To improve understanding of the barriers and enablers to implementing gender and intersectional analysis during the COVID-19 pandemic in Canada.

We conducted a policy document analysis (n = 70) of equity-focused policies of the Canadian government published between March 2020 and August 2023. This analysis was complemented with 16 semi-structured key informant interviews with federal policy actors and leadership of civil society organizations.

Pandemic policy documents demonstrated multiple commitments to address pandemic related inequities, with key informants describing collaborative approaches to implementing these policies, but also limits in terms of the urgent and diffused nature of pandemic response. Implementation gaps related to accessible information, health services and vaccinations were noted and attributed to a reliance on civil society actors who lacked sufficient and sustainable resources, and the behaviors of priority populations whose capacity to comply was limited by the same inequities the policies sought to address.

The Canadian federal government made concerted efforts to address the needs of a range of priority populations and equity issue areas within its pandemic response, with mixed results. Having a pre-established framework to guide implementation and related relationships overcame some of the urgency challenges related with pandemic response. However, implementation gaps reflected preexisting inequities shaped by broader economic, social and political systems which were infrequently addressed in pandemic policies. There is a need for greater understanding of policy implementation gaps during emergency and crisis response.

Within the last decade, system and policy-level changes have driven substantial shifts in heart failure (HF) care from hospital to home, requiring greater support from informal care partners. What has not been examined is the state of the care partner science by person and system-level domains using qualitative studies to understand impact across multiple person and system levels.

(1) Identify by person and system levels and domain what is known about informal care partners and (2) Identify gaps in the caregiving science and suggest ways to move forward.

This secondary analysis of a large HF systematic review is guided by the National Institute on Minority Health and Health Disparities and MIRACLE frameworks and uses meta-synthesis techniques with critical realist approaches to synthesize and interpret the themes across papers.

Using data from 46 papers and 1695 care partners, we identified patterns occurring across 6 domains (biological, behavioral, affective, physical/built environment, sociocultural environment, and healthcare system) and on 4 levels (individual, interpersonal, community, and societal). Existing research predominantly addressed affective and behavioral domains, followed by health system and sociocultural domains. Few studies focused on biological and physical/built environment domains, leaving large gaps in what is known about caregiving at the cellular (biological) and societal (community and societal) levels.

HF caregiving continues to be studied at a very rudimentary level. This synthesis also reveals critical gaps in what is known about caregiving within the physical/built environment domain and at the community and societal levels.

Most people in low- and middle-income countries work in the informal sector and lack social protection. In Bolivia, the unified family, community, and intercultural health model established universal health coverage for informal workers and their families in 2019. The COVID-19 pandemic, which occurred soon after, exposed both the vulnerabilities and the strengths of this health policy.

To describe the community-based design of a health promotion strategy based on people-centered and participatory research within a vulnerable community of informal market vendors during the COVID-19 pandemic.

As part of participatory action research during the COVID-19 pandemic, market vendors collaborated with a multidisciplinary research team, local authorities, and the health network to promote health and safety in their markets. Market vendors developed a health promotion strategy facilitated by a highly structured mixed qualitative-quantitative concept mapping approach and reached a consensus on an operational health strategy with measurable goals, actions, timelines, and actors.

A community health diagnosis together with health education and individualized clinical care, created a common understanding of health and built trust between the community and the research/health team. Market vendors identified health needs related to care access, self-care, market organization, and the social determinants of health, including strategies to prevent infections, reduce cardiometabolic risk, and improve mental health.

Effective strategies to promote health or to manage health crises such as a pandemic can be developed by organized communities in primary care supported by individual and collective health data, health education, and the integration of social scientists, epidemiologists, and health professionals.

Spatial social polarization (SSP) refers to the uneven spatial distribution and subsequent concentration of polarized social and/or economic groups in a specified geographic area. However, there is heterogeneity in how SSP is measured and operationalized in research. To this end, we conducted a scoping review to characterize the use of SSP measures in public health research, providing a foundation for those seeking to navigate this complex literature, select measurement options, and identify opportunities for methodological development. Using a structured search strategy, we searched PubMed for any primary research, published since 2007, that examined the relationship between SSP and health outcomes. Across 117 included studies, we found a body of evidence that was primarily set in the United States (n = 104), published between 2020 and 2022 (n = 52), and focused on non-communicable diseases (n = 40). We found that defining SSP in the context of privilege, deprivation, and segregation returns a variety of measures. Among measures, we categorized 18 of them as SSP measures, with the Index of Concentration at the Extremes (n = 43) being the most common, and 5 of them as composite indices based on numerous underlying variables spanning several domains like education and race/ethnicity. While most employed a single SSP measure (n = 64), some included up to 5 measures to examine the robustness of findings or to identify how a multidimensional approach to SSP affected associations. Our findings fill a critical literature gap by summarizing options for operationalizing SSP measures and documenting their respective methodologies. Future research should consider using multiple SSP measures to capture the multidimensionality of SSP, widen the scope of health outcomes, and clearly explain the choice of measure(s) and methods used to derive them. Our findings can inform future research questions and help guide researchers in the selection and utilization of the various SSP measures.

This protocol is registered on the Open Science Framework (OSF) (available at https://doi.org/10.17605/OSF.IO/SN5ZY) and Figshare (available at https://doi.org/10.6084/m9.figshare.25908340) platforms.

