Utilization Of Services Research Articles

Abstract A147: A ten-year overview of cancer genetic family history screening in Georgia’s Latina population

Abstract Introduction: Population-based cancer genetic family history screening to identify families at high risk for BRCA-associated cancers has been endorsed by national public health policies. This report aimed to describe the utilization of family history screening services from 2013 to 2022 according to rurality and socioeconomic deprivation among the Latina community in the state of Georgia. Methods: Self-identified Latina women who attended a medical appointment at participating Georgia Public Health Clinics were invited to utilize the cancer genetic family history screening services. Screening results and participant zip code were reviewed. Area deprivation index (ADI) was measured at the census block group level and assessed as a dichotomous variable (more deprived and less deprived). Rurality was measured through Rural-Urban Commuting Area (RUCA) codes and was assessed dichotomously (urban and rural). The ADI and RUCA codes were linked to participant data by zip code to characterize genetic service access among the Latina community. Results: We found 9,330 (3.31%) adult Latinas in Georgia completed cancer genetic family history screening from 2013-2022. In this sample, 9,066 (97.17%) women screened negative, and 264 (2.83%) women screened positive (i.e., family history suggestive of higher risk for carrying BRCA1/2 mutations compared to the general population). The family history screening program reached Latinas in 16 of 18 public health districts in Georgia. However, family history screening completion varied significantly across the 16 districts (mean=327 women, range: 2 - 1,337). FH screening completion was higher among Latinas in urban areas (n=7,871) than Latinas in rural areas (n=1,459). Latinas who lived in more socially deprived areas appeared to have a higher number of screening completion (n=5,207) than those living in less socially deprived areas (n=4,123) due to interaction with urbanicity. Conclusions: Georgia’s family history screening program was able to reach Latina women across the state of Georgia, particularly those living in urban, socially deprived areas. To ensure equitable cancer genetic screening dissemination, future efforts should prioritize tailored outreach in rural regions and a comprehensive evaluation to identify key determinants of screening trends among Georgia’s Latina population. Citation Format: Dayanna A. Ramírez León, Lauren E. Barber, Sheryl Gabram-Mendola, Cindy Snyder, Susan Vadaparampil, Lindsay Fuzzell, Lauren E. McCullough, Lynn Durham, Yue Guan. A ten-year overview of cancer genetic family history screening in Georgia’s Latina population [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A147.

Abstract C007: Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention

Abstract Background. Tobacco use remains a significant public health issue, particularly among the LGBTQ+ community. Los Angeles County, which is home to the second-largest LGBTQ+ population in the US, has notably higher prevalence of tobacco use compared to the general population, partly due to targeted marketing by the tobacco industry, social stressors, and discrimination. These factors contribute to higher rates of smoking and tobacco-related health disparities; however, little is known about the capacity of community-based organizations, clinical providers, support staff, and other personnel that work closely with the LGBTQ+ community to provide smoking cessation services. Methods. Cedars Sinai Cancer Center Community Outreach and Engagement (COE) assisted in the facilitation of conducting a needs assessment, Clinical Provider and Staff Survey, to assess the opinions of clinical providers and community leaders about tobacco cessation-related topics related to 1) Building culturally competent tobacco cessation services; 2) Reducing health disparities in tobacco cessation services; 3) Improving access to care (Medicaid/Medi-Cal access and uptake) for diverse populations that are affected by tobacco-related disparities; 4) Improving the utilization of tobacco cessation services. The survey was administered online from December 2022 to April 2023 with providers throughout Los Angeles County. Results. A total of 261 surveys were collected which revealed several key issues at the organization level: they do not prioritize tobacco screening, treatment, or referrals; there is no standardized process for client management; staff have limited knowledge on tobacco prevention and patient navigation; and there is limited staff capacity and funding. To address organizational-focused barriers, COE trained 147 clinical providers and staff from 4 local health clinics and organizations and on capacity building, including the basics of tobacco, evidence-based interventions like "Ask, Advice, Refer," and lung cancer screening. Additionally, to address Client/Patient-Focused Barriers for Organizations, such as: lack of motivation to quit, low perception of the severity of smoking, and a lack of culturally competent or targeted cessation resources, COE staff assisted in navigating resources, ensuring both providers and clients were aware of and could access relevant support services. This involved sharing LGBTQ+ affirming resources, including medical care, behavioral health, and housing, and referred smokers to gender-affirming cessation support groups. Conclusion. The survey highlighted the need to enhance service delivery and support for the LGBTQ+ community. With these findings, our COE staff were able to increase organizational capacity through training and education for clinical providers and staff to enhance their knowledge and skills in tobacco cessation and share gender-affirming resources and navigation, which are crucial towards improving the overall effectiveness of tobacco cessation services for LGBTQ+ populations. Citation Format: Victor Cristanto, Alexandra Caro, Reener Balingit, Zul Surani. Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C007.

Knowledge And Utilization Of Market-Oriented Agricultural Extension Service Among Farmers In Oyo State, Nigeria

Market-oriented agricultural extension services (MOAES) are pivotal in transforming subsistence farming into a profitable and sustainable venture, thereby reducing rural poverty. This study investigates the knowledge and utilization of market-oriented agricultural extension services among farmers in Oyo State, Nigeria. The study employs a two-stage cluster sampling technique to select 106 farmers from four agricultural zones in Oyo State. Data was collected through structured questionnaires and interview schedules on knowledge, accessibility, utilization, and satisfaction with MOAES provided. The public extension (61.6%) was the primary provider of market-oriented agricultural extension services, with low knowledge and satisfaction. Utilization of the services on types of crops to grow, food safety standards, and sourcing of farm inputs were moderate. Overall utilization of MOAES by 55.7% of the farmers was low. Constraints were poor linkage (x̅=1.90), limited access to credit for input purchases (x̅=1.84), and inadequate price information for various inputs (x̅=1.68). Significant relationships existed between farmers sex (X2=3.259), marital status (X2=0.186), educational level of MOAES (X2=8.055). Strengthening the capacity of extension agents and focusing on value addition are recommended.

Culture, tradition and healthcare: exploring the Kisiizi Community Health Insurance scheme

In southwestern Uganda, a custom of health and social support has been managed through collective organizations known as engozi for centuries. Subscribers advanced help for those who were not able to provide for themselves and their households. Participants pooled financial and food resources, offered emotional assistance, and aided in transporting patients to hospitals. The institution of “free government health amenities” caused the decline of the engozi custom. However, with an insufficient annual health sector budget allocation, the state health services cannot satisfactorily meet the needs. The Kisiizi neighborhood, while depending on the engozi practice, arrived at a CHI system in 1996 as a self-help innovation to eliminate financial obstacles and enhance access to quality health amenities. Numerous studies on CHI have examined the structure, registration and memberships, health-related advantages, and monetary-related benefits, but little has been documented on how cultural beliefs and customs have affected its application. This study aimed to identify the role of culture and customs in tackling healthcare disparities via a CHI strategy. This study adopted a case study methodology and qualitative methods. The study utilizes Woolcock’s social capital theory and Cultural competence theory as the analytical framework. It identifies Brotherhood, Solidarity, Belonging, Cooperation, Volunteering, Reciprocity, and Respect for Authority and Leaders as key values upheld by the engozi tradition, strengthening social capital and laying a solid foundation for successful CHI. This study also identified that societal values and traditions have significantly impacted the implementation of the Kisiizi CHI scheme, as evidenced by the influence on CHI leadership and governance, collecting premium fees from subscribers, mobilization and registration of participants, and information dissemination. Lastly, the study identified that CHI has positively affected healthcare challenges within the community, evidenced by increased utilization of healthcare services, improved access to antenatal care, health promotion and disease prevention initiatives, and improved quality of services due to user feedback.

Immunization Status, Immunization Coverage, and Factors Associated with Immunization Service Utilization Among HIV-Exposed and HIV-Infected Children in India

Immunization Status, Immunization Coverage, and Factors Associated with Immunization Service Utilization Among HIV-Exposed and HIV-Infected Children in India

Eye care service utilization and associated factors among adults in Debre Berhan Town, North Shewa, Ethiopia, 2023.

Globally, the utilization of eye care services varies widely, ranging from 18 to 90%. Low utilization of eye care services can lead to delayed detection of vision problems. However, there are limited data on the proportion of eye care service utilization and its associated factors in Ethiopia at the community level. The objective of this study was to determine the proportion of eye care service utilization and its associated factors among adults in Debre Birhan town, North Shewa, Ethiopia. Using a multistage sampling method, a community-based cross-sectional study was conducted on 960 adults in Debre Birhan town from 8 May to 8 June 2023. Binary logistic regression was performed. Variables with a p-value of less than 0.05 were considered significant. A total of 940 study participants participated, resulting in a response rate of 97.9%. The mean age of the participants was 54.67 years (SD ± 8.69). The proportion of good-level eye care service utilization was found to be 32.98% [95% confidence interval (CI): 29.97, 35.99]. Factors positively associated with good-level eye care service utilization included older age [adjusted odds ratio (AOR) = 1.58, 95%CI: 1.00, 2.51], higher educational status (AOR = 2.25, 95%CI: 1.25, 4.06), high family monthly income (AOR = 8.70, 95%CI: 4.99,15.18), awareness of regular eye checkups (AOR = 1.77, 95%CI: 1.15, 2.73), a history of eye disease (AOR = 2.57, 95%CI: 1.77,3.74), health insurance (AOR = 1.99, 95% CI: 1.34, 2.95), and history of spectacle use (AOR = 1.94, 95%CI:1.34, 2.80). The study revealed that the proportion of good-level eye care service utilization was low. Older age, higher educational status, high family monthly income, awareness of regular eye checkups, a history of eye disease, health insurance, and history of spectacle use were significantly associated with a good level of eye care service utilization.

Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students

BackgroundAustralia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia.MethodsSemi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19–30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels.ResultsChinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information.ConclusionsOur study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

A Qualitative Exploration of Refugee Experiences of Access to a Dedicated Multi-Disciplinary Refugee Health Team in an Australian Context: Implication for Future Care

Aims Refugees experience physical and mental health issues that need attention following settlement in a new community. However, access to and utilisation of healthcare services is challenging. We aimed to explore the experience of refugee access to a dedicated multi-disciplinary refugee health team. Methods An interpretative qualitative study. 17 qualitative interviews were conducted with Ezidi refugees who attended a newly established multi-disciplinary refugee health program in a regional town in NSW, Australia. Data were analysed using an inductive thematic approach. Results Participants ( n = 17) identified as Ezidi and were from Iraq. Parents were between 23 and 57 years of age and had 1–12 children per family. Most had been in Australia between 2 and 5 years. Four key themes were identified: (1) Identifying the extent of health needs following a long wait to migrate; (2) Health support across the life span: the benefit of access to a multi-disciplinary team; (3) Gaps in cultural competence – impacted by understanding and interpreter access; and (4) Ongoing health and lifestyle concerns – influenced by understanding and education. Conclusions We identified the benefit of access to allied health for prompt diagnosis, treatment and management of conditions including congenital and developmental conditions, mental health and chronic diseases. Access to a dedicated team ensured early intervention for a broad range of health and social issues including early referral to services, close coordination and help to complete supporting paperwork and applications. Ongoing investments are needed to maintain this comprehensive and coordinated approach to care that is underpinned by a family centric approach.

Voluntary private health insurance and cancer screening utilisation in Europe.

Cancer is a leading cause of death in Europe and prevention measures, like screening, are therefore becoming increasingly important. Although European countries provide universal health coverage, including cancer screenings, many people also have private health insurance. The aim of this study is to analyse the relationship between Voluntary private health insurance (VPHI) and cancer screening, specifically breast and colorectal cancer screening. Using data from SHARE, the Survey of Health, Ageing and Retirement in Europe, different logistic and multilevel regressions were estimated. The major finding shows a positive correlation between people being screened for cancer and having VPHI. Three conclusions can be drawn: advantageous selection may exist in private health insurance; spillover effects may exist from the public sector into the private sector, which in turn may result in a lower insurance premium; and there may be a perpetuation of inequalities in health service utilisation. Several policy implications can be drawn from this result, but the most relevant concerns narrowing the inequities that could potentially arise between those who have private health insurance and those who do not.

Psychological Service Utilization and its Impact on Return to Work in Vocational Retraining Centers: A Cohort Study

Psychological Service Utilization and its Impact on Return to Work in Vocational Retraining Centers: A Cohort Study

Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience.

With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans. It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation. An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking. The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices. The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals. Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Why do some Mexicans with psychosis risk symptoms seek mental health care and others do not?

Help-seeking barriers differ according to the sociocultural context and country-specific mental healthcare system. More research is needed in low-middle-income countries, where early psychosis programs are still scarce, and the mental health care gap is wide. This study aims to explore predisposing, enabling, and need factors associated with mental health service utilization in 481 Mexicans self-reporting psychosis risk symptoms, as well as differences between those who were currently mental health service users (MHSU) and those who were not (non-MHSU). Participants responded to self-reported measures through an online survey. The factors associated with an increased probability of using mental health services were having an occupation, having a medium/high socioeconomic status, an intention to seek help from a mental health professional, fewer help-seeking barriers, moderate/severe anxious symptoms, higher distress associated with psychosis risk symptoms and social functioning impairment. Findings provide relevant information for designing more effective strategies to improve help-seeking, early identification, and timely treatment delivery in Mexico. The need to generate strategies focused on reducing stigma, enhancing psychosis literacy in the community, and increasing the identification of emerging signs of psychosis in primary healthcare professionals is highlighted, mainly when co-occurring with other psychiatric symptoms.

Sexual and reproductive health service utilization and associated factors among high school students in Ethiopia: systematic review and meta-analysis.

Several studies have been done on the utilization of sexual and reproductive health services by high school students in Ethiopia, but they have yielded inconsistent results. This study aimed to evaluate the extent to which high school students in Ethiopia are using sexual and reproductive health services by conducting a systematic review and meta-analysis. Various electronic databases such as PubMed, Cochrane Library, AJOL, Google Scholar, and Grey Literature were used to search for relevant articles. Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines were followed for this review and meta-analysis. Heterogeneity was assessed using I2 and Cochrane Q statistical tests, and data analysis was done with STATA 17 software. Random effect meta-analyses were used to determine the overall utilization rate of sexual and reproductive health services. This review included 20 studies with 12, 215 study participants. The pooled magnitude of sexual and reproductive health service utilization among high school students in Ethiopia was 29.79% (95% CI: 25.14, 34.43). Students with grades 11-12 (AOR = 2.33, 95% CI: 1.39, 3.90), aged between 20 and 24 years (AOR = 2.61; 95% CI: 1.79-3.81), having higher level of knowledge towards sexual and reproductive health issues (AOR = 3.10; 95% CI: 1.67-5.77), previous history of sexual intercourse (AOR = 4.18; 95% CI: 2.59-6.75), previous history of sexually transmitted infection (AOR = 3.74; 95% CI: 2.22-6.31), presence of a reproductive health service facility in the school (AOR = 2.55; 95% CI: 1.72-3.77), and ever-discussed reproductive health issues (AOR = 4.04; 95% CI: 1.62-10.03) were more likely to utilize sexual and reproductive health services. The overall utilization of sexual and reproductive services among high school students in Ethiopia was found to be low as compared to SDG 3.7. Older individuals with higher education levels and knowledge about sexual and reproductive health services, as well as those who have had previous sexual experiences or discussions about sexual health, are more likely to utilize reproductive health services. To increase utilization, the Ministry of Health and the Ministry of Education should prioritize these factors.

