Health Policy Research Articles

Abstract 4124875: Association between Elevated Lipoprotein(a) and Cardiovascular Events and Mortality in a Nationally Representative Sample of US Medicare, Medicaid, and Commercial Enrollees with ASCVD

Background: Elevated lipoprotein(a) [Lp(a)] is an independent and causal risk driver for atherosclerotic cardiovascular disease (ASCVD). Few patients with ASCVD receive Lp(a) screening and real-world data assessing the association between elevated Lp(a) and risk of cardiovascular (CV) events and mortality is limited. Objectives: To examine the association of elevated Lp(a) and risk of CV events and death in an ASCVD population using large US health claims databases. Methods: Patients with ASCVD were pooled from US Medicare, commercial, and Medicaid health plans from 2017 to 2022. Lp(a) levels were linked at the patient level from HealthVerity Lab Data and categorized as: <30 mg/dL (<75 nmol/L), ≥30-<50 mg/dL ( > 75-<125 nmol/L), ≥50-<70 mg/dL ( > 125-<175 nmol/L), ≥70-<90 mg/dL (≥175-<225 nmol/L) and ≥90 mg/dL (≥225 nmol/L). Patients were followed from the 1 st ASCVD diagnosis (index) to insurance plan disenrollment, death, or end of study. Cox regression, adjusted for age, sex, race, insurance, comorbidities, LDL-C, and other risk factors, measured the association between Lp(a) levels and risk of CV events and death. Results: Of 28.8 million ASCVD patients, 180,240 (0.6%) had Lp(a) levels: mean(±SD) age 68.6±1 years, 50.1% male, 5.9% Black, 2.8% Hispanic, 2.1% Asian, 72.8% Medicare, 21.8% commercial, and 5.4% Medicaid. Mean follow-up was 3.7 years; 23.3% and 15.7% had Lp(a) ≥50mg/dL [≥125 nmol/L] and ≥70 mg/dL (≥175 nmol/L), respectively. Black patients had highest median Lp(a) (50 mg/dL/111 nmol/L), followed by Asian (13.5 mg/dL/35.5 nmol/L), White (13 mg/dL/32 nmol/L), and Hispanic (11.5 mg/dL/29 nmol/L) patients. Lp(a) levels of ≥30-<50 mg/dL, ≥50-<70 mg/dL, ≥70-<90 mg/dL, and ≥90 mg/dL were associated with 7%, 10%, 16%, and 26% greater risks of CV events vs. <30 mg/dL (p-values <0.0001; cumulative incidence reported in Figure 1). All-cause mortality risk was also greater for those with Lp(a) ≥90 mg/dL vs. <30 mg/dL: hazard ratio (HR)=1.11, p=0.003. Similar trends persisted for patients with LDL-C ≤70 mg/dL. Conclusion: In this national-scale real-world cohort of patients with ASCVD, Lp(a) testing is infrequent and elevated Lp(a) levels were significantly associated with a greater risk of CV events and mortality.

Abstract 4137461: Elevated Lipoprotein(a) Increases Cardiovascular-Related Healthcare Resources Utilization and Costs among US Medicare, Medicaid, and Commercial Enrollees with ASCVD

