Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria.

Achieving universal health coverage (UHC) and the Sustainable Development Goals (SDG) by 2030 relies on the delivery of quality healthcare services through effective primary healthcare (PHC) systems. This necessitates robust infrastructure, adequately skilled health workers and the availability of essential medicines and commodities. Despite the critical role of minimum standards in benchmarking PHC quality, no global consensus on these standards exists. Nigeria has established minimum standards to enhance healthcare accessibility and quality, including the Revised Ward Health System Strategy (RWHSS) by the National Primary Health Care Development Agency (NPHCDA). This paper outlines the evolution of PHC minimum standards in Nigeria, evaluates compliance with RWHSS standards across all public PHC facilities, and examines the implications for ongoing PHC revitalization efforts. The study used a cross-sectional descriptive design to assess compliance across 25 736 public PHC facilities in Nigeria. Data collection involved a national survey using a standardized assessment tool focussing on infrastructure, staffing, essential medicines and service delivery. Compliance with RWHSS minimum standards was found to be below 50% across all facilities, with median compliance scores of 40.7%. Outreach posts had a median compliance of 32.6%, level 1 facilities 31.5% and level 2+ facilities 50.9%. Key findings revealed major gaps in health infrastructure, human resources and availability of essential medicines and equipment. Compliance varied regionally, with the North-west showing the highest number of facilities but varied performance across standards. The lessons learned underscore the urgent need for targeted interventions and resource allocation to address the identified deficiencies. This study highlights the critical need for regular, comprehensive compliance assessments to guide policy-makers in identifying gaps and strengthening PHC systems in Nigeria. Recommendations include enhancing monitoring mechanisms, improving resource distribution and focussing on infrastructure and human resource development to meet UHC and SDG targets. Addressing these gaps is essential for advancing Nigeria's healthcare system and ensuring equitable, quality care for all.

Revisiting a decade of inequality in healthcare financial burden in Cambodia, 2009-19: trends, determinants and decomposition.

BACKGROUND: Out-of-pocket healthcare expenditure (OOPHE) without adequate social protection often translates to inequitable financial burden and utilization of services. Recent publications highlighted Cambodia's progress towards Universal Health Coverage (UHC) with reduced incidence of catastrophic health expenditure (CHE) and improvements in its distribution. However, departing from standard CHE measurement methods suggests a different storyline on trends and inequality in the country. OBJECTIVE: This study revisits the distribution and impact of OOPHE and its financial burden from 2009-19, employing alternative socio-economic and economic shock metrics. It also identifies determinants of the financial burden and evaluates inequality-contributing and -mitigating factors from 2014-19, including coping mechanisms, free healthcare, and OOPHE financing sources. METHODS: Data from the Cambodian Socio-Economic Surveys of 2009, 2014, and 2019 were utilized. An alternative measure to CHE is proposed: Excessive financial burden (EFB). A household was considered under EFB when its OOPHE surpassed 10% or 25% of total consumption, excluding healthcare costs. A polychoric wealth index was used to rank households and measure EFB inequality using the Erreygers Concentration Index. Inequality shifts from 2014-19 were decomposed using the Recentered Influence Function regression followed by the Oaxaca-Blinder method. Determinants of financial burden levels were assessed through zero-inflated ordered logit regression. RESULTS: Between 2009-19, EFB incidence increased from 10.95% to 17.92% at the 10% threshold, and from 4.41% to 7.29% at the 25% threshold. EFB was systematically concentrated among the poorest households, with inequality sharply rising over time, and nearly a quarter of the poorest households facing EFB at the 10% threshold. The main determinants of financial burden were geographic location, household size, age and education of household head, social health protection coverage, disease prevalence, hospitalization, and coping strategies. Urbanization, biased disease burdens, and preventive care were key in explaining the evolution of inequality. CONCLUSION: More efforts are needed to expand social protection, but monitoring those through standard measures such as CHE has masked inequality and the burden of the poor. The financial burden across the population has risen and become more unequal over the past decade despite expansion and improvements in social health protection schemes. Health Equity funds have, to some extent, mitigated inequality over time. However, their slow expansion and the reduced reliance on coping strategies to finance OOPHE could not outbalance inequality.

Hydrodynamic frictional performance of fouled panels: a comparative study of different coating types.

