How the COVID-19 Pandemic Influenced HIV Care: Are We Prepared Enough for Future Pandemics? An Assessment of Factors Influencing Access, Utilization, Affordability, and Motivation to Engage with HIV Services amongst African, Caribbean, and Black Women.

The COVID-19 pandemic resulted in disruption in healthcare delivery for people living with human immunodeficiency virus (HIV). African, Caribbean, and Black women living with HIV (ACB WLWH) in British Columbia (BC) faced barriers to engage with HIV care services prior to the COVID-19 pandemic that were intensified by the transition to virtual care during the pandemic. This paper aims to assess which factors influenced ACB WLWH's access to, utilization and affordability of, and motivation to engage with HIV care services. This study utilized a qualitative descriptive approach using in-depth interviews. Eighteen participants were recruited from relevant women's health, HIV, and ACB organizations in BC. Participants felt dismissed by healthcare providers delivering services only in virtual formats and suggested that services be performed in a hybrid model to increase access and utilization. Mental health supports, such as support groups, dissolved during the pandemic and overall utilization decreased for many participants. The affordability of services pertained primarily to expenses not covered by the provincial healthcare plan. Resources should be directed to covering supplements, healthy food, and extended health services. The primary factor decreasing motivation to engage with HIV services was fear, which emerged due to the unknown impact of the COVID-19 virus on immunocompromised participants.

Tracking the digital health gap in elderly: A study in Italian remote areas.

The Covid-19 pandemic has provided a major innovative thrust to public services regarding their digitization to continue providing an effective response to the population's needs and to reduce management costs. However, there has been a partial lack of those welfare policies that can provide an adequate response to the elderly segment of the population, which is most affected by the introduction of new technologies into the public sphere. This study analyses the digital gap in health in the elderly living in remote areas of Italy and investigates the use of digital devices for health purposes. It compares the use of digital solutions for health with people's common digital competencies and their willingness to use them. A descriptive analysis of the sample was constructed to verify the different responses of the elderly by age, gender, educational qualification, and geographic area. Furthermore, regression analyses have been conducted to test whether there is any dependent effect among the elderly's characteristics or geographic areas. The results highlight the existence of a potential digital health gap among the elderly in remote areas of Italy both due to infrastructural issues and the lack of digital skills. The latter are positively correlated with educational qualification, such that it is also possible to highlight differences between age groups analysed and shape future welfare policies to reduce digital inequality.

Health Care Access and Affordability Among US Adults Aged 18 to 64 Years With Self-reported Post-COVID-19 Condition.

Importance: Many US adults report having post-COVID-19 condition (PCC), but little is known about their access to health care. Objective: To estimate the association of PCC with access and affordability challenges among US adults aged 18 to 64 years. Design, Setting, and Participants: This survey study used data from the Health Reform Monitoring Survey, a probability-based internet survey conducted June 17 to July 5, 2022. Participants included a nationally representative sample of 9484 US adults ages 18 to 64 years drawn from the Ipsos KnowledgePanel. Main Outcomes and Measures: Self-reported PCC was defined as experiencing symptoms more than 4 weeks after first having COVID-19 that were not explained by another condition or factor. Access and affordability outcomes included having a usual place of care; forgoing care in the past 12 months because of costs, difficulty finding clinicians, or difficulty using health insurance; having problems paying family medical bills in the past 12 months; and having past-due medical debt. Results: Of 19 162 panel members recruited for the survey, 9599 individuals completed the survey (completion rate, 50.1%) and 9484 respondents were included in the final analytic sample (4720 females [50.6%, weighted]; mean [SD] age, 41.0 [13.5] years). A total of 3382 respondents (36.4%; 95% CI, 34.7%-38.2%) reported ever being diagnosed with COVID-19, among whom, 833 respondents (22.5%; 95% CI, 20.9%-24.2%) reported currently having PCC. After adjustment for differences in demographic, health, and geographic characteristics, adults with PCC were more likely than 2549 adults with a COVID-19 diagnosis but no report of PCC and 6102 adults never diagnosed with COVID-19 to report unmet health care needs in the past 12 months because of the following challenges: costs (27.0%; 95% CI, 23.2%-30.7% vs 18.3%; 95% CI, 15.9%-20.7% and 17.5%; 95% CI, 15.4%-19.6%) and difficulties finding clinicians accepting new patients (16.4%; 95% CI, 14.3%-18.4% vs 10.1%; 95% CI, 8.8%-11.5% and 10.7%; 95% CI, 9.6%-11.8%), getting a timely appointment (22.0%; 95% CI, 19.3%-24.8% vs 14.4%; 95% CI, 13.2%-15.7% and 13.9%; 95% CI, 12.9%-14.8%), and getting health plan care authorization (16.6%; 95% CI, 14.6%-18.6% vs 10.8%; 95% CI, 9.6%-12.1% and 10.3%; 95% CI, 9.4%-11.2%) (P < .001 for all comparisons). Conclusions and Relevance: This study found that adults aged 18 to 64 years with PCC were more likely than other adults to have difficulty getting and paying for health care. These findings suggest that policies aimed at improving access and affordability may focus on accelerating development of treatments and clinical guidelines, training clinicians, and addressing insurance-related administrative and cost barriers.

Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study.

BACKGROUND: Since May 1, 2018, every alcoholic drink sold in Scotland has had minimum unit pricing (MUP) of £0·50 per unit. Previous studies have indicated that the introduction of this policy reduced alcohol sales by 3%. We aimed to assess whether this has led to reductions in alcohol-attributable deaths and hospitalisations. METHODS: Study outcomes, wholly attributable to alcohol consumption, were defined using routinely collected data on deaths and hospitalisations. Controlled interrupted time series regression was used to assess the legislation's impact in Scotland, and any effect modification across demographic and socioeconomic deprivation groups. The pre-intervention time series ran from Jan 1, 2012, to April 30, 2018, and for 32 months after the policy was implemented (until Dec 31, 2020). Data from England, a part of the UK where the intervention was not implemented, were used to form a control group. FINDINGS: MUP in Scotland was associated with a significant 13·4% reduction (95% CI -18·4 to -8·3; p=0·0004) in deaths wholly attributable to alcohol consumption. Hospitalisations wholly attributable to alcohol consumption decreased by 4·1% (-8·3 to 0·3; p=0·064). Effects were driven by significant improvements in chronic outcomes, particularly alcoholic liver disease. Furthermore, MUP legislation was associated with a reduction in deaths and hospitalisations wholly attributable to alcohol consumption in the four most socioeconomically deprived deciles in Scotland. INTERPRETATION: The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. The greatest improvements were in the four most socioeconomically deprived deciles, indicating that the policy is positively tackling deprivation-based inequalities in alcohol-attributable health harm. FUNDING: Scottish Government.

Exploring the Determinants and Experiences of Senior Stroke Patients with Virtual Care.

OBJECTIVE: The study sought to explore the experiences of participants affected by stroke with home video visit (HVV) for follow-up visits in order to understand the determinants, barriers, and benefits associated with HVVs. METHODS: Semi-structured interviews were conducted with (n = 23) participants to gather insight and descriptive information about patients' experiences with HVV. Specifically, we sought to collect descriptions about the (1) costs and time associated with in-person visits, (2) facilitators and barriers to in-person and virtual visits, and (3) their values attached to traditional and virtual forms of patient care. RESULTS: HVVs were perceived to be a mode of healthcare that is time-saving and convenient for both participants and physicians. However, our study also found some participants felt uncomfortable using technology to conduct medical visits while others still supported a positive view of traditional forms of in-person visits because they valued the in-person interactions and safe environment of the hospital. CONCLUSION: While HVVs were considered to be useful in addressing geographical barriers to health care, technological and digital health literacy may serve to impede seniors from using the service, with some of them opting to go to the hospital despite geographical barriers. Resultantly, HVVs may serve both to alleviate and exacerbate certain determinants to health care.

Effects of COVID-19 outbreak in pricing and collaboration of a health-social dual-channel supply chain.

The coronavirus pandemic has affected most aspects of product supply and consumer behaviors and led to transformations in the supply chain. The COVID-19 pandemic and the requirements to reduce its prevalence have led many people to shop online and encouraged many manufacturers to sell their products online. In this study, a manufacturer, who intends to possess an online sales channel, and a retailer, who has an in-person sales channel, are considered. Then, pricing strategies and collaboration mechanisms between them in the health-social dual-channel supply chain are investigated. This study is developed in three models, including centralized, decentralized, and collaborated under Stackelberg game, whereas the optimal price of products in each channel, level of implementation of health and safety protocols in retailers, advertising level, and status of online shopping performance are obtained for improving customer trust. Moreover, the demand is represented as a function of selling prices of products in online and in-person shops, compliance level of health protocols, level of online shopping performance, and advertising in health during the COVID-19 pandemic. Although the centralized model provides more profit for the manufacturer, the collaborated model provides the highest profit for the retailer. Thus, since the supply chain profit of centralized and collaborated models is close, the collaboration model is the best option for members in this situation. Sensitivity analysis is finally performed to evaluate the impact of key parameters, and then according to obtained results, some management insights are suggested for the dual-channel supply chain during the COVID-19 pandemic.

