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Abstract The complex epidemiological profile of Brazil, the aging population and the proportion of individuals with disabilities have led to a substantial increase in the demand for rehabilitation. The spatiotemporal distribution of the offer of physiotherapy, speech therapy and occupational therapy in the Brazilian public healthcare system from 2007 to 2019 was analyzed for the five macro-regions of the country. Data from the National Register of Health Establishments and census estimates from the Brazilian Institute of Geography and Statistics were used. Indicators of the offer of professionals in these fields services and relative changes in the offer were calculated. The spatial distribution of the relative change in the offer was also determined. A regression model with inflection points was adopted for the analysis of the temporal trend. A growing temporal trend was found in the offer of the three professionals in Brazil as a whole and in all regions of the country, but with a slowdown in growth. Differences were observed in the offer among the regions of the country, revealing healthcare inequality that needs to be overcome. The present findings can assist in planning to expand access to rehabilitation services in the country. Resumo O complexo perfil epidemiológico do país, o envelhecimento populacional e a proporção de pessoas com deficiência apontam para o aumento substancial da demanda por reabilitação. Nesse contexto, foi analisada a distribuição espaço-temporal da oferta de profissionais de fisioterapia, fonoaudiologia e terapia ocupacional no Sistema Único de Saúde (SUS) de 2007 a 2019 nas cinco regiões do Brasil. Foram utilizados dados do Cadastro Nacional de Estabelecimentos em Saúde, as estimativas censitárias do Instituto Brasileiro de Geografia e Estatística e calculados os indicadores da oferta potencial de profissionais e sua evolução relativa. Foi realizada a distribuição espacial da evolução relativa da oferta potencial de profissionais. Para a análise da tendência temporal, adotou-se o modelo de regressão por pontos de inflexão. Houve tendência temporal crescente na oferta potencial das três categorias profissionais no Brasil e em todas as regiões, mas com uma desaceleração do crescimento. Observaram-se diferenciais entre as profissões e as regiões do país, representando um quadro de desigualdade de oferta que precisa ser superado. Resultados que podem subsidiar o controle social e o planejamento nacional para a ampliação do acesso aos serviços de reabilitação

Confronted with a global pandemic, public healthcare systems are under pressure, making access to healthcare services difficult for patients. This provides fertile ground for using illegal practices such as informal payments to gain access. This paper aims to evaluate the use of informal payments by patients during the COVID-19 pandemic and the institutions that affect the prevalence of this practice. Various measurements of formal and informal institutions are here investigated, namely the acceptability of corruption, the level of trust, transparency, and performance of the healthcare system. To do so, a logistic regression of 10,859 interviews with patients conducted across 11 Central and Eastern Europe countries in October–December 2020 is employed. The finding is that there are large disparities between countries in the prevalence of informal payments, and that the practice is more likely to occur where there are poorer formal and informal institutions, namely higher acceptability of corruption, lower trust in authorities, lower perceived transparency in handling the COVID-19 pandemic, difficult access to, and poor quality of, healthcare services, and higher mortality rates due to the COVID-19 pandemic. These findings suggest that policy measures for tackling informal payments need to address the current state of the institutional environment.

