Equity Study in Health Workforce on Tuberculosis Control in China: a Nationwide Evaluation

We aimed to describe the distribution of tuberculosis （TB） health workers in China and provide evidences of potential inequity for policy development. We used Lorenz curves and Gini index to characterize the distribution of TB health workers by population size, geographical area and number of annual registered TB cases. An additional stratified analysis was done by three economic regions. The Gini index were 0.33 for population size, 0.62 for geographical area and 0.30 for number of registered tuberculosis cases that indicated an acceptable average, significant inequity and a relative average distribution nationwide respectively.

Rural implementation of the perioperative surgical home:A case-control study

BACKGROUND Perioperative surgical home(PSH)is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction.PSH has proven success in large urban health centers by reducing surgery cancellation,operating room time,length of stay(LOS),and readmission rates.Yet,only limited studies have assessed the impact of PSH on surgical outcomes in rural areas.AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study.METHODS The research study was conducted at an 83-bed,licensed level-III trauma rural community hospital.A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts(n=2305).To evaluate the importance of PSH in the rural surgical system,a case-control study was performed to compare TJR surgical outcomes(LOS,discharge disposition,and 90-d readmission)of the PSH cohort against two control cohorts[Control-1 PSH(C1-PSH)(n=1413)and Control-2 PSH(C2-PSH)(n=892)].Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t-test were performed for continuous variables.The general linear models(Poisson regression and binomial logistic regression)were performed to fit adjusted models.RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts(median PSH=34 h,C1-PSH=53 h,C2-PSH=35 h)(P value<0.05).Similarly,the PSH cohort had lower percentages of discharges to other facilities(PSH=3.5%,C1-PSH=15.5%,C2-PSH=6.7%)(P value<0.05).There was no statistical difference observed in 90-d readmission between control and PSH cohorts.However,the PSH implementation reduced the 90-d readmission percentage(PSH=4.7%,C1-PSH=6.1%,C2-PSH=3.6%)lower than the national average 30-d readmission percentage which is 5.5%.The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician comanagement.The elements of PSH including preoperative assessment,patient education and optimization,and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital.CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS,increased directto-home discharge,and reduced 90-d readmission percentages.

Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area

BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Factors acting as barriers to organ donation registration have been classified as:(1)Bodily integrity;(2)medical mistrust;(3)“ick”-feelings of disgust towards organ donation;and(4)“jinx”-fear that registration may result in one dying due to premeditated plans.We predict that by providing necessary information and education about the donation process via a short video,individuals will be more willing to register as organ donors.AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.METHODS This study was approved by the Institutional Review Board at Northwell Health.The approval reference number is No.19-0009(as presented in Supplementary material).Eligible participants included Hispanic New York City(NYC)residents,18 years of age and above,who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents.The survey an 85-item Redcap survey measured participant demographics,attitudes,and knowledge of organ donation as well as the intention to register as an organ donor.Attention checks were implemented throughout the survey,and responses were excluded for those who did fail.Participants were randomly assigned two-between subject conditions:To view a short video on organ donation and then proceed to complete the survey(i.e.,video first)and view the same video at the end of the survey(video last).No intra-group activities were conducted.This study utilized an evidenced-based emotive educational intervention(video)which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles.Results were analyzed using Jamovi statistical software.Three hundred sixty-five Hispanic individuals were included in the analysis.Once consent was obtained and participants entered the survey(the survey sample is presented in Supplementary material),participants were asked to report on demographic variables and their general impression of organ donation after death.The video depicted stories regarding organ donation after death from various viewpoints,including from the loved ones of a deceased person who died waiting for a transplant;from the loved ones of a deceased person whose organs were donated upon death;and,from those who were currently waiting for a transplant.RESULTS Using a binomial logistic regression,the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors.The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions(odds ratio:2.05,95%confidence interval:1.06-3.97).Motivations for participation in organ donation were also captured with many stating the importance of messages coming from“people like me”and a message that highlights“the welfare of those in need”.Overall,the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous.Future studies should explore using targeted messaging that resonates with specific cultural groups,highlighting the welfare of others.CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.

Hearing Disability in Colombia Self-Perception and Associated Factors 2002-2008

Introduction: Hearing disability is a condition that affects normal ear function, as much in adulthood as in the first years of life. According to the 2005 Census, 6.3% of the Colombian population has some type of disability, of which 17.4% have hearing limitations, including those with hearing devices. Elucidating the conditions of this population and identifying the factors related to hearing disability will permit the management of strategies from different sectors to mitigate the consequences associated with this limitation. Objective: To estimate the self-perception of hearing disability in Colombia and to determine the factors associated with this limitation. Materials and Methods: The present study is cross-sectional, based on the analysis of secondary information obtained from the Registry for Localization and Characterization of Persons with Disability (RLCPD) during the 2002-2008 period. Socio-demographic and healthcare variables were analyzed. Results: 13.6% (102,648/750,377) of the population reported hearing limitations even with the use of special hearing devices. 43.52% (44,041) of people over 3 years of age could neither read nor write. 29.39% (30,145) of people who reported this limitation are not affiliated to any sort of health insurance system. Factors found to be associated with hearing limitations were: socioeconomic stratus (OR: 1.33;CI 95% 1.25;1.42), illiteracy (OR: 1.44;CI 95% 1.42;1.46) and lack of affiliation to a health insurance system (OR: 1.03;CI 95% 1.01;1.04). Conclusion: People registered with hearing disability live under vulnerable conditions;among them, most/the majority pertained to a segment of the population with low economic resources and had difficulty obtaining/accessing work, education and healthcare services.

Distribution and equity trends for general practitioners in China from 2012 to 2015

Objective:This study aimed to identify the distribution and equity trends for general practi-tioners(GPs)in China from 2012 to 2015 and to provide evidence to guide the discipline’s develop-ment of general practice and for policy-making.Methods:On the basis of data from the National Health Statistics yearbooks,the distribution and equity trends for GPs from 2012 to 2015 were analyzed with the Lorenz curve and Gini coef-ficient as indictors of health equity.Results:From 2012 to 2015 the number of GPs increased at rates ranging from 9.3%to 32.5%,while the number of registered GPs increased at rates ranging from 32.6%to 37.2%.In 2015 the average number of GPs was 1.38 per 10,000 people(among the 31 provinces the highest rate was 3.90 per 10,000 people in Zhejiang and the lowest rate was 0.50 per 10,000 people in Xizang)and 1.98 per 100 km2(among 31 provinces the highest rate was 89.23 per 100 km2 in Shanghai and the lowest rate was 0.01 per 100 km^(2) in Xizang).From 2012 to 2015 the Gini coefficients weighted by population were 0.31,0.29,0.26,and 0.25 respectively,while the Gini coefficients weighted by geographical area were 0.74,0.72,0.72,and 0.72 respectively.Conclusion:The number of GPs increased rapidly in China;however,the proportion of regis-tered GPs was unsatisfactory,and there were inequities among the different provinces.The govern-ment should launch integrated strategies to encourage GP trainees to become registered GPs and optimize the distribution and equity of GPs.

Experiences and perceptions of COVID‑19 infection and vaccination among Palestinian refugees in Jerash camp and Jordanian citizens:a comparative cross‑sectional study by face‑to‑face interviews

Background:During the COVID-19 vaccination,the access to vaccines has been unequal among countries and indi‑viduals,for example low-income countries displayed signifcant low levels of vaccination.Furthermore,most refugees are living in developing low-income countries which struggling to access the essential health-care services including vaccination.Thus,the objective of this study was to assess the experiences and perceptions of COVID-19 infection and vaccination among Palestine refugees in Jerash camp compared to resident Jordanian citizens.Methods:A face-to-face interview-based comparative cross-sectional study was carried out among Palestine refu‑gees in Jerash camp located in northern Jordan and Jordanian citizens from diferent cities in Jordan from October,2021 to March,2022.A Chi-square test was used to determine the diferences in the experiences and perceptions of COVID-19 infection and vaccination between Palestinian refugees and resident Jordanian citizens.Logistic regres‑sion analysis was performed to predict factors associated with the beliefs,barriers and hesitancy towards COVID-19 vaccines.Results:The total number of participants was 992,with 501(50.5%)Palestinian refugees and 491(49.5%)Jordanian citizens.Most participants(64.1%)who have never been tested for COVID-19 were from the refugees(P<0.001),whereas about 80.3%of the participants tested for COVID-19 at private healthcare institutions were citizens(P<0.001).While 70.0%of the participants who tested positive for COVID-19(n=303)were from the refugees(P<0.001).Com‑pared to the citizens,the refugees had signifcantly lower levels of beliefs about the safety(P=0.008)and efciency(P<0.001)of COVID-19 vaccines.They also had lower rates of vaccine hesitancy(P=0.002)and vaccine uptake(P<0.001),and a higher rate of facing difculties during registration for COVID-19 vaccination(P<0.001).Furthermore,refugees have more negative attitudes toward the importance and implementation of COVID-19 precautionary activi‑ties,including wearing face masks,practicing social distancing and following proper prevention hygiene compared to citizens(P<0.001).The regression analysis showed that gender(P<0.001),age(P<0.001)and level of education(P=0.001)were signifcantly associated with COVID-19 vaccine hesitancy.Also,being a refugee(P<0.001)and being a male(P=0.012)were signifcantly associated with facing more difculties upon the registration to receive a COVID19 vaccine.Conclusions:This study showed that,compared to citizens,refugees had lower attitudes and practices toward COVID-19 infection and vaccination.They also had and a lower rate of COVID-19 vaccine hesitancy and uptake with limited access to vaccines.Government sectors and non-government organizations should implement policies and regulations to raise the awareness of refugees towards COVID-19 infection,testing,preventive measures,and the safety and efcacy of vaccines.

Ethical challenges in mass drug administration for reducing childhood mortality:a qualitative study

Background:Mass drug administration(MDA)of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases.MDA of the broad-spectrum antibiotic azithromycin has demonstrated the potential to reduce childhood mortality in children at risk of premature death in some global settings.However,MDA of antibiotics raises complex ethical challenges,including weighing near-term benefts against longer-term risks—particularly the development of antimicrobial resistance that could diminish antibiotic efectiveness for current or future generations.The aim of this study was to understand how key actors involved in MDA perceive the ethical challenges of MDA.Methods:We conducted 35 semi-structured interviews from December 2020–February 2022 with investigators,funders,bioethicists,research ethics committee members,industry representatives,and others from both highincome countries(HICs)and low-and middle-income countries(LMICs).Interview participants were identifed via one of seven MDA studies purposively chosen to represent diversity in terms of use of the antibiotic azithromycin;use of a primary mortality endpoint;and whether the study occurred in a high child mortality country.Data were analyzed using constructivist grounded theory methodology.Results:The most frequently discussed ethical challenges related to meaningful community engagement,how to weigh risks and benefts,and the need to target MDA We developed a concept map of how participants considered ethical issues in MDA for child mortality;it emphasizes MDA’s place alongside other public health interventions,empowerment,and equity.Concerns over an ethical double standard in weighing risks and benefts emerged as a unifying theme,albeit one that participants interpreted in radically diferent ways.Some thought MDA for reducing child mortality was ethically obligatory;others suggested it was impermissible.Conclusions:Ethical challenges raised by MDA of antibiotics for childhood mortality-which span socio-cultural issues,the environment,and efects on future generations-require consideration beyond traditional clinical trial review.The appropriate role of MDA also requires attention to concerns over ethical double standards and power dynamics in global health that afect how we view antibiotic use in HICs versus LMICs.Our fndings suggest the need to develop additional,comprehensive guidance on managing ethical challenges in MDA.