Transportation Difficulties Research Articles

Brief Video-Delivered Intervention to Reduce Anxiety and Improve Functioning in Older Veterans: Pilot Randomized Controlled Trial.

Older veterans with anxiety disorders encounter multiple barriers to receiving mental health services, including transportation difficulties, physical limitations, and limited access to providers trained to work with older persons. To address both accessibility and the shortage of available providers, evidence-based treatments that can be delivered via guided self-management modalities are a potential solution. This study aims to determine the feasibility and acceptability of a randomized controlled trial of 2 guided self-management interventions. This study compared the treatment effects of these 2 interventions (relaxation and health psychoeducation) on anxiety symptom severity and functioning in older veterans with anxiety disorders. Our exploratory aims examined factors related to home practices and treatment engagement and perceptions of the practices. Participants were randomized to one of two video-delivered interventions: (1) Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE)-breathing and progressive relaxation or (2) Healthy Living for Reduced Anxiety-psychoeducation about lifestyle changes. Telephone coaching calls were conducted weekly. Measures of anxiety, depression, and functioning were obtained at baseline, week 4 (end of treatment), week 8, and week 12. Participants completed a semistructured interview at week 12. Analyses included descriptive statistics to summarize measures of intervention engagement; mixed-effects models to characterize symptom change, and qualitative analyses. Overall, 56 participants (n=48, 86% men; n=23, 41% from ethnic or racial minority groups; mean age 71.36, SD 6.19 y) were randomized. No difference in retention between study arms was found. The Healthy Living group (29/56, 52%) completed significantly more lessons (mean 3.68, SD 0.86) than the BREATHE group (27/56, 48%; mean 2.85, SD 1.43; t53=2.60; P=.01) but did not differ in completion of coaching calls. In the BREATHE group, greater baseline anxiety scores (r=-0.41; P=.03) and greater severity of medical comorbidity (r=-0.50; P=.009) were associated with fewer completed practices. There was no effect of intervention on change in total anxiety scores or functioning. For specific anxiety subtypes, Healthy Living produced a greater decline in somatic anxiety compared with BREATHE. Qualitative analyses found barriers to practicing, including difficulty setting time aside to practice, forgetting, or having other activities that interfered with BREATHE practices. Some participants described adapting their practice routine to fit their daily lives; some also used relaxation skills in everyday situations. These findings suggest that a larger randomized controlled trial of guided self-management approaches to treating late-life anxiety is feasible; however, BREATHE was not effective in reducing anxiety compared with Healthy Living. Possible contributing factors may have been the reliance on a single technique. Progressive relaxation was reported to be enjoyable for most participants, but maintaining home practices was challenging. Those with milder anxiety severity and fewer health problems were better able to adhere to practices. ClinicalTrials.gov NCT02400723; https://clinicaltrials.gov/study/NCT02400723.

Assessing Challenges and Sources of Dissatisfaction among Accredited Social Health Activists Employees

Accredited Social Health Activists (ASHAs) are integral to India’s healthcare system, particularly in rural and underserved areas like those in district Aligarh, Uttar Pradesh. They serve as community health workers who facilitate access to essential health services, but their roles often place them in vulnerable positions. Operating within patriarchal societies and situated at the lower levels of the healthcare hierarchy, ASHAs are prone to various forms of violence and harassment. Despite their crucial role, there is limited understanding of the specific challenges they face, particularly regarding harassment in their work environment. This study aims to identify the key challenges encountered by ASHA workers in the Aligarh district of Uttar Pradesh and sources of dissatisfaction faced by ASHAs. A cross-sectional survey was conducted involving a representative sample 150 of ASHAs across several blocks of in Aligarh of Uttar Pradesh. Data were collected through structured questionnaires and semi-structured interviews. The survey addressed various aspects, including working conditions, support from healthcare systems, remuneration, training, and community relations. In a study of 150 ASHA workers, key challenges include delays in incentives (70%), excessive workload (92%), and unsatisfactory training (71.3%). Many faces harsh working conditions (73.3%), harassment (95.3%), and high stress (89.3%). Issues like inadequate facilities (97%) and transportation difficulties (90.6%) further impact their performance and well-being. This study evaluates ASHA workers’ duties, challenges, and well-being. Despite their critical role, they face financial instability, inadequate facilities, harsh conditions, and harassment, including from hospital staff. Long travel, stigma, and social discrimination further impact their effectiveness and morale, emphasizing the need for better support and protective measures.

