the rate of involuntary admissions was 199 per 100,000 people 16 years and older in 2020. Individuals’ paths towards involuntary psychiatric admissions usually unfold when they live in the community and referrals to such admissions are often initiated by primary health care professionals. Interventions at the primary health care level can therefore have the potential to prevent such admissions. Interventions developed specifically for this care level are, however, lacking. To enhance the quality and development of services in a way that meets stakeholders’ needs and facilitates implementation to practice, involving both persons with lived experience and service providers in developing such interventions is requested.AimTo develop a comprehensive intervention for primary mental health care aiming to prevent involuntary admissions of adults.MethodsThis study had an action research approach with a participatory research design. Dialogue conferences with multiple stakeholders in five Norwegian municipalities, inductive thematic analysis of data material from the conferences, and a series of feedback meetings were conducted.ResultsThe co-creation process resulted in the development of the ReCoN (Reducing Coercion in Norway) intervention. This is a comprehensive intervention that includes six strategy areas: [1] Management, [2] Involving Persons with Lived Experience and Family Carers, [3] Competence Development, [4] Collaboration across Primary and Specialist Care Levels, [5] Collaboration within the Primary Care Level, and [6] Tailoring Individual Services. Each strategy area has two to four action areas with specified measures that constitute the practical actions or tasks that are believed to collectively impact the need for involuntary admissions.ConclusionsThe ReCoN intervention has the potential for application to both national and international mental health services. The co-creation process with the full range of stakeholders ensures face validity, acceptability, and relevance. The effectiveness of the ReCoN intervention is currently being tested in a cluster randomised controlled trial. Given positive effects, the ReCoN intervention may impact individuals with a severe mental illness at risk of involuntary admissions, as more people may experience empowerment and autonomy instead of coercion in their recovery process.

Quality improvement in a crisis: a qualitative study of experiences and lessons learned from the Irish National Ambulance Service response to the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has produced radical changes in international health services. In Ireland, the National Ambulance Service established a novel home and community testing service that was central to the...

Magnitude of terminological bias in international health services research: a disambiguation analysis in mental health.

Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system. This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs - DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ. The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population. Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by 'text-based descriptions'.

COVID-19 Pandemic: Economy Transformation in Conditions of Restrictions and Uncertainty

COVID-19 pandemic drastically changed life of people all over the world. The economic situation has become unique in new history. When restrictive measures were introduced economy in the majority of countries functioned according to the temporary economic model. The article studies key economic figures characterizing the economic situation during the first wave of the pandemic, as well as changes in customer behavior of people connected with restrictive measures. The author supports the opinion of some researchers that leaders of many states should pay serious attention to the development of economy of disasters, as COVID-19 pandemic is a real disaster. In this connection the most important aspects of state policy should include: provision of the overall country security and safe life in the critical situation, the development of international public health services and information systems based on network on-line platforms, industry 4.0 and artificial intellect. Proposals were put forward aimed at designing the complex concept of economy of disasters, which shall be developed on the basis of advanced achievements in the fields linked with providing safe life of people. According to the author this concept should be ratified by heads of leading states of the world. Conclusions concerning prospects of developing global economy after COVID-19 pandemic were drawn.

Examining the prominence and congruence of organizational corporate social responsibility (CSR) communication in medical tourism provider websites

PurposeThis study examines the prominence and congruence or “fit” between corporate social responsibility (CSR) activities and medical tourism providers (MTPs). In doing so, this study seeks to understand the forms of CSR commonly used in the marketing of health-care services by international MTPs.Design/methodology/approachExploratory quantitative content analysis methods are used to examine CSR communication provided by MTPs. Descriptive statistics and analyses of variance are used to analyze the data.FindingsResults show that 22% of MTP websites provided CSR information. There was a high degree of congruence or “fit” between the MTPs and the CSR. Furthermore, each MTP averaged between three and six CSR engagements demonstrating a commitment to not only the practice of CSR but also the stakeholders and communities who benefit.Research limitations/implicationsThis analysis focused on organizational websites and did not examine CSR communications delivered through alternative media channels (e.g. digital platforms, promotional brochures, print advertising, etc.).Practical implicationsThis study adds to the CSR framework in the medical tourism context by discovering what forms of CSR are commonly used in the marketing and promotion of international health services and further analyzes the strategic communication techniques used to deliver these messages.Social implicationsCSR is argued to have direct impacts on employee satisfaction, investor relations and consumer behavior; therefore, current findings may contribute to the development of measurement tools for empirical studies that test relationships between the persuasiveness of CSR messages on the attitudes of medical tourists.Originality/valueResearch inquiries into the CSR strategic communication practices help to identify strengths and opportunities, while informing reputation management and relationship-building practices.

Application of Mixed Methods in Health Services Management Research: A Systematic Review.

