Integrated Health Policy Research Articles

Anesthesia and Patients With Cardiovascular Diseases: Challenges and Approaches

Objective: This article analyzes anesthesia strategies for cardiovascular patients, highlighting challenges and advances. The review evaluates the effectiveness of approaches like continuous hemodynamic monitoring and personalized plans in reducing perioperative complications. It also proposes measures to overcome implementation barriers, emphasizing the need for integrated health policies and innovative technologies to improve outcomes and reduce mortality. Theoretical Framework: Effective management of anesthesia in patients with cardiovascular diseases is crucial due to the increasing global prevalence of these conditions and their association with severe complications such as myocardial infarction, heart failure, and thromboembolic events. Method: A narrative literature review was conducted using major scientific databases to collect articles on anesthesia management for cardiovascular patients. Key studies were evaluated to measure the effectiveness of continuous hemodynamic monitoring and personalized plans. Specific keywords helped identify research on challenges and advances, allowing for synthesis of effective strategies and identification of implementation gaps. Results and Discussion: The review found that continuous hemodynamic monitoring and personalized anesthesia plans reduce perioperative complications in cardiovascular patients, significantly decreasing myocardial infarction, heart failure, and thromboembolic events. Implementation barriers include limited access to specialized services and managing patients with multiple comorbidities. Improving access to specialized care, continuously training healthcare professionals, and developing integrated policies and innovative technologies are essential for better diagnosis, treatment, and outcomes, reducing perioperative mortality.

A constant learning curve in working towards integrated health policy: twelve years of practical experience at a Dutch municipality

Background By establishing and implementing an integrated four-year health policy, Dutch municipalities contribute significantly to the protection and promotion of public health. Scientific literature has many insights into integrated health policy, determinants of health and interventions. How is this knowledge used when determining and shaping an integrated health policy? The authors share their experiences concerning the role of knowledge in: 1) determining policy; 2) integrated collaboration; 3) working towards a healthy living environment; and 4) creating a citywide health movement. Key points Based on working on an integrated health policy and the setbacks we have encountered, we have experienced that scientific knowledge and models provide a framework for policy implementation, but other types of knowledge about context, processes and practice are just as important. Furthermore, we learned that other factors are often more decisive in policy and implementation, including the interests of individual parties, correct timing, continuity of persons, and courageous administrators. Working on integrated health policy is a continuous process of staying on course and adapting at the same time, in which searching for the suitable knowledge to work in an evidence-informed way must be part of it. Conclusion The greatest challenge when using knowledge in practice lies in expanding the collaboration between researchers, policymakers, professionals and inhabitants, for example by using boundary spanners. The collaboration should aim to organise a long-lasting adaptive collaboration aimed at mutual learning. This should focus on shared discussion of relevant knowledge, with less emphasis on pure acquisition and use of scientific knowledge.

Traditional and complementary medicine perspectives of family physicians in Istanbul

Introduction: The World Health Organization, within the scope of the Traditional Medicine Strategy for 2014-2023, recommends the development of integrated health policies, particularly in the area of primary healthcare. However, family physicians often report feeling insufficiently trained to effectively integrate these practices into patient care. This study aims to assess the views, understanding, and experiences of family physicians regarding the utilization of Traditional & Complementary Medicine (T&CM).Methods: The family physicians employed by the Istanbul Health Directorate Public Health Services were solicited to participate in an 18-question online survey to assess their level of education in T&CM methods, their views on integration of T&CM into family medicine, and the impact of these practices on patient care.Results: A total of 324 family physicians took part in the survey; 12.0% were specialists, 64.5% had worked in primary care for over 10 years, and 59.6% were in the age range of 31-50 years. Among the physicians, the majority (70.1%) reported a preference for integrating T&CM practices with conventional medicine (ConvM). The majority of the participants (71.6%) had no formal T&CM training, and 66.4% reported inquiring about T&CM in their patient consultations. Over half of the physicians (56.79%) believed that T&CM methods should be used in preventive medicine. The most widely recognized T&CM technique was cupping therapy (18.5%), which was also the most frequently recommended method by physicians.Conclusion: Most of the family physicians who participated in the study expressed a desire for integrative medicine, despite acknowledging limited formal education in this field. Offering physicians training in evidence-based complementary medicine therapies could provide them with additional non-invasive treatment options. However, patients' diffidence to inform their family physicians about T&CM practices they undergo may pose significant risks. As a result, incorporating education on integrative medicine into formal medical education and residency training may be necessary.Keywords: Family physician, complementary medicine, integrative medicine, traditional medicine

