A Review of Trends and Knowledge Gaps in Latinx Outdoor Recreation on Federal and State Public Lands

The Latinx population in the United States, estimated to compose 28% of the country’s population by 2050, has a long history of public land use. Yet while research on Latinx outdoor recreation in urban green spaces has increased over the past 20 years, research on Latinx outdoor recreation on federal and state public lands has waned. This study synthesizes the literature on public land use and outdoor recreation on federal and state public lands by the Latinx population in the United States to assess the state of knowledge and to strategically identify research needs in Latinx public land use and outdoor recreation. Our analysis reveals that while institutional barriers such as policies, practices, and procedures that favor some ethnic groups over others continue to exist, barriers to access, such as distance to sites, available free time, and knowledge about how to use public lands may be shifting, offering clues that may help guide informed approaches to outdoor recreation management.

Prenatal Telemedicine During COVID-19: Patterns of Use and Barriers to Access

Lay Summary To protect pregnant patients from infection during the COVID pandemic, maternity care providers turned to video and phone visits (“telemedicine”) to provide as much prenatal care as possible. To evaluate this change in our prenatal care program, we surveyed 164 pregnant people who had participated in a virtual prenatal visit about their care. Participants reported both positive and negative experiences, ranging from appreciation for having a safer option than in-person visits during the pandemic, to problems due to poor internet connection, lack of privacy, and lack of access to necessary equipment. Although 77.4% of respondents indicated they would recommend telemedicine to a friend, our program evaluation highlights the fact that the ability to participate in virtual care is not equally distributed. Unless steps are taken to address this problem, relying on telemedicine for a significant portion of prenatal care could result in widening disparities in prenatal care and outcomes. Policymakers and healthcare systems which provide telemedicine must address issues of access to technology and connectivity to avoid adding to maternal health disparities. Objective To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic. Materials and Methods We conducted a post-visit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in five domains; 1) engagement with prenatal care; 2) barriers to telemedicine and in person healthcare; 3) experience of prenatal care; 4) remote pregnancy surveillance tools; 5) sources of COVID-19 information. Results Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to accessing telemedicine was poor internet or phone connectivity, followed by childcare responsibilities, lack of equipment and lack of privacy. Participants also engaged in additional remote prenatal care including phone calls with registered nurses (7.6%), communication with the obstetrics team through a secure health messaging portal (21.1%) and home health monitoring (76.3%). Discussion and Conclusions In this survey evaluating the experience of pregnant people participating in a prenatal telemedicine visit during the COVID-19 pandemic, respondents had a positive experience with telemedicine overall, but also identified significant barriers to participation including issues with connectivity and lack of equipment for the visit. Most participants used telemedicine in combination with other tools for remote self-care.

Selling Beautiful Births: The Use of Evidence by Brazil’s Humanised Birth Movement

Maternal health care continues to be excessively medicalised in many national health systems. Global, national, and local level policy initiatives seek to normalise low-risk birth and optimise the use of clinical interventions, informed by strong evidence supporting care that is centred on women’s preferences and needs. Challenges remain in translating evidence into practice in settings where care is primarily clinician-led and hospital-based, such as in Brazil.I conducted an ethnography of the movement for humanised care in childbirth in São Paulo between 2015 and 2018. I draw on interviews and focus groups with movement members (including mothers, doulas, midwives, obstetricians, politicians, programme leads, and researchers), and observations in health facilities implementing humanised protocols, state health council meetings, and key policy fora (including conferences, campaigning events, and social media). Key actors in this movement have been involved in the development and implementation of evidence-based policy programmes to “humanise” childbirth. Scientific evidence is used strategically alongside rights-based language, such as “obstetric violence”, to legitimise moral and ideological aims. When faced with resistance from pro-c-section doctors, movement members make use of other strategies to improve access to quality care, such as stimulating demand for humanised birth in the private health sector. In Brazil, this has led to a greater public awareness of the risks of the excessive medicalisation of birth but can reinforce existing inequalities in access to high-quality maternity care. Lessons might be drawn that have wider relevance in settings where policymakers are trying to reduce iatrogenic harm from unnecessary interventions in childbirth and for supporters of normal birth working to reduce barriers to access to midwifery-led, woman-centred care.

Oncology palliative care: access barriers: bibliometric study

ObjectiveTo perform a bibliometric analysis of studies that evaluated the barriers to access to cancer palliative care (PC).MethodsThis was a bibliometric review using MEDLINE; EMBASE; Web Of Science; LILACS and the Cochrane Library. A search was conducted with the terms Barriers, Palliative Care and Cancer. Articles whose objectives targeted barriers to access to PC were considered, regardless of the year of publication. The setting is articles published from 1987 to 2020.ResultsA total of 6158 articles were identified, of which 217 were eligible for analysis. The USA and UK being the countries with the largest number of articles on the subject (n=101, n=18, respectively). After expert analysis, the barriers were grouped into nine categories.ConclusionsBarriers related to symptom control were identified in 19% of the eligible articles, along with barriers related to health, which with 24% of occurrence in the articles, were the most frequently cited barriers. Countries which have implemented PC for some time were those with the greatest number of publications and in journals with the highest impact factors. Cross-sectional study design continues to be the most frequently used in publications.

