UNASSIGNED: Public health nurses (PHNs) perform more than the provision of direct care to clients. They are also expected to perform roles as leaders, managers, and collaborators in different settings, especially in areas where there are no physicians. Their continuous professional development must be facilitated to empower them to lead the delivery of health programs and services in pursuit of universal healthcare. This study aims to determine the perceived competencies of public health nurses and describe their training needs.
UNASSIGNED: A descriptive, cross-sectional study was utilized, where an online survey was administered to PHNs across the Philippines to determine their self-perceived competencies and training needs based on the eight domains of core competencies of public health professionals. Descriptive statistics was used to summarize the data.
UNASSIGNED: A total of 330 PHNs answered the survey. The results showed that at baseline, PHNs perceived themselves to be competent (from most to least) in the following: communication, analytical/assessment, community dimensions of practice, policy development/ program planning, leadership and systems thinking, cultural competency skills, public health science, and financial planning and management. In terms of training needs, the enablers mentioned include a supportive work environment that can provide a work schedule that is inclusive of time for professional development and work-life balance; a learning environment where colleagues and supervisors support the need for training and innovation; strong internet connection; and enough equipment to participate and submit deliverables for courses taken.
UNASSIGNED: Filipino public health nurses perceived themselves to be competent in the areas of communication and community practice, but less competent in public health science, and financial planning and management. Future capacity-building programs must be designed to meet this demand. Furthermore, to make training programs truly responsive to the needs of nurses, steps must be taken to promote capacity-building enablers.

We examined the impact of the first year of the COVID-19 pandemic on unmet healthcare need among New Yorkers and potential differences by race/ethnicity and health insurance. Data from the Community Health Survey, collected in 2018, 2019, and 2020, were merged to compare unmet healthcare need within the past 12 months during the pandemic versus the 2 years prior to 2020. Univariate and multivariable logistic regression models evaluated change in unmet healthcare need overall, and we assessed whether race/ethnicity or health insurance status modified the association. Overall, 12% of New Yorkers (N = 27,660) experienced unmet healthcare during the 3-year period. In univariate and multivariable models, the first year of the pandemic (2020) was not associated with change in unmet healthcare need compared with 2018-2019 (OR = 1.04, p = 0.548; OR = 1.03, p = 0.699, respectively). There was no statistically significant interaction between calendar year and race/ethnicity, but there was significant interaction with health insurance status (interaction p = 0.009). Stratifying on health insurance status, those uninsured had borderline significant lower odds of experiencing unmet healthcare need during 2020 compared to the 2 years prior (OR = 0.72, p = 0.051) while those with insurance had a slight increase that was not significant (OR = 1.12, p = 0.143). Unmet healthcare need among New Yorkers during the first year of the pandemic did not differ significantly from 2018-2019. Federal pandemic relief funding, which offered no-cost COVID-19 testing and care to all, irrespective of health insurance or legal status, may have helped equalized access to healthcare.

\"Comprehensive Healthcare for America\" is a largely single-payer reform proposal that, by applying the insights of behavioral economics, may be able to rally patients and clinicians sufficiently to overcome the opposition of politicians and vested interests to providing all Americans with less complicated and less costly access to needed healthcare.

This article is part of the Research Topic \'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict\'.
COVID-19 has highlighted existing health inequalities and health system deficiencies both in Ireland and internationally; however, understanding of the critical opportunities for health system change that have arisen during the pandemic is still emerging and largely descriptive. This research is situated in the Irish health reform context of Sláintecare, the reform programme which aims to deliver universal healthcare by strengthening public health, primary and community healthcare functions as well as tackling system and societal health inequities.
This study set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation.
The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with sixteen health system professionals (including managers and frontline workers) from a range of responses to explore their experiences and interpretations of social processes of change that enabled (or hindered) better access to universal integrated care during the pandemic. A complexity-informed approach was mobilized to theorize the processes that impacted on access to universal, integrated care in Ireland in the COVID-19 context.
A range of circumstances, strategies and mechanisms that created favorable system conditions in which new integrated care trajectories emerged during the crisis. Three key learnings from the pandemic response are presented: (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a social, human-centered health system. Policy and practice implications for health reform are discussed.