The COVID-19 pandemic exacerbated mental health issues, particularly in vulnerable communities. Non-psychiatric interventions, including psychological emotional regulation, contemplative practices, and physical activity, can be powerful tools for improving mental health, especially in vulnerable populations. The present study evaluates the effect of a novel low-cost Socioemotional and Physical Activity Intervention in a Brazilian large vulnerable community during the pandemic's final period.

Participants were adults (18 to 60 years of age) that resided in the Paraisópolis, the third largest favela in Brazil. Recruitment was done through advertising via mobile messaging. Participants were divided into two groups, Intervention (Group I) or Waiting List Control (Group C). Group I participants underwent an in-person Multidimensional Intervention of 1 h per week, for 12 weeks, which was composed of socioemotional skills learning and moderate physical activities, while Group C maintained their usual daily routines. All participants were evaluated before (T0) and after (T1) the Intervention. The evaluation included four validated questionnaires to assess mental health (DASS-21, PANAS, WHO-5 and BRS), IPAQ for evaluating physical activity levels and a physical fitness assessment, which provided quantitative data. A semi-structured interview was also done, which provided qualitative data and was analyzed using a reflexive thematic analysis.

Quantitative data was collected from 88 participants, 43 from Group I and 45 from Group C. We observed a reduction in the scores for depression (DASS-21; Mean difference between evaluations [MD] = -3.2 [± 1.13, SEM], p = 0.006) and negative affects (PANAS, MD = -2.7 [± 0.97], p = 0.012) observed only in the participants of the I group in T1 compared to T0, but not for the C group. We also found a reduction in systolic arterial blood pressure in hypertensive or pre-hypertensive participants after exercise (Group I n = 28; -7.0 [± 2.8] mmHg, p = 0.014), an increase in physical endurance (walk test, MD = +56.0 [±8.7] m, p < 0.001) and flexibility (sit and reach test, MD = +5.12 [±0.85] cm, p < 0.001) only in the I group on T1, compared to T0. The reflexive thematic analysis results suggest that the Intervention not only alleviated negative emotional states, such as anxiety and sadness, but also provided a notable enhancement in participant's physical vitality, corroborating and complementing the quantitative analysis results.

The results presented here indicate that the Intervention presented here has the potential to reduce symptoms correlated with mental disorders and improve physical fitness in residents of a large vulnerable community.

COVID-19 created an urgent element of clinical and financial strain to the public health system, forcing it into rapid response mode. Key public health decisions were quickly made, with limited data and guidance to address decision trade-offs and community inequities. Gaps identified in the pandemic confirmed the need for a new tool, like this study's Dashboard Instrument to Review Equity (DIRE) Framework, to ensure decision-makers are given quick and equitable decision-making guidance.

Scoping review and tool development.

The scoping review was conducted through PRISMA-ScR, and by utilizing tools like PubMed, Scopus, and Paper Piles to compile and cite. Three levels of thematic analysis were completed. Tool development consisted of building a conceptual model on the DIKW Pyramid and Informatics Stack. Then the review's five themes were integrated into DIRE.

The review closed at a final count of 102 articles, with five themes emerging: COVID-19 impact, Health Equity, Decisions During Emergencies, Dashboards and Decision Support, and Frameworks. COVID-19 dashboards were also reviewed. DIRE was designed into three layers (context, data flow, and dashboard users) and three data flow buckets (data sources, DIK pillars, and interventions).

This study aimed to (1) Establish a research foundation of health equity, COVID-19 lessons learned, and decision support, and (2) Develop an evidence-based framework. Though further research is still recommended, DIRE is now the first 3-point framework aimed at preparing decision-makers to respond quickly and equitably to future emergencies.

Strong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses.

We conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis.

From 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten 'pressure points' affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system.

PCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived 'pressure points' that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design.

Analyze how pandemics contribute to the increase in social inequalities in the health sector.

Data are taken from Eurobarometer 97.3. We use the Generalized Structural Equation Model (GSEM) methodology for this analysis.

People with lower socio-economic status, considered to be of lower social class, living in areas with worse infrastructure for practicing physical activity, and in countries with high levels of social inequality, are less likely to engage in leisure time physical activity. In addition, these individuals are more likely to interrupt physical activity practices as a result of COVID-19. In contrast, people of higher socio-economic status, considered to be of upper class, living in contexts where there are opportunities for physical activity, and in countries with low levels of social inequality, are more likely/ to belong to the group of those who increased the frequency of practicing physical activity in free time/ to have increased the frequency of their leisure time physical activity.

There are widespread inequalities in leisure time physical activity linked to personal variables (social status and subjective social class) and contextual variables (infrastructures and Gini Index) that were significantly aggravated with the COVID-19 pandemic.

Health disparities represent one of the most pressing challenges in modern healthcare systems worldwide (Shadmi et al [...].

This study examines the allocation of COVID-19 funding for Indigenous Peoples in Canada, Australia, New Zealand, and the United States during the pandemic's first wave. Indigenous communities, already facing health disparities, systemic discrimination, and historical forces of colonisation, found themselves further vulnerable to the virus. Analysing the funding policies of these countries, we employed a Health Equity Impact Assessment (HEIA) tool and an Indigenous Lens Tool supplement to evaluate potential impacts. Our results identify three major funding equity issues: unique health and service needs, socioeconomic disparities, and limited access to community and culturally safe health services. Despite efforts for equitable funding, a lack of meaningful consultation led to shortcomings, as seen in Canada's state of emergency declaration and legal disputes in the United States. New Zealand stood out for integrating Māori perspectives, showcasing the importance of consultation. The study calls for a reconciliation-minded path, aligning with Truth and Reconciliation principles, the UN Declaration on the Rights of Indigenous Peoples, and evolving government support. The paper concludes that co-creating equitable funding policies grounded in Indigenous knowledge requires partnership, meaningful consultation, and organisational cultural humility. Even in emergencies, these measures ensure responsiveness and respect for Indigenous self-determination.

