Health Policy Discussions Research Articles

Review of the Paradigm on the Role of Print Media in Influencing Public Health

This paper explores important issues related to media research in the context of public health debates and emphasises the requirement of a research plan including media production based on political sciences. Consensus is that via topic selection and presentation, the media significantly impacts public health dialogues and influences public opinions. Often reflecting the interests of strong stakeholders, the way the media presents health challenges, their causes, and solutions greatly influences public health debate. But modern studies often overlook the complex processes of media production necessary for knowledge of how political economics, power, and culture impact these debates. Media production is not just the consequence of linked networks, occupational practices, technology, and institutional contexts reflecting ideological convictions; it is also the output of newsrooms, revealed by a thorough study of media production. Examining non-communicative diseases (NCDs), a major worldwide health concern affected by unsustainable commodity sectors, this viewpoint is very vital. Public health studies have not yet completely revealed the media tactics used by businesses pushing negative items such alcohol, tobacco, and processed foods. Underexplored is the impact of these sectors on public health policy discussions mediated via media coverage.

Originalarbeiten / Original Articles. Die Behandlung von Kindern und Jugendlichen mit substanzbezogenen Störungen im deutschen Gesundheitssystem – eine Quantitative Studie

The Treatment of Children and Adolescents with Substance-Related Disorders in the German Health Care System - a Quantitative Study This study evaluates the minimum characteristics of OPS code 9-694 for specific treatment in special settings for substance-related disorders in children and adolescents. The research questions to be answered are the extent to which given minimum characteristics and potentials are assessed as practical, up-to-date, needs-oriented and necessary. The survey was conducted using a nationwide online survey in special wards of child and adolescent psychiatric clinics. Given minimum characteristics reflect everyday clinical practice and are assessed as practical, up-to-date and relevant. Nevertheless, setting- and method-specific potential for further development was identified, most of which has already been implemented in the clinics but has not yet been incorporated into the minimum characteristics. The topic has received little research attention to date. The findings of the original study can provide a basis for the optimization and adaptation of minimum characteristics and treatment offers for children and adolescents with substance-related disorders and lead to the further development of the OPS code. A theory-practice transfer tailored to the target group requires the networking of individual players in the help system as well as the health policy discussion and gradual adaptation of the content of given minimum characteristics and potential for change.

Parental perceptions of an oral health promotion program in early childhood education and care settings: A qualitative study.

Early Childhood Caries is a global health problem. The Bright Smiles Bright Futures (BSBF) program seeks to equip educators, children, and parents with skills and knowledge about oral health promotion habits early in life. The aim of this study was to examine parental perceptions of the BSBF program and identify key facilitators and barriers for its implementation. Twelve mothers of children who participated in the BSBF program in five Early Childhood Education and Care (ECEC) settings in NSW, Australia were recruited in this qualitative study. Data were collected via focus groups and interviews, transcribed verbatim and coded to categorize for inductive thematic analysis. Five major themes emerged: Promoters of the BSBF oral health program, barriers to the BSBF oral health program implementation and participation, online resources, impact of the BSBF oral health program, and strategies for enhancing the BSBF oral health program. While participants reported that the program encouraged their children's toothbrushing, they found issues with the program's materials, ECEC center attendance, and communication about the oral health program with their children. The program improved message retention, attitudes, routines, and family perceptions toward oral health. Participants recommended oral health literacy, changed delivery formats, increased dental access, and inclusion of interactive elements to enhance the program. The findings from this study provide insight to improve parents' experiences and engagement in oral health promotion. This can help to raise awareness of the importance of child oral health among policymakers, healthcare professionals, and the public to inform public health policy discussions.