This research study delves into the hydrodynamic frictional characteristics of fouled panels coated with different types of coatings, investigating how fouling coverage and surface roughness influence drag. The investigation incorporates data on the overall percentage coverage of fouling, as well as roughness measurements obtained through a 3D profilometer. Drag data collected from a flowcell simulation of real-world flow conditions complements these measurements. Notably, the determination of the level of fouling leverages the capabilities of CIE L*a*b as an image analysis method, focusing on the overall coverage rather than individual fouling species. The objective is to illustrate how fouled panels perform under varying flow and coating conditions compared to their clean counterparts. Furthermore, the paper proposes a roughness scaling approach that considers both the percentage coverage and measured areal roughness for each coating type, encompassing both fouled and unfouled areas. This approach provides valuable insights into the combined effects of fouling and surface roughness on hydrodynamic performance, enhancing our understanding of the intricate interplay between these factors.

COMPARATIVE STUDY OF STRIPED CATFISH (PANGASIUS HYPOPHTHALMUS) SKIN, NILE TILAPIA (OREOCHROMIS NILOTICUS) SKIN, AND PORCINE SKIN AS A XENOGRAFT MATERIAL FOR BURN WOUND.

Burn injury remains a health problem, specifically in Indonesia. In major burns, xenograft has been proved to be useful as temporary wound coverage. However, some xenografts are not widely available due to cultural, financial and religious backgrounds, or have an unesthetic appearance, such as the scaly appearance of tilapia fish xenograft. Striped catfish (Pangasius hypophthalmus) is a scaleless fish that has abundant type 1 collagen. This study aimed to compare striped catfish skin to commonly used xenograft (Nile tilapia and porcine skin) as xenograft material for burn wound. In this experimental study, nine different skin samples of striped catfish, Nile tilapia and porcine were prepared and histologically examined using hematoxylin-eosin stained samples. Macroscopic and microscopic features of each sample were documented and analysed. The macroscopic skin appearances of striped catfish were hairless and scaleless with black-silver color and moderate thickness. As for microscopic features, the epidermal thickness of striped catfish skin (8.49±1.60 µm) was significantly different to both Nile tilapia (2.18±0.37 µm; p<0.001) and porcine skin (42.22±14.85 µm; p=0.002). The dermal thickness of striped catfish skin (288.46±119.04 µm) was similar to Nile tilapia (210.68±46.62 µm; p=0.783) but differs significantly to porcine skin (1708.44±505.12 µm; p<0.001). The integrity and collagen organization of striped catfish was also similar to tilapia based on semi-quantitative histology scoring system (p>0.05). Striped catfish had potential macroscopic appearance and comparable microscopic features to Nile tilapia; smoother macroscopic appearance, thicker epidermis, and similar dermis thickness. Therefore, we believe it can be potentially used as a xenograft material. Further studies are required to evaluate the effectiveness and feasibility of striped catfish xenograft in burn wound management.

Les brûlures restent un problème de santé publique, en Indonésie comme ailleurs. Les xénogreffes ont montré leur utilité comme couverture temporaire en cas de brûlure étendue. Certaines xénogreffes peuvent n'être pas utilisables pour des raisons financières, culturelles ou religieuses. L'aspect écaillé des xénogreffes de tilapia peut aussi rebuter. Le silure- requin a une peau dépourvue d'écaille, abondante en collagène de type 1. Cette étude expérimentale compare cette xénogreffe à celles de tilapia du Nil et de porc. Neuf biopsies cutanées de silure- requin, tilapia du Nil et de porc ont été examinées macroscopiquement et histologiquement (après coloration hématoxyline- éosine). Macroscopiquement, la peau de silure- requin est glabre, dépourvue d'écaille, argent à noire et d'épaisseur modérée. Microscopiquement, l'épiderme du silure- requin (8,49 +/- 1,6 µm) est plus épais que celui du tilapia du Nil (2,18 +/- 0,37; p<0,001) et moins épaisse que celui du porc (42,22 +/- 14,85; p = 0,002). L'épaisseur du derme du silure- requin est comparable à celle du tilapia du Nil (288,46 +/- 119,04 VS 210,68 +/- 46,62 µm; p = 0,783), nettement plus fin que celui du porc (1 708,44 +/- 505,12 µm; p < 0,001). L'organisation du collagène, évaluée par un score histologique semi- quantitatif, est similaire chez les 2 poissons. Ces aspects macroscopique et microscopique de la peau du silurerequin en font un candidat à la xénogreffe, devant être étudié plus avant.

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

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

A new method for estimating nanoparticle deposition coverage from a set of weak-contrast SEM images.

