Revolutionizing cancer treatment in India: Evaluating the unmet need, economics, and a roadmap for project implementation of particle therapy.

INTRODUCTION: This study aims to quantitatively assess eligible patients and project the demand for particle therapy facilities in India from 2020 to 2040. In addition, an economic analysis evaluates the financial feasibility of implementing this technology. The study also examines the prospective benefits and challenges of adopting this technology in India. METHODOLOGY: Cancer incidence and projected trends were analyzed for pediatric patients using the Global Childhood Cancer microsimulation model and adult patients using the Globocan data. Economic cost evaluation is performed for large-scale combined particle (carbon and proton-three room fixed-beam), large-scale proton (one gantry and two fixed-beam), and small-scale proton (one gantry) facility. RESULTS: By 2040, the estimated number of eligible patients for particle therapy is projected to reach 161,000, including approximately 14,000 pediatric cases. The demand for particle therapy facilities is projected to rise from 81 to 97 in 2020 to 121 to 146 by 2040. The capital expenditure is estimated to be only 3.7 times that of a standard photon linear accelerator over a 30-year period. Notably, the treatment cost can be reduced to USD 400 to 800 per fraction, substantially lower than that in high-income countries (USD 1000 to 3000 per fraction). CONCLUSION: This study indicates that, in the Indian scenario, all particle therapy models are cost-beneficial and feasible, with large-scale proton therapy being the most suitable. Despite challenges such as limited resources, space, a skilled workforce, referral systems, and patient affordability, it offers substantial benefits. These include the potential to treat many patients and convenient construction and operational costs. An iterative phased implementation strategy can effectively overcome these challenges, paving the way for the successful adoption of particle therapy in India. PLAIN LANGUAGE SUMMARY: In India, eligible patients benefiting from high-precision particle therapy technology projected to rise till 2040. Despite high upfront costs, our study finds the long-term feasibility of all particle therapy models, potentially offering a substantial reduction in treatment cost compared to high-income countries. Despite challenges, India can succeed with an iterative phased approach.

Effects of disability-related limitations in daily living on unmet needs: a longitudinal-study1.

BACKGROUND: Unmet health needs are particularly important to people with disabilities; however, these unmet needs owing to limitations in daily life have been under-researched thus far. This study examined the effects of disability-related limitations in daily life on unmet needs. METHODS: This study included 5,074 adults with disabilities from the 2018-2020 Korea Disability and Life Dynamics Panel. We analyzed the effects of disability-related limitations in daily life on unmet needs using logistic regression with a generalized estimating equation model. RESULTS: Overall, 4.8% men and 4.6% women with disabilities had unmet needs. For men, unmet needs were 1.46 times (95% confidence interval [CI] 1.09-1.96) higher for those with moderate limitations in daily life. For women, unmet needs were 1.79 times (95% CI 1.22-2.39) higher when there were moderate limitations in daily life. The prominent factors causing this effect were physical or brain lesion disability for men and internal or facial disability and burden of medical expenses for women. CONCLUSIONS: Limitations in daily life due to disability increase the risk of having unmet needs, an effect that is significantly more pronounced in men. These unmet needs differ depending on an individual's sex, disability type, limited body parts, and other specific causes. Efforts are required to reduce the unmet needs of people with disabilities by considering the type of disability, impaired body parts, and causes of unmet needs in daily life.

Percepciones del personal de salud sobre los efectos de la pandemia COVID-19 en un servicio de salud mental y adicciones

Objetivo: Analizar las percepciones del personal de salud sobre los efectos de la pandemia por COVID-19 en la organización de un servicio de salud mental y adicciones. Materiales y métodos: Estudio descriptivo, transversal, cuantitativo. Se aplicó una encuesta diseñada por el Observatorio Argentino de Drogas de la SEDRONAR (Secretaría de Políticas sobre Drogas de la Nación Argentina) al personal de salud del Centro Asistencial Córdoba durante el mes de noviembre 2020. Resultados: Según las percepciones del personal de salud, la institución sostuvo la admisión y la suspensión fue solamente sobre las prestaciones de terapia grupal durante la primera etapa, que se revirtió desarrollando grupos terapéuticos mediante videollamadas. En relación con la variación de la demanda de atención, el 68,9% mencionó estar totalmente en desacuerdo con la afirmación de que la misma disminuyó. El personal de salud observó una variabilidad en los motivos de consulta y un aumento en la demanda de atención, con un crecimiento de las consultas por violencia autoinfligida y por consumos problemáticos de sustancias. Conclusión: Las medidas de aislamiento implicaron una reorganización de los servicios y sus modalidades de atención. Se torna importante preparar a los servicios de salud mental y adicciones para brindar las prestaciones necesarias y dar respuesta a las demandas de atención durante este tipo de contingencias.

