Geographical accessibility to the supply of antiophidic sera in Brazil: Timely access possibilities

Snakebite accidents are considered category A neglected tropical diseases. Brazil stands out for snakebite accidents, mainly in the Amazon region. The best possible care after snakebite accidents is to obtain antiophidic sera on time. And the maximum ideal time to reach it is about 2 hours after an accident. Based on public health information and using a tool to analyze geographical accessibility, we evaluate the possibility of reaching Brazilian serum-providing health facilities from the relationship between population distribution and commuting time. In this exploratory descriptive study, the geographic accessibility of Brazilian population to health facilities that supply antiophidic serum is evaluated through a methodology that articulates several issues that influence the commuting time to health units (ACCESSMOD): population and facilities’ distribution, transportation network and means, relief and land use, which were obtained in Brazilian and international sources. The relative importance of the population without the possibility of reaching a facility in two hours is highlighted for Macro-Regions, States and municipalities. About nine million people live in locations more than two hours away from serum-providing facilities, with relevant variations between regions, states, and municipalities. States like Mato Grosso, Pará and Maranhão had the most important participation of population with reaching time problems to those units. The most significant gaps are found in areas with a dispersed population and sometimes characterized by a high incidence of snakebites, such as in the North of the country, especially in the Northeastern Pará state. Even using a 2010 population distribution information, because of the 2020 Census postponement, the tendencies and characteristics analyzed reveal challenging situations over the country. The growing availability of serum-providing health facilities, the enhanced possibilities of transporting accident victims, and even the availability of sera in other types of establishments are actions that would allow expanding the possibilities of access to serum supply.

TBCOV: Two Billion Multilingual COVID-19 Tweets with Sentiment, Entity, Geo, and Gender Labels

As the world struggles with several compounded challenges caused by the COVID-19 pandemic in the health, economic, and social domains, timely access to disaggregated national and sub-national data are important to understand the emergent situation but it is difficult to obtain. The widespread usage of social networking sites, especially during mass convergence events, such as health emergencies, provides instant access to citizen-generated data offering rich information about public opinions, sentiments, and situational updates useful for authorities to gain insights. We offer a large-scale social sensing dataset comprising two billion multilingual tweets posted from 218 countries by 87 million users in 67 languages. We used state-of-the-art machine learning models to enrich the data with sentiment labels and named-entities. Additionally, a gender identification approach is proposed to segregate user gender. Furthermore, a geolocalization approach is devised to geotag tweets at country, state, county, and city granularities, enabling a myriad of data analysis tasks to understand real-world issues at national and sub-national levels. We believe this multilingual data with broader geographical and longer temporal coverage will be a cornerstone for researchers to study impacts of the ongoing global health catastrophe and to manage adverse consequences related to people’s health, livelihood, and social well-being.

Repurposing of Medicines in the EU: Launch of a Pilot Framework

Repurposing of authorised medicines has been under discussion for a long time. Drug repurposing is the process of identifying a new use for an existing medicine in an indication outside the scope of the original approved indication. Indeed, the COVID-19 health crisis has brought the concept to the frontline by proving the usefulness of this practise in favour of patients for an early access to treatment. Under the umbrella of the Pharmaceutical Committee and as a result of the discussions at the European Commission Expert Group on Safe and Timely Access to Medicines for Patients (STAMP) a virtual Repurposing Observatory Group (RepOG) was set up in 2019 to define and test the practical aspects of a pilot project thought to provide support to “not-for-profit” stakeholders generating or gathering data for a new therapeutic use for an authorised medicine. The group's initial plan was impacted by the outbreak of the SARS-CoV-2 pandemic and the launch of the pilot needed to be postponed. This article describes the progress and the activities conducted by the group during this past and yet extraordinary 2020–2021 to keep the project alive and explores on the background of this topic together with the obvious opportunities this health crisis has brought up in terms of repurposing of medicines.

Mainstreaming Genetic Testing for Epithelial Ovarian Cancer by Oncology Providers: A Survey of Current Practice

PURPOSE With limitations in early detection and poor treatment response, ovarian cancer is associated with significant morbidity and mortality. Up to 25% of epithelial ovarian cancer (EOC) is related to a hereditary predisposition. Current National Comprehensive Cancer Network guidelines recommend that all individuals diagnosed with EOC be offered germline genetic testing. Although this would ideally be performed by genetics professionals, a shortage of genetic counselors can affect timely access to these services. This study sought to investigate the current genetic testing practices of oncology providers to determine the feasibility of oncologist-led genetic testing for patients with EOC. METHODS A survey was distributed to members of the Society of Gynecologic Oncologists with questions regarding timing, frequency, and type of cancer genetic testing, referrals to genetics professionals, confidence with aspects of genetic testing, and any barriers to these processes. RESULTS We received 170 evaluable responses. Eighty-five percent of providers always ordered genetic testing for patients with EOC. Most providers ordered germline multigene panel testing (95.8%), generally at diagnosis (64.5%). Provider confidence with the genetic testing process was generally high and significantly differed by providers' testing practices, namely, respondents who reported always ordering genetic testing tended to be more confident in ordering testing ( P = .008), interpreting results ( P = .005), and counseling a patient ( P = .002). Patient disinterest and concerns for insurance coverage were commonly cited as barriers to testing and referrals. CONCLUSION The findings from this study suggest that oncologist-led genetic testing for patients with EOC, with referrals to genetics professionals when appropriate, has the potential to be a viable alternative service delivery model to increase access to genetic testing for patients diagnosed with EOC.