PurposeBreast cancer (BC) is the most common type of cancer among women in Brazil. Evidence shows that delayed treatment onset is associated with increased mortality. This study aimed to evaluate median days between diagnosis and treatment and factors associated with delayed start of treatment (> 60 days after diagnosis): stage, treatment received, subtype, epidemiological characteristics, and type of healthcare coverage.MethodsThis analysis included 1709 stage I–III BC patients from AMAZONA III, a prospective, observational study, diagnosed from January 2016 to March 2018 in 22 centers in Brazil.ResultsThe median number of days from diagnosis to beginning of first oncologic treatment was 46 days (IQR 28–75) overall, 43 days (IQR 25–75) for stage I disease, 49 days (IQR 28–81) for stage II, and 44 days (IQR 30–68) for stage III, (p = 0.1180). According to first treatment received, diagnosis-to-treatment interval was 43 days (IQR 29–65) for neoadjuvant chemotherapy and 48 days (IQR 26–81) for surgery. Diagnosis-to-treatment interval was higher in women treated in the public system versus the private system (56 vs. 34 days, p < 0.0001). Patients in the public system had an increased odds of delayed treatment initiation (OR 4.74 95% CI 3.09–7.26, p < .0001). The longer interval from diagnosis to treatment in the public system was independent of clinical stage, type of treatment (systemic vs surgery first), subtype and region of the country.ConclusionBy characterizing the delays in care delivery, our study will aid stakeholders to better design interventions and allocate resource to improve timely treatment for breast cancer in Brazil.ClinicalTrials.gov Identifier: NCT02663973, registered on January, 26th, 2016.

Background This study aims to propose a semi-automatic method for monitoring the waiting times of follow-up examinations within the National Health System (NHS) in Italy, which is currently not possible to due the absence of the necessary structured information in the official databases. Methods A Natural Language Processing (NLP) based pipeline has been developed to extract the waiting time information from the text of referrals for follow-up examinations in the Lombardy Region. A manually annotated dataset of 10 000 referrals has been used to develop the pipeline and another manually annotated dataset of 10 000 referrals has been used to test its performance. Subsequently, the pipeline has been used to analyze all 12 million referrals prescribed in 2021 and performed by May 2022 in the Lombardy Region. Results The NLP-based pipeline exhibited high precision (0.999) and recall (0.973) in identifying waiting time information from referrals’ texts, with high accuracy in normalization (0.948-0.998). The overall reporting of timing indications in referrals’ texts for follow-up examinations was low (2%), showing notable variations across medical disciplines and types of prescribing physicians. Among the referrals reporting waiting times, 16% experienced delays (average delay = 19 days, standard deviation = 34 days), with significant differences observed across medical disciplines and geographical areas. Conclusions The use of NLP proved to be a valuable tool for assessing waiting times in follow-up examinations, which are particularly critical for the NHS due to the significant impact of chronic diseases, where follow-up exams are pivotal. Health authorities can exploit this tool to monitor the quality of NHS services and optimize resource allocation.

The aim of this paper was to assess the prospects and opportunities of Artificial Intelligence (AI) in addressing the challenges in public healthcare that have prevented the achievement of good health for sustainable development in Africa. The assessment was done in efforts to understand the nexus between good health and sustainable development. Good health remains a prerequisite for sustainable development. It is the cornerstone of human development and growth, and the development of projects that lead to sustainable development depend on it. A qualitative method was used with a document analysis approach. Secondary data was collected through a literature survey, and document and content analysis techniques were used in the interpretation. The paper found that the use of AI technologies in the public healthcare system protects healthcare providers, quickens treatment and administrative tasks, and promotes innovations in healthcare systems. It combats inequality, long waiting times, corruption and various types of financial crimes that inhibit the performance of the public healthcare system. The use of exoskeleton robots enable paralysed patients to walk again and become self-sufficient in conducting their daily activities. There is need for African countries to use AI technologies in the public healthcare systems to achieve good health for sustainable development.