Objetive: To analyze the perceptions of health personnel about the effects of the COVID-19 pandemic on the organization of a mental health and drug abuse service. Materials and Methods: A descriptive, cross-sectional and quantitative. A survey designed by the Argentine Drugs Observatory of SEDRONAR (Secretaría de Políticas sobre Drogas de la Nación Argentina) was applied to all the health professionals at Centro Asistencial Córdoba during November 2020. Results: According to the perceptions of health personnel, the organization kept admissions open for new treatments and the suspension was only about group therapy benefits during the first moment of lockdown measures, which was reversed by developing therapeutic groups through video calls. Regarding the change in demand for attention, 68, 9% mentioned being totally at odds with the claim that it diminished. Health personnel perceived a variability in the reasons for consultation and an increase in the demand for attention with a growth in consultations due to self-inflicted violence and substance-related disorders. Conclusion: It is possible to conclude that lockdown measures involved a reorganization of services and their modalities of attention. Therefore, it becomes important to prepare mental health services and substance-related disorders to provide the necessary benefits and respond to the demands for attention during this type of critical incidents.

Classification of health needs: a cluster analysis of older adults in urban areas.

BACKGROUND: In this study, a cross-sectional survey was used to understand and analyze the health status and health needs of the elderly in the community. The cluster analysis method was used to explore the relationship between health needs items and investigate the commonness among health demand items, to provide a reference for the development of health management of the elderly with chronic diseases. METHODS: We used convenience sampling to recruit the participants (aged 60 and above) from four urban community centers in Jinzhou City, Liaoning Province, China, in this study. This study uses the Medical Outcomes Study(MOS)36-Item Short-Form Health Survey. The self-designed questionnaire includes sociodemographic characteristics, chronic diseases, physical examination conditions, illness in the past two weeks, and a health needs questionnaire. SPSS 18.0 was used for data entry and analysis. Data analysis methods included descriptive statistical analysis, t-test, one-way analysis, cluster analysis, and linear multiple regression analysis. RESULTS: The rate of health needs among the elderly in the community for various health services is 1.3-69.7%, of which the top three are: regular physical examination (69.7%), day Care Center (67.7%), the establishment of a Medical Alert Systems (66.1%). The health needs of the elderly in the community are divided into three categories: basic needs (24 items), health education (13 items), and first aid (2 items). The regression analysis found that the influencing factors of health status were age, revenue and expenditure, medical expenses, health education, basic needs, and first aid. CONCLUSIONS: The community should strengthen the management of chronic diseases of the elderly and the publicity and education of related knowledge, and provide complementary health care services according to the health needs of the elderly, improve the health of the elderly, and improve the quality of life of the elderly.

Age-Dependent Sex Differences in the Prevalence of Selective Serotonin Reuptake Inhibitor Treatment: A Retrospective Cohort Analysis.

Background: Antidepressants are among the most prescribed medications in the United States. The aim of this study was to explore the prevalence of antidepressant prescriptions and investigate sex differences and age-sex interactions in adults enrolled in the Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment (RIGHT) study. Materials and Methods: We conducted a retrospective analysis of the RIGHT study. Using electronic prescriptions, we assessed 12-month prevalence of antidepressant treatment. Sex differences and age-sex interactions were evaluated using multivariable logistic regression and flexible recursive smoothing splines. Results: The sample consisted of 11,087 participants (60% women). Antidepressant prescription prevalence was 22.24% (27.96% women, 13.58% men). After adjusting for age and enrollment year, women had significantly greater odds of antidepressant prescription (odds ratio = 2.29; 95% confidence interval = 2.07, 2.54). Furthermore, selective serotonin reuptake inhibitors (SSRIs) had a significant age-sex interaction. While SSRI prescriptions in men showed a sustained decrease with age, there was no such decline for women until after reaching ∼50 years of age. There are important limitations to consider in this study. Electronic prescription data were cross-sectional; information on treatment duration or adherence was not collected; this cohort is not nationally representative; and enrollment occurred over a broad period, introducing confounding by changes in temporal prescribing practices. Conclusions: Underscored by the significant interaction between age and sex on odds of SSRI prescription, our results warrant age to be incorporated as a mediator when investigating sex differences in mental illness, especially mood disorders and their treatment.