“Europe Against AIDS”? The European Community Response to AIDS and the Road Towards a European Health Policy, 1981-1996

When AIDS appeared in Europe in 1981, the European Community had no legal competence in the field of health. However, as all Member States detected AIDS-cases, and as the fear of the pandemic rose in European public opinions, the Community, which was experiencing an intense dynamic of integration, was under pressure to “do something” to help Europeans face the crisis. This paper analyses how, under these conditions, the European Community (European Union after 1992) invented ways to become a player in the fight against AIDS and develop an ambitious and unprecedented AIDS policy. It argues that in doing so, and benefiting from an unexpected consensus between its members on fundamental issues related to the disease, the Community made inroads towards what could later become an integrated European health policy. However, it also experienced enduring obstacles to achieving such an ambition.

Strengthening National Public Health: first steps towards the Spanish Public Health Agency

Abstract Issue/Problem The social, ecological, health and economic crisis exacerbated by COVID-19 is a challenge of extraordinary magnitude and complexity for global public health. Part of the response to these challenges requires strong public health institutions. Description of the problem Component 18 of the Government of Spain’s Recovery, Transformation and Resilience Plan proposes the creation of a Spanish Agency of Public Health (SAPH), a centre of excellence to perform surveillance and health system preparedness functions in the face of new or emerging public health threats. The government has opened the debate on what design and functions it should have. Results SESPAS, the Spanish Society of Public Health and Public Administration, set out a proposal for the design and organization of the future Spanish Agency for Public Health [SAPH]. A large working group, made up of experts from various fields of public health and from its ten federated scientific societies, has designed the SAPH proposal. The scope of the public health functions to be assumed include: the strategic planning of the State’s public health (including health security), the prioritisation of public health policies and communication strategies, the assessment of the population’s health status and social conditions, the guarantee of the transversality and horizontality of health policies (health and health equity in all State policies), as well as their verticality (serving as an enriching link between the European Union level and the administrations of the Autonomous Communities and local authorities). The proposal also include 11 recommendations on the main elements to be taken into account in the establishment of the future SAPH. Lessons COVID19 pandemic has highlighted the need of creating strong public health institutions. Spain is giving its first steps toward the creation of the SAPH, which constitute a key step in addressing the current and future challenges of public health in Spain. Key messages • Spanish Public Health Agency is an opportunity to transform health policies and to improve the health of the Spanish population. • Strengthening public health starts with building national institutions that ensure comprehensive and integrated health policies.

Prevalence, Knowledge and Treatment of Systemic Arterial Hypertension in A Campaign Day

Hypertension affects 1.4 billion of the world population, being considered the main cause of cardiovascular diseases and, therefore, an important cause of premature and preventable mortality worldwide. It is associated with complications such as atherosclerotic coronary artery disease, congestive heart failure, stroke, intracerebral hemorrhage, and chronic kidney disease. Given this prevalence and risk, strategies were created to control the disease, such as changes in lifestyle and use of medications. However, non-adherence to treatment is a frequent concern and it is associated with adverse results and an increased number of complications. Therefore, the present study aims to present the incidence of arterial hypertension in the population of a city in the inland part of São Paulo, relating it to its risk factors, adherence to treatment and disease control. The objective is evaluating the incidence and rate of uncontrolled systemic arterial hypertension on a campaign day in a city in the inland part of São Paulo. The method is observational, cross-sectional, descriptive, population-based study, random sample of 545 individuals, 231 women and 314 men, collected in a city in the northwest of São Paulo on a campaign day. The study showed a prevalence of 46.24% for hypertensive patients, with 88.9% adherence to treatment and pressure loss of 34.23%. Among the analyzed hypertensive patients, there was a higher incidence among the elderly, obese, and people with diabetes mellitus. Regarding adherence and disease control, better results were noted among patients with complications such as AMI and thrombotic events, and less adherence among obese, alcoholics and smokers. The results of the present study are consistent with literature data, showing that even with knowledge of the disease, part of the population does not have adequate treatment, showing the need for integrated health policies for early diagnosis, distribution and treatment regulation, and actions to improve lifestyle.

