Inadequate response to antidepressant therapy (ADT) is common in major depressive disorder (MDD); atypical antipsychotic (AA) adjunctive therapy may be effective for these patients. This study aimed to compare healthcare resource utilization (HRU) and costs between patients initiating the AA cariprazine as their first adjunctive therapy vs those initiating cariprazine subsequently.

The Merative MarketScan Commercial Database (January 1, 2015, to June 30, 2021) was used to identify US adults with MDD and ≥1 pharmacy claim for cariprazine adjunctive to ADT in 2018 or after. Rates of mental health (MH)‑related and all‑cause HRU per patient-year (PPY) and mean healthcare costs per-patient-per-year (PPPY) were assessed after patients first initiated adjunctive therapy. HRU and costs were compared between cohorts using rate ratios (RRs) and mean cost differences, respectively, estimated from multivariable regression models.

Of 838 patients receiving cariprazine, 44.7% initiated cariprazine as their first adjunctive therapy to ADT, and 55.3% initiated it subsequently. Those initiating cariprazine first had significantly lower rates of MH‑related hospitalizations (RR [95% confidence interval] = 0.55 [0.30, 0.90], p = .020) and outpatient (OP) visits (0.67 [0.57, 0.82], p < .001) PPY than those initiating cariprazine subsequently. Moreover, patients initiating cariprazine as their first adjunctive therapy had lower annual total MH‑related healthcare costs (mean cost difference [95% confidence interval] -$2,182 [-$4,206, -$69], p = .040), driven primarily by lower OP visit costs (-$1,511 [-$2,330, -$615], p < .001). Similar trends were observed for all-cause HRU and costs.

This was a retrospective analysis of secondary data with limited follow-up. Claims were a proxy for cariprazine use.

Results from this real‑world study of commercially insured US adults suggest that initiating cariprazine as the first adjunctive therapy rather than a subsequent therapy could help mitigate the considerable economic burden of MDD for appropriate patients.

The HPV vaccination program in Brazil, introduced in 2014 for girls and 2017 for boys, aims to reduce HPV-related diseases, including anogenital warts (AGW) and high-grade cervical intraepithelial neoplasia (CIN). This descriptive ecological study evaluated the program's impact on hospitalizations for AGW and high-grade-CIN using interrupted time series analysis of data from the Brazilian Hospital Information System from 2011 to 2019. From 2011 to 2019, there were 4,312 AGW hospitalizations among females, 7,295 AGW hospitalizations among males, and 84,306 hospitalizations for high-grade CIN. Following the implementation of the HPV vaccination program, significant reductions in hospitalizations for AGW and high-grade CIN were observed, particularly in the targeted 15-19-year-old age group. In this group, the median number of hospitalizations prevented was 174 (95% CI: 154-193) for AGW among females, 116 (95% CI: 86-147) for AGW among males, and 217 (95% CI: 94-339) for high-grade CIN, with strong model fits. Downward trends were also noted in older age groups, though with poorer model fits. The HPV vaccination program has significantly reduced hospitalizations for AGW and high-grade CIN in Brazil, particularly among the targeted age group. Local evidence of early disease benefits reinforces the importance of HPV immunization in reducing the burden of HPV-related diseases and support expanding vaccination efforts for broader public health benefits. Reductions of AGW and high-grade CIN in older age groups may reflect indirect vaccination effects and treatment strategies, respectively.

Medical-legal partnerships (MLPs) are innovative, promising models that integrate legal service providers and medical professionals to prevent, detect, and address legal, social, and economic needs arising from social inequities that may negatively impact health. The COVID-19 pandemic impacted health care systems across the United States. MLP workflows and legal services were also interrupted by COVID-19 infection prevention and control measures such as no-visitor policies, social distancing, and the cancellation of non-emergent or routine health care services.

We sought to describe the impact of COVID-19 on legal services provided by an MLP by exploring case types and services provided prior to the COVID-19 pandemic and during the pandemic.

This is an examination of MLP services provided at a Midwestern academic medical center comparing data from three years prior to the pandemic (2017-2019) to three years during the pandemic (2020-2022).

The MLP is a collaboration between the University of Nebraska Medical Center/Nebraska Medicine (an academic medical center) and Legal Aid of Nebraska and Iowa Legal Aid (legal service providers).

Case data was drawn from individuals who were MLP patient-clients between 2017 and 2022.

The main outcome measures were the number of cases and categories and types of legal services provided by the MLP.

Consistent across time, we found that on average 494 cases were closed each year. Consumer/finance cases decreased significantly from pre-COVID-19 to during the pandemic, while family cases increased significantly during the pandemic. Cases related to income maintenance increased across time.

Through the COVID-19 pandemic experience and understanding the case mix, MLPs and health care champions can be better prepared to understand some of the challenges that may occur and changes that may be necessary to better serve patient-clients during a public health emergency.

Social and economic factors play significant roles in the incidence of uterine cancer. This study examined how age, time period and birth cohort affect incidence patterns across various regions.

Data on the incidence of uterine cancer from 1990 to 2021 were obtained from the Global Burden of Disease Study 2021. An age-period-cohort (APC) model was applied to evaluate the effects and geographical variations.

In 2021, there were 473,614 [95 % uncertainty interval (UI) 429,916-513,667] cases of uterine cancer globally, resulting in an age-standardized incidence rate (ASIR) of 10.4/100,000 (95 % UI 9.4-11.2). ASIR was highest in High-income North America and Europe (high-income regions), and lowest in South Asia and most African regions. The incidence of uterine cancer has surged disproportionately over time, especially in high-income regions and areas with rapid socio-economic changes. High-income Asia Pacific saw the fastest growth, with an annual net drift of 2.43 % (95 % confidence interval 2.29-2.57). Age is a critical determinant of the incidence of uterine cancer, with notable regional variation. Globally, the peak incidence of uterine cancer occurs at 70-74 years of age, or older, in most regions. However, earlier peaks in incidence are observed in East Asia and Asia Pacific (both 55-59 years), as well as Central Asia (60-64 years).

The incidence of uterine cancer is increasing globally, with marked geographical disparities in age distribution, temporal trends and cohort effects. While Europe and North America have the highest incidence rates globally, Asia faces a triple challenge: rising incidence, disproportionate caseloads, and younger age at diagnosis. Addressing geographical disparities is crucial in tackling the surge in cases of uterine cancer.

While public health policies implemented during COVID-19, such as prioritizing essential health services and "no visitor" strategies, were important to treat COVID-19 patients and curb disease outbreaks, their potential negative effects on the health of the general population is a growing concern. Research highlights that these policy changes contributed to a near-universal decline in access to all healthcare services and triggered increased morbidity and mortality rates. However, little is known about how health policy changes differentially shaped healthcare access within and between population groups and regions. Few studies qualitatively examine the indirect effects of policy changes on healthcare access among groups disproportionately impacted by COVID-19. This article examines how COVID-19 health policy changes impacted racialized immigrant and racialized non-immigrants' ability to connect with a provider, navigate telehealth and in-person healthcare, and access specialized healthcare in the Peel Region of Ontario, Canada. Using a Client Centered Framework, findings from in-depth interviews (n = 79) reveal that policy changes generated new (in)abilities for individuals to perceive, seek, reach, pay and engage in healthcare services. Health policy changes created new barriers to reach healthcare, compounding health challenges. While telehealth opened more effective avenues to access healthcare among some people, it created new disparities for individuals with limited English language skills and/or for those experiencing technological inequities. Although individuals recognized their need for specialized healthcare, the prioritization of essential services, gaps in health insurance coverage, and new COVID-19 economic inequities created barriers to specialized healthcare. We close with a discussion of the impacts for policy and practice.