Fate or fault? Nurses’ perspectives on dementia prevention in German care facilities

Following the recent shift in medicine towards viewing dementia as a preventable disease, various activating interventions are being discussed to halt cognitive decline of people living in long-term care facilities. This article examines how the dementia discourse, with its turn towards prevention, translates into local everyday care practices. Based on problem-centered interviews, the study analyses how nurses negotiate the prevention paradigm in the context of current health policies, active aging culture, and institutional frameworks in German nursing homes.The study reveals two contrasting patterns in how nurses perceive, interpret, and implement current principles of dementia prevention in care: Despite most nurses being aware of current prevention recommendations, subjective conceptions of both the impact of lifestyle choices in earlier life and the effectiveness of activating interventions in care settings vary greatly. Adopting conceptions of successful aging, neuroplasticity and activity theory, some nurses understand dementia as associated with earlier lifestyle choices and see prevention as a task of nursing care. Focusing strongly on the individuals' personal needs and the well-being of those in need of care, the other group still sees dementia as fated, suggesting either a critical stance or a more holistic understanding of dementia prevention.Furthermore, institutional frameworks and economization processes in the German care system undermine the goal of strengthening prevention and health promotion. While prevention is promoted as an answer to the care crisis in health policy discourses, the implementation of preventive interventions is severely restricted by the fragmentation of nursing tasks, time constraints, and limited resources in care facilities.

Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer-Reviewed Literature.

Despite remarkable growth and relevance of the 340B Drug Pricing Program to current health care practice and policy debate, academic literature examining 340B has lagged. The objectives of this scoping review were to summarize i) common research questions published about 340B, ii) what is empirically known about 340B and its implications, and iii) remaining knowledge gaps, all organized in a way that is informative to practitioners, researchers, and decision makers. We conducted a scoping review of the peer-reviewed, empirical 340B literature (database inception to March 2023). We categorized studies by suitability of their design for internal validity, type of covered entity studied, and motivation-by-scope category. The final yield included 44 peer-reviewed, empirical studies published between 2003 and 2023. We identified 15 frequently asked research questions in the literature, across 6 categories of inquiry-motivation (margin or mission) and scope (external, covered entity, and care delivery interface). Literature with greatest internal validity leaned toward evidence of margin-motivated behavior at the external environment and covered entity levels, with inconsistent findings supporting mission-motivated behavior at these levels; this was particularly the case among participating disproportionate share hospitals (DSHs). However, included case studies were unanimous in demonstrating positive effects of the 340B program for carrying out a provider's safety net mission. In our scoping review of the 340B program, the highest-quality evidence indicates nonprofit, DSHs may be using the 340B program in margin-motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Future studies should examine heterogeneity by covered entity types (i.e., hospitals vs. public health clinics), characteristics, and time period of 340B enrollment. Our findings provide additional context to current health policy discussion regarding the 340B program.

Marital Quality and Depressive Symptoms Among Older Hispanic Adults in the United States.

Despite the cultural importance of marriage as a social support system and its well-established link to mental health, older Hispanic adult populations, which are the largest racial and ethnic minoritized groups, remain understudied. The current study examined how positive and negative dimensions of marital quality are associated with depressive symptoms. Data from Hispanic adults aged 51 years and older (n = 1,012) were obtained from the 2016 and 2018 Health and Retirement Study waves. The Center for Epidemiological Studies-Depression scale (0-8 symptoms) was modeled as a function of positive and negative marital quality measures (1-4), as well as the relevant covariates. Results from a negative binomial regression model showed that a 1-unit change in positive and negative marital quality was associated with a 23.61% reduction and a 23.74% increase, respectively, in depressive symptoms. The interaction terms with marital quality and gender, as well as marital quality and religion, were not statistically significant. In the United States, a large percentage of older Hispanic adults are immigrants, and their extended family tends to reside in their countries of origin. As such, older Hispanic adults may have smaller social networks, and marital quality most likely represents a culturally important social support network in later life. Significant associations between depressive symptoms and marital quality among older Hispanic adults should receive more attention in family and public health policy discussions, particularly given the increasing diversity in U.S. society.

