Health Policy Management Research Articles

Epidemiological determinants of poisoning in pediatric age group around Jamnagar district, Gujarat

Background: Pica, hunger, or thirst are common causative factors for poisoning in childhood. Children are at more risk of accidental poisoning due to their impulsive alertness, curious mind, virtue, and habit of mouthing of objects. There are many measures for interruptions and safety to prevent poisoning in pediatric age group still morbidity and mortality among children are higher. Health policy makers and managers should have robust information regarding types of poisoning, place, substances, etc. to prepare effective protective strategies. This study will provide such information. Aim and Objectives: The aim of the study was to identify epidemiological determinants of poisoning in pediatric age group. Materials and Methods: It is an observational and cross-sectional study. Total study population (n = 204) of poisoning in the age group (1–13 years) conducted at M.P. Shah Medical College, Guru Govind Sinh hospital, Jamnagar. Data were collected from the Medical Records Department section of hospital, from January to December for 1 year of 2013. Results: Kerosene was the most frequent poisoning agent found in this study. Incidence establishes more in age group of 2–4 years. Boys were affected much as compared to girls. Home was found common place of oisoning, others were playground and school. All cases were accidental in nature. April and October months have more cases as compared to other months. Conclusion: Majority of the cases were accidental in nature among young children so precautions like conventional storage methods and disposal facilities of chemicals or guardian awareness can sufficiently decrease the occurrence.

Epidemiological study and health management of an imported incident of COVID–19 asymptomatic cases in Haikou, China

Background: To control the imported risks brought by all international arrivals, China Customs has implemented strict closed-loop health management policy called “three checks, three screenings and one transfer”. This study provides epidemiological evidence for prevention and control measures on imported cases of asymptomatic infections and describes the current COVID-19 prevention and control system on imported risks in China. Methods: We retrospectively analyzed an imported incident of three asymptomatic carriers. Serum SARS-CoV-2 IgM and IgG antibodies were detected by chemiluminescence and gold immnnochromatography(GICA). Results: Three cases were reported positive for SARS-CoV-2 nucleic acid on their arrival, total antibodies and IgG, but negative for IgM. The Ct values of cases A, B and C were 34/36/36, 32/33/32 and 25/31/29, respectively. There were 10726434 pair-end reads sequenced for case C, and approximate 80% reads were aligned to the hCoV-19/Wuhan/IVDC-HB-01/2019 genome (EPI_ISL_402119). The viruses of case A and C were homologous and came from the SARS-CoV-2 variant. Conclusion: Serum antibody IgM and IgG tests are recommended for international travelers from epidemic areas. The “three checks, three screenings and one transfer” policy implemented at custom's entry points was effective in COVID-19 prevention and control.

Implementation of Electronic Health Record and Health Insurance Management System using Blockchain Technology

Implementation of Electronic Health Record and Health Insurance Management System using Blockchain Technology

Factors influencing the use of hearing protection devices in Irish mine workers

Background: Workers who are exposed to high levels of noise should consider wearing HPDs when elimination of noise cannot be put in place. There are several factors including health and safety management systems, peers and policy that could influence workers to either use or not use HPDs. Objectives: To determine worker’s perception of noise risk in a mining setting and to determine if there is an association between organisational rules, knowledge, and the wearing of Hearing Protection Devices (HPDs). Methods: A cross- sectional study was conducted at a mining setting in Ireland in which 116 workers participated; a self-administered questionnaire survey was used. Data analysis was carried out using descriptive statistics and binary regression analysis. Results: The study had a response rate of 94% of the entire population. The mean exposure to noise levels that require HPDs is 5.32 hours. The results showed an association between using HPDs and organisation rules; and no association between preventing abnormal hearing, perceived influences in the workplace, knowledge and information. Conclusion: Factors that can influence workers likelihood to wear HPDs are organisation rules; this is unaffected by the influence of colleagues. Each company should have a clear policy to encourage workers to wear HPDs for preventing Noise Induced Hearing Loss (NIHL). Application: The findings highlighted that a company’s health and safety policy is important to encourage employees to wear HPDs. Mine settings or noisy workplaces should have transparent policies for employees to follow and benefit their hearing health, even if an employee is not aware of the full content of a policy, aspects are known.