The impacts of family physician plan and health transformation plan on hospitalization rates in Iran: an interrupted time series

BackgroundLow and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran.MethodsWe conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1.ResultsA decreasing trend by − 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001).ConclusionsFamily physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.

Concepções e práticas de educação e saúde da população negra: uma revisão integrativa da literatura brasileira

A Política de Saúde Integral da População Negra reiterou a urgência de qualificação dos processos educativos no Sistema Único de Saúde (SUS) em prol da superação do racismo institucional. A revisão integrativa, apresentada neste artigo, analisou as concepções teóricas e as práticas educativas em estudos dirigidos à saúde da população negra. Foram utilizadas as bases de dados da Biblioteca Virtual em Saúde (BVS); a Scientific Eletronic Library Online (SciELO); a ferramenta de pesquisa na web Google Scholar e o acervo da revista da Associação Brasileira de Pesquisadores/as Negros/as, a Revista da ABPN. A produção na temática é heterogênea, dispersa entre periódicos das áreas da educação, educação em saúde e interdisciplinar. Há vanguardismo da enfermagem e forte presença de estudos com povos e comunidades tradicionais. Nota-se dificuldade de interpenetração de referenciais teóricos e pedagógicos do campo da educação na sustentação das práticas educativas de saúde. Sugerem-se a cooperação e a integração científica entre esses campos visando ao protagonismo do sujeito negro nos processos de cuidado.

(In)visibilidades da saúde da população LGBT no Programa de Pesquisa para o SUS (PPSUS), Brasil

Uma das importantes conquistas para consolidação da democracia no Brasil foi a criação e a efetivação da Lei de Acesso à Informação (LAI). Neste artigo, interessa relacionar a LAI, a institucionalização da Política Nacional de Informação e Informática em Saúde e o Programa de Pesquisa para o SUS (PPSUS), privilegiando as Fundações de Amparo à Pesquisa (FAP), um dos atores deste Programa do Ministério da Saúde (MS). O método utilizado para o estudo foi a realização de um levantamento de editais publicados e de projetos de pesquisa contemplados no PPSUS, voltados para a instituição da Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais (PNSILGBT). Ao observar, nos sites das instituições mencionadas, os registros de projetos de pesquisa relacionados à saúde da população LGBT, valorizou-se a dimensão da usabilidade, apreendendo desorganização nas apresentações dos editais e dos resultados, o que proporciona ineficiência na sua operacionalização e na funcionalidade das formulações de políticas no campo da saúde.

Childhood socioeconomic circumstances, social status, and health in older age: Are they related in China?

It is well known that in western countries, people with disadvantaged socioeconomic circumstances during childhood are at a significantly higher risk of ill health in older age. This study further questions whether in China, individuals' different childhood socioeconomic circumstances and social status continue to affect their life-long health. Furthermore, do later-life socioeconomic circumstances affect health so that childhood conditions no longer play a significant role? The influence of social mobility and accumulation was also tested. The analysis was based on the China Health and Retirement Longitudinal Study (CHARLS) 2013 and CHARLS life history survey. Health outcomes were measured based on self-reported health, disability for activities of daily life, depression symptoms, and cognitive impairment. In addition to measurements of childhood, the analysis included current socioeconomic circumstances, current health behaviors, and demographic characteristics. Using ordered logit or logit and Ordinary Least Square (OLS) regression models, the study shows the existence of the association between childhood conditions and later health in China. After adjusting for current socioeconomic circumstances, social status was no longer related to later health. However, childhood socioeconomic circumstances still significantly influenced health at a later age. Advantaged socioeconomic circumstances in the life course (high stability) provided the best protection for later health. However, moving downward-that is, experiencing childhood socioeconomic advantage but later-life socioeconomic disadvantage-was the most detrimental to later health. Overall, this study provides new evidence from China to support the notion that health in older age is related to dynamic processes structured by the social stratification system. Thus, this study emphasizes an integrated health policy based on the premise of maximizing health over the entire life course.

Deaths preventable by actions of the Unified Health System in the population of the Brazilian Southeast Region.