Background: Elevated lipoprotein(a) [Lp(a)] is a recognized genetic, independent, and causal risk driver for atherosclerotic cardiovascular disease (ASCVD). Less is known about how elevated Lp(a) affects downstream cardiovascular (CV)-related healthcare resource utilization (HCRU) and costs in patients with ASCVD. Objective: To assess the association of Lp(a) levels with CV-related HCRU (hospitalizations, outpatient and emergency department [ED) visits), and CV-related costs for patients with ASCVD in a national-scale multi-insurance cohort. Methods: Patients with ASCVD were pooled from US Medicare, commercial, and Medicaid health plans from 2017 to 2022. Lp(a) levels (mg/dL and nmol/L) were linked at the patient level with HealthVerity Lab Data. Elevated Lp(a) was defined as Lp(a)≥70mg/dL (≥ 175 nmol/L) and normal Lp(a) was defined as Lp(a)<30mg/dL (<75 nmol/L). Generalized linear models with log link negative binomial distribution (HCRU) and log link gamma distribution (costs) adjusted for age, sex, race, insurance type, comorbidities, statin use, and prior hospitalizations, measured the association of Lp(a) levels with the annualized rate of CV-related hospitalizations, ED visits, and outpatient visits (incidence rate ratio [IRR]) and CV-related costs (annualized cost ratio). Results: A total of 180,240 ASCVD patients were identified with Lp(a) values. Median (IQR) Lp(a) was 14 mg/dL (4 mg/dL – 48 mg/dL) or 35 nmol/L (12 nmol/L – 114 nmol/L). Mean (SD) age was 68.6 (12.0) years with 49.9% being female; 72.8% of patients were from Medicare, followed by commercial (21.8%) and Medicaid (5.4%). Fully adjusted CV-related HCRU was significantly higher in those with elevated Lp(a) compared to normal Lp(a): inpatient hospitalizations (IRR=1.11), outpatient visits (IRR=1.11) and ED visits (IRR=1.06), all p <0.001 (IRR and 95% CI reported in Table 1). Patients with elevated Lp(a) had 14% higher CV-related annualized healthcare costs than patients with normal Lp(a) (p <0.001) with significantly higher CV-related HCRU beginning with Lp(a) levels >30 mg/dL (>75 nmol/L). Conclusion: Elevated Lp(a) was significantly associated with greater CV-related HCRU and costs in patients with ASCVD.

Abstract 4131439: Routine Social Isolation Screening Among Adults with Cardiovascular Disease: A Survival Analysis

Background: Evidence linking social isolation to cardiovascular disease morbidity and mortality has grown in recent years. Still, information on how this may manifest in real world settings and its implications for screening practices is limited. In 2019, our large national integrated health care system implemented screening for social isolation as part of a broader universal social risk assessment. This repository of screening data was joined to administrative claims to test these associations in real world data and explore differences by demographic and medical factors. Methods: Social isolation responses recorded from 2019-2022 were included for a cohort of adult health plan members with documented atherosclerotic cardiovascular disease (ASCVD). We selected a single random assessment for each member and retained any other responses for sensitivity analyses. Cohort members had at least 10 months of enrollment surrounding assessment date for use as the baseline period and were followed for 365 days. We used cox proportional hazards regression with right censoring for coverage gaps to estimate the risk of all-cause mortality conferred by social isolation. We used Poisson regression to model the rate of inpatient stays. Results: There were 881 deaths among 7,484 members (18% of those with social isolation; 11% of those without). The isolated group skewed less male (54% vs. 65%, p <0.001) and older (68.4 [SD 12.7] vs. 67.5 [SD 12.6] years, p <0.05) than those not isolated. At baseline, the isolated group had higher rates of mean inpatient stays (2.3 [SD 1.9] vs. 1.9 [SD 1.6], p <0.001), ED visits (1.2 [SD 1.9] vs. 0.9 [SD 1.6], p < 0.001), and smoking (50% vs. 44%, p < 0.05), and a higher mean Charlson Comorbidity Index (CCI) (3.6 [SD 2.6] vs. 3.0 [SD 2.4], p < 0.001). Adjusted survival models suggested an independent 33% increase in all-cause mortality risk among those screening positive for social isolation (1.33 HR 95% CI 1.10, 1.62). Adjusted Poisson models found a similar increase in inpatient stays (1.36 IRR 95% CI 1.14, 1.62). Conclusions: Our findings corroborate the association between social isolation and morbidity and mortality among those with known ASCVD. The effect for social isolation was similar in magnitude to clinical comorbidities and smoking, suggesting that routine screening for social isolation may provide valuable information for assessing and managing the risk of death among patients with ASCVD.

