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Previous studies on maternal health have highlighted the need to improve health literacy, particularly among women from lower socioeconomic backgrounds. Some crucial factors for improving maternal health literacy are midwife capacity and systems support that can help ensure women's ability and motivation to access timely health services. However, the extent of roles midwives need and the system that must be developed require further elaboration. The aim of this systematic review was to investigate approaches for enhancing maternal health literacy in low-income pregnant women. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the systematic search was conducted on two databases: PubMed and ScienceDirect. All English articles published from 2011 to 2023 were searched using the keywords pregnant, antenatal, prenatal, perinatal, midwife, health literacy, midwife-led care, helpline, and photo novel. Of the 1,539 articles, 15 were included in the final assessment. The results suggested that improving maternal health literacy among low-income pregnant women was related to: (a) empowering low-income women; (b) empowering midwives as frontline care providers engaging with low-income pregnant women; and (c) empowering the health care system as a health literacy organization. In conclusion, improving the healthcare system and strengthening midwives' leadership as proximal caregivers is crucial for improving maternal health literacy among low-income pregnant mothers. These efforts could be realized with support from government roles, educational institutions, and professional associations.

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In the Romanian healthcare system, public hospitals' contract for the provision of healthcare services with the National Health Insurance Services (NHIS) is the main source of revenue in a hospital's income and expenditure budget. In Romania, for acute diseases, payment is made on a per-case basis for hospitals financed under the diagnostic-related groups (DRG) system, which is calculated according to the indicators achieved. The main objective of the study aimed at the quantitative and comparative analysis of hospital performance indicators used in the calculation of the contracted amount with NHIS, in order to quantify the results and evaluate the effectiveness of the measures taken in the surgical wards of the Emergency Clinical County Hospital of Oradea (ECCHO) compared to the annual average values at the national level, in the period 2012-2022. The indicators, such as the number of beds, number of cases, average length of hospitalization (LOH), and case complexity index (CCI), were analyzed at the level of the ECCHO, a tertiary care hospital in the surgical wards. Rehabilitation and modernization of wards, laboratories, operating theatres, and high-performance equipment have been made possible through efficient management and monthly monitoring of medical and financial activity. The average LOH actually carried out on the surgical wards has been decreasing over the 11 years analyzed, with a lower number of hospital days than at the national level. The CCI achieved by the hospital's surgical wards has had an increasing evolution throughout the period analyzed, higher than the national value. The maximum amount contracted and the amount contracted by the hospital is higher when the LOH and CCI indicators achieved by each section are included in the formula than the indicators established at the national level. A lower LOH and a higher CCI than the national values facilitated the contracting of a higher amount. Optimization of the indicators by hospital performance is correlated with improved funding by the NHIS. Increasing the contracted amount facilitates the contracting of an exponential annual number of cases, resulting in more efficient medical services in the surgical wards.

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BACKGROUND: Preparing healthcare systems for emergencies is crucial to maintaining healthcare quality. Nursing homes (NHs) require tailored emergency plans. This article aims to develop a typology of French private NHs and study their early COVID-19 responses and mortality outcomes. METHODS: We conducted a cross-sectional survey among NHs of a French network consisting of 290 facilities during the first wave of the COVID-19 pandemic. A Hierarchical Clustering on Principal Components (HCPC) was conducted to develop the typology of the NHs. Association tests were used to analyze the relationships between the typology, prevention and control measures, COVID-19 mortality, and the satisfaction of hospitalization requests. RESULTS: The 290 NHs vary in size, services, and location characteristics. The HCPC identified three clusters: large urban NHs with low levels of primary care (Cluster 1), small rural NHs (Cluster 2), and medium urban NHs with high levels of primary care (Cluster 3). The COVID-19 outcomes and response measures differed by cluster, with Clusters 1 and 2 experiencing higher mortality rates. Nearly all the NHs implemented preventive measures, but the timing and extent varied. CONCLUSIONS: This typology could help in better preparing NHs for future health emergencies, allowing for targeted resource allocation and tailored adaptations. It underscores the importance of primary care territorial structuring in managing health crises.

