Improve Health Policy Research Articles

Alternative Methods for Vehicle Emission Modelling and Its Impact on Local Road Transport Emission Inventories in Bradford, UK

Background Estimates of road vehicle exhaust emissions are some of the key inputs to air pollution dispersion models which are used to estimate ambient air pollution levels, human exposure to traffic-related air pollution, and associated health effects and impacts. Current UK vehicle emission estimates for hot exhaust pollutants are derived using functions of the average vehicle speed, over a trip. These average-speed-emission functions are often sourced from a widely used regional European emission model referred to as COPERT. COPERT has been repeatedly shown to underestimate actual exhaust emissions that occur in real-world driving. We aimed to produce a set of more reliable and transparent average-speed-emission functions for all vehicle types and EURO emission standards operating in Bradford, UK. Methods We undertook thirty-three hours of real-world driving over Bradford, UK, in an instrumented Toyota Prius (Euro 5, 2.0l petrol-electric hybrid) equipped with a VBoxII Lite and an OBD Mini data logger; both of which logged the vehicle instantaneous speeds over tracked journeys. The collected instantaneous speeds were verified and fed into the Instantaneous Emission Model PHEM which estimated the second-by-second emissions of NO x for 167 vehicle types and emissions standards. Using these outputs, and following a novel micro-trip approach which splits the driving cycles into smaller driving events contained between adjacent stationary periods (stop-start), new vehicle average-speed-emissions functions were developed. These functions were then linked to speeds and flows modelled and validated in Bradford and were used to estimate NO x road transport emission inventory. Estimates were also derived from COPERT. Results We developed 167 new NO x average-speed-emission functions for the full fleet in Bardford. Compared to COPERT, our functions produced higher emission estimates at the lower speeds which incorporate significant proportions of stop-start driving. Our functions estimated that in the AM peak petrol cars (55.43% of all vehicles) produced 12% of all NO x emissions, diesel cars (26.83% of all vehicles) produced 25%, diesel buses and coaches (1.55% of all vehicles) produced 21%, light duty vehicles (12.54%) produced 14% and heavy duty vehicles (2.13% of all vehicles) produced 27% of NO x . Conclusions This work has shown important differences between predicted emissions from both models and suggested that COPERT may significantly under-predict the air pollution contribution from slower traffic. More data is needed at the higher speed segments and both models need further validation. The two models predicted different emission contributions from the different vehicle classes and this has consequences for health improvement policies.

Hand washing among health workers in tertiary health facilities in Bayelsa State, Nigeria

Background: Hand washing is a cheap and effective method of preventing nosocomial infections by health workers, but it has not been given strong policy support for resource allocation. Objectives: To describe knowledge, attitude and practice of handwashing among health care workers and to identify the factors affecting the practice in tertiary health care facilities in Bayelsa State. Methods: Four groups of health workers who work directly with patients at the Niger Delta University Teaching Hospital and Federal Medical Centre, both in Yenagoa Local Government Area of Bayelsa state, were studied. A multi-stage sampling was conducted to select 224 respondents. Self-administered and interviewer-administered questionnaires were used to collect data which were then analysed on the Microsoft Excel programme.Response rate of 91.50% (205 respondents) was achieved. Krejcie and Morgan’s sample size formula was used at 95% confidence level. Results: 140 (68.30%) of all respondents had good knowledge of hand washing and about half have excellent hand washing practice. But only 44 (21.5%) had very good knowledge of nosocomial infections. The lack of materials such as soap, water and towels are limiting good hand washing practice. Conclusions: Although there is good knowledge of hand washing and of nosocomial infections as well as good attitude towards hand washing, they have no positive correlation with practice. Inadequate resources may be worsening nosocomial infections. Improved health policy for more health manpower and accessible resources for more regular hand washing are recommended.

