Low Healthcare Research Articles

The GLAMM1 Study - Global Access to Myeloma Medications: Potential Barriers to Chimeric Antigen Receptors (CART) and T-Cell-Engaging Bispecific Antibodies (TCE) Globally

Introduction: Novel B cell maturation antigen (BCMA) directed therapies including chimeric antigen receptor- T (CART) such as idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) have been approved since 2021. More recently in 2022, the first BCMA-directed T-cell-engager (TCE), teclistamab (tec), was also approved for the treatment of relapsed/ refractory multiple myeloma (RRMM). Unfortunately, limited access to these therapies worldwide appears to be a major challenge. This study aims to gain insight into the variation in access to these therapies, and barriers to access. Methods: This study was an electronic survey of 176 hematologists/oncologists in centers across the globe outside the USA who treat MM and was conducted in collaboration with US Myeloma Innovations Research Collaborative (USMIRC). The survey was distributed from June 18 th 2023, to July 15 th 2023. Sections included demographics of respondents, availability of drugs in the country, and barriers to access. The respondents categorized each medication as “easily accessible”, “moderately accessible,” “not readily accessible” or “no access”. To categorize a country/region as having “adequate access”, the cut-off was 60% of responders affirming easy/moderately easy access. We investigated whether higher healthcare spending in a country is associated with better drug accessibility. Health expenditure (HE) of a country's Gross domestic product (GDP) from the World Bank was utilized to categorize countries into two groups: “High healthcare investing nations” (HHIN), which included countries spending >10% of their GDP on healthcare, while “Low healthcare investing nations” (LHIN) included countries spending <10% on healthcare. An interim analysis is reported. Results: There were 95 (54%) completed responses from 33 countries. Most (51%) were university-based academic centers and only 17% were centers with a dedicated focus in plasma cell disorders. Only 17% reported adequate access to ide-cel and 16% to cilta-cel, while a limited, yet higher number of respondents had adequate access to tec (23%). Refer to Table 1 Access to CART (ide-cel and cilta-cel): Globally, only 3 of the 33 (9%) countries had access to ide-cel, cilta-cel or both (France, Morocco, Saudi-Arabia). All other countries had limited access. When grouped by continent, none of the continents had adequate access to CART. Both HHIN and LHIN countries had limited access to CART. Access to TCE (tec): Seven of the 33 (21%) countries had adequate access to tec (Switzerland, Netherlands, France, Portugal, Czech Republic, Morrocco, Saudi Arabia). All other countries had limited access. When grouped by continent, although Europe had the most access, none of the continents had adequate access to TEC. Both HHIN and LHIN countries had limited access to TCE, although relatively, TEC was more accessible compared to CART. Figure 1 summarizes access to CART and TCE Barriers to access: Other than Europe, the most common barrier for ide-cel, cilta-cel and tec was cited as financial burden for patients. Financial burden for patients as a top barrier for each of the products by continent was as follows: Asia (83%), South America (64%), Africa (71%) Australia (100%), and North America (100%). In Europe, for CART, financial burden remained a top barrier (50%) along with local agency approval (50% for ide-cel, 44% for cilta-cel). In Europe, the most cited barrier for TCE was the financial burden for patients (44%), while (33%) of oncologists reported no barrier to TCE. Reimbursement for CART and TCE in Europe requires phase 3 randomized controlled trial data, which is just emerging since 2022 for CART and relatively increased access may be due to the presence of compassionate use programs. Conclusion : The survey is the first attempt to highlight the significantly limited global access to novel therapies (ide-cel, cilta-cel, and tec) for the treatment of RRMM. All continents including HHIN had limited access to CART and TCE. Noticeably, CART is less accessible than TCE, even though approved earlier. The main barrier to both CART and TCE is reported as financial burden for patients. USMIRC in collaboration with oncologists worldwide, global agencies, governments, regulatory agencies, policymakers and industry partners, is planning to further explore restrictions to access to CART and TCE and strategies to overcome these barriers.

