Explore the vast range of titles available.

Background Inequalities in geographic access to health care result from the configuration of facilities, population distribution, and the transportation infrastructure. In recent accessibility studies, the traditional distance measure (Euclidean) has been replaced with more plausible measures such as travel distance or time. Both network and raster-based methods are often utilized for estimating travel time in a Geographic Information System. Therefore, exploring the differences in the underlying data models and associated methods and their impact on geographic accessibility estimates is warranted. Methods We examine the assumptions present in population-based travel time models. Conceptual and practical differences between raster and network data models are reviewed, along with methodological implications for service area estimates. Our case study investigates Limited Access Areas defined by Michigan’s Certificate of Need (CON) Program. Geographic accessibility is calculated by identifying the number of people residing more than 30 minutes from an acute care hospital. Both network and raster-based methods are implemented and their results are compared. We also examine sensitivity to changes in travel speed settings and population assignment. Results In both methods, the areas identified as having limited accessibility were similar in their location, configuration, and shape. However, the number of people identified as having limited accessibility varied substantially between methods. Over all permutations, the raster-based method identified more area and people with limited accessibility. The raster-based method was more sensitive to travel speed settings, while the network-based method was more sensitive to the specific population assignment method employed in Michigan. Conclusions Differences between the underlying data models help to explain the variation in results between raster and network-based methods. Considering that the choice of data model/method may substantially alter the outcomes of a geographic accessibility analysis, we advise researchers to use caution in model selection. For policy, we recommend that Michigan adopt the network-based method or reevaluate the travel speed assignment rule in the raster-based method. Additionally, we recommend that the state revisit the population assignment method.

Understanding characteristics that impact linkage-to-care (LTC) among individuals living with HBV and/or HCV can enhance public health efforts to provide tailored care services to prevent and treat viral hepatitis among immigrants. Using HBV/HCV screening and LTC data from immigrants (2016–2019), descriptive and logistic regression analyses were conducted to assess (1) the relationship between LTC and sociodemographic factors and (2) factors associated with HBV/HCV LTC. About 87% of those positive HBsAg had LTC and 52% had LTC among those with HCVAB and confirmed PCR. Access to care was an important LTC predictor for HBV–LTC: those who had neither health insurance nor primary care provider (PCP) were more likely to have HBV–LTC than those who had either health insurance or PCP (aOR = 2.95, 95% CI = 1.32–6.59). It is essential to equally provide HBV/HCV LTC support to all immigrants from countries with high prevalence regardless of access to care.

Background In Indonesia, children living with human immunodeficiency virus (HIV) face a heightened risk of tuberculosis (TB) coinfection. This study aims to explore the clinical characteristics and mortality of children with HIV/TB coinfection. Methods A retrospective observational study was conducted on children diagnosed with HIV/TB coinfection and treated between 2017 and 2021 in Dr. M. Djamil Central Hospital, Padang City, Indonesia. Results Twenty-seven children were diagnosed with HIV/TB coinfection. Most children were male, aged five years or older, and resided in rural areas. All patients exhibited HIV clinical stage III or IV, with a median (IQR) CD4 count of 49 (18–534) cells/mm 3 . The most frequently reported clinical manifestations were fever, cough, and growth/developmental delay. Four patients died while being treated in the hospital, resulting in a mortality rate of 14.8%. In crude analysis, severe anemia ( p  = 0.025) and pneumonia ( p  = 0.012) were significantly associated with mortality. Conclusions This study highlights the considerable mortality risk among children living with HIV/TB coinfection, particularly emphasizing the significance of addressing severe anemia and pneumonia as contributing factors.

Limited access to obstetric care for pregnant women in rural areas increases the risk of maternal mortality. A geographic information system (GIS) was used to analyze spatial and temporal access to obstetric care in southeastern Morocco. The obstetric records of 1,304 pregnant women were examined to determine the diagnosis upon arrival and the duration of ambulance transport. According to maps generated by the GIS, 19 obstetric cases were more than 100 kilometers away from the regional hospital, and 16 cases required over two hours for transport to the regional hospital. Univariate binary logistic regression analysis confirmed that delays exceeding two hours between the sending hospital and the receiving regional hospital increased the likelihood of pregnant women arriving with hemorrhage (OR: 2.82 (1.38, 5.79), p = 0.005). The study revealed the consequences of restricted access to obstetric care on the health of pregnant women, highlighting the need for targeted strategies to improve access to obstetric services in this region.