Systematic review on economic hardship, debt and psychological well-being in western countries

Financial hardship is a phenomenon which mediates many other factors in life regardless of age group one of many is well-being. Well-being is a multi-disciplinary term. This paper will investigate existing literature on the effect of financial hardship on well-being using systematic review to minimize the biases. The data will be systematically searched with following databases: Wiley-online library, Google scholar, JSTOR, Tandfonline and Emerald. The present study is a systematic review of English language research of 2010 to 2020 research papers on financial hardship and well-being. The databases used in the research are Wiley Online Library, Google Scholar with keywords financial hardship, financial pressure, financial challenges, stress, wellbeing, anxiety, psychological well-being. 81 studies were excluded and 12 studies were selected after reviewing the title and abstract of 93 studies based on the PRISMA. The inclusion and exclusion criteria allow studies of 2010 to 2021 to be considered. Fewer data was present in the subject of wellbeing and financial stress. However, the results show impact of both variables. Financial pressure leads to poor wellbeing and other factors such as lack of social support, unhealthy family environment and dept can robust the impact. The research makes a unique new contribution in research, lending support for policy, academic theory, new contributions to current literature not found elsewhere, especially mental health management policy.

Factors associated with loyalty in the mutual health of Kisantu inDemocratic Republic of the Congo

Some African countries have initiated mutual health insurance to improve access to health care, However, most of these initiatives have not succeeded in covering the majority of the population, nor in securing long-term loyalty. Considering that very few studies, if not none, allude to the Democratic Republic of Congo (DRC), this study aims to determine the explanatory factors for both loyalty and non-loyalty within the Kisantu health mutual insurance in DRC and to identify any specific factors in the urban-rural Congolese context. We conducted a five-year prospective study, starting in 2013, among 320households, selected among a cohort of 2202households. Using the SPSS® 21.0 software, the association between loyalty and socio-demographic, socioeconomic variables and the degree of satisfaction with insurance products, as well as the motivations with respect to targeted loyalty, was sought. Thus, we found that the sociodemographic characteristics were not associated with loyalty of payments. In contrast, statistically significant relations were found between loyalty and socioeconomic characteristics, including occupation, estimated income, as the motivations expressed with regard to loyalty (P≤0.001). In a logistic regression model, occupation, estimated household income of $100 or above were twice more likely to be loyal than those with an income below $100. Protection by income has not been identified as a predictor in the studies included in our survey of the literature, but it proved to be significantly associated with loyalty in the present study. On the other hand, beyond the fidelity factors observed in this study, aspects relating to the management of mutual health insurance, which have appeared as predictors in other contexts, are not identified as such in our community. In an urban - rural context in DR Congo where the majority of the population has a low and unstable income, and considering the low amount of contribution to the Kisantu health mutual, 4.2% of the median household income, it will be necessary therefore rethink the place of health spending in households and the extension of solidarity in the form of uniform or income-based contributions.

Registered Nurses' Perceptions After a Patient with Ebola Virus Disease Is Admitted to Their Hospital.

Emerging diseases affect the nursing workforce, but little is known about the willingness of registered nurses (RNs) to work during outbreaks (eg, Ebola virus disease, COVID-19). The objective of our study was to examine the perceptions and attitudes of RNs in the United States regarding their duty to care and willingness to work after a patient infected with the Ebola virus was admitted to their hospital. We performed a quantitative, descriptive study using social media to recruit critical care RNs to complete an online survey. A total of 72 RNs completed the survey. While only 20 respondents reported providing direct care, more than half (n = 38) reported that family members asked them not to work with patients infected with the Ebola virus. A majority of respondents (n = 63) agreed that healthcare workers have a duty to help sick people despite high risks to themselves or their families; however, 59 agreed that family responsibilities would take priority. Respondents were less likely to work if their partners (n = 11) or children (n = 7) were ill but more likely to work if colleagues were infected (n = 48) or dying (n = 40). Shunning was experienced by 32 respondents, and 25 knew of others who were shunned. We observed several factors that affect RNs' willingness to provide care when patients are admitted, including moral conflict between their duty to treat sick people and their duty to protect their family. As part of infectious disease emergency planning, health policy managers should consider these complex factors, which may modulate effective patient care. While this study was limited to RNs in the United States during an Ebola virus disease outbreak, the results signal a need for similar research on other emerging infections such as COVID-19.