Values, challenges, and responses associated with high-priced potential cures: perspectives of diverse stakeholders in South Korea

BackgroundThe emergence of high-priced potential cures has sparked significant health policy discussions in South Korea, where the healthcare system is funded through a single-payer National Health Insurance model. We conducted focus group interviews (FGIs) and accompanying surveys with diverse stakeholders to comprehensively understand related issues and find better solutions to the challenges brought by these technologies.MethodsFrom October to November 2022, 11 FGIs were conducted with stakeholders from various sectors, including government payers, policy and clinical experts, civic and patient organisations, and the pharmaceutical industry, involving a total of 25 participants. These qualitative discussions were supplemented by online surveys to effectively capture and synthesise stakeholder perspectives.ResultsAffordability was identified as a critical concern by 84% of stakeholders, followed by clinical uncertainty (76%) and limited value for money (72%). Stakeholders expressed a preference for both financial-based controls and outcome-based pricing strategies to mitigate these challenges. Despite the support for outcome-based refunds, payers raised concerns about the feasibility of instalment payment models, whether linked to outcomes or not, due to the specific challenges of the Korean reimbursement system and the potential risk of ‘cumulative liabilities’ from ongoing payments for previously administered treatments. In addition, the FGIs highlighted the need for clear budgetary limits for drugs with high uncertainties, with mixed opinions on the creation of special silo funds (64.0% agreement). Less than half (48%) endorsed the use of external reference pricing, currently applied to such essential drugs in South Korea. A significant majority (84%), predominantly non-pharma stakeholders, advocated for addressing cost-effectiveness uncertainty through re-assessment once long-term clinical data become available.ConclusionsThis study uncovers a broad agreement among stakeholders on the need for more effective value assessment methodologies for high-priced potential cures, stressing the importance of more robust and comprehensive re-assessment supported by long-term data collection, rather than primarily relying on external reference pricing. Each type of stakeholders exhibited a cautious approach to their specific uncertainties, suggesting that new funding strategies should accommodate these uncertainties with predefined guidelines and agreements prior to the initiation of managed entry agreements.

A case for ongoing structural support to maximise infectious disease modelling efficiency for future public health emergencies: A modelling perspective

This short communication reflects upon the challenges and recommendations of multiple COVID-19 modelling and data analytic groups that provided quantitative evidence to support health policy discussions in Switzerland and Germany during the SARS-CoV-2 pandemic.Capacity strengthening outside infectious disease emergencies will be required to enable an environment for a timely, efficient, and data-driven response to support decisions during any future infectious disease emergency.This will require 1) a critical mass of trained experts who continuously advance state-of-the-art methodological tools, 2) the establishment of structural liaisons amongst scientists and decision-makers, and 3) the foundation and management of data-sharing frameworks.

478. COVID-19 maternal antibody concentrations in twin infants: impact of multiple pregnancy on transplacental antibody transfer during pregnancy

