Health Policy Report Research Articles

Lingerie, high heels, lipstick, alcohol and tobacco: paraphilias and fetishes and the Mental Health of Sex Workers

Law No. 10,216 (National Mental Health Policy) reports on the rights and protection of people suffering from mental disorders. Objective: to report the perceptions of female sex workers about their mental health in light of the Mandala of Knowledge. Results: 1st moment: Who are we – participants make their self-introduction. 2nd moment: Getting to know the Mandala - explanation of what Popular Health Education is. 3rd moment: Our daily mental health - presentation of images with the main CMDs. 4th moment: How can I help myself? – the sex workers brought their stories about each image present in the mandala. Through constructions and deconstructions of EPS, strong and real stories from sex workers about CMD were highlighted. Conclusion: we noticed the precariousness between quality of life and the job carried out by sex workers, their long working hours, risk of harassment and police violence, precarious financial situation, thus reflecting on their mental health, whether at home or in the work environment.

A Planetary Health Perspective to Decarbonising Public Hospitals in Ireland: A Health Policy Report

Background: Decarbonisation refers to the process by which countries, individuals or other entities aim to achieve zero fossil carbon emissions through reduction of greenhouse gas (GHG) emissions, including procurement, energy and buildings, pharmaceuticals, transport, and waste which impacts public health. Preliminary findings on decarbonisation in healthcare systems suggest that further research is required. Aims: This research was undertaken to explore the opportunities and barriers of decarbonisation of public hospitals within the ‘climate health’ planetary health boundary in the Republic of Ireland. Methodology: A literature review was used in conjunction with semi-structured qualitative interviews to explore barriers and opportunities of decarbonisation of Irish healthcare sector. The purposive sampling for the qualitative interviews resulted in the selection of five key decision-makers within cross-sector fields including environmental, public health, management and transport. Results: Themes emerged which reflected the cross-cutting planetary health principle. Barriers such as financial incentives and the requirement for a transdisciplinary approach were raised. The need for preparing the healthcare sector through adaptation and mitigation of the effects of climate change was also highlighted, as was the importance of leadership within the hospital from all sectors. Recommendations: The findings emerging from this novel research through a planetary health lens can be used to further inform the ‘Climate Action Plan’ in the Republic of Ireland, with adaption to other healthcare sectors internationally, in order to ensure investment within the health sector in preparation for climate change.

Understanding international variation in national low-risk drinking guidelines: health policy report

Abstract Background The harmful use of alcohol is associated with adverse health, social, and economic consequences. National low-risk drinking guidelines provide evidence-based advice on how to reduce the risks associated with alcohol consumption and provide a basis for other alcohol-control interventions. There is substantial variation between guidelines and no international consensus on what constitutes 'low-risk' drinking. These discrepancies may lead to misinterpretation of the guidance, and such variation may undermine public confidence in experts and be exploited by the alcohol industry. Methods This project had two main components: (i) a literature review, to identify any new evidence from January 2016 to August 2019 suggesting a recommended threshold for 'low-risk' drinking; (ii) the analysis of six examples of national guidelines. Those from the UK, Ireland, Australia, New Zealand, Canada, and USA were examined for information about the utilisation of evidence to inform guidance, as well as details of the guideline development process. Thematic analysis of the UK, Canadian and Australian guidance explored wider influences on the guidelines. Results The literature review highlighted that all alcohol consumption carries some degree of risk. Content analysis of the guidelines emphasised the substantial variation in national guidance. Differences in the use of evidence and guideline development process may have given rise to at least some of the observed variation. Thematic analysis suggested that wider influences, such as differences in societal values, may also have contributed to disparities in the guidelines. Conclusions It may be possible to standardise certain areas of the development process, such as agreeing what constitutes an 'acceptable' level of alcohol-attributable risk. Further research is required to verify whether these results are generalisable to other countries, and to determine the most appropriate statistical model for risk calculations. Key messages The factors which determine guideline development are manifold and complex. Any level of alcohol consumption carries some degree of risk.

Medical safety reporting system neccessity and analysis of Turkey 2016 data: A health policy report.