ABSTRACT Healthcare financing is attracting widespread interest due to the coronavirus pandemic. This study aims to assess federal public healthcare financing in Brazil in the light of a legal framework for minimum spending on health and the effects of economic cycles and crises. A literature review showed that public healthcare funding should increase during crises, which is contrary to what fiscal austerity policies postulate. Different formats of fiscal rules for minimum spending on health are analyzed based on the historical evolution of healthcare financing in Brazil. A simulation shows that linking this spending rule to GDP (and especially to current revenue) gives a pro-cyclical character to healthcare financing, which can make it difficult to guarantee health rights in times of crisis. Thus, a debate arises about the need to revise the rule set by the Constitutional Amendment 95/2016 (EC no. 95/2016) and to establish a parameter for growth in public healthcare expenditure that eliminates its pro-cyclical characteristic and enables the needs of the country to be met after the pandemic. RESUMO O financiamento de sistemas de saúde tem atraído amplo interesse devido à pandemia de coronavírus. Este artigo propõe uma avaliação do financiamento do sistema de saúde público no Brasil para o governo Federal à luz da legislação para gasto mínimo em saúde e dos efeitos de ciclos econômicos e crises. A partir de uma revisão da literatura, é indicado que, em momentos de crise, o financiamento do sistema público de saúde deva aumentar, contrário ao que as políticas de austeridade fiscal postulam. Diferentes formatos de regras fiscais para o gasto mínimo em saúde são analisados com base na evolução histórica do financiamento de saúde pública no Brasil. Uma simulação mostra que vincular essa regra de gasto ao PIB, e, principalmente, à receita corrente, atribui um caráter pró-cíclico ao financiamento do sistema público de saúde, o que dificulta a garantia do direito à saúde em momentos de crise. Assim, emerge o debate sobre a necessidade de revisar a regra estabelecida pela Emenda Constitucional nº 95/2016 e definir uma regra de crescimento para o gasto no sistema público de saúde que elimine o traço pró-cíclico e permita que as necessidades pós-pandemia do país sejam atendidas.

[...]available tools for functional characterization of changes in these genes could not be successful in strongly displaying the consequences of such alteration on drug pharmacokinetics (PK) and pharmacodynamics (PD) (Chang et al., 2021). Factors like lower background and expertise for clinical interpretation of PGx test result in physicians and clinicians, lack of particular cost and time benefit instruments and facilities for test implementation through clinical centers, absence of sufficient guidelines for every genomic variant in drug-related genes, no existence of appropriate variant calling tools for many pharmacogenes, no willing and hesitance of insurance parties to cover the tests in clinics, etc. are seen and introduced as the major issues for prevention of combination of PGx and primary care everywhere (Frick et al., 2016). The fourth and fifth articles (DPYD pre-clinical testing in Switzerland and mini review on genetic associations with severe adverse drug events) explored the prospect of prevention of adverse drug reactions (ADRs) through the utilization of clinical PGx tests and demonstrated the advantages of pre-emptive genotyping on anticipation of ADRs and acceleration of integration of PGx tests into daily primary care (Begré et al.;Wang et al.).

Parkinson’s disease (PD) is taking an staggering toll on healthcare systems worldwide, with the bulk of the expenditures invested in the late stages of the disease. Considering the rising life expectancy and the increasing prevalence of PD across the globe, a clear understanding of the early signs and treatment options available for advanced PD (APD), will facilitate tailoring management programs and support services. This task is complicated by the lack of both global consensus in both defining APD and standardized care guidelines. This perspective prepared by a panel of movement disorder specialists, proposes to extend and optimize currently accepted PD coding to better reflect the diverse disease manifestations, with emphasis on non-motor features. The panel seeks to promote timely diagnosis by adjustment of evaluation tools for use by community neurologists and suggests modification of eligibility criteria for advanced therapy. Moreover, they are of the opinion that multidisciplinary assessments of APD patients will drive personalized, patient-centered and holistic management. Overall, earlier and more targeted intervention is expected to markedly improve patient quality of life.

Reproducing Race, an ethnography of pregnancy and birth at a large New York City public hospital, explores the role of race in the medical setting. Khiara M. Bridges investigates how race--commonly seen as biological in the medical world--is socially constructed among women dependent on the public healthcare system for prenatal care and childbirth. Bridges argues that race carries powerful material consequences for these women even when it is not explicitly named, showing how they are marginalized by the practices and assumptions of the clinic staff. Deftly weaving ethnographic evidence into broader discussions of Medicaid and racial disparities in infant and maternal mortality, Bridges shines new light on the politics of healthcare for the poor, demonstrating how the \"medicalization\" of social problems reproduces racial stereotypes and governs the bodies of poor women of color.