International Health Policy Research Articles

Les tests de terrain d’évaluation de la condition physique chez l’enfant paralysé cérébral – Validité et fidélité test-retest –

Practice of regular physical activities improve the physical and mental health of children and adults. Numerous studies on children, teenagers and adults with normal growth have seen the light of day for over 10 years and have enabled the establishment of a national and international public health policy in favor of daily physical activity. For children and teenagers with cerebral palsy, we currently do not find recommendations for the physical activities. In order to support cerebral paralyzed children and teenagers as closely as possible to their health needs, an initial assessment of their physical condition seems essential. Thus, this article shows the results of the current publications and studies concerning field tests of physical condition, validated and reliable, in children and/or teenagers with cerebral palsy.

Harm reduction and abstinence-based models for treatment of substance use disorders during the COVID-19 pandemic: a global perspective.

The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.

The parallel epidemic.

The paper is a reflection on the psychic phenomenon involving the denial of reality of covid-19 pandemic, the denial of data from scientific research about it and the denial of therapeutic purposes of vaccine and national and international health policies, as it emerges in the frame of the so-called no-vax movements. The possible basic or associated psychopathological pictures are described, analogies and differences respect to classic psychiatric nosology are evaluated, psychological and psychiatric interpretative hypotheses are considered, in what they can to some extent characterize a wide and complex reality, in whose knowledge and management psychiatrists could play a much more relevant role than they actually do.

Policy parameters for optimising hospital ePrescribing: An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development

ObjectiveElectronic prescribing systems offer considerable opportunities to enhance the safety, effectiveness and efficiency of prescribing and medicines management decisions but, despite considerable investments in health IT infrastructure and healthcare professional training, realising these benefits continues to prove challenging. How systems are customised and configured to achieve optimal functionality is an increasing focus for policymakers. We sought to develop an overview of the policy landscape currently supporting optimisation of hospital ePrescribing systems in economically developed countries with a view to deriving lessons for the United Kingdom (UK).MethodsWe conducted a review of research literature and policy documents pertaining to optimisation of ePrescribing within hospitals across Organisation for Economic Co-operation and Development (OECD) countries on Embase, Medline, National Institute for Health (NIH), Google Scholar databases from 2010 to 2020 and the websites of organisations with international and national health policy interests in digital health and ePrescribing. We designed a typology of policies targeting optimisation of ePrescribing systems that provides an overview of evidence relating to the level at which policy is set, the aims and the barriers encountered in enacting these policies.ResultsOur database searches retrieved 11 relevant articles and other web resources mainly from North America and Western Europe. We identified very few countries with a national level strategy for optimisation of ePrescribing in hospitals. There were hotspots of digital maturity in relation to ePrescribing at institutional, specialisation, regional and national levels in the US and Europe. We noted that such countries with digital maturity fostered innovations such as patient involvement.ConclusionsWe found that, whilst helpful to achieve certain aims, coordinated strategies within and across countries for optimisation of ePrescribing systems are rare, even in countries with well-established ePrescribing and digital health infrastructures. There is at present little policy focus on maximising the utility of ePrescribing systems.

On the Legitimacy and Effectivity of the World Bank and Its Pandenic Emergency Financing Facility (‘PEF’) at the Time of the covid-19 Outbreak