Identifying modifiable environmental determinants of health is important for improving the resilience of populations to infectious disease. We examined the association between residential greenspace and COVID-19 morbidity and mortality using a Danish Nationwide Cohort, and estimate the potential health benefits of greening initiatives.

We followed all Danish adults aged 50 or older (N = 2,111,233) using the Danish National COVID-19 Surveillance System for COVID-19 incident infection, hospitalization and mortality, from 1 March 2020 to 26 April 2021. Greenspace was characterized using Normalized Difference Vegetation Index (NDVI) at 300x300m grid-cell level and linked to residential addresses. We used Cox regression to assess the association between greenspace and COVID-19 morbidity and mortality, and applied effect modification analyses to identify the most susceptible groups by sociodemographic status and comorbidity. Following a health impact assessment (HIA), we also estimated the preventable burden of disease attributable to greenspace under different counterfactual scenarios.

During an average of 14 months follow-up, 62,880 participants were infected with SARS-CoV-2, of whom 8,759 were hospitalized, and 2,382 died, with COVID-19. We observed a negative association between residential greenspace and COVID-19 morbidity and mortality, with hazard ratios (95 % confidence interval) of 0.98 (0.97, 0.99) for SARS-CoV-2 infection, 0.97 (0.94, 0.99) for COVID-19 hospitalization, and 0.96 (0.91, 1.01) for COVID-19 mortality per interquartile range (0.08 unit) increase in NDVI. Stronger associations were observed in the elderly, those with lower SES, and major chronic diseases than their corresponding groups. Regarding the HIA, we estimated that increasing greenspace around residences up to WHO recommended levels would have prevented 8-14 % of COVID-19 events during the first 14 months, with the largest benefits among those with the lowest income, education, or without employment.

Greening initiatives in urban areas could help prevent COVID-19, and likely other infectious disease, with socially disadvantaged groups benefiting most.

The COVID-19 pandemic disproportionately affected migrant populations in Japan, including Vietnamese migrants, who faced distinct challenges in accessing healthcare compared to native Japanese citizens. These challenges, exacerbated by the structural complexities of Japan's healthcare system during the pandemic, likely influenced their subjective health perceptions. Nevertheless, studies on Vietnamese migrants' difficulties in healthcare access during the pandemic and their perceived health perceptions are lacking. To address this gap, the present study aimed to clarify the relationship between healthcare access difficulties and subjective health perceptions among this migrant group in Japan during the COVID-19 pandemic.

 A repeated cross-sectional design was employed, targeting Vietnamese migrants aged 18 years and older living in Japan. From 2021 to 2023, annual online surveys were conducted to assess demographics, COVID-19 history, healthcare access difficulties, and subjective health perceptions. A binary logistic regression analysis was performed to examine the relationship between healthcare access difficulties when suspected of contracting COVID-19 infection and subjective health perceptions.

 The number of survey participants totaled 631 in 2021, 214 in 2022, and 176 in 2023. The findings showed that in 2021, 26.1% of the respondents faced difficulties accessing healthcare when suspected of contracting COVID-19 infection. This was significantly associated with poor subjective health perception (odds ratio {OR}: 2.35; 95% confidence interval {CI}: 1.15-4.79). In 2022, 13.6% of the respondents reported difficulties accessing healthcare, also significantly associated with poor subjective health perception (OR: 2.75; 95% CI: 1.02-7.45). In 2023, 10.2% of the respondents faced difficulties, but no significant association with subjective health perception was observed (OR: 2.18; 95% CI: 0.72-6.63).

 Difficulties in accessing healthcare during the COVID-19 pandemic had a significant impact on the subjective health perceptions of Vietnamese migrants residing in Japan, particularly in the early stages of the pandemic. Therefore, to improve and ensure equitable access to healthcare services for migrant populations during public health crises, there is a need to implement targeted interventions that reduce the barriers for these vulnerable groups.

The pandemic and its preventive measures disrupted daily routines and posed unforeseen obstacles for families. Users of public online forums chronicled these challenges by freely expressing their sentiments in unrestricted text-length formats. We explored a German COVID-19 forum to understand family perspectives and experiences of pandemic measures, particularly in terms of testing and vaccinating children. Our findings aim to inform future epidemic health policies.

We retrieved all 11,207 entries from a COVID-19 forum during its lifespan (June 2020 - December 2021), posted during the height of the pandemic. We classified the entries into topic clusters including general pandemic situation, testing, or vaccination using state-of-the-art text embeddings and clustering algorithms. The clusters were selected based on the research's aims and analysed qualitatively using a health policy triangle framework.

Users generally appreciated pandemic public health safety measures for everyone's protection, yet voiced concerns about inconsistent policies and disproportional disadvantages for children compared to other societal groups, like the elderly. Non-compliers were overwhelmingly regarded with skepticism and critiqued. Users found COVID-19 (exit) strategies and information about the benefits of vaccination unclear. This created hurdles for parents and caregivers in navigating their children's school and social life. Users endorsed vaccinating children mainly for "normalising" children's lives rather than for their physical health benefits. Some users suggested prioritising teachers and early childhood educators on the vaccination eligibility list to speed up a return to "normality".