Disparities in cardiovascular morbidity and mortality are among the leading health and social care concerns in the UK. The disruption of the COVID-19 pandemic to health services has further placed cardiovascular care and the respective patient communities at the sharp end, not least in exacerbating existing health inequalities across service interfaces and patients\' health outcomes. While the pandemic engenders unprecedented constraints within established cardiology services, it conduces to a unique opportunity to embrace novel transformative approaches within the way we deliver patient care in maintaining best practices during and beyond the crisis. As the first step in navigating toward the \'new norm\', a clear recognition of the challenges inherent in cardiovascular health inequalities is critical, primarily in preventing the widening of extant inequalities as cardiology workforces continue to build back fairer. We may consider the challenges through the lens of health services\' diverse facets, including the aspects of universality, interconnectivity, adaptability, sustainability, and preventability. This article explores the pertinent challenges and provides a focused narration concerning potential measures to foster equitable and resilient cardiology services that are patient centred in the post-pandemic landscape.

The Theory of Change (ToC) approach is one of the methodologies that the Lancet Citizens\' Commission has chosen to build a roadmap to achieving Universal Healthcare (UHC) in India in the next 10 years. The work of the Citizens\' Commission is organized around five workstreams: Finance, Human Resources for Health (HRH), Citizens\' Engagement, Governance, and Technology. Five ToC workshops were conducted, one for each workstream. Individual workshop outputs were then brought together in two cross-workstream workshops where a sectoral Theory of Change for UHC was derived. Seventy-four participants, drawn from the Commission or invited for their expertise, and representing diverse stakeholders and sectors concerned with UHC, contributed to these workshops. A reimagined healthcare system achieves (1) enhanced transparency, accountability, and responsiveness; (2) improved quality of health services; (3) accessible, comprehensive, connected, and affordable care for all; (4) equitable, people-centered and safe health services; and (5) trust in the health system. For a mixed system like India\'s, achieving these high ideals will require all actors, public, private and civil society, to collaborate and bring about this transformation. During the consultation, paradigm shifts emerged, which were structural or systemic assumptions that were deemed necessary for the realization of all interventions. Critical points of consensus also emerged from the workshops, such as the need for citizen-centricity, greater efficiency in the use of public finances for health care, shifting to team-based managed care, empowerment of frontline health workers, the appropriate use of technology across all phases of patient care, and moving toward an articulation of positive health and wellbeing. Critical areas of contention that remained related to the role of the private sector, especially around financing and service delivery. Few issues for further consultation and research were noted, such as payment for performance across both public and private sectors, the use of accountability metrics across both public and private sectors, and the strategies for addressing structural barriers to realizing the proposed paradigm shifts. As the ToCs were developed in expert groups, citizens\' consultations and consultations with administrative leaders were recommended to refine and ground the ToC, and therefore the roadmap to realize UHC, in people\'s lived reality.