VANTAGENS E DESAFIOS DOS CONSÓRCIOS INTERMUNICIPAIS DE SAÚDE: UM ENSAIO TEÓRICO

The loss of resources for public policies requires public authority a more integrated work. Therefore, the organizational networking becomes an alternative to support society’s demands of health. In the Brazilian public health system (SUS), it is possible to notice a process of authority’s decentralization, giving more management autonomy to municipalities, which have found in intermunicipal health consortia (CIS) a way to promote joint efforts from the jointly management of plans to provide several health-related services. In this way, this theoretical essay aimed to discuss inter-municipal health consortia as organizational networks in the public sector, showing how these networks can assist the management of health policies, by presenting the advantages and challenges of both implementation and maintenance of the CIS.

Prediction of viral symptoms using wearable technology and artificial intelligence: A pilot study in healthcare workers.

Conventional testing and diagnostic methods for infections like SARS-CoV-2 have limitations for population health management and public policy. We hypothesize that daily changes in autonomic activity, measured through off-the-shelf technologies together with app-based cognitive assessments, may be used to forecast the onset of symptoms consistent with a viral illness. We describe our strategy using an AI model that can predict, with 82% accuracy (negative predictive value 97%, specificity 83%, sensitivity 79%, precision 34%), the likelihood of developing symptoms consistent with a viral infection three days before symptom onset. The model correctly predicts, almost all of the time (97%), individuals who will not develop viral-like illness symptoms in the next three days. Conversely, the model correctly predicts as positive 34% of the time, individuals who will develop viral-like illness symptoms in the next three days. This model uses a conservative framework, warning potentially pre-symptomatic individuals to socially isolate while minimizing warnings to individuals with a low likelihood of developing viral-like symptoms in the next three days. To our knowledge, this is the first study using wearables and apps with machine learning to predict the occurrence of viral illness-like symptoms. The demonstrated approach to forecasting the onset of viral illness-like symptoms offers a novel, digital decision-making tool for public health safety by potentially limiting viral transmission.

Analysis of Policies to Protect the Health of Urban Refugees and Asylum Seekers in Thailand: A Qualitative Study and Delphi Survey.

The health of urban refugees and asylum seekers (URAS) in Bangkok has been neglected and health policies for USAR have not materialized. This study aimed to explore the views of stakeholders on policies to protect URAS well-being in Thailand. This study conducted a mixed-methods approach comprising both in-depth interviews and Delphi survey. The interview findings revealed six main themes: (1) the government position on URAS; (2) opinions on Thailand becoming a party of the 1951 Refugee Convention; (3) NGOs on health promotion for URAS; (4) options on health insurance management for URAS; (5) working potential of URAS; and (6) uncertainty of future life plans for URAS. The Delphi survey showed that URAS should have the right to acquire a work permit and be enrolled in the public insurance scheme managed by the Ministry of Public Health. Moreover, the ideology of national security was more influential than the concept of human rights. The ambiguity of the central authorities’ policy direction to take care of URAS creates haphazard legal interpretations. The Delphi survey findings suggested the need for a more inclusive policy for URAS, however actual policy implementation requires further research on policy feasibility and acceptance by the wider public.

