Types Of Health Care Services Research Articles

Patient perceptions of healthcare service quality in Romania: Public versus private hospitals – Implications for developed and developing healthcare systems

Objective: Recent increases in per capita income and longevity in Central and Eastern European counties (CEECs), alongside a slow-changing soviet-era public healthcare system, has led to the emergence of private hospitals. This paper investigates the differential patient service quality perceptions for private versus public hospitals, as well as for three types of healthcare services: primary, ambulatory, and inpatient care.Methods: Data from 1,673 patients of private and public hospitals in the capital of Romania were collected in face-to-face interviews. Analysis of covariance and partial-least-squares techniques were used to examine the relationships between perceived service quality, hospital ownership status and the type of health service patients received.Results: Over 70% of women prefer private health facilities to public hospitals (compared to less than 30% of men). While private hospitals rank higher than public hospitals on most attributes, the interaction effect of gender and hospital type reveals that assurance and empathy are the only significant attributes in driving women to private hospitals. (Physical facilities and staff appearance) as well as intangible dimensions of service quality (assurance, responsiveness, reliability, and empathy) have a positive impact on perceived overall service quality of healthcare. Improvements in perceptions of hospital’s tangibles, staff’s responsiveness and empathy have the greatest potential to enhance perceived overall service quality.Conclusions: This paper demonstrates the importance of breaking down health services into various sub-categories both in terms of perceived healthcare attributes and in terms of tangible healthcare facilities, such as public and private hospitals.

Legal aspects of pain management. Selected problems

The article presents considerations on the legal aspects of pain treatment. On the one hand, the patient's right to pain treatment is discussed, and on the other hand, the duties of physicians are referred to. On the latter issue, various regulations that define physicians duties related to pain management are pointed out, including, i.a., a discussion on the regulations on perinatal pain relief and the outpatient necessity of diagnosing and treating chronic pain and clinically significant pain. Particular emphasis is placed on pointing out that regardless of the medical profession or the type of health care services provided by a given entity, it has obligations related to diagnosing, treating and monitoring the effectiveness of pain treatment.

Longitudinal associations among the Big Five personality traits and healthcare utilization in the U.S.

ObjectiveOne critical component of individual and public health is healthcare utilization, or the extent to which individuals have routine check-ups, schedule treatments, or use emergency services. However, we know little about who uses healthcare services and what types, the conditions that exacerbate utilization, or the factors that explain why people seek out services. The present study fills these gaps in the literature by investigating the role of personality factors in predicting various forms of healthcare utilization, how these associations vary by age, socioeconomic resources, and chronic conditions, as well as one potential psychological mediating mechanism (i.e., sense of control). MethodsWe use data from a large longitudinal sample of Americans (N = 7108), with three assessments spanning 20 years. Participants reported on their Big Five personality traits using the Midlife Development Inventory, healthcare utilization across three domains (routine visits, scheduled treatment, urgent care), age, income, insurance, chronic conditions, and sense of control. ResultsMultilevel models showed that people who were more agreeable and neurotic tended to use more healthcare services. Moreover, on occasions when people were more extraverted and open, they tended to use more healthcare services. There were several nuances in personality-healthcare utilization associations depending on the type of healthcare service, age, and socioeconomic resources. Longitudinal mediation analyses demonstrated sense of control as one mechanism linking personality traits to healthcare utilization in the U.S. ConclusionsWe discuss the theoretical and practical implications of interactions between individuals and structural systems for promoting the health of aging U.S. Americans.