This paper aims to analyze the mortality trend in the population aged 5-69 years residing in the Southeast and Federal Units (UF), using the "Brazilian List of Preventable Deaths Causes". An ecological study on time series of the standardized mortality rate from preventable and non-preventable causes, with adjustments for ill-defined causes and underreporting of notified deaths, from 2000 to 2013. A declining mortality rate from preventable (2.4% per year) and non-preventable causes (1.5% per year) was found in the population aged 5-69 years living in the Southeast in the period 2000-2013. A drop in all groups of preventable deaths causes and stability in the maternal death causes was observed. Deaths from noncommunicable diseases fell 2.7% annually and were higher in the age group of 60-69 years in 2013 (211.8/100,000 inhabitants for deaths from ischemic heart disease, 146.3/100,000 inhabitants for cerebrovascular diseases and 96.5/100,000 inhabitants for diabetes). The highest preventable death rates are from chronic noncommunicable diseases and external causes, both of which are sensitive to health promotion and intersectoral interventions, which reinforces the need for integrated health policies.

Determinants of an integrated public health approach: the implementation process of Greenland\u2019s second public health program

BackgroundGreenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined.MethodsQualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II’s implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination.ResultsEnabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee.ConclusionInuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II’s integrated approach does not harmonise with the government’s inflexible organisational structure resulting in insufficient implementation.

Relações étnico-raciais na perspectiva da saúde da população negra no curso de medicina: análise curricular

Esse estudo visa verificar a presença da temática étnico-racial no Curso de Graduação em Medicina de uma instituição pública de Alagoas, investigando abordagens sobre as Relações Étnico-Raciais e da Saúde da População Negra no Projeto Pedagógico e nos conteúdos da matriz curricular. Metodologia qualitativa, exploratória e documental, sustentada pelas recomendações das Diretrizes Curriculares para as Relações Étnico-Raciais, da Política de Saúde Integral da População Negra e das Diretrizes Curriculares para o Curso de Medicina. Foi elaborada uma matriz instrumental visando organizar os dados, a partir das categorias elegíveis: Explicitação das Relações Étnico-Raciais e a Saúde da População Negra nos Fundamentos e Justificativas para a Formação Médica; Aspectos étnico-racial afro-brasileiro nos Objetivos; Habilidades e Competências; Relações Étnico-Raciais na Organização e no Conteúdo, sendo essa dividida em sete subcategorias. Os dados foram interpretados na perspectiva de análise de conteúdo. Os resultados demonstraram um silenciamento acerca das relações Étnico-Raciais na estrutura do Projeto Pedagógico no tocante aos fundamentos e justificativas, bem como, nos objetivos e competências para a formação médica. Nas abordagens dos conteúdos foram encontradas citações pontuais sobre as nosologias consideradas prevalentes na população negra como doença falciforme, diabetes mellitus, glaucoma e hipertensão arterial, para os demais assuntos não foram identificados elementos que considerem de forma explícita o viés étnico-racial ligado à Saúde da População Negra nas ementas e nos planos de disciplinas obrigatórias da graduação. Na organização do curso e na matriz curricular foram identificados aspectos potencializadores possibilitando integralizar essa temática em todos os eixos formativos do curso de forma transversal.

The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men.

The prevalence of body image disorders and anabolic-androgenic steroid (AAS) use is increasing, despite the evidence of their serious adverse health effects and despite the passage of laws regulating their sales. Here we review the evolution of the dual emerging epidemics of body image disorders and AAS use, adverse health effects of AASs, and the need for an integrated health policy and regulatory response. We searched for studies published prior to June 2018. Quality of evidence was low to moderate because of its observational nature; heterogeneity of eligibility criteria; variable doses; reliance on retrospective self-reported data in many studies; and variable quality of outcome ascertainment. Most AAS users are nonathlete young men, who use these substances to look lean and more muscular. Some of these men suffer from "muscle dysmorphia," a form of body dysmorphic disorder. AASs has been associated with cardiovascular disorders, psychiatric disorders, AAS-withdrawal hypogonadism, infertility, neurotoxic effects, musculoskeletal injuries, liver toxicity, and needle-borne infections. Potential adverse effects may be compounded by the use of other substances (e.g., opioids) and high-risk behaviors. Unregulated Internet sales of AASs and selective androgen receptor modulators, which are easily purchased without a prescription, are of concern because of their potential to fuel the epidemic among adolescents and the military. Integrated nationwide efforts are necessary to raise public awareness of this epidemic, to study long-term health effects of AASs and treatment strategies, and to reform regulations to stem the epidemics of AAS use and body image disorders.

