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Abstract Background Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them. Methods Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems. Results The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant. Conclusion ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn’t yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN’s economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.

Background Methods Results Conclusions Generalized myasthenia gravis (gMG) is characterized by fluctuating muscle weakness. Exacerbation frequency, adverse events (AEs) related to immunosuppressant therapy and healthcare resource utilization (HCRU) are not well understood. Our study aimed to describe long‐term clinical outcomes, drug‐related AEs and estimated HCRU in gMG patients.This was a retrospective cohort analysis of clinical data from patients with gMG followed‐up over eight consecutive years in a Spanish referral unit. Myasthenia Gravis Foundation of America (MGFA) clinical classification, MGFA post‐interventional status (MGFA‐PIS), Myasthenia Gravis Activities of Daily Living (MG‐ADL) score, exacerbations, MG crises, therapies, AEs reported, specialist consultations and emergency room visits were studied biannually. An estimation of HRCU was made based on these data.Some 220 patients newly diagnosed with gMG were included. Ninety percent were seropositive (84.5% anti‐acetylcholine receptor [AChR], 5.9% anti‐muscle‐specific kinase [MuSK]). Baseline mean MG‐ADL score was 5.04 points (SD 3.17), improving to 0.7 points (SD 1.40) after 8 years. Exacerbations were more frequent in years 1–2 (30.1%) but still occurred in years 7–8 (20.2%). Myasthenic crisis frequency remained 1% in years 7–8. Eighty‐nine percent achieved MGFA‐PIS minimal manifestations or better at 8 years. Fifty‐one percent of patients reported at least one AE during the study period, leading to drug withdrawal in approximately 20% of cases. HCRU decreased between years 1–2 to years 7–8 with an estimated cost of MG from 8074.19 € per patient/year to 1679.46 €, respectively.There is a group of MG patients that suffers from persistent symptoms and exacerbations (11%–20%) or MG crises, and drug AEs, which may increase disease burden and impact on the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them. Methods: Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems. Results: The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant. Conclusion: ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems. [ABSTRACT FROM AUTHOR]

BackgroundThe COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic.ObjectiveThe study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California.MethodsA pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6-week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores≥3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up.ResultsOf 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2≥3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (β=.27, 95% CI .10-.44; P=.002) and number of COVID-19-related behavior changes (β=.09, 95% CI .05-.13; P

BackgroundTelerehabilitation for musculoskeletal (MSK) conditions may produce similar or better outcomes than usual care, but most telerehabilitation studies address only chronic or postsurgical pain.ObjectiveWe aimed to examine pain and function at 3, 6, and 12 weeks for individuals with acute and subacute MSK pain who took part in a digital MSK program versus a nonparticipant comparison group.MethodsWe conducted an observational, longitudinal study with a nonparticipant comparison group. The intervention group had video visits with physical therapists who recommended exercise therapies and educational articles delivered via an app. Nonparticipants were those who were registered but unable to participate because their benefit coverage had not yet begun. We collected pain and function outcomes through surveys delivered at 3-, 6-, and 12-week follow-ups. We conducted descriptive analyses, unadjusted regression, and mixed effects regression adjusting for baseline characteristics, time as fixed effects, and a time*group interaction term.ResultsThe analysis included data from 675 nonparticipants and 262 intervention group participants. Compared to baseline, the intervention group showed significantly more pain improvement at 3, 6, and 12 weeks versus nonparticipants after adjusting for baseline factors. Specifically, the intervention group's pain scores decreased by 55.8% at 3 weeks versus baseline, 69.1% at 6 weeks, and 73% at 12 weeks. The intervention group's adjusted pain scores decreased from 43.7 (95% CI 41.1-46.2) at baseline to 19.3 (95% CI 16.8-21.8) at 3 weeks to 13.5 (95% CI 10.8-16.2) at 6 weeks to 11.8 (95% CI 9-14.6) at 12 weeks. In contrast, nonparticipants' pain scores decreased by 30.8% at 3 weeks versus baseline, 45.8% at 6 weeks, and 46.7% at 12 weeks. Nonparticipants' adjusted pain scores decreased from 43.8 (95% CI 42-45.5) at baseline to 30.3 (95% CI 27.1-33.5) at 3 weeks to 23.7 (95% CI 20-27.5) at 6 weeks to 23.3 (95% CI 19.6-27) at 12 weeks. After adjustments, the percentage of participants reporting that pain was better or much better at follow-up was significantly higher by 40.6% at 3 weeks, 31.4% at 6 weeks, and 31.2% at 12 weeks for intervention group participants versus nonparticipants. After adjustments, the percentage of participants with meaningful functional improvement at follow-up was significantly higher by 15.2% at 3 weeks and 24.6% at 12 weeks for intervention group participants versus nonparticipants.ConclusionsA digital MSK program may help to improve pain and function in the short term among those with acute and subacute MSK pain.