Abstract 4137949: Trends in Hypertensive Related Heart Disease Mortality Among Older Adults in the United States, 1999 - 2020

Background: Hypertensive heart disease (HHD) is a major global health concern that impairs quality of life and causes significant morbidity and mortality, especially among older adults. We aimed to examine the temporal trends in HHD-related mortality in the United States (U.S.) between 1999 to 2020. Methods: The CDC WONDER multiple-cause of death database was utilized to identify HHD-related mortality among adults aged ≥ 55 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, gender, race, and geographic region. Results: A total of 1,186,183 HHD-related deaths were recorded among individuals ≥ 55 years old. Overall, AAMR increased from 36.7 in 1999 to 133.9 in 2020. AAMRs showed a steady increase between 1999 and 2017 (APC: 3.72 [95% CI: 2.72 to 4.49]), followed by a surge from 2017 to 2020 (APC: 14.28 [95% CI: 8.21 to 22.93]). Gender-based analysis showed a constantly higher AAMR among older men compared to older women. Variations in AAMR based on race revealed that Non-Hispanic (NH) Black or African American population had the highest AAMRs. Geographic disparities among states showed that the District of Columbia had the highest AAMR while Nebraska had the lowest. The southern U.S. also had a consistently higher AAMR followed by the West, Northeast, and Midwest. Moreover, metropolitan areas had a higher AAMR than nonmetropolitan areas. Conclusion: Our findings reveal an increase in HHD-related deaths and demonstrate that NH Blacks consistently bear a higher burden of disease mortality. These insights underscore the importance of integrating demographic and geographic variables into public health planning and interventions.

Maternal mortality in Panama from 1998 to 2022.

To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R 2 was performed to analyze the data. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R 2 = 0.1 (y = -0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R 2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.

Decision Support System (DSS) for Improving Production Ergonomics in the Construction Sector

Ergonomics is essential to improving workplace safety and efficiency by reducing the risks associated with physical tasks. This study presents a decision support system (DSS) aimed at enhancing production ergonomics in the construction sector through an analysis of high-risk postures. Using the Ovako Work Posture Analysis System (OWAS), the Revised NIOSH Lifting Equation (NIOSH equation) and Rapid Entire Body Assessment (REBA), the DSS identifies ergonomic risks by assessing body postures across common construction tasks. Three specific postures—X, Y and Z—were selected to represent typical construction activities, including lifting, squatting and repetitive tool use. Posture X, involving a forward-leaning stance with arms above the shoulders and a 25 kg load, was identified as critical, yielding the highest OWAS and NIOSH values, thus indicating an immediate need for corrective action to mitigate risks of musculoskeletal injuries. The DSS provides recommendations for workplace adjustments and posture improvements, demonstrating a robust framework that can be adapted to other postures and industries. Future developments may include application to other postures and sectors, as well as the use of artificial intelligence to support ongoing ergonomic assessments, offering a promising solution to enhance Occupational Safety and Health policies.

Operation strategies of the supplier, demander, and third party under the DRG/DIP reform

In this study, we analyze the operation strategies of the supplier, demander, and third party involved in the current process of China’s health insurance reform. Specifically, we summarize the relevant literature on the reform of healthcare insurance both in China and abroad, explore the current changes in healthcare policy, and identify the main problems in the current diagnosis-related group/diagnosis-intervention packet (DRG/DIP) payment method reform. Based on our analysis, we propose strategies that can satisfy the needs of the supplier, demand side, and third parties and offer valuable suggestions to enhance the healthcare security system and promote the DRG/DIP payment method reform.

CTNI-01. INTERVENTION OUTCOMES OF ENHANCED RECOVERY AFTER SURGERY PROTOCOL VERSUS STANDARD CARE FOR GLIOMA PATIENTS IN SELECTED HOSPITALS IN DEMOCRATIC REPUBLIC OF THE CONGO: RANDOMIZATION AND STRATIFICATION OF PROVIDERS AND HOSPITALS

