Prevalence of Occupational Injury and Knowledge of Post-Exposure Prophylaxis Accessibility among Healthcare Workers in Mogadishu, Somalia

Introduction: Healthcare workers in Mogadishu, Somalia face significant occupational injury risks, particularly needle stick injuries, with 61.1% reporting incidents. This poses a serious threat to their health, leading to infections such as hepatitis B, hepatitis C, and HIV. Despite the high prevalence of injuries, awareness of Post-Exposure Prophylaxis (PEP) accessibility is relatively high, with 84.0% of respondents aware of it. However, there are gaps in knowledge and implementation, as evidenced by variations in availability of PEP. Improving workplace safety measures, providing comprehensive training on injury prevention and PEP protocols, and ensuring consistent availability of PEP in healthcare facilities are crucial steps to safeguard the well-being of healthcare workers in Mogadishu, Somalia. Methods: A cross-sectional study was conducted among hospital workers in Mogadishu, Somalia, focusing on professionals from various healthcare facilities. The study targeted nurses, doctors, laboratory personnel, and pharmacists. Purposive sampling was employed, resulting in a sample size of 383 calculated using Fisher’s sample size formula. Data were collected using coded questionnaires entered into Microsoft Excel 2019 and analyzed with SPSS software to generate frequencies and proportions, presented through frequency tables and pie figures. Results: The study in Mogadishu, Somalia, examined the prevalence of occupational injuries and knowledge of Post-Exposure Prophylaxis (PEP) accessibility among healthcare workers. Findings indicate a high prevalence of injuries, with 61.1% reporting incidents, predominantly needle stick injuries (60.6%). Despite the majority seeking prompt medical attention (72.0%), work-related illnesses affected 53.2% of respondents, notably work-related stress (59.5%). While most received training on injury and illness prevention (68.9%), gaps exist in PEP awareness, with 16.0% unaware of it. Nonetheless, 84.0% were aware, predominantly through health facilities (52.0%). Availability of PEP was reported by 71.3% in healthcare facilities, with variations in shift availability. The majority reported guidelines for PEP use (55.7%). Efforts are needed to bolster PEP awareness and ensure consistent availability in healthcare facilities to safeguard worker health. Conclusion: High prevalence of occupational injuries among healthcare workers, with needle stick injuries being the most common (60.6%). Despite this, 84.0% of respondents were aware of Post-Exposure Prophylaxis (PEP), primarily learning about it from health facilities (52.0%). While 71.3% reported the availability of PEP in their facility, 28.7% noted its unavailability. These results emphasize the need for improved education and accessibility of PEP to mitigate occupational injury risks.

Interoperative fundus image and report sharing in compliance with integrating the healthcare enterprise conformance and web access to digital imaging and communication in medicine persistent object protocol

AIM:To address issues in interoperability between different fundus image systems,we proposed a web eyepicture archiving and communication system(PACS)framework in conformance with digital imaging and communication in medicine(DICOM)and health level 7(HL7)protocol to realize fundus images and reports sharing and communication through internet.METHODS:Firstly,a telemedicine-based eye care work flow was established based on integrating the healthcare enterprise(IHE)Eye Care technical framework.Then,a browser/server architecture eye-PACS system was established in conformance with the web access to DICOM persistent object(WADO)protocol,which contains three tiers.RESULTS:In any client system installed with web browser,clinicians could log in the eye-PACS to observe fundus images and reports.Multipurpose internet mail extensions(MIME)type of a structured report is saved as pdf/html with reference link to relevant fundus image using the WADO syntax could provide enough information for clinicians.Some functions provided by open-source Oviyam could be used to query,zoom,move,measure,view OICOM fundus images.CONCLUSION:Such web eye-PACS in compliance to WADO protocol could be used to store and communicate fundus images and reports,therefore is of great significance for teleophthalmology.

Accessibility and utilization of healthcare services among diabetic patients:Is diabetes a poor man’s ailment?