Imaging nanomaterials in hybrid systems is critical to understanding the structure and functionality of these systems. However, current technologies such as scanning electron microscopy (SEM) may obtain high resolution/contrast images at the cost of damaging or contaminating the sample. For example, to prevent the charging of organic substrate/matrix, a very thin layer of metal is coated on the surface, which will permanently contaminate the sample and eliminate the possibility of reusing it for following processes. Conversely, examining the sample without any modifications, in pursuit of high-fidelity digital images of its unperturbed state, can come at the cost of low-quality images that are challenging to process. Here, a solution is proposed for the case where no brightness threshold is available to reliably judge whether a region is covered with nanomaterials. The method examines local brightness variability to detect nanomaterial deposits. Very good agreement with manually obtained values of the coverage is observed, and a strong case is made for the method's automatability. Although the developed methodology is showcased in the context of SEM images of Polydimethylsiloxane (PDMS) substrates on which silicone dioxide (SiO2) nanoparticles are assembled, the underlying concepts may be extended to situations where straightforward brightness thresholding is not viable.

Determining factors associated with vaccination coverage in the first year of life in Brazil (2013-2022).

Access to vaccination has emerged as a growing global public health concern; however, there has been limited research on characteristics of local governments that are associated with vaccination coverage. The objective of this study was to evaluate predictors of vaccination coverage in Brazil for the first year of life between 2013 and 2022. We focused on variables pertaining to the available resources of local governments and their investments in infrastructure and human resources in the health sector. We used binomial generalized linear mixed models to estimate the association of these variables with vaccination coverage in Brazilian municipalities. Our results show that municipalities with better fiscal capacity were more effective in delivering vaccines. Municipalities that rely more on federal and state resources had lower vaccination coverage. Additionally, investment in health professionals was often negatively correlated with vaccination coverage. The study underscores the importance of better understanding the relationship between local government characteristics and vaccination coverage, particularly in regions where local governments are responsible for vaccine delivery.

Y and Mitochondrial Chromosomes in the Heterogeneous Stock Rat Population.

Genome-wide association studies typically evaluate the autosomes and sometimes the X Chromosome, but seldom consider the Y or mitochondrial Chromosomes. We genotyped the Y and mitochondrial Chromosomes in heterogeneous stock rats (Rattus norvegicus), an outbred population created from eight inbred strains. We identified 8 distinct Y and 4 distinct mitochondrial Chromosomes among the 8 founders. However, only two types of each nonrecombinant chromosome were observed in our modern heterogeneous stock rat population (generations 81-97). Despite the relatively large sample size, there were virtually no significant associations for behavioral, physiological, metabolome, or microbiome traits after correcting for multiple comparisons. However, both Y and mitochondrial Chromosomes were strongly associated with expression of a few genes located on those chromosomes, which provided a positive control. Our results suggest that within modern heterogeneous stock rats there are no Y and mitochondrial Chromosomes differences that strongly influence behavioral or physiological traits. These results do not address other ancestral Y and mitochondrial Chromosomes that do not appear in modern heterogeneous stock rats, nor do they address effects that may exist in other rat populations, or in other species.

'The national health insurance policy provides little to no benefit to young persons living with type 1 diabetes (T1D)': a qualitative study of T1D management cost-burden in Southern Ghana.

BACKGROUND: Type 1 diabetes (T1D) management exerts a considerable financial burden on patients, caregivers, and developing nations at large. In Ghana, a key governments effort to attenuate the financial burden of T1D on patients was to fashion safety-net mechanisms through financial risk pooling/sharing known as the National Health Insurance Scheme (NHIS). However, there is limited research on patients and caregivers' experiences with the cost of managing T1D within the NHIS in Ghana. OBJECTIVE: This study explored the cost of T1D management, and the impact of the NHIS policy on mitigating costs of care. METHODS: A semi-structured interview guide was developed to collect qualitative data from 28 young people living with T1D (PLWD), 12 caregivers, 6 healthcare providers, and other stakeholders in Western, Central and the Greater Accra regions. Multiple data collection techniques including mystery client and in-depth interviews were used to collect data. Thematic content analysis was performed with QSR NVivo 14. RESULTS: Five key domains/themes which are: cost of T1D management supplies; cost of clinical care; cost of transportation; cost of diet; and NHIS were identified. The daily cost of blood glucose testing and insulin injection per day was between GHC 5-7 (US$ 0.6 to 1.0). The NHIS did not cover supplies such as strips, glucometers, HbA1c tests, and periodic medical tests. Even for those cost which were covered by the NHIS (mainly pre-mixed insulin), marked government delays in funds reimbursement to accredited NHIS facilities compelled providers to push the financial obligation onto patients and caregivers. Such cost obligations were fulfilled through out-of-pocket top-up or full payment of insulin of about GHC 15-25 (US$ 2-4), and GHC 25-50 (US$4-8) depending on the region and place of residence. CONCLUSION: The cost of managing T1D was a burden for patients and their caregivers. There was a commodification of life-saving insulin on the Ghanaian market, and the NHIS did not function well to ease the cost-burden of T1D management on patients and caregivers. The findings call for the need to scale up NHIS services to include simple supplies, particularly test strips, and always ensure the availability of life-saving insulin in healthcare facilities.