Abstract BACKGROUND Enhanced Recovery after Surgery (ERAS) protocols have shown promise in improving perioperative care and patient outcomes in various surgical specialties. Aim: This study will aim to assess the efficacy of ERAS compared to the current standard of care (SOC) for glioma patients in DRC hospitals. METHODS A pragmatic, multicenter, randomized controlled trial will be designed to evaluate the outcomes of glioma patients treated with ERAS protocols versus SOC in selected hospitals in DRC. EXPECTED RESULTS A total of 100 glioma patients will be included in this study, with 50 patients in the ERAS group and 50 in the SOC group. The primary analysis will reveal that the ERAS group will have significantly fewer post-operative complications (p < 0.05) and a shorter length of hospital stay (p < 0.05) compare to the SOC group. Patient satisfaction scores will also higher in the ERAS group. Subgroup analyses by hospital center will indicate consistent trends in favor of the ERAS protocol. Randomization of providers and stratification by hospital will aim to mitigate the influence of individual provider practices and hospital-specific factors on the study outcomes. This approach will be expected to enhance the validity of the results and ensure equitable representation across hospitals. CONCLUSIONS The unique design of randomizing providers and stratifying by hospital will be a critical component of this multicenter trial, which seeks to provide valuable insights into the potential benefits of ERAS protocols for glioma patients in DRC. The findings will guide clinical practice and healthcare policy in resource-constrained settings, ultimately improving the care and outcomes of glioma patients

PREVENTION AND CONTROL OF CHRONIC DISEASES IN VULNERABLE POPULATIONS

Chronic diseases such as diabetes, hypertension and cardiovascular diseases are prevalent in vulnerable populations, who often face difficulties in accessing adequate medical care. Primary care, especially family medicine, plays a central role in the prevention and control of these diseases, as it offers continuous, comprehensive and personalized care, focused on health promotion and the prevention of complications. This model of care is especially effective in communities that face economic, social and cultural barriers, allowing for early intervention and appropriate management of chronic conditions. The aim of this study is to analyze strategies for the prevention and control of chronic diseases in vulnerable populations, with a focus on family medicine. The aim is to identify effective approaches that can be used to improve the quality of life of these populations and reduce the incidence and progression of chronic diseases. The research was carried out through a qualitative literature review, focusing on articles published between 2017 and 2022. The aim was to explore the advances and challenges in the management of chronic diseases, with an emphasis on primary health practices, the impact of social determinants of health, and the role of technologies such as telemedicine in the management of these conditions. By providing continuous and comprehensive care, family medicine uses various strategies to prevent and control chronic diseases. These include regular patient follow-up, early screening for conditions such as hypertension and diabetes, and health education, which guides individuals on healthy behaviors and self-care. In addition, disease monitoring programs and interventions such as modifying eating habits and promoting physical activity have shown positive results in the management of chronic diseases. However, there are still significant challenges, such as the scarcity of resources and the lack of qualified professionals, which limit the effectiveness of these approaches in certain regions and social groups. Overcoming these barriers requires a joint effort between health professionals, managers and public policies. It is concluded that family medicine is a fundamental approach to the control and prevention of chronic diseases, especially in vulnerable populations. The strategies adopted in this model of care, such as continuous monitoring, health education and early intervention, have shown significant results in improving quality of life and reducing complications associated with chronic diseases. However, in order to optimize the results, it is necessary to overcome challenges related to access and the training of professionals, as well as ensuring adequate support for the implementation of public health programs that favour the population in situations of vulnerability. Implementing efficient public policies and expanding access to primary health care are essential to achieving effective control of chronic diseases.

Future Nurses in a Changing Climate: Exploring the Relationship Between Environmental Literacy and Climate Anxiety.

Climate change significantly impacts public health, increasing the prevalence of respiratory, cardiovascular and mental health issues. Nurses, as frontline healthcare providers, need strong environmental literacy to manage these health challenges. This study explores how environmental literacy among nursing students relates to climate anxiety, aiming to improve educational strategies and mental health support for future nurses. Is to investigate how environmental literacy among nursing students affects their levels of climate anxiety. A cross-sectional survey was utilised on a representative sample of 620 nursing students from each academic year. Climate anxiety scale and the environmental literacy scale for adults were used to collect data. Environmental literacy and its components were positively linked to cognitive-emotional and functional impairments and climate anxiety. Gender differences were observed, with females experiencing higher climate anxiety. Increased environmental literacy generally reduced climate anxiety, particularly in females, emphasising gender differences in environmental literacy's impact on climate anxiety. Despite the model's low explanatory power (R2 = 0.026), the findings highlight the importance of gender differences in the relationship between environmental literacy and climate anxiety. Nursing students show promise in their environmental knowledge but face significant climate anxiety. Gender differences in anxiety levels warrant attention. Addressing these concerns is crucial for preparing nurses to effectively address climate change's health effects and ensuring a resilient healthcare system. The study underscores the importance of integrating environmental literacy into nursing education and promoting pro-environmental behaviours among nursing students and professionals. It highlights the crucial role of mental health support services, policy advocacy and ongoing research in addressing climate anxiety and preparing nurses to tackle the health impacts of climate change. No patient or public involvement.

The Rise of Global Health Emergency Governance

AbstractIn this paper I shed new light on contemporary developments in global health governance, policymaking, and knowledge production. Specifically, by investigating the historical roots and emergence of global health emergency governance. Drawing on the Foucauldian notion of “problematisation” and on Science and Technology Studies of disaster, I trace, examine, and elucidate three main axes through which, I argue, health emergencies became a problem of global governance. I show, first, the formation of emergency management as a distinct professional field. Second, the migration of emergency management into global health governance and its proliferation within it. And third, the move from global health emergency management to the global governance of health emergencies. Overall, I suggest the rise of global health emergency governance provides crucial context for understanding social, political, and epistemic tensions and controversies in health emergencies such as COVID-19. Through the analysis, I identify a particular rationale that is rooted in emergency management and had become embedded in global health emergency governance. A rationale that involves “temporal compression” and “structural plasticity.” I discuss possible implications of this rationale for global health governance, policy, and knowledge.

HUMANIZED PRENATAL CARE

Humanized prenatal care is a concept that aims to ensure that pregnant women receive respectful and personalized care, promoting an emotionally supportive and welcoming environment during pregnancy. This approach aims not only to ensure the physical health of the mother and fetus, but also to improve the psychological and emotional well-being of women during pregnancy, which can have a positive impact on maternal and fetal outcomes. Studies have shown that a humanized approach is a determining factor in reducing complications during pregnancy and childbirth, as well as strengthening the bond between mother and baby. This summary seeks to analyze the influence of humanized care during prenatal care on maternal and fetal outcomes, discussing the importance of welcoming and personalized practices for increasing the quality of care. It also examines how humanized care can have a positive impact on both the physical and emotional health of pregnant women, promoting more favorable outcomes for mother and baby. This study used a qualitative methodology based on a literature review, focusing on humanization practices in prenatal care, exploring their impact on maternal and fetal health and public policy guidelines in Brazil. Humanized prenatal care involves practices such as respect for the autonomy of the pregnant woman, active listening, inclusion of the family in the process and psychological support, as well as comprehensive care for the woman’s physical health. Research shows that pregnant women who receive this type of care have lower rates of anxiety and depression, factors that are associated with obstetric complications and negative outcomes. In addition, humanized care contributes to pregnant women’s adherence to prenatal appointments and tests, reducing the risks of premature births, low birth weight and neonatal mortality. Care that respects a woman’s individuality also facilitates the control of conditions such as hypertension and gestational diabetes, promoting a safer pregnancy. Humanized prenatal care therefore plays a crucial role in maternal and fetal outcomes, promoting a healthier pregnancy and reducing the risks associated with labour and birth. In addition to improving the physical health of the mother and fetus, humanized care strengthens the emotional health of the pregnant woman and facilitates the mother-baby bond, factors that are essential for the healthy development of the newborn. The implementation of humanized practices in health services is therefore a fundamental strategy for improving the quality of prenatal care and promoting better outcomes for mothers and babies.