Survey mode and nonresponse bias: A meta-analysis based on the data from the international social survey programme waves 1996-2018 and the European social survey rounds 1 to 9.

The constant increase in survey nonresponse and fieldwork costs are the reality of survey research. Together with other unpredictable events occurring in the world today, this increase poses a challenge: the necessity to accelerate a switch from face-to-face data collection to different modes, that have usually been considered to result in lower response rates. However, recent research has established that the simple response rate is a feeble measure of study quality. Therefore, this article aims to analyze the effect of survey characteristics, especially the survey mode, on the nonresponse bias. The bias measure used is the internal criteria first proposed by Sodeur and first applied by Kohler. The analysis is based on the survey documentation and results from the International Social Survey Programme waves 1996-2018 and the European Social Survey rounds 1 to 9. Random-effects three-level meta-regression models, based on data from countries from each inhabited continent, were created in order to estimate the impact of the survey mode or modes, sampling design, fieldwork experience, year of data collection, and response rate on the nonresponse bias indicator. Several ways of nesting observations within clusters were also proposed. The results suggest that using mail and some types of mixed-mode surveys were connected to lower nonresponse bias than using face-to-face mode surveys.

Prioritising Climate Change Mitigation Behaviours and Exploring Public Health Co-Benefits: A Delphi Study.

Climate change requires urgent action; however, it can be challenging to identify individual-level behaviours that should be prioritised for maximum impact. The study aimed to prioritise climate change mitigation behaviours according to their impacts on climate change and public health, and to identify associated barriers and facilitators-exploring the impact of observed behaviour shifts associated with COVID-19 in the UK. A three-round Delphi study and expert workshop were conducted: An expert panel rated mitigation behaviours impacted by COVID-19 in relation to their importance regarding health impacts and climate change mitigation using a five-point Likert scale. Consensus on the importance of target behaviours was determined by interquartile ranges. In total, seven target behaviours were prioritised: installing double/triple glazing; installing cavity wall insulation; installing solid wall insulation; moving away from meat/emission heavy diets; reducing the number of cars per household; walking shorter journeys; and reducing day/weekend leisure car journeys. Barriers related to the costs associated with performing behaviours and a lack of complementary policy-regulated subsidies. The target behaviours are consistent with recommendations from previous research. To ensure public uptake, interventions should address behavioural facilitators and barriers, dovetail climate change mitigation with health co-benefits and account for the long-term impacts of COVID-19 on these behaviours.

Pandemic fatigue fueled political discontent during the COVID-19 pandemic.

Health authorities have highlighted "pandemic fatigue" as a psychological consequence of the COVID-19 pandemic and warned that "fatigue" could demotivate compliance with health-related policies and mandates. Yet, fatigue from following the policies of authorities may have consequences far beyond the health domain. Theories from the social sciences have raised that real and perceived costs of policies can also drive sentiments of discontent with the entire political establishment. Integrating theories from the health and social sciences, we ask how pandemic fatigue (i.e., perceived inability to "keep up" with restrictions) developed over the pandemic and whether it fueled political discontent. Utilizing longitudinal and panel surveys collected from September 2020 to July 2021 in eight Western countries (N = 49,116), we analyze: 1) fatigue over time at the country level, 2) associations between pandemic fatigue and discontent, and 3) the effect of pandemic fatigue on political discontent using panel data. Pandemic fatigue significantly increased with time and the severity of interventions but also decreased with COVID-19 deaths. When triggered, fatigue elicited a broad range of discontent, including protest support and conspiratorial thinking. The results demonstrate the significant societal impact of the pandemic beyond the domain of health and raise concerns about the stability of democratic societies, which were already strained by strife prior to the pandemic.

Cost analysis of COVID-19 test result notification using an automated messaging system compared to a staff caller practice in Alberta.