Evaluating Trainees' Experiences with Intravenous Iron Use

Background: Iron deficiency (ID) and iron deficiency anemia (IDA) cause significant morbidity. Despite being a disease of high prevalence, affecting people with heart failure, chronic kidney disease, heavy menstrual bleeding, irritable bowel disease, hereditary hemorrhagic telangiectasia (HHT), and bariatric surgery, it has low healthcare priority. The World Health Organization (WHO) estimates 37% of people who are pregnant, and 30% of women 15-49 years of age worldwide are anemic. Fibroids, which are the leading cause of abnormal uterine bleeding, disproportionately impact people of color. ID and IDA cause fatigue, impaired cognitive function, and poor mental health, eroding quality of life and personal productivity. In addition, IDA has been associated with an increase in all-cause mortality is associated with an increased risk of arterial and venous thrombosis. Under-treatment of IDA results in avoidable hospitalizations, emergency room visits, blood transfusions, decreased HRQoL, and loss of personal productivity. Despite the significant impact ID and IDA can have on morbidity, mortality, and quality of life, intravenous iron remains underutilized. No study has been performed to date to assess provider practices, knowledge, and perceptions of intravenous iron use. This qualitative study aims to understand trainees' experiences with intravenous iron use in patients with ID and IDA. Methods: We conducted an inductive reflective thematic analysis of semi-structured qualitative interviews from five focus groups to understand trainees' experiences with and barriers to prescribing intravenous iron in patients with ID and IDA. Internal medicine residents from academic institutions across the country were recruited via snowball sampling. Chief residents from six internal medicine programs were contacted to disseminate sign up links to their residents; programs were chosen for geographic diversity. Results: Twenty-eight internal medicine residents responded and nineteen residents across five institutions participated (PGY levels 1-3). Thematic analysis of trainees' experiences of caring for patients with conditions characterized by iron deficiency resulted in three main themes: education, systemic factors, and practice pattern. Participants identified a wide range of conditions for which they consider administration of oral or intravenous iron. However, they generally expressed uncertainty as to whether evidence-based guidelines exist to guide their decision-making with the exception of intravenous iron administration in heart failure patients. In addition, systemic factors, such as setting, support staff, hospital formularies, order sets, and insurance status often impacted their decision to use intravenous iron. Conclusions: There is a wide variation among residents' practice patterns in regard to their comfort with prescribing intravenous iron. The ease or hesitancy with which they do so is greatly influenced by educational and systemic factors. By gaining a deeper understanding of the experiences of trainees we can lay the foundation to develop evidence-based guidelines and educational initiatives for conditions characterized by ID and IDA. Additionally, by identifying both institutional facilitators and barriers, we can cultivate system-based initiatives to improve access to intravenous iron. To assess this need on a larger scale, our next step involves developing a survey that will be widely distributed via national societies. While cost, insurance status, and need for specialty referral were identified as barriers for intravenous iron use, there was no explicit discussion of how these barriers may contribute to healthcare inequity for underserved populations.

Social inequalities in trajectories of contacts with the healthcare system in adolescence and young adulthood

BackgroundUnderstanding of healthcare utilization of different populations is useful for prevention and prioritization of healthcare resources. This study aims to identify populations following different trajectories of contacts with the healthcare system and to describe social inequalities between the groups. MethodsIndividuals born 1980–2000 in Denmark were linked to national registers. Contacts with somatic hospitals, psychiatric hospitals, general practitioners, and redeemed prescriptions were counted for each year between 16 and 37 years of age. Trajectories of contacts with the four dimensions of healthcare use were identified using group-based multi-trajectory modeling. ResultsFive trajectory groups were identified. One group had low healthcare utilization over time (12% in women; 27% in men). The largest group had low healthcare utilization but more contacts with especially GP (39% in women; 43% in men). A third group had more contacts with most dimensions of the healthcare system (33% in women; 21% in men). The fourth group had many contacts with especially somatic hospitals and GP (7% in women; 4% in men). The fifth group had many contacts especially to psychiatric hospitals (8% in women; 5% in men). Shorter parental education, parental unemployment, family income below the poverty line, and cohabitation with one or no parent was more frequent in the two high utilization groups compared to the lower utilization groups. ConclusionThe observed trajectories of health service use and the social inequalities between trajectory groups highlight that prevention and treatment targeting the entire population will benefit from a complementary focus on social inequalities in health.