Mental health for the indigenous population in Chhattisgarh, India: Navigating challenges and crafting solutions

ABSTRACT Introduction: The ST population, residing in isolated, underdeveloped areas, faces significant health disparities compared to non-tribal communities. In particular, the lack of mental health infrastructure in these regions exacerbates their health challenges. Tribal communities possess distinct cultural beliefs surrounding health and illness, yet scant information exists regarding their physical and mental well-being. In addition, limited access to mental health services prevails, and many tribal individuals opt for traditional healing methods. Methodology: This study is part of the “Tele-mentoring for Rural Health Organizers of Chhattisgarh (TORENT)” project, which aims to equip rural health organizers and community health officers (CHOs) with training to screen, identify, counsel, refer, and follow up with community members facing mental health issues. Results: Covering 27 districts in Chhattisgarh, this study enlisted trained CHOs to employ the MERIT tool for mental health screenings. Among the tribal population, the study unveiled elevated rates of tobacco and alcohol use, anxiety, depression, hallucinations, and substance use disorders. Challenges in seeking professional help were widespread, driven by transportation difficulties and limited awareness. Field visits (77%) played a pivotal role in identifying cases, alongside self-referrals and referrals by Mitanin or ASHA workers. Notably, a significant proportion had a family history of alcohol use, with a preference for a locally brewed liquor called Mahua. Discussion: This study provides vital insights into the mental health status of Chhattisgarh’s tribal populations. It underscores their socioeconomic challenges, high prevalence of substance use disorders, and barriers to accessing mental health services. The study highlights the importance of delivering mental health care within tribal communities, emphasizing the engagement of locally available primary care health workers. Furthermore, it advocates for an integrated approach that acknowledges the role of faith healers in tribal communities’ mental health care.

Moringa oleifera as a multifunctional excipient: Transforming pharmaceutical drug delivery

Moringa oleifera, a multifaceted plant species indigenous to tropical and subtropical climates, has garnered considerable interest in the pharmaceutical sector as a natural excipient. This abstract examines the significance of Moringa oleifera in pharmaceutical formulations, emphasizing its ability to tackle critical difficulties in medication transport and formulation. The plant's many components, such as leaves, seeds, and bark, possess bioactive chemicals with distinct characteristics that render them appropriate for use as excipients. These features include binding, disintegration, film formation, as well as antioxidant and antibacterial activity. The use of excipients generated from Moringa oleifera has several benefits, including increased bioavailability, greater stability, and less toxicity in pharmaceutical formulations. Moreover, the plant's extensive availability, economic viability, and environmentally sustainable characteristics make it a compelling substitute for synthetic excipients. This study consolidates contemporary research on the uses of Moringa oleifera in pharmaceutical formulations, examining its potential to transform drug delivery methods and aid in the creation of more sustainable and effective treatments. The results highlight the need for more research into the pharmaceutical uses of Moringa oleifera, facilitating the development of novel medication formulations and enhanced patient outcomes.

Portable direct spraying porous nanofibrous membranes stent-loaded polymyxin B for treating diabetic wounds with difficult-to-heal gram-negative bacterial infections

Gram-negative bacteria infections in diabetic wounds are complicated to control, leading to amputation and even death in severe cases. There is an urgent need to develop effective therapeutic strategies. In recent years, electrospinning has attracted much attention due to its resemblance to extracellular matrix (ECM), which can regulate local cellular proliferation, migration, differentiation, etc.; however, its use is limited by its high cost and difficulty in transportation. This study proposes a portable direct-injection porous fibre scaffold containing polymyxin B (PMB) for local slow release for treating diabetic wounds infected with difficult-to-heal Gram-negative bacteria. The handheld portable electrospinner is lightweight and easy to operate and can be directly sprayed in situ to cover wounds with irregular shapes and sizes. When covering the wound in situ, the PVB/PVP nanofiber membrane can protect it from the external environment. Meanwhile, the nanofiber membrane dressing has a porosity of 20 % and a controlled drug-loading capacity. What's more, the evaluation of a whole skin defect model of type II diabetes mellitus infected with Gram-negative bacteria showed that the PMB-loaded nanofiber membrane could effectively inhibit Gram-negative bacteria infection, promote collagen deposition and re-epithelialization, and regulate the polarization of M1-type macrophages to M2-type macrophages, thereby controlling inflammation and promoting vascular regeneration, and significantly accelerating the healing of diabetic wounds. Overall, portable direct-injection porous fibre scaffold-loaded drugs are essential for healing difficult-to-heal wounds as local slow-release drug delivery.

