OBJECTIVES

This study investigates the impact of the COVID-19 pandemic on social service accessibility for persons with disabilities in the Philippines, with a focus on disability related opportunity costs and out-of-pocket expenses.

A mixed-methods approach was employed, combining both qualitative and quantitative data collection techniques. Focus group discussions (FGDs) and interviews were conducted to gather qualitative insights, while quantitative analysis, utilizing one-sample t-tests, was used to assess the impact of the pandemic on key areas such as income, access to essential goods, employment, healthcare, mental health, and social support.

Using a mixed-methods approach, data were collected from 141 participants. Qualitative insights highlighted that 89% of participants reported negative effects on daily living conditions due to rising costs and limited access to necessities. Parents of children with disabilities indicated that early childhood care and development services were adversely affected by school closures, and transitioning to online learning posed significant barriers, with 62% lacking access to training and resources. While many participants had access to healthcare, lockdowns exacerbated disability-related opportunity costs, complicating access to routine care. Quantitative data findings were analyzed through one-sample t-tests to assess the impact of COVID-19 on various aspects of daily life, including income, access to essential goods, employment status, healthcare access, mental health, and social support. Findings revealed significant challenges, with an average income decrease rating of 7.39, reflecting substantial financial loss. Ratings for access to essential goods and healthcare services also averaged 7.39, while employment status was rated at 7.82, indicating instability. Mental health impacts averaged 7.13, and social support was rated at 7.42, underscoring inadequacies during this crisis.

Overall, the study emphasizes the urgent need for targeted interventions and inclusive responses in emergency planning to mitigate the pandemic's disproportionate impact on this marginalized group in the Philippines.

BACKGROUND: Infertility is a burdensome, often overlooked condition. This study aimed to investigate the global distribution and trends in the burden of infertility from 1990 to 2021. METHODS: We obtained data on the prevalence and years lived with disability (YLDs) related to infertility from the Global Burden of Disease 2021 study and evaluated them by calculating the estimated annual percentage change in age-standardized rates. We investigated the relationship between sociodemographic index (SDI) and the burden of infertility on the global, regional, and national levels. RESULTS: In 2021, there were 143,261,562 female and 55,481,380 male infertility cases worldwide, respectively. In China, female and male infertility cases accounted for 23.59% and 21.47% of the global totals, reaching 33,795,944 and 11,909,889, respectively. Compared with 2019, the global number of female and male infertility cases increased by 5,286,227 in females and 2,017,271 in males. In contrast, China saw a decline in both female and male infertility cases, with reductions of 698,735 and 154,591, respectively. From 1990 to 2021, the age-standardized prevalence rate (ASPR) and age-standardized YLDs rate (ASYR) for female infertility both increased by 0.59% annually, whereas these two corresponding indicators for male infertility increased by 0.50% annually worldwide. The burden of female infertility was consistently higher than that of male infertility and demonstrated a faster rate of increase. East Asia had the highest ASPR and ASYR for female infertility, whereas Eastern Europe had the highest metrics for male infertility. A horizontal S-shaped association was observed between the SDI and ASPR and ASYR of infertility, with a rapid decline in the infertility burden when the SDI exceeded 0.7. CONCLUSIONS The global burden of infertility has increased over the years, with a higher burden on women and underdeveloped regions. These findings emphasize the need to prioritize healthcare for patients with infertility to address the rising burden.
Humans ; Female ; Male ; Global Burden of Disease ; Prevalence ; Infertility/epidemiology* ; Adult ; Infertility, Male/epidemiology* ; Persons with Disabilities/statistics & numerical data* ; Middle Aged ; Infertility, Female/epidemiology* ; China/epidemiology* ; Disability-Adjusted Life Years