Investigating the impact of long-term bristlegrass coverage on rhizosphere microbiota, soil metabolites, and carbon-nitrogen dynamics for pear agronomic traits in orchards.

Background: Grass coverage (GC) under no-tillage systems in orchards signifcantly infuences underground carbon (C) and nitrogen (N) sequestration, primarily through promoting mineral nutrient utilization by rhizospheric microorganisms. However, the comprehensive impact of GC on microbial communities and plant responses using soil metabolomics remains inadequately recognized. Methods: We investigated two rhizosphere types established since 2002: bristlegrass (Setaria viridis (L.) P. Beauv.) coverage (SC) and clean cultivation (CC) to assess their efects on soil parameters, enzyme activities, and key pear agronomic traits, including yield (single fruit weight (SFW)) and qualities (soluble solids content (SSC), and total soluble sugar (TSS)). We combined microbiological analysis (16S rRNA sequencing) and non-targeted metabolomics (UPLC-MS/MS and GC-MS) to explore how microbial communities infuence fruit agronomic traits and soil nutrient dynamics in pear orchards under SC conditions. Results: Our fndings indicate that SC signifcantly enhances soil organic carbon (SOC), soil organic nitrogen (SON), the C:N ratio, and available nitrogen (AN). Moreover, SC leads to pronounced increases in soil enzyme activities involved in the C cycle and storage, including soil sucrase, ß-glucosidase, polyphenol oxidase and cellulase. Microbiome analysis revealed substantial diferences in microbial community composition and diversity indices between SC and CC rhizosphere soils within the 0-40 cm depth. Metabolomic analysis demonstrated significant alterations in metabolite profiles across both the 0-20 cm and 20-40 cm layers under SC conditions. The identifed metabolites primarily involve sugar and amino acid-related metabolic pathways, refecting perturbations in C and N metabolism consistent with shifts in bacterial community structure. Several plant growth-promoting rhizobacteria (PGPRs) taxa (e.g., Haliangium, Bacteroides, mle1-7, Subgroup_22, Ellin6067, MND1, Flavobacterium, and Cellvibrio) were enriched under SC, associated with metabolites such as sucrose, N-acetyl-D-glucosamine, N-acetyl-L-glutamic acid, rhamnose, UDP-GlcNAc and D-maltose. These fndings suggest their roles in promoting C and N sequestration processes through sucrose synthesis and glycolytic pathways in the soil, which was signifcantly correlated with the formation of agronomic traits such as fruit yield, SFW SSC and TSS (p<0.05), and SC treatments signifcantly increased yields by 35.40-62.72% and sucrose content in TSS by 2.43-3.96 times than CC treatments. Conclusion: This study provides valuable insights into the efects of SC on soil microbial communities and plant physiology, enhancing our understanding of their implications for sustainable orchard management.

RDSC: Range-Based Device Spatial Clustering for IoT Networks.

The growth of the Internet of Things (IoT) has become a crucial area of modern research. While the increasing number of IoT devices has driven significant advancements, it has also introduced several challenges, such as data storage, data privacy, communication protocols, complex network topologies, and IoT device management. In essence, the management of IoT devices is becoming more and more challenging, especially with the limited capacity and power of the IoT devices. The devices, having limited capacities, cannot store the information of the entire environment at once. In addition, device power consumption can affect network performance and stability. The devices' sensing areas with device grouping and management can simplify further networking tasks and improve response quality with data aggregation and correction techniques. In fact, most research papers are looking forward to expanding network lifetimes by relying on devices with high power capabilities. This paper proposes a device spatial clustering technique that covers crucial challenges in IoT. Our approach groups the dispersed devices to create clusters of connected devices while considering their coverage, their storage capacities, and their power. A new clustering protocol alongside a new clustering algorithm is introduced, resolving the aforementioned challenges. Moreover, a technique for non-sensed area extraction is presented. The efficiency of the proposed approach has been evaluated with extensive experiments that gave notable results. Our technique was also compared with other clustering algorithms, showing the different results of these algorithms.