Factors affecting U.S. adults’ comfort level in sharing social needs information with healthcare providers

ObjectiveThis study examines various factors affecting U.S. adults’ comfort level in sharing information about their social needs with healthcare providers. MethodsWe used data from the 2022 Health Information National Trends Survey (cycle 6), a nationally representative survey of U.S. adults (n = 6252). The outcome variables were participants’ comfort level in sharing information about three social needs (food insecurity, transportation difficulties, and housing instability). Data were analyzed using weighted bivariate and multivariable logistic regression models. ResultsParticipants who faced discrimination when getting medical care based on race/ethnicity were more likely to be uncomfortable in sharing information about food insecurity, housing instability, and transportation difficulties. Those who trusted the healthcare system “a lot” were less likely to be uncomfortable in sharing information about food insecurity and transportation difficulties. Patient-Centered Communication (PCC) and social isolation scores significantly affected participants’ comfort level in sharing information about social needs. ConclusionVarious factors such as trust, discrimination, social isolation, and PCC were found to be significantly affecting US adults’ comfort level in sharing information about social needs. Practice implicationsHealthcare systems and policymakers should focus on developing approaches and strategies to enhance trust, reduce discrimination, improve patient-provider communication, and create supportive social environments.

Reabilitação integrada na Aeronáutica: criação de um centro especializado

The article discusses the importance of integrated rehabilitation in the Aeronautics, emphasizing the need for a specialized center to assist injured military personnel. Rehabilitation is presented as a process that goes beyond physical recovery, involving psychological and social aspects. The text highlights the challenges faced by families in continuing treatment after hospital discharge, such as transportation difficulties and lack of qualified professionals. The proposal for a rehabilitation center aims to optimize resources and ensure that military personnel can quickly return to their activities. The creation of an orthopedic workshop is also mentioned as a measure to accelerate the production of prosthetics and orthotics, reducing costs and improving the quality of care.

Application of a digital quality measure for cancer diagnosis in Epic Cosmos.

Missed and delayed cancer diagnoses are common, harmful, and often preventable. We previously validated a digital quality measure (dQM) of emergency presentation (EP) of lung cancer in 2 US health systems. This study aimed to apply the dQM to a new national electronic health record (EHR) database and examine demographic associations. We applied the dQM (emergency encounter followed by new lung cancer diagnosis within 30 days) to Epic Cosmos, a deidentified database covering 184 million US patients. We examined dQM associations with sociodemographic factors. The overall EP rate was 19.6%. EP rate was higher in Black vs White patients (24% vs 19%, P < .001) and patients with younger age, higher social vulnerability, lower-income ZIP code, and self-reported transport difficulties. We successfully applied a dQM based on cancer EP to the largest US EHR database. This dQM could be a marker for sociodemographic vulnerabilities in cancer diagnosis.

Access to dental care among individuals with intellectual and developmental disabilities in India: A scoping review.

Individuals with intellectual and developmental disabilities (IDDs) face numerous challenges in accessing dental care. Despite difficulties, more evidence exploring difficulties among this cohort in India is needed. This study aims to conduct a scoping review of articles published in India exploring access to dental care among individuals with IDD. We followed the Arksey O'Malley framework for scoping reviews and the PRISMA guidelines for reporting studies. Findings were analyzed based on Levesque's framework for access. Seventeen articles were collated from five databases. The perceived need for dental care was low, and dental visits were mainly need-based and infrequent. Knowledge regarding dental care did not translate to dental visits. Patient-related barriers were cost, transportation difficulties, fear, lack of dentist skills, patient behavior, and cooperation. From the providers' perspective, most dentists were willing to treat but noted infrastructural and knowledge-based limitations. Access to dental care was limited due to infrastructure constraints and a lack of dentist training. Caregivers and individuals with IDD did not prioritize dental health, faced communication barriers, and were afraid of dental procedures. It is important to improve preventive dental care and raise awareness among caregivers of individuals with IDD in India. Training dentists and incorporating special care dentistry into the standard dental curriculum will improve access.

