bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inequalities in access to healthcare for older adults during COVID-19 pandemics in Lithuania
Authors: Kalediene R , Kaseliene S , Sauliune S , Mesceriakova O , Zutautiene R , Kalibatas V 
Published: October 2024

Abstract

Background
During COVID-19 pandemic, healthcare systems experienced unprecedented shock. Older adults were the most vulnerable group of Lithuanian society, facing distinctive health challenges and highest mortality rates. The aim of the study was to examine perceived inequalities and challenges in access to healthcare of Lithuanian population over 65 years old during COVID-19 pandemic.

Methods
Representative sample of Lithuanian population over 65 years old (1503 individuals) was involved in the anonymous questionnaire survey, performed in January, 2024.

Results
22 % of respondents reported not using healthcare services during COVID-19 pandemics. Among them, 76% did not have any need for healthcare services, while 13.6% did not approach healthcare due to fear of getting infected by Covid-19, and the other 10.4% had various accessibility challenges. 15.8% reported frequent problems in registering with family doctors, and 20.0% - with the specialist appointment. There was a clear social gradient observed among those underserved: it was associated with educational level and place of residence. Those with lower education and living in smaller towns and rural areas reported more common healthcare accessibility problems. Higher education, income and better self-perceived health correlated with higher satisfaction with travel time reaching health care services and registering for the appointment (p &lt; 0.05).

Conclusions
Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters and protection of the vulnerable groups of the society.

Key messages
• Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics.
• Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters.
Inequalities in prevalence rate of edentulism in the European Union between 1990 and 2019
Authors: Andrade CAS , Mahrouseh N , von der Lippe E , Baravelli C M , Varga O 
Published: October 2024

Abstract

Background
Edentulism, characterized by tooth loss, serves as a global indicator of oral health burden, particularly affecting older and economically disadvantaged populations. We aimed to assess health inequalities in age-standardized prevalence rate (ASPR) of edentulism across 28 EU member states and EU as a whole between 1990 and 2019.

Methods
We retrieved ASPR, annual rate of change (ARC) and 95% uncertainty interval from the Global Burden of Disease (GBD) 2019 study. We calculated the ASPR ratio between 1990 and 2019 and country-paired ASPR for 2019. To estimate the inequalities between countries between 1990 and 2019, we used the Gini Coefficient (GC) and Slope Index of Inequality (SII).

Results
The EU ASPR for edentulism was 5912 (95% UI: 4751-7473) in 1990 while in 2019 it was 5048 (95% UI: 3970-6485). Sweden had the lowest ASPR in 1990, while Spain held this position in 2019. The highest rates in 1990 were observed in Poland and the Netherlands, with the Netherlands maintaining the highest ASPR in 2019. Spain exhibited the lowest ARC at -0.325 (95% UI: -0.477--0.193), while Sweden was the sole country with a positive value, at 0.034 (95% UI: -0.009-0.075). The ASPR ratio across all EU member states exhibited a range of values for males, from 1.00-2.16, and for females, from 1.00 to 1.87. The ASPR ratios ranged between 1.81 and 2.16 from 1990 to 2000. The GC was 0.097 (95% UI: 0.076-0.117) in 1990 and subsequently decreased-0.084 (95% UI: 0.063-0.105) by 2019. The SII exhibited a range from 0.062 (95% UI: 0.051-0.072) in 1990-0.046 (95% UI: 0.038-0.054) in 2019.

Conclusions
Inequalities in edentulism in the EU were similarly low when comparing 1990 and 2019. However, there was an alarming increase in inequalities between 2005 and 2010. This underscores the need for targeted interventions and policy measures-address oral health inequalities, considering socio-economic factors, healthcare policies, sex disparities, and public awareness initiatives.

Key messages
• Edentulism is a significant public health concern within the EU for approximately 30 years.
• It has demonstrated comparable disparities in prevalence at both the beginning and end of the period, with a noticeable intensification in the interim.
Determinants of willingness to vaccinate against HPV among adults: an Italian cross-sectional study
Authors: Mimmo R , Lo Moro G , Golzio F , Campi G , Scaioli G , Bert F , Siliquini R 
Published: October 2024

Abstract

Background
In Italy, heterosexual males over the age of 18 do not participate in the free-of-charge HPV vaccine offer, nor do women over the age of 26, with regional differences; however, they can vaccinate for a fee. This survey aims to assess the vaccination readiness of the 18-40 year old population group, their perceived need with respect to the vaccine, and the determinants of the vaccination choice.