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Background: Social welfare legal needs (matters of daily life, such as finances, housing and employment with legal rights, entitlements or protections) are prevalent towards end of life, creating significant difficulties for both patients and carers. Most people do not know where to go, although a range of services provide advice and support for addressing social welfare legal problems. Navigating this complex and fragmented system across health, social care and social welfare legal support is very challenging. Healthcare professionals are often the first contact for social welfare legal needs, although these are often overlooked and their impact on health and well-being unrecognised. Interprofessional learning can increase awareness of social welfare legal needs and build connections between service providers, offering a more holistic and cohesive multiagency response to the complex needs around end of life. The aim of the research was to co-create a robust foundation for cross-agency research investigating the impact of interprofessional learning on social welfare legal needs towards end of life in the North East England region. Objectives: Convene a research partnership group across academics, multiagency service providers and members of the public with lived experience. Consider and agree key issues for successful place-based multiagency research in this area. Co-create a complexity-appropriate research proposal with interprofessional learning as an intervention. Methods: A series of research activities was implemented to convene a multiagency partnership group and consider the key issues for successful place-based multiagency research. Data were collected from two online workshops, an optional reflective workbook, and a modified Delphi technique. Initial participants were selectively recruited from our established stakeholder and patient and public involvement groups. Increasing diversity of the partnership continued throughout the project, using contacts provided by group members. Representation of services supporting underserved groups was a priority. Results: All invited participants were recruited to the partnership, although contribution to research activities was variable. The partnership bridged knowledge gaps between services and united diverse perspectives, expertise and experience. A greater understanding of the barriers and opportunities for place-based multiagency working was generated, such as considering the importance of language in facilitating collaboration and responding to concerns around capacity. A non-hierarchical partnership was meaningful, with both personal and professional insights viewed as equally important. Facilitators to engagement with interprofessional learning were identified including the need for leadership endorsement. A non-traditional, mixed-method approach to interprofessional learning evaluation was favoured, with both qualitative and quantitative measures at three levels: patient and carer, professional learners and organisations. Important outcomes included raising awareness, connectedness and space to reflect. Limitations: The partnership group expanded throughout the course of the project. While this extended diversity, variable participation hindered depth of discussion, with participants engaging at different points and with different understanding levels of the project. Supplementary materials provided some mitigation. Capacity and funding constraints limited engagement for some participants. Conclusions: Convening a multiagency partnership generated insights into the benefits, barriers and facilitators to research co-design and potential measures of success of interprofessional learning. Future work: Learning from this project has informed a complexity-appropriate research proposal to evaluate the impact of interprofessional learning as an intervention across different stakeholders. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR135276.

Social welfare legal issues, such as unsuitable housing, job difficulties and money concerns, are common in the last 12 months of a person's life and they affect carers too. Getting the right help can be difficult as it is hard to know where to go. Organisations and services often work separately from each other. Healthcare professionals are often the first contact for social welfare legal needs, but they may not be able to provide the required support. Interprofessional learning brings professionals together to learn from each other and connect services better. We think this will make it easier for people to get the help they need when the same is required. We set up a group of professionals and four people with personal experience. This partnership group started with people and organisations we knew already but more joined during the project. By the end, 37 different services, representing a range of health, advice and community services, had joined the research group. All services had experience of social welfare legal issues in the last 12 months of life. The group discussed running research together and how interprofessional learning could be tested in our next research project. Research activities were: two online meetings to discuss key questions a workbook which gave time to think about the questions we were asking a survey which asked participants their views about measuring success of interprofessional learning. Group members brought a variety of experiences and opinions. Some had difficulty taking part, mainly because of time. We learnt that professional and personal experiences are as important as each other and that it is important to avoid jargon. Testing if interprofessional learning makes a difference needs to look at people using services, professionals and organisations. We have written a funding application, based on what we have learnt in this project.