Nats'eji (healing): Examining patient and provider experiences with hospital-based Indigenous wellness services in Northwest Territories, Canada.

This study aimed to examine how Indigenous patients and biomedical healthcare providers understand and experience the Indigenous wellness services at a hospital in the Northwest Territories. The qualitative study (May 2018-June 2022) was overseen by a regional Indigenous Community Advisory Committee. Guided by Two-Eyed Seeing and post-colonial theory, the study employed a community-engaged research design, and included two strategies for data generation: (1) interviews with Indigenous Elders, patient advocates, biomedical healthcare providers, policy makers, and hospital administrators (n = 41), and (2) iterative sharing circles with Indigenous Elders (n = 4). Data from the interviews and first sharing circle were transcribed, thematically analyzed, and presented to the sharing circle Elders for validation. The study revealed three overarching and related themes: (1) Elders and patient advocates emphasized that while the Indigenous wellness services at the hospital play a pivotal role connecting patients with cultural supports, the hospital was still not effectively bringing Indigenous healing practices into hospital care; (2) participants identified that structural factors (i.e., policy and governance decisions) shaped patients' experiences with the wellness services; and (3) participants underscored that deeply rooted forces (i.e., racism, colonialism, and biomedical dominance) inhibit the integration of Indigenous healing practices. The findings extend understandings of hospital-based Indigenous wellness services by surfacing relationships between deeply rooted forces, organizational structures, and Indigenous patients' experiences. Altogether, they suggest that to advance care for Indigenous patients and improve the integration of Indigenous healing practices, a system-wide transformation is necessary, which includes Indigenous governance at the hospital and a recognition of the value of Indigenous healing practices.

Climate Change and Heatwaves in India: Review of Impacts on Public Health, Livelihoods, and Policy

This paper presents a literature review studying the impacts of climate change and heatwaves on public health and livelihoods, with a focus on India. As global climate change accelerates, heatwaves are becoming more frequent and intense, necessitating new approaches to mitigate their effects on vulnerable populations, especially in urban areas. The review draws on recent studies (2021-2024) that explore the intersections of climate change, heatwaves, public health, livelihoods, policy interventions, and Heat Action Plans. The main findings reveal that heatwaves in India have significant public health impacts, such as increased mortality and morbidity, and disproportionately affect livelihoods, especially in agriculture and informal labor sectors. Vulnerable populations, including urban dwellers and informal workers, face heightened risks, further exacerbated by inadequate infrastructure and policy gaps. The purpose of this review is to synthesize current research to highlight these vulnerabilities and identify gaps in knowledge and policy response. A comprehensive, localized approach combining detailed risk assessments, nature-based solutions, technological innovations, and strengthened governance is essential for effective heatwave management in India. The findings underscore the urgent need for continued research focused on local spaces and comprehensive policy interventions to address the escalating risks posed by climate-induced heatwaves, setting the groundwork for future research and effective heatwave management strategies.

“Discover your potential to raise your children”: A psychoeducational infancy parenting intervention in Spain

AbstractBackgroundThe quality of parenting has a significant impact on healthy development across the life cycle. Recent research has highlighted the financial return of evidence‐based parenting programs that are well designed and implemented.ObjectiveTo analyze the impact of a psychoeducational guidance intervention program aimed at improving parenting skills.MethodThirty‐five families with children aged between 0 and 3.5 years referred from the educational, social, and health departments of the Vitoria‐Gasteiz City Council (Spain) participated in the study. Using a longitudinal approach, the intervention took place over the course of three home visits: initial pretest assessment visit, feedback and orientation visit, and a final posttest assessment visit.ResultsStatistically significant pretest–posttest differences were observed in parenting skills, including cognitive and socio‐emotional development scaffolding, parental self‐efficacy, parental adaptive stress, and diversity of experiences.ConclusionsSeveral areas for improvement were detected in the context of an intervention based on customized guidance for individual families. The implementation process indicated issues to be improved in future program editions.ImplicationsOur findings provide family and public health policy makers with empirical support for the implementation of parenting programs designed to help families to acquire and improve parenting competencies to foster their children's comprehensive development, focused on the period between 0 and 3.5 years of life. Results of the study favor the propagation among Spanish professionals who work with families of the use of quality standards of the evidence‐based approach related to quality of implementation and assessment of the impact of parenting programs.