Outcome of Aneurysmal Subarachnoid Hemorrhage in a Population‐Based Cohort: Retrospective Registry Study

BACKGROUND Studies of aneurysmal subarachnoid hemorrhage report an association between higher patient volumes and better outcomes. In regions with dispersed settlement, this must be balanced against the advantages with shorter prehospital transport times and timely access. The aim of this study is to report outcome for unselected aneurysmal subarachnoid hemorrhage cases from a well‐defined rural population treated in a low‐volume neurosurgical center. METHODS This is a retrospective, population‐based, observational cohort study from northern Norway (population 486 450). The University Hospital of North Norway provides the only neurosurgical service. We retrieved data for all aneurysmal subarachnoid hemorrhage cases (n=332) admitted during 2007 through 2019 from an institution‐specific register. The outcome measures were mortality rates and functional status assessed with the modified Rankin scale. RESULTS The mean annual number of cases was 26 (range, 16–38) and the mean crude incidence rate 5.4 per 100 000 person‐years. Two hundred seventy‐nine of 332 (84%) cases underwent aneurysm repair, 158 (47.5%) with endovascular techniques and 121 (36.4%) with microsurgical clipping, while 53 (15.9%) did not. The overall mortality rate was 16.0% at discharge and 23.8% at 12 months. The proportion with a favorable outcome (modified Rankin scale scores 0–2) was 36.1% at discharge and 51.5% at 12 months. In subgroup analysis of cases who underwent aneurysm repair, the mortality rate was 4.7% at discharge and 11.8% at 12 months, and the proportion with a favorable outcome 42.3% at discharge and 59.9% at 12 months. CONCLUSIONS We report satisfactory outcomes after treatment of aneurysmal subarachnoid hemorrhage in a low‐volume neurosurgical department serving a rural population. This indicates a reasonable balance between timely access to treatment and hospital case volume

Access to advanced-level hospital care: differences in prehospital times calculated using incident locations compared with patients’ usual residence

Studies estimate that 84% of the USA and New Zealand’s (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ’s Mortality Collection during 2008–2012 were linked to Coronial files. Estimated access times via emergency medical services were calculated using locations of incident and home. Using incident locations, 73% (n=4445/6104) had timely access to care compared with 77% when using home location. Access calculations using patients’ home locations overestimated timely access, especially for those injured in industrial/construction areas (18%; 95% CI 6% to 29%) and from drowning (14%; 95% CI 7% to 22%). When considering timely access to definitive care, using the location of the injury as the origin provides important information for health system planning.

Information and communication technologies (ICTs): The potential for enhancing the dissemination of agricultural information and services to smallholder farmers in sub-Saharan Africa

The transformation of smallholder farming is poised to be one of the key drivers of achieving the dual objectives of food security and poverty reduction in Sub-Saharan Africa (SSA). Smallholder farmers account for between 60–80% of the food produced in the region but face many challenges that impede their productivity. Such challenges include a lack of timely access to appropriate agricultural information and services, which results in poor decision-making, particularly in addressing challenges and responding effectively to opportunities. In that context, the effective use of Information and Communication Technologies (ICTs) in improving accessibility to appropriate agricultural information and services presents substantial prospects for transforming the productivity and livelihoods of the farmers. Currently, the region experiences massive penetration and propagation of mobile and web-based applications. However, there is a dearth of compelling, comprehensive reviews evaluating their importance in enhancing agricultural information and services dissemination to smallholder farmers. Therefore, the current review explores the potential of enhancing agricultural information and services dissemination to smallholder farmers through ICTs and highlights gaps in their development and deployment in SSA. Five existing mobile applications used to disseminate agricultural information and services to smallholder farmers were identified, and their advantages, limitations, and opportunities were discussed. These were Esoko, iCow, Community Knowledge Workers, WeFarm and DigiFarm. The development and deployment of user-driven mobile applications that provide curated skill-sharing platforms, encourage farmers to give feedback to extension systems in real-time and promote the participation of women and youth in agriculture are recommended.

An Integrative Literature Review on Older Adults, Their eHealth Literacy and Use of Telehealth

Healthcare is challenged by providing high-quality, equitable and timely access to care for older adults. Telehealth can address these challenges, however, a level of eHealth literacy is required. This integrative literature review sought to understand the experiences of older adult patients with poor eHealth literacy who use telehealth. Results include that older adults with less eHealth literacy have many concerns engaging with telehealth and irrespective of their eHealth literacy, most need support to use telehealth.

Providers and Families Weigh in on Delays to Pediatric Kidney Transplant Wait-List Activation

Introduction Timely access to kidney transplant is essential to reducing mortality of children with kidney disease. We examined factors affecting providers’ decisions to delay waitlisting, compared perceptions of important factors of providers to families, when delaying activation, and describe recommendations to improve support for pediatric patients and families to overcome waitlisting delays. Methods Using a mixed-methods design, 20 providers and 20 families of pediatric patients with kidney disease, participated in interviews and surveys. Interviews were analyzed using thematic analysis. Surveys were analyzed with descriptive statistics. Results Avoiding retransplantation, treatment nonadherence, poor psychological readiness for transplant, poor physical health, and greater need for social support were the key themes affecting providers’ decisions to delay waitlisting. At least 70% of both providers and families felt that waitlisting should be delayed until patients and families had reliable access to transportation, mental health support, and caregivers who can better understand medical information. At least 70% of families surveyed felt it was important to delay waitlisting until they had regulated blood pressure and well-managed labs. Ethical concerns emerge that waitlisting practices may contribute to disparities in access to transplant. Conclusion Providers and families agree that stabilizing the family situation and improving adherence to treatment are important reasons to delay waitlisting. However, pediatric patients facing greater disparities need easier access to psychological services, strengthened social support, access to economic resources, and stronger relationships with coordinators. Addressing patient burdens is essential for reaching more equitable listing practices.