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BACKGROUND: The shortage of skilled labor in medicine is one of the most pressing challenges in healthcare. The increasing number of women in medicine, particularly in the field of urology, raises questions about the compatibility of family and career, especially concerning the work environment and working time models. OBJECTIVE: The aim of this study is to capture the impact of motherhood on the professional lives of female physicians and scientists in the field of urology in Germany. Specific challenges in this surgical specialty and the compatibility of family and career will be highlighted. METHODS: The working group "Female Physicians and Scientists in Urology" of the German Society of Urology (DGU) surveyed its 1343 female members regarding demographic data, professional status, and aspects of work-life balance. RESULTS: Among 487 female urologists in Germany, 53.4% had children. Mothers tended to be older, less frequently in training, less often in inpatient settings, and less frequently engaged in surgical activities. Notably, the proportion of full-time working mothers (36.2%) was significantly lower compared to female urologists without children (92.4%). Among female urologists with children, 32.3% reported having changed their workplace because of their children, while 10.7% indicated that their responsibilities had changed at least once after pregnancy. Additionally, 76.9% of mothers had reduced their weekly working hours due to family commitments. Multivariate analysis showed an influence of motherhood on professional status and parttime work. CONCLUSION: The fact that starting a family for women in urology in Germany is associated with a reduction in working hours and the end of clinical careers suggests a need for optimizing the compatibility of family and career in Germany. The increasing feminization of the medical profession exacerbates the existing shortage of skilled workers due to the exit of mothers from professional life. To meet the needs of working parents, particularly mothers, urgent adjustments in the work environment are necessary. Promoting flexible working time models and creating supportive conditions are crucial to preventing the loss of skilled professionals and maintaining job satisfaction in this field.

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BACKGROUND: Patient Organizations (POs) are an important support factor in helping chronically ill patients cope with their illness. Patient involvement in the management of their disease helps to achieve the best possible care for the patient, streamline the work of healthcare providers, shape healthcare policy, and even influence the structures of healthcare systems. The perspective of chronically ill patients on the activities and services provided by patient organizations has not been evaluated yet. This study aimed to identify and map the services and activities of all types of non-profit patient organizations from the perspective of chronically ill patients so that they can be integrated as an integral part of the healthcare system. METHODS: Nineteen services and activities of patient organizations were sampled from Israeli patient organizations and scientific literature. These services and activities were evaluated by chronically ill patients in Israel. Patient-Oriented Questionnaires (POQ) were distributed among patients with chronic diseases (N = 1395) using snowball sampling. RESULTS: Exploratory factor analysis (EFA) was performed, followed by confirmatory factor analysis (CFA) for convergent and discriminant validity. Findings showed that twelve services and activities suggested by patient organizations were found to represent chronically ill patients' needs and categorized into three groups: Interpersonal support (five items), patients' rights (four items), and medical information (three items). CFA showed a good fit for the observed data. CFI = 0.98, NFI = 0.97, TLI = 0.96, RMSEA = 0.058. CONCLUSIONS: Well-organized patient organizations are an important pillar in reformed healthcare systems. They can serve as the social arm of the healthcare system and as an intermediary between patients and healthcare institutions. We narrowed down twelve services and activities given by patient organizations that were important to chronically ill patients in Israel. patient organizations can utilize patient needs or preferences into clinical practice and influence health policy planning, patient-caregiver relationships, research and even healthcare costs. patient organizations recognition by the healthcare system, and establishment of a national patient council will help to realize these processes.