Health policy engagement among graduate nursing students in the United States.

The aim was to understand how health policy education is currently being delivered in the United States' graduate nursing programs. This exploratory cross-sectional design used an anonymous online survey to target graduate nursing students attending American Association of College of Nursing (AACN) member institutions. Over 75% of the sample (n = 140) reported taking a dedicated health policy course and 71.5% ( n = 131) of the sample responded that a health policy course was required and an equal distribution among master's and doctoral students. There was no significant difference between type of graduate degree sought and the requirement to take a health policy course ( P = 0.37). For students involved in health policy, there was a greater proportion of master's students involved at the state level, than doctorate of nursing practice (DNP) or PhD students ( P = 0.04). Health policy and advocacy education are important aspects of graduate nursing curriculum and have been integrated into curricula. Graduate nursing students at all levels reported that health policy AACN Essential competencies are being included in their program, either as stand-alone health policy courses or integrated health policy learning activities during matriculation.

Sicurezza informatica e trattamento dei dati in ambito sanitario

In recent years, the introduction of computer systems in the healthcare sector for organizing and consulting health data has stimulated the identification of new integrated health policies, outlined to improve diagnosis and treatment processes. This paper aims to analyze the issue of cyber-security in the healthcare field, in light of the frequent attacks that are increasingly affecting healthcare infrastructure, causing subtraction of sensitive data and undermining the confidentiality and privacy of patients

INTERNATIONAL CONFERENCE: The 11th Postgraduate Forum on Health Systems and Policy Integrated Health Systems and Policy for Sustainable Development Goals

The 11th Postgraduate Forum on Health Systems and Policy Integrated Health Systems and Policy for Sustainable Development Goals

Engagement of Sectors Other than Health in Integrated Health Governance, Policy, and Action.

Health is created largely outside the health sector. Engagement in health governance, policy, and intervention development and implementation by sectors other than health is therefore important. Recent calls for building and implementing Health in All Policies, and continued arguments for intersectoral action, may strengthen the potential that other sectors have for health. This review clarifies the conceptual foundations for integral health governance, policy, and action, delineates the different sectors and their possible engagement, and provides an overview of a continuum of methods of engagement with other sectors to secure integration. This continuum ranges from institutional (re)design to value-based narratives. Depending on the lens applied, different elements can be identified within the continuum. This review is built on insights from political science, leadership studies, public health, empirical Health in All Policy research, knowledge and evidence nexus approaches, and community perspectives. Successful integration of health governance, policy, and action depends on integration of the elements on the continuum.

Toward Pragmatic and Integrated Health Policies Reforms and Transformation in Africa

Toward Pragmatic and Integrated Health Policies Reforms and Transformation in Africa

Barriers to lung cancer care: health professionals\u2019 perspectives

PurposeGlobally, lung cancer is the most common cancer and the leading cause of cancer death. Problematically, there is a wide variation in the management and survival for people with lung cancer and there is limited understanding of the reasons for these variations. To date, the views of health professionals across relevant disciplines who deliver such care are largely absent. The present study describes Australian health professionals’ views about barriers to lung cancer care to help build a research and action agenda for improving lung cancer outcomes.MethodsQualitative semi-structured interviews were undertaken with a multidisciplinary group of 31 Australian health professionals working in lung cancer care for an average of 16 years (range 1–35 yrs.; SD = 10.2) seeing a mean of 116 patients annually.ResultsThree superordinate themes were identified: illness representations, cultural influences, and health system context. Illness representations included three themes: symptoms attributed as smoking-related but not cancer, health-related stigma, and therapeutic nihilism. Cultural influence themes included Indigenous health care preferences, language and communication, and sociodemographic factors. Health system context included lack of regional services and distance to treatment, poor care coordination, lack of effective screening methods, and health professional behaviours.ConclusionsFractured and locally isolated approaches routinely confound responses to the social, cultural and health system complexities that surround a diagnosis of lung cancer and subsequent treatment. Improving outcomes for this disadvantaged patient group will require government, health agencies, and the community to take an aggressive, integrated approach balancing health policy, treatment priorities, and societal values.