SETTING: In Alberta, polymerase chain reaction (PCR) COVID-19 tests were an important step in detecting and isolating contagious individuals throughout the pandemic. Initially, a staff member provided results to all PCR COVID-19 test clients by phone. As the number of tests increased, new approaches were essential for timely result notification. INTERVENTION: An innovative automated IT system was introduced during the pandemic to reduce workloads and support timely result notification. At the time of the COVID-19 test booking and again following swabbing, clients had an option to consent to receive their test results via an automated text or voice message. Prior to implementation, a privacy impact assessment was approved, a pilot was undertaken, and changes to lab information systems were made. OUTCOMES: Health administration data were used in a cost analysis to compare the unique costs associated with the novel automated IT practice (e.g., administration, integration, messages, staffing costs) and a hypothetical staff caller practice (e.g., administration, staffing costs) for negative test results. The costs of sharing 2,161,605 negative test results in 2021 were assessed. The automated IT practice demonstrated a cost savings of $6,272,495 over the staff caller practice. A follow-up analysis determined the cost savings threshold of 46,463 negative tests to break even. IMPLICATIONS: Using an automated IT practice for consenting clients can be a cost-effective approach to reach clients in a timely manner during a pandemic or other instances warranting direct notification. This approach is being explored for test result notification of other communicable diseases in other contexts.

RéSUMé: LIEU: En Alberta, les tests de réaction de polymérisation en chaîne (PCR) pour la COVID-19 ont représenté une étape importante dans la détection et l'isolement des personnes contagieuses tout au long de la pandémie. Au début, un membre du personnel communiquait par téléphone les résultats de tous les tests PCR de la COVID-19 aux usagers et usagères. Avec l'augmentation du nombre de tests, il a absolument fallu trouver de nouvelles façons de communiquer les résultats rapidement. INTERVENTION: Un système de TI automatisé novateur a été introduit durant la pandémie pour alléger la charge de travail et favoriser la communication rapide des résultats des tests. Au moment de la réservation d'un test de dépistage de la COVID-19 et après l'écouvillonnage, les usagers et usagères pouvaient consentir à recevoir leurs résultats via un message texte automatisé ou un message vocal. Avant la mise en œuvre, une évaluation des facteurs relatifs à la vie privée a été approuvée, un projet pilote a été mené, et des changements ont été apportés aux systèmes d'information des laboratoires. RéSULTATS: Les données administratives sanitaires ont servi à effectuer une analyse des coûts visant à comparer les coûts spécifiquement associés à la nouvelle pratique de TI automatisée (p. ex. frais d'administration, d'intégration, de messages, de personnel) et ceux d'une hypothétique pratique d'appel par un membre du personnel (p. ex. frais d'administration, de personnel) pour les tests négatifs. Les coûts de communication des résultats de 2 161 605 tests négatifs en 2021 ont été évalués. La pratique de TI automatisée a représenté des économies de 6 272 495 $ par rapport à la pratique d'appel par un membre du personnel. Selon une analyse de suivi, le seuil de rentabilité était atteint après 46 463 tests négatifs. CONSéQUENCES: L'utilisation d'une pratique de TI automatisée pour les usagers et usagères ayant consenti à cette option peut être une méthode efficace par rapport au coût pour joindre rapidement les usagères et usagers lors d'une pandémie ou dans d'autres cas où une notification directe est justifiée. Cette méthode est explorée pour la communication des résultats de tests d'autres maladies transmissibles dans d'autres contextes.

Increased use of 6-monthly gonadotropin-releasing hormone agonist therapy for prostate cancer: a capacity and cost-minimization analysis for England.

AIMS: The National Health Service (NHS) in England is facing extreme capacity pressures. The backbone of prostate cancer care is gonadotropin-releasing hormone agonist (GnRHa) therapy, commonly administered every month or 3 months. We estimated the cost and capacity savings associated with increased use of 6-monthly GnRHa therapy in England. METHODS: A capacity and cost-minimization model including a societal perspective was developed (in Microsoft Excel) to generate cost and capacity estimates for GnRHa drug acquisition and administration for "Current practice" and for a "Base case" scenario. In the "Base case" scenario, 50% of patients who were receiving monthly or 3-monthly GnRHa therapy in "Current practice" switched/transitioned to a 6-monthly formulation. Cost/capacity estimates were calculated per patient per administration and scaled to annualized population levels. Sensitivity analyses were conducted to assess the impact of individual model assumptions: 1 tested the impact of drug acquisition costs; 2 and 3 tested the level of nurse grade and the time associated with treatment administration, respectively; 4 tested the rate of switch/transition to 6-monthly GnRHa therapy; and 5 tested differing diagnostic patterns following the coronavirus disease 2019 pandemic. RESULTS: Compared with "Current practice", the "Base case" scenario was associated with annual cost savings of £5,164,296 (148,478 fewer appointments/year and 37,119 fewer appointment-hours/year). The largest savings were in drug administration (£2.2 million) and acquisition (£1.6 million) costs. Annual societal cost savings totaled £1.4 million, mainly in reduced appointment-related travel, productivity and leisure time opportunity losses. Increased use of 6-monthly versus monthly or 3-monthly GnRHa therapy consistently achieved system-wide annual cost and capacity savings across all sensitivity analysis scenarios. CONCLUSIONS: Our holistic model suggests that switching/transitioning men from monthly or 3- monthly GnRHa therapy to a 6-monthly formulation can reduce NHS cost and capacity pressures and the societal and environmental costs associated with prostate cancer care.

Men with prostate cancer often receive hormone injections to slow their cancer progression and relieve their symptoms. In England, most men who are prescribed hormone injections receive them once every month or 3 months; however, a 6-monthly option would reduce the number of injection appointments required each year. If some men who are receiving hormone injections every month or every 3 months switched to treatment once every 6 months, it could reduce the impact of prostate cancer treatment on their lives. It might also reduce the demands of prostate cancer treatment on the National Health Service (NHS). We developed a computer-based model to assess how NHS costs and nursing would be affected if half of the men in England who are receiving hormone injections every month or 3 months switched to injections every 6 months. According to our model, this change could save the NHS about £5.2 million each year. The main cost savings would be in reduced nursing costs. The change would also benefit the NHS because nurses would have almost 150,000 fewer injections to give, meaning that they could spend their time providing care elsewhere. Given that men would have to attend fewer appointments, they would also benefit from reduced time traveling, which would benefit the environment as well. Overall, these benefits to society would contribute about £1.4 million of savings per year. Given how stretched the NHS is in England, particularly after the COVID-19 pandemic, opportunities to reduce time and staffing pressures are very important.

Optimal spatial evaluation of a pro rata vaccine distribution rule for COVID-19.

The COVID-19 Vaccines Global Access (COVAX) is a World Health Organization (WHO) initiative that aims for an equitable access of COVID-19 vaccines. Despite potential heterogeneous infection levels across a country, countries receiving allotments of vaccines may follow WHO's allocation guidelines and distribute vaccines based on a jurisdictions' relative population size. Utilizing economic-epidemiological modeling, we benchmark the performance of this pro rata allocation rule by comparing it to an optimal one that minimizes the economic damages and expenditures over time, including a penalty representing the social costs of deviating from the pro rata strategy. The pro rata rule performs better when the duration of naturally- and vaccine-acquired immunity is short, when there is population mixing, when the supply of vaccine is high, and when there is minimal heterogeneity in demographics. Despite behavioral and epidemiological uncertainty diminishing the performance of the optimal allocation, it generally outperforms the pro rata vaccine distribution rule.

Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study.

Background: Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Methods: Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. Results: A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. Conclusion: We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.

Physical Inactivity and Depression: The Gloomy Dual with Rising Costs in a Large-Scale Emergency.

At the end of October of 2022, the World Health Organization (WHO) released "the Global status report on physical activity 2022" [...].

Availability, price, and affordability of medicines used for the management of Covid-19 in health facilities of Dessie town WHO/HAI survey.

BACKGROUND: The rapidly spreading nature of Covid-19 virus associated with its high mortality and mortality rate is triggering an unprecedented public health crisis. The study assessed the availability, price, and affordability of medicines used in the management of Covid-19 in health facilities of Dessie town. METHODS: A retrospective cross-sectional study design was employed in the health facilities of Dessie town from September 1 to September 20, 2021. Data was collected using a standard checklist adopted from the Logistics Indicator Assessment Tool and WHO/HAI. WHO/HAI methodology was applied to select the surveyed health facilities (30) and medicines (44). The daily wage of the lowest-paid unskilled government worker is used to estimate affordability. RESULTS: Fifteen and five medicines were not found at all public and private health facilities, respectively. The originator brand (OB) and lowest price generic (LPG) availability in private health facilities was 2.03% and 51.33%, respectively. In the public sector, the availability of OB and LPG was 0% and 34.44%, respectively. In public and private health facilities, the mean number of stock-outs was 2.25 and 2.91, and the mean number of stock-out days was 177.83 and 106.16 days, respectively. Eight and one LPG medicines were out of stock in public and private health facilities, respectively. Eight (33.33%) and 6 (28.57%) had higher prices than international prices in private and public health facilities, respectively. The median price ratio in public and private health facilities ranged from 0.02 and 3.05 and 0.04 to 2.70, respectively. Eighty percent of the products were unaffordable in both sectors. CONCLUSIONS: The availability of medicines was low. One-third of the medicines had higher prices than international prices. Eighty percent of the products were unaffordable. The regular supply of these medicines is crucial for better management of the disease.