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BACKGROUND: Overcrowded emergency departments (EDs) are associated with higher morbidity and mortality and suboptimal quality-of-care. Most ED flow management strategies focus on early identification and redirection of low-acuity patients to primary care settings. To assess the impact of redirecting low-acuity ED patients to medical clinics using an electronic clinical decision support system on four ED performance indicators. METHODS: We performed a retrospective observational study in the ED of a Canadian tertiary trauma center where a redirection process for low-acuity patients was implemented. The process was based on a clinical decision support system relying on an algorithm based on chief complaint, performed by nurses at triage and not involving physician assessment. All patients visiting the ED from 2013 to 2017 were included. We compared ED performance indicators before and after implementation of the redirection process (June 2015): length-of-triage, time-to-initial-physician-assessment, length-of-stay and rate of patients leaving without being seen. We performed an interrupted time series analysis adjusted for age, gender, time of visit, triage category and overcrowding. RESULTS: Of 242,972 ED attendees over the study period, 9546 (8% of 121,116 post-intervention patients) were redirected to a nearby primary medical clinic. After the redirection process was implemented, length-of-triage increased by 1 min [1;2], time-to-initial assessment decreased by 13 min [-16;-11], length-of-stay for non-redirected patients increased by 29 min [13;44] (p < 0.001), minus 20 min [-42;1] (p = 0.066) for patients assigned to triage 5 category. The rate of patients leaving without being seen decreased by 2% [-3;-2] (p < 0.001). CONCLUSION: Implementing a redirection process for low-acuity ED patients based on a clinical support system was associated with improvements in two of four ED performance indicators.

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Background: Health systems worldwide are under pressure. Integration seems a possible solution to improve healthcare systems efficiency. This research aims to gather stakeholders' opinions on integrating community pharmacy and the primary healthcare system and secondly to explore and prioritise interventions for an initial integration plan. Method: Using a constructivist qualitative research approach, a two-phase qualitative study was conducted in the Basque Country, Spain. Thematic analysis using NVivo® was undertaken on data gathered during focus groups and semi-structured interviews (phase 1). During phase 2, a nominal group prioritised potential integration interventions identified in phase 1. Results: The study amalgamated findings from four focus groups and nine interviews, revealing six themes. Stakeholders had a diverse understanding of integration, associating the term mainly with collaboration, communication or cooperation. Community pharmacies were positively perceived; however, their commercial and privately owned nature was of concern. Remuneration methods for pharmacists were controversial, with a suggested shift to service-based remuneration. Information availability and barriers such as interprofessional communication gaps were highlighted. The nominal group prioritised, according to importance and feasibility, bidirectional communication development, coordination in using interprofessional protocols and community pharmacist participation in primary healthcare centre meetings as interventions for integrating community pharmacies and primary healthcare centres. Conclusion: Based on the opinions of stakeholders, three interventions are proposed to initiate the integration process of community pharmacy and primary care. The implementation of these interventions will need to be negotiated with the relevant authorities and evaluated.

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District Mental Health Program (DMHP) is part of the broader National Mental Health Program (NMHP) launched in 1982. In India, DMHP has evolved over the years, moving from a pilot project to an integrated component of the NMHP. Efforts have been made to expand services, protect the rights of individuals with mental illness, and integrate mental healthcare into the primary healthcare system. Recent updates and efforts taken by the Government of India and state governments (60% and 40% budget share respectively) have improved the quality of services provided under DMHP. With the increasing use of the internet and mobile technology, DMHP has spread its arena of services more deeply and widely in the last few years reaching up to 738 districts in the country. However, there is still work to be done to address many challenges associated with mental health in India though the recent developments seem promising as a substantial number of patients are now having access to the programme. This narrative review is the summary of information available to date on the evolution of implementation and expansion of DMHP over the years and provides a gist of the positive aspects as well as limitations of the DMHP witnessed in recent years.

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This study examines the effectiveness of the countries' health systems in the Horn of Africa region. It also investigates the perspectives of actors who have played an active role in health affairs in Somalia carried out by Türkiye. Using the Data Envelopment Analysis and Malmquist Total Factor Efficiency Analysis, we investigated the effectiveness of the health systems and improvements made throughout the years. In the countries of interest, efficiency levels and average total factor productivity showed positive and/or negative trends between 2000 and 2020. Kenya showed a marked performance in achieving improved average total factor productivity thanks to the effective use of current technology in health, success in integrating new technologies into the health system, and a high potential to produce more output despite insufficient existing inputs. The remaining countries lagged behind in improving their production factors. Since 2014, Türkiye has provided health services in Somalia through health diplomacy and conducted medical examinations for numerous patients in a well-equipped hospital.