Abstract Pandemic financing has in the current climate of disruption and turmoil of an ongoing global pandemic become the most highly debated and controversial issue within the field of international public health law and policy. From the perspective of international public health law and policy, a precondition for success is that financial resources and funds are employed in an effective manner. Whether the International Bank for Reconstruction and Development (‘World Bank’ or ‘WB’) and the Pandemic Emergency Financing Facility (‘PEF’) – a financing mechanism housed at the WB – may be perceived as effective public health players shall be established by referring to their mandates, their inherent capacity for enhancing accepted global legal standards and rules on public health and their funding methods and practices. After the affirmation and consolidation of its role in the public health sector in the early 1990s, the WB has rapidly accredited itself as the most active intergovernmental institution dealing with pandemic and epidemic financing. Its direct involvement in public health trust funds, such as the Avian Flu Trust Fund Facility and the Health Emergency Preparedness and Response Multi-Donor Fund (the HEPRF), and its lending practices and internal policies and procedures were of crucial significance in this respect. Considering that acceptance of international institutions, including international financial institutions, has always been conditioned by their acknowledgment as legally legitimate, legitimacy is regarded as closely connected to effectiveness. The criteria for establishing legitimacy in relation to international financial institutions are increasingly, amongst others, the respect and promotion of rule of law standards in the recipient states. From this perspective, the WB’s functional and management structures, but not the PEF’s structures and management, have made noteworthy progress, and notwithstanding some deficiencies and peculiarities they present several elements of legitimate decision-making.

WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major health concerns globally. Increased global surveillance of gonococcal AMR is essential. We aimed to describe the 2017-18 data from WHO's global gonococcal AMR surveillance, and to discuss priorities essential for the effective management and control of gonorrhoea. We did a retrospective observational study of the AMR data of gonococcal isolates reported to WHO by 73 countries in 2017-18. WHO recommends that each country collects at least 100 gonococcal isolates per year, and that quantitative methods to determine the minimum inhibitory concentration of antimicrobials, interpreted by internationally standardised resistance breakpoints, are used. In 2017-18, 73 countries provided AMR data for one or more drug. Decreased susceptibility or resistance to ceftriaxone was reported by 21 (31%) of 68 reporting countries and to cefixime by 24 (47%) of 51 reporting countries. Resistance to azithromycin was reported by 51 (84%) of 61 reporting countries and to ciprofloxacin by all 70 (100%) reporting countries. The annual proportion of decreased susceptibility or resistance across countries was 0-21% to ceftriaxone and 0-22% to cefixime, and that of resistance was 0-60% to azithromycin and 0-100% to ciprofloxacin. The number of countries reporting gonococcal AMR and resistant isolates, and the number of examined isolates, have increased since 2015-16. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asian regions. In many countries, ciprofloxacin resistance was exceedingly high, azithromycin resistance was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime continued to emerge. WHO's global surveillance of gonococcal AMR needs to expand internationally to provide imperative data for national and international management guidelines and public health policies. Improved prevention, early diagnosis, treatment of index patients and partners, enhanced surveillance (eg, infection, AMR, treatment failures, and antimicrobial use or misuse), and increased knowledge on antimicrobial selection, stewardship, and pharmacokinetics or pharmacodynamics are essential. The development of rapid, accurate, and affordable point-of-care gonococcal diagnostic tests, new antimicrobials, and gonococcal vaccines is imperative. None.

COVID-19 and the flu: data simulations and computational modelling to guide public health strategies.

BackgroundPandemics threaten lives and economies. This article addresses the global threat of the anticipated overlap of COVID-19 with seasonal-influenza.ObjectivesScientific evidence based on simulation methodology is presented to reveal the impact of a dual outbreak, with scenarios intended for propagation analysis. This article aims at researchers, clinicians of family medicine, general practice and policy-makers worldwide. The implications for the clinical practice of primary health care are discussed. Current research is an effort to explore new directions in epidemiology and health services delivery.MethodsProjections consisted of machine learning, dynamic modelling algorithms and whole simulations. Input data consisted of global indicators of infectious diseases. Four simulations were run for ‘20% versus 60% flu-vaccinated populations’ and ‘10 versus 20 personal contacts’. Outputs consisted of numerical values and mathematical graphs. Outputs consisted of numbers for ‘never infected’, ‘vaccinated’, ‘infected/recovered’, ‘symptomatic/asymptomatic’ and ‘deceased’ individuals. Peaks, percentages, R0, durations are reported.ResultsThe best-case scenario was one with a higher flu-vaccination rate and fewer contacts. The reverse generated the worst outcomes, likely to disrupt the provision of vital community services. Both measures were proven effective; however, results demonstrated that ‘increasing flu-vaccination rates’ is a more powerful strategy than ‘limiting social contacts’.ConclusionsResults support two affordable preventive measures: (i) to globally increase influenza-vaccination rates, (ii) to limit the number of personal contacts during outbreaks. The authors endorse changing practices and research incentives towards multidisciplinary collaborations. The urgency of the situation is a call for international health policy to promote interdisciplinary modern technologies in public health engineering.