The National Safety Reporting System, which is developed for Turkey, aims to classify medical errors with a coding methodology that handles errors in subcategories. Error entries done via the system are added to the statistics immediately by advanced live data reporting capabilities of the software. Our aim was to provide information about the Turkey local reporting system to ensure patient safety by detecting medical errors. The data used for analyses were obtained from https://www.grs.saglik.gov.tr and the web service used by hospital information systems. The error reporting time, most commonly reported errors, errors by professions and errors by location were examined under the major error categories and percentages that have been used in relevant data. In total, 53,477 errors were submitted to the National Safety Reporting System in 2016. When these entries were split into relevant categories such as drug errors, laboratory errors, surgical errors and patient safety errors, the most common errors were wrong dosage order, hemolyzed sample, not marking the side to be operated on and patient fall (patient/caretaker related), respectively. In order to reduce medical errors and provide patient safety, every institution must first of all do its own self-assessment. New user-friendly systems can be developed in order to increase medical error notifications and thus institutions can improve their healthcare quality.

Introducing a sector-wide pooled fund in a fragile context: mixed-methods evaluation of the health transition fund in Zimbabwe

IntroductionAid effectiveness and improving its impact is a central policy matter for donors and international organisations. Pooled funding is a mechanism, whereby donors provide financial contributions towards a common set...

Antimicrobial Resistance.

The development of antibiotics is considered among the most important advances of modern science. Antibiotics have saved millions of lives. However, antimicrobial resistance (AMR) threatens this progress and presents significant risks to human health. To identify factors associated with AMR, the current epidemiology of important resistant organisms, and possible solutions to the AMR problem. PubMed (2000-2016), NIH REPORTER, and ClinicalTrials.gov databases were searched for articles and entries related to AMR, focusing on epidemiology, clinical effects of AMR, discovery of novel agents to treat AMR bacterial infections, and nonpharmacological strategies to eliminate or modify AMR bacteria. In addition to articles and entries found in these databases, selected health policy reports and public health guidance documents were reviewed. Of 217 articles, databases, and reports identified, 103 were selected for review. The increase in AMR has been driven by a diverse set of factors, including inappropriate antibiotic prescribing and sales, use of antibiotics outside of the health care sector, and genetic factors intrinsic to bacteria. The problem has been exacerbated by inadequate economic incentives for pharmaceutical development of new antimicrobial agents. A range of specific AMR concerns, including carbapenem- and colistin-resistant gram-negative organisms, pose a clinical challenge. Alternative approaches to address the AMR threat include new methods of antibacterial drug identification and strategies that neutralize virulence factors. Antimicrobial resistance poses significant challenges for current clinical care. Modified use of antimicrobial agents and public health interventions, coupled with novel antimicrobial strategies, may help mitigate the effect of multidrug-resistant organisms in the future.

Commentaries on health services research

Commentaries on health services research

Health promotion interventions in type 2 diabetes.

To present the most common quality criteria in health promotion interventions in type 2 diabetes mellitus (T2DM). A systematic literature search was conducted to identify review articles, health technology assessments and policy reports of evaluated health promotion interventions in T2DM. A descriptive analysis of study characteristics and evaluation criteria are presented. Seven studies met the inclusion criteria. The findings indicate that the most common health promotion interventions used in T2DM are initiatives targeting health care professionals. The main ambition of the programs was to increase the collaboration between health care professionals and patients, and between health care centres, program managers and community stakeholders. This investigation extends our knowledge of the most common health promotion interventions in T2DM and which structure, process and outcome measurements that are reported in such interventions. Future research could usefully explore how the effectiveness of multicomponent and complex interventions may be evaluated and extend the association of these factors into other settings and in relation to other lifestyle related chronic diseases.