Effects of Public Health Insurance on Labor Supply in Rural China

Purpose Since the implementation of the New Cooperative Medical Scheme (NCMS) in 2003, this program has experienced rapid growth. Even so, little is known about the association between NCMS expansion and labor force supply among rural residents in China. The purpose of this paper is to examine the effects of the NCMS on labor force supply for rural Chinese populations. Design/methodology/approach Using data from the China Health and Nutrition Survey (CHNS), a difference-in-differences (DD) approach is employed to estimate the impact of NCMS expansion on labor supply outcomes, including hours of worked in agriculture, off-farm labor force participation, not working, and weeks off due to illness. A number of falsification tests are conducted to identify whether the assumption of common trends of DD analyses is satisfied. The robustness of results is checked through additional estimation, including panel fixed effects and instrumental variable approach. Findings Results show that the NCMS expansion has a positive effect on the hours of worked in agriculture and off-farm labor force participation, and reduces the likelihood of not working and weeks off due to illness. The effect on hours of agricultural production is larger for male adults, those aged 50 or more, and individuals in low-income families. This study demonstrates the importance of potential health improvements from public health insurance in promoting rural residents’ labor productivity. Originality/value Studies concerning the effects of public health insurance on labor supply in developing countries remain limited. The findings of this study provide important insights into how public health insurance programs, like the NCMS, may affect patterns of labor supply among rural residents, and can help policymakers improve health policies aimed to reduce the number of uninsured farmers while maintaining high levels of labor supply, productivity, and health status among the most vulnerable of populations.

Estado nutricional de crianças segundo critérios do SISVAN em municípios do estado de Alagoas

The aim of the study was to evaluate the nutritional status of children under five in the most populated municipalities of Alagoas, and to compare the results with the population referring in the Northeast of Brazil and all of Brazil, using data from SISVAN, 2013. The populations studied, according to the municipalities were 10,642, 4,351, 1,752, 803 and 3,207 children in Maceio, Arapiraca, Palmeira dos Indios, Rio Largo and Uniao dos Palmares, respectively. For the northeast region, the total was 225,252 children and for Brazil, 527,243. The cross-sectional study used as outcome variables, stunting and overweight, the Body Mass Index/Age and Height/Age, respectively, according to the WHO classification. The stunting ranged from 9% to 15% in the cities studied. In Alagoas, Brazil, and the Northeast, prevalence was approximately 14%. Regarding the risk of overweight, prevalence rates were found between 16% to 20%. Overweight was approximately 13% and obesity from 7.6% to 12.8% in the municipalities of Alagoas. Brazil, Alagoas and the Northeast showed a prevalence for overweight from 17.1% to 19.5%. Excess weight showed high among children, in the evaluated areas without malnutrition has been eradicated. Therefore, the importance of SISVAN for the nutritional diagnosis and the implementation of health improvement policies of the population assisted by the SUS must be recognized.

The epidemiology of chronic pain in Libya: a cross-sectional telephone survey.

BackgroundChronic pain is a public health problem although there is a paucity of prevalence data from countries in the Middle East and North Africa. The aim of this study was to estimate the prevalence of chronic pain and neuropathic pain in a sample of the general adult population in Libya.MethodsA cross-sectional telephone survey was conducted before the onset of the Libyan Civil War (February 2011) on a sample of self-declared Libyans who had a landline telephone and were at least 18 years of age. Random sampling of household telephone number dialling was undertaken in three major cities and interviews conducted using an Arabic version of the Structured Telephone Interviews Questionnaire on Chronic Pain previously used to collect data in Europe. In addition, an Arabic version of S-LANSS was used. 1212 individuals were interviewed (response rate = 95.1 %, mean age = 37.8 ± 13.9 years, female = 54.6 %).ResultsThe prevalence of chronic pain ≥ 3 months was 19.6 % (95 % CI 14.6 % to 24.6 %) with a mean ± SD duration of pain of 6 · 5 ± 5 · 7 years and a higher prevalence for women. The prevalence of neuropathic pain in the respondents reporting chronic pain was 19 · 7 % (95 % CI 14 · 6-24 · 7), equivalent to 3 · 9 % (95 % CI 2 · 8 to 5 · 0 %) of the general adult population. Only, 71 (29 · 8 %) of respondents reported that their pain was being adequately controlled.ConclusionsThe prevalence of chronic pain in the general adult population of Libya was approximately 20 % and comparable with Europe and North America. This suggests that chronic pain is a public health problem in Libya. Risk factors are being a woman, advanced age and unemployment. There is a need for improved health policies in Libya to ensure that patients with chronic pain receive effective management.

Growth of linked hospital data use in Australia: a systematic review.