School evasion at eetepa Dr Celso Malcher in the computer technical course in the subsequent evening mode

This study aims to identify the causes and motivations of school dropout in the subsequent evening technical course in IT at EETEPA Dr. Celso Malcher. In the investigation process, the issue regarding the factors that led students to drop out of the School, based on the problem: how the Dr. Celso Malcher school presents itself in the scenario of the phenomenon of school dropout in relation to the technical course in IT in the subsequent modality ? A case study was used with data collection through questionnaires applied to frequent and dropped out students between 2022/1 and 2023/1. The study had two fronts: a literature review on school dropout and practical research to understand students' perceptions. The approach was quantitative-qualitative, focusing on factors such as distance, safety, need to work, and difficulties with the education system. The results are at the threshold of the objectives and problem researched: implications with the distance from the institution; issues related to security, risk of violence and difficulty in transportation, among others.

Experiences of rural poverty in Stratford district, Aotearoa New Zealand: A qualitative study with implications for rural social work

INTRODUCTION: People experiencing poverty who live in rural communities may have complex needs as rurality exacerbates their issues. Isolation, stigma, transport difficulties and a lack of services contribute to the challenges experienced by people living in rural communities who experience poverty. For social workers, responses need to be creative and flexible to counter the lack of services or people being unable to access services due to distance and/or a lack of transport. METHODS: I conducted semi-structured, in-depth interviews with 28 participants. Participants self-identified as experiencing poverty and ranged in age from teenagers to over 65s. Transcripts were analysed using applied thematic analysis. FINDINGS: Four themes were identified: stigma, isolation, transportation and access to services. Issues in these areas exacerbated participants’ experience of poverty. CONCLUSION: The findings of the study suggest that there is a significant advocacy role for social workers in rural communities regarding access to services and service development, transportation and challenging stigma to improve the lives of people living in rural communities who experience poverty. Further investigation is suggested to explore specific groups experiencing poverty in rural communities, particularly Māori, and to consider other marginalised identity groups and different geographical areas.

9342 Managing Osteoporosis In Patients With Phocomelia: Challenges And Strategies

Abstract Disclosure: M. Renzu: None. C. Hubers: None. V. Mehta: None. A.M. Qazi: None. A.M. Satei: None. D.K. Yerasuri: None. Introduction: Phocomelia, a rare congenital limb malformation, often results from disruptions in limb bud formation during embryonic stage, due to genetic mutations, teratogens, or environmental factors like thalidomide embryopathy. These disruptions pose unique challenges in bone health management, including an increased risk of osteoporosis.We present a case report of a 52-year-old patient with phocomelia who developed an early onset severe osteoporosis. This case stresses the need for specific measures and care to tackle bone health in individuals with congenital limb anomalies. Case Presentation: A 52-year-old white female with phocomelia, had absence of the left forearm and hand, as well as a transverse tibial deficiency with a prosthetic left lower leg since the age of 1. Osteoporosis was diagnosed after follow-up, with initial osteopenia noted at age 49. DEXA scan showed lumbar osteopenia, radial osteoporosis, and bilateral femoral neck osteopenia. FRAX score showed an 11.9% risk of osteoporotic fracture and 3.1% risk of a hip fracture.Risk factors to her osteoporosis included late menarche, early menopause due to hysterectomy, and a history of hormone replacement therapy without pregnancies. Also, chronic colitis and diarrhea caused malabsorption issues. Her left hip bone mineral density was disproportionately low due to chronic prosthesis use, necessitating close monitoring and treatment initiation with Denosumab, along with vitamin D3 and calcium supplementation.As of the latest follow-up, the patient is closely monitored, and improvement is noted in her condition. She has incorporated daily gym sessions into her routine, indicating proactive engagement in her well-being. Discussion: Managing osteoporosis in patients with phocomelia needs a personalized approach, considering the patient's unique anatomical challenges and the limitations of traditional osteoporosis management strategies. Bone tissue adapts its structure based on mechanical loading, with reduced loading in deformed limbs leading to increased resorption and elevated osteoporosis risk. Tailored treatment plans, including Denosumab, which is known as an effective pharmacological option for managing osteoporosis, complemented by dietary adjustments to enhance vitamin D and calcium intake. Physical therapy programs play a vital role in muscle strengthening and balance improvement, reducing fracture risk.Another challenge that patients with phocomelia face is barriers to accessing healthcare services, like limited specialized care providers, financial constraints, and transportation difficulties, leading to increased morbidity. Hence early screening and intervention are essential to prevent osteoporotic complications. Overall, a comprehensive approach to osteoporosis management in phocomelia patients is crucial for optimizing outcomes and enhancing quality of life. Presentation: 6/3/2024