Healthcare Worker Influenza Vaccination in Oregon Nursing Homes: Correlates of Facility Characteristics

ObjectivesNursing home (NH) employee influenza vaccination is associated with reductions in morbidity and mortality among residents. Little is known regarding associations between NH characteristics and employee influenza vaccination rates (EVRs). This study identifies NH characteristics that may be associated with EVRs. DesignData on employee vaccination rates and programs were gathered from the Office for Oregon Health Policy and Research reports for 3 influenza seasons from 2009 to 2012 and merged with Online Survey, Certification, and Reporting files, from which facility characteristics were obtained. Market controls were obtained from the 2010 Area Health Resource File. Multivariate linear and logistic regression were used to model relationships between facility characteristics and EVR per facility per year, whether formal education for employees was conducted, and whether 2010, 2015, and 2020 Healthy People targets were met. SettingOregon nursing homes from 2009 to 2012. ParticipantsNHs reporting sufficient data to calculate an EVR were included. Based on information obtained from 2009–2010, 2010–2011, and 2011–2012 surveys, EVRs were calculated for 113/140, 129/141, and 137/140 (81%, 91%, and 98% of) NHs, respectively. MeasurementsDependent variables were EVR per facility per year, whether formal education for employees was conducted, and whether 2010, 2015, and 2020 Healthy People targets were met. Independent variables included facility characteristics and market controls. ResultsOn average, chain-affiliated NHs had 9% higher EVRs (P = .01) and 73% higher odds of achieving 60% EVR (2010 target, P = .05) than free-standing NHs. For-profit NHs had, on average, 8% lower EVRs (P = .04) than not-for-profit NHs. Surprisingly, a 10% increase in proportion of Medicaid residents was associated with a 2% increase in EVR (P = .01) and higher odds of achieving 60% (odds ratio = 1.20, P = .004) and 70% (2015 target, odds ratio = 1.14, P = .05) EVR. ConclusionGiven that NHs generally have low employee influenza vaccination rates, it may be necessary to target low-performing facilities to achieve substantial improvements. However, significant correlates of this study cannot be easily addressed by NH management or policymakers. Without policy change encouraging key components of vaccination programs, public reporting may be insufficient to improve EVRs.

Analysis and Implementation of a World Health Organization Health Report

A long-standing scientific discourse on the use of health research evidence to inform policy has come to produce multiple implementation theories, frameworks, models, and strategies. It is from this extensive body of research that the authors extract and present essential components of an implementation process in the health domain, gaining valuable guidance on how to successfully meet the challenges of implementation. Furthermore, this article describes how implementation content can be analyzed and reorganized, with a special focus on implementation at different policy, systems and services, and individual levels using existing frameworks and tools. In doing so, the authors aim to contribute to the establishment and testing of an implementation framework for reports such as the World Health Organization World Report on Disability, the World Health Organization International Perspectives on Spinal Cord Injury, and other health policy reports or technical health guidelines.

A Review of the Role of the U.S. Military in Nonemergency Health Engagement

In recent decades, the U.S. Department of Defense has become increasingly committed to involvement in nonemergency medical humanitarian and civic assistance. This health policy report reviews the legal and doctrinal justifications behind the U.S. military's participation in nonemergency health engagement, explores whether the aid provided is achieving stated objectives, and provides recommendations on how the military's role could be improved. Legal and doctrinal foundations are threefold: to provide benefit to the recipients, training to the personnel involved, and enhance security for the United States and host nation. A review of the literature reveals serious questions concerning the measurement of the benefit to recipients from the military's short-term health engagement missions. A robust and systematic monitoring and evaluation capability is necessary before the military's success at meeting strategic objectives with HCA can be understood. Regulations should be modified to minimize local capacity displacement. Some of the suggestions in the literature have been adopted and implemented in recent missions. In addition, Department of Defense involvement in disease surveillance appears to be a constructive way for the military to engage with host nations and improve their capacity to detect and respond to outbreaks.

