Mental health challenges are a severe issue that could lead to suicide if not properly addressed.South Africa has a significant burden of mental health issues,which contributes to the soaring rate of suicide.Adequate ...Mental health challenges are a severe issue that could lead to suicide if not properly addressed.South Africa has a significant burden of mental health issues,which contributes to the soaring rate of suicide.Adequate mental health-care provision could reduce the high suicide rate in South Africa.Since the apartheid regime,the country has made a series of efforts to improve mental health.This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications.This study adopted a narrative review approach.Electronic databases(PubMed,Scilit,Google Scholar and Semantic Scholar)were used to identify published articles in the English language with crucial search terms that included mental health,South African mental health policy,South Africa,suicide and policy.Literature suggests that at the provincial level,there are no adequate mental health policies,and the implementation of the country’s mental health policy is faced with many challenges,such as a shortage of professionals and finances.The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health.This study concludes that the mental health treatment gap still exists in South Africa,and this needs to be tackled using effective,multi-level counselling interventions and policy initiatives.Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.展开更多
Studies of interactions have gained an increasing importance in research related to healthcare.Most empirical studies have explored the dynamics of exchanges between patients and practitioners(Barry et al.,2001,Beach ...Studies of interactions have gained an increasing importance in research related to healthcare.Most empirical studies have explored the dynamics of exchanges between patients and practitioners(Barry et al.,2001,Beach et al.,2001).This study is devoted to the analysis of discussions in two forums to investigate how to develop what we call‘a rational empathy’so as to understand the attitudes and beliefs which constitute the basis of these opinions.展开更多
Objectives:People increasingly search for health information through the media and make decisions about their health based on these health stories.The mainstream media,including newspapers,are often the first source f...Objectives:People increasingly search for health information through the media and make decisions about their health based on these health stories.The mainstream media,including newspapers,are often the first source for the public to obtain health information.This study aims to assess the health stories reported in the health edition of People's Daily in 2019 with four tools of the Media Doctor Toolkit(MDT),which can be an effective tool to evaluate the quality of public health stories.Based on the results,we attempt to address the gap in media coverage in terms of reporting on public health issues,and promote media to display the image of medical staff objectively,both of which can improve relationship of doctors,nurses and patients.Methods:A prospective quantitative analysis of the quality of health stories reported in the health edition of People's Daily from 1 February to September 31,2019 was conducted.Forty-eight articles were collected and divided into four groups according to the MDT standards.Four rating tools were adapted from the MDT to assess the quality of the groups with corresponding criteria.Results:Forty-eight unique health stories were assessed with four MDT rating tools.The mean total satisfactory score was 80%.Health advice had the highest average satisfactory score,84%,compared with health policy group and public health problems and their solutions,at 80%and 77%,respectively.Health news group had the lowest score at 73%.Conclusion:This study provides a description of the quality of health stories on People's Daily.The overall quality of People's Daily was fairly good,although there was a wide range of quality between groups.The health edition of People's Daily covers a wide range of health topics such as new medical methods,doctorpatient relationship,advanced nursing practice,lifestyle change of health promotion etc.which promote excellence in providing the latest health information,representing medical staff image,resolve the disharmonious factors in the relationship between doctors and patients,and creating a good medical environment for the public.The findings of this study also provide insight into problems in health reporting of People's Daily.展开更多
The high burden of kidney disease,global disparities in kidney care,and poor outcomes of kidney failure bring a concomitant growing burden to persons affected,their families,and carers,and the community at large.Healt...The high burden of kidney disease,global disparities in kidney care,and poor outcomes of kidney failure bring a concomitant growing burden to persons affected,their families,and carers,and the community at large.Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find,understand,and use information and services to make informed health⁃related decisions and actions for themselves and others.Rather than viewing health literacy as a patient deficit,improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease.For kidney policy makers,health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care.The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders.Advances in telecommunication,including social media platforms,can be leveraged to enhance persons’and providers’education;The World Kidney Day declares 2022 as the year of“Kidney Health for All”to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy.Kidney organizations should work toward shifting the patient⁃deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers.By engaging in and supporting kidney health-centered policy making,community health planning,and health literacy approaches for all,the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.展开更多
Background Both population-level epidemiological data and individual-level biological data are needed to control the coronavirus disease 2019(COVID-19)pandemic.Population-level data are widely available and efforts to...Background Both population-level epidemiological data and individual-level biological data are needed to control the coronavirus disease 2019(COVID-19)pandemic.Population-level data are widely available and efforts to combat COVID-19 have generated proliferate data on the biology and immunoresponse to the causative pathogen,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).However,there remains a paucity of systemized data on this subject.Objective In this review,we attempt to extract systemized data on the biology and immuno-response to SARS-CoV-2 from the most up-to-date peer-reviewed studies.We will focus on the biology of the virus and immunological variations that are key for determining long-term immunity,transmission potential,and prognosis.Data Sources and Methods Peer-reviewed articles were sourced from the PubMed database and by snowballing search of selected publications.Search terms included:“Novel Coronavirus”OR“COVID-19”OR“SARS-CoV-2”OR“2019-nCoV”AND“Immunity”OR“Immune Response”OR“Antibody Response”OR“Immunologic Response”.Studies published from December 31,2019 to December 31,2020 were included.To ensure validity,papers in pre-print were excluded.Results Of 2889 identified papers,36 were included.Evidence from these studies suggests early seroconversion in patients infected with SARS-CoV-2.Antibody titers appear to markedly increase two weeks after infection,followed by a plateau.A more robust immune response is seen in patients with severe COVID-19 as opposed to mild or asymptomatic presentations.This trend persists with regard to the length of antibody maintenance.However,overall immunity appears to wane within two to three months post-infection.Conclusion Findings of this study indicate that immune responses to SARS-CoV-2 follow the general pattern of viral infection.Immunity generated through natural infection appears to be short,suggesting a need for long-term efforts to control the pandemic.Antibody testing will be essential to gauge the epidemic and inform decision-making on effective strategies for treatment and prevention.Further research is needed to illustrate immunoglobulin-specific roles and neutralizing antibody activity.展开更多
Background: Myanmar’s National Health Plan 2017-2021 set out concrete steps to strengthen the health system on the way to achieving the goal of universal health coverage by 2030. Ensuring these steps include the 7.7 ...Background: Myanmar’s National Health Plan 2017-2021 set out concrete steps to strengthen the health system on the way to achieving the goal of universal health coverage by 2030. Ensuring these steps include the 7.7 million older adults in Myanmar’s population by 2030 will require novel strategies that improve health and reduce financial burden of health expenditures. An examination of the relationship between social networks and selected health outcomes was undertaken to determine whether these networks can safeguard older adults’ continued contributions to family, society and their own health. Methods: Secondary analysis of a nationally representative study of adults aged 60 years and older. Ordered logistic regression analyses with weighted data were used to examine the relationship between a social network variable and a number of health outcomes. Findings: Stronger social networks were associated with better health outcomes like better memory (OR 1.2), lower reported walking difficulties (OR 0.58), better self-reported health (R 1.15). People with higher social ties were also more like to receive regular assistance and provide care for other household members. Interpretation: Social networks play a role in mediating health outcomes and interactions with the health care systems. Social network interventions should be explored as part of policy mechanisms to ensure universal health coverage for older adults in Myanmar.展开更多
BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department(ED) utilization for mental health purposes. We aimed to study the race specifi c association between the dependent...BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department(ED) utilization for mental health purposes. We aimed to study the race specifi c association between the dependent coverage provision of the Affordable Care Act(ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses.METHODS: We utilized a Quasi-Experimental analysis of ED use in California from 2009–2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-indifferences approach comparing those targeted by the ACA dependent provision(19–25 years) and those who were not(27 to 31 years), evaluating changes in ED visit rates per 1 000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and gender.RESULTS: The ACA dependent provision was associated with 0.05 per 1 000 people fewer psychiatric ED visits among the treatment group(19–25 years) compared to the control group(27–31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance.CONCLUSION: The ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacifi c Islander racial groups.展开更多
As the cornerstone of the rule of law in public health,the right to health is an important human right recognized by international covenants of human rights and widely absorbed by foreign constitutions and laws.In int...As the cornerstone of the rule of law in public health,the right to health is an important human right recognized by international covenants of human rights and widely absorbed by foreign constitutions and laws.In international covenants on human rights,the right to health is regarded as a social right,and its core connotation is“the right to the highest attainable standard of health,”which has been recognized by many global and regional human rights conventions.Correspondingly,it has become a norm for this right to be included in constitutions around the world,especially those in the emerging countries that became independent after World War II and is often embodied within the framework of the law.Take China as an example,the right to health in our legal system is included in the Constitution,and has been substantiated in the Law of the People’s Republic of China on the Promotion of Basic Medical and Health Care and the Civil Code in the mode of“the same channel protection of public and private laws”.The rule of law and public policy are important means of substantiating the right to health(norms).The right to health in this category is confirmed and shaped by the policybased legal principles such as the principle of human rights protection,the principle of fairness,the principle of non-discrimination and the principle of due process,and covers the welfare policy and the health service system in modern countries.展开更多
The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and pl...The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and plans available online in seven countries from four regions of Sub-Saharan Africa. Thus, two main reasons have been highlighted. First, national strategic plans and policies for health development, in their formulation, neither sufficiently emphasize multisectoral approaches, nor sufficiently make these approaches operational in strategies and activities. Second, the mindset of health professionals due to their initial training orientation based on the biomedical approach, stands that disease is only a result of a physiological imbalance in the body;therefore, to restore health, such an imbalance only needs sophisticated procedures and interventions to be overcome. Such an orientation completely ignores the social, cultural and economic context in which the individual lives, which has an irretrievable influence on the health imbalance. However, health, influenced by the conditions in which people are conceived, born, grow, live, work and aged, cannot be effectively improved in a sustainable way without taking into account all these conditions. Whence the importance of approaches based on every sector of human activity that influences the living conditions.展开更多
Background:Mental health has recently been receiving a growing amount of attention in China's Mainland,with mental disorders increasingly being recognized as a major public health concern.However,the treatment gap...Background:Mental health has recently been receiving a growing amount of attention in China's Mainland,with mental disorders increasingly being recognized as a major public health concern.However,the treatment gap for mental health care is markedly high in China.Previous research and clinical practice have focused on high-risk physical disorders but overlooked psychosocial factors,especially during the perinatal period.Aims:To explore Chinese professionals'perception and attributions of perinatal mental health in China.Method:The study was conducted in Shanghai,China,in 2018,drawing on interviews with 15 key informants including health professionals,government officials,and policymakers recruited through snowball sampling.Content analysis of the semi-structured interviews was performed.Results:The study yielded insights into the perceptions of perinatal mental health among health professionals in Shanghai.Three themes emerged from the informants'reports:(1)mental health influenced by tradition—describing traditions affecting the perception of mental health at both the societal and individual level;(2)societal changed contributing perinatal mental health problems—referring to a rapidly changing cultural and economic backdrop as a source of stress leading to mental health problems;and(3)existing and required resources—demonstrating a lack of professional training,staff shortages,and inadequacy of resources to provide the required mental health care.Conclusion:Our results provide new insights into key health professionals'perceptions of mental health problems in Shanghai.Hesitation to seek care owing to a lack of knowledge,and resource shortages in health care systems are obstacles to improve mental health among women in urban China.展开更多
BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Fac...BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Factors acting as barriers to organ donation registration have been classified as:(1)Bodily integrity;(2)medical mistrust;(3)“ick”-feelings of disgust towards organ donation;and(4)“jinx”-fear that registration may result in one dying due to premeditated plans.We predict that by providing necessary information and education about the donation process via a short video,individuals will be more willing to register as organ donors.AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.METHODS This study was approved by the Institutional Review Board at Northwell Health.The approval reference number is No.19-0009(as presented in Supplementary material).Eligible participants included Hispanic New York City(NYC)residents,18 years of age and above,who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents.The survey an 85-item Redcap survey measured participant demographics,attitudes,and knowledge of organ donation as well as the intention to register as an organ donor.Attention checks were implemented throughout the survey,and responses were excluded for those who did fail.Participants were randomly assigned two-between subject conditions:To view a short video on organ donation and then proceed to complete the survey(i.e.,video first)and view the same video at the end of the survey(video last).No intra-group activities were conducted.This study utilized an evidenced-based emotive educational intervention(video)which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles.Results were analyzed using Jamovi statistical software.Three hundred sixty-five Hispanic individuals were included in the analysis.Once consent was obtained and participants entered the survey(the survey sample is presented in Supplementary material),participants were asked to report on demographic variables and their general impression of organ donation after death.The video depicted stories regarding organ donation after death from various viewpoints,including from the loved ones of a deceased person who died waiting for a transplant;from the loved ones of a deceased person whose organs were donated upon death;and,from those who were currently waiting for a transplant.RESULTS Using a binomial logistic regression,the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors.The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions(odds ratio:2.05,95%confidence interval:1.06-3.97).Motivations for participation in organ donation were also captured with many stating the importance of messages coming from“people like me”and a message that highlights“the welfare of those in need”.Overall,the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous.Future studies should explore using targeted messaging that resonates with specific cultural groups,highlighting the welfare of others.CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.展开更多
Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, w...Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, while other countries use an automated coding system. The outcome of these two different methods in terms of the selected underlying cause of death for statistics may vary considerably. Therefore, this study explores the effect of coding method on the ranking of countries by major causes of death. Method: Age and sex standardized rates were extracted for 33 European (related) countries from the cause-of-death registry of the European Statistical Office (Eurostat). Wilcoxon’s rank sum test was applied to the ranking of countries by major causes of death. Results: Statistically significant differences due to coding method were identified for dementia, stroke and pneumonia. These differences could be explained by a different selection of dementia or pneumonia as underlying cause of death and by a different certification practice for stroke. Conclusion: Coding method should be taken into account when constructing or interpreting rankings of countries by cause of death.展开更多
Background: In Benin, malaria represents the first cause of consultation and hospitalization (48% for children under 5 years old) in health units. It also accounts for 23.1% of deaths recorded in health facilities (Mo...Background: In Benin, malaria represents the first cause of consultation and hospitalization (48% for children under 5 years old) in health units. It also accounts for 23.1% of deaths recorded in health facilities (MoH, 2019). Between the two main components of vector control adopted by Benin government, the mass distribution campaigns of Insecticide-Treated Nets (ITNs) remained the only proven cost-effective way to rapidly achieve high and equitable coverage (WHO, 2017). After the fourth mass distribution campaign conducted in 2017, the Demographic and Health Survey (DHS) data indicated that the percentage of children who slept under an ITN has increased from 20% in 2006 to 70% in 2011-2012 and to 76% in 2017-2018 while the incidence of malaria (tested positive) is increasing rapidly among children under 5 years old, growing from 36.5% in 2009 to 28.8% in 2012 and then to 51.4% in 2019. This study aims to understand this contrast by identifying the origin of the increase in ITN use over time among children under five years old and the factors which determine this use. Methods: Data from the Demographic and Health Survey (DHS) conducted in Benin respectively in 2006 and in 20018 were used during the analysis, which covered 13,445 children under five years old from 2006 DHS and 12,255 children from 2017-2018 DHS. Firstly, the data were analyzed using decomposition method to highlight the origin of the increase of ITN use over time among children under five years old. Secondly, the chi-square test analysis estimated the association between ITN use and some characteristics (wealth index, maternal or caregiver education level and child age). Finally, the logistic regression model was used to identify the main factors, which influence the net use over the study period. Results: This study shows that the improvement of basic conditions is the main origin of behavior change in the use of ITNs among children under five years old. This improvement of the basic conditions consists of making ITNs available in households and informing household members about the benefits of ITN use. So, the free ITN distribution campaigns, routine distribution, awareness campaigns about the benefits of ITN use are the strategies, which increase the household capacities and knowledge, allowing household members to make their children sleep under net. The analysis also shows that region of residence, wealth index of household, household size, religion, and child age continue to determine the ITN use among children under age 5 years old and MNCP will integrate the factors in malaria prevention strategies in order to achieve universal use of ITNs. Conclusions: Although, sleeping under ITN behavior has indeed spread among children under 5 years old, policymakers and other stakeholders should design strategies to maintain and improve the current level of ITN use to reach the collective protection threshold (80% according to WHO). Therefore, to address the challenges of universal use of ITN, the study recommends expanding the routine distribution system to private sector health centers;discussing issues related to health service utilization (particularly ITN use) within a consultation framework at the communal level. In addition, collecting qualitative and quantitative data in the Oueme region will allow better understanding of all aspects of the ITN use gap among children under 5 years.展开更多
Background:Studies on costs incurred by patients for tuberculosis(TB)care are limited as these costs are reported as averages,and the economic impact of the costs is estimated based on average patient/household income...Background:Studies on costs incurred by patients for tuberculosis(TB)care are limited as these costs are reported as averages,and the economic impact of the costs is estimated based on average patient/household incomes.Average expenditures do not represent the poor because they spend less on treatment compared to other economic groups.Thus,the extent to which TB expenditures risk sending households into,or further into,poverty and its determinants,is unknown.We assessed the incidence and determinants of household catastrophic payments for TB care in rural Nigeria.Methods:Data used were obtained from a survey of 452 pulmonary TB patients sampled from three rural health facilities in Ebonyi State,Nigeria.Using household direct costs and income data,we analyzed the incidence of household catastrophic payments using,as thresholds,the traditional>10%of household income and the≥40%of non-food income,as recommended by the World Health Organization.We used logistic regression analysis to identify the determinants of catastrophic payments.Results:Average direct household costs for TB were US$157 or 14%of average annual incomes.The incidence catastrophic payment was 44%;with 69%and 15%of the poorest and richest household income-quartiles experiencing catastrophic activity,respectively.Independent determinants of catastrophic payments were:age>40 years(adjusted odds ratio[aOR]3.9;95%confidence interval[CI],2.0,7.8),male gender(aOR 3.0;CI 1.8,5.2),urban residence(aOR 3.8;CI 1.9,7.7),formal education(aOR 4.7;CI 2.5,8.9),care at a private facility(aOR 2.9;1.5,5.9),poor household(aOR 6.7;CI 3.7,12),household where the patient is the primary earner(aOR 3.8;CI 2.2,6.6]),and HIV co-infection(aOR 3.1;CI 1.7,5.6).Conclusions:Current cost-lowering strategies are not enough to prevent households from incurring catastrophic out-of-pocket payments for TB care.Financial and social protection interventions are needed for identified at-risk groups,and community-level interventions may reduce inefficiencies in the care-seeking pathway.These observations should inform post-2015 TB strategies and influence policy-making on health services that are meant to be free of charge.展开更多
With the deepening of China’s health-care reform,an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system.For China’s integrated delivery s...With the deepening of China’s health-care reform,an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system.For China’s integrated delivery system,a medical consortium plays an important role in integrating public hospitals and primary care facilities.The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system.This paper illustrates the possible future pathway of China’s medical consortium through retrospection of the 10-year process,changes of the series of policies,and characteristics of the policy issued in 2020.We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry,which would lead to the formation of a dualistic care pattern in China.展开更多
Background:Globally,the threat of infectious diseases,particularly emerging infectious diseases,originating at the human-animal-environment interface,has caught health systems off guard.With forecasts that future path...Background:Globally,the threat of infectious diseases,particularly emerging infectious diseases,originating at the human-animal-environment interface,has caught health systems off guard.With forecasts that future pathogen emergence will be centred in hotspots in Asia,Africa,and Latin America,the need to prepare policy frameworks that can combat this threat is urgent.Discussion:Emergence of diseases such as avian influenza and Ebola virus disease,which threatened social disruption,have established the need for intersectoral coordination/collaboration.These events led to the initiation of establishing institutionalised collaborative frameworks in India to adopt a One Health approach to disease prevention and control.However,the gains made in influenza control could not be adapted to other infectious diseases.Intersectoral coordination was briefly carried out,more as a reactive response to threats.The systemic failure to sustain such efforts have therefore,only undermined a coordinated response.The recent draft National Health Policy,2015,has also failed to establish the need for intersectoral coordination in disease control approaches.Neglecting the need to endorse linkages between human health,animal health and husbandry,agriculture,and environmental sectors,has led to duplicative and weak response systems.The absence of health impact assessment with respect to the development agenda in policies,has cast negative effects on the health and wellbeing of man,animal,and the environment.Lack of attention to building core capacity in these critical sectors has further raised challenges in designing and deploying mitigation strategies.With developing countries like India being home to a major portion of the world’s poorest livestock farmers,the absence of a policy discourse that endorses the One Health approach in development and health policies is a major hurdle in eliminating poverty and poverty-related diseases.Conclusions:The adoption of One Health approaches in health and related sectoral policies is a critical policy requirement for India and other developing countries.The goal should be to not just establish preparedness plans,but also to encourage a policy environment where assessment and mitigation of downstream impacts of different agenda are incorporated.展开更多
Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gas...Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gastric cancer(LSGC)under the Chinese MSP policy.Methods:We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital(n=573)and his MSP institutions(n=508)between January 2017 and December 2020.Baseline demographics,intraoperative outcomes,post-operative recovery,and pathological results were compared between the original hospital and MSP institutions,as well as between MSP institutions with and without specific competence(surgical skill,operative instrument,perioperative multi-discipline team).Results:In our study,690 patients underwent LSCRC and 391 patients underwent LSGC.The prevalence of post-operative complications was comparable for LSCRC(11.5%vs 11.1%,P=0.89)or LSGC(15.2%vs 12.6%,P=0.46)between the original hospital and MSP institutions.However,patients in MSP institutions without qualified surgical assistant(s)and adequate instruments experienced longer operative time and greater intraoperative blood loss.The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC(11.5%vs 21.2%,P<0.01)and LSGC(9.8%vs 20.5%,P<0.01).Conclusion:For an experienced gastrointestinal surgeon,performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible,but relies on the precondition that the MSP institutions are equipped with qualified surgical skills,adequate operative instruments,and complete perioperative management.展开更多
This study compares the associators of healthy ageing in China and the United States,using the 2005-2014 Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the 2004-2014 Health and Retirement Study(HRS).Health ag...This study compares the associators of healthy ageing in China and the United States,using the 2005-2014 Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the 2004-2014 Health and Retirement Study(HRS).Health ageing is measured using an overall healthy ageing index(HAI),defined according to five dimensions:no major chronic diseases,free of physical functional impairment,free of cognitive impairment,no depressive symptoms,and socially active engagement.Multilevel logistic regression analysis is adopted to explore the association of demographic characteristics,socioeconomic status,and healthy lifestyles with the odds ratios of healthy ageing in China and the United States.Results indicate that the proportion of individuals experiencing healthy ageing is slightly higher in US than Chinese older adults aged 65-100(25.67%vs 23.27%).Nevertheless,Chinese oldest-old(80-100)have a higher proportion of healthy ageing than American oldest-old(15.05%vs.12.19%).Our results indicate that the odds of healthy ageing decrease with age,whereas they increase with education,income,marriage,and health behaviours.The odds of healthy ageing are lower for older Chinese women than men,whereas the odds are higher for older US women.Moreover,non-white elders in the United States have significantly lower odds of healthy ageing than their white counterparts.These findings suggest certain similar patterns of healthy ageing across two countries,but distinct patterns do exist.Promoting gender and racial equalities in healthy ageing are crucial for Chinese and American policymakers,respectively.展开更多
Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that hea...Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that health care systems focus on improving access to quality continu-ous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.Objective:To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.Methods:Six databases were examined for quantitative,qualitative,and mixed-methods stud-ies that included the integration of CHWs,their motivation and supervision,and CHW policy making and implementation in developing countries.Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs.Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.Results:CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health.Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings.Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work,as well as financial and nonfinancial incentives,motivation,collaborative and supportive supervision,and a manageable workload.Conclusions:For sustainable integration of CHWs into health care systems,high-performing health systems with sound governance,adequate financing,well-organized service delivery,and adequate supplies and equipment are essential.Similarly,competent communities could contrib-ute to better CHW performance through sound governance of community resources,promotion of inclusiveness and cohesion,engagement in participatory decision making,and mobilization of local resources for community welfare.展开更多
Adopting the FAIR Guidelines—that data should be Findable, Accessible, Interoperable and Reusable(FAIR)—in the health data system in Nigeria will help protect data against use by unauthorised parties, while also mak...Adopting the FAIR Guidelines—that data should be Findable, Accessible, Interoperable and Reusable(FAIR)—in the health data system in Nigeria will help protect data against use by unauthorised parties, while also making data more accessible to legitimate users. However, little is known about the FAIR Guidelines and their compatibility with data and health laws and policies in Nigeria. This study assesses the governance framework for digital and health/e Health policies in Nigeria and explores the possibility of a policy window opening for the FAIR Guidelines to be adopted and implemented in Nigeria’s e Health sector. Ten Nigerian policy documents were examined for mention of the FAIR Guidelines(or FAIR Equivalent terminology) and the 15 sub-criteria or facets. The analysis found that although the FAIR Guidelines are not explicitly mentioned, 70% of the documents contain FAIR Equivalent terminology. The Nigeria Data Protection Regulation contained the most FAIR Equivalent principles(73%) and some of the remaining nine documents also contained some FAIR Equivalent principles(between 0–60%). Accordingly, it can be concluded that a policy window is open for the FAIR Guidelines to be adopted and implemented in Nigeria’s e Health sector.展开更多
文摘Mental health challenges are a severe issue that could lead to suicide if not properly addressed.South Africa has a significant burden of mental health issues,which contributes to the soaring rate of suicide.Adequate mental health-care provision could reduce the high suicide rate in South Africa.Since the apartheid regime,the country has made a series of efforts to improve mental health.This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications.This study adopted a narrative review approach.Electronic databases(PubMed,Scilit,Google Scholar and Semantic Scholar)were used to identify published articles in the English language with crucial search terms that included mental health,South African mental health policy,South Africa,suicide and policy.Literature suggests that at the provincial level,there are no adequate mental health policies,and the implementation of the country’s mental health policy is faced with many challenges,such as a shortage of professionals and finances.The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health.This study concludes that the mental health treatment gap still exists in South Africa,and this needs to be tackled using effective,multi-level counselling interventions and policy initiatives.Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.
文摘Studies of interactions have gained an increasing importance in research related to healthcare.Most empirical studies have explored the dynamics of exchanges between patients and practitioners(Barry et al.,2001,Beach et al.,2001).This study is devoted to the analysis of discussions in two forums to investigate how to develop what we call‘a rational empathy’so as to understand the attitudes and beliefs which constitute the basis of these opinions.
文摘Objectives:People increasingly search for health information through the media and make decisions about their health based on these health stories.The mainstream media,including newspapers,are often the first source for the public to obtain health information.This study aims to assess the health stories reported in the health edition of People's Daily in 2019 with four tools of the Media Doctor Toolkit(MDT),which can be an effective tool to evaluate the quality of public health stories.Based on the results,we attempt to address the gap in media coverage in terms of reporting on public health issues,and promote media to display the image of medical staff objectively,both of which can improve relationship of doctors,nurses and patients.Methods:A prospective quantitative analysis of the quality of health stories reported in the health edition of People's Daily from 1 February to September 31,2019 was conducted.Forty-eight articles were collected and divided into four groups according to the MDT standards.Four rating tools were adapted from the MDT to assess the quality of the groups with corresponding criteria.Results:Forty-eight unique health stories were assessed with four MDT rating tools.The mean total satisfactory score was 80%.Health advice had the highest average satisfactory score,84%,compared with health policy group and public health problems and their solutions,at 80%and 77%,respectively.Health news group had the lowest score at 73%.Conclusion:This study provides a description of the quality of health stories on People's Daily.The overall quality of People's Daily was fairly good,although there was a wide range of quality between groups.The health edition of People's Daily covers a wide range of health topics such as new medical methods,doctorpatient relationship,advanced nursing practice,lifestyle change of health promotion etc.which promote excellence in providing the latest health information,representing medical staff image,resolve the disharmonious factors in the relationship between doctors and patients,and creating a good medical environment for the public.The findings of this study also provide insight into problems in health reporting of People's Daily.
文摘The high burden of kidney disease,global disparities in kidney care,and poor outcomes of kidney failure bring a concomitant growing burden to persons affected,their families,and carers,and the community at large.Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find,understand,and use information and services to make informed health⁃related decisions and actions for themselves and others.Rather than viewing health literacy as a patient deficit,improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease.For kidney policy makers,health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care.The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders.Advances in telecommunication,including social media platforms,can be leveraged to enhance persons’and providers’education;The World Kidney Day declares 2022 as the year of“Kidney Health for All”to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy.Kidney organizations should work toward shifting the patient⁃deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers.By engaging in and supporting kidney health-centered policy making,community health planning,and health literacy approaches for all,the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.
文摘Background Both population-level epidemiological data and individual-level biological data are needed to control the coronavirus disease 2019(COVID-19)pandemic.Population-level data are widely available and efforts to combat COVID-19 have generated proliferate data on the biology and immunoresponse to the causative pathogen,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).However,there remains a paucity of systemized data on this subject.Objective In this review,we attempt to extract systemized data on the biology and immuno-response to SARS-CoV-2 from the most up-to-date peer-reviewed studies.We will focus on the biology of the virus and immunological variations that are key for determining long-term immunity,transmission potential,and prognosis.Data Sources and Methods Peer-reviewed articles were sourced from the PubMed database and by snowballing search of selected publications.Search terms included:“Novel Coronavirus”OR“COVID-19”OR“SARS-CoV-2”OR“2019-nCoV”AND“Immunity”OR“Immune Response”OR“Antibody Response”OR“Immunologic Response”.Studies published from December 31,2019 to December 31,2020 were included.To ensure validity,papers in pre-print were excluded.Results Of 2889 identified papers,36 were included.Evidence from these studies suggests early seroconversion in patients infected with SARS-CoV-2.Antibody titers appear to markedly increase two weeks after infection,followed by a plateau.A more robust immune response is seen in patients with severe COVID-19 as opposed to mild or asymptomatic presentations.This trend persists with regard to the length of antibody maintenance.However,overall immunity appears to wane within two to three months post-infection.Conclusion Findings of this study indicate that immune responses to SARS-CoV-2 follow the general pattern of viral infection.Immunity generated through natural infection appears to be short,suggesting a need for long-term efforts to control the pandemic.Antibody testing will be essential to gauge the epidemic and inform decision-making on effective strategies for treatment and prevention.Further research is needed to illustrate immunoglobulin-specific roles and neutralizing antibody activity.
文摘Background: Myanmar’s National Health Plan 2017-2021 set out concrete steps to strengthen the health system on the way to achieving the goal of universal health coverage by 2030. Ensuring these steps include the 7.7 million older adults in Myanmar’s population by 2030 will require novel strategies that improve health and reduce financial burden of health expenditures. An examination of the relationship between social networks and selected health outcomes was undertaken to determine whether these networks can safeguard older adults’ continued contributions to family, society and their own health. Methods: Secondary analysis of a nationally representative study of adults aged 60 years and older. Ordered logistic regression analyses with weighted data were used to examine the relationship between a social network variable and a number of health outcomes. Findings: Stronger social networks were associated with better health outcomes like better memory (OR 1.2), lower reported walking difficulties (OR 0.58), better self-reported health (R 1.15). People with higher social ties were also more like to receive regular assistance and provide care for other household members. Interpretation: Social networks play a role in mediating health outcomes and interactions with the health care systems. Social network interventions should be explored as part of policy mechanisms to ensure universal health coverage for older adults in Myanmar.
文摘BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department(ED) utilization for mental health purposes. We aimed to study the race specifi c association between the dependent coverage provision of the Affordable Care Act(ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses.METHODS: We utilized a Quasi-Experimental analysis of ED use in California from 2009–2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-indifferences approach comparing those targeted by the ACA dependent provision(19–25 years) and those who were not(27 to 31 years), evaluating changes in ED visit rates per 1 000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and gender.RESULTS: The ACA dependent provision was associated with 0.05 per 1 000 people fewer psychiatric ED visits among the treatment group(19–25 years) compared to the control group(27–31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance.CONCLUSION: The ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacifi c Islander racial groups.
基金the phased achievement(21BFX169)of the“Study on the Implementation ofthe Right to Health under the Background of Same-channel Protection of Public and Private Law”the National Social Science Fund of China
文摘As the cornerstone of the rule of law in public health,the right to health is an important human right recognized by international covenants of human rights and widely absorbed by foreign constitutions and laws.In international covenants on human rights,the right to health is regarded as a social right,and its core connotation is“the right to the highest attainable standard of health,”which has been recognized by many global and regional human rights conventions.Correspondingly,it has become a norm for this right to be included in constitutions around the world,especially those in the emerging countries that became independent after World War II and is often embodied within the framework of the law.Take China as an example,the right to health in our legal system is included in the Constitution,and has been substantiated in the Law of the People’s Republic of China on the Promotion of Basic Medical and Health Care and the Civil Code in the mode of“the same channel protection of public and private laws”.The rule of law and public policy are important means of substantiating the right to health(norms).The right to health in this category is confirmed and shaped by the policybased legal principles such as the principle of human rights protection,the principle of fairness,the principle of non-discrimination and the principle of due process,and covers the welfare policy and the health service system in modern countries.
文摘The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and plans available online in seven countries from four regions of Sub-Saharan Africa. Thus, two main reasons have been highlighted. First, national strategic plans and policies for health development, in their formulation, neither sufficiently emphasize multisectoral approaches, nor sufficiently make these approaches operational in strategies and activities. Second, the mindset of health professionals due to their initial training orientation based on the biomedical approach, stands that disease is only a result of a physiological imbalance in the body;therefore, to restore health, such an imbalance only needs sophisticated procedures and interventions to be overcome. Such an orientation completely ignores the social, cultural and economic context in which the individual lives, which has an irretrievable influence on the health imbalance. However, health, influenced by the conditions in which people are conceived, born, grow, live, work and aged, cannot be effectively improved in a sustainable way without taking into account all these conditions. Whence the importance of approaches based on every sector of human activity that influences the living conditions.
基金funded by the Swedish Foundation for International Cooperation in Research and Higher Education(IB2016-6905).
文摘Background:Mental health has recently been receiving a growing amount of attention in China's Mainland,with mental disorders increasingly being recognized as a major public health concern.However,the treatment gap for mental health care is markedly high in China.Previous research and clinical practice have focused on high-risk physical disorders but overlooked psychosocial factors,especially during the perinatal period.Aims:To explore Chinese professionals'perception and attributions of perinatal mental health in China.Method:The study was conducted in Shanghai,China,in 2018,drawing on interviews with 15 key informants including health professionals,government officials,and policymakers recruited through snowball sampling.Content analysis of the semi-structured interviews was performed.Results:The study yielded insights into the perceptions of perinatal mental health among health professionals in Shanghai.Three themes emerged from the informants'reports:(1)mental health influenced by tradition—describing traditions affecting the perception of mental health at both the societal and individual level;(2)societal changed contributing perinatal mental health problems—referring to a rapidly changing cultural and economic backdrop as a source of stress leading to mental health problems;and(3)existing and required resources—demonstrating a lack of professional training,staff shortages,and inadequacy of resources to provide the required mental health care.Conclusion:Our results provide new insights into key health professionals'perceptions of mental health problems in Shanghai.Hesitation to seek care owing to a lack of knowledge,and resource shortages in health care systems are obstacles to improve mental health among women in urban China.
基金The study was reviewed and approved by the Institutional Review Board at Northwell Health(Approval No.19-0009).
文摘BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Factors acting as barriers to organ donation registration have been classified as:(1)Bodily integrity;(2)medical mistrust;(3)“ick”-feelings of disgust towards organ donation;and(4)“jinx”-fear that registration may result in one dying due to premeditated plans.We predict that by providing necessary information and education about the donation process via a short video,individuals will be more willing to register as organ donors.AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.METHODS This study was approved by the Institutional Review Board at Northwell Health.The approval reference number is No.19-0009(as presented in Supplementary material).Eligible participants included Hispanic New York City(NYC)residents,18 years of age and above,who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents.The survey an 85-item Redcap survey measured participant demographics,attitudes,and knowledge of organ donation as well as the intention to register as an organ donor.Attention checks were implemented throughout the survey,and responses were excluded for those who did fail.Participants were randomly assigned two-between subject conditions:To view a short video on organ donation and then proceed to complete the survey(i.e.,video first)and view the same video at the end of the survey(video last).No intra-group activities were conducted.This study utilized an evidenced-based emotive educational intervention(video)which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles.Results were analyzed using Jamovi statistical software.Three hundred sixty-five Hispanic individuals were included in the analysis.Once consent was obtained and participants entered the survey(the survey sample is presented in Supplementary material),participants were asked to report on demographic variables and their general impression of organ donation after death.The video depicted stories regarding organ donation after death from various viewpoints,including from the loved ones of a deceased person who died waiting for a transplant;from the loved ones of a deceased person whose organs were donated upon death;and,from those who were currently waiting for a transplant.RESULTS Using a binomial logistic regression,the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors.The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions(odds ratio:2.05,95%confidence interval:1.06-3.97).Motivations for participation in organ donation were also captured with many stating the importance of messages coming from“people like me”and a message that highlights“the welfare of those in need”.Overall,the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous.Future studies should explore using targeted messaging that resonates with specific cultural groups,highlighting the welfare of others.CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.
文摘Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, while other countries use an automated coding system. The outcome of these two different methods in terms of the selected underlying cause of death for statistics may vary considerably. Therefore, this study explores the effect of coding method on the ranking of countries by major causes of death. Method: Age and sex standardized rates were extracted for 33 European (related) countries from the cause-of-death registry of the European Statistical Office (Eurostat). Wilcoxon’s rank sum test was applied to the ranking of countries by major causes of death. Results: Statistically significant differences due to coding method were identified for dementia, stroke and pneumonia. These differences could be explained by a different selection of dementia or pneumonia as underlying cause of death and by a different certification practice for stroke. Conclusion: Coding method should be taken into account when constructing or interpreting rankings of countries by cause of death.
文摘Background: In Benin, malaria represents the first cause of consultation and hospitalization (48% for children under 5 years old) in health units. It also accounts for 23.1% of deaths recorded in health facilities (MoH, 2019). Between the two main components of vector control adopted by Benin government, the mass distribution campaigns of Insecticide-Treated Nets (ITNs) remained the only proven cost-effective way to rapidly achieve high and equitable coverage (WHO, 2017). After the fourth mass distribution campaign conducted in 2017, the Demographic and Health Survey (DHS) data indicated that the percentage of children who slept under an ITN has increased from 20% in 2006 to 70% in 2011-2012 and to 76% in 2017-2018 while the incidence of malaria (tested positive) is increasing rapidly among children under 5 years old, growing from 36.5% in 2009 to 28.8% in 2012 and then to 51.4% in 2019. This study aims to understand this contrast by identifying the origin of the increase in ITN use over time among children under five years old and the factors which determine this use. Methods: Data from the Demographic and Health Survey (DHS) conducted in Benin respectively in 2006 and in 20018 were used during the analysis, which covered 13,445 children under five years old from 2006 DHS and 12,255 children from 2017-2018 DHS. Firstly, the data were analyzed using decomposition method to highlight the origin of the increase of ITN use over time among children under five years old. Secondly, the chi-square test analysis estimated the association between ITN use and some characteristics (wealth index, maternal or caregiver education level and child age). Finally, the logistic regression model was used to identify the main factors, which influence the net use over the study period. Results: This study shows that the improvement of basic conditions is the main origin of behavior change in the use of ITNs among children under five years old. This improvement of the basic conditions consists of making ITNs available in households and informing household members about the benefits of ITN use. So, the free ITN distribution campaigns, routine distribution, awareness campaigns about the benefits of ITN use are the strategies, which increase the household capacities and knowledge, allowing household members to make their children sleep under net. The analysis also shows that region of residence, wealth index of household, household size, religion, and child age continue to determine the ITN use among children under age 5 years old and MNCP will integrate the factors in malaria prevention strategies in order to achieve universal use of ITNs. Conclusions: Although, sleeping under ITN behavior has indeed spread among children under 5 years old, policymakers and other stakeholders should design strategies to maintain and improve the current level of ITN use to reach the collective protection threshold (80% according to WHO). Therefore, to address the challenges of universal use of ITN, the study recommends expanding the routine distribution system to private sector health centers;discussing issues related to health service utilization (particularly ITN use) within a consultation framework at the communal level. In addition, collecting qualitative and quantitative data in the Oueme region will allow better understanding of all aspects of the ITN use gap among children under 5 years.
基金This work was supported by a 2010 PATS-MECOR small grant award received by KNU.
文摘Background:Studies on costs incurred by patients for tuberculosis(TB)care are limited as these costs are reported as averages,and the economic impact of the costs is estimated based on average patient/household incomes.Average expenditures do not represent the poor because they spend less on treatment compared to other economic groups.Thus,the extent to which TB expenditures risk sending households into,or further into,poverty and its determinants,is unknown.We assessed the incidence and determinants of household catastrophic payments for TB care in rural Nigeria.Methods:Data used were obtained from a survey of 452 pulmonary TB patients sampled from three rural health facilities in Ebonyi State,Nigeria.Using household direct costs and income data,we analyzed the incidence of household catastrophic payments using,as thresholds,the traditional>10%of household income and the≥40%of non-food income,as recommended by the World Health Organization.We used logistic regression analysis to identify the determinants of catastrophic payments.Results:Average direct household costs for TB were US$157 or 14%of average annual incomes.The incidence catastrophic payment was 44%;with 69%and 15%of the poorest and richest household income-quartiles experiencing catastrophic activity,respectively.Independent determinants of catastrophic payments were:age>40 years(adjusted odds ratio[aOR]3.9;95%confidence interval[CI],2.0,7.8),male gender(aOR 3.0;CI 1.8,5.2),urban residence(aOR 3.8;CI 1.9,7.7),formal education(aOR 4.7;CI 2.5,8.9),care at a private facility(aOR 2.9;1.5,5.9),poor household(aOR 6.7;CI 3.7,12),household where the patient is the primary earner(aOR 3.8;CI 2.2,6.6]),and HIV co-infection(aOR 3.1;CI 1.7,5.6).Conclusions:Current cost-lowering strategies are not enough to prevent households from incurring catastrophic out-of-pocket payments for TB care.Financial and social protection interventions are needed for identified at-risk groups,and community-level interventions may reduce inefficiencies in the care-seeking pathway.These observations should inform post-2015 TB strategies and influence policy-making on health services that are meant to be free of charge.
基金supported by the National Natural Sciences Foundation of China(No.71874058 and No.72174068).
文摘With the deepening of China’s health-care reform,an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system.For China’s integrated delivery system,a medical consortium plays an important role in integrating public hospitals and primary care facilities.The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system.This paper illustrates the possible future pathway of China’s medical consortium through retrospection of the 10-year process,changes of the series of policies,and characteristics of the policy issued in 2020.We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry,which would lead to the formation of a dualistic care pattern in China.
文摘Background:Globally,the threat of infectious diseases,particularly emerging infectious diseases,originating at the human-animal-environment interface,has caught health systems off guard.With forecasts that future pathogen emergence will be centred in hotspots in Asia,Africa,and Latin America,the need to prepare policy frameworks that can combat this threat is urgent.Discussion:Emergence of diseases such as avian influenza and Ebola virus disease,which threatened social disruption,have established the need for intersectoral coordination/collaboration.These events led to the initiation of establishing institutionalised collaborative frameworks in India to adopt a One Health approach to disease prevention and control.However,the gains made in influenza control could not be adapted to other infectious diseases.Intersectoral coordination was briefly carried out,more as a reactive response to threats.The systemic failure to sustain such efforts have therefore,only undermined a coordinated response.The recent draft National Health Policy,2015,has also failed to establish the need for intersectoral coordination in disease control approaches.Neglecting the need to endorse linkages between human health,animal health and husbandry,agriculture,and environmental sectors,has led to duplicative and weak response systems.The absence of health impact assessment with respect to the development agenda in policies,has cast negative effects on the health and wellbeing of man,animal,and the environment.Lack of attention to building core capacity in these critical sectors has further raised challenges in designing and deploying mitigation strategies.With developing countries like India being home to a major portion of the world’s poorest livestock farmers,the absence of a policy discourse that endorses the One Health approach in development and health policies is a major hurdle in eliminating poverty and poverty-related diseases.Conclusions:The adoption of One Health approaches in health and related sectoral policies is a critical policy requirement for India and other developing countries.The goal should be to not just establish preparedness plans,but also to encourage a policy environment where assessment and mitigation of downstream impacts of different agenda are incorporated.
基金funded by the National Facility for Translational Medicine(Shanghai,China)[grant number TMSK-2021–503 to B.F.].
文摘Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gastric cancer(LSGC)under the Chinese MSP policy.Methods:We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital(n=573)and his MSP institutions(n=508)between January 2017 and December 2020.Baseline demographics,intraoperative outcomes,post-operative recovery,and pathological results were compared between the original hospital and MSP institutions,as well as between MSP institutions with and without specific competence(surgical skill,operative instrument,perioperative multi-discipline team).Results:In our study,690 patients underwent LSCRC and 391 patients underwent LSGC.The prevalence of post-operative complications was comparable for LSCRC(11.5%vs 11.1%,P=0.89)or LSGC(15.2%vs 12.6%,P=0.46)between the original hospital and MSP institutions.However,patients in MSP institutions without qualified surgical assistant(s)and adequate instruments experienced longer operative time and greater intraoperative blood loss.The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC(11.5%vs 21.2%,P<0.01)and LSGC(9.8%vs 20.5%,P<0.01).Conclusion:For an experienced gastrointestinal surgeon,performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible,but relies on the precondition that the MSP institutions are equipped with qualified surgical skills,adequate operative instruments,and complete perioperative management.
文摘This study compares the associators of healthy ageing in China and the United States,using the 2005-2014 Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the 2004-2014 Health and Retirement Study(HRS).Health ageing is measured using an overall healthy ageing index(HAI),defined according to five dimensions:no major chronic diseases,free of physical functional impairment,free of cognitive impairment,no depressive symptoms,and socially active engagement.Multilevel logistic regression analysis is adopted to explore the association of demographic characteristics,socioeconomic status,and healthy lifestyles with the odds ratios of healthy ageing in China and the United States.Results indicate that the proportion of individuals experiencing healthy ageing is slightly higher in US than Chinese older adults aged 65-100(25.67%vs 23.27%).Nevertheless,Chinese oldest-old(80-100)have a higher proportion of healthy ageing than American oldest-old(15.05%vs.12.19%).Our results indicate that the odds of healthy ageing decrease with age,whereas they increase with education,income,marriage,and health behaviours.The odds of healthy ageing are lower for older Chinese women than men,whereas the odds are higher for older US women.Moreover,non-white elders in the United States have significantly lower odds of healthy ageing than their white counterparts.These findings suggest certain similar patterns of healthy ageing across two countries,but distinct patterns do exist.Promoting gender and racial equalities in healthy ageing are crucial for Chinese and American policymakers,respectively.
文摘Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that health care systems focus on improving access to quality continu-ous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.Objective:To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.Methods:Six databases were examined for quantitative,qualitative,and mixed-methods stud-ies that included the integration of CHWs,their motivation and supervision,and CHW policy making and implementation in developing countries.Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs.Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.Results:CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health.Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings.Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work,as well as financial and nonfinancial incentives,motivation,collaborative and supportive supervision,and a manageable workload.Conclusions:For sustainable integration of CHWs into health care systems,high-performing health systems with sound governance,adequate financing,well-organized service delivery,and adequate supplies and equipment are essential.Similarly,competent communities could contrib-ute to better CHW performance through sound governance of community resources,promotion of inclusiveness and cohesion,engagement in participatory decision making,and mobilization of local resources for community welfare.
基金VODAN-Africathe Philips Foundation+2 种基金the Dutch Development Bank FMOCORDAIDthe GO FAIR Foundation for supporting this research
文摘Adopting the FAIR Guidelines—that data should be Findable, Accessible, Interoperable and Reusable(FAIR)—in the health data system in Nigeria will help protect data against use by unauthorised parties, while also making data more accessible to legitimate users. However, little is known about the FAIR Guidelines and their compatibility with data and health laws and policies in Nigeria. This study assesses the governance framework for digital and health/e Health policies in Nigeria and explores the possibility of a policy window opening for the FAIR Guidelines to be adopted and implemented in Nigeria’s e Health sector. Ten Nigerian policy documents were examined for mention of the FAIR Guidelines(or FAIR Equivalent terminology) and the 15 sub-criteria or facets. The analysis found that although the FAIR Guidelines are not explicitly mentioned, 70% of the documents contain FAIR Equivalent terminology. The Nigeria Data Protection Regulation contained the most FAIR Equivalent principles(73%) and some of the remaining nine documents also contained some FAIR Equivalent principles(between 0–60%). Accordingly, it can be concluded that a policy window is open for the FAIR Guidelines to be adopted and implemented in Nigeria’s e Health sector.