SARS-CoV-2 seroprevalence and associated factorsamongoutpatient attendees athealth facilities in different provinces in Chad.

Chad with 7,698 confirmed cases of infection and 194 deaths since the beginning of the COVID-19 pandemic, is one of the African countries with the lowest reported case numbers. However, this figure likely underestimates the true spread of the virus due to the low rate of diagnosis. The high rate of asymptomatic infections reflects the reality of SARS-CoV-2 transmission in Chad. In this study, we estimated the seroprevalence and identified factors associated with SARS-CoV-2 infection. A cross-sectional study was conducted between September 2022 and February 2023. A total of 1,290 plasma samples were collected from outpatient attendees at Health Facilities located in 11 provinces of Chad and tested by ELISA method, for the presence of IgG antibodies to SARS-CoV2 nucleocapsid(N)protein. KoboToolbox was used to gather data from the participants and data were analyzed using STATA 16. The overall seroprevalence was 83.0% [95% CI = 81.6%-85.5%], with variations between provinces, ranging from 99.2% [95% CI = 94.0%-100%] in Moundou (Southern Chad) to 46.8% [95% CI = 36.0% -57.1%] in Biltine (Eastern Chad). Factors associated with the seroprevalence included military occupation (OR = 0.37 CI [0.80-1.77] p = 0.025) and age group between 55-64years (OR = 0.33 CI [0.15-0.72] p = 0.005). While, other factors, such as gender and age were not significantly associated with seroprevalence. Our results indicated that, the seroprevalence of COVID-19 in Chad is among the highest in Sub-Saharan Africa. These estimates could guide the response and public health policy decisions, enhancing the management of future outbreaks involving respiratory pathogens.

PROBLEMS OF THE ORGANIZATION OF THE STATE POLICY OF THE PROVISION OF MEDICAL SERVICES BY THE PRIMARY LINK OF MEDICAL AID IN UKRAINE

The article highlights key issues related to management at the level of primary health care in Ukraine. The focus is on aspects such as the growing role of primary care. Primary care is the foundation of the health care system, providing a patient's first contact with health services, prevention, diagnosis and treatment. It is especially important in the conditions of limited financial resources to continue the reforms of the medical industry in Ukraine. The article raises the issue of the availability of medical care: the relevance of management problems is due to uneven access to medical services in rural areas and remote regions. Improving the management of the medical field is necessary to overcome these difficulties. The article examines current problems in the field of primary medical care and ways to overcome them through the reform of state policy in the field of health care. The authors explore key challenges facing primary care, including insufficient funding, lack of qualified staff, uneven distribution of resources, and lack of effective governance mechanisms at various levels. Attention is paid to the issues of ensuring the availability of medical services, the quality of medical care and the implementation of new models of the organization of medical institutions. The article analyzes the reformative steps aimed at improving the functioning of the primary health care system, in particular, the introduction of family medicine and increasing the role of general practitioners. The role of state funding and the involvement of local communities in the management of medical institutions is considered separately. The conclusions emphasize the importance of improving the state's primary health care policy by strengthening financial support, infrastructure development, and improving the qualifications of medical workers to ensure a sustainable and effective health care system in Ukraine. The topic of economic challenges and management efficiency is interesting for analysis. Optimizing the use of financial resources requires their effective use, finding ways to increase the economic sustainability of healthcare institutions.

