Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem. Objectives: This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices. Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation. Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage. Conclusion Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.
Human ; access to medicines ; health services accessibility ; affordability ; costs and cost analysis

Medical assistance programs are government-funded programs that provide financial assistance to low-income individuals and families. These programs aim to reduce financial burdens and improve health care access. Coverage may include outpatient visits, hospital care, mental health services, diagnostic work-ups, prescriptions, and other services. This increases the detection of health conditions and improves drug utilization.1 2 3 Even though government health schemes and compulsory contributory health care financing schemes (e.g., PhilHealth) accounted for the majority of health expenditures in the Philippines, household out-of-pocket (OOP) payment still remains high. In 2022, the country’s total health expenditure (THE) was Php 1.12 trillion, with government health schemes and compulsory contributory health care financing schemes accounting for 44.8% of the THE and household OOP payment accounting for 44.7%. Thus, every Filipino spent an average amount of Php 10,059.49 for health care goods and services in 2022
Medical Assistance ; Health Services Accessibility ; Mental Health Services

OBJECTIVE: To analyze the long-term trends of the changes in the equity of China's health workforce allocation to provide a reference for the more balanced and orderly development of China's health system. METHODS: The Gini coefficient was used to evaluate the degree of equity in the allocation of health workforce between regions, and the Gini coefficients for the allocation of doctors and nurses based on population and regional gross domestic product (GDP) distribution were calculated respectively. RESULTS: In 2019, the number of licensed (assistant) physicians per 1 000 population in China was 2.77, and the number of registered nurses per 1 000 population was 3.18. The Gini coefficient for the distribution of licensed (assistant) physicians by population was 0.141 in 2002, decreasing to 0.081 by 2014 and then remained stable. The Gini coefficient for the distribution of registered nurses by population was 0.164 in 2002 and decreased to 0.066 in 2018. The Gini coefficient for the distribution of licensed (assistant) physicians by GDP was 0.236 in 2002, decreased to 0.169 in 2013, then increased to 0.183 and remained stable. The Gini coefficient for the distribution of registered nurses by GDP was 0.206 in 2002, decreased to 0.150 in 2013, and then increased each year to 0.180 in 2019. The equity of the allocation of registered nurses by population was worse than the equity of the allocation of licensed (assistant) physicians in 2002, and in 2016, for the first time, exceeded that of licensed (assistant) physicians. CONCLUSION Equity in the allocation of health workforce across China has improved, but the improvement in equity between regions has hit a bottleneck, with health workforce allocation in the western regions still relatively scarce. Although nursing workforce allocation equity caught up with licensed (assistant) physicians, the number of licensed (assistant) physicians is close to that of developed western countries, while there is a large gap in registered nurses. It is recommended that the relevant authorities make good long-term planning for health workforce, further increase the policy for the introduction of health workforce in the western region, and increase the supply of healthcare services in the western region with the help of digital transformation of healthcare and internet healthcare. At the same time, they should further increase investment in resources for higher nursing education and actively plan to cope with the ageing population.
China ; Health Equity ; Health Services ; Health Workforce ; Humans ; Workforce

Objective: To analyze the epidemiological characteristics of pneumoconiosis in Qinghai Province from 2011 to 2020, and to provide a basis for the formulation of prevention and control strategy. Methods: In April 2021 , the cases of pneumoconiosis were monitored by the Occupational Disease and Health Hazard Factors Monitoring Information System in Qinghai Province from 2011 to 2020. The distribution of pneumoconiosis, the composition of diseases and the working years exposed to dust were analyzed. Results: All 1026 cases of pneumoconiosis were newly diagnosed in Qinghai Province from 2011 to 2020, silicosis and coal worker pneumoconiosis were the main diseases (78.36% ,804/1026). Stage Ⅰ pneumoconiosis were 484 (47.17%,484/1026) cases. 359 (34.99%,359/1026) cases, 315 (30.70%,315/1026) cases and 252 (24.56%, 252/1026) cases had been diagnosed respectively in Xining City, Haidong City and Haixi Prefecture; 628 (61.21%,628/1026) cases and 418 (40.74%, 418/1026) cases engaged in mining industry and large-sized enterprise, respectively. The working years exposed to dust in silicosis cases were shorter than that in coal worker pneumoconiosis and other pneumoconiosis (P <0.05). Conclusion: The pneumoconiosis area and industry focus in Qinghai Province is obvious. The supervision and adninistration of small and micro scale employers should be strengthened to protect the health rights and interests of workers, especially for the key area and industry.
Anthracosis/epidemiology* ; China/epidemiology* ; Coal Mining ; Dust ; Health Services Accessibility ; Human Rights ; Humans ; Pneumoconiosis/epidemiology* ; Silicosis/epidemiology*

