Health System Development Research Articles

Immune-Related Gene Expression Responses to In Ovo Stimulation and LPS Challenge in Two Distinct Chicken Genotypes

Background: In ovo stimulation introduces bioactive compounds, such as prebiotics, probiotics, or synbiotics into incubating eggs to enhance gut health and immune system development in chickens. This study aimed to determine the genetic and environmental effects modulating responses to in ovo stimulation in commercial broilers and Green-legged Partridge-like (GP) native chickens. Methods: Eggs were stimulated on day 12 of incubation with prebiotics (GOS—galactooligosaccharides), probiotics (Lactococcus lactis subsp. cremoris), or synbiotics (GOS + L. lactis), with controls being mock-injected. Hatched chicks were reared in group pens and challenged with lipopolysaccharide (LPS) on day 42 post-hatching. Cecal tonsils (CT) and spleens were harvested 2 h post-challenge. RT-qPCR was used to analyze the relative gene expression of cytokine genes: IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12p40, and IL-17. Results: The results show that genotype influenced the expression of all immune-related genes, with broiler chickens exhibiting stronger innate inflammatory responses than native chickens. LPS induced both mucosal (CT) and systemic (spleen) immune responses in broilers but only systemic (spleen) responses in native chickens. Conclusions: In ovo stimulation had less of an impact on cytokine gene expression than LPS challenge. Broilers expressed higher inflammatory immune responses than GP native chickens.

Mentoring the Development of Mental Health Systems in Schools

This community service program aims to provide assistance to guidance and counseling teachers who are expected to become pioneers of the school mental health system. The emergence of increasingly complex mental health problems in schools cannot only be handled in responsive and curative ways but also need to be accompanied by preventive efforts from the school. By using the paradigm of positive psychology and positive education through the PROSPER model, guidance and counseling teachers and schools in general are able to collect resources to build a mental health system in schools. The PROSPER model consists of seven components, namely positivity, relationships, outcomes, strength, purpose, engagement, and resilience. The partners selected for this community service are guidance and counseling teachers at junior high schools in the Karanganyar area under the auspices of the Karanganyar Regency Education and Culture Office. The number of participants who attended was 30 guidance and counseling teachers from both private and public schools in this area. The assistance carried out was carried out over a period of 3 months starting with initial coordination, provision of materials, workshops and assistance and monitoring. Initial coordination was carried out through the WhatsApp group media, then the provision of materials was carried out offline. This material provision activity was then continued with a workshop on preparing SOPs for implementing the PROSPER model. It is hoped that after participating in this program, target partners will have the capacity to develop mental health systems and implement them independently and sustainably. The outputs in this PkM include mandatory outputs, namely partner cooperation letters, IA scripts, print and social media publications, and PkM activity posters.

Unveiling the neonatal gut microbiota: exploring the influence of delivery mode on early microbial colonization and intervention strategies.

Recent research has emphasized the critical importance of establishing the neonatal gut microbiota for overall health and immune system development, prompting deeper studies about the early formation of neonatal gut microbiota and its influencing factors. Various factors, including maternal and environmental factors, affect the early formation of neonatal gut microbiota, in which delivery mode has been considered as one of the most crucial influencing factors. In recent years, the increasing trend of cesarean section during childbirth has become a serious challenge for global public health. This review thoroughly analyzes the effects of vaginal delivery and cesarean section on the establishment of neonatal gut microbiota and the potential long-term impacts. In addition, we analyze and discuss interventions such as probiotics, prebiotics, vaginal seeding, fecal microbiota transplantation, and breastfeeding to address the colonization defects of the neonatal gut microbiota caused by cesarean section, aiming to provide theoretical basis for the prevention and treatment of colonization defects and related diseases in infants caused by cesarean section in clinical practice and to provide a theoretical foundation for optimizing the development of neonatal gut microbiota.

Measurement-Based Care as a Tool to Detect and Prevent Harm in Youth Psychotherapy.