ACCESS TO CHILDREN EDUCATION IN MIGRANT WORKERS IN INDUSTRIAL ZONES, EXPORT PROCESSING ZONES IN HO CHI MINH CITY

Children in families migrate more barriers to access to education services. The study showed access to information, access to support, and factors affecting childrens access to migrant workers in industrial parks, export processing zones in Ho Chi Minh city.

Roadblocks in Chagas disease care in endemic and nonendemic countries: Argentina, Colombia, Spain, and the United States. The NET-Heart project

Background Chagas disease (CD) is endemic in Latin America; however, its spread to nontropical areas has raised global interest in this condition. Barriers in access to early diagnosis and treatment of both acute and chronic infection and their complications have led to an increasing disease burden outside of Latin America. Our goal was to identify those barriers and to perform an additional analysis of them based on the Inter American Society of Cardiology (SIAC) and the World Heart Federation (WHF) Chagas Roadmap, at a country level in Argentina, Colombia, Spain, and the United States, which serve as representatives of endemic and nonendemic countries. Methodology and principal findings This is a nonsystematic review of articles published in indexed journals from 1955 to 2021 and of gray literature (local health organizations guidelines, local policies, blogs, and media). We classified barriers to access care as (i) existing difficulties limiting healthcare access; (ii) lack of awareness about CD and its complications; (iii) poor transmission control (vectorial and nonvectorial); (iv) scarce availability of antitrypanosomal drugs; and (v) cultural beliefs and stigma. Region-specific barriers may limit the implementation of roadmaps and require the application of tailored strategies to improve access to appropriate care. Conclusions Multiple barriers negatively impact the prognosis of CD. Identification of these roadblocks both nationally and globally is important to guide development of appropriate policies and public health programs to reduce the global burden of this disease.

Systematic Review of Dementia Support Programs with Multicultural and Multilingual Populations

Background: Dementia care programs have become more common due to a growing number of persons living with dementia and lack of substantial benefit from pharmacologic therapies. Cultural and language differences may present barriers to access and efficacy of these programs. In this article, we aimed to systematically review the current literature regarding outcomes of dementia care programs that included multicultural and non-English speaking populations. Methods: A systematic review was conducted using four scientific search engines. All studies included in the review are English language, randomized control trials evaluating various care coordination models. The initial search strategy focusing on studies specifically targeting multicultural and non-English speaking populations resulted in too few articles. We expanded our search to articles that included these populations although these populations may not have been the focus of the study. Results: Seven articles met inclusion criteria for final review. Measured outcomes included emergency room use, hospitalizations, provider visits, quality of life indicators, depression scores, and caregiver burden. Conclusions: Dementia care programs demonstrate significant ability to provide support and improve outcomes for those living with dementia and their caregivers. There is limited research in this field and thus opportunity for further study in underserved and safety net populations including more high-quality randomized controlled trials with larger sample sizes.

Access to and Barriers to Access for Essential Medicines in Nephrology and Related Non-Communicable Diseases: A Scoping Review Protocol

Objective: This scoping review aims to understand the extent of evidence regarding: 1) access to essential medicines, 2) barriers to access, and 3) interventions to improve access for chronic kidney disease (CKD) and related non-communicable diseases (NCDs). Introduction: Access to essential medicines for treatment of NCDs is lacking in low- and low-middle income countries. In nephrology, access to essential medicines is especially important to reduce risk of CKD progression, as kidney replacement therapy is unavailable or cost-prohibitive in many regions of the world. As part of the International Society of Nephrology Emerging Leaders Program’s mandate to improve health promotion and access to prevention and management of kidney diseases globally, this scoping review serves as an initial step towards designing implementation studies to improve access to essential medicines. Inclusion criteria: Articles of any study design involving populations with chronic kidney disease, cardiovascular disease, hypertension, and/or diabetes will be included. The core concept of essential medicines will encompass access to essential medicines, barriers to access, and interventions to improve access. All geographical regions and all World Bank Income categories will be considered. Methods: Methods for this scoping review are based on the Joanna Briggs Manual for Evidence Synthesis. MEDLINE, EMBASE, Web of Science, CENTRAL will be searched. Included studies will be restricted to English language. Screening of title/abstract of each article and subsequent review of retrieved full-text articles will be performed by one reviewer, followed by a second reviewer checking the excluded lists for accuracy. A data extraction tool will be customized using Covidence software. Data will be summarized narratively, and in tabular and diagrammatic format. Studies assessing barriers to access or interventions to improve access will be categorized by patient-level, provider-level, organization-level, community/regional-level, and national/health policy-level.

Increasing access to allotransplants in the United States: the impact of race, geography, and socioeconomics

Allogeneic hematopoietic cell transplantation (HCT) is particularly susceptible to racial, socioeconomic, and geographic disparities in access and outcomes given its specialized nature and its availability in select centers in the United States. Nearly all patients who need HCT have a potential donor in the current era, but racial minority populations are less likely to have an optimal donor and often rely on alternative donor sources. Furthermore, prevalent health care disparity factors are further accentuated and can be barriers to access and referral to a transplant center. Research has primarily focused on defining and quantifying a variety of social determinants of health and their association with access to allogeneic HCT, with a focus on race/ethnicity and socioeconomic status. However, research on interventions is lacking and is an urgent unmet need. We discuss the role of racial, socioeconomic, and geographic disparities in access to allogeneic HCT, along with policy changes to address and mitigate them and opportunities for future research.