Lessons Learnt From the COVID-19 Pandemic.

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has been characterized by unprecedented rates of spatio-temporal spread. Here, we summarize the main events in the pandemic's timeline and evaluate what has been learnt by the public health community. We also discuss the implications for future public health policy and, specifically, the practice of epidemic control. We critically analyze this ongoing pandemic's timeline and contrast it with the 2002–2003 SARS outbreak. We identify specific areas (e.g., pathogen identification and initial reporting) wherein the international community learnt valuable lessons from the SARS outbreak. However, we also identify the key areas where international public health policy failed leading to the exponential spread of the pandemic. We outline a clear agenda for improved pandemic control in the future.

A Qualitative Analysis of Burn Injury Patient and Caregiver Experiences in Kwazulu-Natal, South Africa: Enduring the Transition to a Post-Burn Life

Over 95% of fire-related burns occur in low- and middle-income countries (LMICs), an important and frequently overlooked global health disparity, yet research is limited from LMICs on how survivors and their caregivers recover and successfully return to their pre-burn lives. This study examines the lived experiences of burn patients and caregivers, the most challenging aspects of their recoveries, and factors that have assisted in recovery. This qualitative study was conducted in KwaZulu-Natal, South Africa at a 900-bed district hospital. Participants (n = 35) included burn patients (n = 13) and caregivers (n = 22) after discharge. In-depth interviews addressed the recovery process after a burn injury. Data were coded using NVivo 12. Analysis revealed three major thematic categories. Coded data were triangulated to analyze caregiver and patient perspectives jointly. The participants’ lived experiences fell into three main categories: (1) psychological impacts of the burn, (2) enduring the transition into daily life, and (3) reflections on difficulties survivors face in returning for aftercare. The most notable discussions regarded stigma, difficulty accepting self-image, loss of relationships, returning to work, and barriers in receiving long-term aftercare at the hospital outpatient clinic. Patients and caregivers face significant adversities integrating into society. This study highlights areas in which burn survivors may benefit from assistance to inform future interventions and international health policy.

The First Three Months of the COVID-19 Pandemic: The World Health Organization's Response

Abstract Infectious diseases are generally preventable public health problems; however, they cause epidemics, economic losses, and deaths at all levels worldwide. Especially with the effect of globalization, it has been observed much better with the COVID-19 pandemic, where viral outbreaks can rapidly affect all stages of life. Experiences show that not only national authorities, but also international organizations should play critical roles in the control of infectious diseases. Based on this perspective, in our study, the responses of the World Health Organization (WHO), which has a decisive role in international health policies, to prevent the spread of the COVID-19 pandemic in the first three-month period were examined. In addition, the possible effects of the national measures and policies taken by Canada, Turkey, Pakistan, and Tajikistan, which are in different income groups according to the World Bank, on the number of cases and deaths were discussed. In this context, the contributions, or potential effects of the WHO on the performance of these countries against the COVID-19 were interpreted. It was understood that the countries in different income groups have developed policies based on their capability at country level independent from other countries in the fight against COVID-19 outbreak. It has been evaluated that the success of countries in the fight against the outbreaks is affected by different parameters such as average age of the country's populations, health infrastructures and income levels that greatly affect access to medical supplies and equipment. However, it can be said that international organizations with institutional power such as WHO cannot play a leading role at the expected level in the prevention of the pandemic and ineffective in directing local policies and ensuring international coordination. Especially in the COVID-19 viral pandemic environment where fast and precise decisions are required, this leading role is desperately needed. The first quarterly decisions and meeting notifications of the WHO in the COVID-19 pandemic were examined in our study and it was understood that these outcomes cannot provide a definite and effective management plan to national health policy makers, although WHO presented diagnostic tools rapidly and, in some degree maintained the supply chain of medical equipment globally. As a result, when all these elements determined in our study were considered together; the need for an integrative, proactive, and fair international health institution that produces prompt, effective and constantly updated comprehensive policies should be emphasized.