Analysis of second wave of COVID-19 cases in Nepal with a logistic model

Background: COVID-19, caused by SARS-CoV-2, is a newly identified highly infectious disease. It has affected almost every country including Nepal causing a pandemic situation. Most of the properties of SARS-CoV-2 are not known and still under intense investigation. Due to high mutation rate, it reappears in many countries in the form of new variant. In Nepal, second wave impact of COVID-19 is mainly caused by newly found delta variant of SARS-CoV-2. In this case, the mathematical modelling is noted to play important role to understand control strategies for the spread of coronavirus. Aims and Objective: To analyze the second wave impact by modelling the data of COVID-19 cases in Nepal. Materials and Methods: We have analyzed COVID-19 daily cases and deaths reported by Ministry of Health and Population, Government of Nepal from April 1 to May 31, 2021. A logistic model has been used to present the trend line of COVID-19 infection in Nepal, based on the law of population growth developed by Verhulst. Results: The results show a good fit between observed and predicted data by logistic model as indicated by coefficient of determination having value near to unity. The point of inflection from the logistic model predicted a maximum of 9951 daily new cases. The maximum number of cumulative cases estimated at the end of second wave was found to be 307293 with 95% confidence interval. Conclusion: Logistic model properly describes the growth of COVID-19 cases with time. This type of data modelling and analysis will be very useful in predicting the upcoming trend of COVID-19 in Nepal as a basis for making health policy management by the government.

A Blockchain-Based Distributed Authentication System for Healthcare

The use of digital health records, stricter health laws and the growing need for health records exchange points towards the need for an efficient security and privacy preserving mechanism. For Health Insurance management systems, multiple entities exchange health information which is used for decision making. Since multiple authoritative entities are involved, a secure and efficient information sharing protocol is required as extremely sensitive health information is exchanged among the entities. Hence this paper aims to put forward a novel a decentralized authentication system based on Blockchain known as Insurance Claim Blockchain (ICBChain) system. The proposed system ensures privacy of patients, provides secure information exchange and authentication of entities. An implementation of the proposed system is provided using Ethereum Blockchain. The security and performance analysis of the system shows its potential to satisfy Healthcare security requirements and its efficiency respectively

Evaluation of National Health Insurance Program Implementation in Jakarta Province, Indonesia

The implementation of National Health Insurance in several regions in Indonesia faces challenges, such as health service providers, health insurance management , and the community. The outcome that occurs may vary depending on the implementation of different aspects of governance, equity or social justice, and aspects of service quality. Therefore, research was conducted by evaluating the implementation of the national health insurance in DKI Jakarta Province. The evaluation is carried out based on the 2019 JKN road map target indicators, grouped into three aspects: including governance, achievement of equal distribution of health services (equity), and quality of service. This research used a mixed-methods design that combined the approach of quantitative and qualitative elements. Quantitative data were collected from secondary data from Health Social Security Agency (BPJS Kesehatan), the National Social Security Council Monitoring and Evaluation System (Sismonev DJSN). The qualitative data comes from in-depth interviews with selected informants using the purposive sampling technique. The result was that DKI Province had achieved the JKN membership target. There are still JKN participants who are inactive / in arrears from participants in the government and private wage-earning segments. Health facilities and human health resources have met the standards, but related to the package of benefits for heart diseases services, the availability of cardiac specialists and cath lab facilities has not been evenly distributed, especially in the Seribu Islands. Patient preferences in choosing the desired health service resulted in implementing a tiered referral system and back-referral still having problems in health facilities.

Scoping the literature on patient travel abroad for cancer screening, diagnosis and treatment.

The incidence of cancer is on the rise globally. Under particular circumstances, patients are willing to travel abroad for healthcare treatments. We know relatively little however about patients travelling overseas for cancer-related screening, diagnosis and treatment. Where do patients go, for what treatments, what are their motivations, decision-making processes and treatment experiences? What do we know about patient safety and risk, and outcomes? More broadly, what are the ethical and legal implications? This review presents the first published assessment of what we term 'transnational oncology treatment', defined as patients travelling overseas or across borders for cancer screening, diagnosis and treatment. The review undertakes detailed search and retrieval of the literature, using an accepted scoping review method. We present a narrative review of existing knowledge and themes, identifying coverage and gaps. There is a five-fold agenda for future investigation: trajectories and itineraries; in depth focus on treatment decisions, experiences and outcomes; locating patient travel within wider health system analysis; exploration of professional perspectives and coordination; and situating travel within the context of health trade. Such an agenda is multidisciplinary and wide-ranging, encompassing epidemiology, health economics, health policy ethics, health politics, health management, and health policy.