During pandemics, governments should prioritize addressing the societal and mental health needs of children by implementing participatory and family-oriented public health measures for schools and kindergartens. Clear communication coupled with consistent design and implementation of safety measures and regulations, would be crucial for building trust in the general population and for ensuring compliance regarding testing and vaccination. Communicating the benefits and risks of vaccinating children is of paramount importance  for informed decision-making among parents. In future epidemics, computer-aided analysis of large online qualitative data would offer valuable insights into public sentiments and concerns, enabling proactive and adaptive epidemic responses.

National health systems have different strengths and resilience levels. During the COVID-19 pandemic, resources often had to be reallocated and this impacted the availability of healthcare services in many countries. To date there have been few quantitative contemporary studies of inequalities in access to healthcare within and between countries. In this study, we aim to compare inequality within and between 16 economically diverse countries.

Online surveys were conducted on 22 150 adults in 16 countries across six continents in 2022. Quota sampling and post-stratification weighting was used to obtain an age, gender, geographically, and educationally representative sample. The study assesses the differences in challenges in access to healthcare during the pandemic (for GP, surgical/clinical and digital GP services) using country-specific expanded health-needs-adjusted Erreygers' concentration indices and compares these values between countries using a Spearman's rank correlation coefficient.

Results show wide variation in income-related challenges in access within countries for different types of care. For example, Erreygers' concentration index for digital services in Colombia exhibited highly regressive inequality at 0·17, compared to Japan with an index of -0·15. Inequalities between countries were also evident, with Spearman rank coefficients of -0·69 and -0·65 (p-values of 0·003 and 0·006) for digital and surgical access, indicating that lower income countries had greater inequality in healthcare access challenges.

During the pandemic, inequalities in challenges to accessing healthcare were greatest in low and middle-income countries. Digital technologies offer a reasonable means to address some of this inequality if adequate support is provided and accessible digital infrastructure exists.

South African research ethics committees (RECs) faced significant challenges during the COVID-19 pandemic. Research ethics committees needed to find a balance between careful consideration of scientific validity and ethical merit of protocols, and review with the urgency normally associated with public health emergency research. We aimed to explore the views of South African RECs on their pandemic preparedness and response during COVID-19. We conducted in-depth interviews with 21 participants from RECs that were actively involved in the review of COVID-19 related research, at seven academic institutions across South Africa. Interviews were conducted remotely using an in-depth interview guide that included questions regarding REC preparedness and response to COVID-19. Interviews were conducted until data saturation, and audio-recordings were transcribed verbatim and coded. An inductive approach to thematic analysis was used to organise data into themes and sub-themes. This study focused on three main themes: coping during COVID-19, building REC capacity during pandemic times and a consistently cautious approach to mutual recognition of REC reviews. Despite an initial sense of unpreparedness, RECs were able to adapt and maintain careful ethical oversight of both COVID and non-COVID research, and the rigour of REC reviews. Several important lessons for preparedness and response to future pandemics were identified, including heightened awareness of publication, funding and political pressures, the importance of regular training for RECs and researchers, and strategies to enhance moral resilience of REC members. Incremental steps are needed to build trust and authentic partnerships among RECs in inter-pandemic times, to facilitate collaboration during future public health emergencies.

Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t-statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe.

As the world comes together through the WHO design and consultation process on a new medical counter-measures platform, we propose an enhanced APT-A (Access to Pandemic Tools Accelerator) that builds on the previous architecture but includes two new pillars - one for economic assistance and another to combat structural inequalities for future pandemic preparedness and response. As part of the APT-A, and in light of the Independent Panel on Pandemic Preparation & Response's call for an enhanced end-to-end platform for access to essential health technologies, we propose a new mechanism that we call the Pandemic Open Technology Access Accelerator (POTAX) that can be implemented through the medical countermeasures platform and the pandemic accord currently under negotiation through the World Health Assembly and supported by the High-Level Meeting review on Pandemic Prevention, Preparedness, and Response at the United Nations. This mechanism will provide (1) conditional financing for new vaccines and other essential health technologies requiring companies to vest licenses in POTAX and pool intellectual property and other data necessary to allow equitable access to the resulting technologies. It will also (2) support collective procurement as well as measures to ensure equitable distribution and uptake of these technologies.

The concept of viewing a patient as an organization within the context of digital healthcare is an innovative and evolving concept. Traditionally, the patient-doctor relationship has been centered around the individual patient and their interactions with healthcare providers. However, with the advent of technology and digital healthcare solutions, the dynamics of this relationship are changing. Digital healthcare platforms and technologies enable patients to have more control and active participation in managing their health and healthcare processes. This shift empowers patients to take on a more proactive role, similar to how an organization functions with various stakeholders, goals, and strategies. The prevalence of mobile phones and wearables is regarded as an important factor in the acceptance of digital health.

This study aimed to identify the factors affecting adoption intention using the TAM (Technology Acceptance Model), HB (Health Belief model), and the UTAUT (Unified Theory of Acceptance and Use of Technology). The argument is made that the adoption of the technology enables patients to create resources (ie, data), transforming patients from mere consumers to producers as well.

