Inequality in Afghanistan in the use of prenatal healthcare services according to the sex of newborns.

Objective: The association between the sex of newborns and the utilization of prenatal healthcare services during pregnancy and childbirth has not been thoroughly studied. This study investigated the association between the sex of newborns and the extent to which women used prenatal healthcare services in Afghanistan. Materials and Methods: This study used data obtained from a nationally representative demographic and health survey. The participants in this analysis were women who had given birth in the last five years (n=19,126). Four indicators related to prenatal healthcare utilization were used: (1) number of antenatal care (ANC) visits, (2) number of ANC services provided by skilled professionals, (3) quality of ANC services, and (4) institutional delivery. Multivariate linear and logistic regression models were employed to examine the association between the sex of newborns and the use of prenatal healthcare services after adjusting for sociodemographic and decision-making autonomy variables. Results: There was a significant association between the sex of newborns and use of prenatal healthcare services. Women with female newborns used ANC services fewer times (ß =-0.10, 95% CI: -0.17, -0.03), used ANC services provided by skilled professionals fewer times (ß=-0.11, 95% CI: -0.18, -0.04), were less likely to receive high-quality ANC (adjusted odds ratio (AOR)=0.78, 95% confidence interval (CI): 0.67, 0.90), and were less likely to deliver their babies at health institutions (AOR=0.83, 95% CI: 0.77, 0.91) than those with male newborns, after adjusting for other variables. Conclusion: The findings revealed a negative association between female newborns and the utilization of prenatal healthcare services among women of reproductive age in Afghanistan. It is important to pay attention to this issue and ensure that all women have equal access to healthcare services regardless of their newborn's sex.

Efficacy of trametinib in a metastatic urothelial carcinoma patient with a BRAF mutation.

Introduction: BRAF mutations in bladder cancer are rare. MEK inhibitors have excellent clinical benefits in the treatment of melanoma. Case presentation: A 60-year-old male was diagnosed with muscle-invasive bladder cancer and underwent total cystectomy and ileal conduit diversion. Despite 4 cycles of gemcitabine and cisplatin chemotherapy and 3 courses of pembrolizumab, the left obturator lymph node enlarged. Cancer multi-gene panel testing confirmed the BRAF G469A mutation and trametinib was recommended. Three months after the initiation of trametinib (2 mg, qd), the left obturator lymph node shrank by more than 50%. The disease has remained stable for more than 18 months. Conclusion: The present case indicates the potential of trametinib to treat mBUC patients with the BRAF G469A mutation in this setting.

Impact of the COVID-19 Pandemic on Home Medical Care Utilization in Japan: An Interrupted Time Series Analysis.

BACKGROUND: The COVID-19 pandemic affected healthcare utilization worldwide, but changes in home medical care utilization have not been fully revealed. OBJECTIVE: This study aims to clarify the changes in the use of home medical care services in Japan due to the pandemic. DESIGN: Interrupted time series analysis of national medical claims data. PARTICIPANTS: Individuals with home medical care use occurring in Japan between April 2019 and March 2022. INTERVENTIONS: The declaration of a state of emergency (April 2020) by the Japanese government. MAIN MEASURES: The outcomes were the monthly uses of regular home visits, emergency house calls, terminal care, and in-home deaths. Terminal care was stratified by care setting (home or nursing home) and the type of home medical care facilities (enhanced home care support clinics and hospitals (HCSCs), conventional HCSCs, and general clinics and hospitals). KEY RESULTS: Regular home visits showed no significant change, but emergency house calls exhibited an upward trend (1258 uses/month, 95% CI 43 to 2473). Both terminal care and in-home deaths experienced an immediate increase in level (1116 uses/month, 95% CI 549 to 1683; 1459 uses/month, 95% CI 612 to 2307), followed by a gradual increase in trend (141 uses/month, 95% CI 73 to 209; 215 uses/month, 95% CI 114 to 317). The immediate increase of terminal care occurred only for home patients. Enhanced HCSCs showed the most prominent increase in both level and trend, followed by conventional HCSCs, and general clinics and hospitals. CONCLUSIONS: The COVID-19 pandemic increased the use of emergency house calls and terminal care among home medical care in Japan, particularly for home patients and enhanced HCSCs. These findings suggest that the pandemic revitalized the importance of home medical care as a patient-centered care delivery model and highlight the need for strategic healthcare planning and home medical care resource allocation to anticipate future pandemics.