The Swedish National Public Health Policy Report 2010

In 2003, the Swedish Parliament adopted a cross-sectorial national public health policy based on the social determinants of health, with an overarching aim--to create societal conditions that will ensure good health, on equal terms, for the entire population--and eleven objective domains. At that time the policy was globally unique, and serves as guidance for public health practice at the national, regional and local levels. The development of the public health policy and the determinants of health are presented regularly in various reports by the Swedish National Institute of Public Health. This supplement is a condensed version of the 174-page Public Health Policy Report 2010, the second produced since the national policy was adopted in 2003. In order to provide a holistic approach to analysing implemented measures and providing new recommendations within the eleven objective domains of the Swedish national public health policy, we have divided these in three strategic areas. These are: Good Living Conditions, Health-Promoting Living Environments and Living Habits, and Alcohol, Illicit Drugs, Doping, Tobacco and Gambling, each described in the respective introductions for Chapters 3-5. The production of the report was supported by a common analytical model that clarified the societal prerequisites for health in the eleven objective domains. These are factors that can be influenced by political actions in order to create a change. Economic analyses have also been developed to provide a priority basis for political decisions. Analyses of the development of public health determinants were based on data from the National Public Health Survey and data delivered from about 15 various national agencies. Measures that have been implemented between 2004 and 2009 are analysed in details, as the basis for new recommendations for future measures. The introduction describes Swedish public health policy in the new millennium and how it has developed, the role of the Swedish National Institute of Public Health and other important stakeholders. Approaches, models and methods used in carrying out the commission to produce the public health policy report are also described. In the following chapters, the trends of important determinants of public health, in relation to the overarching aim and the 11 objective domains as grouped in the three strategic areas, are analysed. The final chapter presents the proposed prioritisation for the large number of recommendations that were made, and a presentation of the annual costs of ill health in Sweden. These are compared with the costs of implementing recommended measures. The final chapter also describes how the Public Health Policy Report 2010 was received and lists the recommendations that the Swedish Government has taken action on as of September 2012. Public health trends have generally been stable or positive, although health inequalities persist. Economic analyses demonstrate that ill-health in Sweden costs 12 billion SEK every year, yet a large amount of this ill-health can be prevented. Sixty-eight recommendations were presented in the report. The government's response to recommendations has been very positive; approximately 60% of the recommendations in the three strategic areas have been adopted less than two years after the Public Health Policy Report 2010 was published.

Facilitators and barriers to implementing clinical care pathways.

BackgroundThe promotion of care pathways in the recent Governmental health policy reports of Lord Darzi is likely to increase efforts to promote the use of care pathways in the NHS. Evidence on the process of pathway implementation, however, is sparse and variations in how organisations go about the implementation process are likely to be large. This paper summarises what is known about factors which help or hinder clinicians in adopting and putting care pathways into practice, and which consequently promote or hinder the implementation of scientific evidence in clinical practice.DiscussionCare pathways can provide patients with clear expectations of their care, provide a means of measuring patient's progress, promote teamwork on a multi-disciplinary team, facilitate the use of guidelines, and may act as a basis for a payment system. In order to achieve adequate implementation, however, facilitators and barriers must be considered, planned for, and incorporated directly into the pathway with full engagement among clinical and management staff. Barriers and/or facilitators may be present at each stage of development, implementation and evaluation; and, barriers at any stage can impede successful implementation. Important considerations to be made are ensuring the inclusion of all types of staff, plans for evaluating and incorporating continuous improvements, allowing for organisational adaptations and promoting the use of multifaceted interventions.SummaryAlthough there is a dearth of information regarding the successful implementation of care pathways, evidence is available which may be applied when implementing a care pathway. Multifaceted interventions which incorporate all staff and facilitate organisational adaptations must be seriously considered and incorporated alongside care pathways in a continuous manner. In order to better understand the mechanism upon which care pathways are effective, however, more research specifically addressing conditions under which providers become engaged in using care pathways is needed.

Developing effective chronic disease interventions in Africa: insights from Ghana and Cameroon

BackgroundAfrica faces an urgent but 'neglected epidemic' of chronic disease. In some countries stroke, hypertension, diabetes and cancers cause a greater number of adult medical admissions and deaths compared to communicable diseases such as HIV/AIDS or tuberculosis. Experts propose a three-pronged solution consisting of epidemiological surveillance, primary prevention and secondary prevention. In addition, interventions must be implemented through 'multifaceted multi-institutional' strategies that make efficient use of limited economic and human resources. Epidemiological surveillance has been prioritised over primary and secondary prevention. We discuss the challenge of developing effective primary and secondary prevention to tackle Africa's chronic disease epidemic through in-depth case studies of Ghanaian and Cameroonian responses.MethodsA review of chronic disease research, interventions and policy in Ghana and Cameroon instructed by an applied psychology conceptual framework. Data included published research and grey literature, health policy initiatives and reports, and available information on lay community responses to chronic diseases.ResultsThere are fundamental differences between Ghana and Cameroon in terms of 'multi-institutional and multi-faceted responses' to chronic diseases. Ghana does not have a chronic disease policy but has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. Cameroon has a policy on diabetes and hypertension, has established diabetes clinics across the country and provided training to health workers to improve treatment and education, but lacks community and media engagement. In both countries churches provide public education on major chronic diseases. Neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness.ConclusionsBoth Ghana and Cameroon require a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. We outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions.

Experiences from the Swedish Determinants-Based Public Health Policy

A comprehensive Swedish public health policy was adopted by the Swedish Parliament, the Riksdag, in April 2003. It pushes health up on the political agenda and affords equity in health high priority. The first phase of implementation of the policy, 2003-5, is described in the 2005 Public Health Policy Report published by the Swedish National Institute of Public Health (SNIPH). For the purpose of investigating the implementation, SNIPH has monitored the development of 42 determinants and used reports from 22 central agencies and eight county administrative boards together with interviews with all Sweden's county councils (21) and a questionnaire sent out to all municipalities (290). The experiences from the implementation of the policy are that: the determinants approach-focusing on structural factors in society, people's living conditions, and health behaviors that affect health-is in general well understood and emphasizes the role of other sectors in public health; the use of indicators to follow up exposures to determinants is of key importance; the support to actors outside the health service is needed to identify their public health role; a continuous steering from the government and other political bodies is of vital importance; public health promotion on the regional level needs a higher level of coordination; municipalities need more skills development. Sweden has a new government that was elected in September 2006; the new government has retracted the former government's public health policy communication submitted to the Riksdag in the spring of 2006, but does not intend to change the public health policy.

Experiences from the Swedish determinants-based public health policy

A comprehensive Swedish public health policy was adopted by the Swedish Parliament, the Riksdag, in April 2003. It pushes health up on the political agenda and affords equity in health high priority. The first phase of implementation of the policy, 2003-5, is described in the 2005 Public Health Policy Report published by the Swedish National Institute of Public Health (SNIPH). For the purpose of investigating the implementation, SNIPH has monitored the development of 42 determinants and used reports from 22 central agencies and eight county administrative boards together with interviews with all Sweden's county councils (21) and a questionnaire sent out to all municipalities (290). The experiences from the implementation of the policy are that: the determinants approach - focusing on structural factors in society, people's living conditions and health behaviours that affect health - is in general well understood and emphasises the role of other sectors in public health; the use of indicators to follow up exposures to determinants is of key importance; the support to actors outside the health service is needed to identify their public health role; a continuous steering from the government and other political bodies is of vital importance; public health promotion on the regional level needs a higher level of co-ordination; municipalities need more skills development; Sweden has a new government that was elected in September 2006; the new government has retracted the former government's public health policy communication submitted to the Riksdag in the spring of 2006, but does not intend to change the public health policy.

Grassroots Activism and the Pursuit of an Expanded Physician Supply

In this Health Policy Report, the author discusses the supply of physicians in the United States and the growing consensus that there will be a shortage of physicians in the future. Medical and osteopathic schools are expanding, and the Association of American Medical Colleges believes graduate medical education (residency) positions also should be increased.

Information Technology Comes to Medicine

This Health Policy Report explores the risks and benefits of health information technology, how policymakers are encouraging and managing its dissemination, and what the future holds for health information technology in U.S. medicine.

Employer-Sponsored Insurance — Riding the Health Care Tiger

The rising cost of health care has become a serious problem for employers who provide health insurance to their workers. In this second part of a two-part Health Policy Report, Blumenthal discusses an array of strategies that employers and health-insurance companies are adopting to reduce health care costs and improve the efficiency of the nation's health care system.

Creating A State Minority Health Policy Report Card

A state minority health policy report card may provide an important tool for evaluating and promoting state policies to reduce health disparities. This study develops criteria that can form the basis of such a state report card and assesses the performance of all fifty states on these measures. The results indicate wide variation among states, with geographic region being a significant predictor of performance on all four measures. Future research should be conducted on other predictors of state variation in minority health policy and connections between state policy and health outcomes for minorities.