Disparities in care access for health conditions where physiotherapy can play a major role are abetting health inequities. Spatial analyses can contribute to illuminating inequities in health yet the geographic accessibility to physiotherapy care across New Zealand has not been examined. This population-based study evaluated the accessibility of the New Zealand physiotherapy workforce relative to the population at a local scale. The locations of 5,582 physiotherapists were geocoded and integrated with 2018 Census data to generate \'accessibility scores\' for each Statistical Area 2 using the newer 3-step floating catchment area method. For examining the spatial distribution and mapping, accessibility scores were categorized into seven levels, centered around 0.5 SD above and below the mean. New Zealand has an above-average physiotherapy-to-population ratio compared with other OECD countries; however, this workforce is maldistributed. This study identified areas (and locations) where geographic accessibility to physiotherapy care is relatively low.

UNASSIGNED: People with disabilities and those with non-English language preferences have worse health outcomes than their counterparts due to barriers to communication and poor continuity of care. As members of both groups, people who are Deaf users of American Sign Language have compounded health disparities. Provider discomfort with these specific demographics is a contributing factor, often stemming from insufficient training in medical programs. To help address these health disparities, we created a session on disability, language, and communication for undergraduate medical students.
UNASSIGNED: This 2-hour session was developed as a part of a 2020 curriculum shift for a total of 404 second-year medical student participants. We utilized a retrospective postsession survey to analyze learning objective achievement through a comparison of medians using the Wilcoxon signed rank test (α = .05) for the first 2 years of course implementation.
UNASSIGNED: When assessing 158 students\' self-perceived abilities to perform each of the learning objectives, students reported significantly higher confidence after the session compared to their retrospective presession confidence for all four learning objectives (ps < .001, respectively). Responses signifying learning objective achievement (scores of 4, probably yes, or 5, definitely yes), when averaged across the first 2 years of implementation, increased from 73% before the session to 98% after the session.
UNASSIGNED: Our evaluation suggests medical students could benefit from increased educational initiatives on disability culture and health disparities caused by barriers to communication, to strengthen cultural humility, the delivery of health care, and, ultimately, health equity.

In the context of implementing the strategy of \"double carbon\" and \"healthy China,\" this paper firstly measures the level of green finance development and the comprehensive index of health care accessibility in each province by using the entropy weight method based on 30 provincial panel data from 2007 to 2021. A panel fixed effects model was also used to empirically analyze the effect of regional green finance development on the improvement of residents\' health. In addition, a panel threshold model was constructed to empirically test the threshold effect of green finance on residents\' health under the influence of four external environments: carbon intensity level, healthcare accessibility, residents\' living standard and human capital level. The empirical results show that the regional green financial development in China significantly improves the health level of residents. And the impact has significant regional heterogeneity, as shown in the improvement effect is more significant for the provinces in the central and western regions. In addition, the impact of green financial development on the health level of residents in China is non-linearly influenced by external environmental factors. The improvement effect of green finance on residents\' health level is more significant in the provinces with higher carbon intensity level, residents\' living standard, human capital level and lower accessibility to medical services. In this regard, regional governments should continue to build and optimize a synergistic development ecosystem of green finance and public health, give full play to the advantages of financial leverage, promote green, low-carbon and high-quality economic and social development, and realize the beautiful vision of harmonious coexistence between human beings and nature.

Background Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast-developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small-area level. Methods and Results We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3-year periods with a Bayesian spatial model. Township-level health care accessibility was measured using an enhanced 2-step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2-173.8) to 49.4 (95% CI, 30.5-73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a -0.71% (95% CI, -1.08% to -0.33%) change in AMI mortality. Conclusions Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township-level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities.