Sarcopenia and Associated Factors in Adults Aged 40 and Above: A Study Conducted in Primary Healthcare.

INTRODUCTION: Sarcopenia, characterized by progressive skeletal muscle loss, has emerged as a significant public health concern, with a global prevalence of 10-27%. While traditionally studied in geriatric populations, recent evidence indicates its impact on individuals aged 40 and above, with early manifestations of muscle decline. Primary care settings play a pivotal role in the early identification and management of sarcopenia, facilitating timely diagnosis and intervention. This study aims to evaluate the prevalence of sarcopenia and its associated factors among individuals aged 40 and above attending a family medicine outpatient clinic. METHODS: A cross-sectional study was conducted in a family medicine outpatient clinic, including participants aged 40 and above. Participants underwent handgrip strength measurements, calf circumference measurements, and a 4-m walking test. Based on the criteria of the European Working Group on Sarcopenia in Older People 2 (EGSWOP2), individuals with sarcopenia and those at risk of sarcopenia were identified. The Mini Nutritional Assessment (MNA) was used to assess nutritional status. Sociodemographic characteristics, comorbidities, and laboratory values were recorded. A comparison was made between individuals with normal muscle strength and those at risk of sarcopenia. RESULTS: Among 213 individuals, 33 (15.4%) were at risk of sarcopenia (probable sarcopenia), and 12 (5.6%) were diagnosed with sarcopenia. There was a negative correlation observed between age and muscle strength (r=-0,339, p<0,001), and positive correlation was found between muscle strength and MNA score (r=0.301, p<0.001). Individuals with higher education and income levels exhibited higher muscle strength. Participants at risk of sarcopenia had higher prevalence rates of comorbidities such as diabetes mellitus (DM), chronic kidney disease, and cardiovascular disease (p=0.20, p<0.01, p=0.015, respectively). CONCLUSION: Our study highlights the prevalence and associated factors of sarcopenia in individuals aged 40 and above emphasizing the need for screening and intervention strategies in primary care settings. The study findings support the role of primary care in addressing sarcopenia and improving patient outcomes.

Development and Validation of a Malay Version Questionnaire to Evaluate Remote Health Monitoring of COVID-19 via Telehealth Applications: Navigating Telehealth Evolution.

