International Journal for Equity in Health最新文献

{"title":"Community-based participatory research (CBPR) approaches in vaccination promotion: a scoping review.","authors":"Yan Zhang, Yao Jie Xie, Lin Yang, Kin Cheung, Qingpeng Zhang, Yan Li, Chun Hao, Harry Hx Wang, Qianling Zhou, Angela Yee Man Leung","doi":"10.1186/s12939-024-02278-1","DOIUrl":"10.1186/s12939-024-02278-1","url":null,"abstract":"<p><strong>Background: </strong>Community-based participatory research (CBPR) is a collaborative research approach that engages academic researchers and community stakeholders as equal partners in all research steps to address community concerns and achieve health equity. The CBPR approach has been widely used in vaccination promotion programmes. However, the elements and steps of CBPR-based programmes varied among studies. The purpose of this scoping review was to synthesize the elements and steps, and establish an implementation framework to guide the utilisation of CBPR approaches in vaccination promotion.</p><p><strong>Methods: </strong>This scoping review was performed in accordance with Arksey and O'Malley's five-stage framework. A systematic search was conducted on a set of electronic databases and grey literature sources. The retrieved articles were screened according to the criteria of CBPR and vaccination promotion, and data were extracted and recorded on a calibrated and predefined form in terms of study characteristics and CBPR components. Two authors worked independently to complete literature search, study selection, and data extraction. A narrative summary was used in categorising characteristics, and the contents of the included studies were summarised through qualitative analysis.</p><p><strong>Results: </strong>A total of 8557 publications were initially screened, and 23 articles were finally included. According to the CBPR conceptual model, the elements in each CBPR component specifically for vaccination promotion included (1) the establishment of community-academic partnership (CAP)s, (2) community capacity building by partner training vaccination knowledge, research literacy, and service abilities and skills, (3) development and implementation of community-based intervention and (4) Outcome evaluation. A CAP was established between academic researchers or institutes and eight types of partners, including community service organisation-related non-government organisations (NGOs), health service institution-related NGOs, religious organisations, government agencies, educational institutions, media agencies, business agencies, and community representatives. The maintenance of CAP was achieved with four key strategies, namely, strengthening communication, forming management groups, sharing resources and information, and providing incentives. Twelve studies provided comprehensive insights into the strategies employed for intervention development, utilising either quantitative surveys, qualitative methods or a combination of both approaches. The contents of interventions included health service supports, health education activities, social marketing campaigns, community mobilisation, interactive discussions, vaccination reminders and incentives. As for outcome evaluation, vaccination rate and the effectiveness of interventions were assessed. A considerable increase was observed in 95.7% of the included studies (22/23), and the high","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"227"},"PeriodicalIF":4.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring attitudes towards ethnic minority patients: the revalidated REMP-3 instrument for graduate healthcare practitioners.","authors":"Stijn Schelfhout, Robin Vandecasteele, Sara Willems, Eva Derous, Stéphanie De Maesschalck","doi":"10.1186/s12939-024-02309-x","DOIUrl":"10.1186/s12939-024-02309-x","url":null,"abstract":"<p><strong>Objective: </strong>Measuring intercultural attitudes can aid in understanding and addressing persistent inequities in healthcare. Instead of creating new instruments, several sources call for a more rigorous revalidation of existing instruments towards a more broad population. As an example of such an existing instrument, the EMP-3 (Ethnic Minority Patients) focuses on the attitudes of physicians towards ethnic minority patients. Starting from a robust theoretical underpinning and a rigorous methodological setup, the present study revalidates the EMP-3 instrument for physicians towards the REMP-3 instrument for graduate healthcare practitioners.</p><p><strong>Methods: </strong>We assessed the reliability and validity of the old EMP-3, which we then updated to a new REMP-3 instrument. We used structural equation modeling to model the framework of intercultural effectiveness on two waves of independent data, N₂₀₂₁ = 368 and N₂₀₂₂ = 390. Within this framework, we tested the new REMP-3 instrument as an operationalization of intercultural attitudes. We conducted a confirmatory factor analysis on the first wave, after which we made adaptations to the original EMP-3 instrument to obtain a new REMP-3 instrument. The new REMP-3 instrument was then cross-validated using the data of the second wave.