Objectives: The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses' perception of their practice environment.

Methods: The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses' practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing.

Results: Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related.

Conclusion: Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).

Key Words: Health Care Rationing, Health Facility Environment, Nursing Care

Background: Tiered services, differentiated by the financial capacity of patients and related payment arrangements with hospitals, are the norm in Philippine facilities. This study considered how these, together with selected demographic and clinical factors, were associated with surgical care utilization, provision, and outcomes for patients with appendicitis in a public university hospital.

Methods: This was a retrospective cohort study, utilizing data obtained from an electronic patient registry. Patients who underwent emergent appendectomies from January 2017 to December 2018 were included. Data were analyzed using multivariate and logistic regression, with the following dependent variables: time from symptom onset to emergency department consultation (ED Lag), time from consult to surgery (OR Lag), selection for laparoscopic appendectomy (LA), the occurrence of complicated appendicitis (CA), and length of stay (LOS). Morbidities and mortalities were tallied.

Results: There were 1,501 patients included in the study. Young adult males comprised the majority and mostly had non-private accommodations. Non-CA was the impression in more than 80% of cases. Extremes of age were associated with longer ED and OR Lags, greater likelihood of CA, and longer LOS. Patients initially assessed as having CA had shorter OR Lags, were less likely to undergo LA, and had longer LOS. Private patients were more likely to have undergone LA, lower CA odds, and slightly longer LOS.

Conclusions: Variations in surgical care utilization, provision, and outcomes for patients with appendicitis were independently associated with socioeconomic and clinical status differences.

ABSTRACT This study investigated personal and professional social media use among orthodontists in Malaysia, to determine marketing strategies and to identify potential determinants associated with their behaviours. A cross sectional study using an online questionnaire distributed to members of the Malaysian Association of Orthodontists (MAO). Data were analysed using SPSS software to derive descriptive statistics and analysis of variance was applied to compare responses between age groups and working sector. Responses to open ended questions were analysed using thematic analysis. A response rate of 41% was obtained (n = 72). Almost all respondents were social media users with Facebook being the most common online platform. Majority relied on traditional methods of marketing such as good service and image practice (94.4%), word of mouth (94.4%) and referrals (93.1%). Only 9.7% of respondents had adopted social media marketing but 23.6% had future plans to adopt it as their marketing strategy. Difference in knowledge of social media marketing was significantly different between age groups (p = 0.024). Concerns over patient confidentiality (p = 0.016) and risk of breaching online professional behaviour (p = 0.025), as reasons discouraging social media marketing was statistically significant between work sector groups. Most orthodontists in Malaysia use social media for personal use but only a minority incorporate it into their marketing strategies. Majority see its potential and predict its use will increase in the future.
Orthodontics ; Social Marketing ; Malaysia

