Impact of COVID-19 and Partial Lockdown on Access to Care, Self-Management and Psychological Well-being among People with Diabetes: A Cross-sectional Study

Background The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, diabetes self-care, behavioral and psychological impact of COVID-19 and partial lockdown in Singapore. Methods We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models. Results Among 301 respondents, 45.2% were women, majority were ethnic Chinese (67.1%), aged 40 to 49 years (24.2%), have Type 2 diabetes (68.4%) and on oral medications (42.2%). During the lockdown, nearly all respondents were able to obtain their medications, supplies (94%) and contact their doctors (97%) when needed. Respondents reported less physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β=11.44, p= 0.017), diabetes-related comorbidities (β= 3.98, p= 0.001) and Indian ethnicity (β= 7.73, p= 0.018) were significantly associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β= 2.71, p= 0.007) while mental health condition was associated with greater barriers to activities (β= 9.63, p= 0.033). Conclusion Health services access were minimally affected but COVID-19 and lockdown had mixed impact on self-care and management behaviors. Greater clinical care and attention should be provided to people with diabetes with greater number of comorbidities and previous mental health disorders during the pandemic and lockdown.

17.B. Round table: Including public health considerations in trade and investment agreements

There is widespread recognition that trade and investment agreements (TIAs) can affect health services, access to medicines, NCD prevention (particularly related to tobacco, alcohol and unhealthy food) and health systems structures. In addition, these binding international economic agreements can constrain the policy space available for innovative, evidence-based health policymaking. Although TIAs can have positive outcomes for employment and economic growth, these benefits are only likely to accrue when governments are pro-active in implementing complementary policies to mitigate impacts on other sectors and to address potential inequalities arising. The aim of this panel session is to examine the ways in which TIAs can be designed to achieve economic goals while also protecting public health, and identify complementary policy measures that may be needed as well as strategies for strategic policy engagement. This panel will be hosted by the UK-PRP PETRA Network (Prevention of the noncommunicable disease using trade agreements). The UK will be negotiating a range of new TIAs over the coming years, representing a window of opportunity for strategic engagement with policymakers regarding how public health can be protected and promoted within these agreements. There is an emerging global body of evidence regarding how consideration of health can be integrated into TIAs, both textually and through strategic engagement with policymakers before and during the negotiation phase. Experience to date indicates common global challenges and opportunities for health and trade, as well as significant potential for cross country learning regarding trade and health. The panel discussion will use the UK experience as a springboard to address these global issues. The expert panel, drawn from the PETRA Network with expertise in political economy, trade law, economics and public health advocacy, will provide brief overview of the current issues in trade and health and how public health can be protected in trade agreements. The 5-minute panel presentations will briefly summarise how inclusions in TIAs can support and protect policy space for health systems and health services, access to medicines, NCD prevention, and nutrition and food systems. The session will then open for a roundtable discussion among participants regarding 1) country-specific examples and questions regarding health protections; 2) experiences related to health-trade policy engagement; 3) lessons for elevating health on the political agenda, particularly regarding trade. (Note that if there are more than 16 participants, then the workshop will split into small groups for discussion with panel/ PETRA Network resource people. The panel session and discussion will provide the basis for a planned public health-oriented briefing note by the PETRA Network on including public health considerations in trade and investment agreements. Key messages Including consideration of health in trade and investment, agreements can protect policy autonomy for public health and promote good public health outcomes; In order to promote consideration of public health in trade and investment agreements, strategic engagement with trade policymakers before and during the negotiation period is critical.

Factors Related To Hypertension Management Efforts In Female Workers At Bringharjo Traditional Market Yogyakarta

<p>Background: Hypertension is a condition of blood pressure in blood vessels increases chronically. Yogyakarta has a population of high blood pressure or hypertension reaches until 7,464 people, stating that hypertension in population aged &gt;15 years is more common in women (63.96%) than men (36.04%) (Year Health Profile 2014 Yogyakarta City).</p><p>Objective: To determine the risk factors associated with hypertension management efforts in female workers at Bringharjo Traditional Market.</p><p>Method: An observational analytic study with a cross sectional approach. The population of this study is all female workers at Bringharjo Market with quantities of 4,140 people. The sampling technique uses Simple Random Sampling technique that is 365 people. The data collection tool is a questionnaire. The data were analyzed using <em>chi square</em> test.</p><p>Results: Factors related to hypertension management efforts included blood pressure level p = 0.049, age p = 0.000, education p = 0,000, family history p = 0,000, service access p = 0.167, insurance ownership p = 0.171, information sources p = 0.118 and knowledge p = 0.010. There is a relationship between blood pressure level, age, education, family history and knowledge with hypertension management efforts. While health services access, insurance ownership and information sources have no relationship with hypertension management efforts.</p><p>Conclusions and suggestions: There is a relationship between blood pressure level, age, education, family history and knowledge with hypertension management at Bringharjo Traditional Market, but there is no relationship between health services access, insurance ownership, and information sources, with respondents of hypertension management at Bringharjo Traditional Market. The results of this study are expected to be used as additional references and for respondents who are not yet aware of hypertension management to carry out routine checks and take medication regularly.</p>

PERSPEKTIF MASYARAKAT TENTANG AKSES PELAYANAN KESEHATAN

Access to health services is often seen only from the provider perspective, while from the community side as a user is less noticed. Improving the quality of health services access requires a complete perspective on two diff erent sides. This research is designed descriptively qualitative. Data were collected by Focus Group Discussion (FGD), in-depth interview and observation. The research was conducted in Malang Regency in June-August 2018. The study results showed health services access generally the community believes that there are still perceived defi ciencies. Especially on the aspect of physical access, due to poor facilities and infrastructure. In addition, social access was also considered inadequate, because there were still health workers who served with less friendly. This study concludes that people still feel access to physical and social aspects is still diffi cult. It should be recommended to the local government for eff orts to improve physical access, and the Health Offi ce to disseminate health information about the rights of patients to the community. Abstrak Akses pelayanan kesehatan seringkali dilihat hanya dari perspektif pemberi pelayanan saja, sementara akses dari sisi masyarakat sebagai pengguna kurang terperhatikan. Perbaikan kualitas pelayanan kesehatan dari sisi akses memerlukan perspektif yang lengkap dari dua sisi yang berbeda. Penelitian ini didesain secara deskriptif kualitatif. Data dikumpulkan dengan Focus Group Discussion (FGD), wawancara mendalam dan pengamatan. Penelitian dilakukan di Kabupaten Malang pada bulan Juni–Agustus 2018. Hasil penelitian menunjukkan aksesibilitas pelayanan kesehatan yang ada, secara umum masyarakat berpendapat bahwa masih ada kekurangan yang dirasakan. Terutama pada aspek akses secara fisik, dikarenakan sarana dan prasarana yang kurang baik. Selain itu akses secara sosial juga dirasa kurang, karena masih ada tenaga kesehatan yang melayani dengan kurang ramah. Penelitian ini menyimpulkan bahwa masyarakat masih merasa akses dari aspek fisik dan sosial masih sulit. Perlu direkomendasikan pada pemerintah daerah setempat untuk upayaperbaikan akses secara fi sik, dan Dinkes untuk mendiseminasikan informasi kesehatan mengenai hak pasien kepada masyarakat.