The COVID-19 pandemic highlighted the urgent need to control airborne virus transmission, particularly in indoor environments with limited ventilation. This study evaluates the effectiveness of UVA and UVC irradiation, along with hydrogen peroxide (H2O2), in inactivating aerosolized viruses. A 19 m3 virus aerosol simulation chamber, replicating indoor conditions, was used to simulate human respiratory emissions by aerosolizing Escherichia phage T4 (T4 phages) embedded in a pig mucin medium that mimics respiratory aerosols. Results showed a clear, dose-dependent reduction in viral genome copies with UVC exposure, where a dose of 129.9 mJ/cm2 reduced over 99% of the viral genome copies. Although less efficient, UVA still contributed to virus inactivation, reducing detectable phages to 20% at 513.30 J/cm2. Mucin provided a protective effect, making virus removal more challenging. Hydrogen peroxide enhanced disinfection, with 1.6 ppm reducing viral genome copies by 78%, and higher concentrations (up to 16 ppm) achieving over 99% reduction in the dark condition. The combination of UVA/UVC with H2O2 further enhanced disinfection, eliminating detectable virus genome copies entirely. These findings underscore the potential for using combined UV light and chemical treatments to effectively mitigate airborne viral transmission in enclosed spaces.

To evaluate the impact of advancing age, comorbidity burden, and the COVID-19 pandemic on HIV clinic visit attendance.

We implemented a repeated cross-sectional study using an ongoing longitudinal cohort of people with HIV (PWH) receiving care in Washington, DC.

Our primary exposures of interest were older age categories (60-69 and 70+ compared with 50-59 years), Veterans Aging Cohort Study (VACS) Index (surrogate for comorbidity burden), calendar year (with the three time points of 2018, 2020, and 2022 representing pre-, peri- and post-COVID). Our outcome was the number of HIV clinic visits (including telehealth) in 2018, 2020, and 2022. Associations were assessed using zero-inflated negative binomial modeling.

4041 (72.7% men, 59.3% ages 50-59; 78.8% Black) DC Cohort participants aged 50+ years were included. In 2018, mean VACS indices for participants aged 50-59, 60-69, and 70+ years were 27.5 (standard deviation [SD] 15.8), 36.9 (SD 17.8), and 50.7 (SD 15.5) respectively. Increase in VACS Index was associated with increase in HIV clinic visits (Rate ratio: 1.03, 95% CI 1.01, 1.05). A VACS Index-calendar year interaction term was significant, indicating the relationship between VACS Index and visits was attenuated in the post-COVID time period. All age groups experienced a decrease in visits from 2018 to 2022. HIV RNA suppression remained stable.

These findings underscore the pandemic's impact on accessing healthcare among the most vulnerable, that is, the oldest participants with the most comorbidities. Developing differential care models for PWH to target services to their local context, clinical status, and preferences may point to a broader public health approach to mitigate post-pandemic changes in HIV care utilization.

General practice has a key role in reducing inequity in access to care relating to sexual and reproductive health (SRH). Unplanned pregnancy, abortion, and sexually transmitted infections are increasing and disproportionately affect deprived communities and minoritised ethnic groups. The Candidacy Framework is a practical and theoretical framework for understanding the complex interactional processes of access to SRH care in general practice.

To use the Candidacy Framework to explore access to SRH care in general practice. The seven interaction stages are: identification of need; navigation of services; permeability of services; appearing and asserting need; adjudication by healthcare professional (HCP); offers or resistance of offer; and the local operating conditions or local production of candidacy.

Systematic review with qualitative evidence synthesis using a framework approach.

A systematic search of MEDLINE, Embase, PubMed, and the Web of Science was conducted to identify primary qualitative research studies exploring access to SRH care in general practice from practitioner, public, and patient perspectives in countries with universal health care. The Candidacy Framework was used to synthesise the findings.

Analysis of 42 studies revealed the impact of stigma, shame, and embarrassment among individuals, communities, and HCPs. Findings showed limited inclusion of demographics, such as ethnicity and socioeconomic status. Barriers to access were more evident for those from lower socioeconomic communities, minoritised ethnic groups, and the LGBTQ+ community. There are multiple barriers, which include the behaviours of HCPs, who have a crucial role in recognising an individual's SRH need.

General practice offers a cradle-to-grave healthcare service that should have SRH as a priority area of provision. Further understanding is needed about the impact of historic harms by medicine and health care on racialised individuals and minoritised genders.

COVID-19 vaccines significantly reduced COVID-19 related morbidity and mortality. Although purposeful response measures like movement restrictions affected delivery of other health services, few studies have investigated the association between COVID-19 vaccination as a response strategy and continuity of other immunization services. We aimed to assess the association between the COVID-19 vaccine rollout and continuity of routine immunization services and describe the interventions instituted to maintain delivery in Uganda. This was a cross-sectional study conducted in Wakiso District, Central Uganda. We applied an explanatory, sequential mixed-methods design. We analyzed routine childhood immunization data by computing the percentage change in vaccine doses given for Bacille Calmette-Guerin (BCG), Diptheria, Tetanus Toxoid Pertussis (DPT3), Polio 0, Polio 1, Polio 2 and Polio 3 between March 2021 and April 2021. This was followed by 19 interviews with health workers and 3 focus group discussions with altogether 33 mothers using the World Health Organization Health System Building Blocks as a guiding framework. We found that the COVID-19 vaccine rollout was associated with changes in the trends of routine vaccine uptake. The number of DPT3 vaccine doses reduced by 4.3% between March 2021 and April 2021 after the COVID-19 vaccine rollout while that for Polio 1 vaccine doses reduced by 5.5%, Polio 2 vaccine doses reduced by 5.8% and Polio 3 doses reduced by 5.6%. The challenges to continuity included increased workload, competition for cold chain and storage capacity and impact on perceptions about vaccination. Interventions to sustain demand included engaging community health workers, community mobilization, health education, and prioritizing routine immunization services. Interventions to maintain delivery included integration of services, increasing health workforce and separating resources for routine vs COVID-19 vaccination. In conclusion, the COVID-19 vaccine rollout was associated with infrastructural and logistical challenges which affected delivery of routine immunization services. Introduction of the COVID-19 vaccines was also associated with negative perceptions about routine childhood vaccines. Deployment of new medical countermeasures should integrate interventions to predict and mitigate effects on existing supply systems like the human resources and infrastructure. Medical countermeasures deployment should also involve education and sensitization that addresses misconceptions and sustains demand for existing health services.

The COVID-19 pandemic prompted a significant increase in the use of remote consultations-by telephone or video-in both primary and secondary healthcare. The reported advantages of remote consulting for both patients and clinicians include greater efficiency, flexibility and convenience. However, disadvantages, such as the uncertainty created by a loss of face-to-face contact, have also been highlighted. The aim of this study was to explore, explain and interpret patients' and clinicians' perceptions and experiences of remote consultations and assist decision-making about their future use.