Cette étude examine l'efficacité des systèmes de santé des pays de la région de la Corne de l'Afrique. Il étudie également les perspectives des acteurs qui ont joué un rôle actif dans les affaires de santé en Somalie menées par Türkiye. En utilisant l'analyse de l'enveloppe des données et l'analyses d'efficacité des facteurs totales de Malmquist, nous avons étudié l'efficience des systèmes de santé et les améliorations apportées au cours des années. Dans les pays intéressés, les niveaux d'efficacité et la productivité totale moyenne du facteur ont montré des tendances positives et/ou négatives entre 2000 et 2020. Le Kenya a fait preuve d'une performance marquée dans l'amélioration de la productivité totale moyenne du facteur grâce à l'utilisation efficace de la technologie actuelle dans le domaine de la santé, au succès de l'intégration de nouvelles technologies dans le système de santé et au potentiel élevé de produire plus de produits malgré l'insuffisance des produits existants. Les autres pays sont en retard dans l'amélioration de leurs facteurs de production. Depuis 2014, Türkiye a fourni des services de santé en Somalie par le biais de la diplomatie de santé et a effectué des examens médicaux pour de nombreux patients dans un hôpital bien équipé.

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Background: The healthcare system in Ireland was profoundly affected by COVID-19. This study aimed to explore the impact of the pandemic on cancer surgery in Ireland, from 2019 to 2022 using three national health data sources. Methods: A repeated cross-sectional study design was used and included: (i) cancer resections from the National Histopathology Quality Improvement (NHQI) Programmes; (ii) cancer surgery from the National Cancer Registry Ireland (NCRI), and (iii) cancer surgery from Hospital Inpatient Enquiry (HIPE) System. Cancer surgery was presented by invasive/in situ and invasive only cancers (NCRI & HIPE), and by four main cancer types (breast, lung, colorectal & melanoma for NCRI & HIPE data only). Results: The annual number of cancer resections (NHQI) declined by 4.4% in 2020 but increased by 4% in 2021 compared with 2019. NCRI data indicated invasive/in-situ cancer surgery for the four main cancer types declined by 14% in 2020 and 5.1% in 2021, and by 12.3% and 7.3% for invasive cancer only, compared to 2019. Within HIPE for the same tumour types, invasive/in situ cancer surgery declined by 21.9% in 2020 and 9.9% in 2021 and by 20.8% and 9.6% for invasive cancer only. NHQI and HIPE data indicated an increase in the number of cancer surgeries performed in 2022. Conclusions: Cancer surgery declined in the initial pandemic waves suggests mitigation measures for cancer surgery, including utilising private hospitals for public patients, reduced the adverse impact on cancer surgery.

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In response to the French hospital system crisis and the challenges faced by the heads of departments, we have undertaken an initiative to create a community of heads of haematology departments willing to assist each other. Our inaugural seminar, held in January 2023, established the foundational "core" group of heads of department. Throughout 2023, this emerging community has prospered, offering sustained support to peers. In January 2024, we broadened our community to include other heads of departments, following a second seminar gathering 36 participants. During this event, we took the time to exchange thoughts and reflect on our missions. Building on the experience of guest speakers and employing methods of co-development and co-construction in plenary sessions, small-group workshops, and social gathering, we were able to discover and experience the collective intelligence, creativity, strength, and support stemming from such a group. This peer community of heads of departments stands as a powerful tool for management support, whereby personal experiences nourish and enrich the experience of others. We hope that our initiative will inspire heads of departments from other specialties so that, together, we can better work towards our missions as heads of departments and collaborate on rebuilding the hospital "from the bottom up".