Modelling a Consultant Workforce for the United Kingdom: needs-based planning for Dental Public Health.

OBJECTIVE: To develop a needs-based workforce planning model to explore specialist workforce capacity and capability for the effective, efficient, and safe provision of services in the United Kingdom (UK); and test the model using Dental Public Health (DPH). BASIC RESEARCH DESIGN: Data from a national workforce survey, national audit, and specialty workshops in 2020 and 2021 set the parameters for a safe effective DPH workforce. A working group drawing on external expertise, developed a conceptual workforce model which informed the mathematical modelling, taking a Markovian approach. The latter enabled the consideration of possible scenarios relating to workforce development. It involved exploration of capacity within each career stage in DPH across a time horizon of 15 years. Workforce capacity requirements were calculated, informed by past principles. RESULTS: Currently an estimated 100 whole time equivalent (WTE) specialists are required to provide a realistic basic capacity nationally for DPH across the UK given the range of organisations, population growth, complexity and diversity of specialty roles. In February 2022 the specialty had 53.55 WTE academic/service consultants, thus a significant gap. The modelling evidence suggests a reduction in DPH specialist capacity towards a steady state in line with the current rate of training, recruitment and retention. The scenario involving increasing training numbers and drawing on other sources of public health trained dentists whilst retaining expertise within DPH has the potential to build workforce capacity. CONCLUSIONS: Current capacity is below basic requirements and approaching 'steady state'. Retention and innovative capacity building are required to secure and safeguard the provision of specialist DPH services to meet the needs of the UK health and care systems.

Association between long working hours and unmet dental needs in wage workers.

BACKGROUND: Many previous studies on the reasons behind unmet dental needs focus on economic issues. However, in this research, we aimed to investigate the relationship between long working hours and unmet dental needs while considering the influence of occupational factors in wage workers. METHODS: This study used data from the Korea National Health and Nutrition Examination Survey (2012-2018) and analyzed a sample of 12,104 wage workers. Unmet dental needs were defined as cases in which individuals did not receive dental care, despite their need for examination or treatment, within the last year. Long working hours were defined as exceeding 52 h per week, based on the standard working hours stipulated by the Labor Standards Act. A binomial model was applied to calculate the prevalence ratio through multivariate logistic regression analysis. RESULTS: The prevalence of unmet dental needs was observed in 3,948 cases (32.5%), among which 1,478 attributed their presence to lack of time. The prevalence of unmet dental needs showed an inverse relationship with the education level and household income. The wage workers who worked long hours had the highest prevalence of unmet dental needs. Long working hours were found to be 1.18 times (95% CI 1.07-1.29) more likely to result in unmet dental care compared to working less than 40 h. The relationship between long working hours and unmet dental needs were statistically significant only in men (PR 1.24, 95% CI 1.07-1.43). However, the relationship between long working hours and unmet dental needs owing to time were in both men and women (men: PR 1.59, 95% CI 1.20-2.11, women: PR 1.90, 95% CI 1.48-2.43). CONCLUSIONS: This study confirmed that long working hours and unmet dental needs are related when occupational factors are taken into consideration, despite the absence of oral health indicators. Using this study as a reference, further research is necessary to identify the underlying causes of unmet dental care and to improve access to dental services in the future.

Approaches and Components of Health Workforce Planning Models: A Systematic Review.

Background: To date, there is still no uniformity in forecasting models for health workforce planning (HWFP). Different countries use various HWFP models, some of which are context-specific. The objective of this systematic review is to determine approaches and components of HWFP models. Methods: A systematic review of studies published in English and Persian between 2004 and 2021 was performed by searching PubMed Central, MEDLINE, Web of Science, Scopus, Eric, and Elmnet databases. Articles that assessed HWFP models, focused on health service delivery, used input-output models, and a clear formulation process were included. Articles that scored ≥20 points on the "strengthening the reporting of observational studies in epidemiology" checklist were considered of acceptable quality for inclusion. Results: Twenty articles were included for qualitative synthesis based on the inclusion and exclusion criteria. Most studies used the mixed method approach "supply and demand", whereas target- and needs-based approaches were used less frequently. The number of components used to estimate supply, demand, needs, and targets were 42, 32, 11, and 6, respectively. In addition, several unique factors used in the various HWFP models were identified. Conclusion: Different approaches are used in HWFP models, which is indicative of the lack of consensus on this topic. High diversity in the identified factors is related to the approach used and the context in which the model is applied.