Association between food insecurity, financial toxicity, and healthcare utilization in adolescents and young adults with cancer.

305 Background: Adolescents and young adults with cancer experience high rates of financial toxicity (FT) and unmet health-related social needs (HRSN: food, housing, transportation insecurity). FT and unmet HRSN, specifically FI, are modifiable factors that impact health outcomes; however, the relationship between FI, FT, and healthcare utilization (emergency department (ED) visits or hospitalizations) remains unclear. Leveraging systematic screening for FT and HRSN using the electronic health record (EHR) patient portal among AYAs with cancer, we examined the association between FI, FT, and healthcare utilization measures among AYAs with cancer. Methods: AYAs (ages 15-39) who utilize the EHR patient portal were prompted to complete an 8-item standardized HRSN survey (i.e., food insecurity, housing instability, transportation difficulties) and a 2-item previously established FT survey during e-check in between November 2022 and April 2024. ED visits and hospitalizations were extracted from the EHR directly. Descriptive statistics and associations using chi-square tests were used to describe the patients and examine associations between FI or FT and ED visits or hospitalizations. Results: Of 691 AYAs who completed the HRSN survey, 16% (n=109) screened positive for FI. Among AYAs with FI, 42% (n=46) had at least one ED visit compared with 28% (n=163) among AYAs without FI (p&lt;0.01). Among AYAs with FI, 39% (n=43) were hospitalized at least once compared to 31% (n=179) among AYAs without FI (p=0.07). Of 439 AYAs who responded to the FT survey, 66% (n=290) met criteria for high FT. Within this group, 26% (n=74) had at least one ED visit compared with 17% (n=26) who screened negative (p=0.06). Among AYAs with high FT, 22% (n=65) were hospitalized at least once, compared with 19% (n=28) among those with low or moderate FT (p=0.38). Among 384 AYAs who responded to both the HRSN and FT surveys, 19% (n=74) screened positive for FI, 92% (n=68) of whom also had high financial toxicity. The table describes characteristics of screened AYAs by language and race/ethnicity. Conclusions: FI may be a risk factor for increased ED visits during cancer treatment among AYAs. Systematic screening to identify FI, FT, and other HRSN is important to facilitate referral for resources, support services, or interventions. Sociodemographic characteristics of AYA participants in FI and FT screening. Characteristic +FI -FI +FT -FT N=109 (%) N=582 (5) p-value N=290 (%) N=149 (%) p-value Language &lt;0.01 &lt;0.01 English 82 (75) 496 (85) 241 (83) 134 (90) Spanish 24 (22) 45 (8) 29 (10) 1(1) Other 3 (3) 41 (7) 20 (7) 14 (9) Race/Ethnicity &lt;0.01 &lt;0.01 Hispanic, any race 67 (61) 175 (30) 125 (43) 16 (11) Non-Hispanic Black 12 (11) 62 (11) 30 (10) 10 (7) Non-Hispanic White 16 (15) 219 (38) 78 (27) 84 (56) Other 14 (13) 126 (22) 57 (20) 39 (26)

A control strategy of DC transmission system for offshore wind power based on hybrid converters

Abstract As the DC transmission system of modular multilevel converters for offshore wind power suffers problems like large volume, heavy weight, difficulty in platform transportation, and high cost, a DC transmission scheme for offshore wind power based on diode rectifier units and modular multilevel converters is put forth in the present work; Meanwhile, the features of active-power coordination, the DC harmonic current, and the AC harmonic current of the hybrid converter in this proposed scheme are analyzed to propose control strategies for active power coordination control, DC harmonic current suppression, and AC harmonic current suppression of the hybrid converter, respectively. The performance and feasibility of the proposed strategies are verified by testing the hardware in the loop real-time simulation system for transmission of offshore wind power through hybrid converters based on RTDS. It is found that the proposed strategies could improve the stability, flexibility, and reliability of the system.

