Uncovering associations between interest in One Health and pre-existing conditions and behaviours: Evidence from a UK survey

This paper endeavours to unveil individual characteristics associated with an interest in One Health. Through the distribution of an online survey randomly distributed among the United Kingdom population, we discovered significant correlations between pre-existing attitudes towards and relationships with nature and animals and interest in One Health, which is quantified by the number of additional pages of One Health information participants agreed to view at the survey's conclusion. Additionally, individuals with poorer mental health demonstrated a higher level of interest in One Health. The findings suggest that interest in One Health and people's connections with nature and animals are driven by the same personal preferences. These insights point towards the potential for more targeted communication strategies to specific groups, facilitating more effective promotion of the One Health concept.

Environmental co-benefits of health policies to reduce meat consumption: A narrative review

Global meat consumption has risen steadily in recent decades, with heterogeneous growth rates across regions. While meat plays a critical role in providing essential nutrients for human health, excessive consumption of meat, particularly red and processed meat, has also been associated with a higher risk of certain chronic diseases. This has led public authorities, including the World Health Organization, to call for a reduction in meat consumption. How governments can effectively reduce the health costs of meat consumption remains a challenge as implementing effective policy instruments is complex. This paper examines health-related policy instruments and potential economic mechanisms that could reduce meat consumption. Health-related taxation could be the most effective instrument. Other policy instruments, such as informational and behavioral instruments, along with regulations, could discourage meat consumption depending on the policy design. We also provide evidence on the link between meat consumption and the environment, including climate, biodiversity, water use, and pollution. Promoting healthy behaviors by reducing meat consumption can then have environmental co-benefits and promote broader sustainable development goals. We also discuss the policy-related challenges that need to be addressed to meet environmental co-benefits.

Prioritization of maternal and newborn health policies and their implementation in the eastern conflict affected areas of the Democratic Republic of Congo: a political economy analysis

BACKGROUND

Maternal and neonatal mortality remains a major concern in the Democratic Republic of Congo (DRC), and the country's protracted crisis context exacerbates the problem. This political economy analysis examines the maternal and newborn health (MNH) prioritization in the DRC, focussing specifically on the conflict-affected regions of North and South Kivu. The aim is to understand the factors that facilitate or hinder the prioritization of MNH policy development and implementation by the Congolese government and other key actors at national level and in the provinces of North and South Kivu.

METHODS

Using a health policy triangle framework, data collection consisted of in-depth interviews with key actors at different levels of the health system, combined with a desk review. Qualitative data were analysed using inductive and then deductive approaches, exploring the content, process, actor dynamics, contextual factors and gender-related factors influencing MNH policy development and implementation.

RESULTS

The study highlighted the challenges of prioritizing policies in the face of competing health and security emergencies, limited resources and governance issues. The universal health coverage policy seems to offer hope for improving access to MNH services. Results also revealed the importance of international partnerships and global financial mechanisms in the development of MNH strategies. They reveal huge gender disparities in the MNH sector at all levels, and the need to consider cultural factors that can positively or negatively impact the success of MNH policies in crisis zones.

CONCLUSIONS

MNH is a high priority in DRC, yet implementation faces hurdles due to financial constraints, political influences, conflicts and gender disparities. Addressing these challenges requires tailored community-based strategies, political engagement, support for health personnel and empowerment of women in crisis areas for better MNH outcomes.

Primary Sjögren's syndrome in Italy: Real-world evidence of a rare disease through administrative healthcare data

OBJECTIVES

Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease with significant impact on morbidity, mortality, and quality of life. This study aimed to evaluate epidemiology, healthcare needs and related costs of pSS patients from the Italian National Health Service perspective.

METHODS

From the Fondazione Ricerca e Salute's database (∼5 million inhabitants/year), pSS prevalence in 2018 was calculated. Demographics, mean healthcare consumptions and direct costs at one year following index date (first in-hospital diagnosis/disease waiver claim) were analysed through an individual direct matched pair case-control analysis (age, sex, residency).

RESULTS

In Italy, 3.8/10,000 inhabitants were identified as affected by pSS (1,746 case: 1,746 controls) in 2018. In the year following index date, 53.7% of cases and 42.7% of controls received ≥1 drug (p<0.001); mean per capita cost was €501 and €161, respectively (p<0.01). At least one hospitalization occurred to 7.8% of cases and 3.9% of controls (p<0.001) with mean per capita costs of €416 and €129, respectively (p = 0.46). At least one outpatient specialist service was performed in 49.8% of cases and 30.6% of controls (p<0.001); mean per capita costs were €200 and €75, respectively (p<0.01). Overall, mean annual costs were €1,171 per case and €372 per control (p < 0.01).

CONCLUSION

According to results of this population-based study, the prevalence of pSS in Italy appears to be consistent with the definition of rare disease. Patients with pSS have higher pharmacological, in-hospital and outpatient specialist care needs, leading to three-times higher overall cost for the INHS, compared to the general population.

Taxing women's bodies: the state of menstrual product taxes in the Americas

The taxation of menstrual products has been identified as unfair, imposing economic burden on people who menstruate based simply on a biological difference. These taxes have been described as major contributors to menstrual poverty. Although they have been debated among governments, and a focus of political activism, academic literature has largely neglected the issue. Here I comprehensively reviewed the status of menstrual product taxes for all countries and populated territories in the Americas in 2022. Data from 57 countries and territories, and 78 states (those of the United States and Brazil) were included. Since 2012, 10 countries and territories have eliminated taxation on menstrual products-Jamaica, Canada, Saint Kitts & Nevis, Trinidad & Tobago, Guyana, Colombia, Puerto Rico, Mexico, Ecuador, and Barbados. Nevertheless, menstrual product taxes were still applied in 63.2% of locations in 2022, with an average tax rate of 11.2% (ranging from 1.0% in Costa Rica to 22.0% in Uruguay). The average woman of reproductive age in the Americas experienced a menstrual product tax rate of 5.8% in 2022. In sum, despite activism and progress, most of the region continues to employ discriminatory taxation against people who menstruate, with particularly high taxation rates concentrated in South America.

Platform for Better Oral health in Europe

The Platform for Better Oral Health in Europe brings together five European organizations (Council of European Chief Dental Officers, Association for Dental Education in Europe, European Association of Dental Public Health, Pan European-International Association For Dental Research, Oral Health Foundation-UK) along with eighteen other associated European or national organizations. The platform aims to encourage oral health promotion and the prevention of oral diseases as fundamental components of good general health. The aim is thus to strengthen oral health promotion in Europe through integrating oral health into the relevant public health policies. It also aims to address the issue of oral health inequality, particularly among vulnerable populations such as children and adolescents, older adults, and people with particular needs. The platform is therefore a European-level resource for providing evidence-based information on best practice in oral health promotion and for guiding oral health policies. It also works to reinforce communication at the European level between stakeholders, policy makers, health professionals, and the public, in order to improve awareness of oral health issues.