A qualitative study based on semistructured online interviews.

Primary mental healthcare or secondary care cardiology services, London, UK, February-March 2022.

Primary care mental health patients (n=5), primary care clinicians (general practitioners) (n=15), secondary care cardiology patients (n=9) and secondary care cardiology clinicians (n=5).

The results demonstrate that a range of factors have influenced the experiences of both clinicians and patients and indicate shifts in the norms of professional practice and clinician-patient relationships.

Patients and clinicians demonstrated pragmatic acceptance of remote consultations and, looking forward, a preference for a balanced 'hybrid model' of remote and face-to-face appointments. The study also highlights a need to consolidate and build on the informal learning and adaptation to remote consulting that has already taken place.

Despite consistent reporting of high fertility levels in Nigeria, contraceptive prevalence rates remain low. Information on the type of contraceptive uptake among women who visit family planning (FP) clinics is still sketchy in Ibadan. Therefore, we assessed the trend and pattern of contraceptive use among women attending a FP clinic at a tertiary health facility in Ibadan.

A mixed-method design was adopted for the study. Records of women (n = 1,619) who accessed FP services at the University College Hospital [UCH] from 2018 to 2022 were reviewed. The qualitative data included a key informant interview (KII) involving a senior officer of the FP Clinic and a focus group discussion (FGD) among high-fertility (≥ 4 living children) women. Data were analysed using a logistic regression model (α0.05), and thematic analysis was used for the qualitative part of the study.

The mean age of women was 33.8 ± 6.34 years, 87.7% were in monogamous marriages, 82.3% were Yoruba, and 47.2% did not intend to bear more children. The uptake of long-term and short-term contraceptive methods showed a declining (slope = -3.5) and increasing (slope = + 4.4) trend, respectively. The likelihood of non-use of a long-term contraceptive method was lower among women with ≥ 3 surviving children who had tertiary education (uOR = 0.539, 95% C.I = 0.338-0.859, p = 0.009) and were Christians (uOR = 0.410, 95% C.I = 0.258-0.652, p < 0.001) compared to their counterparts with at most secondary education and were Muslims, respectively. High fertility women who are not using Long-acting reversible contraceptive methods (LACMs) identified fear, partner's influence, misconceptions, cost, parity, privacy, and inconvenience as reasons for the non-use of the methods.

Conceptive uptake at the UCH followed an increasing trend from 2018 to 2022. Sensitisation on the adoption of LACMs among high-fertility women might improve the use of such methods in the study area.

This study explored the experience of stigma and access to healthcare by persons with long COVID from the majority Dutch and two ethnic minority populations (Turkish and Moroccan) living in the Netherlands.

This was a cross-sectional qualitative study that employed inductive and deductive thematic approaches to data analysis using MAXQDA.

Between October 2022 and January 2023, 23 semi-structured interviews were conducted with participants of Dutch, Moroccan and Turkish ethnic origins with long COVID living in the Netherlands. Participants were men and women aged 30 years and above.

Guided by the concepts of stigma and candidacy, the findings are structured according to the broader themes of stigma and access to care. The findings show that people with long COVID suffer self and public stigma resulting from the debilitating illness and symptoms. Especially among Turkish and Moroccan ethnic minority participants, strong filial obligations and gendered expectations of responsibility and support within their communities further worsen self-stigma. This experience of stigma persisted within healthcare where lack of information and appropriate care pathways led to feelings of frustration and abandonment, especially for participants with pre-existing health conditions which further complicate candidacy. Under the access to healthcare theme, the findings show multiple challenges in accessing healthcare for long COVID due to several multifaceted factors related to the various stages of candidacy which impacted access to care. Particularly for Turkish and Moroccan ethnic minority participants, additional challenges resulting from limited access to information, pre-existing structural challenges and experience of stereotyping based on ethnicity or assumed migrant identity by health professionals further complicate access to health information and long COVID care.

The findings call for urgent attention and research to identify and coordinate healthcare for long COVID. There is also a need for accessible, informative and tailored support systems to facilitate patients' access to information and care pathways for long COVID. Providing tailored information and support, addressing the various barriers that hinder optimal operating conditions in healthcare and leveraging on social networks is crucial for addressing stigma and facilitating candidacy for persons with long COVID towards improving access to care.

During the COVID-19 pandemic, non-pharmaceutical interventions affected the screening of sexually transmitted infections. We investigated the incidence of HIV infection during the COVID-19 pandemic compared with incidence in the pre-pandemic period.

In this observational study, we analyzed HIV surveillance data for all age-groups from 25 geographically diverse regions in Peru from Jan 1, 2015 to Dec 31, 2022. HIV incidence during the COVID-19 pandemic (2020, 2021, and 2022) was compared with pre-pandemic rates (2015-19).

Overall, there were 65,166 new cases of HIV infection from January 1, 2015 to December 31, 2022. HIV incidence risk ratio (IRR) was 26% lower in 2020 (IRR = 0.74; 95% CI, 0.71-0.76), 5% higher in 2021 (IRR = 1.05; 95% CI, 1.02-1.08) and 16% higher in 2022 (IRR = 1.16; CI, 1.13-1.20), compared with the pre-pandemic period. Furthermore, compared with the pre-pandemic period, the annual incidence of HIV among men was 29% lower in 2020 (IRR = 0.71; 95% CI, 0.68-0.73), 4% higher in 2021 (IRR = 1.04, 95% CI, 1.01-1.08) and 10% higher in 2022 (IRR = 1.10; 95% CI, 1.06-1.14). In the age-stratified analysis, the annual HIV incidence in 2020 was 21 and 33% lower for those aged 18-29 (IRR = 0.79; 95% CI, 0.75-0.83) and 30-59 (IRR = 0.67; 95% CI, 0.64-0.70), respectively, compared with the pre-pandemic period. Finally, annual HIV incidence has decreased in 11 out of 25 regions in 2020, compared with the pre-pandemic period.

Our study showed that during the COVID-19 pandemic in 2020, the incidence of HIV infection in the population of Peru decreased. However, this incidence began to return to pre-pandemic rates in 2021, coinciding with the easing or elimination of non-pharmaceutical interventions. By 2022, the incidence of HIV infection was higher than in the pre-pandemic period, especially in regions of the Peruvian Amazon.

To explore changing trends and characteristics in neuroendocrine tumors (NETs) epidemiology, focusing on demographics, clinical aspects, and survival, including the impact of social determinants of health (SDOH) on outcomes.

The escalating incidence and prevalence of NETs underscore the pressing need for updated epidemiologic data to reveal the evolving landscape of this condition. Access to current information is imperative for informing clinical strategies and public health initiatives targeting NETs.

A retrospective, population-based study analyzed NET patient data from 1975 to 2020, using the Surveillance, Epidemiology, and End Results (SEER 8, 12, 18) program. We calculated annual age-adjusted incidence, prevalence, and 5-year overall survival (OS) rates. Survival trends from 2000 to 2019 were examined, employing the Fine-Gray model to evaluate cancer-specific mortality.

