Federal Health Research Articles

An analysis of Nepal's federal health system in the context of the COVID-19 pandemic and the Sustainable Development Goals

Nepal's public health slogan was 'Health for All' with integrated community health services in 1991. The female community health volunteer network was created. District Public health offices (DPHO) managed these programs in their districts. After 2008 federalism, 2017 brought federal, provincial, and local governments. The federal health system substituted the administrative District Public / Health Offices in districts. The local governments or health institutions now oversee the Sustainable Development Goals (SDGs). The federal and provincial authorities should have employed qualified professionals to oversee public health at local health facilities. Healthcare efficacy and goal attainment are concerns today. This study did a microscopic investigation using health system studies. The researcher conducted field observations and stakeholder interviews and participated in public discussions. Data from Nepal's federal health system's community status was compared using SWOT analysis. The study delved into specific research gaps thoroughly. According to previous research, health infrastructure could be more effective with financial expenditures. A hypothesis was formed after comparing further information to domestic and international situations. The researcher emphasizes the need for good governance and suggests allocating 6% of national GDP to health spending, in line with WHO recommendations. To fulfil the needs of the healthcare sector, deliver quality medical services, and attain SDGs, it is imperative to ensure the presence of adequately trained health professionals at the local government level. The head of the local health institution must conduct administrative work connected to public health. Hence, public health-trained health staff are needed there.

Potential inequities in access to in-person SHIP counseling services.

Counseling and education on Medicare coverage options are available through the federal State Health Insurance Assistance Program (SHIP), but little is known about the population that SHIP reaches. Cross-sectional study. Using a novel data source on SHIP counseling site locations, we characterized the availability of in-person SHIP counseling by zip code tabulation area (ZCTA) and used linear regression and t tests to evaluate whether SHIP counseling sites are disproportionately located in higher-income communities. Our sample included 1511 SHIP counseling sites. More than half (63%) of the localities in our sample have a SHIP site within the ZCTA or county. Twenty-four percent do not have a SHIP site within the county but have one in an adjacent county. The remaining 13% do not have a nearby SHIP site. There is a disproportionate number of individuals eligible for Medicare in localities without a SHIP site. Moreover, the population living in areas without in-person SHIP sites is more likely to have low income and fewer years of education than the population living in areas with a SHIPsite. These results suggest that there are areas where in-person SHIP service expansion or other additional navigation support may be warranted.

Severe Work-Related Injuries in the Oil and Gas Extraction Industry - 32 Federal Occupational Safety and Health Administration Jurisdictions, United States, January 2015-July 2022.

The Occupational Safety and Health Administration (OSHA) severe injuries reports include work-related injuries from establishments under federal OSHA jurisdiction that result in an amputation, loss of an eye, or inpatient hospitalization. Data from 32 jurisdictions were examined to determine oil and gas extraction industry-specific severe industry trends during January 2015-July 2022, using the 2012 North American Industry Classification System (NAICS) codes for oil and gas extraction. During this period, a total of 2,101 severe work-related injuries were reported in this sector. Among these severe work-related injuries, well service contract workers' injuries included the highest number of amputations (417) and hospitalizations (1,194), accounting for 20% and 57%, respectively, of all severe injuries reported. Overall, 895 (43%) of all severe injuries reported involved upper extremities. Contract workers in the service and drilling subindustries (NAICS codes 213112 and 213111, respectively) experienced disproportionately more work-related injuries compared with those in the operation subindustry (NAICS code 211). These injuries could be preventable by including contractors in worksite safety plans that administer the hierarchy of controls, are within an effective safety management system, and provide consistent safety training on work equipment, personal protective equipment, and daily site safety meetings that increase safety culture.

Telemedicine Trends and Lessons Learned During the COVID-19 Pandemic-World Trade Center Health Program, 2020-2021.