PLS analysis showed that health beliefs and perceived ease of use had positive effects on the perceived usefulness of digital healthcare, and system capabilities positively impacted perceived ease of use. Furthermore, perceived service, the customer's willingness to change and reference group influence significantly impacted adoption intention (b > 0.1, t > 1.96, P < .05). However, privacy protection and data security, online healthcare resources, and user guidance were not positively associated with perceived usefulness.

Perceived usefulness, the customer's willingness to change, and the influence of the reference group are decisive variables affecting adoption intention among the general population, whereas privacy protection and data security are indecisive variables. Online resources and user guides do not support adoption intentions.

Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC.

A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC.

Beside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency.

Telemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care.

This article presents the development of the Equity, Diversity, Inclusivity, and Accessibility (EDIA) Cross-Cutting Theme Project within the Team Primary Care (TPC) initiative, aimed at addressing systemic inequities through innovative educational strategies. Grounded in the social accountability of health professions framework, this project aims to equip primary care teams with the knowledge, skills, and attitudes necessary to promote health equity. The EDIA Integrated Educational Experience (IEE) model includes a self-assessment tool, digital learning space, and national mentorship network, providing a comprehensive approach for primary care teams to promote health equity. The IEE model utilizes a layered micro, meso, and macro approach to support cultural transformation within highly complex healthcare environments. Key lessons learned involve trust- and relationship-building processes to help dismantle historical silos and encourage open dialogue. Future efforts focus on implementation, ensuring adaptability, scalability, and sustainability, positioning the model as a catalyst for equitable primary care delivery.

This study assessed the impact of distancing measures during the COVID-19 pandemic on cancer diagnostic activities, including gastrointestinal endoscopy (GIE). It analyzed GIE volumes from 2020 to 2022 in comparison to 2018-2019, considering variations in resilience linked to socioeconomic status (SES). The analysis utilized data from the Korean Health Insurance Review and Assessment Services database, covering the entire population and medical facilities. Diagnostic GIE rates (2018-2022) in Gwangju Metropolitan City and Jeonnam province were examined, comparing age-standardized rates (ASRs) by area, gender, and SES. The results indicated a decline in ASRs for colonoscopy and endoscopic gastroduodenoscopy (EGD) in 2020 compared to 2018-2019, followed by an increase in 2021-2022, except for EGD in the medical aid population. SES based and rural-urban disparities were evident in the recovery of GIE rates. The findings suggest that equity-focused strategies are needed to ensure equitable healthcare access among different socioeconomic groups after pandemic.

To investigate inequalities related to race/ethnicity and socioeconomic status in self-reported positive diagnosis for COVID-19 in Brazilian adults.

Data available from the National Household Sample Survey COVID-19 (PNAD COVID 19) (July/September/November, 2020) were used in this retrospective investigation. The analyses considered the sampling design, primary sampling units, strata and sample weights. Poisson regression with robust variance was used to estimate prevalence ratio (PR) and the 95% confidence interval (95%CI) of the associations.

In July, September and November 2020, with regard to the rapid test, indigenous people were 2.45 (95%CI 1.48-4.08), 2.53 (95%CI 1.74-4.41) and 1.23 (95%CI 1.11-1.86) times more likely to report a positive history of SARS-CoV-2 infection, respectively. With regard to the RT-PCR test in November, indigenous people were more likely to test positive for COVID-19 (PR: 1.90; 95%CI 1.07-3.38). It was observed that the indigenous group was 1.86 (95%CI 1.05-3.29) and 2.11 (95%CI 1.12-3.59) times more likely to test positive for COVID-19 in September and November (2020). Income was associated with testing positive for COVID-19: in November, individuals whose income ranged from R$0.00-R$1.044 were more likely (PR: 1.69; 95%CI 1.16-23.06) to test positive using the RT-PCR test; participants whose income was in this range were also more likely to be diagnosed with COVID-19 using blood tests (PR: 1.72; 95%CI 1.43-2.07).

The data presented show an association between race/ethnicity and economic status with a positive diagnosis of COVID-19.

The rising prevalence of depressive symptoms presents a pressing global public health concern, exacerbated by prevailing social inequality.

This study seeks to identify latent profiles of social inequality perception and explore their associations with depressive symptoms.

Data were obtained from the China Family Panel Studies (CFPS) involving 10,529 residents aged 18 years and above. Latent profile analysis (LPA) was used to identify different patterns of social inequality perception. Multiple linear regression analysis examined the links between these patterns and depressive symptoms.

Three distinct patterns of social inequality perception were identified: the disappointed pattern (TDP), the neutral pattern (TNP), and the positive pattern (TPP). Perceived social inequality was significantly associated with short-term and long-term depressive symptoms (β = .51, 95% CI [0.29, 0.72] vs. β = .51, 95% CI [0.27, 0.74]). Increases in social inequality perception patterns were also related to more severe depressive symptoms (β = .55, 95% CI [0.36, 0.74]).

Increasing perceived social inequality is closely linked to elevated depressive symptoms in Chinese adults. This underscores the need for tailored strategies aimed at addressing heightened perceptions of social inequality to reduce the risk of depressive symptoms.

Caregiving for family members at their end of life is stressful. Caregivers' strain, burden, or stress has been measured in various geographical and sociodemographic contexts. The concept of stress, burden, and strain are sometimes used interchangeably. By analysing the factor structure of the Chinese version of the Modified Caregiver Strain Index (C-M-CSI), this study aimed to examine the caregiving strain concept and its demographic correlates.

A sample of 453 family caregivers of patients with a terminal illness in Hong Kong was employed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. In addition, generalized linear models (GLM) were used to examine the demographic correlates.

The EFA yielded a 3-factor model termed "Perception of Caregiving," "Empathetic Strain," and "Adjustment Demand." This 3-factor model explained 50% of the variance and showed good internal consistency. The CFA confirmed the 3-factor construct with satisfactory internal reliability (χ2 [61, N = 226] = 108.86, p < 0.001, CFI = 0.96, TLI = 0.95, SRMR = 0.04, and RMSEA = 0.06). Inspired by this factor structure and concepts of stress and strain from engineering discipline, a new model of caregiver strain is proposed. Additionally, family caregivers of non-cancer patients, who were not living with the patient, or younger were associated negatively with different dimensions of caregiver strain.

The results gave insights into the advancement of the conceptualization of caregiver strain, its multidimensional nature, and process of change, which inform directions for future research and practices.

The COVID-19 pandemic caused an economic, social and health crisis that, despite the lifting of restrictions in the so-called "new normality," resulted in increased vulnerability and informal employment.

To analyze the working and health conditions of a group of informal workers who develop their economic activities in the streets of Bogotá in the context of the COVID-19 pandemic and of the so-called post-pandemic new normality.

A mixed methods study was conducted on a sample of street vendors by applying a standard questionnaire and a qualitative phenomenological analysis. Data were analyzed descriptively, sub analysis was performed according to economic activity, and significant associations were tested.

A total of 191 street vendors of low socioeconomic status were included. Of note was the predominance of workers affiliated to the subsidized social security system (p = 0.012) and the fact that more than 89% were not affiliated to other protection systems. Participants perceived that their income decreased after the pandemic (50-80%) and that the wage-work relationship was unfair (p = 0.045). The health-work relationship was explored in categories such as challenges during the pandemic, work concerns, and work well-being.

The working, employment and health conditions of street vendors in the context of the pandemic worsened their already precarious living conditions and work flexibility, exposing them to adverse situations such as an increased risk of severe acute respiratory syndrome coronavirus 2 infection and a constant need to earn a living wage.

This narrative review explores loneliness among medical students, particularly heightened during the COVID-19 pandemic. This review aims to narratively describe how the digital age, both pre- and post-pandemic, influences loneliness and to assess the psychological effects of the pandemic on medical students. Our literature search, adhering to SANRA guidelines, scrutinized studies published in the last ten years focusing on loneliness among medical students. Our findings reveal that medical students experienced significant loneliness during the pandemic, attributed to virtual learning environments and decreased social interactions. Notably, the transition to online education has mitigated and exacerbated feelings of isolation. The review also highlights the dual role of social media in either alleviating or intensifying loneliness, depending on usage patterns and platform types. Overall, our study underscores the need for targeted interventions and support systems to address the mental well-being of medical students in the digital age and beyond, providing crucial insights for future research and policy-making in educational and psychological support frameworks.

This narrative review explores loneliness among medical students, particularly heightened during the COVID-19 pandemic. This review aims to narratively describe how the digital age, both pre- and post-pandemic, influences loneliness and to assess the psychological effects of the pandemic on medical students. Our literature search, adhering to SANRA guidelines, scrutinized studies published in the last ten years focusing on loneliness among medical students. Our findings reveal that medical students experienced significant loneliness during the pandemic, attributed to virtual learning environments and decreased social interactions. Notably, the transition to online education has mitigated and exacerbated feelings of isolation. The review also highlights the dual role of social media in either alleviating or intensifying loneliness, depending on usage patterns and platform types. Overall, our study underscores the need for targeted interventions and support systems to address the mental well-being of medical students in the digital age and beyond, providing crucial insights for future research and policy-making in educational and psychological support frameworks.

To explore how patients and general practice professionals in low-income neighborhoods experienced the increase of remote care during COVID-19.

As the GP (general practitioner) is the first point of contact in Dutch health care, there are concerns about access to remote care for patients from low-income neighborhoods. Now that general practice professionals have returned to the pre-pandemic ways of healthcare delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care and their satisfaction.

In this qualitative study, 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals were interviewed. Interviews were held on the phone and face-to-face in the native language of the participants.

Remote care, especially telephone consultation, was generally well-approachable for patients from low-income neighborhoods. Contrarily, video calling was rarely used. This was partly because patients did not know how to use it. The majority of patients thought remote care was possible for minor ailments but would also still like to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care. In conclusion, it is important to take the opinions and barriers of patients and care providers into account and to increase patient-centered care elements and care provider satisfaction in remote care. Integrating remote care is not only important in times of crisis but also for future care that is becoming increasingly digitalized.

Introduction: Telehealth in India is growing rapidly and represents a strategy to promote affordable, inclusive, timely and safe access to healthcare. Yet there is a risk that telehealth increases inequity due to the digital divide and existing poor health literacy. Methods: A scoping review was conducted to explore use of telehealth in India during and following the COVID-19 pandemic by people with disabilities to inform strategies to increase equity of telehealth for people with disabilities. Of 1966 studies from the initial search in four databases and three specific telehealth journals, 20 sources met the inclusion criteria, limited to a focus on physical disability in India. Results: Findings showed examples of how people with disabilities can exercise increased control in the timing of appointments, convenience of receiving services from home and not having to travel to clinics or hospitals, and platform preference through tools and applications already familiar to them. Carers and families of people with disabilities were described as highly valued stakeholders with important roles in the uptake and effectiveness of telehealth for people with disabilities. The identified benefits of telehealth resulted in high levels of user satisfaction due to increased control and convenience, however, systemic barriers for accessibility remain. Conclusion: This review suggested that if telehealth is not designed intentionally to change the status quo for people with disabilities and prioritize equity, then the benefits may not be sustainable. Recommendations for telehealth India are provided, based on both findings from the literature and analysis of results.

Conducting urgent eye trauma surgery amidst the COVID-19 pandemic poses distinct difficulties, as strict infection control measures are crucial to safeguard both patients and medical staff. Nonetheless, eye trauma remains a significant contributor to avoidable vision loss in developing countries.

A 57-year-old man presented with redness, bleeding, and injury in the left eye after a motorcycle accident 9 h prior to hospital admission, along with a torn wound on his left cheek. The visual acuity in the left eye showed no light perception. Limited eye movement in all directions, eyelid hematoma, conjunctival injection, hyphema, and tissue protrusion from the limbus at 6 to 8 o'clock positions were observed. The patient had a history of cataract surgery (+) in both eyes and was diagnosed with an open globe injury with zone II penetrating trauma, accompanied by full hyphema, vitreous and choroid prolapse in the left eye, and a confirmed case of COVID-19. Evisceration of the left eye was performed following the basic guidelines for ocular trauma surgery during the COVID-19 pandemic. Postoperative follow-up was conducted as usual by the operator in isolation for confirmed COVID-19 patients with no significant complaints.

Urgent surgical intervention is necessary to prevent visual impairment, following guidelines recommending surgery within 4-72 h. Ocular tissue may facilitate COVID-19 transmission via the nasolacrimal system, posing risks to healthcare workers, particularly during surgery. Preoperative measures, including obtaining COVID-19 status and providing appropriate personal protective equipment (PPE), are crucial. Minimizing aerosol-generating procedures and employing virucidal disinfection further mitigates the transmission risks. This case underscores the need to balance immediate intervention for eye injuries with safety protocols for COVID-19, emphasizing standardized PPE and surgical procedures to safeguard healthcare professionals.

Incorporating insights gained during the COVID-19 pandemic will fortify healthcare systems against future pandemics. In particular, it enables effective surgical emergency response while mitigating infectious disease risks.

COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.

We compared SARS-CoV-2 positivity between the foreign-born adult working population and Italians living in the Verona area to investigate whether being a foreign-born adult could confer an increased risk of infection or lead to a diagnostic delay. The present study included 105,774 subjects, aged 18-65 years, tested for SARS-CoV-2 by nasopharyngeal swabs and analyzed at the University Hospital of Verona between January 2020 and September 2022. A logistic regression model was used, controlling for gender, age, time of sampling, and source of referral. A higher proportion of SARS-CoV-2 positivity in Italian (30.09%) than in foreign-born (25.61%) adults was reported, with a higher proportion of SARS-CoV-2 positivity in men than women in both cohorts analyzed. The difference in swab positivity among Italian and foreign-born adults was the highest in people aged 18-29 years (31.5% vs. 23.3%) and tended to disappear thereafter. Swab positivity became comparable between Italian and foreign-born adults during the vaccination campaign. Multivariable analysis confirmed the lower risk of swab positivity among foreign-born adults (OR = 0.85, 95% CI 0.82-0.89). In the Verona area, foreign-born adults showed a lower rate of SARS-CoV-2 positivity than the native population, likely because of underdiagnosis. Hence, public health should increase attention toward these particularly vulnerable populations.

A growing literature has documented how the secondary effects of the COVID-19 pandemic have compounded socioeconomic vulnerabilities already present in society, particularly across social categories such as gender, race, class, and socioeconomic status. Such effects demonstrate how pandemic response policies act as structural determinants of health to influence not only direct health outcomes but also intermediary outcomes, such as access to education or income.

This review aims to scope research that analyzes pandemic response policies in Canada from an equity perspective, to identify common themes, recommendations, and gaps.

Fourteen studies were thematically analyzed, the majority being qualitative policy document analysis, applying critical frameworks and focused on effects on select priority populations. Analysis of economic and labour policies indicates a lack of consideration for the specific needs of priority populations, and those engaged in precarious, informal, and essential labour. Analysis of social policies illustrate the wide-ranging effects of school and service closures, particularly on women and children. Furthermore, these policies lacked consideration of populations marginalized during the pandemic, include older adults and their caregivers, as well as lack of consideration of the diversity of Indigenous communities. Recommendations proposed in this review call for developing policy responses that address persistent social and economic inequities, pandemic response policies tailored to the needs of priority populations and more meaningful consultation during policy development.

The limited number of studies suggests there is still much scope for research recognizing policies as structural determinants of health inequities, including research which takes an intersectional approach.

This study aimed to determine factors associated with changes in adherence to hypertension management (medication adherence and blood pressure control) in respondents with hypertension before and during the COVID-19 pandemic in Bogor city, Indonesia.

An observational study was conducted using two sources of data (before and during COVID-19 pandemic). Data before the pandemic were derived from the 2019 Cohort Study of non-communicable disease risk factors. Data during the pandemic were derived from an online survey conducted in September and October 2020. Information from 880 participants were analyzed. The dependent variable was the change in adherence to hypertension management before and during the COVID-19 pandemic. Multivariate analysis was performed using logistic polynomial regression.