Abstract Background COVID-19 vaccines in pregnancy protect both pregnant individuals and young infants from severe illness via transplacental transfer of maternally-derived IgG. However, the impact of multiple (e.g. twin) pregnancy on transplacental transfer of SARS-CoV-2 IgG is unknown. We aimed to evaluate anti-Spike (S) antibody transfer among infants from twin pregnancies compared to singleton pregnancies. Methods We conducted a prospective cohort study among individuals with twin and singleton pregnancies who received at least 2 doses of an mRNA COVID-19 vaccine prior to delivery. We tested paired maternal and cord samples for anti-S IgG and used linear regression to evaluate associations between multiple or singleton pregnancy and anti-S antibody. We included as covariates timing of last vaccine dose, gestational age at delivery, number of doses prior to delivery, and small for gestational age (< 10th percentile) birthweight. Results We tested maternal/cord anti-S IgG from 25 twin and 291 singleton pregnancies. The median gestational age at delivery was 36 weeks for twin infants compared to 39 weeks for singleton infants. Median maternal anti-S IgG was 5812 BAU/mL (IQR:754, 16061) and 2971 BAU/mL (IQR:706, 14000) for twin and singleton pregnancies, respectively. Median cord anti-S IgG was 4110 BAU/mL (IQR: 527, 15937) and 3636 BAU/mL (IQR: 1019, 15465) for twin and singleton infants, respectively (Figure 1). Cord:maternal IgG ratios were significantly lower in twin pregnancies compared to singleton pregnancies (p < 0.01; Figure 2). After adjustment for covariates, there was no difference between maternal anti-S IgG concentrations (beta: -0.54; 95% confidence interval [CI]: -1.26,0.18; p=0.14), cord anti-S IgG concentrations (beta: -0.77; 95% CI: -1.68,0.13; p=0.10) or cord:maternal IgG ratios (beta: -0.07; 95% CI: -0.32,0.19; p=0.61) between twin and singleton pregnancies. Conclusion Twin and singleton infants benefit similarly from maternal COVID-19 vaccine during pregnancy. Higher risk pregnancies including multiple pregnancies should be considered in health policy discussions regarding COVID-19 vaccine timing in pregnancy. Disclosures Alisa B. Kachikis, MD, MSc, Merck: Grant/Research Support|Pfizer: Grant/Research Support Mindy Pike, PhD, Merck: Grant/Research Support Alexander L. Greninger, MD, PhD, Cepheid: central contracts|Hologic: central contracts|Janssen: central contracts|Novavax: central contracts|Pfizer: central contracts Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant

Progress towards universal health coverage in the context of mental disorders in India: evidence from national sample survey data

BackgroundUniversal health coverage (UHC) has emerged as one of the important health policy discourses under the current sustainable development goals in the world. UHC in individual disease conditions is a must for attaining overall UHC. This study measures progress towards UHC in terms of access to health care and financial protection among individuals with mental disorders in India.MethodsData from the 75th Round National Sample Survey (NSS), 2017-18, was used, which is the latest round on health in India. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232), from randomly selected 8077 villages and 6181 urban areas, included 283 outpatient and 374 hospitalization cases due to mental disorders in India. Logistic regression models were used for analyses.ResultsSelf-reporting of mental disorders was considerably lower than the actual disease burden in India. However, self-reporting of ailment was 1.73 times higher (95% CI: 1.18–2.52, p < 0.05) among the richest income group population compared to the poorest in India. The private sector was a major service provider of mental health services with a larger share for outpatient (66.1%) than inpatient care (59.2%). Over 63% of individuals with a mental disorder who reported private sector hospitalization noted unavailability or poor service quality at public facilities. Only 23% of individuals hospitalized had health insurance coverage at All India level. However, health insurance coverage among poorest economic class was a meagre 3.4%. Average out-of-pocket expenditure during hospitalization (public: 123 USD; private: 576 USD) and outpatient care (public: 8 USD; private: 37 USD) was significantly higher in the private sector than in the public sector. Chances of facing catastrophic health expenditure at 10% threshold were 23.33 times (95% CI: 10.85–50.17; p < 0.001) higher under private sector than public sector during hospitalization. Expenditure on medicine, as the share of total medical expenditure, was highest for hospitalization (public: 45%, private:39.5%) and outpatient care (public: 74.1%, private:39.7%).ConclusionsSocial determinants play a vital role in access to healthcare and financial protection among individuals with mental disorders in India. For achieving UHC in mental disorders, India needs to address the gaps in access and financial protection for individuals with mental disorders.Trial registrationNot applicable.

To Tweet or Not to Tweet: Tweets About Tobacco Regulation can Help Disseminate Anti-regulatory Messages.