NETs' age-adjusted incidence rate quadrupled from 1.5 per 100,000 in 1975 to 6.0 per 100,000 in 2020. A decline in incidence occurred from 6.8 per 100,000 in 2019 to 6.0 per 100,000 in 2020. All-cause survival multivariable analysis demonstrated high grade (HR: 2.95, 95% CI: 2.63-3.09, P <0.001), single patients (HR: 1.49, 95% CI: 1.45-1.54, P <0.001), and Black patients (HR: 1.17, 95% CI:1.13-1.22, P <0.001) all had worse survival than their controls.

Our study shows a steady increase in NETs incidence until 2019, with a decline in 2020. Understanding the reasons behind this trend is vital for improved management and public health planning. Further research should focus on the factors driving these changes to enhance our understanding of NET epidemiology.

The COVID-19 pandemic has significantly impacted healthcare systems, including dentistry. This retrospective analysis aims to evaluate long-term changes in the spectrum of performed dental procedures due to the COVID-19 pandemic based on the example of the university specialized centre in Poznan.

We explored the patient dataset from the University Center of Dentistry and Specialized Medicine (Poznan, Poland) covering the period from 1 January 2017 to 31 December 2023. Services performed during the prepandemic (2017-2019), pandemic (2020), and postpandemic (2021-2023) periods were compared. Selected procedures in restorative dentistry, endodontics, dental surgery, and dental radiology were analyzed in detail, including data for both children and adults.

Our study analyzed a total of 342,112 patient medical records, including 158,882 conservative procedures and 101,556 surgical procedures. During the pandemic, there was a significant reduction in conservative procedures, particularly commercial services. In the postpandemic period, the number of refunded restorations and endodontic treatments for anterior teeth increased significantly, which was not observed for commercial procedures. A notable disruption between surgical and conservative procedures occurred during the first wave of the pandemic. The prepandemic period and the first quarter of the year were more conducive to conservative and endodontic treatments.

The COVID-19 pandemic has led to a significant long-term shift from preventive and conservative dentistry into surgical interventions. Although the overall number of services provided has increased, more patients are opting for procedures that do not require out-of-pocket expenses.

The pandemic has a lasting impact on the clinical decisions made by dental patients, with a greater preference for reimbursed and surgical services.

During the COVID-19 pandemic, there were concerns about health and safety, and there was increased medical misinformation about vaccines.

Assess how the COVID-19 pandemic impacted Tetanus, Diphtheria, and Pertussis (Tdap) and influenza vaccine administration in pregnancy.

This was a retrospective review of Tdap and influenza vaccine administration among pregnant patients delivering at our health system from Mar 2018 to Dec 2022. The Acute COVID period was defined by gestational age and estimated due date. Pre-COVID and Chronic COVID periods comprised surrounding matched months. Vaccination groups were: neither, Tdap only, influenza only, or both. Patient characteristics were compared using X2 or ANOVA tests. Multinomial logistic regression evaluated COVID period and vaccination status.

9867 patients were included, with 3967, 1930, and 3970 patients in the Pre-COVID, Acute COVID and Chronic COVID periods. Maternal age (≥35), race and ethnicity, smoking, and diagnosis of chronic hypertension differed significantly by COVID periods. Vaccination rates significantly differed across Pre-, Acute, and Chronic COVID periods. 18.2 %, 9.9 %, and 15.2 % received neither vaccination, and 42.7 %, 50.0 %, and 35.9 % received both vaccines. The proportion receiving Tdap only increased across COVID periods (33.5 %, 36.6 % and 46.0 %, respectively), while influenza only vaccination declined (5.7 %, 3.5 %, and 2.9 %, respectively). In multinomial logistic regression analyses, rates of Tdap only (aOR 2.35; 1.95-2.84) or both vaccinations (aOR 2.63; 2.19-3.17) were higher in Acute COVID period compared to Pre-COVID. Compared to Pre-COVID, rates of Tdap only vaccination were higher in Chronic COVID (aOR 1.64; 1.44-1.87), and receipt of both vaccinations no longer differed. Influenza only vaccination did not differ between Acute COVID and Pre-COVID but was decreased in Chronic COVID (aOR 0.61; 95 % CI 0.47-0.78).

Tdap vaccination was more robust to pandemic influences than influenza vaccination. However, vaccination rates are suboptimal, and efforts are needed to combat vaccine hesitancy and misinformation.

The COVID-19 pandemic significantly impacted primary health care-seeking behavior of the general population. The extent to which health care-seeking behavior of pregnant women in general practitioner (GP) care was affected remains largely unknown. The unique health care needs of pregnant women necessitate regular monitoring and care to ensure the well-being of expectant mothers, fetuses, and neonates, as timely interventions and screenings can profoundly influence the long-term health outcomes. Understanding how pandemic-related changes have influenced pregnant women's primary health care-seeking behavior is essential for developing targeted interventions and informing policy decisions to improve health outcomes for expectant mothers, fetuses, and neonates, both during public health emergencies and in routine health care settings.

This study aims to examine the impact of different COVID-19 pandemic phases on health care-seeking behavior among pregnant women in Dutch GP practices throughout 2020 and 2021. By analyzing clinical electronic health record (EHR) GP data, we aim to evaluate the health care consumption, occurrence of pregnancy-relevant symptoms and diagnoses, and types of contact (ie, regular consultations, phone consultations, home visits, and digital consultations) during different pandemic phases.

Using a retrospective cohort design, EHRs of selected pregnant women from 3 Dutch GP networks between 2019 and 2021 were analyzed, comparing 6 pandemic phases divided into 13 subphases with a prepandemic phase. Contact rates were analyzed by interrupted time-series analyses, pregnancy-relevant symptoms, and diagnoses by comparing the frequency of pregnancy-relevant International Classification of Primary Care (ICPC) code registrations and type of contact by descriptive statistics.

In total, 10,985 pregnant women were included, yielding 39,023 patient-GP contacts. Contact rates fluctuated significantly across pandemic phases, with the sharpest declines at the onset and the end of the pandemic. Pregnancy-relevant symptoms and diagnosis in the category related to pregnancy showed the highest variability across the pandemic phases, such as an increase in the frequency of health care consumption concerning gestational diabetes mellitus and nausea or vomiting of pregnancy. Detailed statistical results are reported in the main text. Contacts for symptoms and diagnosis like digestive or urinary tract problems did not fluctuate across the pandemic phases. The number of physical contacts decreased, while telephone contacts increased.

By analyzing EHR data from over 10,000 pregnant women, this study highlights the pandemic's impact on pregnant women's GP health care-seeking behavior, including declining health care consumption trends during the initial and end phases of the pandemic (2020-2021). The observed increase in GDM and its potential long-term effects underscore the need for enhanced public health strategies within GP practices, ensuring continuous access to prenatal care and striving for improved outcomes of expectant mothers, their fetuses, and neonates during times of pandemics and in routine health care settings.

To determine the impact of the Covid-19 pandemic on the number of occupational health consultations and to highlight influencing factors.

Retrospective observational study of consultations from an inter-company occupational health service. Data were retrieved during three consecutive years: 2019 (baseline), and 2020-2021. For comparisons purposes, we used the number of occupational health consultations per day and per full-time equivalent occupational healthcare worker (n consultations/d/FTE). Multivariate analysis was performed using logistic regression, for each lockdown vs the same period one year before.