Point-of-Care Lung Ultrasound in the Intensive Care Unit-The Dark Side of Radiology: Where Do We Stand?

Patients in intensive care units (ICUs) are critically ill and require constant monitoring of clinical conditions. Due to the severity of the underlying disease and the need to monitor devices, imaging plays a crucial role in critically ill patients' care. Given the clinical complexity of these patients, who typically need respiratory assistance as well as continuous monitoring of vital functions and equipment, computed tomography (CT) can be regarded as the diagnostic gold standard, although it is not a bedside diagnostic technique. Despite its limitations, portable chest X-ray (CXR) is still today an essential diagnostic tool used in the ICU. Being a widely accessible imaging technique, which can be performed at the patient's bedside and at a low healthcare cost, it provides additional diagnostic support to the patient's clinical management. In recent years, the use of point-of-care lung ultrasound (LUS) in ICUs for procedure guidance, diagnosis, and screening has proliferated, and it is usually performed at the patient's bedside. This review illustrates the role of point-of-care LUS in ICUs from a purely radiological point of view as an advanced method in ICU CXR reports to improve the interpretation and monitoring of lung CXR findings.

Cancer risk behavior and healthcare utilization among people experiencing homelessness in Europe

Abstract Background People experiencing homelessness (PEH) are a vulnerable population, having higher cancer morbidity and mortality compared to the housed population. Reasons for this may be due to higher prevalence of risky health behaviors but also owning to barrier to access and utilize healthcare services. This study aimed to show the prevalence of risky health behavior and utilization of healthcare services in PEH in Austria, Greece, Spain and the UK. Methods Data from 262 PEH participating in an ongoing longitudinal study on cancer prevention and early detection were included in a preliminary analysis (03/2023). Participants were adults, with no history of cancer recruited during their visits to social and healthcare services. Demographic data, high-risk health behaviors and visits to healthcare services were collected via questionnaires. Results Mean age of participants was 47.6 years (SD = 12.9) with 56.2% identifying themselves as male. The majority (50.4%) were homeless for up to 3 years and 61.6% had no history of homelessness. On average, 13.6 (SD = 10.2) cigarettes per day were reported by 62% of active smokers, 51% reported regular alcohol intake and 20.6% reported use of illicit drugs. Multimorbidity (co-occurrence of two or more chronic illnesses) was prevalent in 20.2% of participants. Half of participants reported having health insurance and 55% reported utilizing health care services in the past 12 months. The average number of visits to general practitioners and medical specialists was 3.9 (SD = 5.5) and 2.1 (SD = 5.1), respectively with an average of 2.2 (SD = 7.3) nights spent in hospital. Conclusions The proportion of PHE engaging in high-risk health behaviors is higher and utilization of health services is lower compared to the housed population. PEH may benefit from improved access to preventive and community health services, which is currently assessed by implementing the Health Navigator Model as part of the Horizon 2020 CANCERLESS project (GA965351). Key messages • High prevalence of risky health behaviors and multimorbidity in PEH was observed. • The reported low health care utilization among PEH may be due to structural barriers.

Health Literacy in a migrant portuguese speaking community in Portugal and healthcare use

