Inequalities in the demand and unmet need for contraception among women in four regions of Ethiopia.

BACKGROUND: Unmet need for family planning is a major cause of unwanted pregnancies, which may contribute to the death of mothers and children. The aim of this study is to examine inequalities in the demand and unmet need for contraception among women in four regions (i.e., Afar, Benishangul-Gumzu, Gambela and Somali regions) of Ethiopia. METHODS: The study utilized data from the 2016 Ethiopian Demographic Health Survey (EDHS), collected from 3,343 women of reproductive age 15-49 years situated in these study regions. Multilevel binary and multivariable logistic regression analysis, concentration index, and multivariate decomposition analysis were employed. RESULTS: The study revealed that women's employment status, education level, household wealth index, total number of children ever born, and husband's working status had a statistically significant association with the demand for contraception. Furthermore, women's educational level, household size, wealth index and husband's working status had statistically significant association with unmet need for contraception. The results of the concentration index indicated that illiteracy among respondents (56%), being in the richest economic status/ wealth index (41%) and non-working status of respondents (21%) contributed substantially to the inequality in the demand for contraception use. Illiteracy of the husband (197%) and the household size less than or equal to five (184%) contributed positively, but illiteracy of respondent (-249%) and unemployment status of respondents (-119%) contributed negatively to the existing inequality in unmet need for contraception. CONCLUSION: The findings of this study highlight the presence of unacceptably high inequality in the demand and unmet need for contraception among women in the four study regions. Policymakers should give due attention to reducing existing socio-economic inequality to address the high unmet need for family planning and increase demand for contraception in these regions. The study strongly recommends implementing multidimensional and multisectoral approaches, which will significantly reduce inequalities in the outcome variables.

World Federation of Neurology Needs Registry Survey 2021.

The WFN Needs Registry survey was developed and conducted over two and a half years commencing in 2020 to investigate the accessibility and affordability of neurological services and therapeutics and the most urgent needs. METHOD: An experienced neurologist responded in each of 118 societies to an online electronic survey comprising 13 questions. General data sought comprised the respondent's training, place of practice, duration in practice, number of neurologists in the society, health care system and types of neurological practice available. Specific data collected comprised neurological facilities, specialist services available, resources, therapeutics accessibility, challenges and three most urgent needs. RESULTS: Responding neurologists spent a median of 26 years in practice and represented a median of 225 neurologists per society. Of 13 classes of neuromedicines deemed readily available to 70% of the population, 41 societies listed ≥1 and 14 societies ≥3 unavailable. The three most frequent unavailable neuromedicines were second level AEDs, Dopamine agonists and MS DMTs. Of 14 neurological services, 15 societies had all services accessible and affordable, 13 had none and 72 had ≥1 services either inaccessible or unaffordable. EEG, Epilepsy, Headache and EMG services were most available; Neurogenetics, Neuropsychology, Neurorehabilitation and Neurodevelopmental services were least available. Of 13 specified challenges, lack of subspecialists and specialty centers were both identified by 61% of societies followed by costs of neurological care, neuromedicines availability and stigma. Ten societies had no challenges. CONCLUSION: A unique insight into the inequities of neurological care globally and a potential tool to assist their remedy.

Social prescribing needs and priorities of older adults in Canada: a qualitative analysis. / Besoins et priorités des aînés en matière de prescription sociale au Canada : une analyse qualitative.

INTRODUCTION: Social prescribing (SP) is a holistic and collaborative approach to help individuals access community-based supports and services for their nonmedical social needs. The aim of this study was to assess the needs and priorities of Canadian older adults (aged 55 years and older), with a focus on optimizing SP programs for those who are systemically disadvantaged and socially marginalized. METHODS: Semistructured focus groups (N = 10 groups, 43 participants) were conducted online via Zoom with participants from across Canada. Data transcription and thematic analysis were completed in NVivo. Analyses were informed by self-determination theory. RESULTS: Our results suggest that older adults desire SP programs that respect their ability to maintain their autonomy and independence, aid and facilitate the development of connectedness and belonging, are built on a foundation of trust and relationship-building in interactions with providers and link workers, and prioritize the person and thus personalize SP to the unique needs of each individual. CONCLUSION: SP programs should be informed by the values of older adults. As work is currently underway to formalize and scale SP in Canada, personalizing these programs to the unique circumstances, needs and priorities of participants should be a top priority.

