Contraceptive dynamics among women with disabilities in low- and middle-income countries: a scoping review protocol.

INTRODUCTION: Contraceptive dynamics is the use of contraception, unmet need, discontinuation, and/or switching of contraception. Women with disabilities (WWDs) in low- and middle-income countries (LMICs) face a common problem: a low prevalence of contraceptive usage and a high unmet need. Even though certain studies have been conducted in high-income countries, research is scarce on the degree of contraceptive method mix, unmet needs, contraception discontinuation, and switching among WWDs in LMICs. As a result, the scoping review's goal is to investigate, map available evidence, and identify knowledge gaps on contraceptive dynamics within LMICs WWDs. METHODS: The scoping review is guided by the six-stage Arksey and O'Malley methodology framework. Published articles will be retrieved from databases such as PubMed (MEDLINE), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health. Grey literature databases will be searched using electronic search engines such as Google Scholar, Google, OpenGrey, and Worldcat. In addition, a manual search of reference lists from recognized studies will be conducted, as well as a hand search of the literature. Any type of study design (e.g., randomized controlled trials, quasi-experimental studies, prospective and retrospective cohort studies, case-control or nested case-control studies, qualitative, cross-sectional studies) will be included in this scoping review. There will be no restrictions on publication year. Two independent reviewers will screen relevant publications, and data will be charted accordingly. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guidelines will be used to report all parts of the protocol and scoping review. DISCUSSION: When compared to non-disabled women, WWDs had a lower prevalence of contraceptive usage and a higher unmet need in LMICs. Despite these facts, they are the most marginalized people on the planet. This is, therefore, critical to map available evidence and identify knowledge gaps on contraceptive dynamics. As a result, the findings of this scoping review will be significant in terms of the contraceptive dynamic among WWDs in LMICs. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (OSF), with registration number; DOI/10.17605/OSF.IO/XCKPT.

Retrospective cross-sectional study examining the association between loneliness and unmet healthcare needs among middle-aged and older adults using the Canadian Longitudinal Study of Aging (CLSA).

OBJECTIVES: Our primary objective was to estimate the association between loneliness and unmet healthcare needs and if the association changes when adjusted for demographic and health factors. Our secondary objective was to examine the associations by gender (men, women, gender diverse). DESIGN, SETTING, PARTICIPANTS: Retrospective cross-sectional data from 44 423 community-dwelling Canadian Longitudinal Study on Aging participants aged 45 years and older were used. PRIMARY OUTCOME MEASURE: Unmet healthcare needs are measured by asking respondents to indicate (yes, no) if there was a time when they needed healthcare in the last 12 months but did not receive it. RESULTS: In our sample of 44 423 respondents, 8.5% (n=3755) reported having an unmet healthcare need in the previous 12 months. Lonely respondents had a higher percentage of unmet healthcare needs (14.4%, n=1474) compared with those who were not lonely (6.7%, n=2281). Gender diverse had the highest percentage reporting being lonely and having an unmet healthcare need (27.3%, n=3), followed by women (15.4%, n=887) and men (13.1%, n=583). In our logistic regression, lonely respondents had higher odds of having an unmet healthcare need in the previous 12 months than did not lonely (adjusted odd ratios (aOR) 1.80, 95% CI 1.64 to 1.97), adjusted for other covariates. In the gender-stratified analysis, loneliness was associated with a slightly greater likelihood of unmet healthcare needs in men (aOR 1.90, 95% CI 1.64 to 2.19) than in women (aOR 1.73, 95% CI 1.53 to 1.95). In the gender diverse, loneliness was also associated with increased likelihood of having an unmet healthcare need (aOR 1.38, 95% CI 0.23 to 8.29). CONCLUSIONS: Loneliness was related to unmet healthcare needs in the previous 12 months, which may suggest that those without robust social connections experience challenges accessing health services. Gender-related differences in loneliness and unmet needs must be further examined in larger samples.

What do young people know about HIV? Results of a cross sectional study on 18-24-year-old students.