Objective The aim of the present study was to quantify and understand the utilisation of linked hospital data for research purposes across Australia over the past two decades. Methods A systematic review was undertaken guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. Medline OVID, PsycINFO, Embase, EconLit and Scopus were searched to identify articles published from 1946 to December 2014. Information on publication year, state(s) involved, type of data linkage, disease area and purpose was extracted. Results The search identified 3314 articles, of which 606 were included; these generated 629 records of hospital data linkage use across all Australian states and territories. The major contributions were from Western Australia (WA; 51%) and New South Wales (NSW; 32%) with the remaining states and territories having significantly fewer publications (total contribution only 17%). WA's contribution resulted from a steady increase from the late 1990s, whereas NSW's contribution is mostly from a rapid increase from 2010. Current data linkage is primarily used in epidemiological research (73%). Conclusion More than 80% of publications were from WA and NSW, whereas other states significantly lag behind. The observable growth in these two states clearly demonstrates the underutilised opportunities for data linkage to add value in health services research in the other states. What is known about the topic? Linking administrative hospital data to other data has the potential to be a cost-effective method to significantly improve health policy. Over the past two decades, Australia has made significant investments in improving its data linkage capabilities. However, several articles have highlighted the many barriers involved in using linked hospital data. What does this paper add? This paper quantitatively evaluates the performance across all Australian states in terms of the use of their administrative hospital data for research purposes. The performance of states varies considerably, with WA and NSW the clear stand-out performers and limited outputs currently seen for the other Australian states and territories. What are the implications for practitioners? Given the significant investments made into data linkage, it is important to continue to evaluate and monitor the performance of the states in terms of translating this investment into outputs. Where the outputs do not match the investment, it is important to identify and overcome those barriers limiting the gains from this investment. More generally, there is a need to think about how we improve the effective and efficient use of data linkage investments in Australia.

Exploratory study of the role of knowledge brokers in translating knowledge to action following global maternal and newborn health technical meetings

ObjectivesThere have been increasing calls for more research on interventions to successfully translate evidence-based knowledge into improved health policy and practices. This paper reports on an exploratory study of knowledge translation interventions conducted with participants of global health meetings held in Bangladesh in 2012 and in South Africa in 2013. We measured stakeholders' uptake of evidence-based knowledge in terms of their translation of this knowledge into actions around public health policy and practice. The research sought to determine whether participants shared and used knowledge from the meetings to improve health policy and practices in their settings and the factors influencing sharing and use. Study designAn exploratory study employed quantitative and qualitative methods of online surveys and in-depth interviews to collect data from all meeting participants. MethodsAll participants in the Bangladesh and South Africa meetings were invited to complete an online survey during the meetings and over the following six weeks. Of 411 participants in the 2012 Bangladesh meeting, 148 participants from 22 countries completed the survey. Eleven of these respondents (from eight countries) were interviewed. Of the 436 participants in the 2013 South Africa meeting, 126 respondents from 33 countries completed an online survey; none of these respondents were interviewed. ResultsThe analysis revealed that most respondents used new knowledge to advocate for policy change (2012: 65.5%; 2013: 67.5%) or improve service quality (2012: 60.1%; 2013: 70.6%). The type of knowledge that respondents most commonly shared was clinical or scientific information (2012: 79.1%; 2013: 66.7%) and country-specific information (2012: 73.0%; 2013: 71.4%). Most 2012 respondents shared knowledge because they thought it would be useful to a co-worker or colleague (79.7%). DiscussionFindings on knowledge use and sharing suggest that most respondents saw themselves as knowledge brokers or intermediaries in a position to influence the translation of knowledge into action in health policy and practices in their countries. Results suggest that supporting knowledge brokers working in a local and regional context to spur change, as described in the paper, has the potential to improve health outcomes. Further research is needed to isolate specific interventions and their knowledge translation outcomes.

Incidence and survival of adult cancer patients in Taiwan, 2002-2012.