Pregravidary preparation

Preconception care is an essential component of promoting maternal and child health at the national and international levels. The term “preconception care” is found both in various recommendations of the World Health Organization and in practical recommendations for the protection of maternal and child health. Although programs and guidelines may differ depending on local needs (endemic diseases, financial security, educational level of the population, etc.), the general concept of preconception care is present in developing and developed countries within different health systems and does not depend on political, cultural or religious beliefs. In addition, the history of incorporating various preconception strategies and ideologies into international maternal and child health programs and policies spans nearly 30 years, demonstrating the long-term recognition of the relative importance of this approach as a means of optimizing pregnancy outcomes. However, at present there is a large proportion of women who do not know about the importance of preparing for pregnancy.The purpose of this review was to study international experience in the implementation of preconception care in the practice of practical health care professionals. The main tools were highlighted – motivated counseling and reflective practice. Since the United States of America is the world health leader in improving pregnancy outcomes, the information sources were selected from PubMed and the Centers for Disease Control. This review provides evidence of the importance of motivated counseling, identifies the main stages of establishing a trusting relationship between a doctor and a woman or a married couple.Conclusions. Correct pregravid behavior will improve the demographic indicators of the country, however, systematic work is needed with regard to the social responsibility of married couples and the interest of medical personnel in high-quality motivated counseling.

Health and economic burden estimates of snakebite management upon health facilities in three regions of southern Burkina Faso.

BackgroundSnakebite has become better recognized as a significant cause of death and disability in Sub-Saharan Africa, but the health economic consequences to victims and health infrastructures serving them remain poorly understood. This information gap is important as it provides an evidence-base guiding national and international health policy decision making on the most cost-effective interventions to better manage snakebite. Here, we assessed hospital-based data to estimate the health economic burden of snakebite in three regions of Burkina Faso (Centre-Ouest, Hauts Bassins and Sud-Ouest).MethodologyPrimary data of snakebite victims admitted to regional and district health facilities (eg, number of admissions, mortality, hospital bed days occupied) was collected in three regions over 17 months in 2013/14. The health burden of snakebite was assessed using Disability-Adjusted Life Years (DALYs) calculations based upon hospitalisation, mortality and disability data from admitted patients amongst other inputs from secondary sources (eg, populations, life-expectancy and age-weighting constants). An activity-based costing approach to determine the direct cost of snake envenoming included unit costs of clinical staff wages, antivenom, supportive care and equipment extracted from context-relevant literature.FindingsThe 10,165 snakebite victims admitted to hospital occupied 28,164 hospital bed days over 17 months. The annual rate of hospitalisation and mortality of admitted snakebite victims was 173 and 1.39/100,000 population, respectively. The estimated annual (i) DALYs lost was 2,153 (0.52/1,000) and (ii) cost to hospitals was USD 506,413 (USD 49/hospitalisation) in these three regions of Burkina Faso. These costs appeared to be influenced by the number of patients receiving antivenom (10.90% in total) in each area (highest in Sud-Ouest) and the type of health facility.ConclusionThe economic burden of snake envenoming is primarily shouldered by the rural health centres closest to snakebite victims–facilities that are typically least well equipped or resourced to manage this burden. Our study highlights the need for more research in other regions/countries to demonstrate the burden of snakebite and the socioeconomic benefits of its management. This evidence can guide the most cost-effective intervention from government and development partners to meet the snakebite-management needs of rural communities and their health centres.