Introduction The rapid adoption of telehealth services due to the COVID-19 pandemic has highlighted the necessity for effective tools to evaluate patient experiences. This study developed and validated the Telehealth Usability, Acceptability, and Satisfaction Questionnaire (TUASQ) for virtual COVID-19 Assessment Centres (CACs) in Malaysia, aiming to comprehensively measure usability, acceptability, and satisfaction. Methodology The TUASQ was developed in two phases. Initially, the questionnaire development phase included item generation guided by the Technology Acceptance Model (TAM) and the Health Belief Model (HBM), with feedback from a panel of six experts. Items were refined through Content Validity Index (CVI) - Item-Level Content Validity Index (I-CVI) ≥ 0.82, Scale-Level Content Validity Index (S-CVI) ≥ 0.82, and Content Validity Ratio (CVR ≥ 0.78); and Face Validity Index (FVI) by 10 respondents - Item-Level Face Validity Index (I-FVI) ≥ 0.82 and Scale-Level Face Validity Index (S-FVI ≥ 0.82). The psychometric validation phase involved a cross-sectional study of 705 respondents, recruited through convenience sampling from March to July 2024, to perform Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), followed by reliability testing using Cronbach's alpha, Composite Reliability (CR), and Average Variance Extracted (AVE). Results Content validation showed that most items' I-CVI exceeded 0.82, indicating significant expert consensus on relevance and clarity. The CVR also surpassed the 0.78 threshold, affirming their essential role. Face validation indices generally exceeded 0.80, confirming the questionnaire's clarity and comprehensiveness from the users' perspective. EFA with 250 participants indicated a high Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) of 0.933 and significant Bartlett's test (χ² (136) = 3752.698, p < 0.001), supporting the factorability of the data and extracting three distinct factors. CFA with 455 participants initially showed a poor fit, prompting model adjustments that subsequently improved the fit indices (Root Mean Square Error of Approximation (RMSEA) = 0.076, Standardized Root Mean Square Residual (SRMR) = 0.045, Goodness of Fit Index (GFI) = 0.94, Tucker-Lewis Index (TLI) = 0.96, Comparative Fit Index (CFI) = 0.97). Reliability testing revealed a high internal consistency with Cronbach's alpha of 0.975. CR for each factor exceeded the 0.70 threshold, and the AVE for each factor was above 0.50, indicating good convergent validity. Conclusion The validated TUASQ is a reliable and effective instrument for assessing the experiences of Malaysian patients using virtual CAC. Demonstrating robust psychometric properties through comprehensive validation processes, the TUASQ accurately measures usability, acceptability, and satisfaction, identifying strengths and areas for improvement in telehealth services. This contributes to enhanced care quality and patient satisfaction in the evolving healthcare landscape.

Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study.

BACKGROUND: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. OBJECTIVE: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. METHODS: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression-based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. RESULTS: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ≥36 years (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and having home births (64.1%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. CONCLUSIONS: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation.

Prevalence of undiagnosed hypertension and associated factors in Ndera sector, Gasabo district of Rwanda: a cross-sectional study.

BACKGROUND: Hypertension remains a major global health challenge, including in low- and middle-income countries. In Rwanda, a lack of adequate information and healthcare services impacts healthcare-seeking behaviors, contributing to undiagnosed hypertension in rural areas. Therefore, the need to determine its prevalence and associated factors. METHODS: A cross-sectional study was conducted with 393 adults in the Ndera Sector, of Rwanda's Gasabo District, through a multistage sampling technique. Data was gathered using the WHO STEP-wise approach to non-communicable disease risk factor surveillance (STEPS) questionnaire; physical examination was done to determine blood pressure and body-mass index (BMI), after which the data collected was analyzed using SPSS. Newly diagnosed hypertension was determined when on two different intervals, systolic blood pressure readings was > 140 mmHg, and/or the diastolic blood pressure readings was > 90 mmHg, in the absence of previous hypertension diagnosis. RESULTS: The overall prevalence of hypertension among patients at Ndera sector was 15%, all of which were newly diagnosed. The mean (SD) age of the participants was 37 (13.7) years and half (53%) were women. The mean systolic blood pressure for men was 124.3 mmHg compared to 120.9 mmHg for women (p = 0.043, 95%CI: 0.12-6.74). Women had a significantly higher mean BMI (26.0) compared to men (22.8) (p < 0.001, 95%CI: -4.18 - -2.31). Age (χ² = 37.400, p < 0.001), residence (χ² = 10.200, p < 0.001), BMI (χ² = 22.1, p < 0.001), and lack of knowledge about hypertension (χ² = 25.1, p < 0.001) were the factors with significantly undiagnosed hypertension. CONCLUSIONS: The high prevalence of undiagnosed hypertension in Ndera Sector is linked to gender, older age, higher BMI, location, and lack of hypertension knowledge. These findings call for multifaceted approaches, combining educational initiatives, geographical targeting, lifestyle modifications, and policy implementations, all aimed at mitigating the burden of undiagnosed hypertension and enhancing community health within the Ndera Sector.

Latent Profile Analysis of Pressure Injury Knowledge Levels Among Nursing Staff in Tertiary General Hospitals.