Mapping and analysis of health financing in South Kivu province (DRC)

Introduction

In South-Kivu, the health system is underfunded due to numerous constraints. Several initiatives have been tested but are insufficient for increasing and sustaining health financing.

Purpose of research

Analyze the health financing system in South-Kivu, through a mapping as well as quantitative and qualitative analysis of health financing mechanisms.

Results

The provincial health financing system is fragmented, with poorly coordinated mechanisms and interventions, leading to duplication of health system strengthening activities in addition to the absence of a mechanism for pooling external funding flows. Costs recovery (i.e. user fees) and external supports are the most widely used schemes while the government hardly contributes to the financing of the provincial health system. Mutual health insurance is supposed to improve access to health care, but its coverage is still extremely low. Results-Based Financing and free health care programs, fully financed by external donors, are irregular and insufficiently sustainable.

Conclusions

It would be critical to implement a strategic purchasing model that is anchored in local institutions, owned by all stakeholders, and integrating all existing financing mechanisms, which could be supported by a common fund supporting the provincial health system. The “Single Contract” initiative developed to harmonize, pool, and sustain external programs, could be a good basis in this respect. This would involve strengthening policy dialogue, developing an investment case to support resource mobilization and implementing a joint monitoring and evaluation platform for disbursements led by the provincial health authorities.

Do clean energy technologies, ecotourism, health policy, and green education help in achieving sustainability in China?

Sustainable development has become the foremost requirement for sustainable economic conditions all around the globe, and this aspect demands new literature and regulators' emphasis. Hence, the present research investigates the impact of clean energy technologies, human development, health policies, green education, and ecotourism policy on sustainable development in China from 1991 to 2021. The researchers investigate the association among the variables using dynamic autoregressive distributed lag (DARDL). The outcomes revealed that clean energy technologies, human development, health policies, green education, and ecotourism policy have positive linkages with sustainable development in China. The article provides guidelines to the policymakers in developing policies related to attain sustainable development using effective clean energy technologies, human development, health policies, green education, and ecotourism policy.

Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile

BACKGROUND

MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS.

OBJECTIVE

To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile.

METHODS

Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed.

RESULTS

We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05).

CONCLUSION

MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.

The influence of SYRIZA-ANEL Greek health policies on hospital efficiency

BACKGROUND

We analyse the impact of the three following categories of Health Policies (HP) carried out by the Greek SYRIZA-ANEL governments on the efficiency of Greek public general hospitals. These governments have implemented policies intended to change the rate of contributions to publicly funded healthcare (PCnH), policies to affect the volume and quality of publicly funded health care (PVQH) and those intended to affect the costs of publicly funded healthcare (PCH). A literary review of the PCnH. PVQH and PCH policies of the Greek SYRIZA-ANEL governments was carried out and an efficiency window-DEA study was executed using data from the Ministry of Health (MoH) and the Greek Statistical Authority (ELSTAT).

METHODS

The study was designed to assess the impact of PCnH. PVQH and PCH policies by the Greek SYRIZA-ANEL governments on the efficiency of Greek general hospitals. The data was collected from HEAL-Link scientific journals. Information on HPs was extracted from the work collected. The values of inputs and outputs used for the efficiency study were obtained from ELSTAT and Greek MoH databases.

RESULTS

HPs of the Greek SYRIZA-ANEL governments extend to all three HP categories of the sample used. These policies have a dual effect on both the inputs and outputs used in efficiency. Efficiency values exhibit fluctuations with good and bad years. The SYRIZA-ANEL governments seek to ensure more equality in access to health services. Some of the policies reduce costs and have a positive impact on efficiency, while others have the opposite effect. The increase in outputs achieved as a result of health policies is counter balanced by an increase in inputs.

CONCLUSIONS

The PCnH, PVQH and PCH policies of the SYRIZA-ANEL governance seem to have a dual orientation: some policies reduce the cost of a category and contain the total cost, thus positively contributing to an increase in efficiency. Certain policies are aimed more at fulfilling the criterion of equality in the provision of health services and thus the cost inevitably increases. From the window-DEA study, three relatively "good" years emerge (2015, 2016, 2018) and two "bad years" (2017, 2019). This analysis will be useful for further research on the effect of health policies on hospital efficiency in other countries and periods.

Characteristics of self-management support (SMS) interventions and their impact on Quality of Life (QoL) in adults with chronic diseases: An umbrella review of systematic reviews

OBJECTIVE

To provide an overview of types and characteristics of self-management support (SMS) interventions in adults with chronic disease and to assess the impact on the patient reported outcome Quality of Life (QoL).

METHODS

An umbrella review of systematic reviews was conducted. We searched PubMed, Embase, Web of Science, CINAHL and the Cochrane Library from January 2016 to November 2020 for reviews on SMS interventions for chronic diseases, assessing the impact on the patient reported outcome QoL. Quality assessment was based on the JBI Critical Appraisal Checklist for Systematic reviews and Research Syntheses tool.

RESULTS

28 reviews were included. The extensive literature review revealed a variety of SMS interventions. The most frequently cited target group for the interventions were individuals with diabetes. Interventions primarily took place in the home setting. Interventional components that were often incorporated were education, eHealth and mHealth technologies, and coaching techniques. Telephone communication was regularly reported as a type of intervention follow-up. The impact on QoL was mixed and no firm conclusions can be drawn. However, our review revealed a beneficial effect of education.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Interventions including educational components seem promising for supporting self-management and showed a beneficial effect on QoL. More research is needed to explore where, by whom and how interventions are ideally delivered.

Interdisciplinary frontline teams in home-based healthcare services-paradoxes between organisational work structures and the trust model: a qualitative study

BACKGROUND

Achieving access to quality healthcare services to ensure healthy lives and promote well-being for all at all ages is one of the United Nation's Sustainable Developments Goals. In view of this goal, sustainable community healthcare services in Norway need to be urgently restructured in light of demographic changes, including an increase in the percentage of older adults in the country. National healthcare policies recommend finding new ways to organise and perform services using new technology, new methods and new solutions. The goal is to ensure greater continuity in the provision of services and softer transitions that enable service users to deal with a smaller number of people. The trust model is one such suggested organisational approach. The goal of the trust model is to involve service users and their next of kin in decisions that concern them while also trusting frontline workers' professional judgement in assessing the need for services and adjusting them to address changes in the health of the users, thus making the services individually tailored and more flexible. This study aims to explore how organisational work structures influence the delivery of interdisciplinary home-based healthcare services.

METHODS

Observations, individual-, and focus groups interviews were conducted within community home-based healthcare services in a large Norwegian city with managers at different levels, nurses, occupational therapists, physiotherapists, purchaser-unit employees and other healthcare workers. Data was analysed thematically.

RESULTS

The results are presented in terms of themes- "Balancing on the margins: Negotiations between the time available, users' needs, unforeseen events and administrative tasks" and "One gathered unit, but with different work structures". The results identify organisational work structures that influence the performance of the trust model with regard to its intention of making flexible and individually tailored services available. However, these structures are different for the members of the interdisciplinary team, thus creating several paradoxes that need to be negotiated while fulfilling their daily responsibilities.

CONCLUSION

This study suggests that it is crucial to pay attention to paradoxes and structures experienced by interdisciplinary frontline workers in home-based healthcare services, since they are unavoidable factors that need to be acknowledged when designing approaches for addressing the changes expected in community healthcare services.

"In some clinics, they said it's elective, and then they would refuse": A Mixed-Methods Study on the impact of the COVID-19 pandemic on access to abortion services in Germany

OBJECTIVE

The World Health Organization recognizes abortion as essential health care and has encouraged governments to ensure access to abortion services throughout the COVID-19 pandemic. However, the threat of infection combined with government responses to COVID-19 have impacted access to abortion services globally. This study explores access to abortion in Germany during the pandemic.

METHODS

This study used a mixed-methods design. An analysis of data collected by Women on Web (WoW) was carried out to assess women's reasons for choosing telemedicine abortion outside the formal health system in Germany during the pandemic. Descriptive statistics were generated for 2057 requests for telemedicine abortion received by WoW between March 2020-March 2021. Semi-structured interviews were conducted with eight healthcare professionals involved in the provision of abortion services to explore how they perceive of women's access to abortion services in Germany during the pandemic.

RESULTS

The quantitative analysis found that preferences and needs for privacy (47.3%), secrecy (44.4%) and comfort (43.9%) were the most common reasons for choosing telemedicine abortion. COVID-19 was another important reason (38.8%). The thematic analysis of the interviews was organized into two overarching themes: service provision, and axes of difference.

CONCLUSIONS

The pandemic affected the provision of abortion services as well as the circumstances of women seeking abortion. The main barriers to access were financial constraints, privacy issues, and lack of abortion providers. Throughout the pandemic, accessing abortion services was more difficult for many women in Germany, especially women experiencing multiple and overlapping forms of discrimination.

Type 2 diabetes epidemic in Mexico. Burden of disease 1990-2021 analysis and implications for public policies

BACKGROUND

Mexico faces a challenge due to the burden imposed by type 2 diabetes (T2D).

OBJECTIVE

To analyze T2D epidemiology and burden in Mexico from 1990 to 2021, at the national and state levels.

MATERIAL AND METHODS

Estimates from the Global Burden of Disease 2021 study were used to evaluate the prevalence, incidence, mortality, fatal and non-fatal burden. Metabolic, environmental and behavioral factors were considered. Comparative analyses were carried out by gender, age and state of the country.

RESULTS

The prevalence of T2D increased by 25%. The incidence increased in those younger than 45 years, with a mortality decrease being found among women. The rate of disability-adjusted life years (DALY) showed an increase in all states, from 45.2% in Nuevo León to 237.6% in Tabasco. In 2021, T2D caused the loss of 3.1 million DALYs, which accounted for 6.6% of total burden in Mexico, out of which 64% was due to premature deaths. Diabetic neuropathy affected 47%, and there were 270,000 cases of visual impairment; 66.3% of the burden was attributed to obesity.

CONCLUSIONS

Comprehensive policies are urgently needed in order to reduce the burden of T2D in Mexico, through standardized guidelines, evidence-based strategies and technological resources that improve medical care accessibility and efficiency.

Five-year performance analysis of a cystic fibrosis newborn screening program in northeastern Brazil

OBJECTIVE

To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state.

METHOD

A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease.

RESULTS

The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days.

CONCLUSIONS

The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.

Preconception exposure to malathion and glucose homeostasis in rats: Effects on dams during pregnancy and post-term periods, and on their progeny

Understanding the individual and global impact of pesticides on human physiology and the different stages of life is still a challenge in environmental health. We analyzed here whether administration of the organophosphate insecticide malathion before pregnancy could affect glucose homeostasis during pregnancy and, in addition, generate possible later consequences in mothers and offspring. For this, adult Wistar rats were allocated into two groups and were treated daily (intragastric) with malathion (14 or 140 mg/kg, body mass (bm)) for 21-25 days. Corn oil was used as vehicle in the Control group. Subgroups were defined based on the absence (nulliparous) or presence (pregnant) of a copulatory plug. Pregnant rats were followed by an additional period of 2 months after the term (post-term), without continuing malathion treatment. Fetuses and adult offspring of males and females were also evaluated. We ran an additional experimental design with rats exposed to malathion before pregnancy at a dose of 0.1 mg/kg bm. Malathion exposure resulted in glucose intolerance in the mothers during pregnancy and post-term period, regardless of the exposure dose. This was accompanied by increased visceral adipose tissue mass, dyslipidemia, unchanged pancreatic β-cell mass, and varying insulin responses to glucose in vivo. The number of total newborns and birthweight was not affected by malathion exposure. Adult offspring from both sexes also became glucose-intolerant, regardless of the pesticide dose their dams were exposed to. This alteration could be associated with changes at the epigenomic level, as reduced hepatic mRNA content of DNA methylases and demethylases was found. We demonstrated that periconceptional exposure to malathion with doses aiming to mimic from work environment to indirect contamination predisposes progenitors and offspring rats to glucose intolerance. Thus, we conclude that subchronic exposure to malathion is a risk factor for gestational diabetes and prediabetes later in life.

Increased airborne transmission of COVID-19 with new variants, implications for health policies

New COVID-19 variants, either of higher viral load such as delta or higher contagiousness like omicron, can lead to higher airborne transmission than historical strains. This paper highlights their implications for health policies, based on a clear analytical understanding and modeling of the airborne contamination paths, of the dose following exposure, and the importance of the counting unit for pathogens, itself linked to the dose-response law. Using the counting unit of Wells, i.e. the quantum of contagium, we develop the conservation equation of quanta which allows deriving the value of the quantum concentration at steady state for a well-mixed room. The link with the monitoring concentration of carbon dioxide is made and used for a risk analysis of a variety of situations for which we collected CO₂ time-series observations. The main conclusions of these observations are that 1) the present norms of ventilation, are both insufficient and not respected, especially in a variety of public premises, leading to high risk of contamination and that 2) air can often be considered well-mixed. Finally, we insist that public health policy in the field of airborne transmission should be based on a multi parameter analysis such as the time of exposure, the quantum production rate, mask wearing and the infector proportion in the population in order to evaluate the risk, considering the whole complexity of dose evaluation. Recognizing airborne transmission requires thinking in terms of time of exposure rather than in terms of proximal distance.

How do economic and public finance statuses affect policy responses during a pandemic? - learning from the COVID-19 first wave

BACKGROUND

In the time of a pandemic, it is typical for public health bodies to collaborate with epidemiologists to design health policies both at national and international levels for controlling the spread. A point largely overlooked in literature is the extent economic capability and public finance status can influence the policy responses of countries during a pandemic situation. This article fills this gap by considering 12 public health and 7 economic measures (i.e., policies) in 200 countries during the COVID-19 first wave, with countries grouped across income categories.

METHODS

We apply statistical analysis, inclusive of regression models, to assess the impact of economic capability and public finance status on policy responses. Multiple open-access datasets are used in this research, and information from the hybrid sources are cumulated as samples. In our analysis, we consider variables including population characteristics (population size, density) and economic and public finance status (GDR, current account balance, government surplus/deficit) further to policy responses across public health and economic measures. Additionally, we consider infection rates across countries and the institution of the measures relative to infection rate.

RESULTS

Results suggest that countries from all income groups have favoured public health measures like school closures and travel bans, and economic measures like influencing interest rates. However, strong economy countries have more adopted technological monitoring than low-income countries. Contrarily, low-income countries have preferred traditional measures like curfew and obligatory mask-wearing. GDP per capita was a statistically significant factor influencing the institution of both public health and economic measures. Government finance statuses like current account balance and surplus/deficit were also significant factors influencing economic measures.

CONCLUSIONS

Overall, the research reveals that, further to biological characteristics, policymakers and epidemiologists can consider the economic and public finance contexts when suggesting health responses to a pandemic. This, in turn, calls for more international cooperation on economic terms further to public health terms.

Mapping the complex causal mechanisms of drinking and driving behaviors among adolescents and young adults

BACKGROUND

The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S.

METHODS

We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review.

RESULTS

The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving.

CONCLUSION

This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017

AIMS

To describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period.

METHODS

Service data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development.

RESULTS

Rates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of - 0.14 and - 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility.

CONCLUSIONS

The majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

Achille Sclavo (1861-1930) and His Innovative Contributions to Italian Preventive Medicine and Healthcare Policy

Achille Sclavo was a scientist with a multifaceted personality; throughout his life, he steadfastly maintained his commitment to research and teaching, while also gaining precious experience as an educator, politician and entrepreneur. He carried forward these various activities with the aim of bringing relief to a country smitten by epidemic diseases, of spreading the gospel of hygiene, and of creating and training medical and healthcare personnel that would be able to tackle the difficult problem of public health in Italy at the beginning of the twentieth century. In this regard, Achille Sclavo can undoubtedly be considered a precursor of modern public health and preventive medicine.

Gender differences in acculturation and cardiovascular disease risk-factor changes among Chinese immigrants in Italy: Evidence from a large population-based cohort

Background

In recent decades, the Chinese presence in Southern Europe has grown rapidly but no data is available on the influence that residing in Mediterranean countries has on Chinese immigrants. In this study, we aim to examine the association between acculturation and cardiovascular risk factors among first-generation Chinese immigrants in Italy.

Design

Population-based, cross-sectional study.

Methods

A sample of 2589 Chinese first-generation immigrants (1599 women and 990 men) living in Prato, Italy, underwent blood pressure measurement, blood tests (with measurement of glucose, cholesterol, and triglycerides), and anthropometric measurements. The influence of length of residence (dependent variable) on hypertension, type 2 diabetes, overweight/obesity, and hyperlipidemia (high cholesterol) (independent variables) was investigated with multivariable logistic regression adjusted for age, sex, education and urban/rural home area in China before migration.

Results

Mean age of Chinese participants was 47.2 ± 10.7 years and 61.7% were women. Immigrants residing in Italy for ≥20 years were more likely to be hypertensive [odd ratio (OR) 1.84; 95% confidence interval (CI) 1.33 to 2.59], or diabetic (1.91; 1.26 to 2.86) than those residing in Italy for <10 years. Differently, prevalence of hypercholesterolemia (total cholesterol≥240 mg/dl) was lower in immigrants residing in Italy for ≥20 years than in those with <10 years of residence (0.52; 0.32 to 0.83). The association between indicators of acculturation and cardiovascular risk factors appeared to differ by sex.

Conclusion

Acculturation of Chinese immigrants in Italy was associated with hypertension and type 2 diabetes whereas a favorable effect on hypercholesterolemia was observed.

Containment, Health, and Social Policies in the Time of COVID-19 - Patterns and Determinants of Initial Reponses from Spring 2020 Across 120 Countries

The COVID-19 pandemic has triggered an unprecedented number of policy responses around the world across multiple policy domains. While governments have combined containment and health policies with social policies (CHSP) during the initial phase of the pandemic in various ways, current literature offers little knowledge of the patterns of these combinations and their determinants and outcomes. This paper fills this gap by investigating CHSP combinations across more than 120 countries. We further examined whether the CHSP policy response was determined by political regimes or compensation hypotheses-serving the purposes of responding to pre-existing economic downturns, inequality, or social unrest. We also investigated the associations between CHSP responses and mobility, virus infection, and unemployment. Using policy data from the Oxford COVID-19 Government Response Tracker, results from sequence analysis indicated that governments' CHSP responses could be clustered into five categories: high social policies (SP), middle SP, containment and health (CH) leading SP, low SP, and gradual high SP. We used multinomial regression models to investigate determinants of CHSP responses. We found that CHSP policy responses did not differ by political regime, and CHSP combinations were not driven by compensation hypotheses. Instead, GDP per capita and government effectiveness were the key drivers for high levels of policy responses. We also found that low SP responses were associated with fewer mobility changes. Taken together, our findings suggest that lower income countries required more support and resources in order for them to adopt necessary CH and SP responses.

Practical considerations for expediting breast cancer treatment in Brazil

Patients in Brazil continue to present with late-stage breast cancer. Notwithstanding these figures, policies and programs to overcome this long-lasting scenario have had limited results. We enlist the main barriers for advancing breast cancer diagnosis in Brazil, based on the available evidence, and we propose feasible strategies that may serve as a platform to address this major public health challenge.

Adjusting the use of preprints to accommodate the 'quality' factor in response to COVID-19

Preprints are typically crude precursors of peer-reviewed papers that are placed almost immediately, save for some superficial screening, on an open-access repository to allow the information to reach readers quickly, circumventing the long-drawn process typically associated with processing in peer-reviewed journals. For early-career researchers who might be enthusiastic about obtaining some recognition for their efforts, or wanting open and public input about their work, preprints are certainly a useful publication choice. However, if health-related data and information have not been carefully scrutinised, they may pose a risk and may even serve as a source of public health misinformation. Surging growth and competition among preprint servers, coupled with a massive volume of COVID-19-related preprints, mainly on bioRxiv and medRxiv, as well as select indexing now being tested on PubMed, suggests that preprints are being increasingly used in the biomedical sciences. Stronger and more robust ethical policies are needed to screen preprints before they are released to the public, and even if this implies a slight delay in publication, it may increase academics' trust in this form of scientific information and communication. Clear and stringent ethical policies need to be urgently introduced by ethics groups such as COPE and the ICMJE, whose many member journals allow preprints to be posted before traditional peer review. Stringent ethical guidelines that treat misconduct equally in preprints and peer-reviewed papers will boost the integrity of academic publishing.

Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models

BACKGROUND

Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions.

METHODS

We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model's features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded.

RESULTS

We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model's outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%).

CONCLUSIONS

There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption.

PROSPERO PROTOCOL NUMBER

CRD42020121025 .

Identifying key environmental barriers experienced by persons with mild, moderate, or severe disability in Bankim Health District, Cameroon: a policy-targeted secondary analysis of data obtained with the World Bank and WHO model disability survey

BACKGROUND

Comprehensive data is key for evidence-informed policy aiming to improve the lives of persons experiencing different levels of disability. The objective of this paper was to identify the environmental barriers - including physical, social, attitudinal, and political barriers - that might become priorities for cross-cutting policies and policies tailored to the needs of persons experiencing severe disability in Cameroon.

METHODS

A secondary analysis of data obtained with the WHO Model Disability Survey was completed in the Bankim Health District (N = 559) using random forest regression to determine and compare the impact of the environmental factors on the experience of disability.

RESULTS

The physical environment had by far the highest influence on disability, with transportation, toilet of the dwelling, and the dwelling itself being the most important factors. Factors inside one's own home (toilet of the dwelling, and the dwelling itself) were the most important for persons with moderate and severe disability, followed by attitudes of others and issues with accessing health care.

CONCLUSION

Our study provides country policy makers with evidence for setting priorities and for the development of evidence-informed policies for the Bankim Health District in Cameroon.

An analysis of the impact of newborn survival policies in Pakistan using a policy triangle framework

Introduction

Pakistan has made slow progress towards reducing the newborn mortality burden; as a result, it has the highest burden of newborn mortality worldwide. This article presents an analysis of the current policies, plans, and strategies aimed at reducing the burden of newborn death in Pakistan for the purpose of identifying current policy gaps and contextual barriers towards proposing policy solutions for improved newborn health.

Methods

We begin with a content analysis of federal-level policies that address newborn mortality within the context of health system decentralization over the last 20 years. This is then followed by a case study analysis of policy and programme responses in a predominantly rural province of Pakistan, again within the context of broader health system decentralization. Finally, we review successful policies in comparable countries to identify feasible and effective policy choices that hold promise for implementation in Pakistan, considering the policy constraints we have identified.

Results

The major health policies aimed at reduction of newborn mortality, following Pakistan’s endorsement of global newborn survival goals and targets, lacked time-bound targets. We found confusion around roles and responsibilities of institutions in the implementation process and accountability for the outcomes, which was exacerbated by an incomplete decentralization of healthcare policy-making and health service delivery, particularly for women around birth, and newborns. Such wide gaps in the areas of target-setting, implementation mechanism, and evaluation could be because the policy-making largely ignored international commitments and lessons of successful policy-making in comparable regional counties.

Conclusions

Inclusion of clear goals and targets in newborn survival policies and plans, completion of the decentralization process of maternal and child healthcare service delivery, and policy-making and implementation by translating complex evidence and using regional but locally applicable case studies will be essential to any effective policy-making on newborn survival in Pakistan.

Model strategies to address barriers to cervical cancer treatment and palliative care among women in Zimbabwe: a public health approach

Background

Cervical cancer treatment and care remains limited in Zimbabwe despite the growing burden of the disease among women. This study was aimed at investigating strategies to address barriers in accessing treatment and care by women with cervical cancer in Harare, Zimbabwe.

Methods

A qualitative inquiry was conducted to generate evidence for this study. Eighty-four (84) participants were purposively selected for interviews and participation in focus group discussions. The participants were selected from cervical cancer patients, caregivers of cervical cancer patients, health workers involved in the care of cervical cancer patients as well as relevant policy makers in the Ministry of Health and Child Care. Participants were selected in such as a way as to ensure different of characteristics to obtain diverse perspectives about the issues under study. Discussion and interview guides were used as data collection tools and discussions/interviews were audio-recorded, transcribed and translated into English. Inductive thematic analysis was conducted using Dedoose software.

Results

Salient sub-themes that emerged in the study at the individual patient level were: provision of free or subsidized services, provision of transport to treating health facilities and provision of accommodation to patients undergoing treatment. At the societal level, the sub-themes were: strengthening of health education in communities and training of health workers and community engagement. Salient sub-themes from the national health system level were: establishment of more screening and treatment health facilities, increasing the capacities of existing facilities, decentralization of some services, building of multidisciplinary teams of health workers, development and rolling out of standardized guidelines and reformation of Acquired Immunodeficiency Virus (AIDS) levy into a fund that would finance priority disease areas.

Conclusion

This study revealed some noteworthy strategies to improve access to cervical cancer treatment and care in low-income settings. Improved domestic investments in health systems and reforming health policies underpinned on strong political are recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01322-4.

Breast cancer in Colombia: a growing challenge for the healthcare system

AIM

To provide a comprehensive overview of breast cancer in Colombia.

METHODS

Data on breast cancer in Colombia are scarce. We present incidence data from population-based cancer registries that represent 4 distinct regions of the country. Other data originate from non-governmental institutions and healthcare providers within Colombia, official sources, expert opinion, Colombian legislation, and the Cancer Mortality Atlas publishes by Colombian National Cancer Institute.

RESULTS

In Colombia, the age-standardized incidence rate remained relatively stable between 2012 and 2020 (43.1 to 47.8 cases per 100,000 women-years); Additionally, survival since 1995 has presented a substantial improvement from 65.7 to 72.1. In 33% of cases, the diagnosis of breast cancer was made in advanced stages, stage III or higher. The health demography survey conducted in 2015 showed that the participation in mammography screening in women aged 40 to 69 remains low 48.1%. Some limitations regarding access to early detection and diagnosis include economic strata, health insurance coverage, origin, and accessibility. On average, a 90-day period was reported from onset of symptoms to diagnosis of breast cancer.

CONCLUSION

The first action towards improving outcomes in breast cancer should be to improve stage at diagnosis and timely access to care.

Impact of COVID-19 pandemic on oral health procedures provided by the Brazilian public health system: COVID-19 and oral health in Brazil

Objective

The objective of this study was to assess the number of dental procedures performed in the Brazilian Public Health System (SUS) during the first wave of COVID-19 in Brazil (1^st semester of 2020) and compare it with the same period of 2019.

Methods

A retrospective study was conducted based on the SUS Dataset (DATASUS). Descriptive analysis of the number of dental procedures and socio-demographic regions was presented and the number of dental procedures during the first semester of 2020 was compared to 2019, using Wilcoxon Signed Rank Test (α = 0.05). The number of COVID-19 confirmed cases and deaths were also retrieved from DATASUS.

Results

Dental procedures decreased from 47 million in the first semester of 2019 to 15 million in 2020, representing an overall decrease of about 66%. Statistically significant differences were observed for the numbers of procedures regarding preventive actions related to oral health (-84.53%; p < 0.001), primary care (-60.69%; p < 0.001), endodontic specialized care (-52.50%; p < 0.001), and periodontal and oral surgery specialized care (-54.57%; p < 0.001).

Conclusion

The COVID-19 pandemic also reduced by half the number of oral health procedures provided by the SUS in almost all Brazilian states regardless of whether these states had a large number of confirmed cases or deaths. Future policies are recommended in order to reduce the negative impact of the suspension of dental services on the oral health of the population.

Responsibility for chemical exposures: perspectives from small beauty salons and auto shops in southern metropolitan Tucson

Background

Throughout the United States, low-wage, minority workers are disproportionately affected by occupational illnesses and injuries. Chronic exposure to hazardous chemicals at work can lead to serious illnesses, contributing to health inequities. In this article, we expand on theories of ‘responsibilization’ in an occupational health context to reveal how responsibilities for workplace chemical exposures are negotiated by workers and owners in Latinx-owned small businesses.

Methods

We conducted semi-structured interviews with a total of 22 workers and owners in auto repair shops and beauty salons – two high-risk industries – in Southern Metropolitan Tucson. Participants were asked about their insights into workplace chemical exposures and health. A qualitative analysis team with representation from all study partner organizations collectively coded and reviewed the interview data in QSR International’s NVivo 11 and identified overarching themes across the interviews.

Results

We identified three primary themes: 1) ambivalence toward risks in the workplace; 2) shifting responsibilities for exposure protection at work; and 3) reflections on the system behind chemical exposure risks. Participants discussed the complexities that small businesses face in reducing chemical exposures.

Conclusions

Through our analysis of the interviews, we examine how neoliberal occupational and environmental policies funnel responsibility for controlling chemical exposures down to individuals in small businesses with limited resources, obscuring the power structures that maintain environmental health injustices. We conclude with a call for upstream policy changes that more effectively regulate and hold accountable the manufacturers of chemical products used daily by small business workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10336-4.

Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries

PURPOSE

The United Nations (UN) has published a Policy Brief on the impact of the Coronavirus Disease 2019 (COVID-19) that identifies policies and responses to protect older adults. Our objective was to summarize actions, health policies and clinical guidelines adopted by six European countries (Belgium, France, Italy, Poland, Spain and United Kingdom) during the pandemic, and to assess the impact of national policies on reducing adverse effects of the COVID-19 pandemic in older populations.

METHODS

Reports by geriatricians on the measures and actions undertaken by governmental institutions in each country between March and July 2020, as well as the role of primary care during the pandemic, covered three areas: (a) general health strategies related to the pandemic; (b) impact of COVID-19 on health inequity; and (c) initiatives and challenges for the COVID-19 pandemic and beyond.

RESULTS

In the six countries, COVID-19 mortality in nursing homes ranged from 26 to 66%. Although all countries endorsed the World Health Organization general recommendations, the reports identified the lack of harmonized European guidelines and policies for nursing homes, with competencies transferred to national (or regional) governments. All countries restricted visits in nursing homes, but no specific action plans were provided. The role of primary care was limited by the centralization of the crisis in hospital settings.

CONCLUSIONS

The older population has been greatly affected by COVID-19 and by the policies initiated to control its spread. The right to health and dignity are transgenerational; chronological age should not be the sole criterion in policy decisions.

Not the Time to Take Chances! Why African Governments' Response to COVID 19 Matters

Since independence, African governments have been criticized for either their slow, ineffective, or lack of homegrown solutions when addressing challenges in their respective countries. From economic and development models to dealing with conflicts, governance practices, and planning, overreliance and dependence on external practices which sometimes fail to take into consideration the unique domestic challenges have characterized the response of many African governments. This has, in turn, tainted the image of the continent over their ability to adequately deal with disasters. As the rest of the world is struggling to deal with their share of challenges as a result of the pandemic, it is becoming increasingly important that every country adopts measures that will effectively deal with the spread of the disease. This essay seeks to step back from the seemingly crowded debate over where the next epicentre of COVID 19 will be in Africa and focus on what lessons and measures governments in Africa can adopt during and after the pandemic.

Oral rehydration therapies in Senegal, Mali, and Sierra Leone: a spatial analysis of changes over time and implications for policy

BACKGROUND

Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes.

METHODS

We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access.

RESULTS

We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children.

CONCLUSIONS

Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.

Prevalence of long-term disability in Portugal, 2014: Evidence of variation by personal and contextual factors

BACKGROUND

Disability is not just a health problem. It is a wider phenomenon that reflects the gap between a person's capacities and their ability to fully perform the role demanded by society. Both personal and environmental factors are major contributors to disability.

OBJECTIVE

We aimed to estimate the prevalence of self-reported disability, overall and by sex, and associated factors in the Portuguese population in 2014.

METHODS

This was a cross sectional study based on data from the Portuguese National Health Interview Survey (2014) (n = 18,204). Long-term disability was evaluated based on the respondent reporting reasons for current disability lasting more than 6 months. Sex, age group, region, marital status, self-rated health, having or not health insurance, educational level, income, tobacco and alcohol consumption, physical activity and body mass index were considered as independent variables. A poisson model was performed to identify factors associated with disability.

RESULTS

Approximately 40% of the respondents reported having some long-term disability. Disability prevalence was higher in women than men (44.4% and 34.2%, respectively). Results showed age, region, education, self-rated health, physical activity and body mass index were associated with disability (p < 0.05).

CONCLUSIONS

This study shows that along with personal factors, the context plays an important role in disability. We believe this piece of evidence emphasizes the factor context namely the region, when decision makers design disability related policies.

Harm Reduction Policies Where Drugs Constitute a Security Issue

There is strong evidence suggesting that harm reduction policies are able to reduce the adverse health and social consequences of drug use. However, in this article I will compare two different countries to demonstrate that some social aspects lead to the adoption or rejection of harm reduction policies. In this case, countries where drugs are seen as a security concern are less likely to adopt these harm reduction policies. For that purpose, I will compare Colombia and Uruguay's political, normative, and social aspects, which are considered drivers in the adoption of harm reduction policies, as well as how those factors influence the treatments available for substance abuse disorders.

Avoiding the Banality of Evil in Times of COVID-19: Thinking Differently with a Biopsychosocial Perspective for Future Health and Social Policies Development

The COVID-19 pandemic provides the opportunity to re-think health policies and health systems approaches by the adoption of a biopsychosocial perspective, thus acting on environmental factors so as to increase facilitators and diminish barriers. Specifically, vulnerable people should not face discrimination because of their vulnerability in the allocation of care or life-sustaining treatments. Adoption of biopsychosocial model helps to identify key elements where to act to diminish effects of the pandemics. The pandemic showed us that barriers in health care organization affect mostly those that are vulnerable and can suffer discrimination not because of severity of diseases but just because of their vulnerability, be this age or disability and this can be avoided by biopsychosocial planning in health and social policies. It is possible to avoid the banality of evil, intended as lack of thinking on what we do when we do, by using the emergence of the emergency of COVID-19 as a Trojan horse to achieve some of the sustainable development goals such as universal health coverage and equity in access, thus acting on environmental factors is the key for global health improvement.

The ethics of AI in health care: A mapping review

This article presents a mapping review of the literature concerning the ethics of artificial intelligence (AI) in health care. The goal of this review is to summarise current debates and identify open questions for future research. Five literature databases were searched to support the following research question: how can the primary ethical risks presented by AI-health be categorised, and what issues must policymakers, regulators and developers consider in order to be 'ethically mindful? A series of screening stages were carried out-for example, removing articles that focused on digital health in general (e.g. data sharing, data access, data privacy, surveillance/nudging, consent, ownership of health data, evidence of efficacy)-yielding a total of 156 papers that were included in the review. We find that ethical issues can be (a) epistemic, related to misguided, inconclusive or inscrutable evidence; (b) normative, related to unfair outcomes and transformative effectives; or (c) related to traceability. We further find that these ethical issues arise at six levels of abstraction: individual, interpersonal, group, institutional, and societal or sectoral. Finally, we outline a number of considerations for policymakers and regulators, mapping these to existing literature, and categorising each as epistemic, normative or traceability-related and at the relevant level of abstraction. Our goal is to inform policymakers, regulators and developers of what they must consider if they are to enable health and care systems to capitalise on the dual advantage of ethical AI; maximising the opportunities to cut costs, improve care, and improve the efficiency of health and care systems, whilst proactively avoiding the potential harms. We argue that if action is not swiftly taken in this regard, a new 'AI winter' could occur due to chilling effects related to a loss of public trust in the benefits of AI for health care.

Impact on mortality after implementation of a network for ST-segment elevation myocardial infarction care. The IPHENAMIC study

INTRODUCTION AND OBJECTIVES

Little is known about the impact of networks for ST-segment elevation myocardial infarction (STEMI) care on the population. The objective of this study was to determine whether the PROGALIAM (Programa Gallego de Atención al Infarto Agudo de Miocardio) improved survival in northern Galicia.

METHODS

We collected all events coded as STEMI between 2001 and 2013. A total of 6783 patients were identified and divided into 2 groups: pre-PROGALIAM (2001-2005), with 2878 patients, and PROGALIAM (2006-2013), with 3905 patients.

RESULTS

In the pre-PROGALIAM period, 5-year adjusted mortality was higher both in the total population (HR, 1.22, 95%CI, 1.14-1.29; P <.001) and in each area (A Coruña: HR, 1.12; 95%CI, 1.02-1.23; P=.02; Lugo: HR, 1.34; 95%CI, 1.2-1.49; P <.001 and Ferrol: HR, 1.23; 95%CI, 1.1-1.4; P=.001). Before PROGALIAM, 5-year adjusted mortality was higher in the areas of Lugo (HR, 1.25; 95%CI, 1.05-1.49; P=.02) and Ferrol (HR, 1.32; 95%CI, 1.13-1.55; P=.001) than in A Coruña. These differences disappeared after the creation of the STEMI network (Lugo vs A Coruña: HR, 0.88; 95%CI, 0.72-1.06; P=.18, Ferrol vs A Coruña: HR, 1.04; 95%CI, 0.89-1.22; P=.58.

CONCLUSIONS

For patients with STEMI, the creation of PROGALIAM in northern Galicia decreased mortality and increased equity in terms of survival both overall and in each of the areas where it was implemented. This study was registered at ClinicalTrials.gov (Identifier: NCT02501070).

[Framing of childhood obesity in Spanish lay press]

OBJECTIVE

To explore the frame, individual or collective, of childhood obesity in the main Spanish lay media.

METHOD

Analysis of a convenience sample of 132 publications regarding childhood obesity (August 2016-September 2018). Descriptive analysis about approach, measures and causes of obesity and food industry influence in the development of the publication.

RESULTS

47% of the publications presented an individual approach. 54% included eating and physical activity as cause. 29% of the measures propose a healthy environment and 27% individual recommendations. Individual frame was present in 77% of the news influenced by the industry.

CONCLUSION

Publications on childhood obesity of the main Spanish lay press reveal a predominance of the individual approach to the problem. This majority perception may condition the development and implementation of public health policies or interventions.

Regionalization of congenital heart disease care: A pending goal

Congenital heart diseases (CHDs) are considered the most frequent malformations. In Mexico, every year between 12 and 16 thousand children are born with some type of CHD and it is the second cause of mortality in children under 1 year of age and in children aged between 1 and 4 years. The problem of the care of CHDs is analyzed from a perspective of health policies in the country with an emphasis on regionalizing their care to rationalize the use of available resources and with the aim of serving the largest number of patients and achieve the best clinical results. It emphasizes the need to promote cooperation among the different civil society organizations and institutions to exchange ideas to create consensus and joint projects for a better use of available resources to achieve universal and quality care of children with CHD in all the country.

Cesarean or Cesarean Epidemic?

Due to advances in surgical procedure, anesthesia techniques, blood transfusion and antibiotic therapy, the technique of cesarean section has been progressing over the time. However, cesarean section is still a risk-specific operation, with long-term and shortterm consequences for the mother and neonate. The rate of cesarean surgery is constantly growing due to both justifiable and nonjustifiable medical and non-medical reasons. There is evidence indicating that efforts are made in many countries to reduce the rate of cesarean delivery. In this review article, we try to assess the frequency of cesarean section in different countries, especially Iran. We searched several keywords, including cesarean section prevalence, cesarean section rate, world, delivery, Iran and health policies within the newest articles published in Google Scholar, PubMed, and ISI/Web of Sciences, as well as Iranian databases (Magiran, SID), from January 2017 to April 2019. The results show that there is still a high prevalence of C-section. In Iran, the highest rate of cesarean was in Tehran province (62.1%-72.1%) and the lowest was in Sistan and Baluchestan province (12%). It appears necessary to plan for effective interventions in terms of painless vaginal delivery, improving the quality of vaginal delivery services, proper culture and education.

Cancer care in Brazil: structure and geographical distribution

Background

The organisation and systematisation of health actions and services are essential to ensure patient safety and the effectiveness and efficiency of cancer care. The objective of this study was to analyse the structure of cancer care envisaged in Brazilian norms, describe the types of accreditations of cancer services and their geographic distribution, and determine the planning and evaluation parameters used to qualify the health units that provide cancer care in Brazil.

Methods

This observational study identified the current organisation of cancer care and other health services that are accredited by Brazil’s national health system (SUS) for cancer treatment as of February 2017. The following information was collected from the current norms and the National Registry of Health Establishments: geographic location, type of accreditation, type of care, and hospital classification according to annual data of the number of cancer surgeries. The adequacy of the number of licensed units relative to population size was assessed. The analysis considered the facilitative or restrictive nature of policies based on the available rules and resources.

Results

The analysis of the norms indicated that these documents serve as structuring rules and resources for developing and implementing cancer care policies in Brazil. A total of 299 high-complexity oncology services were identified in facilities located in 173 (3.1%) municipalities. In some states, there were no authorised services in radiotherapy, paediatric oncology and/or haematology-oncology. There was a significant deficit in accredited oncology services.

Conclusions

The parameters that have been used to assess the need for accredited cancer services in Brazil are widely questioned because the best basis of calculation is the incidence of cancer or disease burden rather than population size. The results indicate that the availability of cancer services is insufficient and the organisation of the cancer care network needs to be improved in Brazil.

[Understanding the China Blue Paper on Obesity Prevention and Control and policy implications and recommendations for obesity prevention and control in China]

With the rapid economic development and dramatic changes in lifestyle, the prevalence of overweight and obesity in China has been increasing significantly and become a serious public health threat. This article introduced the main contents of "China Blue Paper on Obesity Prevention and Control", aiming to facilitate understanding and applications of the "China Blue Paper on Obesity Prevention and Control" by policymakers, researchers and practitioners in related fields. Built upon these, recommendations were made for obesity screening, diagnosis, treatment and management, prevention and control policies and strategies, and future research priorities in China.

Moving upstream: Changing policy scripts on migrant and ethnic minority health

This article uses the concept of 'policy scripts' to explore the aims and assumptions underlying policies on migrant and ethnic minority health. Firstly, it analyses the shift in health policies from 'downstream' approaches (emphasising health care for the sick and injured) to 'upstream' ones (emphasising health protection for the whole population). The field of migrant health has been relatively slow to move upstream. Two factors appear to have impeded this shift: (a) the reluctance of the 'social determinants of health' movement to regard migrant status and ethnicity as important causes of health inequities; and (b) the one-sided emphasis on short-term emergency health provisions for migrants arising from the recent increase in forced migration worldwide, in particular the sudden peak in mixed migration to the EU in 2015. The article contends that (a) the usual arguments against treating migration and ethnicity as health determinants do not stand up to critical examination; and (b) the overwhelming emphasis on unauthorised entrants which characterises current discussions of migration policy, including health, is out of all proportion to their volume relative to that of other migrants. Fortunately, recent policy initiatives at UN level have the potential to restore the balance between 'upstream' and 'downstream' approaches, as well as between unauthorised entry and 'routine' migration.

Facility readiness in low and middle-income countries to address care of high risk/ small and sick newborns

Background

The successful promotion of facility births in low and middle-income countries has not always resulted in improved neonatal outcome. We evaluated key signal functions pertinent to Level II neonatal care to determine facility readiness to care for high risk/ small and sick newborns.

Method

Facility readiness for care of high risk/ small and sick babies was determined through self-evaluation using a pre-designed checklist to determine key signal functions pertinent to Level II neonatal care in selected referral hospitals in Uganda (10), Indonesia (4) and India (2) with focus on the Sub-Saharan country with greater challenges.

Results

Most facilities reported having continuous water supply, resources for hand hygiene and waste disposal. Delivery rooms had newborn corners for basic neonatal resuscitation, but few practiced proper reprocessing of resuscitation equipment. Birth weight records were not consistently maintained in the Ugandan hospitals. In facilities with records of birth weights, more than half (51.7%) of newborns admitted to the neonatal units weighed 2500 g or more. Neonatal mortality rates ranged from 1.5 to 22.5%. Evaluation of stillbirths and numbers of babies discharged against medical advice gave a more comprehensive idea of outcome. Kangaroo Mother Care was practiced to varying extents. Incubators were more common in Africa while radiant warmers were preferred in Indian hospitals. Tube feeding was practiced in all and cup feeding in most, with use of human milk at all sites. There were proportionately more certified pediatricians and nurses in Indonesia and India. There was considerable shortage of nursing staff, (worst nurse –bed ratio ranging from 1 to 15 in the day shift, and 1 to 30 at night). There was significant variability in facility readiness, as in data maintenance, availability of commodities such as linen, air -oxygen blenders and infusion pumps and of infection prevention practices.

Conclusions

Referral neonatal units in LMIC have challenges in meeting even the basic level II requirements, with significant variability in equipment, staffing and selected care practices. Facility readiness has to improve in concert with increased facility births of high risk newborns in order to have an impact on neonatal outcome, and on achieving Sustainable Development Goals 3.2.2.

Electronic supplementary material

The online version of this article (10.1186/s40748-019-0105-9) contains supplementary material, which is available to authorized users.

Introduction of new vaccines for immunization in pregnancy - Programmatic, regulatory, safety and ethical considerations

Immunizing pregnant women is a promising strategy to reduce infectious disease-related morbidity and mortality in pregnant women and their infants. Important pre-requisites for the successful introduction of new vaccines for immunization in pregnancy include political commitment and adequate financial resources: trained, committed and sufficient numbers of healthcare workers to deliver the vaccines; close integration of immunization programs with antenatal care and Maternal and Child Health services; adequate access to antenatal care by pregnant women in the country (especially in low and middle-income countries (LMIC)); and a high proportion of births occurring in health facilities (to ensure maternal and neonatal follow-up can be done). The framework needed to advance a vaccine program from product licensure to successful country-level implementation includes establishing and organizing evidence for anticipated vaccine program impact, developing supportive policies, and translating policies into local action. International and national coordination efforts, proactive planning from conception to implementation of the programs (including country-level policy making, planning, and implementation, regulatory guidance, pharmacovigilance) and country-specific and cultural factors must be taken into account during the vaccines introduction.

[Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain)]

OBJECTIVE

To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used.

METHOD

The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater.

RESULTS

176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72).

CONCLUSIONS

This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.