The Benefits and Challenges of Implementing Teleophthalmology in Low-Resource Settings: A Systematic Review.

Technology has significantly changed medical practice, including diagnosis, treatment, and availability. Telemedicine use in the specialty of ophthalmology seems to be a promising field. In underserved populations, limited coverage of ophthalmic healthcare facilities results in a higher burden of eye-related diseases and visual impairment. The main obstacle preventing these individuals from receiving eye care consultations is difficulty in access and transportation. There is an urgent need for eye care facilities for these people, and teleophthalmology has the potential to provide eye care facilities to these underserved people. Teleophthalmology was reported as cost-effective, time-saving, reliable, and efficient for underserved populations. However, teleophthalmology has certain limitations in its implementation in the form of a high initial cost of equipment, problems with consistent electricity and internet supply, and the reluctance of people in certain regions toward acceptance of teleophthalmology. This systematic review assessed the benefits and challenges of implementing teleophthalmology in low-resource settings.

Factors contributing to delays in accessing health facility-based maternal delivery services in Sierra Leone, 2018: A community-based cluster survey.

With a Maternal Mortality Ratio (MMR) of 516 deaths per 100,000 live-births, Sierra Leone hosts one of the highest maternal mortalities in globally. National data indicates that over 98% of maternal deaths are related to delays in accessing obstetric services. This study sought to examine factors contributing to delays in accessing maternal delivery services as perceived by women in Sierra Leone. We conducted a community-based survey among women who delivered from May 1, 2017 to June 30, 2018, in four districts of Sierra Leone. Delay one was defined as perceived delays in deciding to seek facility-based delivery. Delay two was defined as perceived delays reaching the health facility for delivery services. Data on participants' socio-demographics, delay one, delay two, three and determinants of delays one and two and three were collected using questionnaires. We calculated frequencies and proportions for factors contributing to delays as well as Prevalence Odds Ratios (POR) to identify risk factors for the delays. A total of 614 mothers were interviewed, median age 28 years (range, 14-52 years). The prevalence of Delay One was 23.3% (143/614), and Delay Two was 26.9% (165/614). Mother with secondary education were associaited with delay one (aPOR = 2.3; 95% CI:1.14, 4.46). These was an association between perceived delay-two and previous pregnancy-related complications (aPOR = 1.6; 95% CI:1.071, 2.538) and poor condition of roads (POR = 2.34; 95%CI, 1.15, 4.77). Additinally, there was an association between delay-three and previous-related complication during last pregnancy (aPOR = 1.9; 95% CI: 1.055, 3.67). This study revealed a high prevalence of perceived delays one and two for mothers to access obstetric services. Delays were mainly related to transport difficulties, low knowledge of pregnancy-related complications, and costly obstetric services. A practical strategy for birth preparedness and readiness to reduce delays is urgently needed.

Role and Function of Frontline Health Workers During the COVID-19 Pandemic in a Rural Health Center in Kerala: A Qualitative Study.