Impetrações judiciais de mães de crianças com síndrome congênita do vírus zika: das motivações aos desfechos / Impetracciones judiciales de madres de personas menores con síndrome congénito del virus zika: De las motivaciones a los resultados / Judicial impetractions of mothers of children with congenital zika virus syndrome: From motivations to outcomes

Introdução: As famílias de crianças com Síndrome Congênita do Zika (SCZ) convivem com dificuldades para suprir suas necessidades de saúde, portanto acionam o poder judiciário para gozar do seu direito à saúde. Objetivo: Apreender as principais motivações das impetrações judiciais requeridas por mães de crianças com SCZ e seus desfechos. Metodologia: Estudo exploratório documental com abordagem qualitativa, realizado no sítio eletrônico JusBrasil e coleta procedida em março de 2020. Foram incluídas 15 impetrações judiciais publicadas entre janeiro de 2016 e junho de 2019. A análise lexical através do software IRaMuTeQ e a análise de conteúdo temática foram realizadas. Resultados: O acesso às tecnologias assistivas é a principal motivação para impetrações judiciais, com vistas a assegurar melhora no desenvolvimento da criança e consequente independência da criança. As decisões judiciais beneficiaram as crianças com SCZ, fundamentadas no direito à saúde, direito à vida e proteção, e o direito de ir e vir. Conclusão: Para mitigar os impactos da judicialização da saúde as autoridades sanitárias e judiciárias podem investir em melhor vigilância e monitoramento dos fatores de risco e morbidades; rigor nos protocolos sanitários que envolvem migração de pessoas em zonas fronteiriças; ofertas de condições ambientais e de moradia dignas; realização de cuidados preventivos com destaque para a eficiência da imunização; além da organização e funcionamento de uma rede de atenção à saúde eficaz com abordagem interdisciplinar.

Introducción: Las familias de personas menores con síndrome de zika congénito (SZC) viven con dificultades para satisfacer sus necesidades de salud, por lo que hacen un llamado al Poder Judicial para gozar de este derecho. Objetivo: Conocer las principales motivaciones de las demandas presentadas por madres de niños y niñas con SZC y sus desenlaces. Metodología: Estudio documental exploratorio con enfoque cualitativo, realizado en el sitio web de JusBrasil y recogido en marzo de 2020. Se incluyeron 15 juicios publicados entre enero de 2016 y junio de 2019 en JusBrasil. Se realizó el análisis léxico a través del software IRaMuTeQ y el análisis de contenido temático. Resultados: El acceso a las tecnologías asistenciales es la principal motivación de las demandas, con el fin de asegurar la mejora en el desarrollo de la persona menor y su consecuente independencia. Las decisiones judiciales beneficiaron a niñas y niños con SZC, basadas en los derechos a la salud, a la vida y protección y a ir y venir. Conclusiones: Para mitigar los impactos de la judicialización en salud, las autoridades sanitarias y judiciales pueden invertir en una mejor vigilancia y seguimiento de los factores de riesgo y morbilidades, rigor en los protocolos sanitarios que implican la migración de personas en zonas fronterizas, ofrecer condiciones ambientales y habitacionales dignas, realizar cuidados preventivos, con énfasis en la eficiencia de la inmunización, además de la organización y operación de una red de atención de salud efectiva con enfoque interdisciplinario.

Introduction: Families of children with Congenital Zika Syndrome (CSZ) live with difficulties to meet their health needs; therefore, they resort to the law system in order claim their right to health. Objective: To apprehend the main motivations and outcomes of the lawsuits filed by mothers of children with CSZ. Methodology: Exploratory documentary study with a qualitative approach carried out on the JusBrasil website and collected in March 2020. The study included 15 lawsuits published between January 2016 and June 2019 in JusBrasil. A lexical analysis through the IRaMuTeQ software and a thematic content analysis were performed. Results: The access to assistive technologies is the main motivation for the lawsuits; these are issued with the objective to ensure improvement in the child's development and further independence of the child. Court decisions benefited children with CSZ based on the right to health, the right to life and protection, and the right to come and go. Conclusion: To mitigate the impacts of health judicialization, health and judicial authorities can invest in better surveillance and monitoring of the risk factors and morbidities, strictness in the health protocols that involve migration of people in border areas, offering of decent environmental and housing conditions, execution of preventive care with emphasis on the efficiency of immunization, as well as the organization and execution of an effective health care network with an interdisciplinary approach.

The Impact of Interpersonal Continuity of Primary Care on Health Care Costs and Use: A Critical Review.

PURPOSE: Interpersonal continuity has been shown to play an essential role in primary care's salutary effects. Amid 2 decades of rapid evolution in the health care payment model, we sought to summarize the range of peer-reviewed literature relating continuity to health care costs and use, information critical to assessing the need for continuity measurement in value-based payment design. METHODS: After comprehensively reviewing prior continuity literature, we used a combination of established medical subject headings (MeSH) and key words to search PubMed, Embase, and Scopus for articles published between 2002 and 2022 on "continuity of care" and "continuity of patient care," and payor-relevant outcomes, including cost of care, health care costs, cost of health care, total cost of care, utilization, ambulatory care-sensitive conditions, and hospitalizations for these conditions. We limited our search to primary care key words, MeSH terms, and other controlled vocabulary, including primary care, primary health care, family medicine, family practice, pediatrics, and internal medicine. RESULTS: Our search yielded 83 articles describing studies that were published between 2002 and 2022. Of these, 18 studies having a total of 18 unique outcomes examined the association between continuity and health care costs, and 79 studies having a total of 142 unique outcomes assessed the association between continuity and health care use. Interpersonal continuity was associated with significantly lower costs or more favorable use for 109 of the 160 outcomes. CONCLUSIONS: Interpersonal continuity today remains significantly associated with lower health care costs and more appropriate use. Further research is needed to disaggregate these associations at the clinician, team, practice, and system levels, but continuity assessment is clearly important to designing value-based payment for primary care.

Patterns and determinants of health and social care service needs among community-dwelling older adults.

AIM: Using Anderson's behavioral model, we examined the patterns and determinants associated with older adults' needs for community- and institution-based care services. METHODS: Participants included 411 community-dwelling older adults from the 2020 National Survey of Older Koreans. Logistic regression analyses were performed to examine factors associated with service needs among older adults. RESULTS: The need was greatest for movement support services. Enabling factors (marital status, co-residence with children, receipt of financial assistance for medical expenses, social participation, and satisfaction with healthcare facilities) were associated with service needs. Long-term care beneficiary status, activities of daily living limitations, depressive symptoms, hypertension, and vision impairment were also significant factors. CONCLUSIONS: Older adults with physical disabilities, depressive symptoms, and limited resources for care require prioritization in support policies to promote aging in place. Both health and social care needs should be addressed in long-term care to enhance social participation among older adults.

Facilitating discharge planning: the Risk Assessment of Complex Discharge Index.

BACKGROUND: Untimely social interventions prolong hospitalizations, suggesting discharge planning should begin early. This study aimed to create a tool to identify, already in Emergency department, patients at risk of complex discharge for social reasons. METHODS: We developed the Risk Assessment of Complex Discharge Index (RACDI). In Emergency department, we administered RACDI to patients destined to hospitalization. We calculated sensitivity and specificity of RACDI in identifying patients who need a social intervention. RACDI was compared with simplified BRASS. A multivariable logistic regression explored social intervention predictors (P-value < 0.05). RESULTS: RACDI was administered to 296 patients. There were significant associations between classes of risk defined by RACDI or by simplified BRASS and social intervention. The sensitivity of RACDI and simplified BRASS was, respectively, 0.59 and 0.43; the specificity 0.81 and 0.83. Chances of social intervention were higher for patients at high risk with RACDI (adjOR:3.13, 95% CI: 1.23-8.00, P = 0.017). CONCLUSIONS: The reduced items and mostly dichotomous answers made RACDI a tool easy to be used in daily practice. RACDI helps in classifying patients needing discharge planning for social care and is a starting point to standardize the evaluation of social context early in hospitalization. Further work is needed to overcome limitations and assess additional outcomes.

Estimation of the demand for palliative care in non-oncologic patients in Chile.

BACKGROUND: Access to palliative care is an emerging global public health challenge. In Chile, a palliative care law was recently enacted to extend palliative care coverage to the non-oncologic population. Thus, a reliable and legitimate estimate of the demand for palliative care is needed for proper health policy planning. OBJECTIVE: To estimate the demand for Palliative Care in Chile. METHODOLOGY: Diseases likely to require palliative care were identified according to literature and expert judgement. Annual deaths of diseases identified were estimated for the periods 2018-2020. Demand estimation corresponds to the identification of the proportion of deceased patients requiring palliative care based on the burden of severe health-related suffering. Finally, patient-years were estimated based on the expected survival adjustment. RESULTS: The estimated demand for palliative care varies between 25,650 and 21,679 patients depending on the approximation used. In terms of annual demand, this varies between 1,442 and 10,964 patient-years. The estimated need has a minor variation between 2018 and 2019 of 0.85% on average, while 2020 shows a slightly higher decrease (7.26%). CONCLUSION: This is a replicable method for estimating the demand of palliative care in other jurisdictions. Future studies could approach the demand based on the decedent population and living one for a more precise estimation and better-informed health planning. It is hoped that our methodological approach will serve as an input for implementing the palliative care law in Chile, and as an example of estimating the demand for palliative care in other jurisdictions.

Teacher-reported emotional and behavioural problems and ethnic background associated with children's psychosocial care use: a longitudinal population-based study.

Approximately, 15% of children in Western countries suffer from emotional and behavioural problems. However, not all children receive the psychosocial care they need, especially children with a non-Western background experience an unmet need for care. This might be because parents of non-Western children report a lower need for care than parents of Western children, unrelated to the actual need. This study examined the association between teacher-reported problems and psychosocial care use, independent of mother-reported problems. Further, the role of ethnic background in this association was investigated. The study sample of 9-year-old children was retrieved from the Generation R Study (N = 3084), a prospective, population-based cohort of children born in Rotterdam, the Netherlands. Teacher- and mother-reported problems were measured via questionnaire when the children were  6/7 years old. Psychosocial care use was mother-reported at the research centre when children were 9 years old (8.1%). Hierarchical logistic regressions showed significant positive associations between teacher-reported total, externalising and internalising problems and later psychosocial care use. These associations were independent of mother-reported problems. Children with a non-Western background used less care, but ethnic background did not moderate the association between teacher-reported problems and care use. Our findings suggest that teachers might have an important role, next to parents, in the identification of problems and children's access to care. This may be particularly important for non-Western children, as they use less psychosocial care than Western children, despite other research showing that they generally display higher levels of problems. Directions for future research and implications are discussed.

Need, demand, supply in health care: working definitions, and their implications for defining access.

Effective policymaking in health care systems begins with a clear typology of the terminology - need, demand, supply and access to care - and their interrelationships. However, the terms are contested and their meaning is rarely stated explicitly. This paper offers working definitions of need, demand and supply. We draw on the international literature and use a Venn diagram to explain the terms. We then define access to care, reviewing alternative and competing definitions from the literature. We conclude by discussing potential applications of our conceptual framework to help to understand the interrelationships and trade-offs between need, demand, supply and access in health care.

Adolescent and Young Adult Perspectives on Quality and Value in Health Care.

OBJECTIVE: To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment. METHODS: A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses. RESULTS: Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality. CONCLUSIONS: When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.

Disparities in spatial accessibility to public dental services relative to estimated need for oral health care among refugee populations in Victoria.

OBJECTIVES: To examine the spatial accessibility to public dental services (PDS) relative to the estimated oral health needs of refugee populations within the state of Victoria, Australia. METHODS: The study employed enhanced two-step floating catchment area method to measure spatial accessibility to PDS by driving and public transit modes at statistical area level 2 (SA2). Principal component analysis of select census-derived socioeconomic variables specific to the refugee population was conducted to derive an area-based indicator of refugee oral health needs, also at SA2 level. Individual indices were then developed for each of these components using standardized z-scores. Finally, an integrated need-accessibility index was developed to identify low-accessibility areas associated with high needs. RESULTS: The results show clear contrast in spatial accessibility to PDS for the refugee populations between metropolitan and rural areas as well as between driving and public transit modes. There are critical limitations in accessibility for refugees living in the rural areas and those dependent on public transit mode for travel. Also, there is evident disparity between the estimated oral health needs of refugees in metropolitan and rural areas. Overall, approximately 29% of all SA2s with refugee population are in the 'High' needs category, which comprise 19.8% of the total Victorian refugee population. Integrating accessibility and oral health needs measures revealed that about 30% and 18% of refugee population are identified as under-serviced, when considering driving and public transit modes respectively. CONCLUSION: The findings provide implications for researchers and policy makers to address the inequalities in access to PDS among the refugee population in Victoria. The methodology outlined in this study provides a complementary approach in planning oral health service provision in the absence of population level data at a small-area scale on access to dental services or need for oral health care.

Sistema inteligente para la gestión de la demanda en atención primaria.

INTRODUCTION AND OBJECTIVES: The Galician Health Service designed a system to improve demand management in primary care known as "XIDE". In it, all professionals participate in an interdisciplinary manner and within their competence framework, to respond to a reason for consultation in a certain time and manner. This article evaluates the pilot phase of implementation of XIDE in primary care of the Galician Health Service. MATERIALS AND METHODS: Cross-sectional descriptive study carried out in 45 primary care centers selected opportunistically at the discretion of the management of the Galician Health Service. For each center, were included all on-demand appointments requested by the adult population in the administrative units in person or by telephone, between 11/2021-05/2022. The XIDE integrates an intelligent search engine that, through algorithms, guides the administrative staff to make an appointment on demand. It performed a descriptive analysis of all the variables, as well as a bivariate analysis with chi-square to identify the causes of the population's rejection of XIDE. RESULTS: The three most frequent reasons for consultation were: knowing the results of the analysis (11.2%), performing blood tests (11.2%) and prescriptions for drugs (10.9%). Family medicine and nursing professionals are the ones who received the most citations. 22.1% of the appointments required to be scheduled on the same day or immediately. The acceptance of the population to the XIDE system was 85.0%. The reason for consultation, response time, mode of care and the recipient professional had a significant influence (p<0.0001) on the rejection of the appointment. CONCLUSIONS: The XIDE adapts globally well to the appointment systems and the organization of primary care of the Galician Health Service, which could facilitate its extension to all health centers in Galicia. However, it is necessary to delve deeper into the causes of rejection in order to introduce improvements that guarantee its viability in the medium-long term.

The impact of the COVID-19 pandemic on the oncology services demand in a middle-income setting with universal health insurance.

Aim: We analyze the impact of the COVID-19 pandemic on oncology service demand in a middle-income country with universal health coverage. Methods: We collected data from January 1st-2017 to December 31th-2021 at a reference center in Bogotá-Colombia regarding first-time consultations of cross-cutting services (clinical oncology, hematology, palliative care, radiation oncology); specialized multidisciplinary units (breast, prostate, lung, stomach); inpatient and outpatient systemic therapy; radiotherapy; oncology surgery; and bone marrow transplant. A descriptive time series analysis was performed, estimating monthly percent change and endemic channels. Results: Starting the confinement (April 2020), a general decrease in service demand was observed (R: -14.9% to -90.0%), with an additional but lower decrease in August 2020 coinciding with the first pandemic wave (R: -11.3% to -70.0%). Follow-up visits and ambulatory treatment showed no consistent reductions. New patients' consultations for cross-cutting services had a speedy recovery (1 month), but clinical oncology, specialized units, and in-hospital treatment resumed more slowly. Only breast and stomach cancer showed a sustained reduction in early-stage disease. Women and older patients had a more significant reductionin service demand. Conclusion: Despite no changes in service supply, the confinement induced a significant reduction in service demand. Variations by cancer type, service type, and population demographics deserve careful consideration for a suitable response to the emergency. The speedy recovery and the absence of a significant decrease during subsequent waves of the pandemic suggest patient resiliency and a lower impact than expected in middle-income settings in the presence of universal health insurance.

Objetivo: Analizar el impacto de la pandemia de COVID-19 sobre la demanda de servicios oncológicos. Metodos: Se recolectaron datos de enero 1/2017 hasta diciembre 31/2021 de consulta de primera vez en servicios transversales (oncología clinica, hematología, cuidados paliativos, oncología radioterápica) y servicios especializados multidisciplinarios (mama, próstata, pulmón, estómago), así como de suministro de tratamiento (terapia sistémica ambulatoria y hospitalaria, radioterapia, cirugía oncológica, trasplante de médula ósea), en un centro de referencia en Bogotá-Colombia. Se realizó un análisis descriptivo de series de tiempo estimando el cambio porcentual mensual y los canales endémicos. Resultados: Al inicio del confinamiento obligatorio (abril/2020) hubo una disminución general en la demanda de servicios transversales (R: -14.9% a -90.0%), con nuevo descenso de menor grado en agosto/2020 durante la primera ola de infecciones (R: -11.3% a -70.0%). Las consultas de seguimiento y tratamientos ambulatorios no mostraron reducciones consistentes. Exceptuando oncología clínica, las consultas de primera vez para servicios transversales tuvieron rápida recuperación hasta cifras basales (1 mes), pero las unidades especializadas y los tratamientos intrahospitalarios tuvieron recuperación mas lenta. Únicamente los cánceres de mama y estómago mostraron una reduccion sostenida de estadios tempranos de la enfermedad. La reducción de la demanda fue mas marcada en mujeres y adultos mayores. Conclusión: A pesar de no tener cambios en la oferta, el confinamiento indujo una reducción significativa en la demanda de servicios oncológicos con variación diferencial por tipo de cáncer, servicio y características demográficas de la población. Esto merece consideración especial para generar respuestas adecuadas a las emergencias sanitarias. La rápida recuperación de la demanda y la ausencia de caídas en olas de infección subsiguientes sugieren resiliencia de los pacientes e impacto menor del esperado en países con cobertura de salud universal.

Demandas de saúde dos jovens brasileiros: perfil e manifestações da população de 15 a 29 anos à Ouvidoria-Geral do SUS (2014-2018) / Health demands of young Brazilians: profile and manifestations of the population aged 15 to 29 years to the SUS General Ombudsman (2014-2018)

RESUMO O objetivo do estudo foi analisar o perfil e as principais demandas apresentadas por jovens de 15 a 29 anos à Ouvidoria-Geral do Sistema Único de Saúde (SUS) do Ministério da Saúde. Foram extraídas as bases de dados 'manifestações' e 'perfil cidadão' do Sistema Informatizado OuvidorSUS, de 2014 a 2018. Os dados foram analisados segundo os canais de atendimento, classificação e tipificação. O perfil foi desagregado em idade, raça/cor, sexo, orientação sexual, escolaridade, ocupação e faixa de renda. Foram registradas 114.618 manifestações com perfil do cidadão, sendo que 15,17% possuíam entre 15 e 29 anos. Prevaleceram negros (pretos e pardos), mulheres, heterossexuais, com nível superior concluído ou em curso, renda de até 2 salários mínimos e empregados no setor privado. A maior parte das manifestações foram solicitações, seguidas de reclamações e denúncias. As solicitações majoritariamente eram de consultas e cirurgias, nas áreas de ginecologia e obstetrícia e ortopedia e traumatologia. As reclamações e denúncias referiam-se, em grande parte, à gestão, sobretudo a profissionais e estabelecimentos de saúde. As sugestões foram as menos frequentes. As demandas refletem, em geral, os serviços utilizados pelos jovens e devem ser consideradas pela gestão para o direcionamento de políticas de saúde adequadas a essa população.

ABSTRACT This study aimed to analyze the profile and the main demands presented by young people (15 to 29 years old) to the Unified Health System (SUS) General Ombudsman of the Ministry of Health of Brazil. The databases 'manifestations' and 'citizen profile' of the System were extracted from the OuvidorSUS computerized system, referring to the years 2014 to 2018. The data were analyzed according to the service channels, classification, and typification. The profile was disaggregated by age, race/color, gender, sexual orientation, education, occupation, and income. 114,618 manifestations were registered with the citizen's profile, with 15.17% being by people from 15 to 29 years old. Blacks (including pardos), women, heterosexuals, with completed or ongoing higher education, income of up to 2 minimum wages, and employed in the private sector prevailed. Most of the manifestations were 'requests', followed by 'complaints' and 'denunciations'. Most requests were for consultations and surgeries, in the areas of gynecology and obstetrics, and orthopedics and traumatology. Complaints and denunciations were largely related to management, especially to health professionals and establishments. The suggestions were the least frequent. The demands largely reflect the services used by young people and should be considered by managers to guide health policies appropriate to this population.