Defining medical deserts-an international consensus-building exercise

BACKGROUND

Medical deserts represent a pressing public health and health systems challenge. The COVID-19 pandemic further exacerbated the gap between people and health services, yet a commonly agreed definition of medical deserts was lacking. This study aims to define medical deserts through a consensus-building exercise, explaining the phenomenon to its full extent, in a manner that can apply to countries and health systems across the globe.

METHODS

We used a standard Delphi exercise for the consensus-building process. The first phase consisted of one round of individual online meetings with selected key informants; the second phase comprised two rounds of surveys when a consensus was reached in January 2023. The first phase-the in-depth individual meetings-was organized online. The dimensions to include in the definition of medical deserts were identified, ranked and selected based on their recurrence and importance. The second phase-the surveys-was organized online. Finally, external validation was obtained from stakeholders via email.

RESULTS

The agreed definition highlight five major dimensions: 'Medical deserts are areas where population healthcare needs are unmet partially or totally due to lack of adequate access or improper quality of healthcare services caused by (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services or (v) other socio-cultural barriers'.

CONCLUSIONS

The five dimensions of access to healthcare: (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services and (v) other socio-cultural barriers-ought to be addressed to mitigate medical deserts.

Transnational collaboration for global health education: Romania as West-East hub

Background

Similar to many Eastern European countries, Romania has faced significant health professional outflow in the past decades. However, in the recent global context, this pattern is slightly changing and increasingly more complex. Although Romania is not yet experiencing significant inflows of already trained health professional, it has gradually become a preferred destination country for Western students pursuing a medical degree. Moreover, Romania has become attractive as a setting for students in high income countries with an interest in global health. The aim of this paper is to describe how Eastern European countries can provide global health training opportunities for Western students.

Methods

The paper describes a case study of global health education through a global health practicum program managed by the Department of Public Health at the Babeș-Bolyai University in Cluj-Napoca, Romania.

Results

The global health program is designed to provide a rich, hands-on practical approach to public health issues for students in health professions. The program has an internship format, with a minimum length of four weeks, organized as either a research project, medical shadowing, community practice, or rural health program. It builds on four key elements: customized placements in public health organisations; academic support and mentoring; instruction conducted in English; and additional cultural elements. For the past ten years, the program has included over 50 participants from the United States of America, UK and Denmark.

Conclusions

The program implemented by the Department of Public Health revealed the importance of a blended approach - academic-based, and practice-oriented - to providing global health training for health professionals. This approach is vital for preparing the future health workforce towards implementation of SDGs and could serve as a model for other collaborative initiatives.

Smoking and Smoking Cessation During Pregnancy. An Analysis of a Hospital Based Cohort of Women in Romania

Perinatal smoking is associated with a wide range of negative reproductive and pregnancy outcomes. The aim of the current study was to examine the prevalence and characteristics of women who report smoking prenatally and quit during pregnancy in a large sample of Romanian women. Understanding which women are more likely to quit will contribute to public health knowledge that will help more women stop smoking prior to or during pregnancy and prevent relapse postpartum. This cross-sectional analysis was conducted based on cross-sectional data collected between May 2012 and April 2015 as part of a cohort study of pregnancy implemented in six clinical settings in central Romania (N = 2370). Approximately 28 % of the sample reported smoking in the 6 months prior to learning they were pregnant. Half of the women who reported smoking 6 months before learning of their pregnancy, also reported that they stopped smoking by the time of the interview. Overall, tobacco consumption decreased from a sample mode of 10 cigarettes/day (range: 1-30) before pregnancy, to a sample mode of 5 cigarettes/day (range: 1-25) at the time of the interview. Women who quit had a higher socioeconomic position, were more likely to live in urban areas, partnered, primigravid, nulliparous, and reported lower anxiety and more social support. The combination of a socioeconomic gradient, less anxiety, and more social support suggests that efforts should be increased to target lower income, less educated, multigravid, and multiparous women and to develop programs that heighten social support and alleviate anxiety.

Adolescents’ Needs Towards School-Based Nutrition Interventions

Background and Aims: This study aimed to identify adolescents’ knowledge and attitudes towards healthy eating and their needs and preferences towards school-based nutrition interventions, thus investigating the “must have” components on school-based nutrition interventions than can improve adolescents’ dietary patterns.

Material and Methods: To reach the proposed aims, we used a qualitative strategy of inquiry, by conducting semi-structured focus groups. We collected data in two urban schools from Cluj-Napoca, Romania. 32 adolescents aged 11 to 14 years old attended focus group discussions. Focus group discussions were audio-taped, transcribed and analyzed using thematic analysis.

Results: A viable strategy to deliver effective nutrition interventions for adolescents needs to address adolescents' interests and concerns, use visuals and stories to present nutrition related information, increase adolescents' self-efficacy in choosing healthy foods, train adolescents in having a balanced diet, promote healthy eating as acceptable for peers, and involve parents in nutrition interventions through home-based activities.

Conclusions: Improving adolescents' nutrition related knowledge and behavior and creating supportive environments is not sufficient in improving adolescents' dietary patterns. Practitioners should aim at designing school-based nutrition interventions addressing adolescents' specific needs and rely on the needs assessment process as a major component of the design.