Acute pancreatitis (AP) is a significant gastrointestinal cause of hospitalization with increasing incidence. Risk stratification is crucial for determining AP outcomes, but the association between frailty and AP outcomes is poorly understood. Moreover, age disparities in severity indices for AP complicate risk assessment. This study investigates frailty's impact on local and systemic complications in AP, readmission rates, and healthcare resource utilization. Using the National Readmission Database from 2016 to 2019, we identified adult AP patients and assessed frailty using the Frailty Risk Score. Our analysis included local and systemic complications, resource utilization, readmission rates, procedures performed, and hospitalization outcomes. Multivariate regression was employed, and statistical significance was set at P < 0.05 using Stata version 14.2. Among 1,134,738 AP patients, 6.94 % (78,750) were classified as frail, with a mean age of 63.42 years and 49.71 % being female. Frail patients experienced higher rates of local complications (e.g., pseudocyst, acute pancreatic necrosis, walled-off necrosis) and systemic complications (e.g., pleural effusion, acute respiratory distress syndrome, sepsis, abdominal compartment syndrome) compared to non-frail patients. Frailty was associated with increased readmission rates and served as an independent predictor of readmission. Frail patients had higher inpatient mortality (7.11 % vs. 1.60 %), longer hospital stays, and greater hospitalization costs. Frailty in AP patients is linked to elevated rates of local and systemic complications, increased mortality, and higher healthcare costs. Assessing frailty is crucial in AP management as it provides a valuable tool for risk stratification and identifying high-risk patients, thereby improving overall outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the status quo of mental health prevention and control management facilities (MHPCMFs) up to 2020 in the mainland of China for providing evidence to the development of infrastructure and strategies of mental health prevention and control. MethodsThe information on the status of MHPCMFs at province, municipality/prefecture, and district/county level in 31 province-level administrative divisions (PLADs) across China was collected during May – June 2021 using a questionnaire designed by The National Mental Health Program Office. The organizational system and personnel of the MHPCMFs were analyzed. ResultsBy the end of 2020, totally 3 315 MHPCMFs were established at all PLADs, 99.70% of 333 municipalities/prefectures and 99.73% of 2960 districts/counties in the mainland of China. Of the established MHPCMFs, only 7 were independent legal entities and 3 308 were affiliated to health institutions or government departments, with 77.42% of the province-level and 76.51% of the municipality/prefecture-level MHPCMFs affiliated to mental health medical facilities and 61.25% of the county/district-level MHPCMFs affiliated to centers for disease control and prevention. The total number of personnel in the established MHPCMFs was 9 846, among which 34.43% were public health physicians, 17.79% were registered nurses, and 15.57% were psychiatrists and there were a few psychological therapists/counselors and social workers in the MHPCMFs. The average number of personnel engaged in services provided by the MHPCMFs was 0.7 for 100 000 population. The median number of staff was 6, 3 and 2 for the MHPCMFs at province-, municipality/prefecture-, and county/district-level, respectively. ConclusionThe management system for mental health promotion has been developed nationwide and at various administrative level across the mainland of China, but the established MHPCMFs were lack of mental health professionals, suggesting that professional allocation in the MHPCMFs needs to be improved.

Abstract Background Allocation of healthcare resources has a great influence on treatment and outcome of patients. This study aimed to access the inequality of ambulance allocation across regions, and estimate the associations between ambulance density and pre-hospital transfer time and mortality of acute coronary syndromes (ACS) patients. Methods This cross-sectional study was based on an integrated database of electronic medical system for 3588 ACS patients from 31 hospitals, ambulance information of 89 emergency medical stations, and public geographical information of 8 districts in Shenzhen, China. The primary outcomes were the associations between ambulance allocation and transfer delay and in-hospital mortality of ACS patients. The Theil index and Gini coefficient were used to assess the fairness and inequality degree of ambulance allocation. Logistic regression was used to model the associations. Results There was a significant inequality in ambulance allocation in Shenzhen (Theil index: 0.59), and the inequality of inter-districts (Theil index: 0.38) was greater than that of intra-districts (Theil index: 0.21). The gap degree of transfer delay, ambulance allocation, and mortality across districts resulted in a Gini coefficient of 0.35, 0.53, 0.65, respectively. Ambulance density was negatively associated with pre-hospital transfer time (OR = 0.79, 95%CI: 0.64,0.97, P = 0.026), with in-hospital mortality (OR = 0.31, 95%CI:0.14,0.70, P = 0.005). The ORs of Theil index in transfer time and in-hospital mortality were 1.09 (95%CI:1.01,1.10, P

Background: Cytomegalovirus (CMV), a common post‐transplant infection, is associated with increased healthcare resource utilization. In the Phase 3 SOLSTICE trial, maribavir was superior to investigator‐assigned therapy (IAT; valganciclovir/ganciclovir, foscarnet, and cidofovir) for CMV viremia clearance at Week 8 in transplant recipients with confirmed refractory CMV infection with/without resistance. This exploratory analysis evaluated hospital admissions of patients during the SOLSTICE trial. Methods: Patients were randomized to maribavir (400 mg twice daily) or IAT for an 8‐week treatment phase with a 12‐week follow‐up. After ≥3 weeks of treatment, patients on IAT who met pre‐specified criteria could enter a maribavir rescue arm (8‐week maribavir treatment, 12‐week follow‐up). Adjusted hospitalization rates and length of hospital stay (LOS) were estimated using negative binomial models adjusting for the time in the relevant study phase. Subgroup analysis for the maribavir rescue arm was conducted. Results: Overall, 352 patients were randomized (maribavir: 235; IAT: 117); 22 entered the maribavir rescue arm. After adjusting for treatment exposure, patients on maribavir had a 34.8% reduction in hospitalization rate and 53.8% reduced LOS (days/person/year) versus IAT during the treatment phase. No significant differences between treatments were observed during the follow‐up phase, although in both arms, hospitalization rates were lower than in the treatment phase. In the maribavir rescue arm, hospitalizations were 60.6% lower on/after maribavir rescue versus pre‐rescue treatment (p = 0.008). Conclusion: In patients requiring post‐transplant CMV treatment, hospitalization rate and LOS were lower for maribavir than IAT, and hospitalization rates were lower on/after maribavir rescue than pre‐rescue. Reducing hospitalizations can alleviate the burden on patients and healthcare systems. [ABSTRACT FROM AUTHOR]

This study identified the breastfeeding information and support needs of women with pre-pregnancy diabetes and as a result, developed an informed educational resource. The study utilised a mixed-methods design. Women with pre-pregnancy diabetes recruited from a health service in Melbourne and a consumer organisation were invited to complete a survey about perceptions of breastfeeding information and support. Health professionals were invited to participate in a focus group about breastfeeding resources for women with pre-pregnancy diabetes. An educational website was developed, and subsequently reviewed by women and an expert advisory panel. Six women completed the survey. Four health professionals attended a focus group. Both groups identified current sources of information about breastfeeding to be lacking, irrelevant and inapplicable to Australian conditions. A mobile-phone-friendly breastfeeding website was developed, based on the preferences of women and health professionals. Preliminary review indicates the website is informative, easy to read and appealing. It is important for health professionals to discuss breastfeeding support needs and preferences with women with pre-pregnancy diabetes at the earliest opportunity. Provision of tailored evidence-based breastfeeding information and support during pregnancy and the postpartum period will assist women with pre-pregnancy diabetes to make informed breastfeeding decisions, enhancing rates of breastfeeding intentions, initiation, and duration. [ABSTRACT FROM AUTHOR]