Measurement-based care (MBC), the use of routine assessment to guide clinical decision-making, has the potential to significantly enhance the quality of mental health services for youth by improving the detection and prevention of harm. Concerns exist, however, that widespread efforts to implement MBC may have a negative impact on youth mental health care. We explore both perspectives by describing how MBC can be leveraged as a tool to detect and prevent harmful treatment in youth and how misapplication of MBC also has the potential to cause harm. This discussion focuses on how MBC can help therapists identify harm caused by ineffective practices (i.e., deterioration or no symptoms changes), poor client engagement (e.g., early drop-out, poor alliance), and adverse events (e.g., injury caused by treatment). We also discuss multi-level applications of aggregated MBC data to prevent harm through workforce development and organizational and health systems quality and cost of care improvement initiatives. Misapplication of MBC by failing to adhere to MBC best practices, overreliance on data above clinical judgement, providing insufficient organizational support, and using MBC data to justify cost containment are all discussed as possible sources of harm. We conclude with a discussion of future directions for research needed to advance the application of MBC to the prevention of harm in youth psychotherapy.

Health system efficiency and equity in ASEAN: an empirical investigation

BackgroundEquity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them.MethodsData spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems.ResultsThe overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant.ConclusionASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn’t yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN’s economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.

Social Cohesion and COVID-19: Integrative Review.

Nations of considerable wealth and sophisticated health care infrastructures have experienced high rates of illness and death from COVID-19. Others with limited economic means and less developed health systems have achieved much lower burdens. To build a full understanding, an appraisal of the contribution of social relationships is necessary. Social cohesion represents a promising conceptual tool. This study aimed to examine scholarship on social cohesion during the COVID-19 pandemic: specifically, the constructions of social cohesion being deployed, the variables chosen for representation, and the effects of and on social cohesion being reported. The PubMed, Scopus, and JSTOR databases were searched for relevant journal articles and gray literature. A total of 100 studies met the inclusion criteria. Data were extracted and analyzed from these using spreadsheet software. Several constructions of social cohesion were found. These concerned interpersonal relationships, sameness and difference, collective action, perceptions or emotions of group members, structures and institutions of governance, locally or culturally specific versions, and hybrid or multidimensional models. Social cohesion was reported to be influential on health outcomes, health behaviors, resilience, and emotional well-being, but there was some potential for it to drive undesirable outcomes. Scholarship reported increases or decreases in quantitative measures of social cohesion, a temporary "rally round the flag" effect early in the pandemic, the variable impacts of policy on social cohesion, and changing interpersonal relationships due to the pandemic conditions. There are numerous issues with the literature that reflect the well-documented limitations of popular versions of the concept. Social cohesion has been used to express a range of different aspects of relationships during the pandemic. It is claimed to promote better health outcomes, more engagement with positive health behaviors, and greater resilience and emotional well-being. The literature presents a range of ways in which it has been altered by the pandemic conditions. There are significant weaknesses to this body of knowledge that greatly impede its overall quality.

Artificial intelligence in physical education: comprehensive review and future teacher training strategies.

Artificial intelligence (AI) technology is deeply changing our lives and provides impetus for improving production and living efficiency as an important emerging tool. Digitalization and intelligent development have also become the development direction of the sports industry, bringing new requirements to the transformation of physical education (PE) and the improvement of the quality of PE teachers. PE is an important part of the public health system, and AI can deeply participate in the formulation of teaching strategies, the tracking of teaching processes and the evaluation of teaching results, effectively improving the quality of teaching. Research on the application of AI technology in PE has been carried out. This paper comprehensively reviews the existing research and conducts a comprehensive analysis of the research progress and status. The potential application areas of AI in PE are discussed to better promote the intelligent and digital upgrading of PE. We found that the research on the application of AI in PE is still in its early stages, and the research content needs to be strengthened in terms of breadth and depth. Furthermore, this paper analyzes the challenges faced by PE teacher development and training in the context of educational transformation in the era of AI, and explores the necessary skills and knowledge related to AI technology that future PE teachers should master in order to effectively achieve the improvement of teaching level and the sustainable development of public health system. The review of this paper provides valuable guidance for educators and policymakers to formulate high-quality teacher development and training mechanisms, and provides a new reference for the application and development of AI in sports.

