Trends In Coverage Research Articles

Spatial-temporal variations of vegetation coverage and its driving force in Inner Mongolia grassland, China

Inner Mongolia grassland is rich in natural vegetation and mineral resources. Based on Landsat5/7/8 NDVI data, we used pixel binary model to invert vegetation coverage of Inner Mongolia grassland area, investigated the stability, spatial distribution, and future evolution trend of vegetation coverage by using Sen+MK and Hurst index, and analyzed the driving factors of the spatial differentiation of vegetation coverage by the optimal parameters-based geographical detector. The results showed that vegetation coverage of Inner Mongolia grassland showed an increasing trend from 2006 to 2020, and the overall spatial pattern was high in the east and low in the west, mainly with great fluctuation. The regions with slight or obvious improvement characteristics (64.8%) were much more than those with slight or severe degradation characteristics (23.2%). Compared with that in the past 15 years, the proportion of degraded vegetation in the future is expected to increase to 36.6%. The central part of Xilin Gol League and Wulanqab in the central grassland area, the western part of Hulunbuir and Erdos in the eastern grassland area, and Wuhai in the western grassland area were at the risk of degradation, which should be paid more attention. Precipitation was the dominant factor of spatial differentiation in Inner Mongolia grassland, while soil type, land use, and air temperature had the most significant synergistic effect.

Decoupling the response of vegetation dynamics to asymmetric warming over the Qinghai-Tibet plateau from 2001 to 2020

Global land surface air temperature data show that in the past 50 years, the rate of nighttime warming has been much faster than that of daytime, with the minimum daily temperature (Tmin) increasing about 40% faster than the maximum daily temperature (Tmax), resulting in a decreased diurnal temperature difference. The Qinghai-Tibet Plateau (QTP) is known as the "roof of the world", where temperatures have risen twice as fast as the global average warming rate in the last few decades. The factors affecting vegetation growth on the QTP are complex and still not fully understood to some extent. Previous studies paid less attention to the explanations of the complicated interactions and pathways between elements that influence vegetation growth, such as climate (especially asymmetric warming) and topography. In this study, we characterized the spatial and temporal trends of vegetation coverage and investigated the response of vegetation dynamics to asymmetric warming and topography in the QTP during 2001–2020 using trend analysis, partial correlation analysis, and partial least squares structural equation model (PLS-SEM) analysis. We found that from 2001 to 2020, the entire QTP demonstrated a greening trend in the growing season (April to October) at a rate of 0.0006/a (p < 0.05). The spatial distribution pattern of partial correlation between NDVI and Tmax differed from that of NDVI and Tmin. PLS-SEM results indicated that asymmetric warming (both Tmax and Tmin) had a consistent effect on vegetation development by directly promoting greening in the QTP, with NDVI values being more sensitive to Tmin, while topographic factors, especially elevation, mainly played an indirect role in influencing vegetation growth by affecting climate change. This study offers new insights into how vegetation responds to asymmetric warming and references for local ecological preservation.

Variations in HIV Prevention Coverage in Subpopulations of Australian Gay and Bisexual Men, 2017–2021: Implications for Reducing Inequities in the Combination Prevention Era

Using repeated behavioural surveillance data collected from gay and bisexual men (GBM) across Australia, we assessed trends in HIV prevention coverage (the level of ‘safe sex’ achieved in the population by the use of effective prevention methods, including condoms, pre-exposure prophylaxis [PrEP] and having an undetectable viral load). We stratified these trends by age, country of birth/recency of arrival, sexual identity, and the proportion of gay residents in the participant’s suburb. Among 25,865 participants with casual male partners, HIV prevention coverage increased from 69.8% in 2017 to 75.2% in 2021, lower than the UNAIDS target of 95%. Higher levels of coverage were achieved among older GBM (≥ 45 years), non-recently-arrived migrants, and in suburbs with ≥ 10% gay residents. The lowest levels of prevention coverage (and highest levels of HIV risk) were recorded among younger GBM (< 25 years) and bisexual and other-identified participants. Younger, recently-arrived, and bisexual GBM were the most likely to use condoms, while PrEP use was concentrated among gay men, 25–44-year-olds, and in suburbs with more gay residents. The use of undetectable viral load was most common among participants aged ≥ 45 years. Our analysis shows that high HIV prevention coverage can be achieved through a mixture of condom use, PrEP use, and undetectable viral load, or by emphasising PrEP use. In the Australian context, younger, bisexual and other-identified GBM should be prioritised for enhanced access to effective HIV prevention methods. We encourage other jurisdictions to assess the level of coverage achieved by combination prevention, and variations in uptake.

92 Trends in COVID-19 Vaccination Coverage among Children &amp;lt;5 Years of Age in Canada

Abstract Introduction/Background COVID-19 vaccinations for those aged 6 months to 5 years were announced in the summer of 2022. Specifically, Moderna Spikevax and Pfizer-BioNTech Comirnaty were authorized on July 14, 2022, and September 9, 2022, respectively. Given that this was the last age group to become eligible for vaccination against COVID-19, promoting and measuring vaccination coverage in this vulnerable population is of public health significance. Objectives This analysis describes and compares the trend in vaccination coverage (VC) over the initial weeks of eligibility in those 0-17 years old. Design/Methods Data were obtained from the Canadian COVID-19 Vaccination Coverage Surveillance System and were analyzed to describe and compare VC of those &amp;lt;5, 5-11, and 12-17-year-olds over the first 16 weeks of eligibility. VC is defined as the percent of the population that have received at least 1 dose of a COVID-19 vaccine. Results Sixteen weeks after those &amp;lt;5 years became eligible for vaccination, coverage was 10.9% in those aged 2-4 and 6.3% in those aged &amp;lt;2. Compared to other paediatric age groups, VC in those &amp;lt;5 is markedly lower, where, after 16 weeks of eligibility, coverage in those aged 5–11 was 54.4% and 81.5% in those 12-17. There was an immediate spike in coverage for both 5–11-year-olds and 12–17-year-olds over the first 4 weeks following eligibility, where VC was 40.1% and 63.3%, respectively. A similar increase was not observed 4 weeks following eligibility in those aged &amp;lt;5, where VC was 7.4% in those aged 2-4 and 4.0% in those &amp;lt;2. The weekly increase in VC decreased more rapidly as age groups decreased; weekly increase in VC slowed to less than 1% in 28 weeks, 20 weeks, and 16 weeks after eligibility in those aged 12-17, 5-11, and &amp;lt;5, respectively. Conclusion These data suggest that VC over time in the &amp;lt;5 population has been slow and has not followed the trajectory of other paediatric populations, when compared to the 5-11 and 12-17 age groups. Reasons for this may include but are not limited to parents and guardians’ knowledge, attitudes, and beliefs toward getting their infant children vaccinated, as well as pandemic fatigue, as eligibility for the infant population occurred after the other paediatric age groups.

Vaccination coverage in rural Burkina Faso under the effects of COVID-19: evidence from a panel study in eight districts

BackgroundImproving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low- and middle-income countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010–2021.MethodsUsing a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0–13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants’ vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels.ResultsA total of 736 child-year observations were included in the analysis. The proportion of children with age-appropriate complete vaccination was 69.76% in 2010, 55.38% in 2015, 50.47% in 2019–2020, and 64.75% in 2021. Analyses assessing changes in age-appropriate full-vaccination coverage before and during the pandemic show a significant increase (OR: 1.8, 95% CI: 1.14–2.85). Our models also confirmed the presence of heterogeneity in full vaccination between health administrative districts. The pandemic could have increased inequities in infant vaccination completion between these districts. The analyses suggest no disruption in age-appropriate full vaccination due to COVID-19. Our findings from our sensitivity analyses to examine trends since 2010 did not show any steady trends.ConclusionOur findings in Burkina Faso do not support the predicted detrimental effects of COVID-19 on the immunization schedule for infants in low- and middle-income countries. Analyses comparing 2019 and 2021 show an improvement in age-appropriate full vaccination. Regardless of achieving and sustaining vaccination coverage levels in Burkina Faso, this should remain a priority for health systems and political agendas.

Vaccination coverage survey of children aged 1–3 years in Beijing, China, 2005–2021

BackgroundThe routine immunization program for children is a primary strategy and a core part of vaccination. Achieving and maintaining high level of vaccination coverage are important to reduce morbidity and mortality caused by vaccine-preventable diseases. In Beijing, annual coverage surveys have been conducted since 2005. It is necessary and possible to assess the level and trend of routine vaccination coverage of children in Beijing as well as the disruption of coronavirus disease 2019 (COVID-19) pandemic and provide the reference for the further improve the vaccination coverage. MethodsThe data of 61,521 children aged 1–3 years in the vaccination coverage surveys during 2005–2021 were analyzed by Beijing Center for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the data and the difference of vaccination coverage within the time period. ResultsMore than 99 % of participants had immunization cards and electronic immunization records. The concordance rate of both records were also over 99 %. During 2011–2019, the rates of on-time and in-time vaccination of each routine vaccine reached 96 % or more and increased significantly (all P values <0.05), compared with that of 2005–2010. All rates of the investigated vaccine, except for Bacillus Calmette-Guérin vaccine (BCG) and the first dose of hepatitis B vaccine (HepB), decreased in 2020–2021 significantly (all P values <0.05). For the causes of failing to vaccinate on time, delayed vaccination accounted for 47.82 %. The top two vaccines to be missed were the first dose of hepatitis A vaccine and the 4th dose of diphtheria-tetanus-acellular pertussis vaccine, accounting for 21.41 % and 20.79 %, respectively. The main reason for zero-dose/drop-out vaccination was “Guardians regarded the immunization service time as inappropriate”, accounting for 72.27 %. ConclusionThe coverage level and service quality of routine immunization in Beijing were relatively high. However, as influenced by COVID-19 epidemics, both on-time and in-time vaccination rates decreased significantly, except for BCG and HepB. Under the background of COVID-19 pandemic, the keys to maintain high level of vaccination coverage include flexible immunization service time to ensure the guardians bringing their children for vaccination timely, and more attention from providers to the doses after children’s first birthday.

Inter-comparison and evaluation of global satellite XCO2 products

ABSTRACT Carbon dioxide (CO2) is one of the main greenhouse gases and has become a major concern as its concentration has been growing in recent years. Satellite remote sensing is an efficient way to monitor CO2 in the atmosphere, and several satellites are already used for CO2 monitoring. It is imperative to investigate the spatial coverage and spatio-temporal trends of satellite products, as well as identify the satellites with higher levels of accuracy. Additionally, examining the disparities between the older and new generations of satellites would be meaningful. Therefore, this paper provides a comprehensive evaluation and inter-comparison for the commonly used satellite column-averaged dry-air mole fraction of CO2 (XCO2) products. Specifically, the temporal trends and monthly coverage of the Greenhouse Gases Observing SATellite (GOSAT), Greenhouse Gases Observing SATellite-2 (GOSAT-2), Orbiting Carbon Observatory-2 (OCO-2), Orbiting Carbon Observatory-3 (OCO-3), and SCanning Imaging Absorption spectroMeter for Atmospheric CartograpHY (SCIAMACHY) are investigated. The accuracy of these satellite products is evaluated and analyzed based on Total Carbon Column Observing Network (TCCON) data. The results indicate that the XCO2 of all the satellite products show a year-by-year increase, with seasonal periodicity. In terms of overall accuracy, the OCO series satellites exhibit a slightly higher level of accuracy compared to the GOSAT series. The products of the new generation of satellites are less stable than those of the older generation, probably due to the impacts of the inversion algorithm and platforms.

Heterogeneity Analysis of Spatio-Temporal Distribution of Vegetation Cover in Two-Tider Administrative Regions of China

Vegetation cover is a crucial component of regional ecological environments that plays a vital role in maintaining ecosystem balance. This investigation utilized Google Earth Engine and MODIS NDVI products to examine the spatiotemporal heterogeneity of regional vegetation coverage based on the multi-year average NDVI in China. Using the multi-year average NDVI, multi-year change trend slope, coefficient of variation, and Hurst exponent, the spatial and temporal heterogeneity of provincial and prefectural administrative regions were quantified. The results indicated an upward trend in vegetation coverage from 2000 to 2021 at both provincial and prefectural levels, with growth rates of 0.032/10a and 0.03/10a, respectively. Moreover, the multi-year average NDVI significantly correlated with regional precipitation. Notably, vegetation growth was fastest in the Loess Plateau, while degradation was observed in southern Jiangsu and northern Zhejiang. Additionally, the degree of vegetation cover change in Ningxia and Macau was particularly prominent. These findings support the effectiveness of the Loess Plateau greening project and highlight the potential cost of economic and population growth on the ecosystem in eastern and southeastern coastal areas, where local vegetation degradation occurs. This study can serve as a valuable reference for ecosystem restoration and developmental planning at the administrative regional level, with the goal of enhancing vegetation management and conservation efforts in China.

Vaccination Coverage Among Adolescents Aged 13-17 Years - National Immunization Survey-Teen, United States, 2022.

Three vaccines are routinely recommended for adolescents to prevent pertussis, meningococcal disease, and cancers caused by human papillomavirus (HPV). CDC analyzed data from the 2022 National Immunization Survey-Teen for 16,043 adolescents aged 13-17 years to assess vaccination coverage. Birth cohort analyses were conducted to assess trends in vaccination coverage by age 13 years (i.e., before the 13th birthday) and by age 14 years (i.e., before the 14th birthday) among adolescents who were due for routine vaccination before and during the COVID-19 pandemic. Cross-sectional analysis was used to assess coverage estimates among adolescents aged 13-17 years. In 2022, vaccination coverage by age 14 years among adolescents born in 2008 continued to lag that of earlier birth cohorts and varied by sociodemographic factors and access to health care compared with coverage among earlier birth cohorts. Vaccination coverage by age 13 years among adolescents born in 2009 was similar to coverage estimates obtained before the COVID-19 pandemic. Among all adolescents aged 13-17 years, 2022 vaccination coverage levels did not differ from 2021 levels; however, initiation of the HPV vaccination series decreased among those who were insured by Medicaid. Coverage with ≥1 dose of tetanus, diphtheria, and acellular pertussis vaccine and ≥1 dose meningococcal conjugate vaccine was high and stable (around 90%). Providers should review adolescent vaccination records, especially among those born in 2008 and those in populations eligible for the Vaccines for Children program, to ensure adolescents are up to date with all recommended vaccines.

Medicare coverage of buprenorphine-naloxone film surrounding generic entry.

To investigate trends in Medicare coverage of buprenorphine-naloxone film before and after the FDA approval of its first generic versions. This study used data from the Part D Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from 2015 to 2022, which provide information on all stand-alone Medicare/Medicare Advantage Prescription Drug Plans. We examined the percentage of plans that provided coverage of brand-name and generic buprenorphine-naloxone films with strength 8 mg/2 mg during 2015-2022. Median out-of-pocket (OOP) cost for a 30-day supply was estimated among all plans that provided coverage. Generic buprenorphine-naloxone film was covered by 82% of Medicare Part D plans in 2020, 2 years after market entry. Coverage of brand-name Suboxone film decreased from 76% in 2019 to 42% in 2020. The median OOP cost of buprenorphine-naloxone films faced by Medicare enrollees decreased from $99 in 2019 to $42 in 2020, driven by the lower price of generic films. In contrast, the OOP cost for brand-name buprenorphine-naloxone film increased gradually from $85 in 2015 to $100 in 2022. Medicare Part D plan formularies replaced brand-name buprenorphine-naloxone films with the newly approved generic versions. This was accompanied by a substantial decrease in estimated OOP cost faced by Part D enrollees. These changes could potentially increase access to buprenorphine among Medicare enrollees with opioid use disorder.

Effects of Groundwater Depth on Vegetation Coverage in the Ulan Buh Desert in a Recent 20-Year Period

As a typical desert in the Inner Mongolia Autonomous Region, the Ulan Buh Desert has a dry climate and scarce precipitation all year round. Groundwater has become the main factor limiting the growth of vegetation in this region. It is of great significance to study the influence of groundwater depth on the spatial distribution pattern of vegetation in this region. Based on the PIE-Engine platform and using long-term time-series Landsat data, this paper analyzed the spatial–temporal distribution characteristics and trends in vegetation coverage in the Ulan Buh Desert in the last 20 years using a pixel dichotomy model and the image difference method. The Kriging interpolation method was used to interpolate the groundwater depth data from 106 monitoring wells in the Ulan Buh Desert over the past 20 years, and the spatial distribution characteristics of groundwater depth in the Ulan Buh Desert were analyzed. Finally, the correlation coefficient between changes in vegetation coverage and changes in groundwater depth was calculated. The results showed the following: (1) The vegetation coverage in the Ulan Buh Desert was higher in the periphery and lower in the center of the desert. The overall vegetation level showed an increasing trend year by year; the growth rate was 4.73%/10 years, and the overall vegetation cover showed an improving trend. (2) The overall groundwater depth in the Ulan Buh Desert was deep in the southwest and shallow in the northeast. In the past 20 years, the groundwater depth in the Ulan Buh area has become shallower, and the ecological condition has gradually improved. (3) On the whole, the vegetation coverage varied with the groundwater depth, and the shallower the groundwater depth, the greater the vegetation coverage. When the groundwater depth increased to more than 4 m, the change in the groundwater depth had a significant effect on the vegetation coverage. However, when the groundwater depth was greater than 6 m, the change in the groundwater depth had no significant effect on the change in vegetation coverage.

Effects of hydrothermal factors and human activities on the vegetation coverage of the Qinghai-Tibet Plateau

A systematic understanding of the spatio-temporal changes and driving factors in the Qinghai-Tibet Plateau holds significant scientific reference value for the future of ecological sustainable development. This paper utilizes MODIS normalized difference vegetation index (NDVI) and meteorological data to investigate the spatio-temporal changes and driving factors of vegetation coverage in the Qinghai-Tibet Plateau from 2001 to 2020. Methods employed include the dimidiate pixel model, trend analysis, partial correlation analysis, and residual analysis. The results demonstrate a generally fluctuating upward trend in vegetation coverage across the Tibetan Plateau over the past two decades, with spatial expansion occurring from northwest to southeast. Vegetation coverage exhibits a positive correlation with climate factors. Approximately 60.7% of the area showed a positive correlation between vegetation fractional cover (FVC) and precipitation, with 8.66% of the area demonstrating extremely significant (p < 0.05) and significant (p < 0.01) positive correlation. Human activities, on the whole, have contributed to the enhancement of vegetation cover in the Qinghai-Tibet Plateau. The areas where human activities have positively impacted vegetation cover are primarily situated in north-central Qinghai and north of Ngari, while areas experiencing degradation include certain grassland regions in central-eastern Yushu, Nagqu, and Lhasa.

Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011–2021

BackgroundLow polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021. Methods: This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level. Results: From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05). Conclusions: The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.

Payer reimbursement practices and incentives for improving interpretation of germline genetic testing.

Germline genetic testing for inherited cancer risk has shifted to multi-gene panel tests (MGPTs). While MGPTs detect more pathogenic variants, they also detect more variants of uncertain significance (VUSs) that increase the possibility of harms such as unnecessary surgery. Data sharing by laboratories is critical to addressing the VUS problem. However, barriers to sharing and an absence of incentives have limited laboratory contributions to the ClinVar database. Payers can play a crucial role in the expansion of knowledge and effectiveness of genetic testing. Current policies affecting MGPT reimbursement are complex and create perverse incentives. Trends in utilization and coverage for private payers and Medicare illustrate opportunities and challenges for data sharing to close knowledge gaps and improve clinical utility. Policy options include making data sharing (i) a condition of payment, and (ii) a metric of laboratory quality in payment contracts, yielding preferred coverage or enhanced reimbursement. Mandating data sharing sufficient to verify interpretations and resolve discordance among labs under Medicare and federal health programs is an option for the US Congress. Such policies can reduce the current waste of valuable data needed for precision oncology and improved patient outcomes, enabling a learning health system.

Тенденції основних предикторів вагітності високого ризику

The sustainable development of the society of any country is largely determined by the health of pregnant women, which determines the viability and health of the offspring at all stages of ontogenesis. Purpose - to conduct an analysis, change trends, and an integrated assessment (IA) of the main predictors of high-risk pregnancy (HRP) in Ukraine in 2010-2021. Materials and methods. A comprehensive retrospective analysis, a general characterization of the dynamics and regional features of the integral assessment of the main predictors of HRP based on the data of the State Statistics Service of Ukraine and the Medical Statistics Center of the Ministry of Health of Ukraine, was carried out. Structured by individual components of the IA of the main predictors of HRP, it was carried out according to the generally accepted methodology of comprehensive assessment of the health status of the population based on integral indicators. The interpretation of the results of IA was based on the fact that the higher the integral indicator, the greater the risk of developing HRP. The methods of a systemic approach, structural-logical, epidemiological analysis were used. mathematical, modeling. Results. Analytical data show that in recent years in Ukraine, the levels of maternal and perinatal morbidity and mortality have remained high despite a multidirectional trend, a significant part of which could have been prevented by identifying and minimizing predictors of HRP. The analysis of the state of the main predictors of the development of HRP revealed high levels of the birth rate of young (5.21‰) and older (7.86 ‰) women with an increase in their total contribution to the total birth rate from 9.5% in 2010 to 16.29% in 2021, the rate of growth is 71.5%, insufficient with a negative trend of coverage of pregnant women by dispensary supervision and examination by a therapist (90.7% in 2010 and 87.82% in 2021, the rate of loss is 3.9% and 90.83%, 89.51% and 9.9% respectively). During this period, the frequency of diseases and complications of the gestational period remains high - anemia (26.4% in 2010, 24.75% in 2021, growth rate - 6.5%), diseases of the circulatory system (6.2-6.34% and 2.3%), diseases of the genitourinary system (14.05-14.03% and -2.4%), diabetes (0.17-0.96% and 452.9%), diseases of the thyroid gland (9.65, 9.2% and 1.76%), preeclampsia and eclampsia (2.31-2.1% and -9.1%), preeclampsia (6.65-6.7% and 0.8%) and venous complications (2.84-4.98% and 69.0%). The complex IA of the main predictors of HRP was carried out by dividing the regions into 3 groups - the Group I with a high risk of IA development (IA - 131.1-111.9%), the Group II with an average risk of IA development (106.5-92.0%) and the III group with a lower than average risk of HRP development (89.6-60.3%). The city of Kyiv is included in the 1st group of regions that require a detailed study and correction of the determinants of HRP, Vinnytsia, Poltava, Dnipropetrovsk, Kyiv, Chernihiv and Chernivtsi, to the 2nd group of regions with an average risk of developing HRP, that require strengthening of individual components of medical and social care for pregnant women - Volyn, Mykolaiv, Donetsk, Rivne, Kharkiv, Lviv, Zhytomyr, Cherkasy, Khmelnytskyi and Transcarpathian regions. Conclusions. The toolkit of IA of the main determinants of HRP has been developed, that makes it possible to provide an objective assessment of them as a whole and by individual components across regions and timely identification of problems that require intervention. No conflict of interests was declared by the authors.

Opposing trends of cloud coverage over land and ocean under global warming

Abstract. Clouds play a key role in Earth's energy budget and water cycle. Their response to global warming contributes the largest uncertainty to climate prediction. Here, by performing an empirical orthogonal function analysis on 42 years of reanalysis data of global cloud coverage, we extract an unambiguous trend and El-Niño–Southern-Oscillation-associated modes. The trend mode translates spatially to decreasing trends in cloud coverage over most continents and increasing trends over the tropical and subtropical oceans. A reduction in near-surface relative humidity can explain the decreasing trends in cloud coverage over land. Our results suggest potential stress on the terrestrial water cycle and changes in the energy partition between land and ocean, all associated with global warming.

Health Insurance Coverage And Access To Care Among LGBT Adults, 2013-19.

Historically, lesbian, gay, bisexual, and transgender (LGBT) adults have faced barriers to obtaining health insurance coverage, which have contributed to disparities in access to care and health outcomes. The Affordable Care Act (ACA) and the 2015 Supreme Court ruling on marriage equality had the potential to improve access to health insurance for LGBT people. Using data from the nationally representative Health Reform Monitoring Survey, we provide new evidence on trends in coverage and access to care for LGBT and non-LGBT adults between 2013 and 2019. In 2013 LGBT adults were significantly less likely than non-LGBT adults to have insurance coverage and more likely to report difficulty obtaining necessary medical care. Disparities in insurance coverage began to decline in 2014, when the main coverage provisions of the ACA went into effect. By 2017-19, coverage rates for LGBT adults were comparable to those of non-LGBT adults, although significant disparities in access remained.

Estimating global and regional between-country inequality in routine childhood vaccine coverage in 195 countries and territories from 2019 to 2021: a longitudinal study.

Global routine childhood vaccine coverage has plateaued in recent years, and the COVID-19 pandemic further disrupted immunisation services. We estimated global and regional inequality of routine childhood vaccine coverage from 2019 to 2021, particularly assessing the impacts of the COVID-19 pandemic. We used longitudinal data for 11 routine childhood vaccines from the WHO-UNICEF Estimates of National Immunization Coverage (WUENIC), including 195 countries and territories in 2019-2021. The slope index of inequality (SII) and relative index of inequality (RII) of each vaccine were calculated through linear regression to express the difference in coverage between the top and bottom 20% of countries at the global and regional levels. We also explored inequalities of routine childhood vaccine coverage by WHO regions and unvaccinated children by income groups. Globally between January 1, 2019 and December 31, 2021, most childhood vaccines showed a declining trend in coverage, and therefore an increasing number of unvaccinated children, especially in low-income and lower-middle-income countries. Between-country inequalities existed for all 11 routine childhood vaccine coverage indicators. The SII for the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) coverage was 20.1 percentage points (95% confidence interval: 13.7, 26.5) in 2019, and rose to 23.6 (17.5, 30.0) in 2020 and 26.9 (20.0, 33.8) in 2021. Similar patterns were found for RII results and in other routine vaccines. In 2021, the second dose of measles-containing vaccine (MCV2) coverage had the highest global absolute inequality (31.2, [21.5-40.8]), and completed rotavirus vaccine (RotaC) coverage had the lowest (7.8, [-3.9, 19.5]). Among six WHO regions, the European Region consistently had the lowest inequalities, and the Western Pacific Region had the largest inequalities for many indicators, although both increased from 2019 to2021. Global and regional inequalities of routine childhood vaccine coverage persisted and substantially increased from 2019 to 2021. These findings reveal economic-related inequalities by vaccines, regions, and countries, and underscore the importance of reducing such inequalities. These inequalities were widened during the COVID-19 pandemic, resulting in even lower coverage and more unvaccinated children in low-income countries. Bill & Melinda Gates Foundation.

Using geographic information system to track children and optimize immunization coverage and equity in Karachi, Pakistan.

Despite the potential of geospatial technologies to track and monitor coverage, they are underutilized for guiding immunization program strategy and implementation, especially in low-and-middle-income countries. We conducted geospatial analysis to explore the geographic and temporal trends of immunization coverage, and examined the pattern of immunization service access (outreach and facility based) by children. We extracted data to analyze coverage rates across different dimensions (by enrolment year, birth year and vaccination year) from 2018 till 2020 in Karachi, Pakistan using the Sindh Electronic Immunization Registry (SEIR). We conducted geospatial analysis to assess variation in coverage rates of BCG, Pentavalent (Penta)-1, Penta-3, and Measles-1 vaccines using Government targets. We also analyzed the proportion of children receiving their routine vaccinations at fixed centers and outreach and examined whether children received vaccinations at the same or multiple immunization centers. A total of 1,298,555 children were born, enrolled or vaccinated from 2018 till 2020. At the district level, analysis by enrollment and birth year showed coverage increased between 2018 and 2019 and declined in 2020, while analysis by vaccination year showed consistent increase in coverage. However, micro-geographic analysis revealed pockets where coverage persistently declined. Notably 27/168, 39/168 and 3/156 Union councils showed consistently declining coverage when analyzing by enrollment, birth and vaccination year respectively. More than half (52.2%, 678,280/1,298,555) of the children received all their vaccinations exclusively through fixed centers and, 71.7% (499,391/696,701) received all vaccinations from the same centers. Despite overall improving vaccination coverage between 2018 and 2020, certain geographic areas have consistently declining coverage rates, which is detrimental for equity. Making immunization inequities visible through geospatial analysis is the first step to ensure resources are allocated optimally. Our study provides impetus for immunization programs to develop and invest in geospatial technologies, harnessing its potential for improved coverage and equity.

Coordinating Care for People With HIV Who Have Lower Incomes and Alternative Sources of Health Care Coverage.

As people with HIV increasingly access affordable health care coverage-enabling them to obtain medical care from private providers-understanding how they use the Ryan White HIV/AIDS Program (RWHAP), and their unmet health care needs, can enhance their overall care. We analyzed RWHAP client-level data and interviewed staff and clients at 29 provider organizations to identify trends in health care coverage and service use for clients who received medical care from private providers. The RWHAP helps cover the cost of premiums and copays for these clients and provides medical and support services that help them stay engaged in care and virally suppressed. The RWHAP plays an important role in HIV care and treatment for clients with health care coverage. The growing number of people who receive a combination of services from RWHAP providers and private providers offers opportunities for greater care coordination through communication and data sharing between these settings.