The World Trade Center (WTC) Health Program, a limited federal health care program for eligible people exposed to the terrorist attacks on September 11, 2001, expanded telemedicine services during the COVID-19 pandemic (2020-2021). We analyzed service use trends from January 2020 through December 2021 to describe how the program implemented telemedicine services. About three-quarters (75%) of telemedicine visits were for mental health-related services. In the second quarter of 2020 (April-June), the number of telemedicine visits per 1000 members (n = 367) increased, exceeding in-person visits (n = 152) by 1.4-fold. The number of telemedicine visits per 1000 members decreased gradually during the rest of the study period but still represented 38% of total visits by the end of 2021. Changes in telemedicine visits were offset by comparable changes for in-person visits, such that the rate of total visits was essentially constant during the study period. Multivariate logistic regression models showed differences in telemedicine visit rates by member type and by demographic characteristics. Survivor members (vs responder members), those self-identified as non-Hispanic Other races (vs non-Hispanic White), those with preferred language not English (vs preferred language English), and those not living in the New York metropolitan area (vs living in the New York metropolitan area) were less likely to use telemedicine. Implementing telemedicine services in the WTC Health Program during the COVID-19 pandemic underscored the importance of extensive collaboration among partners, the capacity to rapidly develop necessary technical guidance, and the flexibility to address frequent regulatory guidance updates in a timely fashion. These lessons learned may guide similar health care providers posed with time-sensitive disruptions of in-person services.

Implementing Trustworthy AI in VA High Reliability Health Care Organizations.

Artificial intelligence (AI) has great potential to improve health care quality, safety, efficiency, and access. However, the widespread adoption of health care AI needs to catch up to other sectors. Challenges, including data limitations, misaligned incentives, and organizational obstacles, have hindered implementation. Strategic demonstrations, partnerships, aligned incentives, and continued investment are needed to enable responsible adoption of AI. High reliability health care organizations offer insights into safely implementing major initiatives through frameworks like the Patient Safety Adoption Framework, which provides practical guidance on leadership, culture, process, measurement, and person-centeredness to successfully adopt safety practices. High reliability health care organizations ensure consistently safe and high quality care through a culture focused on reliability, accountability, and learning from errors and near misses. The Veterans Health Administration applied a high reliability health care model to instill safety principles and improve outcomes. As the use of AI becomes more widespread, ensuring its ethical development is crucial to avoiding new risks and harm. The US Department of Veterans Affairs National AI Institute proposed a Trustworthy AI Framework tailored for federal health care with 6 principles: purposeful, effective and safe, secure and private, fair and equitable, transparent and explainable, and accountable and monitored. This aims to manage risks and build trust. Combining these AI principles with high reliability safety principles can enable successful, trustworthy AI that improves health care quality, safety, efficiency, and access. Overcoming AI adoption barriers will require strategic efforts, partnerships, and investment to implement AI responsibly, safely, and equitably based on the health care context.

A collaboration to harmonize COVID-19 health messaging and fill communication gaps during initial U.S. refugee resettlement.

To communicate with U.S.-bound refugees during travel to the United States during the onset of the COVID-19 pandemic, five federal and international organizations collaborated in a strategic work group to synergize COVID-19 prevention health messaging and COVID-19 considerations before, during, and after travel, as well as promote shared resources. This work group sought to establish consistent COVID-19 messaging, disseminate messages to partners, and identify message gaps as the pandemic evolved. In early Fall 2020, CDC released new communication materials, including a fact sheet, a welcome booklet, and infographics translated into 19 languages, to address refugee health partners' need for culturally and linguistically concordant educational materials for refugees. Rapidly changing health communications needs during the pandemic fostered opportunities for collaboration among federal and refugee health partners and highlighted a long-standing need among agencies to address health messaging across the continuum of care for refugees.

High rate of non-vaccine targeted high-risk HPV genotypes circulate among women in Eastern Ethiopia