Disability management in a public-private health care facility in South Africa: an organisational perspective.

Job retention, long-term absenteeism and medical boarding pay-outs are significant concerns for employers within the public health care sector of South Africa. To describe disability management policies, procedures and programmes of employees following impairment and disability in a public-private healthcare facility in South Africa. An exploratory qualitative study design was used with key informants in senior management and nursing managers (n=12) selected via purposive sampling. Audio-recorded data from semi-structured interviews and a focus group were thematically analysed using inductive reasoning. There is poor adherence to occupational health and disability management policies and the current referral process is informal with managers using discretion to manage employees with ill health and acquired disability. The procedures prescribed in the policy and procedure on incapacity and ill-health-retirement need to be followed, and an early return to work programme within the health care facility needs to be implemented. Despite South Africa having many policies on recruitment and reasonable accommodations, there is a lack of implementation of these policies. An integrated disability management policy and programme encompassing health prevention, early return to work strategies, vocational rehabilitation and the implementation of reasonable accommodation is required to ensure that employees who have acquired disabilities or ill health are successful in the workplace.

Effective Biosecurity measures during the Diagnosis of COVID-19 at the Pasteur Institute from the Perspective of Hazardous Hospital Waste Management

BACKGROUND AND AIM: Waste is a daily health hazard that must be addressed through appropriate management. The Institut Pasteur of Côte d'Ivoire (IPCI) produces waste that is generally infectious waste and waste assimilated to household waste. The presence of this mostly infectious waste can create a risk for staff. Thus, since March 11, 2020, the date of the first case of COVID-19, a rigorous health management policy has been taken to protect health workers. METHODS: Diagnosis of the COVID-19 pandemic in Côte d'Ivoire is mainly done at the Institut Pasteur of Côte d’Ivoire (IPCI). Thus, the waste produced in the various laboratories is disinfected, then sorted, packaged in 5 to 10 liter bags, transported in dedicated bins to final storage. The waste is weighed under biosafety conditions before being incinerated in an ATI Environment CP100 incinerator. RESULTS:Waste management at IPCI in 2020 during COVID-19 resulted in biosafety training for staff, collection, packaging, transportation, storage and incineration of 26.4 tons of waste. It should be noted that no waste management personnel were infected during the entire period from March to December 2020 CONCLUSIONS:During the year 2020 and mainly from March 11, 2020 to December 31, 2020, waste management increased significantly from 12.2 tons in 2019 during the same period to 26.4 tons in 2020 and was related to COVID-19. This shows that waste has more than doubled and requires rigorous management. It would therefore be imperative to properly manage waste in order to protect health care personnel. Also, this study showed one aspect of the environmental impact of COVID-19 that needs further research. KEYWORDS: COVID-19, Waste management, incineration

A Blockchain-Based Distributed Authentication System for Healthcare

The use of digital health records, stricter health laws and the growing need for health records exchange points towards the need for an efficient security and privacy preserving mechanism. For Health Insurance management systems, multiple entities exchange health information which is used for decision making. Since multiple authoritative entities are involved, a secure and efficient information sharing protocol is required as extremely sensitive health information is exchanged among the entities. Hence this paper aims to put forward a novel a decentralized authentication system based on Blockchain known as Insurance Claim Blockchain (ICBChain) system. The proposed system ensures privacy of patients, provides secure information exchange and authentication of entities. An implementation of the proposed system is provided using Ethereum Blockchain. The security and performance analysis of the system shows its potential to satisfy Healthcare security requirements and its efficiency respectively

Medical Coordination Rescue Members' and Ambulance Nurses' Perspectives on a New Model for Mass Casualty and Disaster Management and a Novel Terror Attack Mitigation Approach in the Netherlands: A Qualitative Study.

Mass-casualty incidents (MCIs), specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, availability, and adequate provision of prehospital and hospital-based emergency care. In the Netherlands, a new model for Mass Casualty and Disaster Management (MCDM) along with a Terror Attack Mitigation Approach (TAMA) was introduced in 2016. The objective of this study was to provide insight in the first experiences of health policy advisors and managers with a medical rescue coordinator and ambulance nursing background regarding the new MCDM and TAMA in order to identify strengths and pitfalls in emergency preparedness and to provide recommendations for improvement. The study had a qualitative design and was performed from January 2017 through June 2018. Purposeful sampling was used and the inclusion comprehended health policy advisors and managers with a medical rescue coordinator and ambulance nursing background involved in emergency preparedness. The respondents were interviewed semi-structured and the researchers used a topic list that was based on the literature and content of the newly introduced model and approach. All interviews were typed out verbatim and qualitative content analyzing was used in order to identify relevant themes. Respondents based their perceptions on large-scale training exercises, as MCDM and TAMA were not yet used during MCIs. Perceived issues of MCDM were the two-tiered triage system, the change in focus from "stay and play" towards "scoop and run," difficulties with new tasks and roles of professionals, and improvement in material provision. Regarding TAMA, all respondents supported the principles (do the most for the most; scoop and run; acceptable personal risk; never walk alone; and standard operational procedure); however, the definitions were lacking clarity while the awareness of optimal personal safety of professionals was absent.As there are currently regional differences in the level of implementation of MCDM and TAMA, this may pose a risk for an optimal inter-regional collaboration. The conclusions refer to experiences of professionals in the Netherlands. Elements of the MCDM and TAMA were highly appreciated and seemed to improve emergency preparedness, while other aspects needed further attention, training, and integration in daily routine. The Netherlands' MCDM model and TAMA will need continuous systematic evaluation based on (inter)national performance criteria in order to underpin the useful and effective elements and to improve the observed pitfalls in emergency preparedness.

The enlightenment of foreign MD-MPH double degree program to the cultivation of high-level applied public health talents in China

Objective: To understand the current status of foreign dual-degree programs of Medical Doctor (MD) and Master of Public Health (MPH) and provide evidence-based decision-making reference for promoting the education of high-level applied public health talents in China. Methods: The list of involved institutions and information of foreign MD-MPH dual-degree programs was collected through literature retrieval, online information searching, and additional survey of key figures. We extracted the details of each project regarding professional fields, core competence, length of schooling, teaching and learning arrangement, internship eligibility, and graduation assessment. Python 3.8.0 was used for data cleaning, and the occurrence frequency of related items in each dimension was calculated. Results: A total of 99 MD-MPH programs from 104 foreign institutions were included, among which 97.1% of them were implemented in universities from the United States. The School of Public Health provided 42.4% (42/99) of the programs. Epidemiology was the major discipline set up among most programs, accounting for 12.0% (29/241) of all the specialties involved. Epidemiological research methods, health policy management and practice, and public health practice were the top 3 core competencies to be mastered. Of the 99 programs, 87 gave information on the length of the program, of which 74.7% (65/87) were five years, 6.9% (6/87) were four years, and 18.4% (16/87) included both 4-year and 5-year programs. Conclusions: The international MD-MPH programs were sophisticated and mainly organized by the School of Public Health alone or in conjunction with the School of Medicine. Epidemiology is the core course and competence objective, with a length of 4-5 years. Through learning experience from international MD-MPH programs and the Chinese unique medical development background, China should optimize its medical education system to develop a suitable talent training strategy for MD-MPH dual-degree programs in the new era.

Nurse staffing in Portuguese public hospitals.

This study aims to contribute to the knowledge of nurse staffing in hospital settings in central and northern Portugal. Nurse staffing is a critical factor for the quality and safety of health care and is still an understudied topic in Portugal. A cross-sectional study was conducted with a sample of 850 nurses from 12 public hospitals in the central and northern regions of Portugal. Nurse staffing in these hospital units is insufficient, especially in internal medicine units and central hospitals. Nurses' perceptions are in line with the objective data. The shortage of nurses is a horizontal issue that is especially serious in internal medicine units and central hospitals and a potential threat to the quality of care. The results stress the need for an urgent leadership intervention in nurse staffing levels in the hospitals analysed in this study. Contextual knowledge about nurse staffing is essential for decision-making and supporting health and human resource management policies.