A total of 103,351 consultations were included. The number of consultations decreased by 14.3% in 2020 compared to 2019 but increased by 33.7% in 2021 compared to 2020. There were 4.9 consultations/d/FTE, 4.69 to 5.12 in 2019; 4.07, 3.81 to 4.34 in 2020; and 5.35, 5.16 to 5.55 in 2021. The first lockdown had a massive impact on the number of consultations, whereas the activity returned to normal from August 2020 with an increase in 2021. Age was associated with a decrease in the propension of consulting for the three lockdown periods (p < 0.001). The proportion of consultations for return-to-work was multiplied by 2.44 (2.02 to 2.95, p < 0.001) during the first lockdown, associated with a reduced risk of being declared unfit to work (OR = 0.48, 95 CI 0.27 to 0.84, p = 0.010).

The Covid-19 pandemic had a huge impact on the medical activity of occupational health departments, with a massive decrease in 2020 followed by an increase in 2021 compared to 2019.

Evidence describing the burden of antimicrobial resistance (AMR) to healthcare systems is essential to inform healthcare policy to tackle AMR. This study aims to investigate trends, predictors, and clinical and economic burden of AMR within the English National Health Service.

Retrospective cohort study assessing 1,036,850 patients diagnosed with an infection as a hospital inpatient linked to the Clinical Practice Research Datalink within England between 2015 and 2021. Resistance was identified with specific ICD-10 codes. Predictors of AMR were determined using logistic regression and extreme gradient boosting trees. A 1:1 propensity score matched cohort of 78,153 patients with an AMR infection compared to those without was created. Incidence Rate Ratios (IRRs) were estimated between those two groups for hospital length of stay (from admission to discharge), re-hospitalisations within 1-year of diagnosis of infection, and total hospital costs. Acceleration Factors (AFs) were estimated for time to all-cause mortality and first re-hospitalisation.

Between 2015 and 2020, AMR had a proportional increase of 10%. Resistant infections are associated with an additional 9.2 days length of stay and an additional hospitalisation cost of £3,441 per patient compared with infections not reported as resistant. Within 1, 3, and 5-years 3.2%, 6.3%, and 7.3% more patients with AMR infections died and 7.8%, 5.3%, and 3.6% more patients were re-hospitalised, respectively. AFs indicated patients with AMR infections die 27% earlier and re-hospitalised 26% earlier than those with non-AMR infections.

AMR is a significant and growing threat to healthcare; this analysis suggests AMR is associated with significant excess of healthcare use and increased mortality and readmission.

The impact of non-communicable diseases and multimorbidity challenges health systems worldwide. Latin America faces an urgent need to develop practical innovations in that regard. The Centro de Innovación en Salud ANCORA UC implemented a new Multimorbidity Patient-Centered Care Model (MPCM) pilot in Chile between 2017 and 2020. MPCM aimed to reorganize health services from a fragmented diagnosis-based perspective towards a new approach based on patient's needs and offer intervention strategies according to their multimorbidity risk. This article aims to report the evaluation of the implementation process of MPCM in the Southeast Metropolitan Health District in Chile.

The study design corresponds to an implementation collaborative evaluation of MPCM innovation using qualitative methodology. Two main questions guided the research: (1) How has MPCM been implemented in its pilot phase? Moreover, (2) What are the main learnings from the MPCM pilot phase and their contribution to its scalability at the national level? In addition, the Consolidated Framework for Implementation Research and the Outcomes for Implementation Research were considered in the theoretical approach.

Thirty-five (35) interviews were conducted with 69 professionals and key stakeholders involved in the implementation process of MPCM, including health practitioners, transition nurses who coordinate the intervention with the affiliated hospitals, managers, and the implementation team. Overall, the results were positive, suggesting that a complex innovation of this kind may be implemented successfully. Key lessons learned should be considered for scaling up MPCM to the national level. Some critical barriers to implementation were high staff turnover and the COVID-19 pandemic, while leadership and team commitment were relevant facilitators.

This study represents a new step in evaluating an innovative model for addressing multimorbidity in Chile. The scaling up phase requires careful consideration of all lessons learned, as well as a robust evaluation and monitoring plan. This research represents the first evaluative analysis of MPCM in the context of a complex innovation adapted to enhance public health policies using implementation evaluation approaches. Implementation Science is a fundamental approach to fostering quality improvement strategies for health care in Latin America.

Chronic breathlessness is a common and distressing symptom, negatively impacting physical function and quality of life. Many individuals presenting with chronic breathlessness wait years for an explanatory diagnosis, leading to delays in accessing effective treatments and worse individual outcomes including premature mortality. In addition, delays to diagnosis are associated with increased healthcare utilisation and therefore potentially avoidable burden on healthcare systems. Diagnosing the underlying causes of chronic breathlessness is complex and can be challenging for clinicians. The current clinical diagnostic approach, related guidelines, and healthcare service structure are typically aligned with a disease-based focus. For this article, we are using a working definition of 'Chronic Breathlessness' to infer breathlessness that has persisted for at least eight weeks. In this narrative review, using the latest available evidence, we aimed to describe a symptom-based approach to diagnosis for adults presenting with chronic breathlessness alongside describing the potential for this approach to improve both clinical outcomes and efficiency for healthcare systems. Therefore, our objectives were to: 1) summarise what is currently known about the time to diagnosis for adults presenting with breathlessness, 2) describe the impact and possible explanations for the current delays to diagnosis, 3) describe potential solutions towards an effective symptom-based diagnosis, 4) review the potential for Artificial Intelligence (AI) to support several areas along the diagnostic pathway for breathlessness, 5) describe how a symptom-based approach to diagnosis can be directly utilised to enable a 'matched' personalised holistic approach to treatment.

To monitor the safety and utilisation of AZD1222 under real-world use in the UK.

A non-interventional post-authorisation active surveillance study.

Vaccination sites in the UK.

A total of 17 945 participants were eligible and provided consent to participate in the study between 1 March 2021 and 6 April 2023. Participants were followed up at weeks 1, 4 and 14 and at months 6, 9, 12 and 18 after the first dose of AZD1222 vaccination and prompted to complete electronic data capture forms. A total of 11 219 participants submitted a Follow-Up 1 form and 5189 participants submitted a Follow-Up 7 form (at 18 months).

The safety of AZD1222, including the identification, assessment and quantification of serious adverse events (SAEs) and adverse events of special interest (AESI), was examined. The utilisation of AZD1222 was described and characterised, including populations with missing information.

The majority of participants were women (n=10 845; 60.4%) and the median age (IQR) was 50 (43, 62) years. Most participants were from white ethnic groups (n=13 112; 73.1%). Headache and fatigue had the highest reported incidence rate (421.28 cases per 1000 person years and 386.00 cases per 1000 person years, respectively). The most frequently reported AESI was anosmia (6.25 cases per 1000 person years). An increased Observed versus Expected (O:E) ratio was seen for anaphylaxis (O:E 7.38 (95% CI 2.80 to 11.95); based on 10 observed cases (expected cases: 1.36)) and anosmia and/or ageusia (O:E 39.23 (95% CI 29.13 to 49.32), based on 58 observed cases (expected cases: 1.48)).