Diabetes is a non-communicable ailment that has adverse effects on the individual’s overall well-being and productivity in society.The main objective of this study was to examine the empirical literature concerning the association between diabetes and poverty and the accessibility and utilization of medical care services among diabetic patients.The diabetes literature was explored using a literature review approach.This review revealed that diabetes is an ailment that affects all individuals irrespective of socioeconomic status;however,its prevalence is high in low-income countries.Hence,despite the higher prevalence of diabetes in developing countries compared with developed countries,diabetes is not a poor man’s ailment because it affects individuals of all incomes.While the number of diabetic patients that access and utilize diabetes medical care services has increased over the years,some personal and institutional factors still limit patients’access to the use of diabetes care.Also,there is a lacuna in the diabetes literature concerning the extent of utilization of available healthcare services by diabetic patients.

Malaria Illness and Accessing Healthcare in an African Indigenous Population: A Qualitative Study of the Lived Experiences of Uganda’s Batwa in Kanungu District

Purpose: Malaria continues to be a public health threat, especially in sub-Saharan Africa, including Uganda. While Batwa Indigenous People (IPs) face a higher burden of malaria, there is limited understanding of their malaria-lived experiences. We assessed and characterized malaria illness and accessing healthcare lived experiences of the Batwa in Kanungu district to inform contextually and culturally appropriate public health interventions. Methods: An exploratory qualitative study was conducted in 5 Batwa settlements where 5 Focus Group Discussions (n = 36) and 13 Key Informant Interviews (n = 13) were held. Data were collected using printed guides and voice recorders in April 2018. Transcripts from the data that captured the lived experiences of the symptoms, prevention, treatment and barriers to accessing formal healthcare services were applied to Atlas.ti a qualitative data analysis software and condensed into codes, categories, and themes. Results: Many Batwa have experienced malaria in their households, and they know its causes and risk factors, like not sleeping under insecticide-treated mosquito nets (ITNs), living near water bodies, prevention measures like the use of ITNs, and vector management. The lived experiences demonstrate malaria management by an Indigenous population in a rural setting and comprised detecting malaria symptoms, use of herbs as first line of treatment, buying medicines from drug shops, and village health teams (VHTs) treatment. For many Batwa accessing formal healthcare is normally a second option. Barriers for malaria treatment included: long distances to health facilities, geographically difficult terrain, economic constraints, irregular health outreaches, and stockouts of malaria medicines at health facilities. Conclusion: This study characterized Batwa’s malaria illness lived experiences and access to healthcare in rural remote settings. These experiences are essential in appreciating the ways in which Indigenous populations understand and manage common illnesses and how appropriate policies and interventions can be developed.

Accessibility Analysis of Healthcare Delivery System within Enugu Urban Area Using Geographic Information System

The problem of accessibility of health institution, with respect to the available facility to serve the entire population leaving in an area, can be solved using GIS. This paper presents an analysis on accessibility of healthcare facilities in Enugu urban area in a GIS environment. This was achieved through acquisition of a base map of Enugu State showing geographic extent of Enugu Urban, determining the geometric positions of health institutions in Enugu urban using handheld GPS, Creation of a spatial database of existing healthcare facilities and demonstrating through various analyses the potentials of GIS in measurement of accessibility to healthcare facilities in Enugu urban Area. The analysis includes network analysis, used to determine the closeness of a facility and shortest route to these healthcare facilities. ARCGIS 9.3 was the main software used. This was supported by Geocal for coordinate conversion and Microsoft office packages. The result of the study showed the spatial distribution of health institutions, closest facilities in case of emergency and route to those health institutions within Enugu urban Area. It was noticed that most of the healthcare facilities were located within Enugu North local government area (LGA). Other settlements and LGAs had fewer healthcare facilities. Areas deprived of healthcare facility were also identified. Routes and closest facilities to those deprived areas were identified in the settlements/area. The analysis showed the efficacy of GIS in determining accessibility of healthcare institutions in Enugu urban area. The study is thus, recommended as a spatial decision support system for decisions regarding spatial accessibility of healthcare facilities in an urban area.

In Bangla There Is No Word for Vagina —Reflections on Language, Sexual Health, and Women’s Access to Healthcare in Resource-Limited Countries

Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.

Right to Health or the Human Right of Access to Essential Healthcare

The Universal Declaration of Human Rights refers to the human right to health and well-being including medical care, but for the majority of people whom are not covered by health insurance this is better said than done. Ensuring the access of all citizens to the needed medical care requires the provision of health insurance coverage to a population pool and gradually expanding the pool to the whole nation. The ethical perspective of pooling resources across various groups of people with different levels of income and different health risks associated with age, genetics, and lifestyle, may raise the issue of individual autonomy versus social solidarity. Governmental, social, private, and community-based healthcare coverage have been used in different countries with varying details in the sources of funding, pooling of contributions, and the purchase of the covered healthcare services; these models have had varying levels of success depending on not only the availability of funds, but also on the political commitment of the state and the social solidarity and cultural attitude of the population towards universal healthcare. Therefore, universal healthcare requires not only a certain level of economic development, but also a strong sense of solidarity among the people as well as a political commitment in their government. I argue that the statement regarding the right to health, well-being, and medical care needs to be rethought, and instead universal access to essential healthcare should be regarded as a basic human right.

Privacy Preserving Risk Mitigation Approach for Healthcare Domain

In the healthcare domain, protecting the electronic health record (EHR) is crucial for preserving the privacy of the patient. To help protect the sensitive data, access control mechanisms can be utilized to restrict access to only legitimate users. However, an issue arises when the authorized users abuse their access privileges and violate privacy preferences of the patients. While traditional access control schemes fall short of defending against the misbehavior of authorized users, risk-aware access control models can provide adaptable access to the system resources based on assessing the risk of an access request. When an access request is deemed risky, but within acceptable thresholds, risk mitigation strategies can be exploited to minimize the risk calculated. This paper proposes a risk-aware, privacy-preserving risk mitigation approach that can be utilized in the healthcare domain. The risk mitigation approach controls the patient’s medical data that can be exposed to healthcare professionals, according to their trust level as well as the risk incurred of such data exposure, by developing a novel Risk Measure formula. The developed Risk Measure is proven to manage the risk effectively. Furthermore, Risk Mitigation Data Disclosure algorithms, RIMIDI0 and RIMIDI1, which utilize the developed risk measures, are proposed. Experimental results show the feasibility and effectiveness of the proposed method in preserving the privacy preferences of the patient. Since the proposed approach exposes the patient’s data that are relevant to the undergoing medical procedure while preserving the privacy preferences, positive outcomes can be realized, which will ultimately bring forth quality healthcare services.

Balancing medical innovation and affordability in the new healthcare ecosystem in China:Review of pharmaceutical pricing and reimbursement policies

The China Basic Medical Insurance Program was created in 1999 with three objectives:equal accessibility,affordability,and quality.Today,it has become the biggest medical insurance program in the world,covering 95%of China's population.Since 2015,China's healthcare ecosystem has been reshaped by increasing innovation,which has in turn been driven by regulatory reform,enhancement of research and development capability,and capital market development.There has also been improved regulatory efficiency to reduce lags in launching drugs.In 2022,nearly 20%of novel active substances launched globally were from China.China has also risen to become the second biggest contributor to innovation in terms of pipelines.Using a“fast-follow”strategy,many locally developed innovative drugs can compete with products from multinational companies in their quality and pricing.However,China's pharmaceutical and biotechnology industry will continue to face challenges in pricing and reimbursement,as well as a shortened product lifecycle with rapid price erosion.The government has already accelerated the timeline for updating the drug reimbursement list and is willing to create a high-quality medical insurance program.However,some obstacles are hard to overcome,including reimbursement for advanced therapies,limited funding and an increasing burden of disease due to an aging population.This article reviews the trajectory of medical innovation in China,including the challenges.Looking forward,balancing affordability and innovation will be critical for China to continue the trajectory of growth.The article also offers some suggestions for future policy reform,including optimizing reimbursement efficiency with a focus on highquality solutions,enhancing the value assessment framework,payer repositioning from“value buyer”to“strategic buyer”,and developing alternative market access pathways for innovative drugs.