Aims/Background The prevalence of pressure injuries (PIs) is a widely used clinical indicator of patient safety and quality of care. Nurses' understanding of pressure injury (PI) can significantly impact the treatment outcomes for patients. This study, based on latent profile analysis (LPA), reveals the characteristics associated with PI knowledge levels among clinical nurses in district and county tertiary medical institutions. We aim to help nursing managers formulate training plans accurately so that clinical nurses can provide high-level skin care services for patients. Method In June 2023, 1482 nurse staff from 4 tertiary general hospitals at the district and county level in Chengdu were chosen as research subjects using the convenience sampling method. Responses to the general information questionnaire, the Chinese Version of Pressure Ulcer Knowledge Assessment Tool (C-PUKAT), and the Chinese Version of Attitude towards Pressure ulcer Prevention (C-APuP) were used to compare the population's characteristics based on LPA. Results Three latent profiles of nurses' PI knowledge were identified: weak foundation type (46.3%), strengthening foundation type (42.7%), and special improvement type (11.0%). Subjects' departments, administrative positions, highest degrees and PI prevention attitude scores, as well as whether they have participated in the training, all differed significantly between latent profile groups (p < 0.05). Conclusion The PI knowledge level of nursing staff at the district and county tertiary general hospitals requires urgent improvement. Nursing managers should prioritize the management level and quality of PI training among clinical nursing staff. Precise training programs can be developed based on different categories of nursing staff to enhance their PI knowledge, thereby effectively improving the quality of healthcare for inpatients.

Healthcare professionals perceptions towards the determinants of effective emergency health care services in public health centres of Addis Ababa, Ethiopia.

Introduction: Emergency healthcare services enable early detection and life-saving interventions for time-sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023. Methods: A facility-based cross-sectional study was conducted at public health centers in Addis Ababa with a sample of 422 study participants. Study participants were selected using simple random sampling techniques. To identify factors associated with the outcome variable, bi-variable and multi-variable logistic regression analyses were conducted. Variables having a p-value less than 0.05 in multi-variable logistic regression analysis were declared determinants of positive perception towards emergency medical services effectiveness. Results: Among the study participants, 76.3 % (95 % CI: 72.3, 80.6) had a positive perception towards the public health centers effectiveness in providing emergency healthcare services. Moreover, training (AOR: 4.05; 95 % CI: 1.97, 8.32), ICT service implementation (AOR: 6.55; 95 % CI: 3.37, 12.73), resource availability in the emergency department (AOR: 5.07; 95 % CI: 2.51, 10.25), and management support (AOR: 3.22; 95 % CI: 1.66, 6.25) were determinant factors associated with the perception of effectiveness in emergency medical care services. Conclusion: Nearly three-fourths of healthcare providers in Addis Ababa perceived that the emergency healthcare services were effective. Furthermore, training on patient service delivery, ICT service implementation, availability of resources in emergency departments, and management support were independent determinants of positive perception towards effective emergency healthcare services.

How Does the Psychological Impact of COVID-19 Affect the Management Strategies of Individuals with Type 1 and Type 2 Diabetes? A Mixed-Method Study.

(1) Background: During and after the pandemic, individuals with type 1 and type 2 diabetes struggled to maintain a healthy lifestyle due to psychological distress and the struggle to accommodate contextual challenges and changes in their family and work obligations and expectations. This study aims to explore the long-term impacts of the pandemic on proactive self-management behaviors and outcomes that consider contextual and environmental factors, such as family and work dynamics. (2) Methods: In this mixed-method study, data were collected from 418 participants using the Hospital Anxiety and Depression Scale (HADS) and the Insomnia Severity Index (ISI), followed by 16 individual interviews. (3) Results: The prevalence of depression was 37.1%, that of anxiety was 59.1%, and that of insomnia was 66.3%. Significant differences were observed in anxiety by age (p = 0.02), while individuals with other comorbidities were more likely to report insomnia (p = 0.3). Overall, various challenges during the pandemic have exacerbated emotional distress and complicated self-care routines and adherence to healthy lifestyles. (5) Conclusions: The COVID-19 pandemic has prompted individuals with type 1 and 2 diabetes to adopt alternative health-management methods, such as self-care, proactive initiatives, and daily challenges. Enhancing proactiveness, awareness, and an understanding of individuals' needs is crucial for alleviating stress, controlling disease, and preparing for potential future health crises in the wake of the pandemic's long-term effects.