Whole-genome sequencing of Neisseria meningitidis collected in Chile from pediatric patients during 2016-2019 and coverage vaccine prediction.

BACKGROUND: Over the past few years, whole-genome sequencing (WGS) has become a valuable tool for global meningococcal surveillance. The objective of this study was to genetically characterize Neisseria meningitidis strains isolated from children in Chile through WGS and predicting potential vaccine coverage using gMATS and MenDeVAR. METHODS: WGS of 42 N.meningitidis from pediatric patients were processed and assembled using different software. We analyzed genomes with BIGSdb platform hosted at PubMLST.org, and predicted vaccine coverage using MenDeVAR and gMATS tools. RESULTS: Among 42 strains, 25 were MenB, 16 MenW, and 1 MenC. The cc11 and cc 41/44 were the most frequents. The main frequent deduced peptide sequence for PorA was P1.5,2 (40 %), peptide P1.4 was present in one MenB strain; NHBA-29 (64 %), none having peptide 2; fHbp-2 (76 %), one strain had peptide-1, and two had peptide 45; NadA was detected in 52 %, peptide-6 was present in 84 %, none had peptide 8. The MenDeVAR index predicted a coverage in MenB strains for 4CMenB 8 % exact matches, 12 % cross-reactivity, 8 % not coverage and 64 % had insufficient data. gMATS predicted 16 % was covered, 8 % not covered and 76 % unpredictable, and overall coverage of 54 %. For rLP2086-fHbp, the MenDeVAR index predicted exact match in 8 %, cross-reactivity in 64 %, and insufficient data in 28 % and an overall coverage of 72 %. In non-MenB strains, the MenDeVAR index predicted for 4CMenB vaccine: cross-reactivity 88 %, 6 % for not covered and insufficient data. For rLP2086-fHbp, predicted cross-reactivity 12 % and insufficient data in 88 %. gMATS predicted an overall coverage of 50 % for Non-MenB. CONCLUSION: genetic variability of the Chilean strains that its different from other countries, and until now limit the coverage prediction of vaccine with the available tools like gMATS and MenDeVAR.

Operational description of rare diseases: a reference to improve the recognition and visibility of rare diseases.

Improving health and social equity for persons living with a rare disease (PLWRD) is increasingly recognized as a global policy priority. However, there is currently no international alignment on how to define and describe rare diseases. A global reference is needed to establish a mutual understanding to inform a wide range of stakeholders for actions. A multi-stakeholder, global panel of rare disease experts, came together and developed an Operational Description of Rare Diseases. This reference describes which diseases are considered rare, how many persons are affected and why the rare disease population demands specific attention. The operational description of rare diseases is framed in two parts: a core definition of rare diseases, complemented by a descriptive framework of rare diseases. The core definition includes parameters that permit the identification of which diseases are considered rare, and how many persons are affected. The descriptive framework elaborates on the impact and burden of rare diseases on patients, their caregivers and families, healthcare systems, and society overall. The Operational Description of Rare Diseases establishes a common point of reference for decision-makers across the world who strive to understand and address the unmet needs of persons living with a rare disease. Adoption of this reference is essential to improving the visibility of rare conditions in health systems across the world. Greater recognition of the burden of rare diseases will motivate new actions and policies to address the unmet needs of the rare disease community.

Coding and coverage for cardiac CT in the era of algorithm-based healthcare procedures and services.

In order for patients to gain the benefit of innovation in cardiac CT, it is necessary for coding, coverage, and payment to adapt to the novelty of algorithm-based healthcare procedures and services (ABHS). Appendix S to the CPT Code Set, the "AI Taxonomy", enables creation of discrete and differentiable codes for reimbursement of ABHS which has been clinically validated and FDA-labeled. Payment policy in OPPS and PFS is evolving to take account of the unique opportunities and issues arising from the clinical adoption of ABHS.

Theoretical Prediction of Enhanced Hydrogen Evolution Reaction Electrocatalysts Based on Tantalum Phosphide.