The World Health Organization [WHO] recommends a genotype-specific human papillomavirus [HPV] vaccination as a primary prevention strategy to control the burden of cervical cancer globally. In Ethiopia, where the non-vaccine-targeted HPV genotypes have not been adequately studied, a vaccination initiative was launched in 2018 targeting HPV-6,-11, -16, and -18 for girls aged 14–18 years. The co-existence of both vaccine-targeted and non-targeted genotypes is a serious concern, as it can accelerate cancer progression. Therefore, this study was conducted to determine the prevalence of non-vaccine-targeted HPV genotypes and assess the level of multiple infections with other genotypes in eastern Ethiopia. A health facility-based cross-sectional study including 110 women with positive HPV DNA results was conducted from April to August 2021. A structured questionnaire to collect demographic and clinical data was used. Cervical swabs were collected using L-shaped FLOQSwabs. Women's cytological profile was determined based on Pap smear test results. An automated nucleic acid extraction system using STARMag 96 ProPrep Universal Extraction Kit was utilized following the manufacturer's protocol. An amplification assay in real-time was employed to amplify and identify the HPV Late 1 [L1] gene, which is utilized for genotyping purposes. Following this, the collected data was entered into Epi data version 3.1 software, and the analysis was performed using STATA version 14. A total of 110 women [age range 30–60 years, mean age = 36.5 years and SD ± 6.9] had positive HPV DNA results and were included in the study. Among these, 108 women had valid co-testing [Pap test and HPV DNA test] results for further analysis, and the results of the remaining 2 women were rejected. Overall, the prevalence of non-vaccine-targeted HPV was 56 (51.8%, 95%CI [0.42, 0.61]), of which 28 women (25.4%, 95%CI [0.18, 0.34]) had a single non-vaccine HPV genotype infection. The remaining 29 women (26.4%, 95% CI: 0.190–0.355) experienced multiple infections. The non-vaccine-targeted genotypes of HPV-35 accounted for 11 cases (10%, 95%CI [0.06, 0.17]), HPV-68 was detected in 9 women (8.2%, 95%CI [0.04, 0.15]), HPV-56 and HPV-66 were both found in 8 cases each (7.3%, 95%CI [0.04, 0.14]) of the total. In addition, out of these 108 women, 93 (86.1%, 95%CI [0.78, 0.91]) had low-grade squamous intraepithelial lesions, 13 (12%, 95%CI [0.07, 0.20]) no intraepithelial lesion or malignancy, and two (1.9%, 95%CI [0.01, 0.07]) high-grade squamous intraepithelial lesions. Furthermore, there was no statistical difference [p = 0.755] between vaccine-targeted and non-vaccine-targeted genotypes as the primary cause of cervical lesions. In conclusion, the findings of the present study highlight the existence of a notable prevalence of multiple infections caused by non-vaccine-targeted HPV genotypes. Therefore, it is recommended that both the Federal and regional health bureaus to evaluate the range of hr HPV genotypes protected by the current HPV vaccine and explore the option of transitioning from the quadrivalent HPV vaccine to a novavalent vaccine that includes seven high-risk HPV genotypes.

Will the United States pass on telemedicine progress?

During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare and Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of the flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023, and the United States has not made permanent decisions about telemedicine policy. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Here, we argue that we must continue the flexibilities to better understand telemedicine's quality, safety, and outcomes, and until the United States can develop an evidence-based digital health strategy. A premature regression to pre-pandemic telemedicine policies risks unintended consequences. We must continue the current policy flexibilities, safeguard against fraud and abuse, and immediately prioritize research and evaluation of telemedicine's quality, safety, and outcomes, to avoid unintended consequences and support more permanent policy decision-making.

The States' Hodgepodge of Physician Licensure Regulations.

The end of the federal COVID-19 public health emergency (PHE) on May 11, 2023, marked a pivotal shift in the landscape of telehealth regulation in the US. Kwan, Jolin, and Shachar analyze the implications of this transition by exposing inconsistencies in access to care. We agree that we now face a "convoluted patchwork of permanent and temporary changes to telehealth law and policy."1.

The Collaborative Improvement and Innovation Network for Children With Medical Complexity.

In response to a number of emerging issues, in 2017 the federal Maternal and Child Health Bureau funded its first collaborative quality improvement network aimed at improving the quality of life for children with medical complexity, the well-being of their families and the cost-effectiveness of their care. This paper is intended as a brief introduction to the Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity or CMC CoIIN project. In it, you will learn about the origins of the project, the guiding principles used to cocreate and promote measurable, meaningful family engagement in systems-level change efforts, its goals and objectives, the impact of the coronavirus disease 2019 pandemic on the project and some high-level learnings from our experiences, which have implications for future care delivery improvements for this growing and vulnerable population of children.

Extreme Heat and Pregnancy: A Content Analysis of Heat Health Risk Communication by US Public Health Agencies.

Exposure to extreme heat events increases the risk for negative birth outcomes, including preterm birth. This study sought to determine the presence and content of web-based heat health information for pregnant people provided by federal, state, and local government public health websites. This website content analysis consisted of 17 federal, 50 state, and 21 city websites, and noted which of 25 recognized pregnancy heat health data elements were included. Data for the analysis were collected from March 12, 2022, through March 16, 2022. The search identified 17 federal websites, 38 state websites, and 19 city websites with heat health information. Within these, only seven websites listed pregnant people as a vulnerable or at-risk population, and only six websites provided information related to heat health specifically for pregnancy. Of the 25 themes recognized as important for pregnancy risk during extreme heat exposure, only 11 were represented within these 6 websites. The presence of web-based pregnancy heat health information is infrequent and limited in content. Boosting web-based publication of extreme heat and pregnancy risks could mitigate negative maternal and child health outcomes.

Telehealth after the Federal COVID-19 Public Health Emergency: Implications and Future Directions.

May 11, 2023, marked the end of the federal COVID-19 Public Health Emergency (PHE). During the PHE, regulatory flexibilities allowed telehealth to more effectively connect physicians providing care and patients seeking it. This paper discusses the implications of the end of the PHE on telehealth coverage, payment, reimbursement, and licensure, and exposes inconsistencies and inequities in extant state regulations.

Lowering the Age of Consent for Vaccination to Promote Pediatric Vaccination: It's Worth a Shot.

This paper challenges historically preconceived notions surrounding a minor's ability to make medical decisions, arguing that federal health law should be reformed to allow minors with capacity as young as age 12 to consent to their own Centers for Diseases Control and Prevention (CDC)-approved COVID-19 vaccinations. This proposal aligns with and expands upon current exceptions to limitations on adolescent decision-making. This analysis reviews the historic and current anti-vaccination sentiment, examines legal precedence and rationale, outlines supporting ethical arguments regarding adolescent decision-making, and offers rebuttals to anticipated ethical counterarguments.

Low-Carbohydrate and Ketogenic Dietary Patterns for Type 2 Diabetes Management.

Type 2 diabetes mellitus (T2DM) has been traditionally considered a chronic, progressive disease. Since 2017, guidelines from the US Department of Veterans Affairs and US Department of Defense have included low-carbohydrate (LC) dietary patterns in managing T2DM. Recently, carbohydrate reduction, including ketogenic diets, has gained renewed interest in the management and remission of T2DM. This narrative review examines the evidence behind carbohydrate reduction in T2DM and a practical guide for clinicians starting patients on therapeutic LC diets. We present an illustrative case and provide practical approaches to prescribing a very LC ketogenic (< 50 g), LC (50-100 g), or a moderate LC (101-150 g) dietary plan and discuss adverse effects and management of LC diets. We provide a medication management and deprescription approach and discuss strategies to consider in conjunction with LC diets. As patients adopt LC diets, glycemia improves, and medications are deprescribed, hemoglobin A1c levels and fasting glucose may drop below the diagnostic threshold for T2DM. Remission of T2DM may occur with LC diets (hemoglobin A1c < 6.5% for ≥ 3 months without T2DM medications). Finally, we describe barriers and limitations to applying therapeutic carbohydrate reduction in a federal health care system. The effective use of LC diets with close and intensive lifestyle counseling and a safe approach to medication management and deprescribing can improve glycemic control, reduce the overall need for insulin and medication and provide sustained weight loss. The efficacy and continuation of therapeutic carbohydrate reduction for patients with T2DM appears promising. Further research on LC diets, emerging strategies, and long-term effects on cardiometabolic risk factors, morbidity, and mortality will continue to inform practice.

Protecting Refugees' Health: How is the Reinstated Interim Federal Health Program Working?

Protecting Refugees' Health: How is the Reinstated Interim Federal Health Program Working?

Teaching Grassroots Health Law, Policy and Advocacy: Service and Collaborative Learning.

This column describes the history, mission, and work of Saint Louis University School of Law's service-learning course Health Law, Policy and Advocacy: Grassroots Advocacy. Grassroots Advocacy allows law students to work with advocacy organizations on state and federal health policy initiatives, engaging in legislative and administrative advocacy and public education. The course uses community collaboration, community-led advocacy, and collaborative learning to train the next generation of health policy advocates for Missouri and the nation.

Overweight during development dysregulates cellular metabolism and critical genes that control food intake in the prefrontal cortex

Backgrounds and aimsChildhood obesity is increasing substantially across the world. The World Obesity Federation (WOF) and World Health Organization (WHO) predicted that in 2030 > 1 billion people will be obese, and by 2035 over 4 billion will reach obesity worldwide. According to WHO, the world soon cannot afford the economic cost of obesity, and we need to act to stop obesity acceleration now. Data in the literature supports that the first 1000 days of life are essential in preventing obesity and related adversities. Therefore, using basic research, the present a study that focuses on the immediate effect of overnutrition and serotonin modulation during the lactation period. MethodsUsing a neonatal overfeeding model, male Wistar rats were divided into four groups based on nutrition or serotonin modulation by pharmacological treatment up to 22 days of life. Cellular and mitochondrial function markers, oxidative stress biomarkers and mRNA levels of hedonic and homeostatic genes were evaluated. ResultsOur data showed that overfeeding during lactation decrease NAD/NADH ratio, citrate synthase activity, and increase ROS production. Lipid and protein oxidation were increased in overfed animals, with a decrease in antioxidant defenses, we also observe a differential expression of mRNA levels of homeostatic and hedonic genes. On the contrary, serotonin modulation with selective serotonin reuptake inhibitors treatment reduces harmful effects caused by overnutrition. ConclusionEarly effects of overnutrition significantly affect the prefrontal cortex at molecular and cellular level, which could mediate obesity-related neurodegenerative dysfunction.

In Case You Haven't Heard…

Federal health authorities have intensified their scrutiny of the drug ketamine for treating mental health disorders as the mind‐altering compound grows in popularity despite the lack of regulatory approval for such use, The Washington Post reported last week. The Food and Drug Administration (FDA) warned in October about the risks of using pharmacy‐made ketamine at home, citing the case of one patient whose breathing slowed to a dangerous level after taking a large dose outside of a health care facility. Then the autopsy of actor Matthew Perry, released Dec. 15, concluded a high dose of ketamine led to his death in October — an event that, while rare, drove home the dark side of the anesthetic that can also be abused recreationally. Meanwhile, the Drug Enforcement Administration continues to craft a rule that would set new limits on how health care professionals can use telemedicine to prescribe tightly regulated drugs like ketamine. Adam Kaplin, who observed the power of ketamine while overseeing clinical trials that led to the approval of Spravato, but also saw the inconvenience and cost that comes with the FDA‐required monitoring, said he is aiming to develop a derivative of ketamine with fewer side effects. The goal, said Kaplin, chief scientific officer of Mira Pharmaceuticals, is to create a drug that the FDA will endorse as safe for patients to take at home.

Governance Framework and Public–Private Partnership for Universal Health Coverage: Findings from India’s Federal Health Structure

Abstract Background: The role of private health sector in advancing universal health coverage is being recognised globally. A number of public–private partnership (PPP) strategies have been implemented across the states in India. States are primarily responsible for health service delivery in India. Objectives: To summarise various PPP schemes and projects in health sector across the states in India and to understand the ecosystem, i.e. policy, legal and institutional framework that are critical for effectively governing the partnerships. Materials and Methods: The study was carried out in two stages: a comprehensive desk review, followed by field visits for in-depth interviews (IDIs) of key stakeholders in selected states. A total of 52 IDIs were conducted from various levels of stakeholders. Results: Nearly 250 PPP initiatives in health sector across all Indian states were identified and studied. Partnership with the private sector was predominantly in the areas of emergency transport and laboratory diagnosis and in the delivery of selected primary care services. PPPs in health infrastructure (hospitals and medical colleges) and purchasing arrangements are rapidly emerging across most states. However, only few Indian states have health sector-specific PPP policy or legal and/or institutional framework governing PPPs and organisational units implementing partnership schemes. The capacity to conceive, design, implement and manage PPPs in health sector was found either absent or insufficient in most states. Conclusion: There is a need for developing mechanisms for effective and functional partnerships with the PHS for achieving national health policy goals in India. There is a need for well-enunciated policy and governance framework for private sector engagement. Indian union and state governments need to do detailed assessment of the PHS market behaviour; legal, regulatory and oversight mechanisms; building organisational structures with capacities and developing platforms for stakeholder dialogue. Findings from the Indian context could offer useful insights for other low- and middle-income countries aiming to advance towards achieving universal health coverage.

Governing failed neoliberal subjects: Representations of women’s mental health in Australian mental health policies

This paper uses Carol Bacchi’s ‘What’s the problem represented to be?’ (WPR) framework to explore representations of women’s mental health in federal and South Australian mental health policies. It argues that mental health policies govern women through neoliberal discourses that individualise mental health and illness while neglecting the social structural factors which significantly influence mental health outcomes and health equity. In a ‘self-monitoring’ neoliberal society, people are increasingly required to seek medical and pharmaceutical intervention to promote ideal personhoods, with women overrepresented in this group. The disciplinary power of the medicalisation discourse categorises women as either ideal or failed neoliberal subjects. This is concerning for social workers because neoliberal and medicalisation discourses shape how women’s mental health is represented in policy and responded to in practice. This paper challenges biomedical and neoliberal discourses underpinning policy representations and identifies the implications for social work and social policy.