Equity of Accessibility to Health Care Services and Identification of Underserved Areas

Characterizing the availability of opportunities to residents has been a long-term aim in health care geographic investigation.It is important to measure the degree of inequity in health care accessibility and to identify underserved areas, due to the uneven distribution of health care services. In this study, JavaScript was used to calculate travel time based on Amap, as this can provide a more reliable data support to measure the health care accessibility in Xi’an communities, China. Based on the overall equity, herein, an attempt was made to quantify the equity of health care accessibility, and to identify health care underserved areas inside the different communities. Results show that the accessibility to low-level health care services is high in the northern areas and low in the southern areas, while the accessibility to high-level and comprehensive health care services shows a clear core-periphery spatial structure. Moreover, the overall equity of the health care accessibility is relatively low, and the inequity of high-level health care accessibility is further aggravated.Furthermore, the quantified equity of accessibility to high-level and comprehensive health care services in the central urban areas is better;however low-level health care services are relatively inadequate. There are significant differences among health care underserved areas, in particular, for the worst equity and the lowest accessibility areas(A1) and the worse equity and the lowest accessibility areas(B1) in high-level underserved areas. Notably, the sharing of health care services and the reasonable flow of health technical personnel among different levels of health institutions can make the high-level health care services in the central urban areas have a greater trickle effect on the surrounding areas.

Nations for Mental Health──A Special Programme for Mental Health in Underserved Populations

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Examining the Factors that Influence the Use of Social Media for Disaster Management by Underserved Communities

This study examined the propensity of social media use by underserved communities by drawing on the literature on the digital divide and attribution theory.Specifically,this research explored the factors that can influence the use of social media for disaster management.The study used survey methodology to collect data and partial least squares structural equation modeling(PLSSEM)to analyze the data and test the hypotheses.The results of the study indicate:(1)that the propensity of social media use for disaster management is low for underserved communities;(2)a positive relationship between an individual’s effort and the intention to use social media for disaster management;and(3)a negative relationship between task difficulty and the intention to use social media for disaster management.The study expanded the literature on the use of social media in disaster management.The article also provides both theoretical and practical implications.

Residential smoking restrictions are not associated with reduced child SHS exposure in a baseline sample of low-income, urban African Americans

Second hand smoke exposure (SHSe) relates to many chronic and acute illnesses. Low income African American (AA) maternal smokers and their children have disproportionately higher tobacco-use and child SHSe-related morbidity and mortality than other populations. While public health officials promote residential smoking restrictions to reduce SHSe and promote smoking cessation, little is known about the impact of restrictions in changing smoking behavior and SHSe in this population. Thus, the purpose of this study was to examine associations between residential smoking restrictions, maternal smoking, and young children’s SHSe in the context of other factors known to influence low income AA mothers’ smoking behavior. For this study, we used cross-sectional, baseline data from 307 AA maternal smokers’ pre-treatment interviews completed as part of a subsequent behavioral counseling trial to reduce their young (< 4 years old) children’s SHSe. Residential smoking restriction was dichotomized as 0 = no restrictions and 1 = some restrictions. Child urine cotinine provided a biomarker of SHSe. Mothers reported cigarettes/day smoked, cigarettes/day exposed to child, and intention to quit. Multivariate regressions modeled effects of restriction as the primary predictor of smoking and exposure outcomes. Maternal smoking patterns such as cigarettes per day (β = 0.52, p < 0.001) and years smoked (β = ?0.11;p = 0.03) along with presence of additional smokers in the home (β = 0.10;p = 0.04), but not residential restriction (β = ?0.09, p = 0.10), predicted reported SHSe. Restriction did not relate to baby cotinine or maternal intention to quit. Thus, residential smoking restrictions may contribute to efforts to reduce children’s SHSe and promote maternal smoking change;but alone, may not constitute a sufficient intervention to protect children. Multi-level intervention approaches that include SHSe-reduction residential smoking policies plus support and cessation assistance for smokers may be a necessary approach to smoke-free home adoption and adherence.

Expanding Treatment Access for Chronic Hepatitis C with Task-shifting in the Era of Direct-acting Antivirals

In the United States,the fight to eradicate hepatitis C virus (HCV) infection has been ongoing for many years,but the results have been less than ideal.Historically,patients with chronic hepatitis C (CHC) were treated with interferon-based regimens,which were associated with frequent adverse effects,suboptimal response rates,and long durations of treatment-of up to 48 weeks.Expertise from specialistphysicians,such as hepatologists and gastroenterologists,was needed to closely follow patients on these medications so as to monitor laboratory values and manage adverse effects.However,the emergence of direct-acting antiviral (DAA) agents against HCV infection have heralded outstanding progress in terms of safety,tolerability,lack of adverse effects,efficacy,and truncated duration of therapy-12 weeks or less-thereby making the need for close monitoring by specialist-physicians obsolete.With the recent approval of DAA agents by the Food and Drug Administration,the treatment model for CHC no longer relies on the limited number of specialist-physicians,which represented a major barrier to treatment access in the past,especially in underserved areas of the United States.We propose and share our experiences in adapting a task-shifting treatment model,one that utilizes a relatively larger pool of non-specialist healthcare providers,such as nursing staff (medical assistants,vocational licensed nurses,registered nurses,etc.) and advanced practice providers (nurse practitioners and physician assistants),to perform a variety of important clinical functions in an effort to make DAA-based antiviral therapy widely available against HCV infection.Most recently,task-shifting was implemented by the United States and World Health Organization in the fight against the human immunodeficiency virus and showed encouraging results.Based on our experiences in implementing this model at our outreach clinics,the majority of HCV-infected patients treated with DAA agents can be easily monitored by non-specialist healthcare providers and physician extenders.Task-shifting can effectively address one of the major rate-limiting factors in expanding treatment access for HCV infection.