Through the capacity evaluation of private hospitals in China’s provinces in 2019，this study used the TOPSIS and RSR methods to comprehensively evaluate the capacity of private hospitals in 31 provinces in China to promote the formation of a diversified medical pattern of investment methods and investment entities. The range of evaluation result values of the TOPSIS method showed，the first ranking being Jiangsu Province and the 31st being Qinghai Province，there was a large gap between provinces. The RSR method disaggregation showed that the regression equation constructed with Probit values as the independent variable and the Ci values as the dependent variable was Ci =0.226 6 Probit-0.831 8（F=613.951 9，P<0.01，R2 = 0.954 9）. Private hospitals in Jiangsu Province，Henan Province，Sichuan Province，Shandong Province and Guangdong Province line in the first rank in the evaluation of medical service capacity. This study suggests that it is essential to narrow down the differences in the allocation of private medical resources between regions， encourage social medical and improve the quality of medical services while strengthening the construction of talent teams in these private hospitals to help reduce the significant differences in medical service capacity among private hospitals in various provinces in China. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students' access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants' sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Allocation of healthcare resources has a great influence on treatment and outcome of patients. This study aimed to access the inequality of ambulance allocation across regions, and estimate the associations between ambulance density and pre-hospital transfer time and mortality of acute coronary syndromes (ACS) patients. Methods: This cross-sectional study was based on an integrated database of electronic medical system for 3588 ACS patients from 31 hospitals, ambulance information of 89 emergency medical stations, and public geographical information of 8 districts in Shenzhen, China. The primary outcomes were the associations between ambulance allocation and transfer delay and in-hospital mortality of ACS patients. The Theil index and Gini coefficient were used to assess the fairness and inequality degree of ambulance allocation. Logistic regression was used to model the associations. Results: There was a significant inequality in ambulance allocation in Shenzhen (Theil index: 0.59), and the inequality of inter-districts (Theil index: 0.38) was greater than that of intra-districts (Theil index: 0.21). The gap degree of transfer delay, ambulance allocation, and mortality across districts resulted in a Gini coefficient of 0.35, 0.53, 0.65, respectively. Ambulance density was negatively associated with pre-hospital transfer time (OR = 0.79, 95%CI: 0.64,0.97, P = 0.026), with in-hospital mortality (OR = 0.31, 95%CI:0.14,0.70, P = 0.005). The ORs of Theil index in transfer time and in-hospital mortality were 1.09 (95%CI:1.01,1.10, P < 0.001) and 1.80 (95%CI:1.15,3.15, P = 0.009), respectively. Conclusions: Regional inequities existed in ambulance allocation and has a significant impact on pre-hospital transfer delay and in-hospital mortality of ACS patients. It was suggested to increase the ambulance accessibility and conduct health education for public. [ABSTRACT FROM AUTHOR]

Cardiometabolic disease in patients with severe mental illness is a major cause of shortened life expectancy. There is sparse evidence of real-world clinical risk prevention practice. We investigated levels of assessments of cardiometabolic risk factors and risk management interventions in patients with severe mental illness in the Norwegian mental health service according to an acknowledged international standard. We collected data from 264 patients residing in six country-wide health trusts for: (a) assessments of cardiometabolic risk and (b) assessments of levels of risk reducing interventions. Logistic regressions were employed to investigate associations between risk and interventions. Complete assessments of all cardiometabolic risk variables were performed in 50% of the participants and 88% thereof had risk levels requiring intervention according to the standard. Smoking cessation advice was provided to 45% of daily smokers and 4% were referred to an intervention program. Obesity was identified in 62% and was associated with lifestyle interventions. Reassessment of psychotropic medication was done in 28% of the obese patients. Women with obesity were less likely to receive dietary advice, and use of clozapine or olanzapine reduced the chances for patients with obesity of getting weight reducing interventions. Nearly nine out of the ten participants were identified as being at cardiometabolic high risk and only half of the participants were adequately screened. Women with obesity and patients using antipsychotics with higher levels of cardiometabolic side effects had fewer adequate interventions. The findings underscore the need for standardized recommendations for identification and provision of cardiometabolic risk reducing interventions in all patients with severe mental illness. [ABSTRACT FROM AUTHOR]

目的 研究山东省县（区、市）级妇幼保健机构资源效率的空间分布特征及聚集性, 为妇幼保健机构资源效率的提升提供科学依据。方法 用ArcGIS 10.5软件进行Moran’s Ⅰ空间自相关分析和Getis-Ord Gi*热点分析。结果 目前, 山东省还有13家（占9.42%）基层妇幼保健机构没有开展门诊服务, 41家（占29.71%）未开展住院服务。山东省基层妇幼保健机构的日均住院工作负担和床位使用率呈空间正相关(Moran’s Ⅰ住院工作负担=0.194, P=0.001；Moran’s Ⅰ床位使用率=0.223, P ＜ 0.001)。Getis-Ord Gi*热点分析显示, 日均门急诊工作负担、日均住院工作负担和床位使用率均存在热点和冷点聚集区域。其中, 热点区域主要分布在临沂、潍坊和烟台等市, 冷点区域主要分布在济南市、青岛市、东营市和菏泽市。结论 山东省基层妇幼保健机构的资源使用效率指标具有空间异质性, 应密切关注冷热点区域, 分类指导、统筹规划, 提高妇幼保健资源的利用效率。 [ABSTRACT FROM AUTHOR]

Background: In China, a developing country, the imbalance of development exists in different fields, and the inequalities in the distribution of healthcare services have garnered increasing attention. This study aimed to assess the healthcare services allocation and compare the latest distribution ratios of the essential healthcare indicators with the national requirement values announced by the government to research the level of healthcare development in China. Methods: Data were extracted from the Chinese Statistical Yearbook (2010–2019). The Healthcare Resource Density Index (HRDI) was used to evaluate equity in the demographic and geographical dimensions. The requirement values related to the ratio of doctors, nurses, and institution beds per thousand people were drawn from government documents. The data of healthcare serviceability indicators were compared with those requirements to check the situation of each province's medical development. Results: From 2010 to 2018, there was a sustainable upward trend in government investment, however, a noticeable drop in the investment in northeast areas was seen. Although the HRDI of the institutions, beds, doctors, and nurses experienced some small fluctuations over the years, the developing areas in the middle-west areas had almost approached the level of developed east areas. There were only four provinces that met the requirements of the government in all three indicators (the ratio of institution beds, doctors, and nurses per thousand people). Conclusion: The equality of the distribution of healthcare services in China was unfair between the eastern and middle-western areas. The government launched the developing requirements and paid additional attention to narrowing the imbalance among different economic level regions to meet the needs of the local people. Although many provinces did not meet the requirements for medical resources in 2019, the distribution of healthcare services was approached relatively equitably countrywide. [ABSTRACT FROM AUTHOR]

Background: Self-help interventions have the potential to increase access to evidence-based mental health care. Self-help can be delivered via different formats, including print media or digital mental health interventions (DMHIs). However, we do not know which delivery format is more likely to result in higher engagement. Objective: The aims of this study were to identify if there is a preference for engaging in print media versus DMHIs and whether there are individual differences in relative preferences. Methods: Participants were 423 adults between the ages of 18 and 82 years (201/423, 47.5% female) recruited on Prolific as a nationally representative sample of the US population, including non-Hispanic White (293/423, 69.2%), non-Hispanic Black (52/423, 12%), Asian (31/423, 7%), Hispanic (25/423, 6%), and other individuals (22/423, 5%). We provided individuals with psychoeducation in different self-help formats and measured their willingness to use print media versus DMHIs. We also assessed participants' demographics, personality, and perception of each format's availability and helpfulness and used these to predict individual differences in the relative preferences. Results: Participants reported being more willing to engage with print media than with DMHIs (B=0.41, SE 0.08; t422=4.91; P<.001; d=0.24, 95% CI 0.05-0.43). This preference appeared to be influenced by education level (B=0.22, SE 0.09; t413=2.41; P=.02; d=0.13, 95% CI -0.06 to 0.32), perceived helpfulness (B=0.78, SE 0.06; t411=13.66; P<.001; d=0.46, 95% CI 0.27-0.66), and perceived availability (B=0.20, SE 0.58; t411=3.25; P=.001; d=0.12, 95% CI 0.07-0.30) of the self-help format. Conclusions: This study suggests an overall preference for print media over DMHIs. Future work should investigate whether receiving mental health treatment via participants' preferred delivery format can lead to higher engagement. [ABSTRACT FROM AUTHOR]

Purpose: The present study aims to evidence the origin of resources, the implementation and distribution processes of the emergency benefit destined to the popular classes, comparing with Lowi's distributive theory, and justify the control and accountability. Methodology: A literature review was conducted regarding Lowi's approach to distributive theory and a documentary research in federal executive transparency sites for the construction of this theoretical essay. Results: The results point to the existence of a mere mutation of the origins of resources in education and health, for the Ministry of Citizenship leaving doubts about whether there was effectiveness of investments. The emergency benefit immediately serves the most disadvantaged people but does not repair the permanent damage of the trajectory of vulnerability and sub citizenship of the population of the popular classes. The control action and accountability of resources by the Federal Court of Auditors shows that there was a lack of focus on social policy, as predicted by Lowi's distributive theory (Marcuso & Moreira, 2013). Contributions of the Study: In the academic and scientific sphere, this study contributes to the debate of Lowi's distributive theory applied in contingency situations, such as in the context of covid's pandemic 19. For society, its contributions permeate the need for more transparent, reliable information and greater comprehensibility of the use and origins of public resources to avoid budgetary manipulations. And the need for intervention of controlling institutions to ensure the proper use of the public office. [ABSTRACT FROM AUTHOR]

Based on the three⁃stage SBM model and the Malmquist index method，the article conducted static and dynamic evaluation of the allocation efficiency of medical and health resources in 31 provinces and cities (excluding Hong Kong，Macao and Taiwan regions) in China from 2015 to 2020. The results showed that after eliminating environmental factors and random errors，the average comprehensive efficiency of health resource allocation in China from 2015 to 2020 was 0.720，and the average total factor productivity was 0.937. Among them，the technological progress index decreased by 5.4%，the pure technical efficiency change index decreased by 0.7%，and the scale efficiency change index decreased by 0.3%. From 2015 to 2020，the overall efficiency of health resource allocation in China is low and on a downward trend，with obvious constraints on technological progress. There are large differences in the allocation efficiency between regions and provinces； regional gross domestic product，resident population and urbanization levels have a significant impact on allocation efficiency. It is suggested to improve efficiency based on appropriate development scale and driven by technological progress；focusing on regional coordination，enhancing the balance，fairness and accuracy of health resource input；and using the improvement of the external environment as a breakthrough，to improve the health service system. [ABSTRACT FROM AUTHOR]