Ta-based transition metal catalysts have shown significant catalytic activity for the hydrogen evolution reaction (HER) in recent studies. However, the application of tantalum phosphide (TaP) in the HER has not been documented. Herein, a systematic study of TaP catalysts was performed through density functional theory (DFT). The performance of TaP (004) for the HER was predicted. Thermodynamic analyses of Ta-terminated and P-terminated surfaces with adsorbed hydrogen atoms were conducted, and the HER mechanism on TaP (004) surfaces was carefully investigated. Theoretical results revealed that TaP (004) exhibits excellent HER activity (ΔGH* = 0.0456 eV), and both the Ta-terminated and P-terminated surfaces follow the Volmer-Heyrovsky mechanism under acidic conditions, with the Volmer step being the rate-determining step. A mixed surface strategy was also applied to explore the synergistic effects of Ta-terminated and P-terminated surfaces, which enhanced the HER activity. Additionally, the study screened dopants to assess their impact on the HER activity, revealing that doping with S, Ni, Co, Fe, and Cr could improve the HER performance.

The Affordable Care Act Dependent Coverage Provision and Unintended Pregnancy.

Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability of family planning services among young adults. Furthermore, the impact of this provision may differ by young adult income level as those with lower income are less likely to be insured and thus more likely to benefit from this provision. Our objective was to estimate the association between the ACA dependent coverage provision and unintended pregnancy, overall, and by young adult income level. Methods: We applied a difference-in-differences approach to data from multiple cycles of the National Survey of Family Growth (n = 10,104) and compared trends in unintended pregnancy between those who were eligible to benefit (ages 18-25 years) and those who were ineligible to benefit (ages 26-33 years) from the provision, overall, and among income subgroups. Results: We found evidence that the dependent coverage provision was associated with a -7.4 percentage point reduction (95% CI: -13.5, -1.3) in the prevalence of unintended pregnancy among young adults with lower income (<100% of the federal poverty level). There was limited evidence, however, that the provision was associated with unintended pregnancy among young adults with higher income levels. Conclusions: These findings suggest the ACA dependent coverage provision may have reduced unintended pregnancy among a particularly high-risk group (i.e., young adults with lower income).

'Broken souls' vs. 'mad ax man' - changes in the portrayal of depression and schizophrenia in the German media over 10 years.

AIMS: Population studies show the stigma of depression to diminish, while the stigma of schizophrenia increases. To find out whether this widening gap is reflected in the media portrayal of both disorders, this study compares the portrayal of depression and schizophrenia in German print media in 2010 vs. 2020. METHODS: We conducted a qualitative content analysis using a mixed deductive-inductive approach to establish a category system. In total, we analyzed 854 articles with the summative approach by Mayring. RESULTS: The study found a widening gap in the portrayal of schizophrenia and depression in German media between 2010 and 2020. Schizophrenia was depicted increasingly negative between 2010 and 2020, covering more negative stereotypes and focusing on its biological causes. Depression received increased attention and more neutral and professional coverage, with a greater emphasis on psychosocial causes and discussion of treatment options. CONCLUSIONS: By showing a widening gap the study highlights how media may shape public views on mental illnesses and reflects public attitudes at the same time. Media analyses from other nations have shown similar trends. This emphasizes the need for responsible reporting to combat stigma and promote understanding worldwide. Therefore, the authors recommend a balanced coverage that includes accurate professional information about all mental illnesses.

Measuring progress towards universal health coverage in 22 Middle East and North African countries.

Purpose: Monitoring progress towards universal health coverage (UHC) has become increasingly important, especially given the centrality of UHC in achieving the sustainable development goals. We sought to estimate the progress towards UHC in the 22 Middle East and North Africa (MENA) countries. Methods: Employing the Joint World Bank and World Health Organization Framework for Monitoring UHC, we estimated the UHC index for MENA countries using both service coverage and financial protection indicators. We also explored the correlation between the UHC index with government expenditure/investment in health. Results: The 2021 UHC index ranged from 48.2 (Somalia) to 90.3 (United Arab Emirates) with a mean, median, and standard deviation of 74.9, 77.4, and 11.1, respectively, with significant differences between low-income and high-income countries. Service coverage lags behind financial protection in most MENA countries. There is a significant positive relationship between UHC and government health spending/investments. Conclusion: The majority of MENA countries are yet to achieve UHC. There is a need to expand healthcare services, especially PHC services, and adopt strategies that address concerns related to financial protection.