Using preprints in evidence synthesis: Commentary on experience during the COVID-19 pandemic

Using preprints in evidence synthesis: Commentary on experience during the COVID-19 pandemic

Environmental correlation and epidemiologic analysis of COVID-19 pandemic in ten regions in five continents

BackgroundCoronavirus disease-2019 (COVID-19) has caused worldwide health emergencies during the last 6 months of 2020. Within very short time, severe acute respiratory coronavirus-2 (SARS-CoV-2) has infected over 64,516,333 people with 1,493,264 fatalities in 210 countries and regions. Previous studies have reported that environmental factors can affect the viability and transmission of SARS-CoV-2. This study aimed to determine the correlation of environmental factors with COVID-19 pandemic and epidemiology of COVID-19 across nine countries in five continents. MethodsBoth environmental and health data were retrieved from various databases during January 1, 2020 to June 30, 2020. Mean value of environmental factors were calculated for weekly and daily cases and fatalities. Spearman correlation test was conducted. ResultsIn this study, most of the COVID-19 cases and fatalities were detected from regions (New York, Madrid, Lombardy, London and Sau Paulo) with 7 °C–25 °C mean temperature per day, 3 to 6 mean UV index per day and 14 km/h to 22 km/h mean wind velocity per day. Both cases and fatalities increased significantly after removing lockdown in Bangladesh, India, Brazil and South Africa. Over 50% COVID-19 patients were asymptomatic in every country except Brazil and Australia. Fever (>50%) was the most common symptom followed by cough (45%), tiredness (38%) and sore throat (30%), respectively. In India and Bangladesh over 70% of cases were reported in male. Significant correlation of COVID-19 cases with temperature and UV were detected in London, Lombardy, Madrid, New York and Dhaka. ConclusionThis is one of the first cross-country epidemiologic and correlation studies between environmental factors and COVID-19 pandemics. This study will help both local and international health organizations and policy makers to face the COVID-19 challenge.

Predictors of COVID-19 testing rates: A cross-country comparison

ObjectivesCross-country comparisons of coronavirus disease (COVID-19) have largely been applied to mortality analyses. The goal of this analysis is to explore predictors of COVID-19 testing through cross-country comparisons, to better inform international health policies. MethodsTesting and case-based data were amassed from Our World in Data, and information regarding predictors was gathered from the World Bank. We investigate Human Development Index (HDI), health expenditure, universal health coverage (UHC), urban population, service industry workers (%), and air pollution as predictors. We explored testing data through July 31, 2020, or most recently available, using case-indexing methods, which involve synchronizing countries by date of first reported COVID-19 case as an index date and normalizing to the cumulative tests 25 days post-index date. Three multivariable linear regression models were built in a stepwise fashion to explore the association between the indexed number of COVID-19 tests and HDI scores. ResultsA total of 86 countries were included in the final analytical sample, excluding countries with missing data. HDI and urban population were found to be significantly associated with testing levels. ConclusionsResults suggest that social conditions and government capacity remain consistently salient in the consideration of testing rates. International efforts to assist low-HDI countries are needed to support the global COVID-19 response.

Chapter 5. Specific role of lawyers and the legal perspective in the development of Integrative Bioethics in Croatia.

Athough, first forms of legal provisions concerning medical research in Croatia (ex Yugoslavia) came into force during 1970s (regulating work of "commissions for drugs"), more vivid presence and impact of law within bioethics can be traced in the 1990s. Beside the new Law on Health Protection (1997) - articles 51 and 52 requiring the establishment of ethics committees and regulating the framework of their duties, the introduction and the success of the law occured as a consequence of political changes and international opening, influencing education, research, health and social policies. Later progression of the legal discipline within bioethics can be noticed not only with respect to the work of prominent legal experts, but also the main tide of Croatian bioethics, particularly the Integrative Bioethics of Ante Čović.The aim of this paper is to detect the main representatives of legal perspective and discipline within modern bioethical trends in Croatia, as well as to clarify some of the many intriguing mutal influences.

Foreign representative offices of the Soviet Red Cross in the 1920s and 1930s in the context of the international health policy of the USSR

Foreign representative offices of the Soviet Red Cross in the 1920s and 1930s in the context of the international health policy of the USSR

Priorities for the global advancement of care for older adults with cancer: an update of the International Society of Geriatric Oncology Priorities Initiative.