Respondents who adhered to hypertension management decreased from 82.0% in 2019 to 47.8% in 2020. The likelihood of non-adherence (respondents who did not adhere to hypertension management both before and during the pandemic) increased in respondents below 55 years old, who did not own any healthcare insurance, who were not obese, and who had no other comorbidities. In the partial adherence group (respondents who did not adhere to hypertension management either before or during the pandemic), we found that most respondents adhered before the pandemic but no longer adhered during the COVID-19 pandemic. We found an increased partial adherence in young and highly educated respondents.

Efforts to improve adherence to hypertension management after the COVID-19 pandemic should target those who were young, highly educated, who did not have any healthcare insurance, and who did not perceive themselves as not having comorbidities.

While priority setting is recognized as critical for promoting accountability and transparency in health system planning, its role in supporting rational, equitable and fair pandemic planning and responses is less well understood. This study aims to describe how priority setting was used to support planning in the initial stage of the pandemic response in a subset of countries in the Western Pacific Region (WPR).

We purposively sampled a subset of countries from WPR and undertook a critical document review of the initial national COVID-19 pandemic response plans. A pre-specified tool guided data extraction and the analysis examined the use of quality parameters of priority setting, and equity considerations.

Nine plans were included in this analysis, from the following countries: Papua New Guinea, Tonga, The Philippines, Fiji, China, Australia, New Zealand, Japan, and Taiwan. Most commonly the plans described strong political will to respond swiftly, resource needs, stakeholder engagement, and defined the roles of institutions that guided COVID-19 response decision-making. The initial plans did not reflect strong evidence of public engagement or considerations of equity informing the early responses to the pandemic.

This study advances an understanding of how priority setting and equity considerations were integrated to support the development of the initial COVID-19 responses in nine countries in WPR and contributes to the literature on health system planning during emergencies. This baseline assessment reveals evidence of the common priority setting parameters that were deployed in the initial responses, the prioritized resources and equity considerations and reinforces the importance of strengthening health system capacity for priority setting to support future pandemic preparedness.

Most United States medical schools have affiliated student-run free clinics, but the quality of services provided in such contexts compared to national metrics is unknown. This study determines whether a student-run, attending-supervised free clinic servicing a low-income and minority race patient population in New York City can meet national metrics of care.

Through chart review from January 1, 2020 to December 31, 2020, patient outcomes and service utilization in the Healthcare Effectiveness Data and Information Set were examined and compared to national rates of patients using Medicaid HMO or Medicare. Patients are ≥ 21 years of age, residents of East Harlem, and ineligible for health insurance because of legal residency requirements. The majority identify as Hispanic and speak Spanish as their primary language. All patients who were seen in the clinic during the 2020 calendar year were included. The primary study outcome is the number of Healthcare Effectiveness Data and Information Set measures in which patients, seen in a student-run free clinic, meet or exceed national comparisons.

The healthcare outcomes of 238 patients, mean age 47.8 years and 54.6% female, were examined in 18 Healthcare Effectiveness Data and Information Set measures. The student-run free clinic met or exceeded national metrics in 16 out of 18 categories.

The student-run free clinic met or exceeded the national standard of care according to national metrics. Evidence-based priorities have been clarified for future improvement. Other student-run free clinics should similarly evaluate the quality of their services.

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has required a complete change in the management of patients with gastrointestinal disease who needed to undergo endoscopic procedures. In the second year of the COVID-19 pandemic, due to restrictions for elective endoscopic procedures, a large number of cancer patients were prevented from early diagnosis of several digestive cancers, which has led to a serious burden in the health system that now needs to be dealt with. We designed a prospective study that included patients in whom access to elective endoscopic examinations during the COVID-19 pandemic had been delayed. Our aim was to investigate the impact of the COVID-19 pandemic on the diagnosis rate of digestive tract malignancies in the context of health crisis management that generates an ethical dilemma regarding the balance of utilitarianism versus deontology. Our study shows that the decrease in the number of newly diagnosed gastrointestinal cancers by endoscopy and biopsy during the pandemic restrictions and the delay in diagnosis have had a clear impact on stage migration due to disease progression.

Medical students can assist in reducing healthcare disparities and promote health equity by engaging with rural communities and gaining insights into their unique healthcare needs. A two-arm student-delivered program was designed and implemented during COVID-19 in a social-geographic peripheral area to assist clinics with complex chronic and/or socially disadvantaged patients and improve preventive behavior in townships through home visits delivering community kits.

We conducted a pre-post design study which included weekly structured medical student reports and monthly structured telephone interviews with clinic directors and municipal partners. Students completed pre-post program survey on their knowledge, skills, and capabilities to address chronic patients from diverse cultural backgrounds (n = 73). The Wilcoxon-Signed-Rank test for related samples was used to determine differences.

Following the program, the knowledge and awareness levels of students about working in the community (P < 0.001) and their knowledge of common chronic diseases were significantly improved (Mean Difference (MD) = 0.31; p < 0.001). The program significantly increased students' interest to integrate into community care alongside a hospital (P = 0.012). Thematic analysis of student reports revealed improved insight into the role of primary care. Clinic directors (90%) were highly satisfied and reported that students became an integral part of the clinics' teams.

Integrating medical students into the community through primary-care clinics and home visits in diverse communities, exposed students to the interwoven effect of clinical and social determinants on health and improve their knowledge of common chronic diseases. Participation in the program encouraged students to consider a career in community care.

The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic.

This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects.

Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing.

It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies.