Visceral leishmaniasis is a vector-borne, protozoan disease with severe public health implications. Following the successful implementation of an elimination programme in South Asia, there is now a concerted endeavour to replicate these efforts in Eastern Africa based on the five essential elimination pillars of case management, integrated vector management, effective surveillance, social mobilisation and operational research. This article highlights how key social determinants (SD) of health (poverty, sociocultural factors and gender, housing and clustering, migration and the healthcare system) operate at five different levels (socioeconomic context and position, differential exposure, differential vulnerability, differential outcomes and differential consequences). These SD should be considered within the context of increasing the success of the five-pillar elimination programme and reducing inequity in health.

The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals’ needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients’ needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members’ needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time.

Objectives. To analyze factors associated with COVID-19 vaccine acceptance in Spain, over time. Methods. We used data from a national study that included 5 online surveys carried out every 2 months from September 2020 to May 2021. Each round recruited a sample of 1000 participants aged 18 years or older. We performed a multivariable logistic regression with vaccination acceptance as the dependent variable. We evaluated time trends through the interaction terms of each of the explanatory variables and the time. Results. Vaccination acceptance increased from 43.1% in September 2020 to 84.5% in May 2021. Sex, age, concerns about disease severity, health services overload, and people not wearing a face mask, together with adherence to preventive behavior, health literacy, and confidence in scientists, health care professionals’ information, and adequacy of governmental decisions, were variables associated with vaccination acceptance. Conclusions. In a changing situation, vaccine acceptance factors and time trends could help in the design of contextualized public health messages. It is important to strengthen the population’s trust in institutions, health care professionals, and scientists to increase vaccination rates, as well as to ensure easy access to accurate information for those who are more reluctant. (Am J Public Health. 2022;112(11):1611–1619. https://doi.org/10.2105/AJPH.2022.307039 )

Pediatric patients with chronic conditions frequently have unmet care needs, make extensive use of healthcare services, and often encounter fragmented, non-centered care. This study aimed to analyze the differences in the utilization of primary care (PC) and hospital care (HC) services by these patients according to sex, age, and complexity and to identify associated factors. A cross-sectional study was conducted in a basic health area of Madrid, including patients under 18 years. Among these patients, 15.7% had ≥1 chronic disease, 54.1% were male, the average age was 9.5 years, 3.5% had complexity, and 11.3% had multimorbidity. The mean number of contacts/year with the healthcare system was 9.1, including 8.3 contacts/year with PC (4.9 with pediatricians and 1.9 with nurses) and 0.8 contacts/year with HC (0.8 in external consultations and 0.01 hospitalizations). The factors associated with PC utilization were complexity; female sex; European origin; and diseases like asthma, epilepsy, stroke, recurrent urinary infection, attention deficit hyperactivity disorder, and anxiety, while older age was negatively associated. Thyroid disorders were significantly associated with HC utilization. These findings could help guide the design of optimized pediatric patient-centered care approaches to coordinate care across healthcare services and reduce high healthcare utilization, therefore improving the healthcare outcomes and quality of life for these patients.

Background: Many schools are committed to the “Five Steps to a Health Promoting School guide” created by the Schools for Health in Europe (SHE) network to avoid chronic disease and promote healthy environments. Objectives: The aim of this study was to evaluate schools’ health promotion policies and practices via the SHE rapid assessment tool. Methods: From February 2019 to June 2019, a cross-sectional survey based on this tool was conducted in nine international schools that are part of a private network operating in multiple countries. The entire school community was offered the opportunity to participate. The survey consisted of 37 questions aligned with the whole-school approach to health promotion and addressed orientation, healthy school policy, the physical and social environment, health skills, community links, and staff well-being using a three-point scale. A univariate analysis was subsequently performed. Results: A total of 929 people responded, 59.7% of whom were women, representing 74 different nationalities (82.5% Europeans). The average age was 25.9 years, ranging from 7 to 77 years. The participants included 57.2% students, 21.3% teachers, 15.3% families, 3.2% management teams, 1% counsellors/psychologists, 1% administrative/service staff, 0.5% catering staff, 0.3% nursing/medical staff, and 0.2% maintenance staff. The findings revealed that 80% of the respondents felt that most of these health promotion needs were being partially or fully addressed, predominantly with medium or high priority. However, 30% of the respondents indicated that the school had not yet assessed the students’ and employees’ health and well-being needs or fully promoted a healthy work-life. Conclusions: The SHE rapid assessment tool serves as an effective initial step in identifying key indicators within the school community, offering insights for future action towards becoming a health-promoting school. These results underscore the importance of addressing social and behavioural determinants of health within different international educational settings to promote positive sociorelational well-being and youth development. By fostering the well-being of children, adolescents, and the educational community, schools play a pivotal role in reducing the risk factors for chronic diseases and supporting psychosocial adaptation.

Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30–2.01), female sex (BC = 1.04; CI = 0.30–1.78), having a caregiver (BC = 8.70; CI = 6.72–10.69), complexity (B-coefficient = 0.46; CI = 0.38–0.55), high-risk (B-coefficient = 2.29; CI = 1.26–3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37–2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00–6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.