BACKGROUND:For limited English-proficient (LEP) patients, the digital divide has narrowed, creating a new population of Internet users. However, language-appropriate health information is difficult to find. Community health center (CHC) websites are health information resources and their homepages are critical access points for patients. CHCs supported by Health Resources and Services Administration (HRSA) care for many LEP patients. OBJECTIVE:We sought to determine the number of HRSA-supported CHC websites providing translated homepage content. RESEARCH DESIGN:In February 2017, we performed a cross-sectional analysis of the language availability of CHC homepages. MEASURES:The primary outcome was availability of translated content on CHC homepages. Secondary outcomes were method of translation and associations between homepage translation and CHC demographics, including percent LEP population and socioeconomic and Internet access characteristics. RESULTS:Of the 1400 CHC homepages, 480 (34.3%) provided translated information with half using Google Translate. We found higher odds of having a translated homepage as the LEP population by county increased [odds ratio (OR)1.26, confidence interval (CI)1.07–1.49, P=0.005], Internet subscription at the state level increased (OR1.19, CI1.02–1.38, P=0.026), and if health centers were in metropolitan areas (OR1.81, CI1.31–2.51, P<0.001). There was also higher likelihood of having a homepage translated to Spanish in counties with higher Spanish LEP populations (OR1.39, CI1.19–1.63, P<0.001), but this did not extend to non-Spanish languages (OR0.85, CI0.71–1.04, P=0.131). CONCLUSIONS:Despite increased Internet use among LEP patients and linguistic diversity of the CHC populations, there is a lack of language-appropriate content on CHC website homepages.

Atypical skin lesions are common incidental findings in patients across all settings where nurse practitioners practice, and it is imperative that each provider is competent to identify and address concerning findings. In patients with limited access to care, this becomes especially important and can be more challenging. This case study describes the unique approach to the evaluation and treatment of a patient experiencing several barriers to accessing the care he needed promptly. •A thorough history and examination are critical to avoid missing potentially malignant skin lesions.•Differential diagnoses in this case included acute otitis media, otitis media with effusion, basal cell carcinoma, squamous cell carcinoma, and herpes zoster oticus.•This case study highlights the unique barriers to obtaining prompt evaluation and treatment for acute and chronic conditions among underserved populations.

Advanced practice registered nurses (APRNs) working in rural and austere environments face unique challenges when identifying and managing heat-related illness. The incidence and severity of the health impacts of climate change are getting worse, highlighting the importance of being able to prevent, recognize, and manage the spectrum of these conditions. This article aims to improve APRN understanding of the scope of heat-related illnesses and their treatments, allowing APRNs to serve as community educators and advocates, helping to reduce heat-related morbidity and mortality through anticipatory guidance and culturally sensitive outreach in resource-limited settings. •Climate change is increasing the incidence and severity of heat-related illnesses.•Resource-limited settings present unique and challenging situations.•Advanced practice registered nurse understanding is paramount to decreased morbidity and mortality.

Background: Nepal’s diverse geography creates significant challenges for healthcare accessibility, particularly for neonatal care. Rural areas, especially in the mountainous regions, face severe healthcare gaps due to isolation, inadequate infrastructure, and a shortage of skilled staff. Strengthening healthcare in these underserved regions is essential to reducing neonatal mortality. Helping Babies Breathe (HBB) is a neonatal resuscitation training program designed to reduce neonatal mortality due to birth asphyxia in low-resource settings. Methods: A comprehensive literature search identified studies on neonatal mortality and interventions, particularly HBB, which were analyzed using a narrative synthesis approach. This review examines disparities in neonatal health outcomes, regional differences, and barriers to healthcare access. Findings: This review identifies key themes related to healthcare disparities, neonatal mortality, and birth outcomes in Nepal’s remote regions. Geographical isolation, inadequate healthcare infrastructure, and cultural barriers contribute to persistently high neonatal mortality, particularly in mountainous areas such as Jumla and Dolpa, where rates exceed 60 per 1000 live births. HBB has shown a significant impact, reducing neonatal mortality by up to 60% when effectively implemented. However, infrastructural gaps, lack of emergency transport, and the uneven distribution of skilled birth attendants (SBAs) remain critical challenges. Addressing these disparities requires expanded training, increased availability of neonatal resuscitation equipment, and culturally sensitive healthcare strategies.

This study addresses the persistence of patriarchal structures and the reproduction of traditional gender roles in rural settings. In particular, this research explores agritourism, an emerging sector of rural tourism that, while providing economic opportunities in rural areas, also ends up perpetuating female subordination. In response to this issue, the manifestation of symbolic gender-based violence in the field of agritourism was analyzed, and a reliable and validated psychometric measurement scale was developed. The instrument identified and quantified the specific dimensions of symbolic gender-based violence in this context. To meet these objectives, the Delphi Method was used asynchronously for the design of the questionnaire, and an exploratory factor analysis was applied with a sample of 299 participants to validate its internal structure. The results indicate the existence of a robust structure made up of six key factors: feminized entrepreneurship, occupational self-segregation, stereotyped roles, limited access to land, glass ceiling, and wage discrimination. These findings contribute to a deeper understanding of the symbolic mechanisms of gender-based violence in agritourism and offer an analytical tool for future research in the field of gender studies and rural tourism.