Past trends and future projections of palliative care needs in Chile: analysis of routinely available death registry and population data.

BACKGROUND: The number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses, including non-cancer conditions. We aimed to estimate the number of people affected by serious health-related suffering and need for palliative care in Chile to 2050. METHODS: We used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997-2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative care needs. RESULTS: Population palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousand people in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78-1.80). This increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85-2.95) and cardiovascular conditions (IRR 1.86, 95% CI 1.83-1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents (not expected to die within a year). CONCLUSIONS: Chile will experience a large increase in palliative care needs, particularly for people with dementia and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and new sustainable models of care are urgently required to ensure universal access to palliative care.

What are the home care needs of Chinese healthcare workers: a latent class analysis.

Background: The aging population has led to a surge in demand for home care, which has developed rapidly in China in recent years. However, there has been less empirical research into the needs of healthcare workers about providing home care. The purpose of this study was to explore the latent classes of healthcare workers' needs in primary health care institutions and to identify associated factors. Methods: From August 2021 to June 2022, a convenience sampling method was adopted to conduct a questionnaire survey on the workers of 62 primary healthcare institutions in Sichuan Province. Latent class analysis was used to categorize home care needs by Mplus 8.3. Multinomial logistic regression analysis was adopted to explore the influencing factors using SPSS 25.0. Results: A total of 1,152 healthcare workers were included in the study. Their needs for home care were classified into four latent classes: overall high need group (18.0%); overall low need group (34.8%); high training and low support need group (29.9%), and the high security and low training need group (17.3%). The factors influencing the different need categories included working area, professional title, role of medical workers, had participated in training about home care, and feelings about home care, with Class 1 as the reference group. Conclusion: Our findings indicate that primary healthcare workers have multifaceted needs for providing home care. Paying attention to their diverse needs can help optimize home care and enhance service capacity. Exploring the factors affecting needs can provide targeted support to healthcare workers to ensure the quality and continuity of home care services.

Health of refugees settled in Australia over time and generations: a transformative mixed methods study protocol.

BACKGROUND: Refugees resettled in Australia may experience significant physical, mental and emotional health issues on arrival and difficulty accessing mainstream healthcare that often demands specialised services. It is not known if and how refugee health needs and service use change over time and generations, how this compares with the broader Australian population and what level of resourcing is required to maintain specialised services. There is also a significant knowledge gap concerning the resources and skills of refugees that can be harnessed to sustain the health and well-being of individuals and communities. Such knowledge gaps impede the ability of the health system to deliver responsive, efficient, acceptable and cost-effective care and services and limit the engagement of refugees in the coproduction of these services. METHODS: This study will be the first to provide comprehensive, longitudinal, population-based evidence of refugee health, service use and the accumulated resources or assets related to positive health and well-being (compared with data on deficits, illness and death) across the lifespan and generations. This will enable a comprehensive understanding of the relationships among assets, health status, service gaps and behaviours. We will identify the assets contributing to increased capacities to protect and promote health. This evidence is essential for planning health prevention programmes.This project has three phases: (1) employ national linked datasets to examine the health and social outcomes of refugees in Australia; (2) engage with refugees in a participatory manner to map the social, economic, organisational, physical and cultural assets in their communities and deliver an integrated model of health; and (3) codesign a roadmap of agreed actions required to attain health and well-being in communities and indicators to assess outcomes. ETHICS AND DISSEMINATION: Ethics and procedures-phase I:Ethical approval for phase I was gained from the Australian Bureau of Statistics (ABS) for Person Level Integrated Data Asset microdata (unit record data) via the ABS DataLab and the NSW Population and Health Services Research Ethics Committee (2023ETH01728), which can provide a single review of multijurisdictional data linkage research projects under the National Mutual Acceptance Scheme. This will facilitate approval for the Victorian and ACT datasets. The ABS will be the integrating/linkage authority. The Centre for Health Record Linkage (CHeReL) and the Victorian Data Linkage Unit will prepare a data extract representing all data records from the dataset to provide to the ABS for linkage.Ethics and procedures-phases 2 and 3:Written consent will be obtained from all participants, as well as consent to publish. We have obtained ethical approval from the University of Technology Sydney Medical Research Ethics Committee; however, as we deepen our consultation with community members and receive input from expert stakeholders, we will likely seek amendments to hone the survey and World Café questions. We will also need to provide flexible offerings that may extend to individual interviews and online interactions. DISCUSSION: This innovative approach will empower refugees and put them at the centre of their health and decision-making.