Bridging the gap: Addressing disparities in hepatitis C screening, access to care, and treatment outcomes

Hepatitis C virus(HCV)is a significant public health challenge globally,with substantial morbidity and mortality due to chronic liver disease.Despite the availability of highly effective and well-tolerated direct-acting antiviral therapies,widespread disparities remain in hepatitis C screening,access to treatment,linkage to care,and therapeutic outcomes.This review article synthesizes evi-dence from various studies to highlight the multifactorial nature of these dispari-ties,which affects ethnic minorities,people with lower socioeconomic status,in-dividuals with substance use disorders,and those within correctional facilities.The review also discusses policy implications and targeted strategies needed to overcome barriers and ensure equitable care for all individuals with HCV.Recom-mendations for future research to address gaps in knowledge and evaluation of the effectiveness of interventions designed to reduce disparities are provided.

Disease-wide accessibility of the elderly in primary care setting: The relationship between geographic accessibility and utilization of outpatient services in Tokushima prefecture, Japan

In Japan, a rapid pace of aging coupled with the lower birth rates causes the decrease of the population especially in rural area, which leads to the problems with the delivery of healthcare services. We investigated the relationship between the geographical accessibility (time and distance) and the utilization rate of outpatient services in the elderly by major disease groups in Tokushima prefecture, Japan. Distances and driving times to the nearest facilities from residential sites in major disease categories were measured by using geographic information system. Utilization data was obtained from the claim data. In diseases of the musculoskeletal system and connective tissue (M00-M99), diseases of the digestive system (K00-K93), endocrine, nutritional and metabolic diseases (E00-E90), diseases of the eye and adnexa (H00-H59) and diseases of the respiratory system (J00-J99), there were moderate negative correlations (around –0.4 to –0.6) both in distance and time. Distance and time to the nearest facilities were important factors for the utilization of outpatient services of major disease categories in Japanese elderly. Comprehensive approach which include socio- economic factors is needed to mitigate access problems in aging Japanese society.

Access to Supportive Health Services for People with Physical Disabilities: A Case of Health Facilities in Singida Rural District, Tanzania

Background: It is estimated that above one billion people (15%) of the world’s populations are living with disabilities. The poor and unfriendly infrastructure at health facilities is the core challenge for people with physical disabilities in accessing healthcare. This study aimed to explore at what extent the existing infrastructure and design of health facilities in Singida rural district, Tanzania supports people with physical disabilities to access healthcare. Methods: A cross sectional health facility-based assessment of all thirty-two functioning health facilities in the district was done between June and December 2020 using observational checklist and key informants’ interviews consist of measurement procedures of the architectural condition of health facilities. Observation checklist was designed based on standard of health facilities in Tanzania, national guideline for safe care standards for dispensaries, health centers and district hospital of 2014 and national guideline for water, sanitation and hygiene in healthcare facilities of 2017. Data were analyzed by SPSS-26 using descriptive statistics to obtain frequencies tables, percentage and figure. Qualitative data were analyzed by using NVivo-12 software. Results: The study revealed that there was no signage, entrance area, parking and toilets designated for people with physical disabilities in all health facilities. There was no special seat, examination table/bed and special weight scale for people with physical disabilities in all facilities. Also, the doors were not wide enough to support wheelchair user to maneuver in all health centers and dispensaries. In addition, door handles were not user friendly for wheelchair users. In fact, only the hospital and health centers had wheelchairs while 27 (96.4%) of all dispensaries had no wheelchairs. Furthermore, ramp and pathways were not available in all dispensaries. All health facilities had stairs but the challenge was most of the staircases had no floor located before the steps. Conclusion: The study revealed that the infrastructures in most healthcare facilities pose challenges to people with physical disabilities when they access healthcare services. These findings call for need of improving health facilities’ infrastructure to accommodate people with physical disabilities and this should be given a priority.

基于医保视角的公立医疗机构医用耗材准入策略研究

目的:基于医保管理角度,探讨公立医疗机构医用耗材准入机制,完善医用耗材准入顶层设计。方法:从医保监管、医保贯彻执行编码标准(简称贯标)、医保集采、医疗服务项目及价格和医保评审技术5个维度,设计医用耗材准入流程并提出针对性策略。结果:从加强医用耗材医保监管、落实医用耗材医保贯标、推进医用耗材医保集采落地、推动医保医疗服务项目和医疗服务价格项目发展以及积极开展卫生技术评估5个维度设计医用耗材准入流程,提出加强医保业务学习和培训、打造院内医用耗材准入多学科协作管理体系、探索建立适合我国医疗机构的卫生技术评估方法,推进医用耗材准入信息一体化建设的医用耗材准入针对性策略。结论:基于医保管理角度从理论上着重强调医保在公立医疗机构医用耗材准入中的核心位置,为医用耗材准入研究提供新思路,丰富医用耗材准入管理维度。

医疗服务可及性对老年人生活满意度的影响

提升老年人生活满意度是积极应对人口老龄化的重要举措。使用2014年和2018年中国老年人健康影响因素跟踪调查(CLHLS)数据,探究医疗服务可及性对老年人生活满意度的影响及其作用机制,结果表明:医疗服务可及性对老年人生活满意度存在积极影响,地理可及性和知识/服务可及性均能显著提升老年人生活满意度;提升医疗服务可及性能够有效改善老年人的健康状况,进而提升老年人的生活满意度。异质性分析表明,医疗服务可及性对有充足经济来源、有家人照料以及有情感支持的老年人生活满意度的影响更大。因此,提升老年人的生活满意度可从以下几方面入手:大力推进医疗服务的可及性与均等化,优化医疗资源的配置;加强健康保健知识的宣传教育,提升医疗服务的利用率;同时加快建设友好型社区,充分发挥家庭、社区的功能,鼓励老年人积极参与社会活动,提升老年人的生活品质。

基于就医活动推断的老年人公交就医可达性研究

为准确评估老年人公交就医出行的实际可达性,本文基于老年卡数据构建公交出行链,提出基于公交出行链的老年人就医活动推断方法,获取老年人的实际就医出行需求和出行时间。引入公交实时到站数据以反映公交实际运营水平对就医可达性的影响,构建面向出行全过程的实际出行成本矩阵,包括等候时间、乘车时间、换乘时间。考虑不同医院服务供给能力差异构建综合服务能力指标,引入分级服务半径和高斯距离衰减函数,提出基于改进两步移动搜索法的老年人公交就医可达性计算方法。以北京市六环内区域为例进行实证分析,结果表明:老年人公交就医可达性整体呈现由中心向外围递减的趋势,在城市外围区域其分布也存在空间异质性,五环路外的东部和西部区域可达性较好,而北部、东北部区域的可达性相对较差;各区域高峰时段的平均可达性均明显低于平峰时段的平均可达性。本文可为提升老年人就医出行可达性和公交系统适老化水平提供支撑。

深圳市公共住房居民就医可达性——基于互联网地图服务和改进两步移动搜索法

基于互联网地图服务测算人才住房、经济适用房、公共租赁房在步行、公共交通和驾车3种出行方式下到达不同等级医院的通勤时间,通过引入高斯距离衰减函数、设立多级搜索半径、考虑供给和需求方竞争效应并利用实时交通大数据改进两步移动搜索法,对深圳市公共住房居民就医可达性进行多维度评价。研究发现:1)紧急就医情境下15%公共住房点驾车30 min内不可抵达三甲医院,普通就医情境下仅10%公共住房点实现15 min就医目标;2)可达性由老经济特区向非经济特区逐渐衰减;3)人才住房可达性最优,其次是经济适用房,最后是公共租赁房;4)公共交通和步行相比于驾车模式下的可达性空间分异更显著。

基于区块链的轻量级物联网医疗数据访问控制方案

基于物联网的智慧医疗系统,给患者和医务工作者带来极大的便利,但是物联网医疗设备产生的海量医疗数据包含着患者的个人隐私,一旦泄露会造成重大损失,以往的访问控制方案存在不灵活,中心化,加密效率较低等问题。针对这些问题,提出了一种基于区块链的轻量级物联网医疗数据访问控制方案。提出了一种改进的多中心属性基加密(multi-authority attribute-based encryption, MA-ABE)方案为患者提供细粒度的安全数据共享,并且利用IPFS技术存储患者数据。结合雾计算技术,利用雾节点承担属性基加解密过程中大部分的计算开销,减轻了物联网设备负担。进行安全性分析和仿真实验,结果表明,提出的方案在保证安全的情况下为物联网医疗数据提供了高效并且轻量级的访问控制。

基于公办与民办差异视角的养老机构医养结合服务质量评价研究

背景近几年,关于我国医养结合服务模式、影响因素等的研究报道较多,但关于养老机构医养结合服务质量的研究报道较少,且缺乏对不同类型养老机构医养结合服务质量差异的比较研究。目的评价公办与民办养老机构医养结合服务质量。方法2020年10月—2021年9月,采用分层随机抽样方法在内蒙古自治区包头市、陕西省西安市、湖北省宜昌市、浙江省绍兴市共4个地区进行问卷调查,共选取25家养老机构老年人1106名。通过SERVQUAL模型构建包含可靠性、及时性、保障性、规范性、移情性5个维度和15项二级指标的医养结合服务质量评价指标体系,结合熵权法与模糊综合评价法分别计算公办、民办养老机构医养结合服务质量评分并进行比较。结果公办、民办养老机构老年人对医养结合服务质量满意度综合评价值分别为41.66、38.82分,其中公办养老机构15项二级指标评分均在40.00分以上,民办养老机构13项二级指标评分在40.00分以下。结论公办与民办养老机构老年人对医养结合服务质量满意度综合评价结果存在一定差异,其中规范性、移情性维度评分差异较大,可靠性、及时性、保障性维度评分差异较小,这为发现不同维度下医养结合服务存在的问题、促进养老机构医养结合服务高质量提供了参考。

卫生服务空间可及性评估模型的比较研究

目的比较供需比例法、重力模型、传统两步移动搜索法及改进两步移动搜索法四种模型在卫生服务空间可及性评估中的原理方法和应用价值,为卫生服务空间可及性评估模型的科学选用提供参考。方法以南宁市妇幼卫生服务为例,收集南宁市行政区划矢量地图、道路交通网络矢量图、妇幼卫生资源及需求人口等资料,采用供需比例法、重力模型、传统两步移动搜索法及改进两步移动搜索法分别从县区、乡镇/街道、行政村多尺度上综合评估南宁市妇幼卫生服务的空间可及性。结果四种模型均发现南宁市妇幼卫生服务空间可及性呈明显的空间分异性,可及性从市中心向周边地区递减。但不同模型和不同空间尺度下探测到的可及性高值/低值区域,可及性递减趋势,可及性中位数和四分位数间距等存在较大差异。结论供需比例法、重力模型、传统两步移动搜索法及改进两步移动搜索法在卫生服务空间可及性评估中的应用价值不同,测算出的空间可及性强度亦不同。应用时需参考四种模型结果从多维空间尺度上仿真现实情景,综合评估卫生服务的空间可及性。

A critical literature review of security and privacy in smart home healthcare schemes adopting IoT&blockchain:Problems,challenges and solutions

Protecting private data in smart homes,a popular Internet-of-Things(IoT)application,remains a significant data security and privacy challenge due to the large-scale development and distributed nature of IoT networks.Recently,smart healthcare has leveraged smart home systems,thereby compounding security concerns in terms of the confidentiality of sensitive and private data and by extension the privacy of the data owner.However,proof-of-authority(PoA)-based blockchain distributed ledger technology(DLT)has emerged as a promising solution for protecting private data from indiscriminate use and thereby preserving the privacy of individuals residing in IoT-enabled smart homes.This review elicits some concerns,issues,and problems that have hindered the adoption of blockchain and IoT(BCoT)in some domains and suggests requisite solutions using the aging-in-place scenario.Implementation issues with BCoT were examined as well as the combined challenges BCoT can pose when utilised for security gains.The study discusses recent findings,opportunities,and barriers,and provides recommendations that could facilitate the continuous growth of blockchain applications in healthcare.Lastly,the study explored the potential of using a PoA-based permission blockchain with an applicable consent-based privacy model for decision-making in the information disclosure process,including the use of publisher-subscriber contracts for fine-grained access control to ensure secure data processing and sharing,as well as ethical trust in personal information disclosure,as a solution direction.The proposed authorisation framework could guarantee data ownership,conditional access management,scalable and tamper-proof data storage,and a more resilient system against threat models such as interception and insider attacks.