Methods
A questionnaire-based cross-sectional study targeting the general population in the 18-40 age group has been ongoing since March 2024. Recruitment occurs through social media and flyers. Demographic characteristics, social determinants, deprivation index by area via HAZ (health action zone) method (SR: -15;25), risk factors, main barriers to vaccination are assessed. Our main outcome is HPV vaccination willingness. People already vaccinated were excluded from the analysis. Descriptive and logistic regression analyses were performed with Jamovi.

Results
Our preliminary results included 159 individuals of whom 57.2% would like to receive HPV vaccine. The main characteristics of the sample were: median age 30 years (IQR:26.5;34), 47.2% female gender, median deprivation index 3.7 (IQR:-0.2;7.1), 75% working, 11.9% from the LGBTQ+ community. Regarding barriers, 31.9% rated fatigue in accessing the vaccine as significant, 10.4% feared a risk in receiving the vaccine. Among the people who did not want to vaccinate or did not know, 75% would do so by paying less than the normal amount, 21.6% if free, and 3.4% would not vaccinate anyway. Vaccination willingness was positively associated with female gender (OR:3.1; p = 0.026) and belonging to the LGBTQ+ community (OR:10.0; p:0.050) and negatively associated with working status (OR:0.19; p = 0.013).

Conclusions
Socioeconomic barriers appeared to play a significant role in the choice to vaccinate. Policies to reduce economic barriers could increase vaccination in an uncovered but still potentially sexually active population.

Key messages
• Coverage of HPV vaccine is not yet at optimal thresholds, yet people excluded from free vaccination programs could benefit from vaccination incentive policies.
• Vaccination intention among heterosexual men is significantly lower than among women in the same age group, a symptom that there would still be room for awareness-raising interventions on the issue.
Closing the gap: introducing the EQUALS MAP framework for equity-focused evidence synthesis
Authors: McCann L , Johnson L , Gkiouleka A , Pearce H , Ford J 
Published: October 2024

Abstract

Background
Equity-focused analysis is vital to understanding how interventions affect disadvantaged groups and prevent widening inequalities via intervention-generated inequalities. We reviewed PROGRESS-Plus usage - a commonly used framework in equity-focused reviews and proposed a novel framework.

Methods
First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis.

Results
From the 325 studies included, the PROGRESS-Plus dimensions most assessed were sex(52%), ethnicity/race(49%), and age(44%). The PROGRESS-Plus framework missed context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Our new framework EQUALS MAP includes: Ethnicity (and culture and race); Qualifications (and other socioeconomic factors of household or individual); Underprivileged areas; Age; Lesbian, gay and other sexual identities; Sex and gender; Multiple disadvantages; Additional groups experiencing significant disadvantage; and Physical and mental disability.

Conclusions
EQUALS MAP encapsulates the key dimensions of health inequities whilst for allowing context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions.

Key messages
• PROGRESS-Plus - a commonly used framework for equity-focuses evidence synthesis - misses context-specific groups, those with multiple intersecting disadvantage, and people who experience disability.
• EQUALS MAP is a novel framework which encapsulates the key dimensions of health inequalities whilst allowing for context-specific flexibility.
Post-operative Mortality Trends for Complicated Appendicitis: Adults with and without Disabilities
Authors: Kim Y J , Yeob K E , Kim S Y , Park J H 
Published: October 2024

Abstract

Background
Even for the same complicated appendicitis, the prognosis may vary if appropriate post-operative care and follow-up are not provided. We aimed to investigate the 10-year trend of complicated appendicitis mortality among disabilities and non-disabilities peoples in Korea, recognizing potential disparities in post-surgical outcomes and the importance of adequate post-operative care.

Methods
Patients with complicated appendicitis were classified by severity using DRG codes. Causes of death were categorized into infectious, respiratory, cardiovascular, and digestive diseases using ICD-10 data. Age-adjusted mortality rates were calculated annually from 2008 to 2017 based on disability presence, severity, and type. Factors associated complicated appendicitis mortality were analyzed using multivariate logistic regression models.

Results
The mortality of complicated appendicitis was 10.2 times (40.8% vs. 413.9%) higher in people with disabilities, especially those with severe disabilities. This difference was more evident in patients with a severe disability (aOR=2.12, 95% CI:1.58-2.86), intellectual or psychological disability (aOR=2.95, 95% CI:1.49-5.85) and internal organ problems (aOR=2.05, 95% CI:1.28-3.28).

Conclusions
Our findings suggest that insufficient post-operative care among disabled peoples, especially those with severe disabilities, internal organ problems, and intellectual or psychological disabilities, may impact outcomes. This is exacerbated by poor healthcare facilities and limited disability awareness among healthcare workers. Additionally, further research is required to uncover unexplained mortality causes. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165).

Key messages
• Complicated appendicitis mortality rates show a stark 10.2-fold disparity between people with and without disabilities.
• Severe disabilities, intellectual or psychological disabilities, and internal organ problems heighten the risk, emphasizing the importance of disability-inclusive healthcare practices.
The Welsh Health Equity Solutions Platform – a mechanism for health equity solutions
Authors: Stewart D , Couzens L 
Published: October 2024

Abstract

Health inequities are a longstanding issue in Wales, as they are across the globe. They disproportionately affect the health and wellbeing outcomes of disadvantaged groups, restricting opportunities to live full and prosperous lives. Post COVID-19 new groups are emerging with disproportionately higher risk of poor health and premature death and disease, especially those with unmet needs and vulnerabilities, with the rising cost of living amplifying health inequities. Despite their prevalence, health inequities are avoidable. Efforts to reduce health inequities require action on all the social determinants of health across the life course. Improved understanding of the key drivers of health gaps is needed to address the problem and provide support for solutions-driven action to break down the barriers to health equity. The Welsh Health Equity Solutions Platform (WHESP) launched on 22nd June 2023, a collaboration between Public Health Wales, Welsh Government and WHO European Office for Investment in Health and Development. The WHESP is an innovative digital tool developed around the WHO Health Equity Status Report initiative framework of the ‘five essential conditions’ for healthy, prosperous lives for all. It is a mechanism for health equity solutions and aims to inform and facilitate policy and decision making to improve population health and address the increasing health gap through an online gateway to data, health economics, policies, and innovative health equity tools. Emerging evidence is highlighted to identify solutions for achieving healthy equity, which informs evidence-based decision making to reduce the health gap, improve overall population health and wellbeing, and achieve inclusive and sustainable economic growth and prosperity for all. Collating and sharing health equity solutions, evidence, data and best practice both across Wales and globally supports equitable, long-term action to improve the health and wellbeing of the population.

Key messages
• Highlighting health equity solutions informs best practice on tackling health inequalities.
• WHESP provides extensive evidence to facilitate cross-sectoral action and policy change.
Factor Influencing Unmet Healthcare Needs among the disabled
Authors: Park B H , Kim S Y , Park J H 
Published: October 2024

Abstract

Background
The unmet Healthcare needs (UHNs) of the disabled are not only detrimental to their quality of life but also can lead to serious health outcome including death. A variety of factors including socioeconomic, personal, environmental factors affect UHNs for the disabled.

Methods
We analyzed the UHNs status and influencing factors among 4,326 adult the disabled using Korea disability Life Data. Chi-square analysis was conducted to identify differences in UHNs according to characteristics of general, disability, environmental of the disabled. Logistic regression analysis was conducted to determine factors affecting UHNs.

Results
Those with low educational level (aOR=1.23, 95% CI = 1.02-1.48), those enrolled in private insurance (aOR=1.23, 95% CI = 1.02-1.50), those need help with daily living (aOR=1.30, 95% CI = 1.06-1.59), those who rarely go out (aOR=1.57, 95% CI = 1.27-1.92), those who use taxis (aOR=1.41, 95% CI = 1.05-1.89) or call taxi for the disabled when going to the hospital (aOR=1.37, 95% CI = 1.01-1.88), the communication disabled (aOR=1.30, 95% CI = 1.03-1.65), those with poor subjective health status (aOR=1.25, 95% CI = 1.04-1.49), those felt the explanation of treatment results was insufficient (aOR=4.04, 95% CI = 1.37-11.93), and those dissatisfied with healthcare services (aOR=3.52, 95% CI = 2.74-4.51) were more likely to experience UHNs.

Conclusions
Effective healthcare service provision for the disabled requires not only financial assistance but also social support, along with education for healthcare staff, policies with the characteristics of disabilities. Funding: This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165) and by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2024-00394642)

Key messages
• The disabled need not only financial support when using healthcare services, but also support from society, such as accompanying them to the hospital and providing transportation.
• Education for healthcare staff who communicate with the disabled and provision policy to provide appropriate healthcare services according to the characteristics of disabilities are needed.
We are wales: taking the hospital to the community - an engagement experiment
Authors: Hopkins J , Abdul Waheed M , Parry B , Bromwelll J , Blakeborough N 
Published: October 2024

Abstract

In Wales we are facing two major barriers to public health engagement. The first is describing our communities as ‘hard to reach’ when in public service we make little effort to reach them, and second, we do not consider in population level research or practice how we are perpetuating the sense of, and real, inequality in our communities that our work on social determinants of health and health inequalities seeks to address. In Wales we want to take the ‘hospital to the community’; to meet people where they are at, where they live and work and where they experience barriers to inclusion, discrimination, lack of trust and fear. ‘We are Wales’ is is built on the Museum of the United Nations concept of a global we - except we will start small with a small nation that as yet has not worked out how to include and involve everyone in our communities in the policy and practice decisions that may help, or hinder us all from leading a healthier, happier life. ‘We are Wales’ is a simple concept; it is about amplifying and connecting people who would not normally do so, because they do not have the resources or capacity to travel or take time out. It is about equal power in a connection to find solutions to adversity and trauma caused by structural inequality; it is about relationships, inclusion, kindness and compassion - and listening, sharing and taking action without judgement. We have taken a dome to communities in economically deprived areas of Wales and stimulated conversation between politicians, young people and communities around the concept of home. Using a virtual reality dome to project images to encourage discussion we have provided a safe space to amplify and include the voices of those who want to be heard and deserve to be listened to.

Key messages
• ‘Take the hospital to the community’ - meet people where they are at and feel safe.
• power sharing and an equal place at the table stimulates ideas and knowledge change in a trauma-informed way.
Mobile street clinics and harm reduction: pathways to provide care to homeless people in Brazil
Authors: Araujo MCA , Souza A A , Fraga PVR , Dantas ACMTV , Marinho R A , Martins ALJ , Junior HMM , Sousa R P 
Published: October 2024

Abstract

Homeless people (HP) are defined as a heterogeneous group that lives in extreme poverty, with weakened or severed family ties, lacking access to conventional housing, and using public spaces as residence. In terms of health, mental health conditions are prominent as a primary treatment demand, with care aimed at addressing needs arising from the use of alcohol and other drugs being a priority in serving HP. In this context, mobile street clinics (MSC) provide health services directly in street environments, focusing on individuals who use alcohol and other substances through harm reduction approaches. Harm reduction is defined as a set of practices aimed at minimizing the adverse health effects of alcohol and drug use without necessarily eliminating usage. Moreover, it represents an ethical and political direction in care, confronting the logic of criminalization and compulsory abstinence, enhancing access to health care for alcohol and other drug users through strategies that foster autonomy development. In the current study, we conducted an integrative review assessing the facilitators and barriers for HP access to mental health services. Preliminary results indicated that MSC, the connection between healthcare workers and the HP they serve, and the implementation of local street-based actions were the main facilitators of access for individuals who engage in harmful use of alcohol and other drugs to mental health services. Conversely, stigma, services’ lack of adjustment to the lifestyles of homeless people, and excessive bureaucracy were identified as the principal barriers of access. MSC, through their harm reduction activities, have emerged as a potential care technology to facilitate access to health services for homeless people. This research aims to present harm reduction as an ethical and political direction of care through the actions of mobile street clinics, as a way to facilitate access to health services for the homeless people.

Key messages
• Homeless people require mental health care tailored to the use of alcohol and other drugs, and harm reduction strategies implemented through mobile street clinics prove to be an effective form of care.
• Mobile street clinics and harm reduction are important care technologies that enhance access to health services for the homeless population.
Implementing a pilot primary care program: Armenia’s steps toward universal health coverage
Authors: Dayal S , Libaridian L 
Published: October 2024

Abstract

Problem
Armenia has struggled to transform its ineffective primary healthcare (PHC) system into one that can address the non-communicable disease burden, which causes 93% of mortality. To address this issue, Armenia aims to establish universal health coverage and invest in high-quality primary care.

Description
In 2023, the Armenian Ministry of Health signed a multisectoral policy to implement a pilot primary care program to trial a multitude of reforms related to diabetes (DM) and hypertension (HTN). Pilot interventions include pathways for screening/diagnosis, provider training, free medications and diagnostics, and new provider financial incentives. The key question to be answered is if these pilot interventions cause DM and HTN health outcomes to improve. Beginning in 2024, the program is being piloted in a primary care clinic in Dsegh.

Results
As a result of the 2023 Ministerial policy, multisectoral stakeholders designed and implemented this pilot program. Baseline focus groups found that the pilot addresses the financial barriers that community members noted lead to delays in seeking care and that providers perceive the pilot to be beneficial to their patients. Although final results are not yet available, the pilot has already positively changed features in the national EMR and brought together stakeholders in a way never done before.

Lessons
The pilot’s innovation comes from it being the first time that hypertension and cholesterol medications are provided by the government for free, provider bonuses are based on outcome indicators, indicator targets are set this high, a point-of-care A1c machine is utilized, and a robust monitoring and evaluation (M&E) plan is implemented, all of which are currently shaping discussions on national policy. For countries similarly working on strengthening primary care, it is recommended to pilot specific reforms and establish mechanisms through M&E systems that allow pilots to inform evidence-based decision making.

Key messages
• To move towards universal health coverage, pilot programs designed with multi-sectoral stakeholders are needed to trial suggested healthcare reforms.
• It is essential to invest in monitoring and evaluations systems to generate the data necessary to develop evidence-based policies.