As a key component of overall health and quality of life, oral health is recognized by public health organizations globally as a basic human right. Dentists are oral health experts involved in the primary prevention of oral injury and the detection and management of oral diseases. As regulated healthcare professionals, dentists identify and treat dental caries, gum disease, oral cancers, and edentulism, among other conditions. Oral diseases that go undetected and/or untreated burden patients with increased severity of disease and worse health outcomes. The Canadian Dental Association (CDA) recommends routinely scheduled reexamination and preventive care as an essential component of maintaining optimal oral health. Investments by the federal government into dental services for high-risk groups have failed to resolve pervasive oral health disparities among Canadians related to dental care affordability, accessibility, and availability. Vulnerable groups across Canada, including children, seniors in long-term care, Indigenous peoples, new immigrants with refugee status, people with special needs, and the low-income population, have been identified as having challenges accessing regular dental care. Herein, an equity-focused commentary on the current climate of oral healthcare in Canada is presented. We outline how addressing disparities in Canadian dental care will require the engagement of physicians on multiple levels of care, negotiation with both dentists and policymakers, as well as sustained oral health data collection to inform provincial and national decision-making/strategies.
RéSUMé: Élément clé de la santé globale et de la qualité de vie, la santé buccodentaire est reconnue par les organismes de santé publique du monde entier comme un droit humain fondamental. Les dentistes sont des spécialistes de la santé buccodentaire qui s’occupent de la prévention primaire des lésions buccodentaires et de la détection et de la prise en charge des maladies buccodentaires. Ce sont des professionnels de santé réglementés qui détectent et qui traitent les caries dentaires, les maladies des gencives, les cancers buccaux et l’édentement, entre autres affections. Les maladies buccodentaires non détectées ou non traitées s’aggravent et conduisent à de plus mauvais résultats cliniques pour les patients. L’Association dentaire canadienne (ADC) recommande des examens dentaires périodiques et des soins préventifs, car elle les juge essentiels au maintien d’une santé buccodentaire optimale. Les investissements du gouvernement fédéral dans les soins dentaires des groupes fortement exposés n’ont pas permis de résoudre les disparités d’état de santé buccodentaire omniprésentes liées à l’abordabilité, à l’accessibilité et à la disponibilité des soins dentaires. On sait que les groupes vulnérables au Canada, dont les enfants, les aînés résidant dans des établissements de soins de longue durée, les peuples autochtones, les nouveaux immigrants ayant le statut de réfugiés, les personnes ayant des besoins particuliers et la population à faible revenu, ont des problèmes d’accès aux soins dentaires réguliers. Nous commentons ici dans une optique d’équité le climat actuel des soins de santé buccodentaires au Canada. Nous expliquons que pour aborder les disparités dans les soins dentaires canadiens, il faudra mobiliser les médecins de multiples niveaux de soins, négocier à la fois avec les dentistes et les responsables des politiques et assurer une collecte soutenue de données sur la santé buccodentaire pour éclairer les décisions et stratégies provinciales et nationales.

Background To facilitate imaging resource planning and address key health targets of the United Nations (UN) 2030 Sustainable Development Goals, accurate data are required on imaging personnel at the country level. Such data are currently limited. Objectives This study aims to analyze trends in the number, geographical distribution, and demographics of South African (SA) diagnostic imaging personnel between 2002 and 2019. Method A retrospective analysis of the Health Professions Council of South Africa (HPCSA) database of imaging personnel from 2002 to 2019 was done. The total number of personnel and personnel per million people were calculated for the country and for each professional group (radiologist, diagnostic radiographer, and sonographer) by calendar year, province, and demographic profile. Population data were provided by Statistics SA. Results The total imaging personnel, number per million people, and national population increased by 283% (3,095 versus 8,753), 119% (68 versus 149/106), and 29% (45.45 versus 58.77/106), respectively. Diagnostic radiographers constituted more than 80% of the workforce throughout the review period, increasing by 185% (2,540 versus 7,242). Sonographers, the smallest cohort, recorded the highest (49 versus 503; 906%) and radiologists (506 versus 1,007; 99%) the lowest proportional growth. Although radiologists showed persistent male predominance, the male proportion decreased from 82% to 69%, while that of females increased from 18% to 31%. The average annual percentage increase in female radiologists (14%) was more than three times that of males (4%). Diagnostic radiographers showed female predominance, but the proportion decreased from 90% to 83%, while that of males increased from 10% to 17%. Sonographers showed overwhelming female predominance (94% versus 92%). The average annual percentage increase in male diagnostic radiographers (21%) was more than double that of females (9%). In 2002, 48% (n = 1,475) of imaging personnel identified as White, and 15% (n = 467) identified as Black African. By 2019, those identifying as White and Black African were 36% (n = 3,122) and 35% (n = 3,045), respectively. The Western Cape Province (WCP) maintained the highest overall number of imaging personnel per million people (165 versus 233/106) and Limpopo the lowest (12 versus 54/106). However, Limpopo recorded the highest proportional growth in imaging personnel/106 people (368%) and the WCP the lowest (41%). The differential between the best- and least-resourced provinces thus decreased from 14:1 in 2002 to 4:1 in 2019. Conclusion In the review period, the SA imaging workforce has shown substantial expansion and transformation and has assumed a more equitable distribution.