Abstract Background Health Literacy is strongly related with barriers to accessing healthcare services. Migrants may represent a vulnerable population in this matter, usually correlated with the language barrier. We aim to answer the question “Which are the perceptions, behaviors and skills of a migrant Portuguese speaking community using and getting access to health care in Portugal?” Methods Descriptive, cross-sectional and exploratory study. The Health Literacy Questionnaire (Osborne et al.,2013) was applied with a sociodemographic and health characterization. Data were collected and processed from a sample of 101 participants from a group of 570 people from a migrant community, all native Portuguese speakers mostly born in African Countries with Portuguese as an Official Language. Results The sample represented 17,7% of the total population. Thus, a confidence level of 95% and a margin of error of 9% were assumed. In the Health Literacy Questionnaire, the Cronbach's Alpha internal consistency coefficient was calculated as between 0.714 and 0.928. The analysis dimensions were mostly positioned below the average of the scale and were influenced by education, migratory status and age. “Feeling understood and supported by health professionals” had the worst score. There were better results in those who sought primary health care services and who had chronic illnesses. Self-rated health worsened with increasing length of stay in the country. Approximately 31% never attended healthcare in Portugal because they did not feel the need or were unable to access it. Conclusions This study demonstrated the association between health literacy with migrants and healthcare use excluding the language factor. This community presented low healthcare services use and low health literacy levels despite the use of the same language. Interaction with primary healthcare services improved migrants health literacy. This study supported a community intervention with public and private stakeholders. Key messages • Migrants places potential constraints on healthcare utilisation in destination countries that are not necessarily related to language barrier. • Health Literacy is crucial to migrants health, health care access and Public Health improvement.

Low back pain-related healthcare utilization following intraosseous basivertebral nerve radiofrequency ablation: a pooled analysis from three prospective clinical trials.

The effectiveness and safety of intraosseous basivertebral nerve ablation (BVNA) for treating vertebrogenic pain is established, but low back pain-related healthcare utilization (LBPr-HU) following BVNA continues to be defined. LBPr-HU data were pooled from 3 prospective studies. LBPr-HU categories of interest included non-invasive conservative care, opioid utilization, lumbosacral spinal injection (LSI), lumbosacral radiofrequency ablation (LRFA), and lumbosacral spinal surgery. Pre- and post-BVNA LBPr-HU were compared at both 1- and 5-years using McNemar's test for proportions and paired t-tests for means. Two hundred forty-seven patients received BVNA and had 1-year follow-up; 205 had long-term follow-up (mean of 5.3 ± 1.33 years). Twenty-seven percent fewer participants initiated conservative care in the year post-BVNA compared to the year preceding BVNA (P < .001; 95% CI 19.8-34.5). Of 77/247 participants taking opioids at baseline, 40.3% and 61.7% fewer were taking them at one-year and 5.3 ± 1.33 years post-BVNA, respectively (P < .001). Of participants receiving LSIs in the year preceding BVNA, 81.2% fewer received LSI(s) in the year post-BVNA (P < .001; 95% CI 70.7-90.7); a 76.4% reduction in LSIs was maintained through a mean of 5.3 ± 1.33 years post-BVNA. LRFA rates were 1.6% at 1-year post-BVNA and 8.3% at 5.3 ± 1.33 years post-BVNA. Lumbar fusion surgery was 0.8% at 1-year post-BVNA and 6.5% at 5.3 ± 1.33 years post-BVNA. In this aggregate analysis of patients with vertebrogenic pain, utilization of conservative care, opioids, LSIs, and LRFA were substantially reduced through 5 years post-BVNA compared to baseline. Lumbar fusion rates were less than half the published value at 5 years in similar populations.

The impact of ageing on adults with cerebral palsy: the results of a national online survey.

Cerebral palsy (CP) is one of the most common neurological disorders in children and results in lifelong physical impairments. Adults with CP have approximately the same life expectancy as their non-disabled peers, so helping them to stay healthy throughout the life course will have long-term cost benefits via reductions in hospital admissions, long-term care, and unemployment rates. To explore how adults with CP experience ageing. National online survey given to adults with CP in the UK. The participants were adults with CP. Items for the online survey were taken from existing self-report measures, with additional items developed for the survey. Several domains of functioning were assessed including mobility, dexterity, fatigue, pain, speech, mental health, swallowing and health maintenance/self-care as well as healthcare usage. Data were analysed using χ2 to examine the relationships between the demographic variables and the survey responses. The survey was completed by 395 participants, of whom 74.2% were female and approximately 59.3% aged <45 years. Responders reported having problems with mobility, pain, and fatigue with older participants reporting higher levels of pain and more mobility problems, although the correlations were fairly small. Healthcare usage was surprisingly low. The study found that age was associated with a decline in mobility and a higher level of pain, although the relationships were weak. It is possible that the low healthcare usage among the responders is owing to services not being available to respond to their needs.

Adverse Childhood Experiences, Preventive Care Utilization, and Patient-Nurse Trust Relationship Among Sexual and Gender Minority Individuals.

Individuals who identify as sexual and gender minorities often experience high rates of adverse childhood experiences and encounter discrimination and stigma in their interactions with healthcare providers, leading to low utilization of healthcare services. However, the relationship between adverse childhood experiences, preventive care utilization, and trust in nurses among sexual and gender minority individuals remains unclear. This study explored the relationship between adverse childhood experiences and preventive care use and assessed the potential interaction effects of trust in nurses between adverse childhood experiences and preventive care use among individuals from sexual and gender minorities. A cross-sectional design was used. A sample of 160 self-reported individuals from sexual and gender minorities completed an electronic online survey. Multiple linear regression and moderation analyses were conducted to examine the association between adverse childhood experiences, preventive care utilization, and nurse trust. There was a significant negative relationship between adverse childhood experiences and preventive care utilization. There was also a significant positive relationship between trust and preventive care utilization. The results also indicated that trust in nurses moderated the relationship between adverse childhood experiences and preventive care utilization among sexual and gender minority individuals. A significant relationship was found between a high prevalence of adverse childhood experiences and low healthcare service utilization. Strengthening the trust relationship between nurses and sexual and gender minority individuals could serve as a potential intervention point, leading to improved health outcomes for this vulnerable population. Hence, enhancing trust in nurses could be a key factor in increasing healthcare service utilization and overall health outcomes.

A Qualitative Study of Participant Perceptions of a Cancer Research Education Program.

Kentucky ranks first in the nation in cancer incidence and mortality rates, with the greatest burden of disease being in the Appalachian region. The cancer disparities in the Appalachian region of the state are tied to high poverty rates, low education attainment, low health care access, and high rates of poor health behaviors, such as tobacco use. The University of Kentucky (UK) Markey Cancer Center (MCC) developed the Appalachian Career Training in Oncology (ACTION) program to address the cancer and education disparities in the region. ACTION is a two-year program that focuses on cancer education and training for high school and undergraduate students from Appalachian Kentucky and features a variety of cancer-focused training activities, including faculty-mentored cancer research, clinical shadowing opportunities, cancer education activities, career development support, and community outreach projects. ACTION has been funded by the National Cancer Institute as a Youth Enjoy Science R25 research education program since 2018. The qualitative study herein used a semi-structured interview approach to identify participants' perceptions of the program including the influential aspects that have helped students pursue their desired academic career paths. Ten ACTION alumni were chosen to participate in the study, including students currently in medical school, graduate school, physician assistant school, and pharmacy school. Thematic analysis generated five themes: motivation for participation, career development, mentorship and future opportunities, knowledge gained, and program improvements. Overall, this study demonstrates that the ACTION program is having a significant impact on students' career preparation.

Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain

ObjectivesChronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently...

A cross-sectional study of the relationship between depression status, health care coverage, and sexual orientation

Health care coverage is an important factor in receipt of behavioral healthcare. This study uses data from the New York City Community Health Survey to examine how sexual minority status impacts the relationship between depression status and having health care coverage. Approximately 10% of the sample (n = 9571; 47% 45+ years old; 35% White Non-Hispanic; 7% sexual minority) reported probable depression and low health care coverage. Compared to heterosexual participants, a greater proportion of sexual minority participants had low health care coverage (17% vs. 9%) and probable depression (19% vs. 9%). Logistic regression examining the association between probable depression status and health care coverage showed that those with probable depression have odds of low health care coverage that are were 3.08 times those who did not have probable depression; this relationship was not modified by sexual orientation. Continued research to understand the interplay of health care coverage, mental health, and sexual orientation is needed.