Little is known about the annual changes in cancer incidence and survival that occurred after the establishment of the long-form cancer registry database in Taiwan. Therefore, this study aimed to investigate the updated incidence and stage-specific relative survival rates (RSRs) among adult cancer patients in Taiwan. Cancer incidence data from 2002 to 2012 were collected using the Taiwan Cancer Registry Database. Age-standardized incidence rates, average annual percent changes (AAPCs), and sex ratios were calculated for adults. Five-year stage-specific RSRs were estimated for cases diagnosed between 2004 and 2008 and were followed up to 2013 for major cancers. The overall age-standardized incidence rates per 100,000 populations increased from 348.39 in 2002 to 401.18 in 2012, and the AAPC was 1.7% (p<0.05), whereas the male:female ratio was approximately 1:3 during the entire period. Most cancer sites showed a trend of increasing incidence, with the exception of common cancers such as cervix uteri (AAPC=-6.2%, p<0.05), bladder (AAPC=-2.5%, p<0.05), stomach (AAPC=-2.4%, p<0.05), nasopharynx (AAPC=-1.2%, p<0.05), and liver (AAPC=-1.1%, p<0.05). The 5-year RSRs for Stage I cancers were greater than 93% for the colon and rectum, female breast, and cervix uteri, whereas RSRs for patients with Stage IV cancers ranged from 2.9% to 38.9%, with patients with liver cancer and those with oral cancer showing the lowest and highest RSRs, respectively. Our study showed increased incidence in most cancers and provided baseline estimates of stage-specific RSRs among the Taiwanese adult population. Continuous surveillance may help politicians to improve health policies and cancer care in Taiwan.

Chapter 10 - Epidemiology of epilepsy

Modern epidemiology of epilepsy maximizes the benefits of advanced diagnostic methods and sophisticated techniques for case ascertainment in order to increase the diagnostic accuracy and representativeness of the cases and cohorts studied, resulting in better comparability of similarly performed studies. Overall, these advanced epidemiologic methods are expected to yield a better understanding of diverse risk factors, high-risk populations, seizure triggers, multiple and poorly understood causes of epilepsy, including the increasing and complex role of genetics, and establish the natural course of treated and untreated epilepsy and syndromes - all of which form the foundation of an attempt to prevent epileptogenesis as the primary prophylaxis of epilepsy. Although data collection continues to improve, epidemiologists still need to overcome definition and coding variability, insufficient documentation, as well as the interplay of socioeconomic factors and stigma. As most of the 65-70 million people with epilepsy live outside of resource-rich countries, extensive underdiagnosis, misdiagnosis, and undertreatment are likely. Epidemiology will continue to provide the necessary information to the medical community, public, and regulators as the foundation for improved health policies, targeted education, and advanced measures of prevention and prognostication of the most common severe brain disorder.

Human Mobility and Accident and Emergency (A&amp;E) Department: A contribution to the knowledge of invisible flows

This article provides a full report of the results of a feasibility study for a project based on the combination of clinical figures with socio-economic data on human mobility within the metropolitan area of Rome. Acknowledging that Accident and Emergency (A&E) Departments represent privileged observatories of health issues of a given territory, the point of departure of this study is the patient register dataset of the A&E Department of the Policlinico Umberto I for the period 2000-2013. The data analysis reveals the existence of a specific relationship between diagnostic groups and certain ethnicities immigrated to Rome. Through a multidisciplinary approach, the analysis undertaken aims to improve the medical practice of the personnel working in facilities for immigrants. The knowledge acquired from the study can be in fact useful to quickly detect specific clinical patterns, overcoming any cultural barrier or linguistic obstacle. Moreover, the analysis can provide suggestions to improve health policies, creating, together with the relevant healthcare facilities, pathways for prevention and care of certain diseases.

A review of environmental and occupational exposure to xylene and its health concerns.

