Mapping Access to Children's Hospitals in Texas Maleki, Shadi; Dede-Bamfo, Nathaniel; Ekren, Elizabeth ...
International journal of environmental research and public health,
2024-Jan-26, Letnik:
21, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Vehicle access, travel time, and distance to hospitals and emergency rooms with sufficient patient beds are critical healthcare accessibility measures, especially for children who require specific ...pediatric services. In a large state like Texas with vast rural areas and limited public transit infrastructure, 75% of the children live over an hour from the closest facility that provides pediatric emergency services or specialty care. In view of this challenge, this study first sought to map the prevailing geographical accessibility to children's hospitals and, second, to model the hospital beds per capita for each hospital's service area within the state of Texas. The results showed disparities in accessing emergency pediatric care, especially in rural areas. However, despite major metro areas recording better geographical accessibility to pediatric healthcare, residents in these areas may experience limited hospital bed availability. The findings indicate an urgent need for more pediatric healthcare services in rural Texas. Given the increasing population growth in metro areas and their surroundings, there is also a need for the expansion of healthcare infrastructure in these areas.
•Lung cancer is still the first cause of cancer-related deaths in Latin America.•Regional challenges include the optimal implementation of tobacco control policies.•Differences in healthcare, ...diagnostic and treatment options generate inequality.•Breaching the gap between the best care available and the current care is adamant.•Regional based research and education programs seek to improve the current outlook.
Lung cancer is a public health problem worldwide and Latin America (LATAM) cannot escape this reality. This malignant disease has not only a high prevalence in the region, but is also the main cause of cancer related deaths, and in other emerging countries, the incidence rates are still on the rise. Interestingly in most LATAM countries, lung cancer mortality has been decreasing in men but not in women, reflecting smoking patterns in countries such as Chile, Bolivia, and Brazil.
Despite the fact that these issues are well known to government agencies, physicians and patients in the region, current efforts still fall behind those needed in order to face this problem of epidemic proportions. Tobacco control and smoking cessation are the most important interventions against lung cancer, but even with their optimal implementation (which is far from reality at this time) the number of cases in the foreseeable future would still be significant. Beyond tobacco control, advances in our understanding of the molecular component of lung cancer have resulted in new targeted therapies and immune check point inhibitors, which have improved clinical outcomes but at a considerably higher financial cost. LATAM has not widely and speedily adopted these strategies, including new technology and approved novel drugs, due to a number of facts, and therefore only a dismal proportion of LATAḾs patient population have benefited from these new advances.
A keen focus on a heterogeneous education system for caregivers in lung cancer treatment would likely help standardize care and improve future potential gains from domestic research. In this review we discuss the challenges of treatment implementation, focusing on new technologies.
Before COVID-19, people with rare diseases (RD) experienced numerous disparities in quality of life and healthcare access and quality, yet little is known about the experiences of this underserved ...group during the pandemic.
During the first wave of the COVID-19 pandemic in the United States, spring and summer of 2020, 759 participants representing 231 unique RDs responded to open-ended questions about the impact of the pandemic on life with a RD, healthcare access, and coping. Qualitative conventional content analysis was used to analyze responses. Identified themes represented positive and negative dimensions of change, including a shock to the (health) system, coping with uncertainty, and the value of social support while isolated.
Limitations in healthcare access and quality were the most frequently described as impacts of COVID-19. Other major negative impacts included exacerbation of symptoms, psychological distress, and a lack of usual social support and reliable information. However, participants also noted silver linings, especially in healthcare. For some, expanded telehealth enhanced their ability to access medical and mental health providers and RD specialists. Finally, many participants hoped that, by highlighting social and health inequities faced by people with RDs and other minorities, the pandemic would prompt greater understanding and policies that could improve the quality of life of the RD community.
Sex workers in east and southern Africa are exposed to multiple occupational health and safety risks. Detailed understanding of barriers to accessing care would optimise design of improved services ...for this population. In this study, trained sex workers conducted 55 in-depth interviews and 12 focus group discussions with 106 female, 26 male and 4 transgender sex workers across 6 urban sites in Kenya, Zimbabwe, Uganda and South Africa. Data were analysed thematically, following an interpretive framework. Participants cited numerous unmet health needs, including diagnosis and treatment for sexually transmitted infections and insufficient access to condoms and lubricant. Denial of treatment for injuries following physical assault or rape and general hostility from public-sector providers was common. Resources permitting, many sex workers attended private services, citing higher quality and respect for dignity and confidentiality. Sex workers in southern Africa accessed specialised sex worker clinics, reporting mostly positive experiences. Across sites, participants called for additional targeted services, but also sensitisation and training of public-sector providers. Criminalisation of sex workers and associated stigmatisation, particularly of transgender and male sex workers, hinder HIV-prevention efforts and render access to mainstream healthcare precarious. Alongside law reform, sex worker-led peer outreach work should be strengthened and calls by sex workers for additional targeted services heeded.
•What is currently known about this topic?.•Surgical care in children has become increasingly regionalized to dedicated children's centers. Studies suggest that rural residence and increased travel ...distance may negatively impact outcomes of adult and pediatric medical care.•What new information is contained in this article?.•While the evidence is limited and mixed, several studies identified geographic disparities in access to and outcomes of children's surgical care.
Ensuring that children have access to timely and appropriate surgical care is a vital component of comprehensive pediatric care. This study systematically reviews the existing evidence related to geographic barriers in children's surgery.