Societal burden and quality of life in patients with Lisfranc Injuries

BackgroundThe incidence of Lisfranc fractures is rising, along with the incidence of foot fractures in general. These injuries can lead to long-term healthcare use and societal costs. Current economic evaluation studies are scarce in Lisfranc fracture research, and only investigate the healthcare costs. The aim of the present study was to accurately measure the monetary societal burden of disease and quality of life in the first 6 months after the injury in patients with Lisfranc fractures in the Netherlands. Materials and methodsThis study used a prevalence-based, bottom-up approach. Patients were included through thirteen medical centres in the Netherlands. Both stable and unstable injuries were included. The societal perspective was used. The costs were measured at baseline, 12 weeks and 6 months using the iMTA MCQ and PCQ questionnaires. Reference prices were used for valuation. Quality-of-life was measured using the EQ-5D-5 L and VAS scores. Results214 patients were included. The mean age was 45.9 years, and 24.3% of patients had comorbidities. The baseline questionnaires yielded approximately €2023 as the total societal costs in the 3 months prior to injury. The follow-up questionnaires and surgery costs assessment yielded approximately €17,083 as the total costs in the first 6 months after injury. Of these costs, approximately two thirds could be attributed to productivity losses. The EQ-5D-5 L found a mean index value of 0.449 at baseline and an index value of 0.737 at the 6-month follow-up. ConclusionThe total monetary societal costs in the first 6 months after injury are approximately €17,083. Approximately two thirds of these costs can be attributed to productivity losses. These costs appear to be somewhat higher than those found in other studies. However, these studies only included the healthcare costs. Furthermore, the baseline costs indicate relatively low healthcare usage before the injury compared to the average Dutch patient. The mean QoL index was 0.462 at baseline and 0.737 at 6 months, indicating a rise in QoL after treatment as well as a long-lasting impact on QoL. To our knowledge, this is only the first study investigating the societal costs of Lisfranc injuries, so more research is needed.

1035-P: Area Deprivation Index and Rates of Specialty Care in Monogenic Diabetes Registry Participants

While diabetes is one of the most common chronic medical conditions, monogenic forms of diabetes represent a rare subtype, and face barriers to timely diagnosis similar to other rare diseases (RD), which are exacerbated by low health literacy (HL) and health care access barriers. The Monogenic Diabetes Registry (MDR) follows more than 1,200 participants with molecular diagnoses of monogenic diabetes who can offer insight into diagnostic barriers and facilitators. Aim: To assess area deprivation index (ADI- a measure of neighborhood disadvantage in the US) as a proxy of HL and health care provider type (specialist versus generalist) as a proxy of health care access in a subset of MDR participants with maturity-onset diabetes of the young (MODY). Methods: Cross-sectional analysis of REDCap data for 79 participants. ADI was constructed for each participant and descriptive statistics were analyzed with RStudio. Kruskal-Wallis was used for comparisons. Results: The median ADI of MDR participants was 26 (less than expected value of 50; p&amp;lt;0.001). Only 20% were from neighborhoods with &amp;gt;50th %ile deprivation. Sixty-two percent were under specialty care for diabetes. The median ADI for those under specialist care was lower than for those under generalist care (23 versus 36), but did not reach statistical significance. There was no difference in median ADI between participants receiving clinical versus research genetic testing or between those referred by providers versus self-referral. Discussion: ADI inversely correlates with HL and SES. MDR participants had ADI percentiles below the national median and a majority were under the care of diabetes specialists compared to ~15% of the general US population living with diabetes. These findings suggest inequity in who finds and enrolls in the Registry, and mimics the broader RD literature. Efforts are needed to better reach populations disproportionately affected by health disparities to ensure equity in monogenic diabetes diagnosis and management. Disclosure R.G.Son: None. R.N.Naylor: None. S.Uiversity of chicago monogenic diabetes registry : n/a. Funding National Institutes of Health (R01DK104942, P30DK020595, K23DK114564, UL1TR000430)

A systematic review protocol for identifying the effectiveness of greenhouse gas mitigation interventions for health care systems in low- and middle-income countries.