Key stakeholders' perspectives of illicit drug use and associated harms in the Northern Territory of Australia.

BACKGROUND: In the Northern Territory (NT) of Australia, there are significant evidence gaps about illicit drug use and harms, despite having established monitoring and reporting systems. This paper reports on illicit drug use, associated harms, contributing factors, service needs and priorities in the NT from the perspective and experiences of key stakeholders engaged in providing services for, or advocating on behalf of, people who use illicit drugs in the NT. METHODS: Face-to-face and online qualitative interviews were conducted with stakeholders across urban and remote locations in the NT. Key stakeholders were service providers, including acute and primary care clinicians, representatives of Aboriginal community controlled health organisations, lived experience advocates, peak body representatives and public health executives. Qualitative data were analysed thematically. RESULTS: Four researchers interviewed 21 participants across urban (62%), and remote areas (38%) of the NT. Themes identified were: (1) Illicit drug use and harms are diverse and distinct; (2) Client support needs are complex and influenced by co-morbidities, socio-demographic and cultural factors; (3) Priority population sub-groups need targeted strategies; (4) Local service strengths can be further developed and enhanced; (5) Local services need better resourcing; (6) Invest in progressive legislative and policy reforms; and (7) Improve routine monitoring and evaluation. CONCLUSIONS: Key stakeholders described illicit drug use, harms and contributing factors, which provided insights into the local challenges. Participants emphasised that clients have complex care needs, and further investment into targeted strategies are required to improve service engagement with priority groups. Service needs included greater understanding the role of dual diagnosis and its implementation and enhancing integrated and collaborative care in both primary health and acute care contexts. The voices of people with lived experience captured in this paper must inform local strategy and policy development relating to illicit drug use, in alignment with national strategy.

The global blood donation index: an imperfect measure of transfusion need.

The optimum number of units of blood and the associated number of blood donors required to meet a given population's needs remain undetermined globally. Typically, a whole blood donation rate of ten donations per 1000 population, at a minimum, is necessary to meet a country's blood needs. This rate is attributed to a WHO recommendation that 1% of a given country's population should donate blood to ensure a blood supply that is sufficient to meet clinical needs. This often cited metric was first referenced in a 1971 WHO report, yet neither supporting data or references were provided, suggesting that it was flawed at its founding. Regardless, this metric does not provide an accurate or contemporary determination of blood needs, which has ramifications for health service provision and planning, particularly in low-income and lower-middle-income countries. Modelling studies that account for geographical variability in disease burden, health-care infrastructure, and transfusion practices are needed to accurately estimate blood needs. A paucity of data to inform modelling remains a major obstacle in this regard. We discuss the history of the global blood donation index and highlight some factors that should be considered to better understand contemporary blood needs.

Transnational adoptees in healthcare: barriers, resources, and needs.

Background: After decades of research output, it is well established that transnational adoptees-i.e., individuals who are placed for adoption outside their country of birth-exhibit an increased risk of various negative mental health outcomes. Even so, there is a lack of suggestions for preventive measures or treatment interventions targeting the transnational adoptee population in the literature. Objective: To explore experiences, opinions, and needs among adult transnational adoptees in Sweden concerning healthcare in general and mental healthcare in particular. Methods: Sixty-six adult transnational adoptees residing in Sweden, born in 15 different non-European countries, were recruited for individual in-depth interviews about their experiences and opinions regarding psychosocial support and healthcare. The interview data were analyzed employing a codebook thematic analysis approach. Results: Three overarching themes were identified: (a) barriers to adequate treatment, (b) helpful resources in dealing with health-related issues, and (c) health-related needs and suggestions for the development of adequate support. Identified barriers include a lack of insight into and interest in adoptee health, colorblindness and unwillingness to address racism, expectations of gratitude, steep financial costs, lack of support from adoptive parents, and mistrust of support structures that involve adoptive parents or adoption organizations. Participants also describe helpful resources, such as the community of fellow transnational adoptees. Health-related needs and suggestions include more well-defined and easily accessible structures of support, improved knowledge and competence, a broader psychotherapeutic repertoire that better addresses adoption-related themes, improved support in situations that can be particularly stressful for adoptees (such as during pregnancy and as new parents), routine follow-up during childhood and adolescence, and education targeting adoptive parents. The need for greater attention to the well-being of children of transnational adoptees is also highlighted. Implications: Based on these findings, a number of recommendations can be made. For example, knowledge about adoptee health should be strengthened, and psychotherapeutic competence in addressing issues related to racism should become a priority. After over 20 years of discussion, one or more national research and knowledge hubs on transnational adoption should be created. Moreover, economic resources should be made available to support transnational adoptees in accessing adequate treatment.

