Public Health in Asia during the COVID-19 Pandemic

Every nation in Asia has dealt with COVID-19 differently and with varying levels of success in the absence of clear and effective leadership from the WHO. As a result, the WHO’s role in Asia as a global health organization is coming under increasing pressure. As its credibility is slowly being eroded by public displays of incompetence and negligence, it has also become an arena of contestation. Moreover, while the pandemic continues to undermine the future of global health governance as a whole, the highly interdependent economies in Asia have exposed the speed with which pandemics can spread, as intensive regional travel and business connections have caused every area in the region to be hit hard. The migrant labor necessary to sustain globalized economies has been strained and the security of international workers is now more precarious than ever, as millions have been left stranded, seen their entry blocked, or have limited access to health services. This volume provides an accessible framework for the understanding the effects of the COVID-19 pandemic in Asia, with a specific emphasis on global governance in health and labor.

Unintended consequences of patient online access to health records: a qualitative study in UK primary care

BackgroundHealth systems around the world are seeking to harness digital tools to promote patient autonomy and increase the efficiency of care. One example of this policy in England is online patient access to full medical records in primary care. Since April 2019, all NHS England patients have had the right to access their full medical record prospectively, and full record access has been the “default position” since April 2020.AimTo identify and understand the unintended consequences of online patient access their medical record.Design and SettingQualitative interview study in 10 general practices in South West and North West England.MethodSemi-structured individual interviews with 13 patients and 16 general practice staff with experience of patient online access to health records.ResultsOnline access generated unintended consequences that negatively impacted patients’ understanding of their health care, for example patients discovering surprising information or information that was difficult to interpret. Online access impacted GPs’ documentation practices, such as when GPs pre-emptively attempted to minimise potential misunderstandings to aid patient understanding of their health care, in other cases, negatively impacting the quality of the records and patient safety when GPs avoided documenting their speculations or concerns. Contrary to assumptions that practice workload would be reduced, online access introduced extra work, such as managing and monitoring access and taking measures to prevent possible harm to patients.ConclusionThe unintended consequences described by both staff and patients show that to achieve the intended consequences set out in NHS policy additional work is necessary to prepare records for sharing and prepare patients about what to expect. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access now that it is the default position.

­­Access to Health Insurance and Treatment Utilization for Opioid Use Disorder: Evidence From State Medicaid Expansions

Background. Medicaid is a major payer of substance use disorder treatment, yet the impact of Medicaid expansion on the opioid epidemic has not been sufficiently quantified. This study exploits state-level differences in Medicaid expansion to assess the impact of access to health insurance on treatment utilization for opioid use disorder (OUD) for adults in need.Method. We use admissions data from Treatment Episode Data Sets (TEDS) to fit a multivariate difference-in-difference model, with non-expanding states as controls, adjusting for age, gender, race/ethnicity, education, and other state-level factors. Results. Medicaid expansion led to substantial gain in OUD treatment utilization. Admissions for substance use disorder among Medicaid beneficiaries increased by 20-33 percentage points in expansion states. Admissions were significantly higher for the newly eligible Medicaid beneficiaries in the 30-34 age group. We also see an increase in treatment admissions for opioid and heroin use among the elderly over the age of 55. Uninsurance rates show a commensurate decline in the expansion states. Finally, we do not find strong evidence of crowding-out of private insurance. Conclusions. Overall, our findings suggest that Medicaid expansions had a positive impact on the financing and utilization of opioid use treatment.

Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort

We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.

Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis

Background Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. Methods This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016–17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. Results Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. Conclusion This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.

Care Giver Competency in Prevention Risk of Diabetic Foot Ulcer in Diabetes Mellitus Patients

Increasing in the incidence of diabetic foot ulcer (DFU) among diabetes mellitus patients (DM), which then access to health services is so far, as well as the lack of knowledge of the local community in preventing and caring for DFU made researchers try to initiate training related to prevention and basic wound care for village health cadres, community leaders, and families family members with DM and at risk for UKD. The activity, which carried out in March 2021, involved the puskesmas in Sui District. Raya, Kab. Kubu Raya. After obtained a permit to carry out activities, the Team briefly contacted the community with the assistance of the Head of RT and RW. Participants who toke part in this activity were those who lived or have a family with diabetes mellitus. Participants were given training related to prevention and treatment of basic wounds, which in the end evaluation followed by publication.

Article 24: The Right to Health

Article 24 reflects the perspective of the drafters that the right to health cannot be understood in narrow bio-medical terms or limited to the delivery of health services. Rather, in its reference, for example, to food, water, sanitation, and environmental dangers, it recognises the wider social and economic factors that influence and impact on the child’s state of health. Thus, the text of Article 24 sets out: a broad right to health for all children combined with a right of access to health services a priority focus on measures to address infant and child mortality, the provision of primary health care, nutritious food and clean drinking water, pre-natal and post-natal care, and preventive health care, including family planning the need for effective measures to abolish traditional practices harmful to children’s health a specific obligation on States Parties to cooperate internationally towards the realisation of the child’s right to health everywhere, having particular regard to the needs of developing countries. The right to health is a prime example of the interelatedness of child rights as it is contingent upon and informed by the realization of so many other rights guaranteed to children under the convention. This chapter analyses the child’s right to health in relation to four essential attributes. The first attribute of the child’s right to the highest attainable standard of health emphasizes what an exacting standard this human rights norm contains. Taking a social determinants of health perspective the right entails not just access to health services but programmatic supports in sanitation, transportation, education and other fields to guarantee the enjoyment of health. The second attribute focuses on the Basic minimum criteria of the right to health as reflected in Article 24(2). A third attribute is the insistence upon child health accountability mechanisms using the Availability, Accessibility, Acceptability and Quality Accountability Framework. Finally, given the wide discrepancies in enjoyment of children’s right to health across the globe, a fourth attribute focuses upon international cooperation to ensure equal access to the right to health.