Introduction Accredited Social Health Activists (ASHAs) are community health workers established under the National Rural Health Mission (NRHM). ASHAs have played a crucial role in responding to the COVID-19 pandemic. The COVID-19 pandemic has prompted ASHAs to adapt their strategies and methods to effectively address the challenges and ensure the well-being of the communities they serve. Objectives This study was done to explore the impact of the COVID-19 pandemic on the duties and performance of ASHAs. Methods A qualitative study was conducted over one month in the rural Primary Health Center (PHC) area of Thrissur district, Kerala. Focus group discussions (FGDs) were conducted among ASHAs and in-depth interviews with a Junior Health Inspector (JHI) and a Junior Public Health Nurse (JPHN). Results During the COVID-19 pandemic, the healthcare system shifted its focus toward managing the virus, leading to changes in the responsibilities of ASHA workers. They were assigned additional duties, and their routine services were disrupted due to lockdown measures. Despite the challenges, several factors played a crucial role in facilitating their services, including social support, teamwork, and personal satisfaction. However, there were several barriers that affected their effectiveness, such as inadequate and inconsistent remuneration, lack of recognition, transportation difficulties, safety concerns, and out-of-pocket expenses. Conclusion ASHAs effectively managed the challenging situation during the COVID-19 pandemic by taking diligent measures and showing a high level of commitment to their duties. It is essential to prioritize regular evaluations of their performance to ensure ongoing quality and effectiveness.

Gender issues and needs of people with disabilities

&lt;p&gt;身心障礙者在特殊性別需求上具有複雜的性別議題，尤其是女性身心障礙者在生殖健康、性別暴力和慢性病管理上所遭遇的諸多挑戰，也會因交通不便和經濟困難，難以獲得持續的慢性病照護與管理。男性身心障礙者則在心理健康和事故預防方面需求較高，社會期望和性別角色壓力使他們難以尋求心理支持。跨性別身心障礙者在性別確認治療上面臨複雜需求，且在醫療機構中經常遭遇歧視和不理解。醫療機構可加強對醫療工作者進行性別意識，以提升包容性和服務品質。因此，需要從各層面加強對身心障礙者特殊性別健康需求，提供性別敏感性的培訓課程，並建立有效的支持機制，包括性別暴力防治措施和心理支持服務，以確保身心障礙者特殊性別議題中，獲得平等權利和安全福祉。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Individuals with disabilities often face complex gender-related problems because of their special needs. In particular, women with disabilities often face many challenges pertaining to reproductive health, gender-based violence, and chronic disease management. In addition, transportation difficulties and financial constraints further hinder their access to continuous chronic disease care and management. Compared with women, men with disabilities have higher needs for mental health and accident prevention; however, social expectations and gender role pressure often deter such men from seeking psychological support. Transgender individuals with disabilities have complex requirements related to gender-affirming treatment and often face discrimination and misunderstanding in medical settings. To solve this problem, medical institutions should enhance gender awareness among their medical personnel to promote inclusivity and improve service quality. Therefore, it is necessary to strengthen the focus on the specific gender health needs of individuals with disabilities from various aspects. This includes providing gender-sensitive training courses, and establishing effective support mechanisms, such as measures to prevent gender-based violence prevention and offering psychological support services. These efforts are essential to ensure that individuals with disabilities receive equal rights and safety in addressing their unique gender issues.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

An Analysis of Social Transformation of Tribal Weekly Market in Coimbatore District

This study explores the socio-economic impacts of market access on tribal individuals across different ranges in Coimbatore District. It examines four case studies representing various socio-economic backgrounds: Papammal from the Karamadai Range, Kandhasamy from the Periyanaikepalayam Range, Valli from the Coimbatore Range, and Nanjammal from the Bolambatty Range. Through detailed analysis, the study highlights the challenges and benefits of market participation, including transportation difficulties, financial constraints, and the broader social transformations experienced by these individuals. The findings underscore the significant role of market access in enhancing awareness, skill development, health, gender equality, and community development among tribal communities.

Clinical training and practice of using digital health solutions among healthcare workers in clinical settings during Hajj season.

Digital health solutions are widely used in Saudi Arabia, but training, clinical practice and challenges related to using digital health applications have not been evaluated from the perspective of healthcare workers during the Haj season in Makkah. The current study was planned to explore clinical training, practices and challenges related to the use of digital health among healthcare workers during the Haj season from June to August 2023. Of the 470 subjects, 347(73.8%) were males and 123(26.2%) were females. The overall median age was 40 years (interquartile range: 27-56 years). In the clinical practice of using digital health, 185(39.4%) of the subjects strongly agreed that digital health was useful and beneficial during transportation difficulties, and 167(35.5%) strongly agreed that digital health applications had changed their working routine during the Haj season. Negative outcome expectations were the challenge least reported by 72(15.3%) respondents.