Background: Autistic adults experience barriers to accessing health care, such as service provider communication not meeting their needs, healthcare facilities causing sensory discomfort and feeling fear or anxiety regarding their healthcare visit. The Academic Autism Spectrum Partnership in Research and Education (AASPIRE) developed and trialled an online healthcare toolkit to reduce such barriers and improve healthcare interactions between autistic adults and their primary care providers in the United States. This preliminary study aimed to explore experiences of autistic adults using the AASPIRE Healthcare Toolkit in Australia. Methods: Semi-structured interviews were conducted with six autistic adults about their experiences and perceptions of utilising the toolkit in an Australian healthcare setting. Results: Participants identified that the toolkit facilitated their interactions with health professionals by providing structure to appointments, supplementing new knowledge and increasing individual confidence. They also offered suggestions to tailor the toolkit for use in Australia. Conclusions: Future research should seek to explore the experiences of autistic adults using a version of the toolkit adapted for Australian use, as well as exploring the views of health professionals utilising it. Autistic adults often experience barriers to accessing health care and have negative healthcare experiences. We wanted to know if an online healthcare toolkit developed with autistic adults to improve healthcare interactions between them and their primary care providers in the US, could be used in Australia. We interviewed six Australian autistic adults about using the toolkit, with positive feedback. An Australian-adapted healthcare toolkit may potentially improve the healthcare experiences of autistic adults living in Australia. [ABSTRACT FROM AUTHOR]

Kengo Tokunaga 1Chihiro Suzuki 2Miyuki Hasegawa 2Ikuo Fujimori 21Department of General Medicine, Kyorin University School of Medicine, Tokyo, Japan; 2Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan Correspondence: Kengo TokunagaDepartment of General Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, JapanTel +81-422-47-5511Email kentoku@ks.kyorin-u.ac.jp Objective: Cost-benefit is an important consideration for Helicobacter pylori (H. pylori) eradication in Japan, where 1.5 million patients were reported to receive first-line eradication annually. This study aimed to identify the optimal cost-saving triple therapy regimen for H. pylori eradication in Japan.Materials and Methods: This retrospective observational study used data from a largescale, nationwide health insurance claims database (2015‒2018). Using success rates of first-line eradication, mean total costs of first-line and second-line eradications per patient were compared between regimens including a potassium-competitive acid blocker (P-CAB) or a proton pump inhibitor (PPI), and between two clarithromycin (CAM) doses (400 and 800 mg/day). Subgroup analyses by smoking habit or body mass index (BMI) were performed.Results: Among propensity score (age, gender, CAM dose, disease name)-matched patients (P-CAB regimen, n=22,002; PPI regimen, n=22,002), total costs were lower with the P-CAB than the PPI regimen (Japanese yen [JPY] 12,952 vs 13,146) owing to significantly higher first-line eradication rates with the P-CAB regimen (93.6% vs 79.7%; p

Patients today have access to an increasing number of health resources to guide medical decision making, including specialist health care providers, the Internet, friends, and family members. No prior studies, to our knowledge, have comprehensively explored health information–seeking behavior (HISB) for patients being managed for shoulder pain. Our primary objective is to identify which health resources patients use and find helpful in a cohort of patients being either evaluated or managed for shoulder pain. With increased access to the Internet and its use, we also hope to quantify the extent of use of Internet resources and identify predictors of patient use. We interviewed a cohort of new and follow-up patients being surgically or nonoperatively managed for shoulder pain by a single fellowship-trained orthopedic surgeon. All patients were administered a questionnaire to determine HISB, which evaluated the types of resources used and those deemed most helpful in guiding medical decision making. For patients using the Internet, specific websites were documented. Additional variables that were collected included age, gender, ethnicity, and highest education attained. Multivariable logistic regression was used to evaluate predictors of Internet use. This study included 242 patients. A discussion with an orthopedic surgeon was reported to be the most informative for nonoperatively treated patients, first postoperative patients, and operative follow-up patients. Patients at the first postoperative visit reported YouTube as their preferred resource almost 4 times more than new patients (odds ratio [OR] 3.9, P =.015). Search engine use was significantly higher in patients at the first postoperative visit (OR 5.8, P =.004) and patients at subsequent surgical follow-up (OR 8.3, P =.001) compared with new patients. Having an undergraduate (OR 0.1, P =.037) or graduate degree (OR 0.03, P =.01) had a significant inverse association with difficulty of using Internet resources. Patients of Black race reported significantly higher rates of distrust for Internet resources than those of White race (OR 5.8, P <.001). This study highlights the patterns of HISB among patients with shoulder conditions. A face-to-face discussion with a physician or a shoulder surgeon was the most crucial resource for information compared to other resources. This study has also defined the preferred Internet resources for patients at different time points of care and the reasons for refraining from seeking health information on the Internet. Such findings can aid shoulder surgeons in understanding the optimal methods for delivering health information for different patient demographics and different phases of their care. [ABSTRACT FROM AUTHOR]

Background: Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. Objective: This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant's responses. Methods: Individuals aged =15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant's responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. Results: A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). Conclusions: This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use. [ABSTRACT FROM AUTHOR]

Simple Summary: Cancer patients who receive radiotherapy often suffer from adverse effects that require healthcare resources to manage. This study summarized evidence of healthcare resource use and costs related to radiotherapy-induced adverse effects and provided recommendations for including this evidence in economic evaluations. Our findings revealed unignorable differences for the same adverse effects, which implied that the potential for the economic burden of adverse effects was overestimated or underestimated. Background: Despite the need for a proper economic evaluation of new radiotherapies, the economic burden of radiotherapy-induced adverse effects remains unclear. A systematic review has been conducted to identify the existing evidence of healthcare resource use and costs related to radiotherapy-induced adverse effects and also to provide recommendations for including this evidence in economic evaluations. Methods: This systematic review of healthcare resource use and/or medical costs related to radiotherapy-induced adverse effects was performed up until 2020, focusing on patients with head and neck cancer, brain cancer, prostate cancer, eye cancer and breast cancer. Results: Resource use for treating the same adverse effects varied considerably across studies; for instance, the cost for mucositis ranged from USD 2949 to USD 17,244. This broad range could be related to differences in (1) severity of adverse effects in the study population, (2) study design, (3) cost estimation approach and (4) country and clinical practice. Conclusions: Our findings revealed unignorable differences for the same adverse effects, which implied that the potential for the economic burden of adverse effects was being overestimated or underestimated in economic evaluation for radiotherapy. [ABSTRACT FROM AUTHOR]

Abstract Background Few recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America. Methods This analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries. Results The proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption. Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p

