Australian children living with rare diseases:health service use and barriers to accessing care

Background Children with rare diseases experience challenges at home and school and frequently require multi-disciplinary healthcare.We aimed to determine health service utilization by Australian children with rare diseases and barriers to access-ing healthcare.Methods Parents completed an online survey on health professional and emergency department(ED)presentations,hospi-talization,and barriers to accessing services.Potential barriers to service access included residential location(city,regional,remote)and child health-related functioning,determined using a validated,parent-completed measure-of-function tool.Results Parents of 462 children with over 240 rare diseases completed the survey.Compared with the general population,these children were more likely to be hospitalized[odds ratio(OR)=17.25,95%confidence interval(CI)=15.50-19.20]and present to the ED(OR=4.15,95%CI=3.68-4.68)or a family physician(OR=4.14,95%CI=3.72-4.60).Child functional impairment was nil/mild(31%),moderate(48%)or severe(22%).Compared to children with nil/mild impair-ment,those with severe impairment were more likely to be hospitalized(OR=13.39,95%CI=7.65-23.44)and present to the ED(OR=11.16,95%CI=6.46-19.27).Most children(75%)lived in major cities,but children from regional(OR=2.78,95%CI=1.72-4.55)and remote areas(OR=9.09,95%CI=3.03-25.00)experienced significantly more barriers to healthcare access than children from major cities.Barriers included distance to travel,out-of-pocket costs,and lack of specialist medical and other health services.Conclusions Children with rare diseases,especially those with severe functional impairment have an enormous impact on health services,and better integrated multidisciplinary services with patient-centered care are needed.Access must be improved for children living in rural and remote settings.

CHINA'S SERVICE TRADE MAKING USE OF FOREIGN INVESTMENT

At the initial stage of the economic reform and opening drive, the Chinese government encouraged foreign businessmen to invest in the industrial field, strictly confining foreign investment to the service trade. For a long period of time, China’s service trade has lagged far behind other developed countries, with such long existing problems

Survey on Pre-pregnancy Health Knowledge and Service Demands among Un-pregnant Married Women

Objective To understand the pre-pregnancy health knowledge and service needs among un-pregnant married women in Shanghai. Methods A total of 968 newly-married un-pregnant women in Changqiao, Lingyun sub-districts and Huajing town of Xuhui district, Shanghai, were recruited and interviewed by structured questionnaire to collect the information on pre-pregnancy health knowledge and service demands. Results 1） Newly-married women thought the contraceptive methods suitable for them was male condom（84.4%）, followed by oral contraceptives（54%）, emergent contraceptive（52.5%） and contraceptive suppository （48.3%）. 2） The score of pre-pregnancy health knowledge was 54.7±14.5 among the subjects. The participants with junior college or a bachelor had more knowledge than those with junior or senior high school, and those who were engaged in medicine /education/science field had higher score. 3） They had higher knowing rate on the common knowledge, and the rate was above 80%. But the knowing rate on the knowledge of birth defect was low, and all below 50%. 4）A proportion of 52. 7% of the respondents knew that there was a station for reproductive health service in their communities, but only 45.5% received the service from the station, 87.0% thought they had insufficient or scarce knowledge, 73.6% planned to consult before pregnancy training courses on preparing pregnancy. and 63.6% were willing to attend the Conclusion The participants had certain pre-pregnancy health knowledge, but still need being improved,＂ in addition, they had higher needs on knowledge and service of birth defect prevention, at the same time they can＇t make full use of the existing reproductive health institution.

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including posttraumatic stress disorder(PTSD), major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results: A total of 1730 subjects(55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information(n=38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors(e.g., age, gender, marital status and education).Conclusions: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

Hepatitis C virus burden:Treating and educating people without prejudice

Hepatitis C virus(HCV)infection has a worldwide incidence of 1.1%.In Italy,60%of people who inject drugs(PWIDs)and are receiving assistance for substance use disorder are infected with HCV.However,this subset of patients has extremely limited access to care due to multiple factors,including alcohol abuse,psychological comorbidities,and homeless status.AIM To describe the impact of our HCV-dedicated service for substance use disorder(SSUD)service on PWIDs receiving anti-HCV therapy.METHODS A dedicated,multidisciplinary team was set up at the SSUD of Trento in October 2020 to provide antiviral treatment to HCV RiboNucleic Acid-positive patients with an active or previous history of substance abuse.The treatment was followed by a health education program.Patients were treated with Direct-Acting Antivirals(DAAs).Data were retrospectively analyzed to assess the efficacy of our dedicated program in terms of therapy completion,HCV eradication,and compliance(primary endpoint).The rate of HCV reinfection and DAA-related toxicity were also assessed(secondary endpoints).RESULTS A total of 40 patients were enrolled in the study:28(70.0%)were treated with Sofosbuvir/Velpatasvir,while 12(30.0%)received Glecaprevir/Pibrentasvir.At the time of inclusion in the study,36 patients were receiving opioid agonist maintenance therapy,whilst another 4 had just finished the treatment.37.5%had a history of alcoholism and 42.5%received concomitant psychiatric treatment.All 40 patients(100.0%)completed the therapy cycle and 92.5%of patients adhered to the program.All patients tested negative for viral load at the end of the treatment.There were no significant drug interactions with common psychiatric treatments and no side effects were observed.The sustained virological response was achieved in 92.5%of cases with good tolerability,although two patients discontinued treatment temporarily.After HCV eradication,one patient died from an overdose,another from complications of cirrhosis,and one reinfection occurred.CONCLUSION Very high adherence to therapy and good tolerability was observed in our series of HCV patients treated at the SSUD,regardless of the substance abuse condition.Further validation in a larger population is required.

The effect of older population on public health spending:Evidence from Spain

ackground:The gradual ageing of the population,and its effect on public spending,constitutes an urgent challenge for advanced economies.Through this study,we analyse the effect of older people,and their health and individual characteristics,on public health spending.Methods:Using logistic regression methods,we have analysed the use of different health services and health technologies by older people in Spain,controlled for several health,socioeconomic,and other individual factors.Results:The main factors that explain the consumption of both health services and health technology,above age,are related to the so-called need factors:self-reported health status,presence of chronic diseases,and disability.Conclusion:Knowing the main factors that imply greater public health spending is a topic of special interest for designing efficient health policies,in a context of growth in public health spending.In this way,preventive attention on the so-called need factors may be an important driver to improve the effectiveness of spending.

Impact of an innovative tuberculosis financing and payment model on health service utilization by tuberculosis patients in China:do the poor fare better than the rich?

Background:Tuberculosis(TB)prevalence is closely associated with poverty in China,and poor patients face more barriers to treatment.Using an insurance-based approach,the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients,particularly among the poor.This study aims to assess the program effects on service use,and its equity impact across different income groups.Methods:Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively.Inpatient and outpatient service utilization,treatment adherence,and patient satisfaction were assessed before and after the program,across different income groups(extreme poverty,moderate poverty and non-poverty),and in various program cities,using descriptive statistics and multi-variate regression models.Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts.Results:After program implementation,the hospital admission rate increased more for the extreme poverty group(48.5 to 70.7%)and moderate poverty group(45.0 to 68.1%),compared to the non-poverty group(52.9 to 643%).The largest increase in the number of outpatient visits was also for the extreme poverty group(4.6 to 5.7).The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups.Satisfaction rates were high in all groups.Qualitative feedback from stakeholders also suggested that increased reimbursement rates,easier reimbursement procedures,and allowance improved patients'service utilization.Implementation of case-based payment made service provision more compliant to clinical pathways.Conclusion:Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group,indicating improved equity in TB service access.The pro-poor design of the program provides important丨essons to other TB programs in China and other countries to better address TB care for the poor.