A Comprehensive Review of Effective Patient Counseling by Healthcare: Principles, Practices, and Outcomes

Effective patient counseling is an important aspect in healthcare which helps the patient to understand the treatment, comply with it and helps in better health outcomes. This review highlights the therapeutic alliance which is based on compassion, cultural respect, attentive to patient needs and imparting education to the patient. Communication between the patient and the healthcare provides an important aspect where the medical language is simplified and the patient understands the diagnosis and treatment provided. When a healthcare provider empathizes with the patient, the patient builds trust and is willing to divulge other important aspects of their health which increases satisfaction and compliance in the care regimen. Besides that, active listening techniques support the patients' worthiness and equity in communication which helps to reinforce the patients’ clarification abilities. Cultural competence plays a central role in meeting the various challenges of patient care by respecting their values and health beliefs. The use of customized educational resources such as brochures, video clips and educational games encourages patient’s participation in making active decisions regarding their health care. Nevertheless, time constraints and patient overflow may hamper the level of counseling that is provided. There is a need for continuing education to ensure that the health providers are trained on appropriate communication and counseling techniques. Most importantly, development of health systems that champion effective communication, compassion and respect for diversity with patients will improve health outcomes, patient satisfaction and adherence to treatment.

Transplantation: A Priority in the Healthcare Agenda.

In November 2023, in the context of the Spanish Presidency of the Council of the European Union, the Organization National de Transplante organized a global summit discussing global action in transplantation for the next decade. This article reports the recommendations supporting the need to prioritize transplantation in healthcare systems. The working group investigated how transplantation addresses noncommunicable disease mortality, particularly related to kidney and liver disease. They also investigated how transplantation can contribute to the achievement of several of the United Nations Sustainable Development Goals, especially Goal 3 (good health and well-being), Goal 8 (sustained, inclusive, and sustainable economic growth and employment for all), and Goal 13 (combat climate change and its impact). By prioritizing transplantation, the increased availability and accessibility of life-saving organs and tissues to the public will not only lead to saving more lives and improving health outcomes for individual patients but also contribute to the development of a resilient health system in general in that country as a consequence of developing the infrastructure required for transplantation. The ethical principles associated with transplantation promote the principles of solidarity in society by fostering the donation process and equity in access to therapy. This article aims to advocate for the widespread availability of solid organ, tissue, and cell transplantation for all patients.

Nursing Practice Environments in Hospitals: A Comparative Study between Portugal and Brazil.

Background: Assessing the elements of nursing practice environments is crucial, as investing in their improvement will enhance outcomes for nurses, patients, and organizations. Moreover, comparing practice environments from different countries improves the definition of cross-cutting guidelines that can be applied in various contexts. Thus, this study aims to evaluate nursing practice environments in hospitals in Portugal and Brazil. Methods: A multicenter and cross-sectional study was conducted in eight Portuguese and eight Brazilian hospitals. Five hundred eighty-two nurses completed a survey regarding their sociodemographic and professional attributes, as well as the Scale for the Environments Evaluation of Professional Nursing Practice. The data were subjected to comparative analyses between the two countries. We adhered to ethical requirements in both participating countries. Results: In Brazil, the Structure, Process, and Outcome components were considered favorable to the quality of care and well-being of nurses. In Portugal, nurses considered the Structure and Outcome components favorable and the Process component very favorable. Statistically significant differences were found between the two countries in several dimensions of the three subscales. The Structure and Outcome components scored significantly better in hospitals in Brazil, and the Process component scored better in Portuguese hospitals. Conclusions: These conclusions underscore the urgent need for investment in continuous training and a culture of evaluation that promotes continuous improvement. Additionally, promoting the involvement and participation of nurses could simultaneously contribute to the development of more sustainable health systems.

Cognitive abilities and household financial portfolios in association with economic development and national health system: A cross-country analysis based on SHARE data

Cognitive abilities and household financial portfolios in association with economic development and national health system: A cross-country analysis based on SHARE data

Implementation of the Digital Health Approach to Support Learning for Health Students Based on Bloom's Taxonomy: A Systematic Review.