Rural and Frontier Communities.

Children and adolescents in rural communities have statistically more unmet mental health needs and fewer mental health resources than their urban counterparts. The rural population is ill-served by the traditional medical model of hyperspecialization and would benefit more from a population-based approach. By embracing the community, including each area's distinct culture, mental health providers can best affect change in these areas. Increased pediatric integration via telepsychiatry, including clear and codified teleprescribing parameters for controlled substances, can reach more rural youth and eliminate current burdens to primary care providers who currently treat most rural mental illness.

How enabling factors determine unmet healthcare needs? A panel data approach for countries.

Health service need refers to the essential care required to achieve optimal health outcomes within resource constraints. When necessary services to address identified health issues are not received, unmet needs arise. This research focuses on the determinants of unmet healthcare needs across the 34 countries within the European region from 2011 to 2019, focusing on Andersen's Behavioral Model's enabling factors. We employed a static and robust panel regression model using Stata 14.0 software. Key determinants analyzed include GDP per capita, urbanization rate, and physicians per capita. Findings reveal that lower GDP per capita and lower urbanization rates are significantly correlated with higher levels of unmet healthcare needs, highlighting income level and geographical accessibility as critical factors. Additionally, a higher number of physicians per capita is associated with reduced unmet healthcare needs, indicating the importance of healthcare resources in addressing healthcare access gaps. These findings underscore the importance of targeted healthcare policies that address income level, improve healthcare accessibility, and enhance healthcare resource allocation to reduce unmet healthcare needs effectively. These findings equip policymakers and administrators with empirically grounded insights to comprehend the factors contributing to unmet healthcare needs and to develop policies aimed at addressing this challenge.

National Trends in the Prevalence of Unmet Health Care and Dental Care Needs During the COVID-19 Pandemic: Longitudinal Study in South Korea, 2009-2022.

BACKGROUND: Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets. OBJECTIVE: This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs. METHODS: We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients. RESULTS: From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53%; 673,780, 24.95%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase (ßdiff 0.10, 95% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic (ßdiff 0.23, 95% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the ß difference during the pandemic increased compared with prepandemic values. CONCLUSIONS: Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs.

Responding to healthcare needs of different religious communities: implications for the Italian National Health Service.

BACKGROUND: One of the challenges that our Italian National Health Service is facing is the structural change of society, regarding the migratory flows recorded in the last thirty years with the consequent increase in faithful who follow religions other than the Catholic one. AIM OF THE STUDY: This study highlights the critical issues due to religious indications of different faiths which can have implications for our healthcare system. The study analyses the different concept of health, illness, well-being and pain, life and death, gender issues, rules regarding diet, fasting and drugs that can be taken by the patients. Religious norms regarding procreation, termination of pregnancy, and the use of contraceptive methods are also considered; as well as euthanasia, organ donation and the specific needs for end-of-life rites in different religious faiths, as they are presented in the literature and as they emerged in the dialogue with the national representatives of the religious faiths that make up the Interreligious Table of Rome. Conclusions and future perspective. The complexity of this relatively recent Italian reality necessarily leads to an in-depth analysis of religious and cultural diversity. The National Health Service must face a series of changes which concern both the adaptation of health structures and the adequate preparation of health workers, who are called upon to know how to communicate and offer care and assistance to all.

Global Workforce and Access: Demand, Education, Quality.

There has long existed a substantial disparity in access to radiotherapy globally. This issue has only been exacerbated as the growing disparity of cancer incidence between high-income countries (HIC) and low and middle-income countries (LMICs) widens, with a pronounced increase in cancer cases in LMICs. Even within HICs, iniquities within local communities may lead to a lack of access to care. Due to these trends, it is imperative to find solutions to narrow global disparities. This requires the engagement of a diverse cohort of stakeholders, including working professionals, non-governmental organizations, nonprofits, professional societies, academic and training institutions, and industry. This review brings together a diverse group of experts to highlight critical areas that could help reduce the current global disparities in radiation oncology. Advancements in technology and treatment, such as artificial intelligence, brachytherapy, hypofractionation, and digital networks, in combination with implementation science and novel funding mechanisms, offer means for increasing access to care and education globally. Common themes across sections reveal how utilizing these new innovations and strengthening collaborative efforts among stakeholders can help improve access to care globally while setting the framework for the next generation of innovations.

Originalarbeiten / Original Articles. Die Behandlung von Kindern und Jugendlichen mit substanzbezogenen Störungen im deutschen Gesundheitssystem ­ eine Quantitative Studie.

The Treatment of Children and Adolescents with Substance-Related Disorders in the German Health Care System - a Quantitative Study This study evaluates the minimum characteristics of OPS code 9-694 for specific treatment in special settings for substance-related disorders in children and adolescents. The research questions to be answered are the extent to which given minimum characteristics and potentials are assessed as practical, up-to-date, needs-oriented and necessary. The survey was conducted using a nationwide online survey in special wards of child and adolescent psychiatric clinics. Given minimum characteristics reflect everyday clinical practice and are assessed as practical, up-to-date and relevant. Nevertheless, setting- and method-specific potential for further development was identified, most of which has already been implemented in the clinics but has not yet been incorporated into the minimum characteristics. The topic has received little research attention to date. The findings of the original study can provide a basis for the optimization and adaptation of minimum characteristics and treatment offers for children and adolescents with substance-related disorders and lead to the further development of the OPS code. A theory-practice transfer tailored to the target group requires the networking of individual players in the help system as well as the health policy discussion and gradual adaptation of the content of given minimum characteristics and potential for change.

Survivorship Needs in Patients With Head and Neck Cancer in Regional, Rural and Remote Areas: A Systematic Review.

OBJECTIVE: Understanding survivorship issues among people with head and neck cancer (HNC) is important as survival rates increase. Most research has focused on urban patients, leaving a gap in understanding the challenges faced by those in rural areas. This study aims to summarise the literature on survivorship needs for people with HNC in rural areas. METHODS: PubMed, PsycINFO, Scopus, Medline, CINAHL, Web of Science, and Embase were searched from database inception to 10 July 2024, with no restriction on publication period, country, or language. Data on study aims, country, methodology, and major findings related to HNC survivors in rural areas were extracted. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklists. RESULTS: Twenty-one studies met the inclusion criteria. Eight studies were qualitative, 11 were quantitative, and two adopted a mixed-methods approach. Results demonstrate the impact of complex treatments on physical (n = 13) and psychosocial (n = 14) functioning. This study also emphasises multifaceted challenges, including reduced access to specialised services, resulting in greater travel and financial burden, extending to caregivers. Hence, primary healthcare services are crucial in supporting these patients closer to home. CONCLUSIONS: Addressing the gaps in equitable post-treatment care requires an even distribution of healthcare funding and workforce in rural areas. Future research could target these issues to develop tailored interventions or models of care, such as shared care, to ease access and financial burden.

An assessment of the attitudes, knowledge, and education regarding the health care needs of LGBTQ patients with cancer: results of an ESMO/SIOPE global survey.

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals with cancer have specific and unique health issues and needs. Reports persist of inequalities in the care provided for these patients, making it important to assess the attitudes and knowledge of LGBTQ needs among those who provide care. MATERIALS AND METHODS: The European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOP Europe) Adolescents and Young Adults Working Group designed this survey comprising 67 questions covering demographics, knowledge, and education of LGBTQ health needs, and attitudes regarding LGBTQ patients with cancer. RESULTS: Among the 672 respondents, a majority do not ask about sexual orientation and gender identity during first visit (64% and 58%, respectively). Only a minority of the respondents considered themselves well informed regarding gay/lesbian and transgender patients' health (44% and 25%, respectively) and psychosocial needs (34%). There was high interest in receiving education regarding the unique health needs of LGBTQ patients (73%). CONCLUSIONS: Survey respondents indicated a willingness to provide care to LGBTQ patients, but a lack of confidence in the knowledge of the health issues and needs of LGBTQ individuals. Lack of training provided in medical schools and postgraduate training programmes and strong interest for additional education on these issues were reported.