Xylene is a cyclic hydrocarbon, and an environmental pollutant. It is also used in dyes, paints, polishes, medical technology and different industries as a solvent. Xylene easily vaporizes and divides by sunlight into other harmless chemicals. The aim of the present review is to collect the evidence of the xylene toxicity, related to non-cancerous health hazards, as well as to provide possible effective measurement to minimize its risk ratio. For current study a bibliographic search of more than 250 peer-reviewed papers in scientific data including PubMed, and Google Scholar about xylene was done. But approximately 130 peer-reviewed papers relevant to xylene were included (Figure 1(Fig. 1)). All scientific data was reviewed with key words of “xylene toxicity”, “xylene toxic health effects”, “environmental volatile organic compounds”, “human exposure to xylene”, “xylene poisoning in laboratory workers”, “effects of xylene along with other hydrocarbons”, “neurotoxicity of selected hydrocarbons”, and “toxic effects of particular xylene isomers in animals”. According to these studies, xylene is released into the atmosphere as fugitive emissions from petrochemical industries, fire, cigarette, from different vehicles. Short term exposure to mixed xylene or their individual isomers result in irritation of the nose, eyes and throat subsequently leading toward neurological, gastrointestinal and reproductive harmful effects. In addition long term exposure to xylene may cause hazardous effects on respiratory system, central nervous system, cardiovascular system, and renal system. The health concerns of xylene are well documented in animals and human. It is important to improve health policies, launch xylene related health and toxicity awareness campaigns, to get rid of its dangerous outcomes. Chronic diseases have become a threat to human globally, with special prominence in regions, where xylene is used with other chemicals (benzene, toluene etc.) especially in petroleum and rubber industry. The mechanism of toxicity and interactions with endocrine system should be followed up which is the main threat to human health.

Leprosy in a University Hospital in Southern Brazil.

BACKGROUNDLeprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years.OBJECTIVESTo evaluate the epidemiological profile of patients followed at a University Hospital.MATERIALS AND METHODSThis is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.RESULTSThe mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.CONCLUSIONSThis study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.

Health disparities among the western, central and eastern rural regions of China after a decade of health promotion and disease prevention programming

Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate (IMR), maternal mortality rate (MMR) and under 5 mortality rate (U5MR) had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR (65.05%); whereas, western rural China had the greatest reduction in MMR (72.99%) but smallest reduction in U5MR (57.36%). Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators (odds ratios): IMR (central: 2.13; western: 5.31), U5MR (central: 2.25; western: 5.69), MMR (central: 1.94; western: 3.31), and prevalence of infectious diseases (central: 1.62; western: 3.58). The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health disparities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Help seeking behavior of women with self-discovered breast cancer symptoms: a meta-ethnographic synthesis of patient delay.

Background and ObjectivePatient delay makes a critical contribution to late diagnosis and poor survival in cases of breast cancer. Identifying the factors that influence patient delay could provide information for adopting strategies that shorten this delay. The aim of this meta-ethnography was to synthesize existing qualitative evidence in order to gain a new understanding of help seeking behavior in women with self-discovered breast cancer symptoms and to determine the factors that influence patient delay. MethodsThe design was a meta-ethnography approach. A systematic search of the articles was performed in different databases including Elsevier, PubMed, ProQuest and SCOPUS. Qualitative studies with a focus on help seeking behaviors in women with self-discovered breast cancer symptoms and patient delay, published in the English language between 1990 and 2013 were included. The quality appraisal of the articles was carried out using the Critical Appraisal Skills Programme qualitative research checklist and 13 articles met the inclusion criteria. The synthesis was conducted according to Noblit and Hare’s meta-ethnographic approach (1988), through reciprocal translational analysis and lines-of-argument.FindingsThe synthesis led to identification of eight repeated key concepts including: symptom detection, initial symptom interpretation, symptom monitoring, social interaction, emotional reaction, priority of medical help, appraisal of health services and personal-environmental factors. Symptom interpretation is identified as the important step of the help seeking process and which changed across the process through active monitoring of their symptoms, social interactions and emotional reactions. The perceived seriousness of the situation, priority to receive medical attention, perceived inaccessibility and unacceptability of the health care system influenced women’s decision-making about utilizing health services.ConclusionHelp seeking processes are influenced by multiple factors. Educational programs aimed at correcting misunderstandings, erroneous social beliefs and improving self-awareness could provide key strategies to improve health policy which would reduce patient delay.

Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

Measures of Highly Functioning Health Coalitions: Corollaries for an Effective Public Health System

In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on 20 questions serving as proxy measures of functional characteristics. Eight functional characteristics related to structure, operations and leadership were identified. These characteristics are essential in further developing and tracking capacity and performance of health coalitions serving as an advisory and possibly decision making entity of the LPHS. This study also lays the groundwork to explore how to link coalition function with performance to determine characteristics that are most strongly associated with optimal performance and population health. [ABSTRACT FROM AUTHOR]

Health big data analytics: current perspectives, challenges and potential solutions

Modern health information systems can generate several exabytes of patient data, the so called ‘health big data’, per year. Many health managers and experts believe that with the data, it is possible to easily discover useful knowledge to improve health policies, increase patient safety and eliminate redundancies and unnecessary costs. The objective of this paper is to discuss the characteristics of health big data as well as the challenges and solutions for health big data analytics (BDA) – the process of extracting knowledge from sets of health big data – and to design and evaluate a pipelined framework for use as a guideline/reference in health BDA.