The most frequent vaccinee-reported adverse events (AEs) were headache and fatigue. An increased O:E ratio was seen for the AEs of anaphylaxis and anosmia and/or ageusia. No safety signals were identified throughout the course of this study.

This study is registered with the HMA-EMA Catalogue of RWD studies (EUPAS44035).

The COVID-19 pandemic disrupted routine hospital services, causing a substantial backlog of surgeries in 2020. This study investigates hospital resilience in resuming activities during the pandemic, focusing on the impact of pre-pandemic adoption of enhanced recovery after surgery protocols (ERAS) in digestive cancer surgery. ERAS involves patient-centered care protocols proven to improve care process and outcomes but are not systematically implemented in hospitals. We define hospital resilience as the ability to maintain and resume surgery levels in the second half of 2020 during the pandemic. Using French national hospital data for digestive cancer surgeries, we categorized hospitals by the intensity of their ERAS volume before the pandemic and estimated a multilevel model allowing to control for hospital characteristics and pandemic conditions in the area they are situated. Results show that, all else being equal, hospitals that implemented ERAS before the pandemic absorbed the surgical backlog and recovered their pre-pandemic activity level more quickly. High-volume hospitals and specialized cancer centers were also quicker than other hospitals in resuming surgical operations. The findings highlight the differences in care practices across hospitals and the importance of quality protocols in bolstering hospital resilience during health crises. Beyond improving patient outcomes, widespread adoption of such protocols could enhance healthcare resource utilization and help to mitigate broader economic and environmental pressures.

Our study highlights the impact of out-of-pocket health expenditure (OOPHE) in highly unequal countries, where the middle class is particularly vulnerable to declines in well-being. We modify 2 financial protection measures-impoverishment and catastrophic health expenditure (CHE)-to address this issue. The first adjustment improves the classification of households based on their risk of poverty due to OOPHE, whereas the second corrects the underestimation of CHE for poorer households and the overestimation for the richest.

We applied our adjusted financial protection measures to data from the Chilean Household Budget Surveys (2006-2007, 2011-2012, 2016-2017, and 2021-2022) and compared the results with conventional CHE and impoverishment measures. Logistic regressions were used to identify factors associated with CHE.

Our impoverishment risk indicator indicates that approximately 10% of Chilean households entered poverty, became poorer, or were at high risk due to OOPHE in 20. Our revised CHE measure suggests that approximately 15.8% of households faced financial hardship, with both figures exceeding conventional estimates. Households with more women and an older average age were more likely to experience CHE.

Effective and equitable access to health services, along with adequate financial protection, is critical to achieving universal health coverage. However, in countries with high-income inequality and a high proportion of nonpoor households close to the poverty line, conventional measures may have blind spots for monitoring and analyzing financial hardship in health spending. This research provides evidence to open the debate on this issue.

The COVID-19 pandemic has greatly disrupted adolescents' access to sexual health services, resulting in a decline in their overall sexual well-being. This systematic review explored adolescent sexual health during the COVID-19 pandemic.

A systematic review of quantitative studies-including observational research, clinical trials, and quasi-experimental interventions-examined English-language articles published between January 2020 and February 10, 2025, sourced from databases such as PubMed, Web of Science, Scopus, and Google Scholar. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies, Cochrane RoB 2 for clinical trials, and ROBINS-1 for quasi-experimental designs. Due to the heterogeneity of the data.

After identifying 781 articles, 10 studies with a total sample size of 636,873 participants were included in the final systematic review. Observational studies during the COVID-19 pandemic revealed diminished access to sexual and reproductive health (SRH) services, greater dependence on informal information sources, widening health inequalities, and negative impacts on adolescent sexual behavior. Intervention studies on online SRH education demonstrate significant positive impacts across key areas: access to SRH services, safe sex practices, communication with parents about sexual health, lower acceptance of dating violence, normative beliefs regarding adolescent sexuality, HIV/STI awareness, and condom use. The findings emphasize notable improvements in communication, knowledge, and attitudes toward sexual health, driven by these targeted interventions.

The COVID-19 pandemic disrupted adolescent SRH globally, reducing service access and amplifying inequities. While some behaviors (e.g., sexual activity) showed resilience, systemic gaps in education and healthcare persist. Multisectoral efforts are needed to ensure adolescents' SRH rights are upheld during crises. However, the interventional studies underscore the viability of digital, media-literate interventions in improving adolescent sexual health.

The review study was officially registered on the PROSPERO website on 02/08/2023 under the code CRD42023438631 and received approval from the jury.

In trials, dengue vaccine efficacy evaluation relies on participants presenting with febrile illness/clinically suspected dengue contacting the study site for sample collection and clinical assessment within a short timeframe. Here, we present key considerations to maintain high compliance with the febrile surveillance procedures in a trial that assessed TAK-003 efficacy.

DEN-301 (NCT02747927) is a randomized phase 3 trial in children/adolescents from eight dengue-endemic countries in Latin America (LATAM) and Asia-Pacific (APAC). Febrile surveillance consisted of weekly contact with the participant to identify cases of fever (≥38 °C; two of three consecutive days). Blood samples were collected for molecular testing, preferably ≤5 days of fever onset, together with thorough clinical assessment by the investigators. The data are presented descriptively.

Of the 20,071 (LATAM, 11,080; APAC, 8991) participants who received TAK-003/placebo, 18,260 (91.0 %) completed 4.5 years of follow-up. The overall incidence of febrile illness was 30 (LATAM, 26.0; APAC, 35.1) cases per 100 person-years. The rate samples collected during the acute phase was 98.1 %. The overall rate of samples collected after 5 days of fever onset (missed/out-of-window) was 6 % (LATAM, 10 %; APAC, 2 %). A trend toward reduced missed/out-of-window samples was observed after implementing measures, such as transportation, engagement, and healthcare aid tailored per study site in 2017, which appeared to increase during the COVID-19 pandemic.

The design of the febrile surveillance protocol ensured high compliance in the trial. Maintaining engagement and access to healthcare beyond the protocol was important in improving febrile case evaluation ≤5 days of fever onset.

BackgroundThe COVID-19 pandemic, marked by significant lifestyle changes and healthcare-seeking behavior shifts, prompted the implementation of widespread Work from Home (WFH) policies.ObjectiveThis study aimed to explore the impact of the COVID-19 pandemic and WFH policies on public interest in foot surgery by using Google Trends searches as a proxy for public interest in the United States.MethodsA comprehensive dataset of foot-related orthopaedic terms was compiled using Google Trends data from March 2018 to March 2022 and captured weekly, representing over 200 observations. The dataset was separated into pre-pandemic and post-pandemic periods. Shaprio-Wilk testing demonstrated nonparametric data, so Mann-Whitney U tests with Cohen's d for effect size were calculated between the two subgroups.ResultsAn analysis of 26 terms showed declines in five and increased interest in four. The largest decrease was noted in "bunion," "foot pain," and "foot fracture." Terms that were newly coined during the pandemic, including "COVID toe" and "COVID feet" were significantly increased. The remaining 17 terms showed nonsignificant fluctuations in search interest.ConclusionThe decline in search interest for foot-related orthopaedic terms during the COVID-19 pandemic may represent the reduced prioritization of nonurgent conditions in the United States. Healthcare professionals should address this through targeted public health initiatives. In a post-pandemic era, healthcare providers should adapt to shifting patient sentiments, public policies, and patient needs.

The SARS-CoV-2 pandemic had a profound impact on healthcare systems worldwide. In sub-Saharan Africa, it significantly affected several health services for infectious diseases such as HIV; however, less is known about its impact on Tuberculosis (TB). This study aimed to assess the pandemic's impact on access to health services in Angola, focusing on diagnosis and treatment services for TB.

An observational study combining data from routine statistics and surveys based on ad-hoc questionnaires was conducted on TB and non-TB services between 2018 and 2022. On routine data, temporal trends were analyzed comparing different non TB- and TB-specific indicators across the five-year period using the chi-square test. Questionnaires were administered to healthcare professionals from TB/non-TB services and structured interviews were conducted with TB patients to understand their perceptions about the impact of COVID-19 pandemic.

There was a significant decline in access to TB services during the pandemic, with a substantial decrease in reported cases (-15.5% in 2020; -18.3% in 2021) and treatment rate (from 86% in 2019 to 68% in 2020), an increase in multidrug-resistant-TB (from 0.2% in 2018 to 2.1% in 2022) and TB/HIV co-infections (from 6% in 2018 to 8.8% in 2021). The impact was most pronounced in the province of Luanda (capital city). TB services in Angola were disproportionately affected compared to general healthcare access indicators. The healthcare professionals' and patients' questionnaires showed that fear of COVID-19, unavailability of drugs, reduced income, and transportation challenges were the main barriers to healthcare access.

The COVID-19 pandemic negatively impacted the TB services provision in Angola. This highlights the urgent need for health systems to develop robust contingency plans to ensure the continuity of TB services during and after public health crises and to maintain essential healthcare services by supporting the healthcare workforce and addressing barriers to patient access.

The COVID-19 pandemic caused a significant disruption to the delivery of surgical services. Guidance prioritising life-saving and cancer surgery was issued. Inflammatory bowel disease (IBD) often requires considered, timely surgery, which may have not been feasible under the conditions imposed by the pandemic. This systematic review aims to quantify the impact of COVID-19 on IBD surgery and assess the safety of performing such surgery.

A systematic review of MEDLINE, Embase and Web of Science was performed. Studies that included a prepandemic and a pandemic cohort for comparison and reported on numbers of IBD surgeries or postoperative outcomes following IBD surgery were included. Heterogeneity of included studies precluded any meta-analyses.

In total, 1,220 titles were screened and 13 were included in the final review. All were cohort studies other than one case-control study. A total of 1,673,282 and 1,445,971 patients were included in the prepandemic and pandemic cohorts, respectively. Rates of elective surgery during the pandemic varied from a 66% reduction to a 9.66% increase and emergency surgery varied from no difference to an 18% reduction. Urgent surgery in IBD inpatients appears to be unaffected. Postoperative outcomes were not shown to be negatively impacted by resource limitations.

The COVID-19 pandemic affected IBD surgical services considerably; however, those who did undergo surgery during this period do not appear to have been at an increased risk of adverse outcomes. Further work is required to describe the long-term impacts of these cancellations on IBD services and patient morbidity.

Background/Objectives: COVID-19 has impacted Romania's healthcare, economy, society, and public health. This study aims to evaluate the financial impact of the COVID-19 pandemic in Romania by analyzing both hospital costs and key elements of economic costs. The assessment was conducted from the perspective of the national payer. Hospital costs were analyzed covering two distinct timeframes: Q4 2020-Q3 2021 and Q1 2022-Q4 2022. The estimation of economic costs covered Q4 2020-Q3 2021. Methods: Hospital care costs were estimated using financial data from eight hospitals. The costs were extrapolated to inpatient data from 60 public hospitals for each of the two study periods. The disease burden was determined based on official data, including the number of confirmed cases, hospital bed occupancy, reported fatalities, and various cost components from an economic perspective. Results: The findings indicate that the average hospital cost per patient episode was EUR 2267 (95% CI: 2137-2396) during the first period and EUR 2003 (95% CI: 1799-2207) in the second. The total national hospitalization expenses amounted to EUR 1.35 billion and EUR 730 million, respectively. When accounting for productivity losses and testing costs, the overall expenditure reached EUR 5.39 billion for Q4 2020-Q3 2021. Conclusions: In conclusion, the total economic burden of the COVID-19 pandemic in Romania by the end of 2021 was estimated at EUR 5.39 billion, encompassing hospitalization, isolation, premature deaths, quarantine, testing, and parental allowances. Despite the emergence of costlier treatment options, overall treatment costs declined, possibly due to increased vaccination rates. The study highlights the significant financial strain on the healthcare system and underscores the importance of evidence-based resource allocation to better manage future public health crises.

In the Netherlands, selective ultrasound (US) screening for developmental dysplasia of the hip (DDH) typically occurs at 3 months of age. During the COVID-19 pandemic, US screening was temporarily halted in Dutch hospitals, with consequent delay in DDH screening and possibly inferior outcomes in DDH patients.

We analyzed 1849 infants screened for DDH during the COVID-19 pandemic (March-August 2020) and 1663 infants screened before the pandemic (March-August 2019). We compared mean age and timing of screening (standard vs. delayed (delayed defined as ≥15 weeks)). For secondary outcomes, we compared DDH patients with delayed screening to standard screening, assessing severity at diagnosis, treatment method and duration, and outcomes at the age of one year, including acetabular index (AI) on radiographs.

Mean age at screening was 17.3 weeks during the COVID-19 crisis (2020) vs. 15.8 weeks in the 2019 cohort (mean difference 1.5, 95% CI 1.1-1.8, p < 0.001). Delayed screening occurred in 57.6% of infants in 2020 vs. 36.7% in 2019 (p < 0.001). Patients with DDH with delayed screening (n = 284), compared to standard screening (n = 284), did not differ in mean alpha angle at diagnosis (55.0° vs. 54.4°, mean difference 0.6, 95% CI -0.06-1.25, p = 0.08) and AI at one year (24.0° vs. 24.5°, mean difference -0.5, 95% CI -1.05-0.14, p = 0.13).

This study revealed that disruption of healthcare caused by the COVID-19 pandemic resulted in a delay in the Dutch DDH-screening program. However, in this study, delayed screening was not associated with inferior outcomes at the age of one year.

Identifying influences on engagement with blood pressure (BP) checks can assist with intervention design for hypertension detection. This systematic review searched four databases (Embase, Emcare, MEDLINE and Web of Science) for papers published from 2015 to 2023 (PROSPERO ID: CRD42023398002). Eligible studies reported influences on BP checks in community or primary care settings. Data were coded and mapped using the Action, Actor, Context, Target, Time framework and Behaviour Change Wheel. Analysis of 18 studies generated eight themes: (1) 'Difficult-to-use devices with no accessible information on how to use them' (2) 'Lack of awareness about hypertension and BP checks', (3) 'Stigma and disconnect with identity' (4) 'Beliefs about the value of BP checks', (5) 'Fear and uncertainty', (6) 'Lack of appropriate and comfortable local services' (7) 'Financial cost of engaging with BP check services' and (8) 'Social contacts or health professional recommended a check'. Knowledge, identity, emotions, social contacts and environmental factors are key behavioural influences on adults' engagement with BP checks. Potential intervention strategies include education on hypertension, addressing misconceptions about BP checks, increasing access to BP check services and harnessing the influence of social norms, social connections and trusted sources to improve engagement.