Introduction: Increasing people's knowledge of transmission, prevention, early diagnosis, and available treatments is a key step toward HIV control; it means setting the conditions for empowerment and enabling individuals to make aware choices about the prevention strategy best suited to their needs. This study aims to identify unmet needs on HIV knowledge among freshman students. Methods: A cross sectional study was carried out at the University of Cagliari, which is an Italian public state university. Data were collected by means of an anonymous questionnaire; the final sample included 801 students. Results: Results offer a detailed picture of students' knowledge and perceptions of HIV. Several topics deserve to be better understood by students, but the main gaps relate to the pre-exposure prophylaxis and the decreased likelihood of sexually transmitting HIV due to early treatments. Students' vision of the quality of life of people living with HIV was negatively affected by perceiving as relevant the effects of HIV on physical health or on sexual/affective domains, while conversely, it seemed positively affected by knowing that current treatments are useful for counteracting physical symptoms and decreasing the possibility of transmitting HIV. Conclusion: Being aware of the potential benefits of current therapies could favour a less negative view, in line with the current state of the beneficial effects of HIV treatment. Universities are a valuable setting to bridge the HIV knowledge gap and thus also contribute to tackling stigma and actively promoting HIV testing.

Demanda asistencial en un Servicio de Pediatría durante el estado de alarma secundario a la COVID-19 / Demand for care in a Pediatric Service during the state of alarm secondary to COVID-19

Antecedentes y objetivos. La COVID-19 es una enfermedad producida por el virus SARS-CoV-2. En España,entre el mes de marzo y junio de 2020 se declaró el primer Estado de Alarma con el fin de contener la pandemia.Nuestro objetivo es evaluar la demanda asistencial y lasenfermedades que acudieron a Urgencias Pediátricas y quefueron ingresadas durante el tiempo que duró el primer Estado de Alarma, comparando con los mismos meses delos años 2018 y 2019.Resultados. Existe una reducción del número de ingresosde 345 a 141, un incremento de la complejidad demostrada por una mayor duración de los ingresos hasta 7,3±12,4 días(6,2±8,6 días en 2018 y 4,8±6,9 en 2019). Las enfermedades infecciosas (principalmente las respiratorias) descendieron, permaneciendo estables los ingresos por neoplasias, patología psiquiátrica, apendicitis y enfermedades circulatorias. EnUrgencias Pediátricas, en los años 2018 y 2019 (de 1 marzoa 30 junio) se atendieron 9.075 y 8.525 pacientes, mientras que en el 2020 se atendieron 2.215, aumentando el porcentajede ingresos procedentes de urgencias del 3,6% y 3,4% al 6%en 2020. Las enfermedades que aumentaron de forma más importante fueron las lesiones traumáticas y las intoxicaciones. Tanto en los ingresos como en urgencias existe unincremento en la edad de los pacientes. Conclusiones. El Estado de Alarma influyó en la presión asistencial y en el tipo de enfermedades atendidas enel Servicio de Pediatría, con una disminución del número de Urgencias y de ingresos, un incremento de la edad y unamodificación del tipo de enfermedades atendidas.

Introduction and objectives. COVID-19 is a disease caused by the SARS-CoV-2 virus. In Spain, between March and June 2020, the first State of Alarm was declared in order to contain the pandemic. Our objective is to evaluate the health care demand and the diseases that came to the Pediatric Emergency Department and were admitted during the time that the first State of Alarm lasted, comparing with the same months of the years 2018 and 2019.Results. There is a reduction in the number of admissions from 345 to 141, an increase in complexity demonstrated by a longer duration of admissions to 7.3±12.4 days (6.2 ± 8.6 days in 2018 and 4, 8±6.9 in 2019). Infectious diseases (mainly respiratory) decreased, with admissions for neoplasms, psychiatric pathology, appendicitis and circulatory diseases remaining stable. In Pediatric Emergencies, in the years 2018 and 2019 (from March 1 to June 30), 9,075 and 8,525 patients were attended, while in 2020, 2,215 were attended, increasing the percentage of admissions from the emergency room of 3.6% and 3.4% to 6% in 2020. The diseases that increased most significantly were traumatic injuries and poisonings. Both in admissions and in emergencies there is an increase in the age of the patients. Conclusions. The State of Alarm influenced the care pressure and the type of diseases treated in the Pediatric Service, with a decrease in the number of Emergencies and admissions, an increase in age and a modification of the type of diseases treated (AU)

Assistência de urgência e emergência: desafios no atendimento a múltiplas vítimas / Urgency and emergency assistance: challenges in caring for multiple victims / Urgencias y emergencias: retos en la atención a múltiples víctimas