Background: Climate change is predicted to be our century's most significant health threat. In 2021, 46 countries committed to environmentally sustainable low carbon health care systems. Of those, 34 were from low- and middle-income countries (LMICs). Currently, health systems are responsible for 4.4% of global greenhouse gas (GHG) emissions, with health systems in high-income countries (HICs) contributing the largest proportion to the sector's GHG emissions. However, future increases are predicted in LMICs in the absence of robust GHG mitigation. This systematic review aims to identify evidence-based GHG mitigation interventions to guide the transformation of health care systems towards net zero, specifically in LMICs. Additionally, potential synergies between interventions that aid adaption to climate change and mitigate GHG emissions will be investigated. Methods: This protocol will follow the 'Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist of recommended items to address in a systematic review protocol'. A comprehensive search will be conducted on electronic databases identified as relevant. Search terms were identified to capture all relevant peer-reviewed, primary research published between 1990 and 2022. The risk of bias will be assessed, and the quality of evidence graded. The eventual narrative synthesis will feed into a theory of change framework on GHG mitigation of health care systems in LMICs. Discussion: This systematic review will synthesise the existing evidence around GHG mitigation interventions across all scopes of emissions, including scope 1 (health care operations), scope 2 (energy), and scope 3 (supply chains). It can be used to inform recommendations on how health care systems in LMICs can reduce emissions while prioritising which actions to take to gain the most significant reductions in GHG emissions, considering ease of implementation, scope and cost. Finally, this can catalyse further research in this area which is urgently needed.

The impact of low socioeconomic statusand primary health care access on emergency department presentations in young children in regional Queensland.

The purpose of this study was to empirically evaluate if children from low socio-economic status (SES) families in regional southeast Queensland utilise acute care services for low acuity health care rather than utilising primary health services. A retrospective audit of children under the age of 5 years presented at a regional hospital emergency department (ED) over a 12-month period. Medical records were examined for presenting problem, Australasian triage category, care outcomes, whether the child's parent/guardian held an Australian concession/health care card (AC/HCC) and accessed child health services or a general medical practitioner (GP). Eight hundred and eighty-eight children who had not reached their fifth birthday presented to ED between 1 June 2019 and 31 May 2020, with a total of 1691 presentations. Most children were bought to the ED by their parents with semi-urgent health concerns and were discharged home following medical review. Holding an AC/HCC was a significant predictor for hospital presentation. Holding an AC/HCC was not associated with access to child health services. However, accessing child health services resulted in a small but significant increase in hospital presentations. The AC/HCC may be an important proxy to identify low SES individuals. These card holders tended to use acute services more frequently than those who did not qualify for an AC/HCC. Furthermore, families that engage with primary care services such as child health also accessed acute care services more frequently. The results indicate accessing primary health-care services does not ameliorate the use of acute care services.

Health care workers' self-perceived infection risk and COVID-19 vaccine uptake: A mixed methods study.

Vaccination is the most cost-effective way of preventing Coronavirus Disease 2019 (COVID-19) although there was a considerable delay in its institution in Tanzania. This study assessed health care workers' (HCWs) self-perceived infection risk and uptake of COVID-19 vaccines. A concurrent embedded, mixed methods design was utilized to collect data among HCWs in seven Tanzanian regions. Quantitative data was collected using a validated, pre-piloted, interviewer administered questionnaire whereas in-depth interviews (IDIs) and focus group discussions (FGDs) gathered qualitative data. Descriptive analyses were performed while chi-square test and logistic regression were used to test for associations across categories. Thematic analysis was used to analyze the qualitative data. A total of 1,368 HCWs responded to the quantitative tool, 26 participated in the IDIs and 74 in FGDs. About half of the HCW (53.6%) reported to have been vaccinated and three quarters (75.5%) self-perceived to be at a high risk of acquiring COVID-19 infection. High perceived infection risk was associated with increased COVID-19 vaccine uptake (OR 1.535). Participants perceived that the nature of their work and the working environment in the health facilities increased their infection risk. Limited availability and use of personal protective equipment (PPE) was reported to elevate the perceived infection risks. Participants in the oldest age group and from low and mid-level health care facilities had higher proportions with a high-risk perception of acquiring COVID-19 infection. Only about half of the HCWs reported to be vaccinated albeit the majority recounted higher perception of risk to contracting COVID-19 due to their working environment, including limited availability and use of PPE. Efforts to address heightened perceived-risks should include improving the working environment, availability of PPE and continue updating HCWs on the benefits of COVID-19 vaccine to limit their infection risks and consequent transmission to their patients and public.