The impact of COVID-19 on the demand of arthroplasty

Abstract Background Nowadays healthcare systems are affected both by a growing demand for prosthetic surgery, and by an increase of patients’ migration who are seeking a place of care more suited to their needs. This study aims to evaluate the impact of COVID-19 on patients’ migration for lower limb arthroplasty in Italy's regional healthcare systems. Methods We conducted a cross sectional study on Hospital Discharge Cards provided by the Italian Ministry of Health from 2015 to 2020. We considered hospitalizations for lower limb arthroplasty (Diagnosis Related Groups 544; 545 and 471). We analyzed the interregional patients’ migration, comparing the average number of admissions in the years 2015-2019 with that of 2020. Regional data of Residents, Attractions and Escapes, were graphically represented through Gandy's Nomogram (GN). Results In years 2015-2019, the GN shows that all regions satisfied care needs of their Residents, except for Basilicata, for which the number of Escapes is greater than the number of residents hospitalized in their own region. However, only Piedmont, Lombardy, Veneto, E.Romagna, Tuscany, Abruzzo, and the Autonomous Province (A.P.) of Bolzano showed an Attractions minus Escapes positive balance. However, A.P. of Bolzano had a negative balance in 2020, while in Liguria and Molise, the number of Escapes exceeded the admission of residents to regional hospitals. During studied period, Attractions increased for Piedmont, A.P. of Trento, Veneto, Friuli V.G., E.Romagna, Marche, Apulia, and Calabria, while Escapes decreased for Piedmont, A.P. of Trento, E. Romagna, Tuscany, Marche, Lazio, Abruzzo, Campania, Apulia, Calabria, Sicily, and Sardinia. Conclusions Hospitalization for lower limb arthroplasty decreased in most of the regions during the COVID-19 pandemic. Piedmont, A.P. of Trento, E.Romagna, Marche, Apulia, and Calabria showed to be the most “resilient” regions, increasing the Attractions, and decreasing the Escapes at the same time. Key messages • Mapping flows by type of healthcare service is essential to identify the lack of supply so as to strengthen it in critical areas. • Italian Regions have responded to the impact of COVID-19 pandemic on hospital activity in different ways.

Development and validation of a subjective end-of-life health literacy scale.

Personal health literacy is the ability of an individual to find, understand, and use information and services to inform health-related decisions and actions for oneself and others. The end of life is commonly characterized by the occurrence of one or several diseases, the use of many different types of healthcare services, and a need to make complex medical decisions that may involve challenging tradeoffs, such as choices between quality and length of life. Although end-of-life care issues concern most people at some point in life, individuals' competencies to deal with those questions have rarely been explored. This study aims to introduce, develop, and validate an instrument to measure individuals' self-assessed competencies to deal with end-of-life medical situations, the Subjective End-Of-Life Health Literacy Scale (S-EOL-HLS), in a sample of older adults aged 50+ living in Switzerland who participated in wave 8 (2019/2020) of the Survey of Health, Ageing, and Retirement in Europe. The S-EOL-HLS uses a series of questions on self-rated difficulties in understanding end-of-life medical jargon, defining in advance which end-of-life medical treatments to receive or refuse, and communicating related choices. Aside from conducting exploratory and confirmatory factor analysis to evaluate the construct validity, we compared measurements from the S-EOL-HLS to respondents' general health literacy measured with the European Health Literacy Survey questionnaire. We obtained a three-factor model with acceptable fit properties (CFI = 0.993, TLI = 0.992, RMSEA = 0.083, SRMR = 0.061) and high reliability (α = 0.93). The partial associations between the health literacy scores from the two scales and respondents' sociodemographic characteristics were similar; however, individuals with higher end-of-life health literacy scores appeared to have more positive attitudes towards end-of-life care planning outcomes. The S-EOL-HLS demonstrates reliable and consistent results, making the instrument suitable for older adults in population surveys.