Tax Dispute Analysis of Incorrect Vat Payment on Offshore Royalty Viewed From the Ease of Administration Principle (Case Study of PT X)

The purposes of this research are: (i) to analyse basic considerations from the Indonesian Tax Authority (ITA) in making regulations regarding the incorrect transfer of VAT on taxable services from outside customs territory which cannot be overbooked; and (ii) to analyse whether the administrative sanctions penalized to the taxpayer are appropriate from the ease of tax administration principle’s perspective. This study is using (i) VAT imposition on intangible taxable goods and services from outside the Indonesian customs territory; (ii) Ease of Administrative principles: certainty, efficiency, convenience of payment, and simplicity as theoretical references. The research is categorized as applied study with a qualitative method using qualitative data collection techniques through literatures and field studies (interview with various key informants from ITA, representatives of the taxpayers, and taxation experts and academia. The qualitative analysis on data/information was done via triangulating process with related theories, VAT laws and regulation, as well as expert opinions. Results of the study conclude that the basis of considerations of the ITA makes regulations for the utilization of Intangible Taxable Goods and Taxable Services from Outside the Customs Territory, which cannot be done with overbook because both offshore VAT objects are difficult to detect and can be used for tax avoidance modus by the taxpayers. The ownership of documentary evidence is actually a foreign party while the person who is supposed to make a transfer request is the owner of the document evidence, and the tax that has been deposited has become a tax credit and will not move to another place other than the state treasury because the tax credit is the taxpayer's right. Considerations taken by ITA have not met the theory of good tax administration because there has been no legal formulation related to this matter and ITA's accountability is still considered to be lacking in terms of supervision and control. Administrative sanctions penalized to PT X due to tax deposit errors are not in accordance with the ease of tax administration principle. Even though it is certainly stipulated in the prevailing law and regulation, but the procedure is so lengthy and detrimental to the taxpayer, increase and disrupt cash flow for business activities carried out by PT X. In terms of efficiency principle, the rejection of overbooking process creates additional compliance costs to the taxpayer, namely: fiscal financial cost, time cost and psychological cost and denial the facts that actually the fund/money have been transferred to the State Treasury. Implications of research: To provide examples of practice in the field of how complicated tax administration procedures can cause unnecessary losses for taxpayers if the tax regulations are not made by taking into account the principle of ease of tax administration. It is also recommended that the tax authorities should reduce administrative burden for the implementation of rights and fulfillment of tax obligations that are too rigid to be more friendly in order to make it easier for taxpayers to carry out their tax obligations and make themselves a facilitator for taxpayers to increase cooperative tax compliance. Originality/value: Ease of carrying out tax obligations for taxpayers must be something that is facilitated by the Tax Authority rather than being subject to penalties and this can be done, one way, through the application of the principle of ease tax administration in the formulation of tax regulations.

Baltimore community resident and collaborator perspectives on the influence of guaranteed income on health: a formative qualitative study

BackgroundGiven increased interest and investment in guaranteed income initiatives across North America, it is critical to understand the impact of guaranteed income on health, an understudied outcome. As part of Baltimore, Maryland’s guaranteed income pilot, we conducted formative research to understand the influence of increased income on health and develop concrete recommendations for implementation and evaluation of the pilot.MethodsWe conducted semi-structured in-depth interviews with Baltimore community residents (n = 8) and community collaborators (n = 8), probing on familiarity with guaranteed income; effect of guaranteed income on overall health and specific health outcomes (e.g., mental health, nutrition); and recommendations for program structure (e.g., eligibility, target population). Data were analyzed thematically using a framework analysis approach.ResultsRespondents agreed that guaranteed income could have beneficial effects on health though some were unsure of specific mechanisms. Respondents emphasized pathways through which guaranteed income could improve health: (1) reduced financial-related stress; (2) improved nutrition through purchase of healthier foods; (3) improved family well-being including child health and parent-child relationships; (4) increased utilization of health services; (5) improved community health through increased community cohesion and decreased violence. Respondents described decreased feelings of time scarcity as a social determinant of health. Most respondents reported that Baltimore’s guaranteed income program should prioritize young, low-income families with $1,000/month or more for at least one year.ConclusionsThis formative research on the potential health impacts of guaranteed income in Baltimore highlights important health outcomes and pathways, such as social cohesion and decreased feelings of time scarcity, to prioritize for evaluation.

Segmented assimilation trajectories of physician trust among internal migrants in Shanghai, China: A cross-sectional study

Physician trust is necessary for improving physician–patient relationships and maintaining an effective health-care system. Most studies on the theory of segmentation assimilation have mainly focused on comparing immigrants in different countries and few studies have applied segmented assimilation to clarify physician–patient relationships, especially physician trust among internal migrants in the context of Chinese megacities. A random sample of 1200 internal migrants was collected through an online questionnaire conducted in Shanghai from August to December 2021. An exploratory K-means cluster analysis and multivariate logistic regression models were employed to identify patterns of segmented assimilation and examine their relationships with physician trust, as well as the factors influencing physician trust among internal migrants in Shanghai. Results show four main patterns were revealed, namely first-generation classic assimilation, first-generation integrative assimilation, first-generation segmentation, and second-generation underclass assimilation, supporting the theory of segmented assimilation. Association between assimilation pattern and physician trust was observed. A relationship was found between assimilation patterns and trust in physicians. Migrants belonging to the first-generation classic and integrative assimilation groups exhibited a higher level of trust in doctors compared to those in the segmented assimilation groups. Additionally, undergraduate and postgraduate education attainment, an annual income of <400 000 yuan, visiting the physician ≥2 times in the past year, and self-rated health status before and after population floating were significant contributing factors for good physician trust. The government can implement corresponding measures to maintain physician trust, improve cultural adaptability instead of only at the economic level among internal migrants, achieving the facilitation of their understanding of the health system and health service utilization to increase physician trust.

Six-year (2016-2022) longitudinal patterns of mental health service utilization rates among children developmentally vulnerable in kindergarten and the COVID-19 pandemic disruption.

In the context of the COVID-19 pandemic, it becomes important to comprehend service utilization patterns and evaluate disparities in mental health-related service access among children. This study uses administrative health records to investigate the association between early developmental vulnerability and healthcare utilization among children in Alberta, Canada from 2016 to 2022. Children who participated in the 2016 Early Development Instrument (EDI) assessment and were covered by public Alberta health insurance were included (N = 23 494). Linear regression models were employed to investigate the association between service utilization and vulnerability and biological sex. Separate models were used to assess vulnerability specific to each developmental domain and vulnerability across multiple domains. The service utilization was compared between pre- and post-pandemic onset periods. The analysis reveals a significant decrease in all health services utilization from 2016 to 2019, followed by an increase until 2022. Vulnerable children had, on average, more events than non-vulnerable children. There was a consistent linear increase in mental health-related utilization from 2016 to 2022, with male children consistently experiencing higher utilization rates than females, particularly among vulnerable children. Specifically, there was a consistent linear increase in the utilization of anxiety-related services by children from 2016 to 2022, with females having, on average, 25 more events than males. The utilization of ADHD-related services showed different patterns for each group, with vulnerable male children having more utilization than their peers. Utilizing population-wide data, our study reveals sex specific developmental vulnerabilities and its impact on children's mental health service utilization during the COVID-19 pandemic, contributing to the existing literature. With data from kindergarten, we emphasize the need for early and targeted intervention strategies, especially for at-risk children, offering a path to reduce the burden of childhood mental health disorders.

Experience of sexual and reproductive health service utilization among Jimma University students: a qualitative study

BackgroundAmong the limits of the university spirit are potential sexual and reproductive health issues. Sexual and reproductive health services are essential for assisting students in overcoming such challenges. However, according to many facility reports and research, students prefer private services and do not use them. Despite the difficulties, a few studies have been conducted on the experiences of Ethiopian University students. Thus, this study explored the experiences of Jimma University students who used sexual and reproductive health services.MethodsA qualitative phenomenological approach was conducted from January 22nd to March 2nd, 2019, among Jimma university students. In-depth interviews were carried out to explore the lived experiences of sexual and reproductive health service use. Students were chosen by a purposive sampling method and recruited using gatekeepers until the needed sample size was obtained and the data was theoretically saturated. Key informants required to present decent information for study objectives were selected purposefully. The data were analyzed using the thematic analysis approach with the help of the ATLAS ti software package.ResultsEleven In-depth interviews and four key informant interviews were conducted. The study revealed seven overarching themes: sexual and reproductive health awareness and perception, problems, service delivery point preferences and practices, availability and accessibility, barriers to service utilization, handling mechanisms, and suggestions.ConclusionsOur study recognized positive and negative experiences of sexual health service use among Jimma University students. These findings suggested planning a comprehensive intervention that addresses the identified challenges and problems to improve students’ sexual and reproductive health services.

Reconstruction trends in New York City: A multi-decade, multi-institutional experience before and after the implementation of the Breast Cancer Provider Discussion Law

IntroductionThe potential benefits of breast reconstruction for achieving greater patient satisfaction, wellbeing, and functional outcomes after mastectomy have been widely acknowledged. However, sociodemographic and economic disparities exist in accessing reconstruction. This study aims to characterize the influence of various factors on access to reconstruction and investigate the impact of the Breast Cancer Provider Discussion Law (BCPDL), a legislation that mandates patient education and referral to plastic surgery at the time of breast cancer diagnosis, on utilization of reconstructive services. MethodsRetrospective chart review was performed to collect data on patients who underwent mastectomy at two institutions within the New York-Presbyterian system from 1998-2019. Sociodemographic, past medical history, and treatment approach information were recorded. Interrupted time series analysis and logistic regression were used for statistical analysis. Results6,122 patients were included in the cohort. 3,737 (61.04%) underwent reconstruction and 2,385 (38.96%) did not. We found that older age, Medicaid/Medicare insurance, higher tumor staging, and identity as Asian American/Pacific Islander were negative predictors of undergoing reconstruction. On interrupted time series analysis of the years prior to and the years following the 2010 BCPDL implementation, while there was an immediate increase in the proportion of patients who received reconstruction, the effects were not sustained. ConclusionOur data indicates that patient-physician communication alone may not be sufficient to bridge the gap in reconstructive care. This study highlights the need for consistent plastic surgery referral for sustained equal access to reconstructive services.

Determinants of Utilization of Antenatal Care Services Among Women of Childbearing Age in Jigawa State, Nigeria.

Antenatal care (ANC) services play a crucial role in safeguarding the health of pregnant women during their reproductive years. This study aimed to evaluate the primary factors influencing the utilization of ANC among women of childbearing age in Isari town, Jigawa State. We conducted a cross-sectional study among 400 mothers of childbearing age, selecting them using a simple random sampling method. Data were collected using interviewer-administered questionnaires. The statistical analyses performed were descriptive analysis, Pearson's chi-square test, and binary logistic regression analysis. The majority of respondents (92.5%) indicated awareness of ANC, with a significant proportion expressing the necessity of ANC services (85.7%). 57.8% of the respondents indicated attending ANC services at least four times during pregnancy. Furthermore, the number of visits has a significant relationship with age (P < 0.001), educational level (P = 0.003), occupation (P = 0.043), mother's knowledge of pregnancy danger signs (P = 0.001), and husband's support for ANC (P < 0.001). Enhancing ANC utilization will necessitate focusing on women residing in rural areas and those with limited educational attainment.