Providing diabetes mellitus care to regional Australia remains a significant challenge due to limited access, workforce and travel. While primary care is essential, some patients require specialised care that necessitates adapted models of care.

The study assessed the effect on diabetes mellitus metrics in patients attending a multidisciplinary centre in regional Victoria. We assessed changes in HbA1c over 6 months. Secondary outcomes included biometrics, drug combinations, insulin initiation and the proportion achieving diabetes care targets.

We performed a longitudinal cohort study for all adult patients receiving multidisciplinary diabetes care at South West Healthcare between 1 July 2020 and 30 June 2022. Participants who had followed up over 6 months at three-monthly intervals (V1, V2 and V3) were included, excluding haemodialysis or transplant care or failure to attend three visits.

We assessed 90 participants with a balanced demographic with a generally low comorbidity burden. There was a significant decrease in HbA1c at 3 months (OR = -1.2 (95% CI: -1.6 to -1.1), P < 0.001) and 6 months (OR = -1.8 (95% CI: -2.2 to -1.5), P < 0.001) for all groups. Attendance within the cohort significantly increased for multidisciplinary services, including optometry, cDNE, dietetics and podiatry, but no change in drug regimens or insulin initiation.

This study highlights the impact of an adapted model of care for diabetes mellitus at South West Healthcare, focusing on a regional population. Among 90 patients over 6 months, there was a significant reduction in HbA1c levels and improved multidisciplinary engagement. This approach has successfully increased access to specialist and multidisciplinary diabetes care in rural areas.

This study evaluates the association between trust in health care professionals and health care delays across 21 countries.

We apply logistic regression models to survey data of over 621,000 individuals collected in Spring 2023.

Results show 44.5% of respondents with medical conditions experienced delays in accessing health care and 44.1% reported lack of trust in health care professionals. Those who trusted health care professionals had significantly lower odds of delaying medical care. Trust was most strongly associated with delays in the United Kingdom (OR = 0.373, 95% CI = 0.273-0.510), while South Africa had the smallest association (OR = 0.762, 95% CI = 0.582-0.997).

Trust is important in influencing health care-seeking behaviors, though the causal direction warrants further research. There is a need for targeted strategies to build and sustain trust in health care relationships as well as enhancing health care access.

Objective: The aim of this study was to assess the impact of the COVID-19 pandemic on the adequacy between treatment decisions made in multidisciplinary team meetings (MTMs) and therapy administered to patients with upper aerodigestive tract cancers. Secondary aims included assessing treatment administration times at different periods and identifying factors explaining discrepancies. Methods: A retrospective, monocentric study was conducted at a university hospital center from 2019 to 2021, including 475 first-line patients. Patients were divided into two groups: those with matching treatments (MTMs vs. delivered) and those with discrepancies. Alignment between treatment decision and treatment delivery was compared among the three periods (before, during, and after the COVID-19 pandemic), and factors influencing non-alignment were analyzed using univariate and multivariate analysis. Results: Of the 475 patients, 106 (23%) received treatments differing from MTM decisions. The pandemic period saw more advanced cancers (4.8% metastatic in 2019 vs. 12% in 2020), poorer general condition, and undernutrition. The pandemic did not significantly affect treatment matching (p = 0.4). Factors linked to mismatches included worse general condition (PS ≥ 2, p < 0.001) and more locally advanced tumors (T3/4, p = 0.002). Shorter processing times were noted during the pandemic and post-pandemic periods. Conclusions: Despite more advanced cancers and poorer general condition, patients treated during the pandemic had continuous care and similar treatment alignment as before. This study shows the effectiveness of ongoing care during the pandemic, ensuring treatment adherence.

Universal population coverage for healthcare was achieved in several countries, including Thailand, while retaining fragmented health insurance schemes. Fragmentation in health financing has been debated since it can exacerbate inequalities, especially when health systems are under stress due to a public health emergency. This study examines whether the type of public health insurance affects outpatient healthcare utilization and out-of-pocket expenditure in Thailand before and during the coronavirus pandemic.

Using the 2019 and 2021 waves of the nationally representative Health and Welfare Survey and a repeated cross-sectional design, logit and multinomial logit models are estimated to investigate the effect of health insurance type on outpatient healthcare utilization (n=10,220), while two-part and Tobit models are employed as alternative models for the analysis of out-of-pocket expenditure (n=12,014). For both healthcare utilization and out-of-pocket expenditure, the study also explores models with and without interactive terms between insurance coverage type and a dummy variable capturing the COVID-19 period.

Type of health insurance is found to impact provider choice (i.e., designated versus non-designated providers) rather than outpatient care utilization per se. Insignificant interaction effects indicate further that the relationship between health insurance type and outpatient care utilization is not affected by the pandemic. The regression results also show that health insurance type is associated with out-of-pocket expenditure (separated into medical and transportation spending) but the magnitude of the effect is relatively small, pre- and peri-pandemic. High-need persons with, for example, chronic conditions, however, face a higher out-of-pocket burden in terms of medical and transportation spending.

Overall, the results suggest that Thailand's universal health coverage system has continued to live up to its promise of access and financial protection in the face of COVID-19, despite existing fragmentation. Notwithstanding, this study highlights that universal health coverage is an ongoing effort that requires careful monitoring, inter alia to mitigate undesirable consequences of fragmentation and to ensure that high-need and other vulnerable persons are not left behind.

We investigated healthcare avoidance during the first COVID-19 wave in a Dutch region with high infection rates. A mixed-method, multiphase study used (1) primary care electronic health records to identify patients, (2) questionnaires to capture patients with unreported COVID-19 symptoms, and (3) interviews om care avoidance. Additionally, a natural language model estimated COVID-19 incidence from routine care data. Of 2361 respondents (39% response rate), 535 (23%) reported COVID-19 symptoms; 180 sought help, mainly from GPs. Care-seeking rates did not differ significantly between those with or without relatives who experienced severe illness or death before their own illness (p = 0.270). Interviews showed the main barriers were feeling not ill enough and concerns about an overstressed healthcare system, especially GPs. Only a third of participants with symptoms sought help, mostly from GPs. Serious illness or death of loved ones had no significant impact. Findings highlight the need for clear communication and accessible healthcare, including telemedicine, for future pandemics.

This study examines socio-economic inequalities in the prevalence and treatment of hypertension and diabetes among adults in India, utilising data from the National Family Health Survey (NFHS) collected before and during the COVID-19 pandemic. Disparities associated with individual demographic and socio-economic characteristics are measured, with the level of inequality quantified using the dissimilarity index and contributing factors analysed through decomposition analysis. The results reveal significant socio-economic gradients, with wealthier individuals more likely to have elevated blood pressure and blood glucose levels and to treat them. Socio-economic gradients in treatment are even steeper among middle-aged groups during the pandemic. These wealth- and education-related disparities become more pronounced with age. This study highlights the need for targeted interventions and policies to address socio-economic disparities in access to essential care for socio-economically disadvantaged populations.

Epidemiology of pulmonary embolism (PE) may have shifted since the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to describe temporal trends in PE epidemiology in the Netherlands since 2015.