Infecções sexualmente transmissíveis na população ribeirinha: prevalência e comportamento de risco

Introduction: The riparians population is considered vulnerable to Sexually Transmitted Infections due to restrictions related to access to health, information and education.Objective: To analyze the prevalence of self-reported Sexually Transmitted Infections among the riparians population and associated sociodemographic and behavioral factors.Material and Method: Cross-sectional, analytical study, conducted with 250 riparians dwellers from João Pessoa, Paraiba state, from June to October 2019. Data were collected through interviews using a structured questionnaire. Logistic regression analysis was performed. The research was approved by the Research Ethics Committee under opinion number 3,340,273.Results: The prevalence of Sexually Transmitted Infections was 20.8%. Male ribs (OR=3.27; CI95%:1.74-6.15), who reported sexual intercourse with sex workers (OR=6.54; CI95%:3.05-14.0) and illicit drug use (OR 2.13; CI95%:1.10-4.13) were more likely to develop sexually transmitted infection.Conclusions: High prevalence of sexually transmitted infections and presence of risk behaviors among riparians. Screening, early diagnosis and health education is essential for discontinuation of the transmission chain. Introducción: La población ribereña se considera vulnerable a las infecciones de transmisión sexual debido a cambios relacionados con el acceso a la salud, la información y la educación.Objetivo: Analizar la prevalencia de infecciones de transmisión sexual autoinformadas en una población ribereña y los factores sociodemográficos y conductuales asociados.Material y Método: Estudio transversal, analítico, realizado con 250 habitantes ribereños de João Pessoa, en el estado de Paraíba, de junio a octubre de 2019. Los datos fueron recolectados a través de entrevistas mediante un cuestionario estructurado. Se realizó un análisis de regresión logística. La investigación fue aprobada por el Comité de Ética en Investigación con el dictamen número 3.340.273.Resultados: La prevalencia de Infecciones de Transmisión Sexual fue de 20,8%. Hombres habitantes de la ribera (OR = 3,27; IC del 95%: 1,74-6,15), que informaron haber tenido relaciones sexuales con una trabajadora sexual (OR = 6,54; IC del 95%: 3,05-14,0) y uso de drogas ilícitas (OR 2,13; IC del 95%: 1.10-4.13) disipación mayores posibilidades de desarrollar una infección de transmisión sexual.Conclusiones: Alta prevalencia de riesgo de transmisión sexual y presencia de tendencia de riesgo entre los habitantes de las riberas. El cribado, el diagnóstico precoz y la educación sanitaria son fundamentales para interrumpir la transmisión. Introdução: A população ribeirinha é considerada vulnerável às Infecções Sexualmente Transmissíveis devido às restrições relacionadas ao acesso à saúde, informação e educação.Objetivo: Analisar a prevalência de Infecções Sexualmente Transmissíveis autorreferidas entre a população ribeirinha e fatores sociodemográficos e comportamentais associados. Material e Método: Estudo transversal, analítico, realizado com 250 ribeirinhos de João Pessoa, no estado da Paraíba, no período de junho a outubro de 2019. Os dados foram coletados por meio de entrevista com a utilização de questionário estruturado. Realizou-se análise de regressão logística. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa sob número de parecer 3.340.273.Resultados: A prevalência de Infecções Sexualmente Transmissíveis foi de 20,8%. Ribeirinhos do sexo masculino (OR=3,27;IC95%: 1,74-6,15), que relataram relação sexual com profissional do sexo (OR=6,54;IC95%:3,05-14,0) e uso de droga ilícita (OR 2,13; IC95%: 1,10-4,13) apresentaram maiores chances de desenvolver alguma infecção sexualmente transmissível. Conclusões: Alta prevalência de infecções sexualmente transmissíveis e presença de comportamentos de risco entre os ribeirinhos. Rastreio, diagnóstico precoce e educação em saúde é fundamental para descontinuação da cadeia de transmissão.

Outlining the therapeutic itineraries of children with disabilities in the professional health care subsystem

ABSTRACT Objectives: to identify the outlining of therapeutic itineraries of families of children with disabilities in the professional health care subsystem. Methods: qualitative research carried out in two specialized services in the state of Ceará, with 41 family members interviewed using the life path technique and reports submitted to descending hierarchical classification and similitude analysis, with the help of the IRaMuTeQ software and the theoretical framework of health care systems. Results: the classes described the families’ itineraries in five paths, related to faith, support structures, medical behaviors, professionals, and health services. The professional subsystem stood out as deficient in outlining the therapeutic itinerary for access to health care for children with disabilities, without promoting integration between services in the Care Network. Final considerations: the families’ therapeutic itineraries showed homogeneous discourse with themes related to the care of professionals and spiritual aspects.