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BACKGROUND: The Jordanian healthcare system has evolved over the past decades expanding its services, technological, and educational resources. A comprehensive view of this system is lacking. The objective of this report is to describe the structure of the Jordanian healthcare system, the challenges facing it, and the current and recommended health policies. MATERIALS AND METHODS: This study reviewed the current status of the Jordanian healthcare system. The following parameters were analyzed: health indicators, infrastructure, human resources, insurance system, pharmaceutical expense, health education system, and medical tourism. Data were collected from various relevant official institutions and related published literature. RESULTS: Jordan has a young population with a median age of 23.8 years. Life expectancy is 78.8 years for females and 77.0 years for males. The Jordanian healthcare system is divided into three major categories: (1) Governmental Insurance (i.e., the Ministry of Health (MOH), the Royal Medical Services (RMS) and semi-governmental insurance); (2) Private Insurance; and (3) Refugee Insurance, including the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR). The Governmental Insurance covers 64.30% of the total population. Health expenditure is 6.37% of the gross domestic product (GDP). Pharmaceutical expenses make up 26.6% of the total national healthcare budget. Human resource assessment shows a high ratio of medical staff per 10.000 inhabitants, especially concerning physicians (31.7), dentists (7.9), and pharmacists (15.1). However, the ratio of nursing staff per 10.000 inhabitants is considered low (37.5). The Hospital bed/1000 population ratio is also relatively low (1.4). Healthcare accreditation is implemented through the Joint Commission International (JCI) accreditation which was achieved by 7 hospitals and by the National Health Care Accreditation Certificate (HCAC) achieved by 17 hospitals and 42 primary healthcare centers. Postgraduate medical education covers almost all medical and surgical fields. Medical tourism is currently well-established. CONCLUSIONS: Assessment of the Jordanian healthcare system shows high ratios of physicians, dentists, and pharmacists but a low ratio of nursing staff per 10.000 inhabitants. The hospital bed/1000 population ratio is also relatively low. Pharmaceutical expenses are significantly high and medical tourism is well-developed.

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The multifaceted crises that Lebanon is facing have led to a shortage of medications in the country's community pharmacies. This shortage has triggered a cascade of adverse effects, rippling throughout the nation's healthcare system. In this report, we examine the causes, which range from economic turmoil to inadequate resource distribution, along with the profound impacts on public health, such as increased length of hospital stays and compromised patient care. The paper also proposes a suite of solutions aimed at mitigating the immediate challenges and paving the way for a more resilient healthcare framework.

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PURPOSE: Accurate healthcare data is indispensable for monitoring the epidemiology of autism spectrum disorders (ASD) and improving the quality of care for individuals on the spectrum. In Colombia, the Ministry of Health has developed the social protection information system (SISPRO) as a comprehensive registry, drawing data from the healthcare system with close to universal coverage (approximately 95%). This study utilizes data gathered by SISPRO to estimate the prevalence and specific characteristics of autistic children registered between January 2020 and December 2022. METHOD: A descriptive epidemiological approach was employed, using the International Statistical Classification of Diseases as search terms for ASD within the SISPRO dataset. RESULTS: The study revealed a prevalence of 13.788 cases per 10,000 children in 2022 among aged 4 to 14. Regarding healthcare coverage types in 2022, the majority of autistic children served were under the contributory regime (68.28%), followed by the subsidized regime (25.36%). Geographic analysis indicated a non-uniform distribution of ASD prevalence in Colombia. The regions with the highest GDP, such as Antioquia, Atlántico, Bogotá, Cundinamarca, and Valle del Cauca, exhibited the highest prevalence (M = 17.90; SD = 14.3). In contrast, areas with the lowest GDP, including Amazonas, Guainía, Vaupés, Vichada, and Guaviare, showed the lowest prevalence among children (M = 2.6; SD = 2.5). CONCLUSION: The estimation of ASD prevalence in Colombia represents an ongoing initiative to inform public policy actions. During the COVID-19 pandemic, there was a decrease in the number of autistic children served by the healthcare sector; however, the prevalence of ASD changed to higher levels in 2022. These findings contribute to strategies aimed at improving the quality of life for autistic individuals and mitigating the economic burden on their families.