Towards value‐based rehabilitation: an analysis of South African policies for people with disabilities

AbstractSouth Africa has progressively established good healthcare policies and actively promotes the rights of people with disabilities. However, as the healthcare sector is moving towards value‐based care to achieve universal health coverage, it remains unclear whether South African rehabilitation policies provide sufficient guidance for delivering value‐based rehabilitation services for people with disabilities. This article attempts to ascertain whether the content of South African rehabilitation policies is aligned with value‐based care. Rehabilitation policies were identified through a literature search (including grey literature) and discussions with stakeholders in the health policy field. A framework for value‐based care was created for deductive policy content analysis. A qualitative descriptive approach was used to describe the content that correlates with the framework's components. The National Rehabilitation Policy and the Framework and Strategy for Disability and Rehabilitation Services were included in this study. Both documents aligned with the value‐based framework, however, various barriers in South Africa challenge value‐based rehabilitation services. We conclude that South Africa's rehabilitation policies can guide value‐based rehabilitation services. However, these policies need to be operationalized and supported by empirical data on disability and rehabilitation services. A concerted effort is required from the government to ensure the allocation of resources for the implementation of policy.

Quality of Life of Adolescents and Young Adult Survivors of Childhood Cancer: A Qualitative Study.

To analyse how adolescents and young adults who survived childhood cancer experience their quality of life and to explore their meanings and conceptualisations of quality of life. Narrative design following Squire's method. In-person and virtual recruitment, due to the global COVID-19 pandemic, was carried out in Brazil between May and November 2021. Eighteen semi-structured virtual interviews were conducted with childhood cancer survivors. These data were analysed using reflexive thematic analysis and employing a triangulation of investigators. Four subthemes were identified, encompassing participants' perceptions and meanings of quality of life. Through the reflection and synthesis of these subthemes, a central theme emerged entitled 'New self', capturing the profound impact of the cancer and survival experience on every aspect of the self, along with participants' sense of having gained 'a new life' and a 'second chance'. The study provides a rich and nuanced understanding of quality of life for childhood cancer survivors. The results highlight that after all the changes in life due to cancer, integrating the new self becomes a central aspect of quality of life for survivors. Recognising the profound shifts in self-perception that survivors of childhood cancer undergo, nurses should engage early in empowering patients and families, offering education, space and support to help adolescents and young adults grow throughout their journey. The richness and depth inherent in qualitative data on quality of life can inform the development of care standards and health policies for survivors, guide the allocation of strategic resources and shape the development of plans and interventions focusing on childhood cancer survivors. The COREQ checklist was used. No patient or public contribution.

Effectiveness of Ayush Rasayana A and B on the Quality of Life of Older Adults: Protocol for a Cluster Randomized Controlled Trial.

With advancing age among older adults, the associated debilities increase, indicating a deteriorating health status as there is a gradual loss of muscle mass, strength, and functionality. Ayush Rasayana A and B are coded Ayurvedic medicines developed from herbal extracts. This study has been planned to prevent debilitating conditions and improve the quality of life (QOL) in older adults. This study aimed to assess the effectiveness of Ayush Rasayana A and B on the QOL, quality of sleep, and functionality of older adults, along with the tolerability of the intervention. This was a multicenter, open-label, cluster randomized controlled trial conducted with 720 participants aged 60 to 75 years. The participants were divided into 2 groups (intervention and control), with both receiving Ayurvedic ancillary treatment for 3 months. The intervention group additionally received 10 g of Ayush Rasayana A orally once daily at bedtime for 6 days, followed by 1.5 g of Ayush Rasayana B orally twice daily before food for the remaining 84 days. The assessment criteria included the Older People's Quality of Life Questionnaire Brief, Katz Index of Independence in Activities of Daily Living, Pittsburgh Sleep Quality Index, Five Times Sit-to-Stand Test, and shoulder and scapular movements. Any change in hematological and biochemical parameters and occurrence of treatment-emergent adverse events were also assessed during the study period. The recruitment of the participants started in December 2023, and the final follow-up was completed in April 2024. Out of the total 720 enrolled participants, 686 (95.3%) completed the study up to the last follow-up. This study may provide evidence-based data to establish preventive treatment protocols for enhancing the QOL and functionality among older adults. The study results may also be helpful for the planning of interdisciplinary health policies for improving the health conditions of different populations. DERR1-10.2196/58186.