Many countries with universal healthcare have a parallel private healthcare sector due to the waiting time in the public sector. People purchase individual health insurance to pay for private services. Past studies on the relationship between the public sector\'s waiting time and the demand for health insurance have two limitations: not considering the capacity of the private sector, and subsequently, the omission of a feedback loop. These limitations are also present in the health insurance policy discussion in Hong Kong, where the public sector is overstretched. A lack of understanding of market dynamics might lead to unrealistic expectations of public policy. This study highlights these limitations, and tries to answer the research question: whether the historical dynamics between the intersectoral imbalance of burden and the demand for health insurance in Hong Kong could be quantitatively explained.
A system dynamics model was created based on a negative feedback loop. The model\'s initial input was the percentage of population with health insurance in 2009, and to simulate the percentage continuously until 2019. Results from 2015 to 2019 were compared with actual figures to examine the model\'s explanatory power. Multivariable sensitivity analysis was performed.
With initial fluctuation, the simulated result stabilized and was within the acceptable error range from 2015 to 2019. The mean absolute percentage error (MAPE) was 0.94%. At the end of 2019, the simulated percentage of population with health insurance is 36.6% versus the \"real value\" of 36.7%. Simulated patient admissions and occupancy rates also approximate the reality. Sensitivity analysis demonstrates the robustness of the model.
We can quantitatively explain the feedback loop between health system burden and demand for health insurance. With local parameterization, this model should be transferable to other universal health systems for a better understanding of the system dynamics and more informed policy-making.

Veterinarians, among other health professionals, are considered health professionals at high risk of exposure to and contraction of COVID-19. The main objective of this study is to assess changes in the clinical practices of veterinarians during the COVID-19 pandemic around prophylactic and biosafety measures, as well as to evaluate changes in workload and cost-benefit ratio. An online questionnaire was sent to veterinary professionals from July 2020 to July 2021 using Google Forms. A total of 1134 veterinarians answered the questionnaire on clinical experiences and biosafety practices during the COVID-19 pandemic. Veterinarians changed their routine clinical practices, as there was a reduction in working hours, and applied new patient approaches and advice to their owners, as well as restricting the number of people allowed inside. Biosafety measures were added in their workplaces, with an increase in the use of personal protective equipment. COVID-19 tests were administered at least once in 19.0%, and more than once in 9.5% of the respondents. Flu symptoms were present in 23.8% of the respondents, and 31.0% of the veterinarians attended to COVID-19 positive pet owners. Therefore, most veterinarians altered their routine practices, and some were exposed to sources of COVID-19 infection.
Os médicos veterinários, entre outros profissionais de saúde, são considerados profissionais de saúde sob alto risco de exposição e contração do COVID-19. O objetivo principal do presente estudo foi avaliar as mudanças na prática clínica de médicos veterinários durante a pandemia de COVID-19 em torno das medidas profiláticas e de biossegurança, assim como avaliar as mudanças na carga de trabalho e a relação custo-benefício. De julho a dezembro de 2020, um questionário online foi enviado aos profissionais por meio da ferramenta Formulários Google. Um total de 1.134 veterinários responderam ao questionário relacionado às experiências clínicas e práticas de biossegurança durante a pandemia COVID-19. Os médicos veterinários mudaram suas práticas clínicas rotineiras, pois houve redução da jornada de trabalho, novas abordagens dos pacientes e orientações aos proprietários, além da restrição do número de pessoas nos locais. Medidas de biossegurança foram adicionadas aos locais de trabalho, com aumento do uso de equipamentos de proteção individual. Os testes COVID-19 foram realizados pelo menos uma vez em 19,0% e mais de uma vez em 9,5% dos entrevistados. Sintomas de gripe estavam presentes em 23,8% dos profissionais entrevistados e 31,0% dos veterinários atendiam tratadores de animais positivos para COVID-19. Portanto, a maioria dos veterinários alterou suas práticas de rotina e alguns foram expostos a fontes de infecção COVID-19.