Feeding Infants with Cleft Lip and/or Palate in Brazil: Suggestions to Improve Health Policy and Research

Objective : To verify feeding resources used prior to corrective surgery among cleft babies from Brazil and to discuss suggestions to improve common feeding problems around the world. Design : Cross-sectional descriptive study conducted at eight medical centers. Participants : A total of 215 parents or guardians of cleft children. Methods : Interview based upon a prevalidated questionnaire. The chi-square test and comparison of means by analysis of variance were used; significance level adopted was 5% (P < .05). Results : Feeding guidelines were provided in the maternity unit to 53% of the families. Breast-feeding was encouraged among 80% of mothers, predominantly in the South (P = .016). However, follow-up after maternity discharge was not appropriately carried out and failure to breast-feed occurred in 78% of families. The feeding tube was used in 21%. According to families, for those who used the ordinary nipple, it was considered the best option by the majority (29%). Conclusion : Neonatal feeding in cleft babies is a global challenge. Reports about the difficulties encountered and successful experiences would be helpful to disseminate strategies and stimulate research directed at the large-scale applicability of neonatal feeding for cleft babies on public health. This study detected the need to increase professional training and emphasizes the need for public policies addressing neonatal referral to specialized care wherever possible. It also stimulates research into using an ordinary nipple as another resource for feeding cleft babies and suggests an international discussion about specific recommendations for humanized primary health care.

Pharmaceutical supply chain and inventory management strategies: Optimization for a pharmaceutical company and a hospital

A high level of service for medical supplies and effective inventory policies are essential objectives for all health care industries. Medicine shortages and improper use of pharmaceuticals can not only lead to financial losses but also have a significant impact on patients. Many health systems and hospitals experience difficulties in achieving these goals as they have not addressed how medicines are managed, supplied, and used to save lives and improve health. Studies are essential to understand operations in health care industries and to offer decision support tools that improve health policy, public health, patient safety, and strategic decision-making in the pharmaceutical supply chain. We present an inventory model that integrates continuous review with production and distribution for a supply chain involving a pharmaceutical company and a hospital supply chain. The model considers multiple pharmaceutical products, variable lead time, permissible payment delays, constraints on space availability, and the customer service level (CSL). We develop a procedure for determining optimal solutions for inventory lot size, lead time, and the number of deliveries to achieve hospital CSL targets with a minimum total cost for the supply chain. A numerical example illustrates the model application and behavior.

Innovation in Newborn Hearing Screening in Peru: Applying Design Thinking to Improve Health Policy

Objectives: 1) Apply Design Thinking methodology to create an innovative national program for newborn hearing screening (NHS) in Peru. 2) Collaborate with Peruvian Ministry of Health to optimize implementation of a newly mandated national NHS program. 3) Provide a model for expanding NHS throughout the developing world. Methods: Descriptive study with focus groups and guided interviews. Design Thinking is a human-centered approach to interdisciplinary problem solving that tackles complex problems with many stakeholders. Insight is gained through immersion, observation, and engagement. Study dates: June-December 2012. Condition studied: Permanent congenital hearing loss. Subjects: Stakeholders involved in NHS. Policy-makers: officials, politicians, academic physicians. Providers: audiologists, pediatricians, otolaryngologists, health workers. Recipients: neonates, mothers, hearing-impaired children and families. Field sites included community clinics, tertiary care hospitals, ministry of health offices, schools for the deaf, audiology offices, and patient homes. Results: Interviewed 105 individual stakeholders at 14 sites. Data were captured in logbooks, photography, and video. Data obtained from this work were applied in the following ways: creation of a needs assessment tool for use in Peruvian hospitals to facilitate implementation of NHS; inclusion of NHS data in Peru’s national electronic medical record; development of educational resources, both online and classroom-based for providers of NHS. Conclusions: This work represents the first application of Design Thinking to innovate in health policy at a national level. Through publication of these methods, the authors hope to empower providers throughout the developing world to broaden access to NHS.