Medline and Scopus databases were searched for any English language studies that examined associations between geographic burden (rural residence or distance to care) and a quantifiable outcome within pediatric surgical subspecialties. Two independent reviewers extracted data from each study.
From 6331 studies screened, 22 studies met inclusion criteria. Most studies were retrospective analyses and conducted in the U.S. or Canada (14 and three studies, respectively); five were conducted outside North America. In transplant surgery (seven studies), greater distance from a transplant center was associated with higher waitlist mortality prior to kidney and liver transplantation, although graft outcomes were generally similar. In congenital cardiac surgery (five studies), greater travel was associated with higher neonatal mortality and older age at surgery but not with post-operative outcomes. In general surgery (eight studies), rural residence was associated with increased rates of perforated appendicitis, higher frequency of negative appendectomy, and increased length of stay after appendectomy. In orthopedic surgery (one study), rurality was associated with decreased post-operative satisfaction. No evidence for disparate outcomes based upon distance or rurality was identified in neurosurgery (one study).
Substantial evidence suggests that geographic barriers impact the receipt of surgical care among children, particularly with regard to transplantation, congenital cardiac surgery, and appendicitis.
Placenta accreta spectrum (PAS) disorder is a serious condition that frequently requires special care in specialized centers. Migrant pregnant women face economic and social disadvantages that place ...them in situations of pervasive health disparities and, thus, poorer pregnancy outcomes can be expected.
Describe the care of migrants without health insurance, affected by PAS and treated in a reference center for PAS.
The institutional registry of PAS in a private Latin American center was reviewed in search of migrant patients, identifying three patients without health insurance, with PAS, referred outside the traditional administrative channels, in the context of an inter-institutional collaboration program.
Migration imposes additional difficulties in the management of complex obstetric pathologies such as PAS. We recommend interinstitutional collaboration as a strategy to bring patients affected by PAS to experienced hospitals.
Antibiotic prescribing rates in the outpatient setting have been shown to differ, sometimes dramatically, at the state, national, and international levels 1–4. These differences have been attributed ...to provider factors (eg, time from training and specialty, density of providers) 5–7, practice setting (eg, urgent care compared to ambulatory clinics) 8, 9, patient and family characteristics (eg, socioeconomic status, race) 10, and geographic location (eg, urban versus rural settings) 11.
The paper analyzes the healthcare-seeking behavior of South Korean immigrants in Toronto, Canada, and how transnationalism shapes post-migration health and health-management strategies. Built upon ...largely separate research areas in ethnicity and health, health geography, and transnationalism, the paper conceptualizes immigrant health as influenced by individual characteristics, the migration and resettlement experience, and place effects at both a local and a transnational scale. A mixed-method approach is used to capture insights into health status and experiences in accessing local and transnational healthcare among South Korean immigrants – a fast growing visible minority group in Canada. Statistical analysis of data from the Canadian Community Health Survey discloses patterns and trends in health and healthcare use among the Korean Canadian, overall foreign-born, and native-born populations. Focus groups reveal in-depth information on the decline of Korean immigrants' health status and the array of sociocultural, economic and geographic barriers in accessing healthcare in Canada, which gave rise to their transnational use of health resources in the home country. The transnational strategies included traveling to South Korea for medical examinations or treatment, importing medications from South Korea to Canada, and consulting health resources in South Korea by phone or email. The results provide timely knowledge on how a recent immigrant group adapts to Canada in the domain of health and adds a transnational perspective to the literature on ethnicity and health.
•Study examines transnational healthcare seeking behavior of Korean immigrants.•Mixed-methods include focus groups and analysis of Canadian Community Health Survey.•Care seeking in home country emerges as an important health coping strategy.•Transnational care use is a response to local barriers to healthcare•Local and global place effects and individual experiences shape access to care.
Intimate partner violence (IPV) impacts physical health, mental health, and healthcare use. IPV during pregnancy, in particular, is associated with lower rates of antenatal care, but no studies have ...assessed the association between IPV and postpartum healthcare. This study aims to examine the link between IPV (emotional, physical, and sexual) and two outcomes: postpartum healthcare use and access to family planning.
This study uses data from a cross-sectional survey of 859 women in Nairobi and Kiambu counties in Kenya who gave birth during the COVID-19 pandemic in 2020.
In this sample, 36% of women reported ever experiencing IPV. Of those, 33% indicated the frequency of IPV stayed the same or increased during COVID-19. Nearly 17% of women avoided postpartum healthcare and 10% experienced issues accessing family planning. Those who experienced any form of IPV during pregnancy had approximately twice the odds of avoiding postpartum healthcare compared to those who did not experience any form of IPV. Compared to those who did not experience IPV during pregnancy, experiencing sexual IPV was associated with 2.25 times higher odds of reporting issues accessing family planning. Additionally, reporting fair or poor self-rated health was associated with both avoiding postpartum healthcare and reporting issues accessing family planning. Experiencing food insecurity was also associated with avoiding postpartum healthcare.
To our knowledge, this is the first study to establish the link between IPV during pregnancy and postpartum healthcare access. During COVID-19 in Kenya, postpartum women who had experienced IPV were at increased risk of disengagement with healthcare services. Women should be screened for IPV during pregnancy and postpartum in order to better support their healthcare needs. In times of crisis, such as pandemics, policymakers and healthcare providers must address barriers to healthcare for postpartum women.
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