The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis

The COVID-19 pandemic substantially disrupted healthcare utilization patterns, globally. South Korea had been praised widely in its efforts to contain the spread of the pandemic, which may have contributed to a significantly smaller reduction in healthcare utilization compared to neighboring countries. However, it remains unknown how the COVID-19 pandemic impacted utilization patterns across population sub-groups, particularly vulnerable patient groups in South Korea. This paper quantifies the changes in healthcare utilization attributable to COVID-19 and the COVID-19 vaccination by sub-groups. An interrupted time series analysis was conducted to examine the impact of COVID-19 on healthcare utilization in South Korea from January 2016 to December 2022 using aggregated patient-level data from the national health insurance system that accounts for 99% of all healthcare services in South Korea. We applied negative binomial models adjusting for seasonality and serial correlation. Falsification tests were conducted to test the validity of breakpoints. Stratified analyses by type of healthcare services, age, sex, income level, health facility type, and avoidable/non-avoidable hospitalizations was performed, and we assessed differences in utilization trends between population groups across three phases of the pandemic. In early 2020, the COVID-19 pandemic caused a reduction in monthly volume of outpatient utilization by 15.7% [95% CI 13.3%-18.1%, p<0.001] and inpatient utilization by 11.6% [10.1%-13.0%, p<0.001]. Most utilization recovered and rebounded to pre-COVID-19 levels as of December 2022 although variations existed. We observed heterogeneity in the magnitude of relative changes in utilization across types of services, varying from a 42.7% [36.8%-48.0%, p<0.001] decrease for pediatrics, a 23.4% [20.1%-26.5%%, p<0.001] reduction in utilization of public health centers, and a 24.2% [21.2%-27.0%, p<0.001] reduction in avoidable hospitalizations compared to the pre-pandemic period. Contrary to global trends, health utilization among the elderly population (65 and older) in South Korea saw only marginal reductions compared to other age groups. Similarly, Medicaid patients and lower income groups experienced a smaller reduction compared to higher income groups. The impact of the COVID-19 pandemic on healthcare utilization in South Korea was less pronounced compared to the global average. Utilization of vulnerable populations, including adults over 65 years old and lowest-income groups reduced less than other type of patients. No funding.

Effects of social capital on healthcare utilization among older adults in Indonesia.

Social capital potentially affects older adults' access to healthcare services. However, the effects of social capital on the use of various types of healthcare services using longitudinal data have yet to be explored. This study aimed to examine the effects of structural and cognitive social capital on different types of healthcare utilization by older adults in Indonesia. Data were from the Indonesian Family Life Survey (waves 4 and 5) in 2007 and 2014. The sample consisted of participants aged 60 years and older who completed both waves (n = 1374). Healthcare utilization by older adults assessed health posts (posyandu), health checkups, outpatient care and hospital admissions. Social capital consisted of neighborhood trust and community participation. Generalized estimating equation models were used for the analysis. Older adults with high community participation had a higher likelihood of using preventive care in posyandu (OR = 5.848, 95% CI = 2.585-13.232) and health checkup visits (OR = 1.621, 95% CI = 1.116-2.356). Meanwhile, neighborhood trust was related to a higher probability of hospital admissions (OR = 1.255, 95% CI = 1.046-1.505). Social capital significantly affects older adults' preventive and treatment healthcare utilization. Maximizing the availability of social participation and removing barriers to access to preventive and medical care in an age-friendly environment are suggested.

Equity assessment of maternal and child healthcare benefits utilization and distribution in public healthcare facilities in Bangladesh: a benefit incidence analysis

BackgroundThe distribution of healthcare services should be based on the needs of the population, regardless of their ability to pay. Achieving universal health coverage implies first ensuring that people of all income levels have access to quality healthcare, and then allocating resources reasonably considering individual need. Hence, this study aims to understand how public benefits in Bangladesh are currently distributed among wealth quintiles considering different layers of healthcare facilities and to assess the distributional impact of public benefits.MethodsTo conduct this study, data were extracted from the recent Bangladesh Demographic and Health Survey 2017–18. We performed benefit incidence analysis to determine the distribution of maternal and child healthcare utilization in relation to wealth quintiles. Disaggregated and national-level public benefit incidence analysis was conducted by the types of healthcare services, levels of healthcare facilities, and overall utilization. Concentration curves and concentration indices were estimated to measure the equity in benefits distribution.ResultsAn unequal utilization of public benefits observed among the wealth quintiles for maternal and child healthcare services across the different levels of healthcare facilities in Bangladesh. Overall, upper two quintiles (richest 19.8% and richer 21.7%) utilized more benefits from public facilities compared to the lower two quintiles (poorest 18.9% and poorer 20.1%). Benefits utilization from secondary level of health facilities was highly pro-rich, while benefit utilization found pro-poor at primary levels. The public benefits in Bangladesh were also not distributed according to the needs of the population; nevertheless, poorest 20% household cannot access 20% share of public benefits in most of the maternal and child healthcare services even if we ignore their needs.ConclusionsBenefit incidence analysis in public health spending demonstrates the efficacy with which the government allocates constrained health resources to satisfy the needs of the poor. Public health spending in Bangladesh on maternal and child healthcare services were not equally distributed among wealth quintiles. Overall health benefits were more utilized by the rich relative to the poor. Hence, policymakers should prioritize redistribution of resources by targeting the socioeconomically vulnerable segments of the population to increase their access to health services to meet their health needs.