Twitter enables public organizations to engage the public in health policy discourse. However, documented hostility towards tobacco control proposals on Twitter suggests that a closer examination of the nature of interaction with such content is warranted. We scraped tweets from government bodies with tobacco control interests between July and November of 2021 (N = 3889), 2 months before and after the Food and Drug Administration's (FDA) Premarket Tobacco Authorization Act's (PMTA) September deadline. PMTA is a review process for authorizing the sale of new and existing e-cigarette or vaping products. Tweets related to PMTA were identified (n = 52) using a keyword filter. A content analysis of quote tweets and replies examined the amplification of pro and anti-policy sentiment via likes and retweets. Replies were overwhelmingly anti-policy (96.7%). Moreover, the amplification of these replies, including 83.3% of likes and 65.6% of retweets, amplified anti-policy replies. Quote tweets, which allow users to add their own commentary to an existing tweet, were 77.9% (n = 120) anti-policy, receiving 87.7% of likes (n = 1708) and 86.2% of retweets (n = 726) compared to pro-policy quote tweets (n = 240 likes and n = 116 retweets). Regression analyses showed a significantly greater amplification of anti-policy content. Communicating about tobacco policy on Twitter carries risks. Anti-policy advocates can weaponize quote tweets for easy construction of messages designed in accordance with evidence-based guidelines for conferring resistance to persuasion. Future research should examine whether public health organizations can adapt this strategy to counter anti-regulatory advocates on Twitter. The primary implications of this research are that communication about tobacco policy on Twitter should be part of a broader public engagement strategy with quantifiable metrics of success. The information environment on Twitter is demonstrably hostile to pro-tobacco regulatory policy positions. As a result, efforts to engage on the platform by regulatory institutions like the FDA can inadvertently provide materials that are easily leveraged as effective counter-messaging. Moreover, this counter-messaging can disseminate more broadly than the original message.

Trends in Abortion- and Contraception-Related Internet Searches After the US Supreme Court Overturned Constitutional Abortion Rights

The US Supreme Court ruling in Dobbs v Jackson Women's Health Organization on June 24, 2022, revealed immediate and distinct differences between states regarding abortion legality. Whether the ruling was associated with population-level changes in seeking information on reproductive health care-related information is unknown. To determine whether the US Supreme Court ruling on Dobbs v Jackson Women's Health Organization was associated with increased information seeking for reproductive health care access in the states with immediately effective (trigger and pre-Roe) abortion laws vs other states. This was a retrospective cross-sectional study of nationwide real-time internet search data by state-week from January 1, 2021, through July 16, 2022. Difference-in-difference event study estimates were used to evaluate abortion- and contraception-related internet searches after the Supreme Court draft majority decision was leaked on May 2, 2022, and the final ruling was issued on June 24, 2022, in states immediately affected vs other states. Data analyses were performed from July 18 to January 14, 2022. The Supreme Court's draft majority decision leaked on May 2, 2022, and the final ruling on Dobbs v Jackson Women's Health Organization on June 24, 2022. Preexisting state trigger laws and pre-Roe bans that became effective immediately when Roe was overturned by the decision on Dobbs. Number of searches per 10 million Google queries in a state-week for terms related to abortion or contraception. Searches for abortion-related terms increased from 16 302 to 75 746 per 10 million searches per state-week during the weeks before vs after the May 2, 2022, leak of the draft majority decision in states with trigger laws or abortion bans. This was a 42% (95% CI, 24%-59%) higher increase than in states with laws that protect abortion access. Searches for contraception also increased from 56 055 to 82 133 searches per state-week after the ruling in the states with abortion bans, 25% (95% CI, 13%-36%) higher than the increase in states protecting abortion access. The findings of this retrospective cross-sectional study suggest that changes in internet searching for terms related to reproductive health care can capture immediate population-level changes in information-seeking behavior regarding reproductive health care access. These data are critical for shaping health policy discussions.