Examining the Effectiveness of Financial Protection Schemes in Reducing Health Inequality.

Health protection schemes such as health insurance and financial assistance provide immense help and support to access health care services, especially to the poor and marginalized section of society. India is witness to low health-related expenditure, and the society's socioeconomic and demographic structure further drops health care access to the new bottom. Consequently, inequality in health care access is highly observed across many socioeconomic attributes. The condition of Bihar, the poorest state of India, is more alarming. The analysis suggests that financial support in terms of universal health insurance coverage considerably reduces out-of-pocket expenditure and thus health inequality. Further, the low health insurance coverage is not solely due to a lack of institutional commitment and implementation process; the cognitive behavior and attitude of people are equally responsible for low health care access. An intensive awareness program to show the benefit of the health insurance scheme and sensitization of people against the social stigma is important to provide better health care access and reduce health inequality.

Prevalence of and racial/ethnic distribution of full-body skin examination among sexual and gender minority patients.

10557 Background: Skin cancer disproportionately affects sexual and gender minorities in the United States. A full-body skin examination (FBSE) can help detect early signs of skin cancer and is an important prevention method. However, there are no national guidelines of routine FBSE for skin cancer. Further, data on FBSE participation among lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) patients are lacking, and little is known about the racial/ethnic distribution of FBSE in this patient population. Methods: Cross-sectional survey data on FBSE participation and key characteristics were collected from patients who were recruited at clinics and community centers or via social media from August 2022 to January 2023. Eligibility criteria included being at least 18 years old and self-identifying as LGBTQ+. Receipt of an FBSE, assessed by asking patients whether they had ever received an FBSE in the past, was dichotomized as yes and no. Descriptive statistics, i.e., mean (SD) and count (%), were calculated, with distribution comparisons using Student’s t, Pearson’s Chi-square, or Fisher’s exact tests as appropriate. Results: A total of 124 LGBTQ+ patients responded to the survey. The mean age was 32.4 (SD = 12.1) years. Overall, 41.5% of the patients reported ever having received an FBSE in the past. By race/ethnicity, 62.5% of Non-Hispanic Black patients reported ever having received an FBSE, followed by 52.1% of Non-Hispanic White, 28.6% of Hispanic or Latino, 28.6% of multiple races, and 10.5% of Asian ( p= 0.005). By gender identity, 61.5% of transgender male patients reported receipt of an FBSE in the past, followed by 57.1% of transgender female, 39.3% of cisgender female, 35.4% of cisgender male, and 35.0% of genderqueer, non-binary, or gender non-conforming. Comparing patients who reported ever having received an FBSE, those who did not were more likely to not be employed (47.9% vs. 26.0%, p= 0.046), to be on Medicaid (18.5% vs. 6.1%, p= 0.074), to not have visited a dermatologist in the past (41.7% vs. 7.8%, p&lt; 0.001), and to not have been told at an increased risk for skin cancer (87.3% vs. 43.2%, p&lt; 0.001). No significant differences in educational attainment or sexual orientation were observed between patients who reported ever having received an FBSE and those who did not. Conclusions: The prevalence of FBSE was higher among Non-Hispanic Black or Non-Hispanic White LGBTQ+ patients than among those who are Hispanic or Latino, multiracial, or Asian. In addition, our findings suggest that low socioeconomic status and health care utilization may influence FBSE access or participation in LGBTQ+ patients. Strategies for improving equitable access to FBSE among LGBTQ+ patients, particularly among those with ethnic minority background or low socioeconomic status and health care utilization, may be needed.

ResQvent: A Practical Solution for Addressing the Needs of Mechanical Ventilation in Low Resource and Income Healthcare Settings

ResQvent: A Practical Solution for Addressing the Needs of Mechanical Ventilation in Low Resource and Income Healthcare Settings