UNASSIGNED: Autistic adults have an elevated risk of many health problems compared with the general population, making health care access extra critical. Unfortunately, autistic people often find health care settings quite aversive, and many medical providers report feeling unsure about how to interact with autistic patients. We aimed at characterizing specific challenges regarding sensory experiences and communicative barriers in health care settings.
UNASSIGNED: We recruited adults to complete an anonymous online questionnaire on the topic of improving health care experiences for everyone. The questions covered demographics, sensory experiences in medical settings, and communication with health care providers. We quantified the associations between autism diagnosis and experiences of sensory discomfort and communication barriers in health care settings. We also did a qualitative analysis of text responses to questions on how to improve sensory environments and communication with providers.
UNASSIGNED: Swedish adults (62 autistic and 36 nonautistic) participated in the study. The cohort was well educated, and autistic participants received their autism diagnosis late in life (median age 36 years, range 13-57). Compared with nonautistic participants, autistic participants reported greater discomfort with background sound levels in health care settings and felt more misunderstood by health care providers. Thematic analyses showed that auditory stimuli and proximity to other people were particularly bothersome for autistic participants, causing stress or avoidance and affecting the ability to interact with providers. Providers contributed to communication barriers by failing to recognize the need for individualized information, especially when respondents\' difficulties were not visible or taken seriously. Participants requested greater clarity and supplementary written information. Providers also misunderstood autistic adults\' body language or eye contact patterns, as they interpreted their clients through the lens of neurotypical expectations.
UNASSIGNED: Our results extend previous research by emphasizing sensory aspects of health care settings and suggesting specific and reasonable adaptations. The results also highlight how the provider\'s implicit expectations of nonverbal communication caused misinterpretations of autistic people who were socially skilled but did not use typical body language. Based on the data, we suggest specific adaptations, many of which may also benefit nonautistic people.
UNASSIGNED: Health care needs of autistic adults are often unmet. This may contribute to poorer health outcomes in autistic compared with nonautistic adults. Autistic differences may not be obvious in this group because of behavioral compensation strategies. Health care providers may underestimate the support needs of autistic adults, leading to decreased quality of care. By analyzing autistic adults\' own experiences, we may better understand barriers to effective health care.
UNASSIGNED: We aimed at identifying patterns of sensory and communicative experiences that autistic adults find problematic in health care settings.
UNASSIGNED: In an online questionnaire, we asked autistic and nonautistic adults how they experienced various medical settings. We focused on specific sensory inputs, such as light levels and background sounds, in waiting rooms and other medical contexts. We also asked questions about communication between patients and providers. Finally, we did a qualitative analysis on free-text responses about sensory environments for both groups, and about communication for the autistic group.
UNASSIGNED: Ninety-eight people (62 autistic) participated. Most of the cohort was female or gender-diverse, middle-age, and well educated. Autistic participants identified auditory inputs as one of the greatest stressors in medical settings. They discussed the impact of light levels and other people\'s presence on their energy levels and ability to communicate. Health care providers often misunderstood their autistic patients, leading to a failure in transferring medical information. Participants described how providers underestimated their needs, even when they were aware of the autism diagnosis. Participants wanted to get information delivered at a slower pace and with a greater amount of detail, to be better able to process medical or procedural information.
UNASSIGNED: The study contributes with information on specific sensory challenges and suggests that auditory noise is particularly problematic for autistic people. On the topic of communication, the findings point to a “double empathy” problem, whereby the provider\'s own limitations contribute significantly to communication barriers. This was apparent in accounts of nonverbal communication, where the provider\'s expectations of neurotypical body language caused misunderstandings that were difficult to overcome.
UNASSIGNED: The sample was small and comprised an ethnically narrow demographic group. Thus, the results are not generalizable to other autistic populations, such as minimally verbal adults. We also did not measure health status beyond diagnosed conditions.
UNASSIGNED: The consequences of sensory and communicative barriers may go entirely unnoticed when autistic differences are not visible. Unsuccessful interactions with the health care system may have enormous effects on the health and quality of life of autistic people. Therefore, educators and providers may use the insightful information provided by autistic participants in this study to inform decisions on staff training or design of sensory environments.

BACKGROUND: Telemedicine has expanded access to high-quality, appropriate, and affordable health care for people with multiple sclerosis (MS). This study explored how the expansion of MS telemedicine is perceived and experienced by people with MS, health care providers (HCPs), and payers and policy experts (PYs).
METHODS: Forty-five semistructured interviews with 20 individuals with MS, 15 HCPs, and 10 PYs were conducted between September 2020 and January 2021. The interviews were recorded on a televideo platform, transcribed, and analyzed for themes using qualitative data software.
RESULTS: Interviews revealed the following 4 themes. Technology: Telemedicine increases access and convenience. Technical challenges were the most cited downside to telemedicine. Clinical encounters: Confidence in MS care via telemedicine varies. Virtual \"house calls\" have clinical benefits. Financing and infrastructure: Reimbursement parity is critical to utilization and expansion of telemedicine. Stakeholders are hopeful and fearful as infrastructure and business models begin to shift. Shifting expectations: The familiar structure of the office visit is currently absent in telemedicine. Telemedicine visits need more intentionality from both providers and patients.
CONCLUSIONS: Telemedicine is an efficient, convenient way to deliver and receive many aspects of MS care. To expand telemedicine care, many HCPs need more training and experience, people with MS need guidance to optimize their care, and PYs in the United States need to pass legislation and adjust business models to incorporate benefits and reimbursement for telemedicine health in insurance plans. The future is promising for the ongoing use of telemedicine to improve MS care, and stakeholders should work to preserve and expand the policy changes made during the COVID-19 pandemic.

Breast cancer is the most common cause of death, due to malignant neoplasms in women worldwide. The nature of the symptoms associated with breast cancer depends on the stage of the disease. In this case, any cancerous changes in the initial phase of the disease can only be detected during imaging tests. Participation in mammography screening can reduce breast cancer mortality by up to 40%, if only 70% of the eligible population participates in preventive programs. The purpose of the study was to assess the impact of accessibility to health care resources on breast cancer mortality.
Eurostat aggregated health care data was extracted. Hierarchical cluster analysis of average breast cancer mortality identified four groups of countries with similar mortality rates and trends. The data was then analyzed, in terms of access to health care.
It was observed that the higher the financial expenditure on health care and the better the health care accessibility, the lower the mortality rates of breast cancer.
There are examples indicating that the studied elements are not the only factors affecting the improvement of population health. The authors would like to emphasize the need to influence lifestyle factors, direct cancer risk, and introduce a multidisciplinary approach to breast cancer prevention.

BACKGROUND: Studies on the effects of poverty on unmet medical needs are limited. Therefore, this study aimed to identify the impact of entering poverty on the unmet medical needs of South Korean adults.
METHODS: This study used data from the Korea Health Panel Survey (2014-2018) and included 10,644 adults. Logistic regression was used to examine the impact of entering poverty on unmet medical needs (poverty status: no → no, yes → no, no → yes, yes → yes; unmet medical needs: no, yes). Poverty line was considered to be below 50% of the median income.
RESULTS: When entering poverty, the proportion of unmet medical needs was 22.8% (adjusted odds ratio [AOR] 1.17, 95% confidence interval [CI] 1.01-1.36). Men (AOR 1.29, 95% CI 1.02-1.64), rural dwellers (AOR 1.24, 95% CI 1.01-1.50), and national health insurance (NHI) beneficiaries (AOR 1.21, 95% CI 1.04-1.42) were susceptible to unmet medical needs and entering poverty. Poverty line with below-median 40% had an AOR of 1.48 (95% CI 1.28-1.71). For the cause of unmet medical needs, the AORs were 1.50 for poverty (95% CI 1.16-1.94) and 1.08 for low accessibility to health care and information (95% CI 0.79-1.48).
CONCLUSIONS: Entering poverty had the potential to adversely affect unmet medical needs. Men, rural dwellers, and NHI beneficiaries were vulnerable to unmet medical needs after entering poverty. Rigid definitions of poverty and inaccessibility to health care and information increase the likelihood of unmet medical needs and poverty. Society must alleviate unmet medical needs due to the increase in the population entering poverty.

The implementation of a national suicide prevention hotline is imminent and will need to be supported by comprehensive crisis systems, which are currently rarely implemented in part due to their cost. In this Commentary paper we identify three core components of a high-functioning, integrated crisis service system. We identified regional crisis call centers, mobile response teams, and crisis receiving and stabilization centers as core components of an integrated crisis service system. We then outline how this approach has been used in Arizona. Building out these systems and sustainable funding models to support these systems is necessary to ensure that 988 implementation lives up to the promise of creating a lifeline to support services for individuals in crisis.

Spatial accessibility to health care plays a vital role in the evaluation of medical resource equality. A widely used method of spatial accessibility is the Two-Step Floating Catchment Area (2SFCA) method. However, the 2SFCA model (and its later variants) implicitly assumes that each doctor has the same attraction (unlimited resources) to care seekers and each care seeker\'s need is the same; it does not consider insurance that doctors accept or patients\' different needs by age and gender. In fact, patients usually choose doctors within their insurance network and seniors and females usually have higher health care needs/demands than others. Here we present an improvement to the 2SFCA method to address these shortcomings. On the supply side, we allocate each doctor\'s resource equally to the insurance plans that he/she accepts. On the demand side, we adjusted the population based on their health care needs by age and gender and estimated the population holding each insurance based on the insurance\'s market share (assuming each insurance\'s market share is a reasonable representation of the population using that insurance). Next we calculate the accessibility score of each insurance plan following the 2SFCA approach and sum them at each population location as the accessibility at that location. We call the new improved approach Supply-Demand Adjusted 2SFCA. The results indicate that the SDA-2SFCA model could better reflect the actual supply and demand situation of health care and thus provide a better measure of spatial accessibility to health care. The SDA-2SFCA model can help researchers and government agencies better allocate limited resources to the neediest areas.