Analysing the global and local spatial associations of medical resources across Wuhan city using POI data

BackgroundThere is a sharp contradiction between the supply and demand of medical resources in the provincial capitals of China. Understanding the spatial patterns of medical resources and identifying their spatial association and heterogeneity is a prerequisite to ensuring that limited resources are allocated fairly and optimally, which, along with improvements to urban residents’ quality of life, is a key aim of healthy city planning. However, the existing studies on medical resources pattern mainly focus on their spatial distribution and evolution characteristics, and lack the analyses of the spatial co-location between medical resources from the global and local perspectives. It is worth noting that the research on the spatial relationship between medical resources is an important way to realize the spatial equity and operation efficiency of urban medical resources.MethodsLocalized colocation quotient (LCLQ) analysis has been used successfully to measure directional spatial associations and heterogeneity between categorical point data. Using point of interest (POI) data and the LCLQ method, this paper presents the first analysis of spatial patterns and directional spatial associations between six medical resources across Wuhan city.Results(1) Pharmacies, clinics and community hospitals show “multicentre + multicircle”, “centre + axis + dot” and “banded” distribution characteristics, respectively, but specialized hospitals and general hospitals present “single core” and “double core” modes. (2) Overall, medical resources show agglomeration characteristics. The degrees of spatial agglomeration of the five medical resources, are ranked from high to low as follows: pharmacy, clinic, community hospital, special hospital, general hospital and 3A hospital. (3) Although pharmacies, clinics, and community hospitals of basic medical resources are interdependent, specialized hospitals, general hospitals and 3A hospitals of professional medical resources are also interdependent; furthermore, basic medical resources and professional medical resources are mutually exclusive.ConclusionsGovernment and urban planners should pay great attention to the spatial distribution characteristics and association intensity of medical resources when formulating relevant policies. The findings of this study contribute to health equity and health policy discussions around basic medical services and professional medical services.

Reproductive Subjects and Shifting Global Health Policy Discourses

Reproductive Subjects and Shifting Global Health Policy Discourses

Confidence in nicotine for tobacco harm reduction-Bridging the policy-practice gap.

Decades of research show that constituents other than nicotine are the harmful agents in tobacco products. This knowledge is incorporated into the nicotine regulatory policies of countries leading in tobacco control, such as the UK and New Zealand. Alternative nicotine products, such as nicotine replacement therapy and e-cigarettes, are now endorsed in the UK by a number of healthcare bodies in a tobacco harm reduction approach that encourages tobacco users to completely switch to a less risky nicotine-containing product. The potential role of 'clean' nicotine alternatives to reduce the harms from tobacco is, however, not being translated into practice. Many healthcare practitioners still bundle tobacco, cigarettes, smoking, cancer and nicotine into one, thus preventing them from supporting their patients to make informed choices on safer nicotine alternatives. This misperception among healthcare professionals, in turn, is a hurdle to effective tobacco control policymaking in many low- and middle-income countries and effective cessation support everywhere in the world. Nicotine confidence based on nicotine literacy among the key decision-makers should start with reforming medical curricula and myth-busting in the lay media to include factual statements about nicotine and public health policy discussions on the principles of harm reduction.

‘Small’ data, isolated populations, and new categories of rare diseases in Finland and Poland

Health policy and academic discourses on rare diseases and people with rare conditions frequently employ terms such as ‘low prevalence’ and ‘unique’ to characterize the smallness of the population under consideration and to justify targeted action toward these patient groups. This paper draws from recent anthropological scholarship on smallness and data, ethnographic research in Finland and Poland, as well as document and media analysis to examine how data is utilized in the context of isolated populations that are considered sites of rare diseases in these two countries. Specifically, this paper juxtaposes the notion of Finnish Disease Heritage (FDH) with that of a ‘Kashubian gene’ in Poland. The concept of FDH was developed by Finnish researchers in the 1970s; it encompasses almost forty rare hereditary diseases that are significantly more prevalent in Finland than elsewhere globally. On the other hand, the notion of the ‘Kashubian gene’ was first utilized by the media and some members of the Polish medical community around 2008. Based on ‘unstable’ data gathered during genetic research, the term referred to the high prevalence of a rare metabolic disorder (Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase (LCHAD) deficiency) among Kashubians, an ethnic minority that resides in Northern Poland’s Pomerania region. Whereas FDH facilitated the production and branding of ‘a unique Finnish genetic identity’ (Tupasela 2016b, 61), the notion of the ‘Kashubian gene’ has engendered health policy interventions targeting members of this ethnic minority and has contributed to stigmatizing practices carried out against Kashubians.

Tobacco industry messaging around harm: Narrative framing in PMI and BAT press releases and annual reports 2011 to 2021.

Influencing public perception is a key way in which all transnational corporations (TNCs) maintain market dominance and political power. Transnational tobacco companies (TTCs) have a long history of leveraging narratives to serve commercial ambitions. The global reach of these companies' narratives has been highlighted as a challenge in combatting public health problems caused by tobacco. The corporate power of TTCs is carefully curated, and their narratives play an important role in the setting of governance dynamics at local, national and transnational levels. This qualitative work explores and compares the language used by British American Tobacco (BAT) and Philip Morris International (PMI) around harm, harm reduction and terms used to refer to newer nicotine and tobacco products, including electronic cigarettes and heated tobacco products. We systematically examine framings used by these two TTCs through company reports published between 2011 and 2021. Qualitative coding was carried out by four coders, according to a protocol developed specifically for this work. We firstly identified the presence of pre-selected keywords and then assigned chunks of text containing those key words to one or more associated frames drawn from Boydstun's policy frames codebook (2013). Qualitative coding identified the most common frames from Boydstun's codebook and thematic analysis highlighted three overarching themes. The most common frames assigned were "capacity and resources", "health and safety" and "economic" frames. The overarching themes were individualization, normalization, and regulation. These themes capture how both BAT and PMI use particular framings to downplay the role of TTCs in the perpetuation of population- and individual-level harms related to tobacco use. They seek to normalize their role in public discussions of health policy, to cast themselves as instrumental in the redress of tobacco-related inequalities and shift responsibility for the continuation of tobacco-product use onto individual consumers. These tactics are problematic for the effective and impartial development and implementation of local, national and international tobacco control agendas.

Short-term outcomes of patients transferred from non-acute care centers with sick sinus syndrome

Abstract Background Non-acute care centers, such as nursing homes and urgent care clinics, are a staple of healthcare systems worldwide. The short-term prognostic outcomes of patients transferred from a non-acute care center to an acute healthcare facility for further management have been less studied. Purpose In this study, we examine the in-hospital outcomes of patients with sick sinus syndrome who are transferred to an acute care hospital from a non-acute care center. Methods This was a retrospective cohort study comparing adult patients who were transferred to a hospital from a non-acute center with regular, non-transferred hospital admissions between 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted with a principal diagnosis of sick sinus syndrome. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities was used to compare mortality. The comorbidities adjusted for included atrial fibrillation, atrial flutter, first and third-degree atrioventricular block, heart failure, hypertension, obstructive sleep apnea and type 2 diabetes mellitus. Results 120,300 patients met our inclusion criteria. Patients transferred from non-acute care centers had 2.63 times higher odds of suffering in-hospital mortality compared to regular hospital admissions (aOR 2.63, 95% CI: 1.54–4.49; p&amp;lt;0.001). When separated by race, non-acute care transfers had higher mortality rates amongst Asian (6.9% vs 0.7%, p&amp;lt;0.001), Hispanic (4.8% vs 0.8%, p&amp;lt;0.001) and White (1.8% vs 0.6%, p&amp;lt;0.001, Figure 1) patients as well as longer hospital stays (4.7 vs 4.0 days, p&amp;lt;0.001, Table 1). Furthermore, these patients had higher rates of comorbidities such as atrial fibrillation, atrial flutter, heart failure and chronic kidney disease, but decreased rates of hypertension, type 2 diabetes mellitus and first and third-degree atrioventricular block (Table 1). Non-acute care transfers were also more likely to have a pacemaker placed (1.5% vs 0.9%, p&amp;lt;0.001). In terms of operative complications, non-acute transfers were more likely to have intraoperative cardiac arrest (0.1% vs 0.03%, p&amp;lt;0.005, Table 1). There was no significant difference between our two cohorts in postoperative complications such as cardiac arrest and intracerebral infarction. Conclusion Patients who were transferred to an acute care hospital from a non-acute care center with sick sinus syndrome had higher odds of suffering in-hospital mortality compared to regular hospital admissions. These patients were also at increased risk of intraoperative cardiac arrest. Our findings illustrate that non-acute care transfers require additional support in the acute care setting. This study highlights the need for further health policy discussion and an increased emphasis on medical resource reallocation to support this vulnerable population. Funding Acknowledgement Type of funding sources: None.

Encounters and management of oral conditions at general medical practices in Australia

BackgroundPoor oral health has been widely recognised as an ongoing public health issue. Patients with oral conditions may visit either a general practitioner (GP) or a dental practitioner for management. The aims of this study are to report (i) the GP management rate of oral health conditions by patient and GP demographics, (ii) what specific oral conditions were managed, and (iii) how GPs managed oral conditions.MethodsData from the Bettering the Evaluation and Care of Health study (2006 to 2016 inclusive) were analysed. Descriptive statistics with 95% confidence intervals around point estimates were used to summarise data. Multivariate logistic regression was performed to determine the independent effect of patient and GP characteristics.ResultsA total of 972,100 GP encounters were included in the dataset, with oral condition-related encounters managed at a rate of 1.19 oral conditions per 100 GP encounters. Patients who were aged 54 years or younger, resided in a socioeconomically disadvantaged area, came from a non-English speaking background or Indigenous background were more likely to have oral conditions managed by GPs. The most commonly reported oral conditions were dental and oral mucosa-related. Over 60% of oral conditions were managed by GPs through prescribed medications.ConclusionsThis study provided an overview of management of oral conditions by GPs in Australia. Patients from certain vulnerable demographic groups were more likely to attend a GP for management of oral conditions. Common oral conditions and management approaches were identified. The findings of this study contribute to public health and health policy discussions around optimising primary care provision in oral health.

Echoes through Time: Evolution of the Italian COVID-19 Vaccination Debate

Italy was the first European country to be hit by COVID-19 in the early 2020, since then losing over 100,000 people to the disease. By the end of the vaccination campaign of 2021, 81% of the public received at least one dose. These dramatic developments were accompanied by a rigorous discussion around vaccination, both about its urgency and its possible negative effects. Twitter is one of the most popular social media platforms in the country, but pre-pandemic vaccination debate has been shown to be polarized and siloed into echo chambers. It is thus imperative to understand the nature of this discourse, with a specific focus on the vaccination hesitant individuals, whose healthcare decisions may affect their communities and the country at large. In this study we ask, how has the Italian discussion around vaccination changed during the COVID-19 pandemic, and have the unprecedented events of 2020-2021 been able to break the echo chamber around this topic? We use a Twitter dataset spanning September 2019 - November 2021 to examine the state of polarization around vaccination. We propose a hierarchical clustering approach to find the largest communities in the endorsement networks of different time periods, and manually illustrate that it produces communities of users sharing a stance. Examining the structure of these networks, as well as textual content of their interactions, we find the stark division between supporters and hesitant individuals to continue throughout the vaccination campaign. However, we find an increasing commonality in the topical focus of the vaccine supporters and vaccine hesitant, pointing to a possible common set of facts the two sides may agree on. Still, we discover a series of concerns voiced by the hesitant community, ranging from unfounded conspiracies (microchips in vaccines) to public health policy discussion (vaccine passport limitations). We recommend an ongoing surveillance of this debate, especially to uncover concerns around vaccination before the public health decisions and official messaging are made public.