OBJECTIVE: To explore the current status and changing trends of the disease burden of traumatic brain injury (TBI) in China from 1990 to 2023, and to quantitatively assess the impact of different influencing factors on this disease burden, thereby providing references for the prevention of TBI. METHODS: Based on the 2023 Global Burden of Disease Study (GBD), indicators including incidence and years lived with disability (YLDs) were used to analyze the status and changing trends of TBI disease burden in China from 1990 to 2023. Additionally, the decomposition method established by Gupta was adopted to quantify the effects of population growth, population aging, age-specific incidence rate, and disease severity on YLDs. RESULTS: From 1990 to 2023, the age-standardized incidence rate and YLDs rate of TBI in China showed an overall upward trend, with a significant downward trend between 2015 and 2020, followed by a resumption of upward trend after 2020. The disease burden of TBI in males was higher than that in females, with a larger increase amplitude. The elderly population had higher TBI incidence rate and YLDs rate, also with a larger upward amplitude. Falls were the main cause of TBI in China, and the changing trend of the disease burden caused by falls was consistent with the overall trend of TBI disease burden; meanwhile, the elderly population bore a relatively high disease burden from falls. Taking 1990 as the baseline, the growth rates of YLDs in males and females in 2023 were 101.54% and 101.40%, respectively. For males, the proportions of YLDs growth attributed to population growth, population aging, age-specific incidence rate, and disease severity were 26.91%, 49.62%, 37.74%, and -12.73%, respectively; for females, the corresponding proportions were 28.85%, 57.69%, 27.65%, and -12.79%. CONCLUSION From 1990 to 2023, population aging had a significant impact on the disease burden of TBI in China. Strengthening the prevention and control of falls and paying close attention to males and the elderly population should be the key focuses of TBI prevention and control work in China in the future.
Humans ; Brain Injuries, Traumatic/epidemiology* ; China/epidemiology* ; Male ; Female ; Incidence ; Middle Aged ; Aged ; Adult ; Cost of Illness ; Adolescent ; Young Adult ; Persons with Disabilities/statistics & numerical data* ; Child ; Global Burden of Disease ; Disability-Adjusted Life Years ; Child, Preschool ; Infant ; Aged, 80 and over

OBJECTIVES: To investigate the effect of age-friendly social and family care environment on the long-term care (LTC) services for the disabled elderly people. METHODS: A questionnaire-based survey was conducted among disabled elderly people in three cities of Zhejiang province from June to August 2022, involving 311 subjects from Ningbo city (LTC service insurance pilot site, insured group) and 542 subjects from Hangzhou and Quzhou cities (uninsured group). The service provisions, including ensuring daily activities, preventive healthcare, and satisfying spiritual comfort, were compared among the groups. The family friendly care environment was evaluated with the Family Function Scale and assistance of daily activities, financial support and emotional comfort. The social friendly care environment was measured with the revised WHO recommended age-friendly city environmental framework, including accessibility guarantee environment, information dissemination environment, social participant environment, and life security environment. After controlling for covariates such as sociodemographic, elderly care status, and health risk characteristics, the impact of environment on the effectiveness of service provision of LTC insurance was explored by multiple logistic regression analysis. The mediating and moderating effects were tested to explore the role of age-friendly care environment. A fixed effects model was used to test the service provision effects of LTC insurance policy. RESULTS: Disabled elderly with LTC insurance had a higher proportion of their preventive health care and spiritual comfort needs met. Additionally, a multifactorial analysis found a significant positive association between LTC insurance and meeting the spiritual comfort needs. Compared with insured group (Ningbo city), disabled elderly people in Hangzhou urban area (OR=0.45, 95%CI:0.27-0.74, P<0.01) and Quzhou rural area (OR=0.21, 95%CI:0.12-0.37, P<0.01) were more likely to feel unsatisfied with spiritual comfort. The results of mediation analysis showed that the scores of accessibility guarantee environment (OR=1.22, 95%CI:1.02-1.45, P<0.05), information dissemination environment (OR=1.19, 95%CI:1.02-1.39, P<0.05), and social participation environment (OR=1.40, 95%CI:1.17-1.67, P<0.01) in a socially friendly care environment were positively correlated with the satisfaction rate of mental comfort services. The results of the moderation effect analysis indicated that a socially friendly care environment (OR=1.46, 95%CI:1.16-1.84, P<0.01) could compensate for the difference in effectiveness between insured (Ningbo) and uninsured (Hangzhou and Quzhou) areas of LTC insurance. A fixed effect model confirmed the policy chain of LTC insurance policy-social friendly care environment-mental health service satisfaction. CONCLUSIONS The implementation of LTC insurance has improved service accessibility, making disabled elderly people feel "seen and valued", and generating psychological and spiritual satisfaction. Accelerating the establishment and improvement of the LTC insurance system requires systematic design, especially emphasizing the supportive role of a socially friendly care environment, and promoting it in urban and rural areas according to the local conditions.
Humans ; Aged ; Persons with Disabilities ; Surveys and Questionnaires ; Long-Term Care ; Female ; Male ; China ; Social Environment ; Middle Aged ; Aged, 80 and over

Human ; Health Promotion ; Persons

Cerebral venous sinus thrombosis ( CVST) results from occlusion of cerebral venous sinuses, usually resulting in hemorrhagic infarction. It is a rare type of stroke affecting 3-5 per million people, often due to hypercoagulable states from clotting factor abnormalities or diseases like cancers, autoimmune and collagen vascular disease. Headache, visual changes, changes in sensorium, focal neurologic signs, seizures, and coma are some of the symptoms.