Objective: To understand the current situation and influencing factors of cervical and lumbar spine diseases of the express delivery employees, and provide scientific basis for carrying out their occupational health protection in a targeted manner. Methods: From February 2020 to January 2021, the current situation research method was used to obtain 527 express delivery employees by cluster sampling. Online questionnaires were used to investigate sociodemographic characteristics and emotional characteristics, and clinical data were obtained by digital X-ray (DR) examination of the neck and waist. Pearson χ(2) test and multivariate logistic regression were used to analyze the influencing factors of cervical and lumbar spine diseases in express delivery employees. Results: The prevalence rates of cervical spine and lumbar spine diseases among express delivery employees were 49.15% (259/527) and 67.74% (357/527) , respectively. Univariate analysis showed that there were statistically significant differences in the distribution of cervical and lumbar spine disease among express delivery employees with different ages, length of service, working hours per week, and different degrees of distress due to emotional factors (P<0.05) . Multivariate analysis showed that express delivery employees aged ≥25 years old had a higher risk of cervical spine disease (P<0.05) , the express delivery employees who worked 49-55 hours per week had a lower risk of cervical spine disease (P<0.05) . Express delivery employees aged≥35 years old had a lower risk of lumbar spine disease (P<0.05) , and the risk of lumbar spine disease was higher among express delivery workers who suffered moderate or more distress due to emotional factors (such as anxiety, depression, or irritability) in the past 4 weeks (P<0.05) . Conclusion: The prevalence of cervical and lumbar spine diseases is relatively high among express delivery employees. It is recommended to adjust the weekly working hours of express delivery employees, organize psychological counseling training, and effectively protect the occupational health rights of express delivery employees.
Adult ; Health Services Accessibility ; Human Rights ; Humans ; Occupational Health ; Prevalence ; Surveys and Questionnaires

Background: Health information systems (HIS) such as Electronic Medical Record (EMR) systems are essential in the integration of fragmented local health systems. Investing in HIS is crosscutting; it can address multiple interrelated health system gaps. However, public health authorities, especially those in resource-constrained communities, are often faced with the dual challenge of upgrading and digitalizing local HIS and addressing other more apparent health system gaps. Objectives: The study aimed to identify and document strategies that not only motivate policy change towards adoption of electronic HIS but also address other health system gaps. Methodology: The author, in his capacity as a local health official in a resource-constrained community, developed, implemented, and documented a social marketing strategy wherein community stakeholders were influenced to invest in an electronic medical record (EMR) system because it was shown to also have the capacity to address other priority health system gaps identified. Results: The strategy, based on situational, stakeholder, and risk analyses, prompted local governance to first invest in improving the delivery of services accredited by the national health insurance program (PhilHealth), for which reimbursements would require electronically submitted claim forms. Community stakeholders then supported the proposal to invest in an EMR system because they were persuaded that it can facilitate increased financing from PhilHealth claims reimbursements, which could be used to enable not only improvement in existing health services but to also initiate other health programs. Conclusion Social marketing using the perspective of health as an investment influenced stakeholders to invest in an EMR system.
Public Health ; Health Information Systems ; Health Communication ; Social Marketing

Post-marketing surveillance is the principal means to ensure drug use safety. The spontaneous report is the essential method of post-marketing surveillance for drug safety. Often, most spontaneous reports come from medical staff and sometimes come from patients who use the drug. The posts published by individuals on social media platforms that contain drugs and related adverse reaction content have gradually been seen as a new data source similar to spontaneous reports from drug users in recent years. Those user-generated posts potentially provide researchers and regulators with new opportunities to conduct post-marketing surveillance for drug safety from patients' perspectives mostly rather than medical professionals and can afford the possibility theoretically to discover drug-related safety issues earlier than traditional methods. Social media data as a new data source for safety signal detection and signal reinforcement have the unique advantages, such as population coverage, type of drugs, type of adverse reactions, data timeliness and quantity. Most of the social media data used in post-marketing surveillance research for drug safety are still text data in English, and even multiple languages are used by different people worldwide on several social media platforms. Unfortunately, there is still a controversy in the academic circles whether social media data can be used as reliable data sources for routine post-marketing surveillance for drug safety. A couple of obstacles of data, methods and ethics must be overcome before leveraging social media data for post-marketing surveillance. The number of Chinese social media users is large, and the social media data in the Chinese language is rapidly snowballing, which can be employed as the potential data source for post-marketing surveillance for drug safety. However, due to the Chinese language's specific characteristics, the text's diversity is different from the English text, and there is not enough accepted corpus in medical scenarios. Besides, the lack of domestic laws and regulations on privacy and security protection of social media data poses more challenges for applying Chinese social media data for post-market surveillance. The significance of social media data to post-marketing surveillance for drug safety is undoubtedly significant. It will be an essential development direction for future research to overcome the challenges of using social media data by developing new technologies and establishing new mechanisms.
Humans ; Information Storage and Retrieval ; Marketing ; Social Media