A urgência e emergência, por sua vez, se faz como ocorrência imprevista com ou sem risco potencial à vida, onde o indivíduo necessita de assistência e pressupõem atendimento rápido, proporcional a sua gravidade. O presente trabalho tem o objetivo de promover reflexões acerca dos desafios que surgem diante do atendimento a múltiplas vítimas nos serviços médicos de urgência e emergência. Trata-se de uma revisão integrativa da literatura. Realizou-se uma análise de materiais já publicados na literatura e artigos científicos divulgados em bases de dados: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e Localizador de informação em Saúde. Foram encontradas nas bases de dados, 25 estudos completos, após a leitura dos resumos, 21 artigos foram selecionados para análise na íntegra, sendo 17 eleitos para integrar a revisão integrativa. Diante dos resultados obtidos, observou que as equipes de atendimento pré- hospitalar vivenciam desafios para atender múltiplas vítimas, e dentro desse paradigma existem várias etapas que devem ser seguidas, que envolvem comunicação desde um protocolo de atendimento inicial ao transporte final. Portanto, observa-se a necessidade de maiores estudos e desenvolvimento de novas tecnologias que auxiliam na assistência a múltiplas vítimas, como também o prepara e atualização dos profissionais.

Urgency and emergency, in turn, is made as an unforeseen occurrence with or without potential risk to life, where the individual needs assistance and quick care, in turn, proportional to its severity. The work of emergency care and the need to respond to problems presented in urgent and emergency services. This is an integrative literature review. An analysis was performed of materials already published in the literature and articles published in databases: Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online and Health Information Locator. All studies were complete, after reading the studies,21 articles were selected for full analysis, with 17 studies elected to integrate the integrative review. Results obtained, observed that pre care teams experience challenges to support various hospital communication protocols, and within these paradigms from initial care to transport. Therefore, there is a need for studies and development of technologies that assist in the installation of larger and more up-to-date devices, there is a need for studies and development of new technologies, as well as preparation.

La atención de urgencia y emergencia es un suceso imprevisto con o sin riesgo potencial para la vida, en el que el individuo necesita asistencia y requiere una atención rápida, proporcional a su gravedad. Este documento pretende promover la reflexión sobre los retos que surgen al tratar con múltiples víctimas en los servicios médicos de urgencia y emergencia. Se trata de una revisión bibliográfica integradora. Se ha realizado un análisis de los materiales publicados en la literatura y los artículos científicos divulgados en las bases de datos: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online y Localizador de información en Salud. Se encontraron en las bases de datos, 25 estudios completos, después de leer los resúmenes, se seleccionaron 21 artículos para el análisis en su totalidad, siendo 17 elegidos para integrar la revisión integradora. A partir de los resultados obtenidos, se observa que los equipos de atención prehospitalaria viven desafíos para atender a múltiples víctimas, y dentro de este paradigma existen varias etapas que deben seguirse, que implican la comunicación desde un protocolo de atención inicial hasta el transporte final. Por lo tanto, se observa la necesidad de realizar más estudios y desarrollar nuevas tecnologías que ayuden en la asistencia a las múltiples víctimas, así como la preparación y actualización de los profesionales.

Perception of pharmacists regarding human resources, training, and development of a national hospital pharmacy: a preliminary report on Basel Statements

Abstract The hospital pharmacy needs a constant process of evaluation and monitoring of its activities. In Brazil, several agencies establish tasks and duties for pharmacists, but little is known about the compliance and the perception of the professional regarding these policies. The present study aims to characterize the pharmacist's perception of Brazilian hospital pharmacy policies according to the Basel Statements. A search was performed for the contacts of all medium and high complexity hospitals in the country. Subsequently, a questionnaire elaborated following the Basel Statements was sent by e-mail to hospital pharmacists throughout the country. The domain analyzed was "Human Resources, Training, and Development". Statistical analyses were performed using SPSS 19.0. Pharmacists representing a total of 111 hospitals from all Brazilian regions answered the survey questionnaire and showed that more than half of the hospital pharmacists perceive themselves as not complying, whether in the service of local, national, or pharmaceutical education. Besides updating the professionals in relation to national policies, it is necessary that the representative bodies of the pharmaceutical class be more present in the elaboration and evaluation of the policies directed to human resources, seeking uniformity and the possibility of carrying out the activities required.

Perfil epidemiológico da clientela que busca atendimento em práticas integrativas e complementares / Epidemiological profile of the clientele that seeks assistance in integrative and complementary practices / Perfil epidemiológico de la clientela que busca asistencia en prácticas integradoras y complementarias

Objetivo: descrever o perfil epidemiológico da clientela que busca atendimento em Práticas Integrativas e Complementares. Método: pesquisa descritiva, tipo corte transversal e abordagem quantitativa, realizado com 104 indivíduos que buscaram atendimento em Práticas Integrativas e Complementares na Universidade Federal Fluminense. Resultados: houve predomínio de jovens de 19 a 30 anos com alta escolaridade. Apesar de 57 (76%) ingerem regularmente a água e 14 (79%) praticam atividade física três ou mais vezes/semana, 14 (18,9%) eram etilistas, sete (9,3%) tabagistas, três (4,2%) consumiam drogas ilícitas e 27 (39,6%) dedicavam-se "nada" ou "muito pouco" ao lazer. Apenas 29 (37,1%) possuíam boa disposição geral, nove (11,8%) bom humor e 10 (9,3%) sentiam-se tranquilos a maior parte do tempo. Apetite e sede normal foram relatados em 43 (56,5%) e 38 (49,3%) respectivamente e 59 (90,7%) exibiram problemas com o sono. Conclusão: o atendimento tem sido buscado pela população que manifesta certo grau de sofrimento mental

Objective: describe the epidemiological profile of the clientele that seeks assistance in Integrative and Complementary Practices. Method: descriptive, cross-sectional research and quantitative approach, conducted with 104 individuals who sought assistance in Integrative and Complementary Practices at Universidade Federal Fluminense. Results: there was a predominance of young people from 19 to 30 years old with high schooling. Although 57 (76%) regularly drink water and 14 (79%) practice physical activity three or more times/week, 14 (18,9%) were alcoholics, seven (9,3%) smokers, three (4,2%) used illicit drugs and 27 (39,6%) devoted "nothing" or "very little" to leisure. Only 29 (37,1%) had good general disposition, nine (11,8%) good mood and 10 (9,3%) felt calm most of the time. Normal appetite and thirst were reported in 43 (56,5%) and 38 (49,3%) respectively and 59 (90,7%) exhibited problems with sleep. Conclusion: care has been sought by the population that manifests a certain degree of mental suffering

Objetivo: describir el perfil epidemiológico de la clientela que busca asistencia en Prácticas Integrativas y Complementarias. Método: enfoque descriptivo, transversal y cuantitativo, realizado con 104 personas que buscaron asistencia en Prácticas Integrativas y Complementarias en la Universidad Federal Fluminense. Resultados: predominó la juventud de 19 a 30 años con estudios secundarios. Aunque 57 (76%) beben regularmente agua y 14 (79%) practican actividad física tres o más veces/semana, 14 (18,9%) eran alcohólicos, siete (9,3%) fumadores, tres (4,2%) usaron drogas ilícitas y 27 (39,6%) dedicaron "nada" o "muy poco" al ocio. Solo 29 (37,1%) tenían buen humor general, nueve (11,8%) estaban de buen humor y 10 (9,3%) se sentían tranquilos la mayor parte del tiempo. Se informaron apetito y sed normales en 43 (56,5%) y 38 (49,3%) respectivamente y 59 (90,7%) exhibieron problemas con el sueño. Conclusión: la población ha buscado atención que manifieste cierto grado de sufrimiento mental

Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs?

Due to demographic change with an ageing workforce, the proportion of employees with poor health and a need for medical rehabilitation is increasing. The aim was to investigate if older employees with migrant background have a different need for and utilization of medical rehabilitation than employees without migrant background. To investigate this, self-reported data from older German employees born in 1959 or 1965 of the first and second study wave of the lidA cohort study were exploratory analyzed (n = 3897). Subgroups of employees with migrant background were separated as first-generation, which had either German or foreign nationality, and second-generation vs. the rest as non-migrants. All subgroups were examined for their need for and utilization of medical rehabilitation with descriptive and bivariate statistics (chi-square, F- and post-hoc tests). Furthermore, multiple logistic regressions and average marginal effects were calculated for each migrant group separately to assess the effect of need for utilization of rehabilitation. According to our operationalizations, the foreign and German first-generation migrants had the highest need for medical rehabilitation while the German first- and second-generation migrants had the highest utilization in the bivariate analysis. However, the multiple logistic model showed significant positive associations between their needs and utilization of rehabilitation for all subgroups. Further in-depth analysis of the need showed that something like under- and oversupply co-exist in migrant groups, while the foreign first-generation migrants with lower need were the only ones without rehabilitation usage. However, undersupply exists in all groups independent of migrant status. Concluding, all subgroups showed suitable use of rehabilitation according to their needs at first sight. Nevertheless, the utilization does not appear to have met all needs, and therefore, the need-oriented utilization of rehabilitation should be increased among all employees, e.g. by providing more information, removing barriers or identifying official need with uniform standards.