The role of exogenous estrogen in developing CVST among transgenders has not been reported frequently in literature. We report a 26-year-old transgender female who presented with throbbing headache after four years of exogenous high dose parenteral and oral estrogen. Magnetic resonance venography findings showed dural sinus thrombosis involving the left internal jugular vein, left sigmoid sinus, left transverse sinus, straight sinus, torcula and posterior aspect of the superior sagittal sinus. Patient was treated with topiramate, steroids and anticoagulants. Patient symptoms improved and was subsequently sent with home medications edoxaban. This case underscores the importance of monitoring the use of hormonal therapy in transgender individuals.

This report is an example of a rare cause of thrombosis secondary to self-administration of parenteral and oral estrogen. Prompt diagnosis in this patient resulted in the prevention of a catastrophic event like a major stroke, highlighting the importance of vigilance in managing hormone therapy. Increasing awareness about transgender issues can improve health and reduce inequities in this population. Cerebral venous sinus thrombosis ( CVST) results from occlusion of cerebral venous sinuses, usually resulting in hemorrhagic infarction. It is a rare type of stroke affecting 3-5 per million people, often due to hypercoagulable states from clotting factor abnormalities or diseases like cancers, autoimmune and collagen vascular disease. Headache, visual changes, changes in sensorium, focal neurologic signs, seizures, and coma are some of the symptoms.

The role of exogenous estrogen in developing CVST among transgenders has not been reported frequently in literature. We report a 26-year-old transgender female who presented with headache after 4 years of exogenous high dose parenteral and oral estrogen. Magnetic resonance venography findings showed dural sinus thrombosis involving the left internal jugular vein, left sigmoid sinus, left transverse sinus, straight sinus, torcula and posterior aspect of the superior sagittal sinus. Patient was treated with topiramate, steroids and anticoagulants. Patient symptoms improved and was subsequently sent home on edoxaban. This case underscores the importance of monitoring hormonal therapy in transgender individuals.

This report is an example of a rare cause of thrombosis secondary to self-administration of parenteral and oral estrogen. Prompt diagnosis in this patient resulted in the prevention of a catastrophic event like a major stroke, highlighting the importance of vigilance in managing hormone therapy. Increasing awareness about transgender issues can improve health and reduce inequities in this population.

Objective: To investigate the population size of transgender women (TGW) in Tianjin and analyze the characteristics of their sexual behaviors to provide a basis for AIDS prevention and control. Methods: To estimate the population size of TGW in Tianjin using the capture-recapture method. At the same time, an anonymous questionnaire was collected to conduct a multi-factor logistic analysis of the TGW population's sexual behavior. Results: A total of 213 TGW were investigated. Tianjin's estimated TGW population size was 599 (95%CI: 407-792). Multivariate logistic analysis of the use of condoms consistently showed that compared with TGW without regular sex partners, those with regular sex partners had a lower proportion of consistent condom use (aOR=0.44, 95%CI: 0.23-0.82) and had received HIV tests in the last year were more likely to adhere to condom use than those who had not been tested (aOR=2.73, 95%CI: 1.06-6.99). Conclusion: It is necessary to strengthen HIV mobilization testing among the TGW population and their regular sexual partners to improve condom use.
Humans ; Female ; Population Density ; Transgender Persons ; Sexual Behavior ; Sexual Partners ; HIV Infections/prevention & control*