</p><p><strong>Results: </strong>The new REMP-3 instrument is a psychometric upgrade compared to the EMP-3. The REMP-3 now has a cross-validated structure, with three subscale dimensions (i.e., task perception, background perception and the perceived need to communicate) and an overarching higher-order, full-scale dimension. Both the subscales as well as the full instrument show acceptable to good internal consistency reliability, with a reduced number of items from eighteen to ten. As theoretically predicted, the REMP-3 also functions as a measure of intercultural attitudes in an intercultural competence framework.</p><p><strong>Conclusion: </strong>Ultimately, the REMP-3 instrument can contribute to more equity in healthcare by concisely and reliably assessing and monitoring attitudes in healthcare practitioners. This attitude assessment represents the potential of learning new skills and knowledge to address interactions with ethnic minority patients, which is especially useful during training situations like an internship.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"226"},"PeriodicalIF":4.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrimination experiences of transgender individuals in healthcare: an interview study on the perspective of health professionals specializing in the treatment of transgender individuals.","authors":"Tobias Skuban-Eiseler, Marcin Orzechowski, Florian Steger","doi":"10.1186/s12939-024-02313-1","DOIUrl":"10.1186/s12939-024-02313-1","url":null,"abstract":"<p><strong>Background: </strong>Experiences of discrimination in healthcare lead to poorer mental and physical health for transgender individuals. There is evidence that trans-specialists, i.e. health professionals specializing in transgender care, are an important source of discrimination experienced by transgender individuals in healthcare. In this qualitative interview study, we explored the reasons for this possibly surprising finding by analyzing subjective views of trans-specialists on various issues related to discrimination of transgender individuals.</p><p><strong>Methods: </strong>We conducted 20 semi-structured, qualitative, exploratory interviews with healthcare professionals specializing in transgender care. Interview questions were developed based on an extensive literature analysis and results of previous research on the topic. The interviews were conducted online, were digitally recorded and transcribed. Data analysis was conducted using the methods of content analysis and thematic analysis.</p><p><strong>Results: </strong>The interviewees had great difficulty giving a consistent definition of the concept of gender identity. Most of them saw it as a self-determination of a transgender individual. Although herewith emphasizing the autonomy of transgender individuals, most trans-specialists felt that they had to be convinced of their patient's transsexuality to carry out treatment. Most trans-specialists reported having had doubts about whether some transgender individuals were suffering from gender incongruence or not. There was also ambiguity among interviewees about whether transsexuality is a mental illness.</p><p><strong>Conclusions: </strong>We were able to identify specific topics that can cause discrimination experiences on the part of transgender individuals in their contact with trans-specialists. These include the vagueness of the construct of gender identity and the ambivalence between respect for the autonomy of transgender individuals and the validation of the diagnosis \"transsexuality\". Also, uncertainties regarding the classification of transsexuality as a mental illness can lead to experiences of discrimination. Furthermore, our results imply that trans-specialists might remember own discriminatory behavior less than it actually took place. Our results can contribute to the development of specific measures to avoid discrimination experiences of transgender individuals in contact with trans-specialists. These should include a reflection on one's own gender identity and training on mechanisms of discrimination.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"225"},"PeriodicalIF":4.5,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The community food environment as an effect modifier of the relationship between racial discrimination and food insecurity among adults in Southern Brazil.","authors":"Emanuele Bottega de Vargas, Mariane da Silva Dias, Ilaine Schuch, Priscila Bárbara Zanini Rosa, Marcos Fanton, Raquel Canuto","doi":"10.1186/s12939-024-02311-3","DOIUrl":"10.1186/s12939-024-02311-3","url":null,"abstract":"<p><strong>Background: </strong>Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity.</p><p><strong>Methods: </strong>This was a cross-sectional study of 400 adults aged 20-70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis.</p><p><strong>Results: </strong>The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03-1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01-1.10).</p><p><strong>Conclusions: </strong>Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"224"},"PeriodicalIF":4.5,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of COVID-19 vaccination acceptance based on the novel Omale INDEPT FORCIS Framework and recommendations for subsequent pandemics: a qualitative study among community members in Ebonyi state, Nigeria.","authors":"Ugwu I Omale, Azuka S Adeke, Onyinyechukwu U Oka, Cordis O Ikegwuonu, Osarhiemen Iyare, Olaedo O Nnachi, Victor U Uduma, Chidinma I Amuzie, Glory E Nkwo, Ugochi I A Nwali, Okechukwu O Ukpabi, Ifeyinwa M Okeke, Richard L Ewah","doi":"10.1186/s12939-024-02284-3","DOIUrl":"10.1186/s12939-024-02284-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four 'Cis') Determinants of Vaccination Acceptance Conceptual Framework - Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual's condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The evidence ill","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"223"},"PeriodicalIF":4.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refraining from seeking dental care among the Sámi in Sweden: a cross-sectional study.","authors":"Negin Yekkalam, Christina Storm Mienna, Jon Petter Anders Stoor, Miguel San Sebastian","doi":"10.1186/s12939-024-02305-1","DOIUrl":"10.1186/s12939-024-02305-1","url":null,"abstract":"<p><strong>Background: </strong>While equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.</p><p><strong>Methods: </strong>A Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18-84 years old, 3,779 answered the survey during February-May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.</p><p><strong>Results: </strong>Overall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30-44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45-64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65-84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.</p><p><strong>Conclusions: </strong>Approximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"222"},"PeriodicalIF":4.5,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the role of non-state actors in health service delivery and health system resilience in Myanmar.","authors":"K Than, Maria Paola Bertone, T La, Sophie Witter","doi":"10.1186/s12939-024-02292-3","DOIUrl":"10.1186/s12939-024-02292-3","url":null,"abstract":"<p><strong>Background: </strong>Due to the weaknesses of the public health system and its low reach, especially in border areas, provision of health services by non-state actors (NSAs) has historically played an important role in Myanmar. NSAs include local and international NGOs and civil society organisations (CSOs), but also Ethnic Health Organisations (EHOs) in the border areas, as well as the private (for profit) sector. This study aims to understand the changing role of NSAs in the shifting political environment of Myanmar between 2010 and 2022, and to explore their contribution to health system resilience.</p><p><strong>Methods: </strong>Our study includes three main components: a documentary review (n = 22), key informant interviews (KIIs) at central level (n = 14) and two township-level case studies (13 KIIs, 4 FGDs). Mostly qualitative data were collected in 2022 and synthesized, using a health system resilience framework to structure the analysis.</p><p><strong>Results: </strong>During the transition period (2010-2014) and the new political era (2015-2020), while the country gradually transitioned to a democratic system, the government increasingly recognized NSAs. Initially, engagement with NSAs remained focused on disease-specific activities and government oversight was limited, but later it expanded to health system strengthening, including the start of a \"convergence\" with ethnic health systems. Progress was relatively slow, but defined by a clear vision and plans. The military coup of February 2021 brought a halt to this progress. Collaboration between government and NSAs was interrupted, and NSAs restored previous practices and parallel systems. Initially, most health service provision stopped, but with time coping strategies emerged, which showed the capacity of NSAs to absorb the shocks (focusing on basic services; using informal communication channels; maintaining buffer stocks of supplies) and adapt (changing modes of delivery and supply chains, and adjusting HRH training).</p><p><strong>Conclusions: </strong>The study highlights the role of NSAs during crises, and provides insights on how the resilience capacities built over time by NSAs to provide services in adverse circumstances have informed the response to the latest crisis. While strategies of absorption and adaptation are noted in the study, we did not identify any transformation strategy - which might indicate the difficulty of NSAs to introduce radical changes when subjected to multiple shocks and a hostile political environment.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"221"},"PeriodicalIF":4.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: qualitative evidence from Austria.","authors":"Peter Gamillscheg, Agata Łaszewska, Stefanie Kirchner, Kathryn Hoffmann, Judit Simon, Susanne Mayer","doi":"10.1186/s12939-024-02302-4","DOIUrl":"10.1186/s12939-024-02302-4","url":null,"abstract":"<p><strong>Background: </strong>Long COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.</p><p><strong>Methods: </strong>Applying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive 'access to health care' model.</p><p><strong>Results: </strong>Based on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.</p><p><strong>Conclusions: </strong>The findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"220"},"PeriodicalIF":4.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic disparities in antibiotic-resistant outpatient urine cultures in a Boston hospital, 2015-2020: a cross-sectional analysis.","authors":"Courtney W Chan, Leo K Westgard, Andrew Romasco, Krisztian Gado, Shira Doron, Maya L Nadimpalli","doi":"10.1186/s12939-024-02308-y","DOIUrl":"10.1186/s12939-024-02308-y","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients' risks for acquiring antibiotic-resistant (AR) uropathogens.</p><p><strong>Methods: </strong>We identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients' age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients' sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients' census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients' risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.</p><p><strong>Results: </strong>We included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients' odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients' odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.</p><p><strong>Conclusion: </strong>The social determinants of health may play important and intersecting roles in determining a patient's risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"219"},"PeriodicalIF":4.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the availability, affordability, and market dynamics of innovative oncology drugs in Morocco: an original report.","authors":"Nada Benhima, Leila Afani, Mohammed El Fadli, Ismail Essâdi, Rhizlane Belbaraka","doi":"10.1186/s12939-024-02262-9","DOIUrl":"10.1186/s12939-024-02262-9","url":null,"abstract":"<p><strong>Background: </strong>The cost of cancer drugs presents a significant challenge to accessibility of treatment worldwide. Projections indicate that by 2040, two-thirds of cancer cases will occur in low- and middle- income countries. Paradoxically, despite this impending burden, LMICs command less than 5% share of global resources for treating cancer. Morocco, like many LMICs, faces significant obstacles in providing innovative cancer treatments to its population.</p><p><strong>Aim: </strong>Firstly, we aimed to conduct an original research investigating the availability and affordability of innovative cancer drugs in Morocco. Secondly, we sought to review the broader market dynamics, pricing, and reimbursement policies in the country.</p><p><strong>Methods: </strong>For the first objective, we identified a preliminary list of medicines approved for oncological indications in the Moroccan market based on resources from ANAM (National Agency for Health Insurance), pharmacy regulators, and online resources that compile information on approved medicines. For the second objective, we exhaustively reviewed the regulatory documents, legal texts and grey literature reports. All the informations were examined by pharma delegates and local experts.</p><p><strong>Results: </strong>As of January 2024, Morocco has 39 innovative anticancer medicines with market authorization. 30% of these drugs were approved after 2020. The majority of approved drugs were for breast, lung, colorectal, and prostate cancer. The period between FDA approval and entry into the Moroccan market ranges from 2 to 7 years, with a median of 3 years for breast cancer drugs and 7 years for more expensive drugs like Olaparib and Osimertinib. 22 out of the 39 drugs are not reimbursed, with an average reimbursement time of 4 years. Compared to prices in France, the most notable pricing disparities concern immunotherapy agents, priced 600 to 900 euros lower in France, while drugs like Pazopanib and Erlotinib cost 50% less in Morocco.</p><p><strong>Conclusion: </strong>Our study reveals significant disparities in the availability and affordability of innovative cancer drugs in Morocco. Regulatory hurdles, importation challenges, and pricing strategies contribute to this inequitable landscape. Addressing systemic barriers, fostering collaborations between stakeholders, and adopting a value-based pricing approach are imperative steps toward ensuring equitable access to high-quality interventions for patients, regardless of their geographical location.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"217"},"PeriodicalIF":4.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}