Health students' ability to utilize technology effectively is vital for improving the quality of future healthcare services. Relevant digital health education must be comprehensively integrated into training programs, continuing professional development activities, and school curricula to keep them current. This study investigated the most effective digital health approaches to enhance health students' cognitive, affective, and psychomotor skills, thereby preparing them for the workforce. A literature review was conducted by searching for articles from 2013 to 2023 in PubMed, Science Direct, ERIC, and Scopus. The search used the PICO model, focusing on experimental studies and digital learning. The review identified 26 studies, categorizing digital education methods into platform-based (46.2%), tools-based (30.7%), and training-based approaches (23.1%). Participants included health students (57.7%), healthcare professionals (34.6%), and a combination of both (7.7%). The content materials primarily targeted curriculum objectives (65.4%) and clinical applications (34.6%). The outcomes, classified according to Bloom's taxonomy, were divided into cognitive (84.6%), affective (76.9%), and psychomotor (46.1%) domains. Digital health education benefits from a variety of approaches. A platformbased approach is recommended for delivering theoretical and methodological materials, a tools-based approach for simulations, and a training-based approach for practical skills to enhance the cognitive domain. Both platform-based and trainingbased approaches are advised to improve the affective and psychomotor dimensions of learning. This study underscores the importance of an integrated digital learning system in health educational institutions to prepare students for evolving health systems and to improve learning outcomes and skill transfer.

Research progress in the synthesis of 3'- and 6'-sialactose by Escherichia coli

Human milk oligosaccharides (HMOs) are a structurally complex group of unbound polysaccharides, representing the third-largest solid component in breast milk. They play a crucial role in the intestinal health and immune system development of infants. Sialylated HMOs, including 3'-sialactose (3'-SL) and 6'-sialactose (6'-SL), are major components of HMOs, playing significant roles in immune regulation, anti-inflammatory processes, and promotion of probiotic growth. Currently, the cost-effective production of high-value sialactose by microbial fermentation with readily available raw materials has become a research hotspot due to the high nutritional value and potential applications of sialylated HMOs in infant food. This paper summarizes the functions and biosynthesis of 3'-SL and 6'-SL. Furthermore, it reviews the research progress in the synthesis of sialactose by Escherichia coli, offering valuable insights for future industrial production.

Medical researchers' perception of sharing of metadata from case report forms

AbstractIntroductionPublishing medical metadata stored in case report forms (CRFs) is a prerequisite for the development of a learning health system (LHS) by fostering reuse of metadata and standardization in health research. The aim of our study was to investigate medical researchers' (MRs) willingness to share CRFs, to identify reasons for and against CRF sharing, and to determine if and under which conditions MRs might consider sharing CRF metadata via a public registry.MethodsWe examined CRF data sharing commitments for 1842 interventional trials registered on the German Clinical Trials Registry (DRKS) from January 1, 2020, to December 31, 2021. We invited 1360 individuals registered as contacts on DRKS to participate in a web‐based survey between May 10, 2022, and June 30, 2022.ResultsOnly 0.3% (5/1842) of data sharing commitments in DRKS included a plan to share blank CRFs. Survey results showed high support for CRF sharing. More than 70% of respondents (223/301) were willing to share their CRFs, and 83.7% (252/301) were interested in CRF reuse. The most frequently reported reason for CRF sharing was improvement of comparability and interpretability of patient data (244/301; 81.0%). The most frequently reported reason against CRF sharing was missing approval by the sponsor (160/301; 53.2%). Researchers conducting commercial trials were significantly less likely to share CRFs than those conducting noncommercial trials (63.3% vs. 76.2%, OR 0.54, 95% CI 0.32–0.92) and they were less likely to reuse CRFs (78.5% vs. 84.6%, OR 0.66, 95% CI 0.35–1.24). The most frequently mentioned prerequisite for publication of CRFs in a public registry was its trustworthiness (244/301, 81.1%).ConclusionData sharing commitments in DRKS revealed a low awareness of CRF sharing. Survey results showed generally strong support for CRF sharing, including the willingness to publish CRFs in a public registry, although legal and practical barriers were identified.

