Taxing sugar-sweetened beverages: Knowledge, beliefs and where should the money go?

Background

The Sugar-Sweetened Beverage (SSB) industry consciously and subconsciously influences consumers to buy its products. Countering unhealthy messaging and behaviour could be tackled through the SSB levy and allocation of revenue toward healthy lifestyle programs. Given the limited information in the UAE on demographic and consumer knowledge and beliefs and allocation of SSB levy, we conducted a study to explore this further. The study objectives were to a) explore the association between demographic factors (nationality, income and education) with knowledge and beliefs for SSB and b) explore participants' views on allocating SSB levy toward healthy lifestyle programs.

Methods

A cross-sectional study of adults in the United Arab Emirates.

Results

The findings suggest knowledge was high for Sugar-Sweetened Beverages (SSB), obesity, and diabetes (1,231, 96.1%), and there was a high awareness of SSB tax (1,066, 83.2%). Knowledge and beliefs about Sugar-Sweetened Beverages were statistically significant for two demographic factors. There was support for the tax revenue to be spent on government programs and greater support for spending to be directed toward specific healthy lifestyle programs such as school health programmes (514, 39.8%), children's diet and nutrition programmes (497, 38.5%), physical activity programmes (480, 37.2%), among others.

Conclusions

The findings shed light on the influence demographic factors have on knowledge and beliefs, public health gaps and potential areas for SSB levy expenditure. Further research is needed to understand how best to implement healthy lifestyle programs within the community to optimise coverage, cost-effectiveness, and health outcomes.

Review: Medical directors - Is there a need for reform?

Medical leadership remains integral to the health system amidst a growing burden of ill health and disease, rising patient expectations and medical and technological advancements. The study objectives were to (a) provide a perspective through a rapid review of medical director roles and responsibilities in public and private hospital settings across several Organisation for Economic Co-operation and Development (OECD) and Non-Organisation for Economic Co-operation and Development countries, and (b) provide recommendations on how health system performance could be strengthened. A rapid review of Medical Director job descriptions in public and private hospitals was carried out. Medical Directors are influential leaders in organisational decision-making and quality improvement; however, their role has shifted from clinical oversight to several managerial and leadership roles. We report some variation in their role and responsibilities, in the 'intensity of job requirements' and 'complexity of managing resources' dimensions. The changing expectations of medical directors and the variation in their roles and responsibiliteis may contribute to inefficiencies and misalignment within health systems. There may be a need to pursue reform to assure alignment with health system objectives, albeit reform may require different approaches to meet the needs of different health systems. Further research is needed to explore how reform of medical directors' roles and responsibilities can be quantified to demonstrate improvement within health systems.

Optimizing interventional cardiology services

Cardiovascular disease (CVD) is a common and prominent cause of morbidity and mortality interventional cardiology (IC) remains an important noninvasive intervention to improve patient outcomes and life expectancy. Aim: The study objectives were to explore how IC services could be optimized. Methods: We adopted multiple methods, including policy analysis, literature review and interviews. Results: The most prominent themes were medical devices and service integration and management. IC Consultant interviews suggest the need to balance supply and demand, implement standards of practice and establish centres of excellence. Conclusion: Optimizing IC services requires a comprehensive approach, including regulatory and financial oversight, organizational management, adoption of clinical and technological best practices, ongoing training, multidisciplinary working and service integration.

Perspective: Telehealth - beyond legislation and regulation

The World Health Organization describes health innovation as developing new or improved systems, policies, products, technologies, services or delivery approaches that improve health and well-being, specifically of vulnerable people. The study's objectives were to (a) explore the legislative and regulatory journey of telehealth across the Organisation for Economic Co-operation and Development and non-Organisation for Economic Co-operation and Development countries and (b) provide recommendations to strengthen health system performance. We reviewed information sources for Organisation for Economic Co-operation and Development and non-Organisation for Economic Co-operation and Development countries opportunistically, including government and medical board publications, media coverage and peer-reviewed papers, to provide a perspective on the legislative and regulatory telehealth journey. Our review of countries suggests that legislation and regulation remain essential for governance, accountability and assuring that healthcare professionals and technologies are safe and secure. However, there was no uniform approach to telehealth legislation and regulation, and the precautionary approach was observed in some countries. Different strategies appear to have been adopted for telehealth implementation. There is a need to go beyond legislation and regulation to strengthen health system performance and assure the future success of telehealth services. Health system decision makers should work with health system stakeholders to strategise and plan for telehealth services as it will have implications on the future delivery of healthcare services and the health system. Further research is needed to explore how policy frameworks may support innovations in healthcare, such as telehealth.

Knowledge of Jordanian women of reproductive age who underwent bariatric surgery and its effect on birth outcomes: A cross-sectional study

Objectives

This study aims at exploring the knowledge of women of reproductive age who underwent bariatric surgery in Jordan regarding its effect on birth outcomes.

Methods

A cross-sectional study was conducted on 183 women (aged 15-49) who had undergone bariatric surgery at the Jordan University Hospital in Amman, Jordan, between 2016 and 2019, using telephone interviews with conveniently selected participants' samples. The survey tool obtained data on women's knowledge and other sociodemographic, obstetric health, and bariatric surgery information. Unfavorable birth outcomes include preterm delivery, small for gestational age, congenital abnormalities, low birth weight, and admission to the neonatal critical care unit.

Results

More than half of the participants did not know about the possible unfavorable birth outcomes after bariatric surgery and related practice guidelines. This is shown in their median score of 3 (interquartile range: 2-4) out of a maximum possible score of 8. Women who had a good score (>4) had received counseling about unfavorable bariatric surgery outcomes from their surgeon (p < 0.013); those who had educational qualifications higher than secondary school (p < 0.001) as well as those who were employed (p < 0.008) and believed that the surgery would affect the newborn (p < 0.001). The median score was also unfavorably associated with the parity of the participants (p < 0.003).

Conclusion

The extent of knowledge regarding the unfavorable birth outcome of bariatric surgery is low among women who underwent bariatric surgery at Jordan University Hospital in Jordan. Improving health literacy and information on bariatric surgery implications on pregnancy and birth outcomes amongst women of reproductive age is a recommendation from this study.

ICT Enabled Disease Diagnosis, Treatment and Management—A Holistic Cost-Effective Approach Through Data Management and Analysis in UAE and India

This concept paper addresses specific challenges identified in the UN 2030 Agenda Sustainable Development Goals (SDG) as well as the National Health Policy of India (NHP-India) and the Ministry of Health Policy of UAE (MHP-UAE). This policy calls for a digital health technology ecosystem. SDG Goal 1 and its related objectives are conceptualized which serves as the foundation for Virtual Consultations, Tele-pharmacy, Virtual Storage, and Virtual Community (VCom). SDG Goals 2 and 3 are conceptualized as Data Management & Analytical (DMA) Architecture. Individual researchers and health care professionals in India and the UAE can use DMA to uncover and harness PHC and POC data into practical insights. In addition, the DMA would provide a set of core tools for cross-network initiatives, allowing researchers and other users to compare their data with DMA data. In rural, urban, and remote populations of the UAE and India, the concept augments the PHC system with ICT-based interventions. The ICT-based interventions may improve patient health outcomes. The open and flexible design allows users to access various digital materials. Extendable data/metadata format, scalable architecture for petabyte-scale federated discovery. The modular DMA is designed using existing technology and resources. Public health functions include population health assessment, policy development, and monitoring policy implementation. PHC and POC periodically conduct syndromic surveillance to identify population risk patterns. In addition, the PHC and POC deploy medical and non-medical preventive measures to prevent disease outbreaks. To assess the impact of social and economic factors on health, epidemiologists must first understand diseases. Improved health due to compliance with holistic disease treatment plans and access to scientific health information.

Cross Country Determinants of Investors' Sentiments Prediction in Emerging Markets Using ANN

The paper models investor sentiments (IS) to attract investments for Health Sector and Growth in emerging markets, viz., India, Mainland China, and the UAE, by asking questions such as: What specific healthcare sector opportunities are available in the three markets? Are the USA-IS key IS predictors in the three economies? How important are macroeconomic and sociocultural factors in predicting IS in these markets? How important are economic crises and pandemic events in predicting IS in these markets? Is there contemporaneous relation in predicting IS across the three countries in terms of USA-IS, and, if yes, is the magnitude of the impact of USA-IS uniform across the three countries' IS? The artificial neural network (ANN) model is applied to weekly time-series data from January 2003 to December 2020 to capture behavioral elements in the investors' decision-making in these emerging economies. The empirical findings confirmed the superiority of the ANN framework over the traditional logistic model in capturing the cognitive behavior of investors. Health predictor—current health expenditure as a percentage of GDP, USA IS predictor—spread, and Macro-factor GDP—annual growth % are the common predictors across the 3 economies that positively impacted the emerging markets' IS behavior. USA (S&P 500) return is the only common predictor across the three economies that negatively impacted the emerging markets' IS behavior. However, the magnitude of both positive and negative impacts varies across the countries, signifying unique, diverse socioeconomic, cultural, and market features in each of the 3 economies. The results have four key implications: Firstly, US market sentiments are an essential factor influencing stock markets in these countries. Secondly, there is a need for developing a robust sentiment proxy on similar lines to the USA in the three countries. Thirdly, investment opportunities in the healthcare sector in these economies have been identified for potential investments by the investors. Fourthly, this study is the first study to investigate investors' sentiments in these three fast-emerging economies to attract investments in the Health Sector and Growth in the backdrop of UN's 2030 SDG 3 and SDG 8 targets to be achieved by these economies.

Detection of COVID-19 Using Deep Learning Techniques and Cost Effectiveness Evaluation: A Survey

Graphical-design-based symptomatic techniques in pandemics perform a quintessential purpose in screening hit causes that comparatively render better outcomes amongst the principal radioscopy mechanisms in recognizing and diagnosing COVID-19 cases. The deep learning paradigm has been applied vastly to investigate radiographic images such as Chest X-Rays (CXR) and CT scan images. These radiographic images are rich in information such as patterns and clusters like structures, which are evident in conformance and detection of COVID-19 like pandemics. This paper aims to comprehensively study and analyze detection methodology based on Deep learning techniques for COVID-19 diagnosis. Deep learning technology is a good, practical, and affordable modality that can be deemed a reliable technique for adequately diagnosing the COVID-19 virus. Furthermore, the research determines the potential to enhance image character through artificial intelligence and distinguishes the most inexpensive and most trustworthy imaging method to anticipate dreadful viruses. This paper further discusses the cost-effectiveness of the surveyed methods for detecting COVID-19, in contrast with the other methods. Several finance-related aspects of COVID-19 detection effectiveness of different methods used for COVID-19 detection have been discussed. Overall, this study presents an overview of COVID-19 detection using deep learning methods and their cost-effectiveness and financial implications from the perspective of insurance claim settlement.

Predicting Universal Healthcare Through Health Financial Management for Sustainable Development in BRICS, GCC, and AUKUS Economic Blocks

The majority of the world's population is still facing difficulties in getting access to primary healthcare facilities. Universal health coverage (UHC) proposes access to high-quality, affordable primary healthcare for all. The 17 UN sustainable development goals (SDGs) are expected to be executed and achieved by all the 193 countries through national sustainable development strategies and multi-stakeholder partnerships. This article addresses SDG 3.8—access to good quality and affordable healthcare and two subindicators related to societal impact (SDG 3.8.1 and 3.8.2) through two objectives. The first objective is to determine whether health expenditure indicators (HEIs) drive UHC, and the second objective is to analyze the importance of key determinants and their interactions with UHC in three economic blocks: emerging Gulf Cooperation Council (GCC); developing Brazil, Russia, India, China, and South Africa (BRICS) vis-à-vis the developed Australia, UK, and USA (AUKUS). We use the WHO Global Health Indicator database and UHC periodical surveys to evaluate the hypotheses. We apply state-of-the-art machine learning (ML) models and ordinary least square (traditional—OLS regression) methods to see the superiority of artificial intelligence (AI) over traditional ones. The ML Random Forest Tree method is found to be superior to the OLS model in terms of lower root mean square error (RMSE). The ML results indicate that domestic private health expenditure (PVT-D), out-of-pocket expenditure (OOPS) per Capita in US dollars, and voluntary health insurance (VHI) as a percentage of current health expenditure (CHE) are the key factors influencing UHC across the three economic blocks. Our findings have implications for drafting health and finance sector public policies, such as providing affordable social health insurance to the weaker sections of the population, making insurance premiums less expensive and affordable for the masses, and designing healthcare financing policies that are beneficial to the masses. UHC is an important determinant of health for all and requires an in-depth analysis of related factors. Policymakers are often faced with the challenge of prioritizing the economic needs of sectors such as education and food safety, making it difficult for healthcare to receive its due share. In this context, this article attempts to identify the key components that may influence the attainment of UHC and enable policy changes to address them more effectively and efficiently.

The nexus of Sugar-Sweetened Beverages: Insights on demographics, enablers and barriers

Objectives

The study objectives were to a) explore the association between household income and nationality and Sugar-Sweetened Beverage (SSB) enablers and barriers, and b) inform public health policy and health promotion.

Study design

A Cross-sectional Study in the UAE.

Methods

Nationally representative population survey was used to capture demographic and SSB behaviour data.

Results

We recruited 7500 participants into the study and received 1290 responses (17.2% participation rate). We report statistically significant associations between household income, nationality, and enablers and barriers. In some instances, similar enablers and barriers were reported by household income and nationality.

Conclusions

There are several associations between household income, nationality and SSB enablers, and barriers. These associations should be considered for future public health policy and health promotion decision-making to reduce SSB consumption. In addition, further research is needed to explore how other demographic factors (modifying variables) are associated with SSB enablers and barriers.

•

They are statistically significant associations between household income, nationality and SSB enablers, and barriers;

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For SSB enablers, participants agreed that SSB is readily available when they go out, and the label and packaging does not suggest SSB is harmful to health. Participants had neutral viewpoints on SSB affordability and availability at home, ease of access through mobile platforms and lack of healthier alternatives suggesting more work is needed to sway participants to disagree or strongly disagree on these aspects;

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For SSB barriers, participants agreed that they worry about their health if they drink SSB, know about SSB that prevents them from drinking SSB, and were happy with the sugar-free alternatives. There were several areas where participants expressed a neutral viewpoint, e.g. there are no good deals/promotions to buy SSB, SSB is not available when they go out, they do not like the taste of SSB, SSB makes them sick, the label and packaging of SSB tells them it is harmful to their health, and they always have cheaper or free alternatives suggesting more work needed to sway participants to agree or strongly agre; and

•

Household income and nationality can influence SSB enablers and barriers in different ways, and in some instances, presents a nexus.

UAE efforts in promoting COVID-19 vaccination and building vaccine confidence

The United Arab Emirates (UAE) is leading globally in many indicators for tackling the COVID-19 pandemic. This ranges from taking adequate preventive measures to the free vaccination drive and viable public health strategy. As of 18 August 2021, the UAE has significantly reduced the number of cases and successfully administered 17,454,250 doses. Furthermore, efforts and plans are underway to provide the third dose to high-risk people three months after completing the second dose and six months later to others. The UAE is considered one of the leaders globally for vaccinating "medically eligible" residents against COVID-19, with over 70% of the population currently fully vaccinated in the drive towards achieving herd immunity. The UAE's vaccination program is on track, covering a significant part of the population. The massive efforts of the National Vaccination Program's roll-out made by the UAE government and the various health authorities and stakeholders were vital for the general public's active participation in its success.

Hospital Accreditation: A Review of Evidence, Regulatory Compliance, and Healthcare Outcome Measures

<b><i>Background:</i></b> Hospitals are increasingly under pressure to provide safe and high-quality care at an affordable cost. In response to this challenge, many have adopted accreditation as an internationally recognized tool to facilitate improvements in healthcare quality and patient safety. The objectives of the study were to (a) evaluate the impact of international hospital accreditation in Dubai and (b) inform policy decision-making. <b><i>Methods:</i></b> We adopted a literature review, analysis of violation data, and clinical performance measures. <b><i>Results:</i></b> The literature review suggests insufficient evidence to link accreditation to healthcare outcomes. We report a gradual increase in hospital violations and an improvement of clinical outcomes over three years, however the improvement in clinical outcome measures were not statistically significant. <b><i>Conclusions:</i></b> There is limited evidence to determine the impact of international hospital accreditation. Performance measures for accreditation are needed to validate the contribution accreditation may have on reducing non-compliance and improving clinical performance measures. Further research is needed to explore how well accreditation models fit within the Donabedian framework for healthcare quality.

Gender-based disparities on health indices during COVID-19 crisis: a nationwide cross-sectional study in Jordan

Background

COVID-19 has an inevitable burden on public health, potentially widening the gender gap in healthcare and the economy. We aimed to assess gender-based desparities during COVID-19 in Jordan in terms of health indices, mental well-being and economic burden.

Methods

A nationally representative sample of 1300 participants ≥18 years living in Jordan were selected using stratified random sampling. Data were collected via telephone interviews in this cross-sectional study. Chi-square was used to test age and gender differences according to demographics, economic burden, and health indices (access to healthcare, health insurance, antenatal and reproductive services). A multivariable logistic regression analysis was used to estimate the beta-coefficient (β) and 95% confidence interval (CI) of factors correlated with mental well-being, assessed by patients’ health questionnaire 4 (PHQ-4).

Results

656 (50.5%) men and 644 (49.5%) women completed the interview. Three-fourths of the participants had health insurance during the COVID-19 crisis. There was no significant difference in healthcare coverage or access between women and men (p > 0.05). Half of pregnant women were unable to access antenatal care. Gender was a significant predictor of higher PHQ-4 scores (women vs. men: β: 0.88, 95% CI: 0.54–1.22). Among women, age ≥ 60 years and being married were associated with significantly lower PHQ-4 scores. Only 0.38% of the overall participants lost their jobs; however, 8.3% reported a reduced payment. More women (13.89%) were not paid during the crisis as compared with men (6.92%) (P = 0.01).

Conclusions

Our results showed no gender differences in healthcare coverage or access during the COVID-19 crisis generally. Women in Jordan are experiencing worse outcomes in terms of mental well-being and economic burden. Policymakers should give priority to women’s mental health and antenatal and reproductive services. Financial security should be addressed in all Jordanian COVID-19 national plans because the crisis appears widening the gender gap in the economy.

UAE Resident Users’ Perceptions of Healthcare Applications from Dubai Health Authority: Preliminary Insights

<b><i>Background:</i></b> Innovations in healthcare are a way to sustain and improve health outcomes, usually done in a cost-effective way. Thus, the Dubai Health Authority (DHA) is keen on launching the best innovations in all areas such as health apps, telecommunications, electronic patient health records, and others. <b><i>Objectives:</i></b> DHA apps users within the United Arab Emirates (UAE) were studied to determine the extent they were satisfied with the available medical health apps; there are limited studies on users’ perceptions on health innovations in the UAE. <b><i>Method and Results:</i></b> The quantitative methodology included data collection from a sample of 396 apps users. The technology acceptance model (TAM) provided an appropriate framework for this research, independent variables included gender, nationality, education, and age, and the dependent variables included the users’ perceptions related to usefulness, ease of use, and usability as well as satisfaction. The results of the study revealed a statistically significant difference based on the abovementioned independent variables. <b><i>Conclusion:</i></b> The research adds value for policymakers when considering and evaluating the current health apps available in the DHA; the research findings could positively influence public policies for the development of health innovations across the UAE region. Future research should aim to include other factors that may have an influence on the adoption of technology and uncover further reasons that motivate or discourage users.

A Mixed-Methods Study to Explore the Impact of Hospital Accreditation

There are several hospital accreditors globally but there is limited understanding of how accreditation impacts on hospital performance and the health system objectives. The objective of the study were to explore the impact of hospital accreditation and inform policy decision-making. We adopted a mixed-methods approach to include an online survey and 3 focus groups. We report 27 of 36 private hospitals who responded to the survey. Key reasons for accreditation were to improve quality (n = 23), implement evidence-based practice (n = 17), continuity of accreditation (n = 15), and popularity (n = 11). Reported improvements include quality of care (27), patient care (26), organizational processes (21), and patient satisfaction (19) among others. Average stakeholder satisfaction rate was 74%. Participants from the 3 focus group discussions felt that staff hours and stress levels were high during the accreditation process, and some standards were useful while others were deemed non-essential. There was support for a local accreditation body with an emphasis on best practice. The findings from the study suggest accreditation to have an impact on structure and process measures, but the gains in key areas were short-lived. There is a need to strengthen governance and develop performance measures to evidence outcome improvement, assure alignment with regulation and the health system objectives.

Public Health Strategies for the Gradual Lifting of the Public Sector Lockdown in Jordan and the United Arab Emirates During the COVID-19 Crisis

In this viewpoint, we present public policies and public health strategies for a gradual lockdown lifting during the coronavirus disease (COVID-19) crisis in two country cases, Jordan and the United Arab Emirates. While managing pandemics is critical in terms of preparedness, response, and recovery, it is equally vital to ensure that the measures for a lockdown exit are both efficient and effective. It is critical to learn from first-wave lessons to systematize responses during times of crisis and execute appropriate public policies and public health strategies. This viewpoint highlights the importance of the following during lockdown lifting: pandemic control, health care capacity, training, scaling up of resources and systems, and priority setting of public policies by acknowledging challenges, developing policy insights, and setting the policy direction. The systematic approaches and leadership thinking required for lifting lockdowns during a crisis include the three Rs: Readiness, Responses, and Resilience & Recovery.

Privacy protection laws and public perception of data privacy

Purpose

The move toward e-health care in various countries is envisaged to reduce the cost of provision of health care, improve the quality of care and reduce medical errors. The most significant problem is the protection of patients’ data privacy. If the patients are reluctant or refuse to participate in health care system due to lack of privacy laws and regulations, the benefit of the full-fledged e-health care system cannot be materialized. The purpose of this paper is to investigate the available e-health data privacy protection laws and the perception of the people using the e-health care facilities.

Design/methodology/approach

The researchers used content analysis to analyze the availability and comprehensive nature of the laws and regulations. The researchers also used survey method. Participants in the study comprised of health care professionals (n=46) and health care users (n=187) who are based in the Dubai, United Arab Emirates. The researchers applied descriptive statistics mechanisms and correlational analysis to analyze the data in the survey.

Findings

The content analysis revealed that the available health data protection laws are limited in scope. The survey results, however, showed that the respondents felt that they could trust the e-health services systems offered in the UAE as the data collected is protected, the rights are not violated. The research also revealed that there was no significance difference between the nationality and the privacy data statements. All the nationality agreed that there is protection in place for the protection of e-health data. There was no significance difference between the demographic data sets and the many data protection principles.

Originality/value

The findings on the users’ perception could help to evaluate the success in realizing current strategies and an action plan of benchmarking could be introduced.