BACKGROUND: Health screening is a preventive and cost-effective public health strategy for early detection of diseases. However, the COVID-19 pandemic has decreased health screening participation. The aim of this study was to examine regional differences in health screening participation between before and during COVID-19 pandemic and vulnerabilities of health screening participation in the regional context. METHODS: Administrative data from 229 districts consisting of 16 provinces in South Korea and health screening participation rate of each district collected in 2019 and 2020 were included in the study. Data were then analyzed via descriptive statistics and geographically weighted regression (GWR). RESULTS: This study revealed that health screening participation rates decreased in all districts during COVID-19. Regional vulnerabilities contributing to a further reduction in health screening participation rate included COVID-19 concerns, the population of those aged 65+ years and the disabled, lower education level, lower access to healthcare, and the prevalence of chronic disease. GWR analysis showed that different vulnerable factors had different degrees of influence on differences in health screening participation rate. CONCLUSIONS These findings could enhance our understanding of decreased health screening participation due to COVID-19 and suggest that regional vulnerabilities should be considered stringent public health strategies after COVID-19.
Humans ; COVID-19/epidemiology* ; Pandemics ; Republic of Korea/epidemiology* ; Educational Status ; Disabled Persons

Objective: To evaluate the effect of Wendler Glottoplasty to elevate vocal pitch in transgender women. Methods: The voice parameters of pre-and 3-month post-surgery of 29 transgender women who underwent Wendler Glottoplasty in department of otorhinolaryngology head and neck surgery of Beijing Friendship Hospital from January, 2017 to October, 2020 were retrospectively analyzed. The 29 transgender women ranged in age from 19-47 (27.0±6.3) years old. Subjective evaluation was performed using Transsexual Voice Questionnaire for Male to Female (TVQ^MtF). Objective parameters included fundamental frequency (F₀), highest pitch, lowest pitch, habitual volume, Jitter, Shimmer, maximal phonation time (MPT), noise to harmonic ratio (NHR) and formants frequencies(F1, F2, F3, F4). SPSS 25.0 software was used for statistically analysis. Results: Three months after surgery, the score of TVQ^MtF was significantly decreased [(89.9±14.7) vs. (50.4±13.6), t=11.49, P<0.001]. The F₀ was significantly elevated [(152.7±23.3) Hz vs. (207.7±45.9) Hz, t=-6.03, P<0.001]. Frequencies of F1, F2 and F3 were significantly elevated. No statistical difference was observed in the frequencies of F4. The highest pitch was not significantly altered while the lowest pitch was significantly elevated [(96.8±17.7) Hz vs. (120.0±28.9) Hz, t=-3.71, P=0.001]. Habitual speech volume was significantly increased [(60.0±5.2) dB vs. (63.6±9.6) dB, t=-2.12, P=0.043]. Jitter, Shimmer, NHR and MPT were not obviously altered (P>0.05). Conclusions: Wendler Glottoplasty could notably elevate the vocal pitch, formants frequencies and degree of vocal femininity in transgender women without affecting phonation ability and voice quality. It can be an effective treatment modality for voice feminization.
Humans ; Male ; Female ; Young Adult ; Adult ; Middle Aged ; Transgender Persons ; Retrospective Studies ; Speech Acoustics ; Voice Quality ; Phonation

OBJECTIVES: The interaction between elderly people with disabilities and their caregivers and the improvement of caregiver burden is important for elderly people with disabilities and their caregivers. This study aims to explore the multiple mediating roles of caregiver's caring ability and resilience in depression in the elderly people with disabilities on caregiver burden. METHODS: A total of 246 elderly people with disabilities at home and their family caregivers from 5 regions were investigated by questionnaires, including the General Information Questionnaire, the Patient Health Questionnaire, the Family Caregiver Task Inventory, the Resilience Scale, and the Caregiver Burden Interview. A multiple mediation model was constructed and tested. RESULTS: Univariate analysis showed that the caregiver burden of disabled elderly men is higher than that of women; the lower the level of self-care of disabled elderly individuals, the greater the burden on their caregivers (both P<0.05). Correlation analysis showed that depression of the disabled elderly people was positively correlated with the caregiver burden (P<0.01). Caregiver's caring ability was positively correlated with caregiver's resilience (P<0.01), and both were negatively correlated with caregiver burden (both P<0.01). The multiple mediating effects of caregiver caring capacity and resilience between depression of the disabled elderly people and caregiver burden were significant, with the mediating effects of caregiver caring capacity and resilience accounting for 68.9% and 26.2% of the total effect, respectively. CONCLUSIONS Depression in the elderly people with disabilities can indirectly affect caregiver burden through the caregiver's caring ability and resilience. Families of older people with disabilities need to focus on both the elderly and their caregivers. It is possible to reduce the caregiver burden and improve the physical and mental health of the dyads by empowering the caregiver's caring ability and resilience.
Male ; Humans ; Female ; Aged ; Caregiver Burden ; Disabled Persons ; Caregivers ; Surveys and Questionnaires ; Mental Health