Background: Occupational noise-induced deafness (ONID) has replaced occupational poisoning as the second most common occupational disease in China since 2015. However, there is a limited number of articles on epidemiological characteristics of legally diagnosed ONID., Objective: We conducted a comprehensive analysis of the epidemiological and spatiotemporal characteristics of ONID in Guangdong Province from 2006 to 2022, with the aim of providing a scientific foundation for policy formulation and health resource allocation., Methods: Surveillance data of ONID cases in Guangdong Province from 2006 to 2022 were obtained from the "Occupational Diseases and Health Hazard Factors Monitoring Information System." Joinpoint regression analysis was applied to assess the long-term trends in cases of ONID from 2006 to 2022. Global spatial autocorrelation analysis was performed to measure the overall degree of similarity of the attribute values of spatially adjacent or neighboring regional units. The local indicators of spatial autocorrelation (LISA) plots were then used to identify the local clusters of ONID in Guangdong., Results: There were 3761 ONID cases in Guangdong Province from 2006 to 2022, showing a significantly increased trend in cases across the entire study period (average annual percentage change 21.9, 95% CI 18.7-35.1). The Moran's I values for the period of 2006 to 2022 ranged from 0.202 to 0.649 (all P<.001), indicating a positive spatial correlation of ONID across regions each year in Guangdong Province. A total of 15 high-high clusters were notably concentrated in specific counties within the Pearl River Delta., Conclusions: Significant spatiotemporal patterns of ONID in Guangdong Province from 2006 to 2022 were identified, characterized by a dramatic increase followed by stabilization in case numbers. ONID predominantly occur in manufacturing industries, domestically funded enterprises, among males, individuals aged 40-49 years, and those with 5+ years of occupational noise exposure. Spatial analysis demonstrated significant clustering in the Pearl River Delta region, with consistent positive spatial autocorrelation across years. These results could help prioritize the allocation of resources for targeted prevention and control measures for ONID., (© Shanyu Zhou, Yongshun Huang, Lin Chen, Xianzhong Wen, Shu Wang, Lang Huang, Xudong Li. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Abstract Introduction We evaluated the cost‐effectiveness of the “More at Home with Dementia” intervention, a multicomponent training program for co‐residing caregivers of people with dementia (PwDs). Methods We performed a two‐armed randomized controlled trial with an intervention and a control group. Participants were community‐dwelling caregivers living with a person with dementia (59 randomized to intervention and 50 to control arm). The training program lasted 5 days and took place in a holiday accommodation. Quality‐adjusted life‐years (QALYs) were calculated using the EuroQol‐5 Dimensions 3 Levels (EQ‐5D‐3L) for caregivers and PwDs. Costs for informal and formal social care, as well as health care, were collected at four times over a 6‐month period from baseline. Information on nursing home admission or death was collected for 2 years after baseline. Results QALYs for caregivers and PwDs added together were 0.12 higher in the intervention group compared with the control group (P = .11). After 1 year, there tended to be fewer nursing home admissions in the intervention group, but this difference was lost by 2 years (P = .19). The cost of the intervention was estimated at €1000 (USD 1090) per dyad. Compared with the control group, the intervention group used other health care and formal social care significantly less for a year after baseline (P = .02 and .001, respectively). The estimated decrease in total costs was €10,437 (P = .07), with an estimated 96% probability that the intervention was cost‐effective vs usual care. Discussion The multicomponent “More at Home with Dementia” training program is effective and appears to save costs compared with usual care. Savings appear to be achieved by delaying nursing home admissions and by reducing the use of other care resources. Further research is also needed to clarify if this intervention is effective for caregivers who do not live with a PwD, such as adult children, and for the caregivers of patients with other debilitating chronic diseases. At the same time, effort is advised to implement caregiver training in standard care programs.

Introduction:We evaluated the cost-effectiveness of the "More atHome with Dementia" intervention, a multicomponent training program for co-residing caregivers of people with dementia (PwDs). Methods: We performed a two-armed randomized controlled trial with an intervention and a control group. Participants were community-dwelling caregivers living with a person with dementia (59 randomized to intervention and 50 to control arm). The training program lasted 5 days and took place in a holiday accommodation. Qualityadjusted life-years (QALYs) were calculated using the EuroQol-5 Dimensions 3 Levels (EQ-5D-3L) for caregivers and PwDs. Costs for informal and formal social care, as well as health care, were collected at four times over a 6-month period from baseline. Information on nursing home admission or death was collected for 2 years after baseline. Results:QALYs for caregivers and PwDs added together were 0.12 higher in the intervention group compared with the control group (P = .11). After 1 year, there tended to be fewer nursing home admissions in the intervention group, but this difference was lost by 2 years (P = .19). The cost of the intervention was estimated at €1000 (USD 1090) per dyad. Compared with the control group, the intervention group used other health care and formal social care significantly less for a year after baseline (P=.02 and .001, respectively). The estimated decrease in total costs was €10,437 (P=.07), with an estimated 96% probability that the intervention was cost-effective vs usual care. Discussion: The multicomponent "More at Home with Dementia" training program is effective and appears to save costs compared with usual care. Savings appear to be achieved by delaying nursing home admissions and by reducing the use of other care resources. Further research is also needed to clarify if this intervention is effective for caregivers who do not live with a PwD, such as adult children, and for the caregivers of patients with other debilitating chronic diseases. At the same time, effort is advised to implement caregiver training in standard care programs. [ABSTRACT FROM AUTHOR]

Young people use social media to communicate about suicide, however, they often feel ill‐equipped to share their own experiences or to respond to expressions of risk by others. Aims: To describe the adaptation of the Australian #chatsafe guidelines for an international audience, and their initial roll out via social media. Methods: An online survey (n = 48) and two workshops (n = 47) conducted between August and December 2019. Thirty‐eight countries were represented. Results: Minimal adaptation of the Australian guidelines was required however, an abbreviated version and a suite of social media assets were developed. In the 6 weeks following publication the international guidelines were downloaded ~4100 times and the social media content reached over one million young people. Conclusion: The fact that the guidelines and campaign content appear to have had such success speaks to the need for young people to feel better equipped to communicate safely about suicide online. [ABSTRACT FROM AUTHOR]

Aim: To investigate: (1) the types of health information, resources, and supports available to consumers in hospital outpatient waiting areas and (2) whether these are accessed by consumers. Background: Outpatient waiting areas commonly offer health information, resources, and supports to improve the health literacy of waiting consumers. It is not known what is available to or accessed by consumers in hospital outpatient rehabilitation waiting areas. Methods: A multicenter, prospective, observational, cross-sectional study was conducted in the waiting areas of two hospital outpatient rehabilitation services. Direct observations (in person and video recordings) of the waiting areas were used to describe what health information, resources, and supports were available and, if present, what was being accessed and for how long by consumers. Results: Fifteen hours of in-person and video-recorded observations were documented on purpose-designed instruments across the two sites during 18 observation sessions over 8 days. A total of 68 different health information and resources were identified. Approximately half were specifically for consumers (Site 1: 57%; Site 2: 53%). Only seven (10%) were accessed by consumers across both sites. Each resource (n = 7) was only accessed once. Health resources were used by consumers for 0.8% (3/360 min) of the observation time at each site. Health and social supports and use of other non health resources were also observed. Conclusions: Available health information, resources, and supports were infrequently and briefly accessed by consumers. Further research is required to explore what consumers want and need to improve the health literacy responsiveness of hospital outpatient waiting areas. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to estimate the equity and efficiency of traditional Chinese medicine (TCM) health resource allocation, utilization, and trend in mainland China from 2013 to 2017.Methods: The data were downloaded from the China Health Statistical Yearbook (2014–2018) and the China Statistical Yearbook (2018). The equity of TCM health resource allocation was evaluated through the Lorenz curve, Gini coefficient (G), and Theil index (T) based on population size and geographical area. The efficiency and productivity of TCM health resource utilization were assessed using the data envelopment analysis-based Malmquist productivity index.Results: TCM health resource had an increasing trend every year. The equity allocated by population (G ranging from 0.1 to 0.3) was better than that by geographic region (G > 0.5). T in the intra-groups was higher than those in the inter-groups. The equity of TCM resource allocation was the middle region > eastern region > western region. Most provinces (29 out of 31) had negative productivity changes, suggesting deterioration in productivity. Moreover, the middle region with higher scale sizes had more redundant inputs than the other two regions. However, the low technological development (all technical values 1) had increased since 2015. However, the frequency distribution of technical change (score > 1) decreased every year. The slow technological progress and low scale size might be the main reasons for low productivity.

Jessica Himmelstein, William S Wright, Michael W Wiederman Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA Purpose: The United States has an increasing population of individuals with limited English proficiency (LEP). Language access is a right for individuals with LEP in the health care system. As such, it is important for medical providers to be appropriately trained to work with individuals with LEP. Therefore, the purpose of this study was to describe curricula offered by United States medical schools to teach medical students to work with medical interpreters and/or patients with LEP.Methods: An electronic survey was sent in March 2017 to administration at the 147 Liaison Committee on Medical Education® accredited medical schools as of November 7, 2016. The survey consisted of the following question: “As part of your medical school’s curriculum, are students provided specific instruction addressing how to work with medical interpreters and/or patients with limited English proficiency (LEP)?” with different follow-up questions for schools that responded “Yes” vs “No”.Results: Responses were received from 26% (38/147) of medical schools. Among schools responding to the survey, 76% (29/38) offered a curriculum that provides instruction of how to work with medical interpreters and/or patients with LEP. Of schools that provide instruction, teaching methods included didactic sessions (34% [10/29]) and standardized patient experiences (34% [10/29]). In addition, 76% (22/29) offer training in the first 2 years of medical school and 28% (8/29) offer training in the third and fourth years of the curriculum. Sixty-two percent (18/29) of respondents that offered a formal curriculum have been administering a formal curriculum for ≤10 years.Conclusion: The majority of the responding medical schools offer formal instruction of how to work with medical interpreters and/or patients with LEP. Most schools started this type of instruction in the last 10 years with most instruction occurring in the first 2 years of an undergraduate medical curriculum. Keywords: health resource, culturally competent care, health services administration, education, survey

Aim: To determine the incidence, risk factors and health service utilisation for infection in the first 12 months of life in a population-derived Australian pre-birth cohort.Methods: The Barwon Infant Study is a population-derived pre-birth cohort with antenatal recruitment (n = 1074) based in Geelong, Victoria, Australia. Infection data were collected by parent report, and general practitioner and hospital records at 1, 3, 6, 9 and 12 months of age. We calculated the incidence of infection, attendance at a health service with infection and used multiple negative binomial regression to investigate the effects of a range of exposures on incidence of infection.Results: In the first 12 months of life, infections of the upper and lower respiratory tract (henceforth 'respiratory infections'), conjunctivitis and gastroenteritis occurred at a rate of 0.35, 0.04 and 0.04 episodes per child-month, respectively. A total of 482 (72.4%) infants attended a general practitioner with an infection and 69 (10.4%) infants attended the emergency department. Maternal antibiotic exposure in pregnancy and having older siblings were associated with respiratory infection. Childcare attendance by 12 months of age was associated with respiratory infections and gastroenteritis. Breastfeeding, even if less than 4 weeks in total, was associated with reduced respiratory infection.Conclusion: Infection, especially of the respiratory tract, is a common cause of morbidity in Australian infants. Several potentially modifiable risk factors were identified, particularly for respiratory infections. Most infections were managed by general practitioners and 1 in 10 infants attended an emergency department with infection in the first year of life. [ABSTRACT FROM AUTHOR]

Pre‐hospital providers (PHPs) undertake initial patient assessment, often spending considerable time with patients prior to arrival at ED. However, continuity of this assessment with ongoing care of patients in the ED is limited, with repeated assessment in the ED, starting with the process of triage in hospital. A systematic review of the literature was conducted to assess the ability of PHPs to predict patient outcomes in the ED. Manuscripts were screened and were eligible for inclusion if they included patients transported by non‐physician PHPs to the ED and assessed ability of PHPs to predict triage scores, clinical course, treatment requirements or disposition from ED. The initial search returned 10 753 unique articles. After screening and full text review, 10 studies were included in data analysis. Of these, six assessed prediction of disposition (admission versus discharge) from ED, two compared triage score application, one assessed prediction of clinical requirements and one assessed prediction of mortality prior to discharge. Prediction of admission across five studies had a pooled sensitivity of 0.73 (95% confidence interval 0.67–0.79) and specificity of 0.78 (95% confidence interval 0.69–0.85). Triage score application had weighted kappa variables of 0.409 and 0.452 indicating moderate agreement on assessment priority between PHPs and triage nurses. The ability of PHPs to assign triage scores, predict clinical course and predict disposition from the ED have mild concordance with clinical assessment by ED staff. This is an area of potential expansion in PHPs' role; however, training would be required prior to implementation. [ABSTRACT FROM AUTHOR]

Objective: To model the potential financial implications of Australian programs supporting cognitively impaired community‐dwelling older people. Methods: Markov cohort models of (a) an observational study of a residential dyadic training program for carers and people with dementia (GTSAH) and (b) a frailty intervention (FIT) in a cognitively impaired subgroup. Direct health and social welfare costs accrued over 5 years (2018 $AUD prices) were captured. GTSAH costs $3755, FIT costs $1834, and permanent residential aged care (P‐RAC) costs $237 per day. Results: Modelling predicted costs break even in approximately 5 months for GTSAH and 7 months for FIT, after which these interventions saved funds. The primary driver of savings was the P‐RAC cost (discounted at 5%/annum), at $121 030 for GTSAH vs $231 193 for standard care; and $47 857 with FIT vs $111 359 for standard care. Conclusions: Programs supporting cognitively impaired community‐dwelling older people could be financially beneficial; further evaluation and implementation would be a worthwhile investment. [ABSTRACT FROM AUTHOR]

Background: Few recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America. Methods: This analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries. Results: The proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption. Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p <0.05). Conclusions: Healthcare resource consumption associated with adverse clinical outcomes was observed in patients on stable LLT in countries outside Western Europe and North America, particularly those at very-high cardiovascular risk and those who were difficult to treat. [ABSTRACT FROM AUTHOR]

Background: The study is to measure eHealth literacy of medical students at a university in central Vietnam and to examine factors influencing their skills. Material and Method: This is a cross-sectional study. Data were collected through the self-administered structured questionnaire of 410 students who were randomly selected among general medical students and preventive medicine students in the fifth year at Hue University. The eHealth literacy scale was developed on the basis of eHEALS to measure skills for seeking and utilizing sources of eHealth information. Multiple linear regression model was used to identify factors influencing their eHealth literacy. Results: The study found that the general mean score for eHealth literacy among participants is 27.03 (SD = 3.54). Factors influencing eHealth literacy are genders (p=0.001), training program (p=0.013), computer skills (p=0.031) and purpose of seeking and using medical information (p<0.001). Conclusions: The findings showed that eHealth literacy of medical students in the study setting is still limited. In order to improve these skills of students, the educators should have relevant teaching strategies that promote the interest and skills of students to locate and evaluate eHealth resources. [ABSTRACT FROM AUTHOR]

Objective To explore the establishment of human resources database and operation mechanism of mobile nurse human resource database in district and county hospitals. Methods A multi-stage sampling method was used to select 10 health service units from the health service system in Wulong District of Chongqing. The investigation was carried out by means of expert inquiry and questionnaire survey of medical staff. Results 26(96.3%)experts, 157(79.3%)doctors and 298(95. 5%)nurses considered it necessary to establish a mobile nurse human resource database. Among 312 effective questionnaires, 282(90.4%)nurses were willing to join the mobile nurse human resources database, 202(64.7%)nurses wanted the training period to be arranged after4:00 p. m. from Monday to Friday, and 157(50.3%)nurses wanted the training time to be 60 minutes each time. Conclusion It is necessary to set up a mobile nurse human resource database in district and county hospitals, especially those with underdeveloped economy. [ABSTRACT FROM AUTHOR]

• RSV has substantial burden of morbidity and mortality in older and at-risk adults. • Currently, little incentive exists for clinicians to order routine RSV tests in adults. • In future, it will be essential to have established standardized testing protocols. Outcome data to underpin recommendations and give confidence to order RSV molecular tests are needed. Lower respiratory tract infections are a leading cause of hospitalization and viruses are important causal pathogens, especially in the elderly, immunocompromised patients and those with respiratory or cardiovascular comorbidities. Respiratory syncytial virus (RSV) is recognized as comprising a substantial burden of morbidity and mortality in older and at-risk adults, and the emergence of rapid point-of-care molecular testing has made it possible to confirm an RSV diagnosis accurately, in a clinically actionable timeframe. RSV patients have significantly higher healthcare resource use (including hospital stays and emergency room/urgent care visits) than non-RSV matched controls, especially if aged ≥65 years, a longer length of hospitalization than those with influenza, and associated costs nearly three times higher. We found no direct clinical outcome data specific to rapid molecular testing for RSV in adults and very little in children. There is very limited evidence that prompt diagnosis may reduce hospital length of stay but this and other outcome parameters need confirmation in larger, prospective clinical trials. Regarding reducing inappropriate antibiotic prescribing, the picture is mixed and testing alone is unlikely to change entrenched habits. There is little incentive for clinicians to order routine RSV tests in adults given the absence of a specific antiviral therapy. However, with numerous vaccine and antiviral candidates in clinical development, we believe it is good practice to plan and start establishing standardized testing protocols – perhaps as part of outcome studies. For especially vulnerable patients, e.g., immunocompromised and transplant patients, prompt accurate RSV diagnosis may prevent disease spread and save lives. [ABSTRACT FROM AUTHOR]