Mixed methods research (MMR) is versatile, pragmatic, and adaptable to constraints and opportunities during a research process. Although MMR has gain popularity in health services management research, little is known about how the research approach has been used and the quality of research. We conducted a systematic review of 198 MMR articles published in selected U.S.-based and international health services management journals from 2000 through 2018 to examine the extent of MMR application and scientific rigor. Results showed limited, yet increasing, use of MMR and a high degree of correspondence between MMR designs and study purposes. However, most articles did not clearly justify using MMR designs and the reporting of method details and research integration were inadequate in a significant portion of publications. We propose a checklist to assist the preparation and review of MMR manuscripts. Additional implications and recommendations to improve transparency, rigor, and quality in MMR are discussed.

Nanohydroxyapatite (nHAp) Doped with Iron Oxide Nanoparticles (IO), miR-21 and miR-124 Under Magnetic Field Conditions Modulates Osteoblast Viability, Reduces Inflammation and Inhibits the Growth of Osteoclast - A Novel Concept for Osteoporosis Treatment: Part 1.

PurposeOsteoporosis results in a severe decrease in the life quality of many people worldwide. The latest data shows that the number of osteoporotic fractures is becoming an increasing international health service problem. Therefore, a new kind of controllable treatment methods for osteoporotic fractures is extensively desired. For that reason, we have manufactured and evaluated nanohydroxyapatite (nHAp)-based composite co-doped with iron oxide (IO) nanoparticles. The biomaterial was used as a matrix for the controlled delivery of miR-21-5p and miR-124-3p, which have a proven impact on bone cell metabolism.MethodsThe nanocomposite Ca5(PO4)3OH/Fe3O4 (later called nHAp/IO) was obtained by the wet chemistry method and functionalised with microRNAs (nHAp/IO@miR-21/124). Its physicochemical characterization was performed using XRPD, FT-IR, SEM-EDS and HRTEM and SAED methods. The modulatory effect of the composite was tested in vitro using murine pre-osteoblasts MC3T3-E1 and pre-osteoclasts 4B12. Moreover, the anti-inflammatory effects of biomaterial were analysed using a model of LPS-treated murine macrophages RAW 264.7. We have analysed the cells’ viability, mitochondria membrane potential and oxidative stress under magnetic field (MF+) and without (MF-). Moreover, the results were supplemented with RT-qPCR and Western blot assays to evaluate the expression profile for master regulators of bone metabolism.ResultsThe results indicated pro-osteogenic effects of nHAp/IO@miR-21/124 composite enhanced by exposure to MF. The enhanced osteogenesis guided by nHAp/IO@miR-21/124 presence was associated with increased metabolism of progenitor cells and activation of osteogenic markers (Runx-2, Opn, Coll-1). Simultaneously, nanocomposite decreased metabolism and differentiation of pre-osteoclastic 4B12 cells accompanied by reduced expression of CaII and Ctsk. Obtained composite regulated viability of bone progenitor cells and showed immunomodulatory properties inhibiting the expression of inflammatory markers, ie, TNF-α, iNOs or IL-1β, in LPS-stimulated RAW 264.7 cells.ConclusionWe have described for the first time a new concept of osteoporosis treatment based on nHAp/IO@miR-21/124 application. Obtained results indicated that fabricated nanocomposite might impact proper regeneration of osteoporotic bone, restoring the balance between osteoblasts and osteoclast.

THE CURRENT GROWTH EFFECT OF HEALTH TOURISM MARKET DEVELOPMENT IN TURKEY FOR THE EVALUATION ON CURRENT ACCOUNT DEFICIT

Tourism sector is one of the major driving forces to develop the Turkish economy which provides the positive contributions with new employment opportunities and the national income and payments. With aid of this developments in economy by tourism, it has also increased the interaction with alternative areas. Health Tourism is also one of the special areas in which provides to the country high added value and foreign currency exchange income. Since the revenue outcome by health tourism is reaching up to 100 billion dollars, the national policy of health tourism enable countries has been undertaken as a high interested point of investment needed area. The critical threshold of the country’s Gross Domestic Product (GDP) is 4 to 5 percent as a current account balance and this deficient outcome in Turkey mostly takes on 5 to 4 percent which is a considered as a critical threshold. Health Tourism is expected to play a key role in bringing the values to the positive levels and therefore the focus is becoming on this area by health sector. Developing countries such as India, Singapore, and Thailand meet their foreign trade deficits with the income where they have obtained from this specific sector and the level of growth in this sector is at certain rate every year. The health Tourism is very crucial and significant sector for such a country Turkey, who has current budget deficit, and it is real economic sense. With Covid-19 crisis, the plans related with health tourism is re-evaluated by the coordination between Turkish Ministry of Health, Ministry of Tourism and Ministry of Economy. Especially, with the infrastructure works carried for public and city hospitals has been capable of providing health tourism services within the organization which is called “USHAŞ (International Health Services)”. The health tourism sector offers significant opportunities for Turkey during Covid-19 pandemic effects on our current account deficit and the decline in economic recovery of our tourism industry and losses. With health tourism created opportunities is already in an increasing trend, to contribute to the country’s economy much faster by increasing target markets with public-private cooperation.