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BACKGROUND: The health system performance assessment is a challenging process for decision-makers. In case of Kazakhstan's healthcare system, the calculation of avoidable mortality, which has been underutilized to date, could serve as an additional tool to prioritize areas for improvement. Therefore, the aim of the study is to analyse avoidable mortality in Kazakhstan. METHODS: The data was retrieved from the Bureau of National Statistics, Kazakhstan. It covers population data by age, mortality rates from disease groups based on the Joint OECD (Organisation for Economic Co-operation and Development)/Eurostat classification of preventable and treatable causes of mortality. The data spans from 2015 to 2021, categorized by gender and 5-year age groups (0, 1-4, 5-9, ..., 70-74). Standardization was performed using the 2015 OECD standard population. We used joinpoint regression analysis to calculate the average annual percentage change (AAPC). RESULTS: From 2015 to 2019, the annual percentage change (APC) in avoidable mortality per 100 000 population was -3.8 (-5.7 to -1.8), and from 2019 to 2021 it increased by 17.6 (11.3 to 24.3). Males exhibited higher avoidable mortality rates compared to females. The preventable mortality rate was consistently higher than the treatable mortality. Both preventable and treatable mortality decreased from 2015 to 2019, with preventable mortality reaching 272.17 before rising to 379.23 per 100 000 population in 2021. Between 2015 and 2021, treatable mortality rates increased from 179.3 (176.93-181.67) to 205.45 (203.08-207.81) per 100 000 population. CONCLUSION: In Kazakhstan, the leading causes of avoidable mortality were circulatory diseases, respiratory diseases, and cancer. To achieve the goals of universal health coverage (UHC) and improve the overall population health, there is an urgent need to amend the healthcare system and reduce avoidable mortality. While it is important to acknowledge the influence of COVID-19 on these trends, our study's focus on avoidable mortality provides valuable insights that complement the understanding of pandemic-related effects.

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The presence of children and adolescents in migratory flows is growing in Latin America and the Caribbean. Little is known about migration's effects on these groups' health. This article aims to investigate the evidence available on the access and use of healthcare services by migrant children and adolescents in Latin America and the Caribbean. We seek to explore the role of social determinants of health at different levels in the health conditions of these groups. Also, to identify potential recommendations for healthcare systems and public policy to address them. For this purpose, a narrative review of 52 publications was carried out based on a search of scientific literature in the Web of Science and Google Scholar databases. Five relevant topics were identified: use of emergency care associated with lack of healthcare access, preventive services, and other social determinants of health; exposure to preventable infectious diseases; mental health; sexual and reproductive health; and vaccinations and dental health. We conclude that the evidence shows the need to address the inequities and disadvantages faced by migrant children from a perspective of social determinants of health and policies that consider health as a human right regardless of the migratory status of children and adolescents, as well as that of their parents or primary caregivers.

En Latinoamérica y El Caribe la presencia de niños, niñas y adolescentes en los flujos migratorios internacionales es creciente. Los efectos que la migración genera sobre la salud de estos grupos han sido poco estudiados. El objetivo de este artículo es indagar en las principales evidencias reportadas respecto al acceso y uso de servicios de salud por parte de niños, niñas y adolescentes migrantes en América Latina y El Caribe. Esto, con la finalidad de reflexionar sobre el rol que cumplen los determinantes sociales de la salud de diverso nivel, en las condiciones de salud de estos grupos. También se busca identificar recomendaciones para su abordaje desde los sistemas de salud y la política pública. Para ello se realizó una revisión narrativa de 52 publicaciones sobre la base de un proceso de búsqueda de literatura científica de la base de datos y Google Académico. Se identificaron cinco temas relevantes: uso de urgencias asociado a falta de acceso a salud, a servicios preventivos y a otros determinantes sociales de la salud; exposición a enfermedades infecciosas prevenibles; salud mental; salud sexual y reproductiva; y vacunaciones y salud dental. Concluimos que la evidencia muestra la necesidad de abordar las inequidades y desventajas que están acumulando estos grupos, desde una óptica de determinantes sociales de la salud y de políticas que consideren la salud como derecho humano independiente de la situación migratoria de los niños, niñas y adolescentes, así como la de sus padres o cuidadores principales.

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BACKGROUND: In long-term care facilities (LTCF), apathy is a prevalent issue, leading to cognitive decline, functional impairment, and increased mortality risk. Despite its significance, apathy often remains underrecognized and undermanaged in these settings. Recognizing and addressing the predictors of apathy is critical for early intervention and improved care outcomes. PURPOSE: This study aims to assess the prevalence of apathy and identify its associated risk factors among newly admitted residents in the Canadian LTCF, using the InterRAI Minimum Data Set (MDS 2.0). METHODS: We conducted a cross-sectional analysis of MDS 2.0 admission assessment data between 2015 and 2019, covering 157,596 residents across six Canadian provinces and one territory. Apathy was measured using the Apathy Index of the MDS 2.0, with the biopsychosocial model guiding the analysis. RESULTS: The prevalence of apathy was 12.5% (19,758 individuals). The most significant predictors include cognitive impairments, specific age groups, hearing impairments, vision impairments, facility size and location. CONCLUSIONS: The findings of this study underscore the need for tailored strategies in LTCF to address apathy, considering individual, institutional, and regional variations. Emphasis on environmental and personal factors is crucial in the management and prevention of apathy in these settings.

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Introduction: Despite the advancements in oncological medicine and research, cancer remains the second leading cause of death in Europe with Central and Eastern European countries, such as Slovakia and Croatia, showing the highest mortality rates and disparities in access to appropriate and comprehensive cancer care. Therefore, the primary aim of the current study is to investigate cancer patients' perspectives and experiences to understand the possible underlying reasons for cancer disparities. Methods: Croatian cancer patients (n=15) and Slovak patients (n=11) were recruited through social media platforms, patients' organisations, and hospital websites and offered participation in online focus group discussions on perceived disparities, barriers or malfunctioning during and after their cancer journey. Transcripts of video and audio recordings of the interviews were translated and analysed using Thematic analysis. Results: Six Croatian and five Slovak themes emerged from the focus group discussions highlighting encountered barriers and perceived disparities, as well as suggestions or unmet needs. Most of the themes are common to both groups, such as the lack of information and use of the internet, and the taboos regarding cancer or psycho-oncological support. However, some themes are specific to each group, for instance, Slovak cancer patients remarked the fact that they do not mind travelling to get treatment as long as they can be treated in the west of Slovakia, while Croatian patients highlighted the need for more information after the illness and the socioeconomic impact deriving from a cancer diagnosis. Discussion: Urgent intervention is needed in addressing disparities in Central and Eastern Europe. Present results could inform dedicated guidelines or better resource allocation strategies to reduce disparities in cancer care and promote inclusive healthcare.

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Background: Incidence of sexual violence among recently arrived asylum-seeking women in France (INCIDAVI) is a French study which found a past year incidence of 26 % for postarrival sexual violence (SV) among asylum-seeking women (ASW). It reported that fewer than 1 out of 10 victims consulted a healthcare professional when SV occurred. These findings raise the question of how ASW who have been victims of SV get involved in care. We aimed to explore the mechanisms and obstacles to seeking care in the host country among this population. Methods: This qualitative phase of INCIDAVI was based on a grounded theory approach. Twenty semi structured interviews were conducted between February 1, 2022, and July 29, 2022. The interviews explored the conditions under which women talk about SV, the care pathway in France and the perceived consequences of care. We performed an inductive analysis using NVivo® 14 software. Findings: Life paths of ASW are traversed by SV which influence their health and safety behaviour and can re-expose them to SV. Talking about SV is a rare choice focused on seeking protection. When appropriate care is used, it is perceived as beneficial and leads to a change in the perception of a possible recovery. Interpretation: The failure of ASW to seek care for SV is shaped by the fact that SV is initially perceived as ordinary. A proactive attitude on the part of carers towards detecting such violence leads to positive experiences of care, which in turn influence women's initial perceptions of SV, enabling them to envisage health recovery.