In 2011, the International Society of Geriatric Oncology (SIOG) published the SIOG 10 Priorities Initiative, which defined top priorities for the improvement of the care of older adults with cancer worldwide.1 Substantial scientific, clinical, and educational progress has been made in line with these priorities and international health policy developments have occurred, such as the shift of emphasis by WHO from communicable to non-communicable diseases and the adoption by the UN of its Sustainable Development Goals 2030. Therefore, SIOG has updated its priority list. The present document addresses four priority domains: education, clinical practice, research, and strengthening collaborations and partnerships. In this Policy Review, we reflect on how these priorities would apply in different economic settings, namely in high-income countries versus low-income and middle-income countries. SIOG hopes that it will offer guidance for international and national endeavours to provide adequate universal health coverage for older adults with cancer, who represent a major and rapidly growing group in global epidemiology.

Promoción de la salud: una mirada crítica a sus antecedentes y al rol de los profesionales de salud

Introducción: Abordar el tema de Promoción de la salud y particularmente sus antecedentes, es un asunto de permanente vigencia, dada su importancia a la luz de las políticas internacionales de salud pública planteadas desde el siglo XX. Para que la Promoción de la Salud se siga fortaleciendo, se requiere de la creación de condiciones favorables a la salud en lo cual los profesionales de la salud juegan un rol trascendental, que pasa por su formación académica, continuando con su desempeño profesional y participación ciudadana.
 Objetivo: Presentar una revisión crítica de los antecedentes de la promoción de la salud y del rol de los profesionales de la salud en su desarrollo.
 Método: Se realizó una revisión de artículos, libros y documentos oficiales de organismos internacionales de salud, publicados en español y en inglés. Se usaron en español e inglés, los términos “promoción de la salud”, “personal de salud” y “salud pública”. Las bases de datos consultadas fueron PubMed, SciELO y Science Direct.
 Conclusiones: Los hallazgos muestran cómo la Promoción de la salud ha estado enmarcada en críticas y debates desde su origen, lo que demuestra su importancia y vigencia en el tiempo; los profesionales de la salud como actores principales en la promoción de la salud, deben recibir desde su formación las bases necesarias para su aplicación profesional y personal.

Influence of sugar label formats on consumer understanding and amount of sugar in food choices: a systematic review and meta-analyses.

Reducing population intakes of sugar has become a focus of many national and international public health policies. Packaged foods and beverages are key contributors to sugar intakes, and food labels can be an effective tool to reduce sugar consumption. The aim of this systematic review was to examine the influence of sugar label formats on 2 outcomes: consumers' understanding of sugar information, and the amount of sugar in consumers' food choices. Scopus, Web of Science, PubMed, CAB Abstracts, SciELO, and the Cochrane Library databases were searched up until February 4, 2020. Randomized experiments or quasi-experiments were included if they investigated the influence of sugar label formats on consumers' understanding of sugar information or on the amount of sugar in consumers' food choices. Data were extracted independently by 2 authors. Mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs) plus 95%CIs were used to describe between-group differences for intervention label formats using random-effects models. Twenty-three studies, which examined 39 comparisons, were included. Label formats using "high in sugar" interpretative texts (traffic light labels [MD 41.6; 95%CI 37.9-45.4] and warning signs [OR 1.33; 95%CI 1.0-1.78]) were most effective in increasing consumers' understanding of the sugar content in packaged foods. Health warning messages (SMD -0.32; 95%CI -0.43 to -0.22), graphical depictions of sugar content in teaspoons (SMD -0.32; 95%CI -0.48 to -0.17), and warning signs (SMD -0.24; 95%CI -0.35 to -0.13) were most effective for influencing consumers to choose products with lower sugar content. Formats that provide an interpretation of sugar information, particularly those indicating if a product is high in sugar, were more helpful than only numerical information for improving consumer understanding and promoting food choices with less sugar. PROSPERO registration number CRD42018081222.