Dynamic Effects of Long-Term Care Insurance on Healthcare Expenditures: Evidence from South Korea

Long-term care expenses pose a large financial risk to the elderly. In 2008, South Korea introduced a public long-term care insurance (LTCI) program for individuals older than 65. We study the dynamic effects of the LTCI on various healthcare expenditures. We find that after the implementation of the LTCI, average prescription drug and outpatient expenditures of the elderly increased. Dynamically, we observe that the growth in these expenditures moderates. We also find suggestive evidence that after the introduction of the LTCI, the elderly may utilize LTC hospitals instead of inpatient hospital services. These findings underscore the importance of understanding the long-term effects of LTCI on health and healthcare expenditures of the elderly and the need to account for interactions between LTC and other types of healthcare services in policy design.

Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: A multilevel analysis.

The use of dental care among older people is low compared to other forms of health care, with significant health consequences. However, the evidence on the extent to which countries' welfare systems and socio-economic factors influence the uptake of dental care by older people is limited. This study aimed to describe trends of dental care utilisation, and to compare use of dental care with other types of healthcare services among the elderly, considering different socio-economic factors and welfare systems in European countries. Multilevel logistic regression analysis was performed using longitudinal data from four waves (between Wave 5 and 8) of the Survey of Health, Ageing and Retirement in Europe database, with a follow-up period of 7 years. The study sample included 20,803 respondents aged 50 years or older from 14 European countries. The annual dental care attendance was the highest in Scandinavian countries (85.7%), however, improving trends of dental attendance was recognized in Southern and Bismarckian countries (p<0.001). The difference in use of dental care services between socio-economic groups was expanding over time regarding low- and high-income level and residential area. A more marked difference was observed between social groups in dental care utilisation compared to other forms of care. Income level and unemployed status had significant effect on forgoing dental care due to cost and unavailability. The observed differences between socioeconomic groups may highlight the health consequences of the different organization and financing of dental care. The elderly population could benefit from adopting policies aiming to reduce the financial barriers to dental care usage, especially in Southern and Eastern European countries.

Equity and Driving Factors of Medical Service Supply–Demand Balance for the Elderly in Rapidly Urbanized Communities Based on Big Data Analysis—A Case Study of Xiamen City

Against the backdrop of rapid population aging and significant demographic changes, cities are facing great challenges in providing healthcare resources for the elderly. Understanding the equity and spatial differentiation mechanisms between the demand and supply of healthcare resources for the elderly in cities, especially in rapidly urbanized areas, can help policymakers to promote the planning and construction of a ‘Just City’ and ‘Age-Friendly City’, safeguarding the human well-being of the elderly. This study combines outpatient appointment data classified by service type with community-scale demographic data to assess the equity in the supply of medical resources for the elderly in the city using a refined two-step moving search method. Taking Xiamen City as an example, we analyzed the spatial heterogeneity in the equity in the supply of different types of health care services for potential elderly patients in each community in the city. Then, we selected six driving factors to explore the underlying driving factors. The results showed that there were 308 communities (61.11%) with a high medical service balance of the internal medicine type for the elderly in Xiamen City, concentrated in the southwest of the whole area. There are only 157 communities with high medical service balance for the surgical type of medical services, concentrated in the central part and southwest of Xiamen City. For these two types of medical services, the number of communities with low medical service balance is 30 (5.95%) and 182 (36.11%), respectively. These communities are far away from the central city. Economic vitality is the most important driving factor in the spatial distribution pattern of equity in the balance of medical services for the elderly. Our study can provide quantitative information on the current situation evaluation and decision support for the development and design of a ‘Just City’ and ‘Age-Friendly City’ Planning.

Telemedicine in Selected Military Medical Centers: What and How It Is Being Done

Background: Telemedicine is considered a remote diagnosis and treatment of patients using telecommunication. Objectives: This study aimed to share the experience of using telemedicine in selected military medical centers. Methods: Telemedicine includes medical practice and information and communication technology. It has proven to be very effective for telehealth care, especially in areas with poor health facilities. However, the implementation of these technologies is often hampered by various issues. However, due to the spread of military personnel in the vastness of Iran's geography and the need to handle and receive medical care and treatment, telemedicine has been considered for more than a hundred centers since 2019. Results: Telemedicine provides various types of health care services, such as psychological consultations, educational services, health care delivery and management, disease screening, and disaster management services across selected military medical centers. Conclusions: Although telemedicine cannot be a solution to all problems, it can certainly go a long way in reducing the burden on the health care system through safe and effective communication.

Comprehension and Perspectives of the Need for Medical Rehabilitation - Results of a German Online Survey

In Germany, medical rehabilitation usually requires an application of the persons in need. Therefore, these persons have to understand what rehabilitation is and in what case they need this type of health care service. In addition to people with health problems, their close persons (e. g. family members) should also have rehabilitation-related knowledge. Since there is only limited data on the perspective towards medical rehabilitation services, a survey was conducted. In September 2020, we invited 2,401 registered participants (age: 18-79 years) of a population-based online panel study to participate in an online survey. The cross-sectional survey asked about the understanding of need, subjective information as well as attitudes and expectations towards medical rehabilitation services. We analysed the data descriptively, taking into account the participants' rehabilitation experience and health impairment. In a subgroup analysis, the potential factors influencing the subjective need for rehabilitation were tested using logistic regression. Data from 1,464 persons (Ø age: 52.5±14.5 years; 55% non-male) were analysed, 44% of the participants considered themselves to be "rather well" or "very well" informed about medical rehabilitation. The majority associated a need for rehabilitation with the access requirements related to service providers. In case of an emerging need for rehabilitation, family doctors would be the first point of contact. The participants mainly had function-oriented expectations of rehabilitation services and a majority prefer inpatient rehabilitation if necessary. Among 383 persons with long lasting and pronounced health-related impairment, the concrete individual need for rehabilitation was associated by a higher subjective degree of impairment as well as their own previous rehabilitation experience and rehabilitation experience in their personal social environment. Despite an overall good understanding of the need for rehabilitation, different rehabilitation views were found in certain population groups. In order to improve the general understanding of rehabilitation in the public and particularly in close persons, adequate dissemination of low-threshold, population-based rehabilitation information is recommended.

Translation, cultural adaptation and pilot testing of a questionnaire measuring the factors affecting the acceptance of telemedicine by Greek cancer patients.

The emergency presented through the COVID-19 pandemic exposed the need to adopt remote, technology-driven solutions and make healthcare services more resilient. To do so, we need technological applications (i.e., telemedicine) that are designed and tailored to the end-users (i.e., chronic patients) needs and the type of healthcare service they get (i.e., cancer care). The requirements above are especially relevant to Greece, being a country with numerous sparsely populated regions (e.g., islands, regions at the borders) and a deteriorating access to healthcare for all citizens. Trying to address such diverse problems and needs, there have been multiple, different telemedicine and telecare projects in Greece in the past years. To support the future design and implementation of such endeavours, in this study we translated a questionnaire measuring the acceptance of telemedicine by patients and adapted it to the Greek context. We continued by running a small-scale pilot with 73 Greek women with breast cancer to assess the adapted instrument for its reliability and construct validity. The created questionnaire had good overall and internal reliability scores for most sub-scales. Factor analysis did not identify the same number of latent dimensions as the original theoretical model. Reverse wording items needing to be recoded were identified, and items that could be omitted in future versions of the questionnaire. Increasing the sample size for the purposes of a longitudinal study, the construct, convergent, and discriminant validity are elements to be further examined in future studies. It is envisaged that the creation of this questionnaire will support the adoption of telemedicine by Greek healthcare services into more routine areas of patient care provision.

Characterization of micronutrient supplements use by Brazilian children 6-59 months of age: Brazilian National Survey on Child Nutrition (ENANI-2019).

This study aimed to characterize micronutrient supplements use among Brazilian children 6-59 months of age included in the Brazilian National Survey on Child Nutrition (ENANI-2019; n = 12,598). Micronutrient supplements use at the time of the interview and the 6 months prior to it was evaluated using a structured questionnaire. The following indicators were included: micronutrient supplement use; supplements containing a single micronutrient; supplements of the Brazilian National Iron Supplementation Program (PNSF); multivitamin supplements with or without minerals; multivitamin supplements with minerals; multivitamin supplements without minerals. The estimates and their respective 95% confidence intervals (95%CI) were calculated for Brazil and according to macroregion, educational level of the mother or caregiver, and type of health care service used, considering the sampling plan, weights, and calibration. In Brazil, the prevalence of micronutrient supplements use was 54.2% (95%CI: 50.5; 57.8), with the highest prevalence in the North Region (80.2%; 95%CI: 74.9; 85.6) and among children 6-23 months of age (69.5%; 95%CI: 65.7; 73.3). The prevalence of the use of supplements containing exclusively iron and exclusively vitamin A in Brazil was 14.6% (95%CI: 13.1; 16.1) and 23.3% (95%CI: 19.4; 27.1), respectively. The prevalence of the use of multivitamin with or without minerals in Brazilian children 6-59 months of age was 24.3% (95%CI: 21.4; 27.2). These results may help to understand the practice of supplements use among Brazilian children and support the proposal of national public policies for the prevention and control of micronutrient deficiencies.

AMBIENT SOUND IN HEALTHCARE SETTINGS AND ITS EFFECTS ON PATIENTS AND STAFF: A SYSTEMATIC REVIEW

Sound can affect patients, staff, and visitors in healthcare settings in many ways. The purpose of this review was to synthesize and investigate sound in healthcare settings and the effects of these sounds. Relevant studies published between January 2017 and June 2022 were searched through a systematic literature review process using the Google Scholar, PubMed, Scopus, Web of Science, and Wiley Online Library databases. A total of 25 papers met the inclusion criteria. The study results cover three main areas: perceived sound sources and sound levels; associations between healthcare settings and sound; and sound’s effects on patients and staff. This study shows that in terms of sound, the environment in hospitals, nursing homes, and outpatient centers is boisterous. Among other findings, associations were identified between sound and types of healthcare services; activities and behaviors; architectural features and materials; and mobile communication devices. Most studies report that sound has adverse effects on patients and staff, while nursing home-related studies report the positive attitudes of residents to musical activities. By evaluating the multiple sound-related solutions available, this review indicates that future research in this area should focus on the long-term effectiveness of interventions and the provision of standards of practice for optimal sound environments, based on different healthcare settings.

A New Hybrid Model for Mapping Spatial Accessibility to Healthcare Services Using Machine Learning Methods

The unequal distribution of healthcare services is the main obstacle to achieving health equity and sustainable development goals. Spatial accessibility to healthcare services is an area of interest for health planners and policymakers. In this study, we focus on the spatial accessibility to four different types of healthcare services, including hospitals, pharmacies, clinics, and medical laboratories at Isfahan’s census blocks level, in a multivariate study. Regarding the nature of spatial accessibility, machine learning unsupervised clustering methods are utilized to analyze the spatial accessibility in the city. Initially, the study area was grouped into five clusters using three unsupervised clustering methods: K-Means, agglomerative, and bisecting K-Means. Then, the intersection of the results of the methods is considered to be conclusive evidence. Finally, using the conclusive evidence, a supervised clustering method, KNN, was applied to generate the map of the spatial accessibility situation in the study area. The findings of this study show that 47%, 22%, and 31% of city blocks in the study area have rich, medium, and poor spatial accessibility, respectively. Additionally, according to the study results, the healthcare services development is structured in a linear pattern along a historical avenue, Chaharbagh. Although the scope of this study was limited in terms of the supply and demand rates, this work gives more information and spatial insights for researchers, planners, and policymakers aiming to improve accessibility to healthcare and sustainable urban development. As a recommendation for further research work, it is suggested that other influencing factors, such as the demand and supply rates, should be integrated into the method.

Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study.

IntroductionExisting studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers.MethodsIn this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches.ResultsPolicymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women’s complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women’s use of skilled maternal healthcare.ConclusionThe emerging findings on pregnant women’s combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria.

Unmet Healthcare Needs among College Students during the COVID-19 Pandemic: Implications for System-Wide and Structural Changes for Service Delivery.

Background: During the COVID-19 pandemic, college students faced health disparities in addition to a negative burden on academic performance; however, little is reported in the literature regarding healthcare utilization. Methods: A cross-sectional survey was conducted among consenting college student participants aged 18 or older from a Hispanic-serving institution. Descriptive and bivariate statistics were used to analyze demographic characteristics and the types of healthcare services needed by such characteristics. Logistic regression was used to adjust for noted sex differences in associations between reporting limited healthcare services and types of healthcare services. Results: The study population of 223 participants was mostly Hispanic/Latino (65%) and female (73%). Of the population, 11% reported they could not obtain needed healthcare services, with time being reported as the most common reason. Significant associations were found between seeking general healthcare services/routine screening, seeking mental health services, and seeking sexual health services with reporting limited healthcare services, with sex-adjusted odds ratios and 95% confidence intervals of 1.90 (95% CI: 1.08, 3.36), 3.21 (95% CI: 1.44, 4.15), and 2.58 (95% CI: 1.05, 6.35), respectively. Conclusions: Availability and inability to obtain health services may exacerbate college student health disparities. Targeted interventions are needed in the population to mitigate the potential burdens of unmet healthcare needs, particularly among minority college students.

Physical activity and healthcare utilization in France: evidence from the European Health Interview Survey (EHIS) 2014

BackgroundA growing need and focus on preventing and controlling the diseases and promoting a healthier lifestyle is more evident at global, regional, and national levels. In this respect, it is well-known the positive association between physical activity and population’s health, but also its negative association with the demand of healthcare, which could lead to lower spending on healthcare systems. In France, a lack of physical activity, a high prevalence of sedentary behaviours, and a continuous deterioration of these behaviours are observed since 2006. Therefore, promoting and increasing physical activities could contribute to major societal issues. Within this context, the study aims to analyse how the use of different healthcare services are related to physical activity in a nationally representative sample of French population.MethodsThe data used was retrieved from the second wave of the EHIS-ESPS 2014. The relationship between physical activity and healthcare utilization, controlled by a set of socioeconomic, demographic, and health behaviour factors, was explored both at the level of the entire population and separately for two age groups (less than 65 years, 65 years and older), employing probit and recursive multivariate probit models.ResultsOur findings underline that the relation between healthcare utilization and physical activity depends on the type of healthcare services and age group. In this respect, only among adult respondents, we observe a significant negative association between physical activity and prescribed medicines consumption and day hospitalization, while preventive services use is positively related to physical activity. Common to both age groups, the positive association of physical activity with general physician services and non-prescribed medicines reveal that moderately and highly active adults and elders may be more health conscious and therefore may seek referrals to generalist and other prevention measures more frequently than their inactive counterparts. This explanation is also sustained by the negative association between physical activity and overnight hospitalization or home healthcare services.ConclusionsThis study highlights the double role of physical activity on health as preventive measure and treatment and thus support the implementation of public health policies aimed at increasing the level of physical activity in French population.