Health Service Utilization of International Immigrants in Yiwu, China: Implication for Health Policy.

International immigrants' health is receiving increasing attention, reflecting the need for health systems to adapt to diverse migrant populations. To better inform health policies suited for the needs of international immigrants living in China, empirical evidence on the health service utilization of these international immigrants living in China is urgently needed. Our study included 5459 international immigrants including inpatients and outpatients, who were treated over a 4-year period (2015-2018) in one of the most frequented hospitals by international immigrants in Yiwu, Zhejiang province. Data (e.g., demographic information, outpatient costs, inpatient costs, length of stay, and the average number of visits per patient) were extracted from the Health Information System at the hospital. Descriptive analysis was performed to analyze the basic characteristics of international immigrants living in China (e.g., medical costs, length of stay and the average number of visits per patient) during the study period. Multiple regression analysis was conducted to assess the factors that influence the health service utilization of international immigrants. International immigrants tended to use outpatient services (accounting for 97.22% of the whole sample) compared with inpatient services (only 2.78% of the whole sample). Most international immigrants visited the hospital because of orthopedics, otolaryngological diseases, pediatric-related diseases and skin-related diseases, followed by maternity and general surgery. The average number of visits to the outpatient department per patient was 2.1 in 2015 to 2.5 in 2018, and the length of stay increased from 3.45days to 5.81days during last four years. The outpatient costs increased from RMB 800.43(112.22 US$) to RMB 1756.98(246.33 US$), and inpatient costs rose from RMB 10,958.89(1536.44US$) to RMB 20,912.55(2931.94US$) during 2015-2018. The average number of visits and outpatient costs of international immigrants were both lower than those of local Chinese people (P < 0.05). However, there was no statistic difference in inpatient costs and LOS between international immigrants and Chinese. Having health insurance in China was significantly related with higher medical costs. Our results indicate that international immigrants living in China make greater use of outpatient services rather than hospitalization health services. Health services utilization is increasing in the last four years, but it was lower than that of local Chinese people especially outpatient service utilization. Moreover, more attention should be garnered toward specific health issues experienced by international immigrants, such as orthopedic health, maternal and child health, occupational diseases or accidents, and infectious diseases with skin-related symptoms. The policy implications from the results of this study are as follows. First, in order to improve international immigrants' health and access to health services in China, the government needs to pay more attention to incorporating international immigrants' health services to the current health system. Second, health policy is an important determining factor of access to health care, as policy can influence aspects of health services delivery such as the availability of resources, organization, and financing. Therefore, specific framework for the content of health policies focused on international immigrant populations should be developed.

How Do Chinese International Students View Seeking Mental Health Services?

This study explored how Chinese international students view seeking mental health services. One hundred and ten Chinese international students responded to the Attitude Toward Seeking Professional Psychological Help Scale–Short Form (ATSPPH-SF) and a demographic questionnaire. Results of our data analysis revealed no significant main effects of the demographic factors (gender, length of stay in the United States, and awareness of on-campus counseling services) on attitudes toward seeking mental health services. However, awareness of on-campus counseling services was found to be a mediating factor in the relationship between gender and students’ mental health help-seeking attitudes. Based on the findings, we make recommendations on how student affairs professionals can better serve the mental health needs of Chinese and other international students.

SUSTAINABILITY, EQUITY AND EFFECTIVENESS IN PUBLIC FINANCING FOR HEALTH IN UGANDA: AN ASSESSMENT OF MATERNAL AND CHILD HEALTH SERVICES

The aim of this assessment was to understand whether financing for maternal, child health and immunization services are sustainable, efficient, effective and equitable. Data sources included various national and international reports related to financing maternal and child health services. The results show that funding for maternal and child health (MCH) services are unsustainable over the long term because the main financing source are out-of-pocket (67% of total for MCH). However, Uganda shows higher efficiency in delivery as it has the lowest average cost per delivery (USD 50) compared to USD 70 (Kenya) and USD 95 (Ghana). Overall, MCH interventions being financed show some levels of effectiveness; e.g. maternal mortality rates dropped from 420/100000 live births in 2010 to 343/100000 live births in 2016; under-5 mortality rates reduced from 151/1000 live births in 2000 to 64/1000 live births in 2016. There are however, inequities by region, age, education status and wealth index; e.g. 37% in the poorest quintile have unmet family planning needs compared to only 23% in the wealthiest quintile. In conclusion, public financing for primary services such as MCH requires reforms to strengthen health sector performance. The reforms should address sustainable financing, efficiency, effectiveness and equity in service delivery.