Disaster Preparedness Training Needs of Healthcare Workers at the US Department of Veterans Affairs.

OBJECTIVES: Training healthcare workers in disaster preparedness has been shown to increase their willingness and ability to report to work during disasters. Little is known, however, about the relation between sociodemographic, household, and workforce characteristics and the desire for such training. Accordingly, this study aimed to assess healthcare workers' desire for additional workforce preparedness training, and the determinants that influence the need for such training, for three types of disasters (natural, pandemic, manmade). METHODS: The US Department of Veterans Affairs (VA) Preparedness Survey was a random, anonymous, Web-based questionnaire fielded nationwide (October-December 2018). Multivariate, logistic regression analyses were conducted. RESULTS: In total, 4026 VA employees, clinical and nonclinical, responded. A total of 61% of respondents wanted additional training for natural, 63% for pandemic, and 68% for manmade disasters. VA supervisors (natural: odds ratio [OR] 1.28, pandemic: OR 1.33, manmade: OR 1.25, P < 0.05) and clinicians (natural: OR 1.24, pandemic: OR 1.24, manmade: OR 1.24, P < 0.05) were more likely to report the need for additional training. Those who reported that they understood their role in disaster response were less likely to report the need for training (natural: OR 0.25, pandemic: OR 0.27, manmade: OR 0.28, P < 0.001), whereas those who perceived their role to be important during response (natural: OR 2.20, pandemic: OR 2.78, manmade: OR 3.13, P < 0.001), and those who reported not being prepared at home for major disasters (natural: OR 1.85, pandemic: OR 1.92, manmade: OR 1.94, P < 0.001), were more likely to indicate a need for training. CONCLUSIONS: Identifying which factors encourage participation in disaster preparedness training can help hospitals and other healthcare providers create targeted training and educational materials to better prepare all hospital staff for future disasters.

Caring Needs of Cancer Patients from the Perspective of Home Care Nurses: A Qualitative Study.

OBJECTIVE: Cancer is the third leading cause of death in Iran. Todays, caregiving to patients with cancer is shifting towards home based care, and home care needs from a caregiver's perspective can help improve the patient care. This qualitative study aimed to examine the home care needs of cancer patients from the perspective of home care nurses. METHODS: This is a qualitative descriptive study carried out at home care centers in the northwest of Iran. A total of 15 participants were recruited through purposive sampling and underwent face-to-face semi-structured interviews. Data were analyzed through Conventional content analysis method in MAXQDA software.  Measures of trustworthiness were established throughout the study using Lincoln and Guba's (1985) criteria (dependability, credibility, transferability, and confirmability). RESULTS: Data analysis resulted in the extraction of four main categories including physical needs (pain relief, gastrointestinal problems including nausea and anorexia and nutritional problems, lethargy, wound care), psychological support (need for hope and emotional support), educational needs (need for information and self-care) and financial support (service insurance coverage, charity support). To promote these patients home care, insurance coverage of nursing home care services was emphasized by the participants. CONCLUSION: Various aspects of cancer patients home care needs were identified. Interdisciplinary home-based palliative care collaboration is needed to address their physical, psychological, and moral needs.

Factors Influencing Demand for Medical Cannabis Use among Cancer Patients in the North of Thailand.

OBJECTIVE: Cancer treatments often cause side effects. Cannabis is a plant that has been studied and used to treat and relieve side effects from modern medicine. Medical cannabis (MC) was legalized in Thailand in 2019 with limited research on demand for its use. Therefore, this study aimed to identify factors associated with demand for MC use among cancer patients in the North of Thailand. METHODS: This analytical cross-sectional study administered a multistage random sampling to recruit 1,284 cancer patients in northern Thailand to response a self-administered structured questionnaire. Generalized Linear Mixed Model (GLMM) was used to identify the determinants of demand for MC use among the population, presented adjusted odds ratios (adj.OR), 95% confidence intervals (95% CI), and p-values. RESULT: Nearly half of the respondents reported demand to use MC (44.0%). The factors that were significantly associated with demand to use MC included had high levels of health literacy about MC (adj.OR = 5.70; 95% CI: 4.08 to 7.96), higher levels of social support (adj.OR =5.50; 95% CI: 3.60 to 8.39), positive attitudes toward MC use (adj.OR = 2.56; 95% CI: 1.83 to 3.56), aged less than 30 (adj.OR =1.89; 95% CI: 1.21 to 2.93), diagnosis with cancerfor more than 12 months ago (adj.OR =1.73; 95% CI: 1.19 to 2.52) when controlling effect of other covariates. CONCLUSION: We found substantial demand for MC use among cancer patients. Health literacy,social support, attitudes about MC, age, and duration of having cancer were significantly associated with demand for MC use. Therefore, improving health literacy and social support, especially among older cancer patients, could help increasing demand for MC as a complementary medicine to treat cancers.

Self-Reported Treatment Need and Barriers to Care for Adults With Opioid Use Disorder: The US National Survey on Drug Use and Health, 2015 to 2019.

Objectives. To explore barriers to care and characteristics associated with respondent-reported perceived need for opioid use disorder (OUD) treatment and National Survey on Drug Use and Health (NSDUH)‒defined OUD treatment gap. Methods. We performed a cross-sectional study using descriptive and multivariable logistic regression analyses to examine 2015-2019 NSDUH data. We included respondents aged 18 years or older with past-year OUD. Results. Of 1 987 961 adults, 10.5% reported a perceived OUD treatment need, and 71% had a NSDUH-defined treatment gap. There were significant differences in age distribution, health insurance coverage, and past-year mental illness between those with and without a perceived OUD treatment need. Older adults (aged ≥ 50 years) and non-White adults were more likely to have a treatment gap compared with younger adults (aged 18-49 years) and White adults, respectively. Conclusions. Fewer than 30% of adults with OUD receive treatment, and only 1 in 10 report a need for treatment, reflecting persistent structural barriers to care and differences in perceived care needs between patients with OUD and the NSDUH-defined treatment gap measure. Public Health Implications. Public health efforts aimed at broadening access to all forms of OUD treatment and harm reduction should be proactively undertaken. (Am J Public Health. 2022;112(2):284-295. https://doi.org/10.2105/AJPH.2021.306577).

Immigrants resettlement in developing countries: A data-driven decision tool applied to the case of Venezuelan immigrants in Colombia.

Immigrants' choice of settlement in a new country can play a fundamental role in their socio-economic integration. This is especially relevant if there are important gaps among these locations in terms of significant factors such as job opportunities, quality of health service, among others. This research presents a methodology to perform a recommended geographic redistribution of immigrants to improve their chances of socio-economic integration. The proposed methodology adapts a data-driven algorithm developed by the Immigration Policy Lab at Stanford University to allocate immigrants based on a socio-economic integration outcome across available locations. We extend their approach to study the immigration process between two developing countries. Specifically, we focus on the case of the arrival of immigrants from Venezuela to Colombia. We consider the absorptive capacity of locations in Colombia and include the health and education needs of immigrants in our analysis. From the application in the Venezuelan-Colombian context, we find that the proposed redistribution increases the probability that immigrants access formal employment by more than 50%. Furthermore, we identify variables associated with immigrants' formal employment and discuss specific strategies to improve the probability of success of vulnerable immigrants.

Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members.

Importance: Palliative care consultations in intensive care units (ICUs) are increasingly prompted by clinical characteristics associated with mortality or resource utilization. However, it is not known whether these triggers reflect actual palliative care needs. Objective: To compare unmet needs by clinical palliative care trigger status (present vs absent). Design, Setting, and Participants: This prospective cohort study was conducted in 6 adult medical and surgical ICUs in academic and community hospitals in North Carolina between January 2019 and September 2020. Participants were consecutive patients receiving mechanical ventilation and their family members. Exposure: Presence of any of 9 common clinical palliative care triggers. Main Outcomes and Measures: The primary outcome was the Needs at the End-of-Life Screening Tool (NEST) score (range, 0-130, with higher scores reflecting greater need), which was completed after 3 days of ICU care. Trigger status performance in identifying serious need (NEST score ≥30) was assessed using sensitivity, specificity, positive and negative likelihood ratios, and C statistics. Results: Surveys were completed by 257 of 360 family members of patients (71.4% of the potentially eligible patient-family member dyads approached) with a median age of 54.0 years (IQR, 44-62 years); 197 family members (76.7%) were female, and 83 (32.3%) were Black. The median age of patients was 58.0 years (IQR, 46-68 years); 126 patients (49.0%) were female, and 88 (33.5%) were Black. There was no difference in median NEST score between participants with a trigger present (45%) and those with a trigger absent (55%) (21.0; IQR, 12.0-37.0 vs 22.5; IQR, 12.0-39.0; P = .52). Trigger presence was associated with poor sensitivity (45%; 95% CI, 34%-55%), specificity (55%; 95% CI, 48%-63%), positive likelihood ratio (1.0; 95% CI, 0.7-1.3), negative likelihood ratio (1.0; 95% CI, 0.8-1.2), and C statistic (0.50; 95% CI, 0.44-0.57). Conclusions and Relevance: In this cohort study, clinical palliative care trigger status was not associated with palliative care needs and no better than chance at identifying the most serious needs, which raises questions about an increasingly common clinical practice. Focusing care delivery on directly measured needs may represent a more person-centered alternative.

Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021.

Importance: Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective: To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants: In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures: Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures: Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results: More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance: Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.

Global Burden of Orofacial Clefts and the World Surgical Workforce.

BACKGROUND: Orofacial clefts are one of the most common congenital anomalies, but this disease burden is unevenly distributed worldwide. The authors hypothesize that this burden falls disproportionately on the countries with the smallest surgical workforce or lowest Socio-Demographic Index, rather than those with the highest prevalence of disease. METHODS: The authors estimated the prevalence and disease burden of orofacial clefting from 1990 to 2017 in 195 countries using the Global Burden of Disease methodology. Prevalence and disability-adjusted life-years were compared geographically, temporally, and against the size of the national surgical workforce, Socio-Demographic Index, and income status. Linear and logarithmic regressions were performed. RESULTS: In 2017, the prevalence of orofacial clefting was estimated to be 10.8 million people, representing a disease burden of 652,084 disability-adjusted life-years, with most of this disease burden experienced by low- and middle-income countries (94.1%). From 1990 to 2017, there was a decrease in disease burden (-70.2%) and prevalence (-4.9%). There was negative logarithmic association between surgical workforce size and disease burden, with a surgical workforce of greater than six providers per 100,000 population (3.6 disability-adjusted life-years versus 22.4 disability-adjusted life-years per 100,000 population; p < 0.0001). CONCLUSIONS: Burden of orofacial clefting has a strong negative association with the size of the surgical workforce, suggesting that strengthening the surgical workforce will help alleviate this burden. Epidemiologic data on countries and regions with inadequate surgical workforces and high disease burden should guide future research efforts and allocation of resources, and guide the treatment and educational goals of international charitable organizations.

Unmet need of essential treatments for critical illness in Malawi.

BACKGROUND: Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. METHODS: We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). RESULTS: Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). CONCLUSION: There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.

Physicians' knowledge about palliative care in Bangladesh: A cross-sectional study using digital social media platforms.

INTRODUCTION: Palliative care is still a new concept in many developing countries like Bangladesh. Basic knowledge about palliative care is needed for all physicians to identify and provide this care. This study aims to assess the preliminary knowledge level and the misconceptions about this field among physicians. METHODS: This cross-sectional study was conducted among 479 physicians using a self-administered structured questionnaire adapted from Palliative Care Knowledge Scale (PaCKs) on various digital social media platforms from December 2019 to February 2020. Chi-square, Fisher's extract test, and the Monte Carlo extract test was done to compare the knowledge level with the study subjects' demographic variables. RESULTS: An almost equal number of physicians of both genders from four major specialties and their allied branches took part in the study (response rate 23.9%). The majority (71%) of the respondents had an average to an excellent level of knowledge about palliative care, with a median score of 11.0. Although most physicians had average knowledge about the primary goals and general concepts of palliative care, misconceptions are highly prevalent. The commonly present misconceptions were that palliative care discourages patients from consulting other specialties (88.9%), refrains them from taking curative treatments (83.1%), and this care is only for older adults (74.5%), cancer patients (63%), and the last six months of life (56.4%). Age, educational qualifications, and specialties had significant relationships (P<0.05) with the level of knowledge. CONCLUSION: Despite having average or above knowledge about palliative care, the physicians' prevailing misconceptions act as a barrier to recognizing the need among the target populations. So, proper education and awareness among the physicians are necessary to cross this field's barrier and development.