Gaps in the Global Regulatory Frameworks for the Use of Artificial Intelligence (AI) in the Healthcare Services Sector and Key Recommendations.

Artificial Intelligence (AI) has shown remarkable potential to revolutionise healthcare by enhancing diagnostics, improving treatment outcomes, and streamlining administrative processes. In the global regulatory landscape, several countries are working on regulating AI in healthcare. There are five key regulatory issues that need to be addressed: (i) data security and protection-measures to cover the "digital health footprints" left unknowingly by patients when they access AI in health services; (ii) data quality-availability of safe and secure data and more open database sources for AI, algorithms, and datasets to ensure equity and prevent demographic bias; (iii) validation of algorithms-mapping of the explainability and causability of the AI system; (iv) accountability-whether this lies with the healthcare professional, healthcare organisation, or the personified AI algorithm; (v) ethics and equitable access-whether fundamental rights of people are met in an ethical manner. Policymakers may need to consider the entire life cycle of AI in healthcare services and the databases that were used for the training of the AI system, along with requirements for their risk assessments to be publicly accessible for effective regulatory oversight. AI services that enhance their functionality over time need to undergo repeated algorithmic impact assessment and must also demonstrate real-time performance. Harmonising regulatory frameworks at the international level would help to resolve cross-border issues of AI in healthcare services.

Privacy in Community Pharmacies in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Privacy in healthcare is a fundamental right essential to maintain patient confidentiality and trust. Community pharmacies in Saudi Arabia (SA) play a critical role in the healthcare system by providing accessible services and serving as initial points of contact for medical advice. However, the open nature of these settings poses significant challenges in maintaining patient privacy. METHODS: This cross-sectional study used electronic surveys distributed across various online platforms. The target sample included Saudi adults, with a sample size of 385 participants to achieve 80% statistical power at a 95% confidence interval. The survey comprised demographic questions and sections evaluating perceptions of privacy, the importance of privacy, and personal experiences regarding privacy in community pharmacies. Descriptive statistics and logistic regression models were used for the analysis. RESULTS: A total of 511 responses were obtained. The mean age was 33.5 years, with an almost equal distribution of males (49.71%) and females (50.29%). Most participants held a bachelor's degree or higher (78.67%). Privacy perceptions varied, with only 9.0% strongly agreeing that there was a private space for consultations, while 64.0% felt that the design of community pharmacies did not adequately consider patient privacy, and 86.9% reported that conversations could be overheard. Privacy concerns were notable, with almost one-half of the participants (47.6%) having concerns about privacy and 56.6% doubting the confidentiality of their health information. Moreover, 17.6% reported being asked for unnecessary personal information when buying medication, and 56.2% admitted to avoiding discussing a health problem with the pharmacist due to privacy concerns. Experiences of privacy breaches were reported by 15.7% of respondents. Logistic regression analysis revealed that the availability of private space in the pharmacy and patients feeling that the pharmacy respects their privacy were associated with a lower likelihood of avoiding discussions with pharmacists due to privacy concerns (OR = 0.758, CI = 0.599-0.0957 and OR = 0.715, CI = 0.542-0.945 respectively) Conversely, greater privacy concerns and previous privacy breaches significantly increased the likelihood of avoiding discussions with pharmacists in the community pharmacy (OR = 1.657, CI = 1.317-2.102 and OR = 4.127, CI = 1.886-9.821 respectively). CONCLUSIONS: This study highlights the significant concerns regarding privacy practices in community pharmacies in SA. Thus, there is a need for standards to improve privacy in community pharmacies, such as mandating the need for private consultation areas and enhanced staff training on handling privacy-related issues. Addressing the issue of privacy is crucial for maintaining patient trust, improving healthcare service quality, and ensuring effective patient-pharmacist interactions.

Patient Contentment Regarding Health Education Services at King Saud Medical City in Riyadh, Saudi Arabia.

BACKGROUND: Health education enhances healthcare outcomes and patient satisfaction, and with digitalized methods, it is gaining popularity in high-income nations. Effective education promotes behavioral change, treatment adherence, and overall satisfaction while maintaining interpersonal communication. Despite the strides made in medical advancements for diagnosis and treatment, interpersonal communication remains the primary conduit for information exchange, particularly manifested through health education dialogues between medical practitioners and patients. METHODOLOGY: A cross-sectional study was conducted at King Saud Medical City (KSMC), Riyadh, Saudi Arabia, to assess patient satisfaction with health education services. Data were collected through a structured questionnaire. Data were analyzed by IBM SPSS Statistics for Windows, Version 29 (Released 2021; IBM Corp., Armonk, New York, United States). RESULTS: This study on patient satisfaction with health education at KSMC in Riyadh included 225 participants, predominantly females (67.6% (n=152), mean age 38.5 years). Diabetes was the most prevalent (21.3%, n=48) among participants. Doctors were the primary source of health advice (46.2%, n=104). Structural aspects received high satisfaction (mean score of 31.8), surpassing healthcare provider delivery (mean score of 24.9) and print materials (mean score of 22.7). Demographically, occupation significantly impacted contentment (p-value=0.002), with students exhibiting the highest scores. Logistic regression highlighted patients' occupation (aOR=1.498) and patients' level of education (aOR=0.420) as predictors of contentment. CONCLUSION: This study highlighted high satisfaction with structural aspects of health education. Occupation, particularly among students, significantly impacts contentment. Tailoring education strategies based on occupation and education levels is crucial for improved patient satisfaction.

User profiles in digitalized healthcare: active, potential, and rejecting - a cross-sectional study using latent class analysis.

BACKGROUND: There is evidence of different use by different groups of people for general health-related applications. Yet, these findings are lacking for digitalized healthcare services. It is also unclear whether typical use patterns can be found and how user types can be characterized. METHODS: The analyses are based on data from 1 821 respondents to the Health Related Beliefs and Health Care Experiences in Germany panel (HeReCa). Digitalized healthcare services, that were used to determine the user types, include for example sick notes before/after examination and disease related training. User types were determined by latent class analysis. Individual groups were characterized using multinomial logistic regressions, taking into account socioeconomic and demographic factors as well as individual attitudes towards digitalization in the healthcare system. RESULTS: Three types were identified: rejecting (27.9%), potential (53.8%) and active (18.3%). Active participants were less likely to be employed, less likely to be highly educated and less skeptical of digital technologies. Potential users were the youngest, most highly-educated and most frequently employed group, with less skepticism than those who rejected. Rejecters were the oldest group, more likely to be female and of higher socio-economic status. CONCLUSIONS: Socio-demographic and socio-economic differences were identified among three user types. It can therefore be assumed that not all population groups will benefit from the trend towards digitalization in healthcare. Steps should be taken to enhance access to innovations and ensure that everyone benefits from them.

Out-of-pocket medical expenditures, remittances and health outcomes in China.

This study examines the relationship between out-of-pocket medical expenditures, remittances and health outcomes in China using Ordinary Least Squares (OLS) and Propensity Score Matching (PSM) methods. The analysis is based on data from the Global Financial Inclusion database by the World Bank (2021), encompassing a sample of 3,446 individuals. The results indicate that out of-pocket expenditure has a negative impact on health outcomes, while remittance shows a positive association across all age groups, including reproductive and non-reproductive populations. These findings suggest that high out-of-pocket medical costs may hinder access to healthcare services and lead to poorer health outcomes. Conversely, remittance plays a beneficial role in improving health outcomes, highlighting the potential of financial support to positively impact the well-being of individuals.

Cette étude examine la relation entre les dépenses médicales directes, les envois de fonds et les résultats de santé en Chine à l'aide des méthodes des moindres carrés ordinaires (OLS) et de l'appariement des scores de propension (PSM). L'analyse est basée sur les données de la base de données Global Financial Inclusion de la Banque mondiale (2021), portant sur un échantillon de 3 446 personnes. Les résultats indiquent que les dépenses directes ont un impact négatif sur les résultats en matière de santé, tandis que les envois de fonds montrent une association positive dans tous les groupes d'âge, y compris les populations reproductrices et non reproductrices. Ces résultats suggèrent que des frais médicaux élevés peuvent entraver l'accès aux services de santé et conduire à de moins bons résultats en matière de santé. À l'inverse, les envois de fonds jouent un rôle bénéfique dans l'amélioration des résultats en matière de santé, soulignant le potentiel du soutien financier à avoir un impact positif sur le bien-être des individus.

Excruciating existential suffering and complicated grief: The essence of surviving the suicide of a son or daughter.

BACKGROUND: Suicide is the fourth most common cause of death for the 15-29 age group. Research on the impact of suicide on parents is scarce and, therefore, poorly understood. AIM: To explore parents' experiences who have lost a son or a daughter due to suicide and their experience of the services available to them. METHODS: This phenomenological study involved 1-2 interviews with ten parents aged 40-65, seven mothers and three fathers in all 13 interviews. The age range of their sons and daughters was 17-37 years when they died. RESULTS: For the parents, losing a son or a daughter to suicide is an overwhelming life experience characterised by Excruciating existential suffering and complicated grief where they are confronted with deep meaning-making and existential questions without answers since the person who can answer most of them is no longer alive. They, therefore, felt stuck in their grief for up to 4 years. The initial experience was an immense paralysing shock and sense of unreality. The subsequent period was a blur, and they were numb. Then, their psyche and bodies collapsed, and for a long time, they felt no grief processing was taking place. They sorely needed long-term professional trauma-informed support and felt that, in too many cases, they had to reach out for help themselves. They would have liked to see the healthcare system embrace them with more open arms, offer help and be met with information and individualised support. CONCLUSIONS: Standard operating procedures must be installed to support suicide-bereaved parents better. Long-term professional support and trauma-focused care are required following such major trauma, and providing such support could help to reduce their adverse health impacts. Nurses and other health professionals must be better educated on existential suffering in this context.

Development of a home visit solution with a route- and appointment planning tool for patients with severe spasticity: A participatory design study.

Objectives: This article describes how a home visit solution was developed in a co-design process between patients in treatment for severe spasticity, their caregivers and hospital nurses. The solution was developed using a participatory design approach and was based on the identified needs of the participants. Methods: We developed a home visit solution through an iterative process and a collective 'reflection-in-action' approach with patients, caregivers and healthcare professionals. Results: The study revealed the complexities of establishing new routines around home visits. The solution included a new workflow for the nurses and a new route and appointment planning tool. Conclusion: Through a participatory design approach, the users developed a home visit solution that minimised disruption to patients' daily lives and facilitated a dialogue between the nurses and the caregivers about the treatment and the patients' spasticity, which helped to adjust the treatment in line with the patient´s needs.

Beyond the curriculum: A gay medical student's perceptions of health sciences education and healthcare access in KwaZulu-Natal.

Background: The prevailing social constructs of cis-heteronormativity and endosexism have structurally marginalised sexual and gender minorities, leading to their limited representation and inclusion in mainstream health systems and health sciences education. Aim: The study aimed to explore a gay medical student's perceptions of the health sciences curriculum and their experiences in accessing and utilising healthcare services offered both by the university and externally. Setting: At a university in KwaZulu-Natal, South Africa. Methods: This study originates from a larger qualitative study conducted in 2018, involving 12 Lesbian, Gay, Bisexual, Transgender (LGBT)-identifying participants who were selected using purposive and snowball sampling techniques. The larger study used a case study approach to explore how healthcare services meet the sexual health needs of LGBT youth. Among the 12 sampled participants, one participant self-identified as 'gay' and was pursuing a Bachelor of Medicine and Bachelor of Surgery. This participant was specifically selected for analysis in this study because of their knowledge of health sciences education and pursuit of a career in healthcare. Results: Three themes were identified in the participant's interview, including: (1) navigating healthcare services as a young gay man, (2) silenced voices: the impact of the limited Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, Asexual and + (LGBTIQA+) health education, and (3) challenging the silenced voices. Conclusion: There is a need for a well-planned curriculum that includes LGBTIQA+ issues to equip healthcare professionals with the knowledge to provide high-quality care to all patients, regardless of their sex, gender, or sexuality. Contribution: The study provides solid proposals for developing an inclusive healthcare curriculum that considers identities beyond binary going forward.

Understanding the barriers and facilitators of healthcare services for brain injury and concurrent mental health and substance use issues: a qualitative study.

BACKGROUND: People with acquired brain injury (ABI) may experience concurrent conditions such as, mental health and substance use concerns, that require specialized care. There are services that aim to support people with ABI and these conditions separately; however, little is known about the facilitators and barriers of these services. Therefore, the purpose of this study was to engage stakeholders to investigate the facilitators and barriers of healthcare services for ABI and concurrent issues. METHODS: Semi-structured focus groups were conducted in-person and virtually with people with ABI, caregivers, healthcare professionals, and policy makers during a one-day event in British Columbia, Canada. Manifest content analysis was used with a constructivist perspective to analyze data. RESULTS: 90 participants (including 34 people with ABI) provided insights during 15 simultaneous focus groups. Three categories were identified: (1) complexity of ABI, (2) supports, (3) structure of care. Complexity of ABI outlined the ongoing basic needs after ABI and highlighted the need for public awareness of ABI. Supports outlined healthcare professional and community-based supports. Structure of care described people with ABI needing to meet criteria for support, experiences of navigating through the system and necessity of integrated services. CONCLUSIONS: These findings highlight the facilitators and barriers of healthcare services for ABI and concurrent conditions and provide insights into the changes that may be needed. Doing so can improve the accessibility and quality of ABI healthcare services.

Sustainable medical tourism in the global competitive environment: The case of Cyprus.

BACKGROUND: The aim of this study is to examine the perceptions of Cypriot medical tourism experts regarding the phenomenon of medical tourism, as well as to emphasise the benefits and opportunities for Cyprus to become a highly competitive global healthcare destination. METHODS: A Delphi study was conducted in Cyprus, with the participation of 20 experts in the field of medical tourism. At first, 20 experts took part in semi-structured interviews. Based on their feedback provided during that phase, a structured questionnaire was drawn up and completed, addressing a wide variety of medical tourism-related issues, such as benefits and losses from the development of medical tourism in Cyprus, advantages and disadvantages of Cyprus in attracting international patients, the key elements of a medium- to long-term strategic plan for the development of medical tourism in Cyprus, the role of the public and private sector and the importance of international accreditation of private and public hospitals. RESULTS: Cyprus appears to have some very favourable qualities when it comes to its listing as a competitive destination for medical travellers. Undeniably, the growth of medical tourism improves all sectors of the economy and society, but the healthcare industry is the one that benefits most. On the opposite end, medical tourism could potentially impact the access of local people to healthcare services. No clear answers were given by the expert respondents on the need for international accreditation of healthcare providers in Cyprus. CONCLUSION: The competent authorities should promote Cyprus to international markets as a medical tourism destination of choice, upgrading the quality of healthcare services it provides having due regard in parallel to any potential impacts to the access of local population to the healthcare system.