Public health issues in the 21st century: National challenges and shared challenges for the Maghreb countries

In the 21st century, public health is not only about fighting infectious diseases, but also contributing to a "multidimensional" well-being of people (health promotion, non-communicable diseases, the role of citizens and people in the health system etc.). Six themes of public health, issues of the 21st century will be addressed. Climate change is already aggravating already existing health risks, heat waves, natural disasters, recrudescence of infectious diseases. Big data is the collection and management of databases characterized by a large volume, a wide variety of data types from various sources and a high speed of generation. Big data permits a better prevention and management of disease in patients, the development of diagnostic support systems and the personalization of treatments. Big data raises important ethical questions. Health literacy includes the abilities of people to assess and critique and appropriate health information. Implementing actions to achieve higher levels of health literacy in populations remains a crucial issue. Since the 2000s, migration flows of health professionals have increased mainly in the "south-north" direction. India is the country with the most doctors outside its borders. The USA and the UK receive 80% of foreign doctors worldwide. Ways have been identified to try to regulate the migratory phenomena of health professionals around the world. The mobilization of citizen, health system users and patient associations is a strong societal characteristic over the last 30 years. In a near future, phenomena will combine to increase the need for accompaniment of patient or citizen to protect health, such increase of the prevalence of chronic diseases, reinforcement of care trajectories, medico-social care pathways, and importance of health determinants. Interventional research in public health is very recent. It is based on experimentation and on the capitalization of field innovations and uses a wide range of scientific disciplines, methods and tools. It is an interesting tool in the arsenal of public health research. It is essential today to be able to identify the multiple challenges that health systems will face in the coming years, to anticipate changes, and to explore possible futures.

Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications

Purpose. In this policy brief, we assess variation in Medicare’s star quality ratings of Medicare Advantage (MA) plans that are available to rural beneficiaries. Evidence from the recent Centers for Medicare & Medicaid Services (CMS) quality demonstration suggests that market dynamics, i.e., firms entering and exiting the MA marketplace, play a role in quality improvement. Therefore, we also discuss how market dynamics may impact the smaller and less wealthy populations that are characteristic of rural places. Key Data Findings. (1) Highly rated MA plans serving rural Medicare beneficiaries are more likely to be health maintenance organizations (HMOs) and local preferred provider organizations (PPOs), as opposed to regional PPOs. HMOs and local PPOs may be better able to improve their quality scores strategically in response to the bonus payment incentive due to existing internal monitoring mechanisms. (2) On average, the rural enrollment rate is lower in plans with higher quality scores (59 percent) than the corresponding urban rate (71 percent). This differential is likely due, in part, to lack of availability of highly rated plans in rural areas: 17.8 percent of rural counties lacked access to a plan with four or more (out of five) stars, while just 3.7 percent of urban counties lacked such access. (3) MA plans with high quality scores have been operating longer, on average, and have a lower percentage of rural counties within their contract service areas than plans with lower quality scores.

Examining mortality risk and rate of ageing among Polish Olympic athletes: a survival follow-up from 1924 to 2012

OBJECTIVES

Population-based studies have shown that an active lifestyle reduces mortality risk. Therefore, it has been a longstanding belief that individuals who engage in frequent exercise will experience a slower rate of ageing. It is uncertain whether this widely-accepted assumption holds for intense wear-and-tear. Here, using the 88 years survival follow-up data of Polish Olympic athletes, we report for the first time on whether frequent exercise alters the rate of ageing.

DESIGN

Longitudinal survival data of male elite Polish athletes who participated in the Olympic Games from year 1924 to 2010 were used. Deaths occurring before the end of World War II were excluded for reliable estimates.

SETTING AND PARTICIPANTS

Recruited male elite athletes N=1273 were preassigned to two categorical birth cohorts--Cohort I 1890-1919; Cohort II 1920-1959--and a parametric frailty survival analysis was conducted. An event-history analysis was also conducted to adjust for medical improvements from year 1920 onwards: Cohort II.

RESULTS

Our findings suggest (1) in Cohort I, for every threefold reduction in mortality risk, the rate of ageing decelerates by 1%; (2) socioeconomic transitions and interventions contribute to a reduction in mortality risk of 29% for the general population and 50% for Olympic athletes; (3) an optimum benefit gained for reducing the rate of ageing from competitive sports (Cohort I 0.086 (95% CI 0.047 to 0.157) and Cohort II 0.085 (95% CI 0.050 to 0.144)).

CONCLUSIONS

This study further suggests that intensive physical training during youth should be considered as a factor to improve ageing and mortality risk parameters.

The red zone

This simple quality initiative won the best innovation in clinical practice at the recent CEO healthcare awards gala event in the North West of Ireland. It demonstrated how a simple collaborative idea led to improving the quality and safety of care in the operating room. As practitioners we have a huge contribution to make in providing quality and safe care to our patients. It is crucial that we share knowledge and have our input recognised.

Alice Magaw: a model for evidence-based practice

The model of evidence-based practice (EBP) of Alice Magaw places the practice of nurse anesthesia as an early pioneer in patient safety and is prophetic to the aims of the Institute of Medicine (IOM). In its 2001 report, Crossing the Quality Chasm, the IOM identified 6 aims essential to improving the delivery of care. These aims include safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Magaw used her vast expertise in anesthetic administration to develop protocols and a body of knowledge that could be used as a template for practitioners near and far. This early use of EBP principles places nurse anesthesia at the forefront of the model and the movement to provide high-quality care. Practitioners sought her practice model out as she demonstrated her techniques to visiting providers as well as through her published ideal anesthetics in the literature. She wrote, "Pioneers are noted for building upon a body of knowledge, establishing a model for continuous improvement, and exemplifying notable methods of research with subsequent documentation of their findings." Magaw exemplified the EBP model.

The Health Quality and Safety Commission: making good health care better

New Zealand has one of the best value health care systems in the world, but as a proportion of GDP our spending on health care has increased every year since 1999. Further, there are issues of quality and safety in our system we must address, including rates of adverse events. The Health Quality and Safety Commission was formed in 2010 as a crown agent to influence, encourage, guide and support improvement in health care practice in New Zealand. The New Zealand Triple Aim has been defined as: improved quality, safety and experience of care; improved health and equity for all populations; and best value for public health system resources. The Commission is pursuing the Triple Aim via two fundamental objectives: doing the right thing by providing care supported by the best evidence available, focused on what matters to each individual patient, and doing the right thing right, first time, by making sure health care is safe and of the highest quality possible. Improvement efforts must be supported by robust but economical measurements. New Zealand has a strong culture of quality, so the Commission's role is to work with our colleagues to make good health care better.

The attempt on the life of Reinhard Heydrich, architect of the "final solution": a review of his treatment and autopsy

Reinhard Heydrich, architect of the "Final solution of the Jewish problem," had a meteoric career in the SS. He organized the Wannsee Conference and created the SS killing squads. Under his leadership as Acting Reich Protector of Bohemia and Moravia, the suppression of the Czech community was brutal. An attempt on his life in Prague was unsuccessful but it left him severely injured and he died eight days later. Reviewing the available information on his hospital treatment and the autopsy report, it is suggested that Heydrich received substandard medical treatment, quite likely a result of political interference from rival members of the SS hierarchy.

[The prison of Jerez de los Caballeros (Badajoz) in the 19th century]

This article considers the situation of prisoners in Spanish jails, taking the circumstances of the inmates at the prison of Jerez de los Caballeros as a particular example. Documents from the Jerez Municipal Historical Archives were studied along with other contemporary and more current publications. The results show that the conditions of the buildings bordered on the ruinous, the facilities were in poor condition or unavailable and health and hygiene were practically inhumane. Pathologies of the prisoners posed a threat to the general population, as there was the risk of outbreaks of epidemics, but almost nothing is known about them. Efforts by the authorities to remedy structural problems and health problems were few and mostly ineffective due to due to economic difficulties. Medical assistance was provided by local doctors in exchange for a fee.

The politics of presidential medical care. The case of John F. Kennedy

Political concerns often compromise the delivery of high quality medical care in ways that can be both problematic and dangerous for political leaders. President John F. Kennedy's medical care offers a particularly rich exposition of the many ways in which these dynamics can play out and how additional factors can complicate matters, such as when the patient is himself duplicitous, when family members try to intervene in care, and when public exposure risks political future. This article examines the politics and management of Kennedy's medical conditions by the various physicians involved in his care and explores how these considerations may have compromised not only the quality of his care but, in turn, exerted an influence on his behavior. This happened not only through the downstream effect of his treatment on his thoughts and behavior but also through the tremendous allocation of time and attention that his care required--attention a healthier man would have been able to direct toward problems of greater national concern.

[Limited access to the international medical literature in Russia]

Limited access to foreign professional literature in the former Soviet Union had consequences for public health: persistence of some outdated methods and approaches. Several examples are discussed in this letter. The shortage of foreign literature has been partly compensated by domestic editions, sometimes containing compilations from foreign sources, borrowings without references, and mistranslations. International literature is on average scarcely quoted in Russian language scientific publications. Today, however, there are grounds for optimism: the economic upturn must bring improvements.

Questions and answers: Some questions discussed at one of the round tables held at Chicago Institute with public health nurses

There were a number of issues confronting public health nurses in 1919, including the differentiation of practice between visiting nurses and public health nurses, use of community partnerships when developing a new nursing service in a community, and standards of nursing work. Other issues included the focus of nursing work at the community/population versus individual level, how to balance the work load where there was only one nurse in a community, and educating the public about the value of public health nursing to the community. In this excerpt from the original publication, Ella Phillips Crandall responded to questions raised at a round table session held in Chicago in 1919 as a part of a Public Health Nursing Forum, and then published in the October 1919 issue of The Public Health Nurse. While the social context in which PHNs worked in 1919 were significantly different from those nurses face today, these insights are prescient to the issues faced by PHNs today as the profession continues to address issues related to standards of practice, role development, and educational preparation for both entry level and advanced practice.

A ten-year history: the Cancer Quality Council of Ontario

One of the longest-established quality oversight organizations in Canadian healthcare, the Cancer Quality Council of Ontario (CQCO) is an advisory group formed in 2002 by the Ministry of Health and Long-Term Care. Although quasi-independent from Cancer Care Ontario (CCO), the council was established to provide advice to CCO and the ministry in their efforts to improve the quality of cancer care in the province. The council is composed of a multidisciplinary group of healthcare providers, cancer survivors and experts in the areas of oncology, health system policy and administration, governance, performance measurement and health services research. Its mandate is to monitor and report publicly on the performance of the Ontario cancer system and to motivate improvement through national and international benchmarking. Since its formation, the council has played an evolving role in improving the quality of care received by Ontario cancer patients. This article will briefly describe the origins and founding principles of the CQCO, its changing role in monitoring quality and its relationship with CCO.

How costly is hospital quality? A revealed-preference approach

We analyze the cost of quality improvement in hospitals, dealing with two challenges. Hospital quality is multidimensional and hard to measure, while unobserved productivity may influence quality supply. We infer the quality of hospitals in Los Angeles from patient choices. We then incorporate ‘revealed quality’ into a cost function, instrumenting with hospital demand. We find that revealed quality differentiates hospitals, but is not strongly correlated with clinical quality. Revealed quality is quite costly, and tends to increase with hospital productivity. Thus, non-clinical aspects of the hospital experience (perhaps including patient amenities) play important roles in hospital demand, competition, and costs.

"In the last stages of irremediable disease": American hospitals and dying patients before World War II

After a brief discussion of early- and mid-nineteenth-century hospitals, this article focuses on the years between 1880 and 1939, when those facilities underwent a major transformation and the proportion of hospital deaths steadily increased. During both periods, private hospitals refused admission to many seriously ill people and discharged others when death approached. City hospitals dumped poor patients with advanced disease on chronic care facilities and especially on almshouses. With each transfer, the quality of care sharply declined. And trips from one institution to another often inflicted additional suffering; some accelerated death.

The role of hospital heterogeneity in measuring marginal returns to medical care: a reply to Barreca, Guldi, Lindo, and Waddell

In Almond et al. (2010), we describe how marginal returns to medical care can be estimated by comparing patients on either side of diagnostic thresholds. Our application examines at-risk newborns near the very low birth weight threshold at 1500 g. We estimate large discontinuities in medical care and mortality at this threshold, with effects concentrated at “low-quality” hospitals. Although our preferred estimates retain newborns near the threshold, when they are excluded the estimated marginal returns decline, although they remain large. In low-quality hospitals, our estimates are similar in magnitude regardless of whether these newborns are included or excluded.

History of Midwifery in New Mexico: Partnership Between Curandera-parteras and the New Mexico Department of Health

Curandera-parteras (traditional Hispanic midwives) have been in northern New Mexico since before its statehood. In the 1930s, the New Mexico Department of Health began a valuable relationship with the curandera-parteras through the Midwife Consultant Program. This article describes the relationship between the curandera-parteras and the New Mexico Department of Health originating in the 1920s. The amenable and effective working relationship achieved between curandera-parteras and public health during this time period helped create the positive support for midwifery that is apparent in New Mexico today.

Supplier behaviour and public contracting in the English agency nursing market

The worldwide expansion in the use of private firms to deliver public services and infrastructure has promoted a substantial literature on public sector contract and relationship management. This literature is currently dominated by the notion that supplier relationships should be based upon trust. Less prominent are more sceptical approaches that emphasize the need to assiduously manage potential supplier exploitation and opportunism. This article addresses this imbalance by focusing upon the recent experience of the English National Health Service (NHS) in its dealings with its nursing agencies. Between 1997 and 2001, the NHS was subjected to considerable exploitation and opportunism. This forced managers to adopt a supply strategy based upon an assiduous use of e-auctions, framework agreements and quality audits. The article assesses the effectiveness of this strategy and reflects upon whether a more defensive approach to contract and relationship management offers a viable alternative to one based upon trust.

Quality of health care in the United States: implications for pediatric inflammatory bowel disease

The Institute of Medicine's publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in US health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease (IBD).This review is intended to be a primer on the quality of care movement in the United States, with a focus on pediatric IBD. In this article, we review the history, rationale, and methods of quality measurement and improvement, and we discuss the unique challenges in adapting these general strategies to pediatric IBD care.

Accreditation for cardiovascular imaging: setting quality standards for patient care

The accreditation of laboratories performing noninvasive cardiac procedures is now routinely available and often required by insurance companies. In this article, the history of the accreditation for cardiac procedures is reviewed, the process explained, and the number of accredited laboratories listed. Decision pathways are listed, and common reasons for a laboratory being delayed in approval are described specific for the various modalities. Some of the common compliments and concerns received by the Intersocietal Accreditation Commission are described.

[Practice guidelines and accreditation: highlights from 50 years of quality management by the Dutch College of General Practitioners]

The Dutch College of General Practitioners (NHG) was established 50 years ago in response to the threatened position of general practitioners in The Netherlands. The NHG promotes quality care in general practice by aiding in the translation of scientific evidence into daily practice. The NHG practice guidelines form the core of its quality improvement programme, which comprises a cohesive package of continuing educational materials that support adoption in daily practice. The NHG practice accreditation programme is a new method for measuring and improving practice quality. This programme provides the basis for granting stamps of quality to general practices.

Internal influences in the making of the English military hospital: the early-eighteenth-century Greenwich

This chapter uses records at the Royal Greenwich Hospital for ex-sailors to analyse the nature of care, and to uncover how the chronically disabled patients themselves experienced the hospital. Greenwich became a 'reverse' institution, in that the ex-servicemen were closely regulated and treated like unruly visitors, while only officers and medics had free movement and influence. Although initially the inner workings of the Hospital owed much to almshouse and shipboard models, over time medical considerations became paramount. Physicians and surgeons became involved actively in governance and discipline, promoting environmental and dietary changes.

[Organization of stomatological care in Russian army during first World War 1914-1917 y]

The article presents issues on organization of stomatological care in Russian army during First World War. The author showed reasons of low efficiency of the treatment of soldiers with maxillofacial region. Injuries beginning of a new stage in the treatment of maxillofacial region fire wounds and origin of a new specialty developed a military maxillofacial surgery.

Infectious disease in the blood supply and the public health response

The consistent improvements in hemophilia care seen in the years 1960 to 1980 halted when human immunodeficiency virus (HIV) appeared in the blood supply. In the early 1980s, before HIV virulence was fully understood, a complacent blood therapy industry and its regulators waffled on an appropriate response. As a result, the period between the appearance of HIV and its effective elimination from the blood supply was lengthy and many recipients of blood therapies became infected, with devastating impact on their quality of life, quality of care, and longevity. As the decade wore on, even as they began to better understand the threat, industry and public health officials continued to stall, in part because development of interventions was costly and cumbersome. In order to protect the safety of the blood supply and blood-derived therapies, it must be recognized that new pathogens will continue to emerge. Agencies' and companies' decision-making processes in this regard must therefore be proactive rather than reactive, and should preferably implement a formalized risk-management approach. The ongoing safety of blood therapies and the blood supply will also depend on continued vigilance and research. Finally, the hemophilia community must be allowed to play an active and educated role in their own care.