Examining sustained sub-national health system development: experience from the Western Cape Province, South Africa, 1994-2016.

Governance and leadership are recognized as central to health system development in low- and middle-income countries, yet few existing studies consider the influence of multilevel governance systems. South Africa is one of the many (quasi-)federal states. Provincial governments have responsibility for managing health care delivery within national policy frameworks and norms. The early post-apartheid period saw country-wide efforts to address the apartheid legacy of health system inequity and inefficiency, but health system transformation subsequently stalled in many provinces. In contrast, the Western Cape provincial health department sustained service delivery reform and strengthened management processes over the period 1994-2016. This department can be considered a 'pocket of relative bureaucratic effectiveness': an organizational entity that, compared to others, is relatively effective in carrying out its functions in pursuit of the public good. This paper considers what factors enabled the development of the Western Cape health system in the period 1994-2016. Two phases of data collection entailed document review, participatory workshops, 43 in-depth interviews with purposively selected key informants from inside and outside the Western Cape and a structured survey testing initial insights (response rate 42%). Analysis included triangulation across data sets, comparison between the Western Cape and other provincial experience and deeper reflection on these experiences drawing on POE theory and public administration literature. The analysis highlights the Western Cape experience of stable and astute sub-national governance and leadership and the deepening of administrative and technical capacity over time-within a specific provincial historical and political economy context that sustained the separation of political and administrative powers. Multilevel governance systems can create the space for sub-national POEs to emerge in their mediation of wider political economy forces, generating spaces for skilled reform leaders to act in the public interest, support the emergence of distributed leadership and develop robust management processes.

From margins to mainstream: Incorporating internationally educated health professionals' skills into primary care.

This case study explores the collaborative integration of Internationally Educated Healthcare Professionals (IEHPs) into comprehensive primary care through partnerships between non-profit organizations and health systems actors. It addresses the critical need for such collaboration amidst challenges of limited access to primary care and underutilization of IEHPs' skills in the Canadian healthcare workforce. Through the examination of ACCES Employment's integration into the Team Primary Care initiative, this article demonstrates the importance of coordinated efforts in overcoming longstanding barriers faced by IEHPs. Data collection involved a review of program activities, program reports, policy documents, and interviews with key collaborators to highlight strategies, partnerships, and outcomes. Data were analyzed to identify recurring patterns in collaborative integration efforts. The initiative reveals promising outcomes in facilitating IEHPs' transition into various healthcare roles through increasing collaboration between non-profit workforce development organizations and health systems actors.

Sustainability in Participatory Health: Applying WHO's Operational Framework.

The World Health Organization's Operational Framework for Climate Resilient and Low Carbon Health Systems outlines 10 broad components for the development and maintenance of health systems that respond effectively to climate-related challenges. This work analyses the WHO framework from a participatory health informatics perspective and identifies specific initiatives involving non-professionals that align with the framework. Citizen and patient participation in the development of climate-resilient health systems is not only possible but also necessary to maximize climate resiliency at the community and global levels.

Evolution of the Veterans Health Administration Learning Health System: 25 years of QUERI.

Evolution of the Veterans Health Administration Learning Health System: 25 years of QUERI.

Assessing Malaysian Health Care Reform

This study assesses the healthcare reform in Malaysia since its independence. Previous studies and official reports on healthcare reform were analyzed through content analysis. The discussion starts with geographical and socioeconomic factors, then moves to the inception of the Malaysian Health Care System, focusing on the development of primary health system reform initiatives in the country. This paper illustrates the rigorous journey of system reform, emphasizing that political commitment and backing from stakeholders and citizens are vital for its success

Has China’s hierarchical medical system improved doctor-patient relationships?

Background and objectiveDeveloping harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China’s hierarchical medical system on doctor-patient relationships, thus contributing to China’s medical and health system reform.MethodsWith panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy.ResultsHierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger.ConclusionWhile reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries.