National Health Care Program Research Articles

Identifying children at risk in Swedish Child Health Services.

Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme. This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index. By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver's sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden. The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions. This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.

Addressing healthy aging in China: Practices and prospects.

One important challenge for global development is aging. China is one of the world's countries with the highest elderly population and the most rapid aging; in 2022, the percentage of the population over 65 was 14.9%; by 2050, it is expected to rise to 26.1%. China's health security, elderly care, and healthcare services are facing serious challenges as a result of this aging trend. With 80% of provinces including medical and elderly care in national basic public health care programs, China has adopted a proactive national plan to combat population aging. Moreover, geriatric departments have been established at 69.3% of public general hospitals at secondary and higher tiers, 48% of provinces have devises preventive interventions for disability and dementia in the elderly, 48 percent of provinces are serving as test regions for medical care related to rehabilitation, and 49 cities are involved in long-term care insurance (LTCI) trials that encompass 170 million people. There are 4,259 medical and health care facilities that provide hospice care services, 152 hospice care pilot regions, and 87,000 pairs of contracts between medical and health care facilities and elderly care providers. These developments provide a strong basis, but there are still major obstacles to overcome. The Chinese Government is urged to adopt early preventive measures, offer more ongoing, practical, and cost-effective diagnostic and treatment services, allocate resources equitably, and use intelligent technologies to enhance elderly care. The ultimate goals are to lessen the financial burden, enhance the health of the elderly, and offer a vital global resource.

National medical eligibility criteria for contraceptive use 2023: review

Individual sexual and reproductive life management has been сonfirmed by medical and state communities since 1990s. Every citizen officially received rights for access to appropriate goods and services. Such international agreements as 1994 International Conference on Population and Development (ICPD, Cairo, Egypt) and 2004 WHO Reproductive health strategy, estimated reproductive health and family planning as priorities. Worldwide agreement on the 2005 summit declares achieving of female reproductive health before year 2015 as worldwide progress.WHO created complex of international eligibility criteria for male and female contraception with the aim of medical aid improvement. According to WHO plan, those criteria should be used by countries considering policy, needs, priorities and resources of national healthcare programs. For example, USA, United Kingdom, Russia etc. have successfully adopted medical eligibility criteria for contraception on the national level.The present review is summary product created by interdisciplinary expert group including representers of federal and regional healthcare establishments, medical universities, and international medical organizations.

The Epidemiology of Rheumatic Diseases in India

Epidemiological studies, referred to as the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) studies, have been conducted under the aegis of the International League against Rheumatism and the World Health Organization to evaluate the epidemiology of rheumatic and musculoskeletal (RMSK) diseases in India. These COPCORD studies conducted in rural Bhigwan and urban Pune in Maharashtra, rural Calicut and rural Trivandrum in Kerala and rural and urban Lucknow in Uttar Pradesh, along with data from the Global Burden of Diseases study have helped to understand the burden of rheumatic diseases in the community. Based on these studies, RMSK diseases, which are amongst the top 25 causes of disability in the Indian population, are prevalent in nearly 25%–30% of the Indian population. The common rheumatic diseases in the community are soft tissue rheumatism, neck and back pain, fibromyalgia and unspecified pains and osteoarthritis (most commonly affecting the knee). These diseases most commonly affect young persons between the third to the fifth decade of life, more often affect females, are prevalent in both rural and urban populations, and account for considerable disability in up to one-fifth of individuals leading to loss of livelihood and dependence on others for self-care. Community-based national healthcare programs to manage RMSK diseases at the community level are urgently needed. There also remains an unmet need to train more doctors to diagnose and manage rheumatic diseases at the primary, secondary and tertiary levels of care.

Health profiling of elderly in Gujarat: evidences from longitudinal ageing study in India

Background: Considering the burden of different health related disorders amongst the elderly, the present study aims to examine the health profile and the factors associated with various health issues among the elderly in Gujarat. Methods: The current study has used the Longitudinal Ageing Study in India (LASI) Wave-1 data. The chi-square test and logistic regression model have been used to establish the association between the study variables and factors associated with the chronic diseases among elderly in Gujarat. Results: The prevalence of chronic diseases among elderly in Gujarat is 51.3 percent. Hypertension was the highest prevalent disease suffered by nearly one-fourth (24.3%) of the elderly people covered under the study followed by prevalence of chronic bone/joint diseases (15.7%) and diabetes (12.4%). The present study showed that the risk of occurrence of chronic diseases increases along with the age. Consumption of alcohol increases the risk of chronic morbidities. On the other hand, education, work status and physical activity play significant role in reducing the prevalence of chronic diseases. Conclusions: The study highlights the prevalence of different health related disorders amongst the elderly in Gujarat. In addition to this, the study tries to identify the critical factors associated with health issues of elderly. The findings from the study can also help in strengthening the scope of National level preventive and health care programme for the elderly population in Gujarat.

A systematic review of real-world applications of genome sequencing for newborn screening

Aim: With the costs of genomic sequencing falling quickly and an ever-increasing number of clinical laboratories equipped with new-generation sequencing machines, healthcare systems around the world are getting ready to enter the era of genomic newborn screening (NBS). However, the adoption of Genomic Sequencing (GS), encompassing whole-exome sequencing (WES) and whole-genome sequencing (WGS), in NBS programs raises a number of clinical, ethical, and legal questions as well as organizational and economic challenges. This systematic review is part of a feasibility study to assess the introduction of WGS for NBS in Lombardy region with the specific aim of gathering evidence from existing pilots in the field whose results have been published. Methods: Three different sources were identified for the selection of articles in order to obtain a various and unbiased set of publications. 33 articles were retained for analysis to answer the following questions: 1. Clinical: Does genomic sequencing demonstrate clinical utility in the context of NBS? What are the limitations of these kind of programs? 2. Societal: What are the social, ethical and psychological implications of using GS for NBS? 3. Governance: What are the legal, economic, and organizational challenges for GS-based NBS programs? Results: There is a general consensus in the literature on the key principles that should guide the adoption of GS in NBS, such as the inclusion of actionable genes only, the need for informed consent from the parents, the right of the newborn to an open future, which means the exclusion of late-onset diseases even when those are considered treatable. However, there are still several differences in how these principles are detailed and applied. Conclusion: Real-world evidence from a handful of pilot projects (namely BabySeq and NC-Nexus, both carried out in the USA) have been published recently; however, this evidence is not yet sufficient to put an end to the broad and animated debate on the use of GS for NBS. Ethical, legal, and social issues still constitute great challenges and major barriers to wide and uniform adoption of GS in NBS. On the clinical side, a number of issues remain unaddressed, such as the benefits and limitations of the different approaches (targeted sequencing, GS only versus GS+standard NBS), the genes/diseases to include and the frequency of incidental findings, identification of carrier status, and variants of uncertain significance (VUS). Further pilots and consultations with involved stakeholders will be necessary before GS-based NBS can be accepted and systematically implemented in national healthcare programs.

Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

BackgroundTransition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. MethodsA survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. ResultsIn total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. ConclusionDespite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. Level of EvidenceIII.

Expansion of India’s national child healthcare programme, Rashtriya Bal Swasthya Karyakram (RBSK), for rare disease management : a health policy perspective

Rare diseases (RD) are severe and debilitating conditions. They are one of the leading causes of childhood mortality globally. In India, RDs have not been considered in most healthcare programs which usually cater to more common diseases. We believe, that for efficient utilization of resources in a resource-constrained healthcare system, existing programs must integrate RD management strategies. In this study, we explore the utility, expandability, and limitation of one of the important national child healthcare programs, Rashtriya Bal Swasthya Karyakram (RBSK) which translates to National Child Healthcare Program. We found that RBSK has immense potential to cater to RDs through some of its unique features, such as comprehensive screening, wide target age group, and efficient utilization of resources. We provide recommendations that can help to strengthen the present program. This study will inspire other low-resource countries to identify and expand existing public healthcare programs for RD management. Moreover, RBSK can serve as a model program to integrate RD management globally.

One Nation One Health—Journey of a Nation to equipoise health and disease

Being a developing country, India has faced many challenges since freedom concerning the economy, health, and education. Providing healthcare facilities to all strata of society was a monumental task. By formulating National Health Policy in 1983, India took its first initiative in this context. Timely revision of the policy in 2002 and 2017, according to the requirements and implementation of many national healthcare programs, has enabled it to advance in the healthcare system. India now aims at bringing uniformity in the healthcare facilities provided by the government to all the people anywhere in India at minimal expenditure. In this regard, universal health coverage has been introduced as a part of the Ayushman Bharat Yojana to reduce the cost of treatment to patients. Slowly, India is heading toward sustainability in terms of quality health care assessible to all sectors of society. To bring uniformity of health care by integrating different healthcare systems according to the choice and needs of the patients, with minimal financial burden and compromise in quality, the “One Nation, One Health System by 2030” agenda has been introduced. Here, the formulation of the National Health Policy and its timely renewal and the role of Ayurveda in achieving its goals have been discussed.

Two Conceptions of Solidarity in Health Care

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system of mutually advantageous cooperation.

Tax Amnesty: An Old Debate as Viewed From Current Public Choices

The Clinton administration arrived with specific, well-advertised goals: job creation, a comprehensive national health care program, economic recovery and a commitment to reduce the constantly increasing federal deficit. There is no question that President Clinton has established these policy objectives as the primary criteria upon which he desires his forthcoming leadership efforts to be judged by the electorate. Success on these domestic issues would enhance his position for re-election in 1996, and would merit well-deserved respect for leadership and judgment. Whether all of these separate but related goals can be achieved within both the short and long term, without being counter-productive to each other, presents one of the more intriguing enigmas faced by the administration.Job creation and a comprehensive national health care program will necessarily consume more revenue in the short term. Consequently, the federal deficit will increase unless new resources are found to pay the costs of these programs and unless acquisition of such resources does not significantly impair the economic recovery in progress. Indeed, the current economic recovery can, on its own, deliver significant dividends. Nevertheless, the search for resources will be one of the more consuming and politically sensitive issues facing President Clinton. The new resources may be generated by any of the following items: (I) a cut in government expenditures, including mandatory programs; (2) an economic dividend generated through restructuring of the health delivery system; and (3) an increase in tax revenues. Notwithstanding the anticipated economic dividend to be generated from the restructuring of a health delivery system, it is likely that only cuts in federal expenditures coupled with increased tax revenues will provide the funds necessary to attain and sustain President Clinton's goals as laid out in his State of the Union Address.

The Landscape of Strategic Health Purchasing for Universal Health Coverage in Burkina Faso: Insights from Five Major Health Financing Schemes

ABSTRACT Strategic health purchasing is a key strategy in Burkina Faso to spur progress toward universal health coverage (UHC). However, a comprehensive analysis of existing health financing arrangements and their purchasing functions has not been undertaken to date. This article provides an in-depth analysis of five key health financing schemes in Burkina Faso: Gratuité (a national free health care program for women and children under age 5), crédits délégués (delegated credits), crédits transférés (transfers to municipalities), community-based health insurance, and occupation-based health insurance. This study involved a document review and complementary key informant interviews using the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC). Data were collected using the framework’s accompanying Microsoft Excel–based tool. We analyzed the data manually to examine and identify the strengths and weaknesses of governance arrangements and purchasing functions and capacities. The study provides insight into areas that are working well from a strategic purchasing perspective and, more importantly, areas that need more attention. Areas for improvement include low financial and managerial autonomy for some schemes, weak accountability measures, lack of explicit quality standards for contracting and for service delivery, budget overruns and late provider payment, provider payment that is not linked to provider performance, fragmented health information systems, and information generated is not linked to purchasing decisions. Improvements in purchasing functions are required to address shortcomings while consolidating achievements. This study will inform next steps for Burkina Faso to improve purchasing and advance progress toward UHC.

Antigen-Based Point of Care Testing (POCT) for Diagnosing SARS-CoV-2: Assessing Performance.

Currently, the most accurate way to diagnose an active SARS-CoV-2 (COVID-19) infection is through detection of viral RNA using reverse transcription polymerase chain reaction (RT-PCR) test. While RT-PCR tests are the most sensitive for identifying infection, there are significant limitations, such as global access to sufficient test kits, turnaround times (TAT) from specimen collection to test result is often greater than 24h and the need for skilled operators in accredited laboratories requiring specialized equipment. A rapid test performed at the point of care (POC) could provide a result within an approximate time of 30min post specimen collection, be performed by a health care worker and comprise a simple workflow, improving both turnaround time and potentially decreasing costs (e.g., transport, cold-chain, skilled laboratory staff, complex equipment). Determining the performance of SARS-CoV-2 RT-PCR tests is, however, easier to assess than antigen-based POCT, as residual clinical specimens (swabs in universal transport media [UTM]) are readily available in laboratory environments, and do not require patient informed consent. Evaluating the performance of POCT requires informed-consent driven studies, with patients required to provide a standard of care specimen as well as study evaluation specimens, which is often not acceptable as nasopharyngeal swabbing can be invasive, clinical field trials are costly and time consuming. Many institutions and regulatory bodies also require preliminary data prior to use in field settings. Therefore, we have developed a method to determine the performance of antigen based POCT that can be used by implementers in national healthcare programs, regulators and rapid test developers. The method investigates both quantitative and qualitative parameters, with the latter providing insights into the capability for implementation and national program uptake.

Challenges Related to the Use of Next-Generation Sequencing for the Optimization of Drug Therapy.

Over the last decade, next-generation sequencing (NGS) methods have become increasingly used in various areas of human genomics. In routine clinical care, their use is already implemented in oncology to profile the mutational landscape of a tumor, as well as in rare disease diagnostics. However, its utilization in pharmacogenomics is largely lacking behind. Recent population-scale genome data has revealed that human pharmacogenes carry a plethora of rare genetic variations that are not interrogated by conventional array-based profiling methods and it is estimated that these variants could explain around 30% of the genetically encoded functional pharmacogenetic variability.To interpret the impact of such variants on drug response a multitude of computational tools have been developed, but, while there have been major advancements, it remains to be shown whether their accuracy is sufficient to improve personalized pharmacogenetic recommendations in robust trials. In addition, conventional short-read sequencing methods face difficulties in the interrogation of complex pharmacogenes and high NGS test costs require stringent evaluations of cost-effectiveness to decide about reimbursement by national healthcare programs. Here, we illustrate current challenges and discuss future directions toward the clinical implementation of NGS to inform genotype-guided decision-making.

IL-1 and IL-6 inhibition affects the neutralising activity of anti-SARS-CoV-2 antibodies in patients with COVID-19.

IL-1 and IL-6 inhibition affects the neutralising activity of anti-SARS-CoV-2 antibodies in patients with COVID-19.

Assessing the efficiency of using medical and economic standards when treating surgical patients in day hospitals

Studying the issues of improving the outpatient surgery in a megalopolis based on standardization is essential both for practical healthcare and medical science. In order to increase the quality and accessibility of surgical treatment, as well as to reduce the cost of treatment and post-operative rehabilitation, medical and economic standards were introduced at Shymkent Municipal Center of Outpatient Surgery in 2016, as a part of the National Healthcare Program. Also, day hospitals were organized for treatment and post-operative rehabilitation of surgical ambulatory patients. The training to increase the doctors’ qualification and their knowledge of medical and economic standards was carried out at South Kazakhstan Medical Academy. The efficiency of using medical and economic standards at day hospitals was assessed with indices based on medical, social and economic criteria. The data was taken from statistical records of attendance and clinical protocols of treatment. Respondents’ opinions were studied with a poll. The research showed that after introduction of the medical and economic standards the doctors’ payment increased depending on the medical efficiency and quality of treatment and post-operative rehabilitation of surgical ambulatory patients; the levels of incidence with temporary and permanent disability decreased, and the time of patients’ staying in hospital reduced.

Design of an Ultrasound-Navigated Prostate Cancer Biopsy System for Nationwide Implementation in Senegal.

This paper presents the design of NaviPBx, an ultrasound-navigated prostate cancer biopsy system. NaviPBx is designed to support an affordable and sustainable national healthcare program in Senegal. It uses spatiotemporal navigation and multiparametric transrectal ultrasound to guide biopsies. NaviPBx integrates concepts and methods that have been independently validated previously in clinical feasibility studies and deploys them together in a practical prostate cancer biopsy system. NaviPBx is based entirely on free open-source software and will be shared as a free open-source program with no restriction on its use. NaviPBx is set to be deployed and sustained nationwide through the Senegalese Military Health Service. This paper reports on the results of the design process of NaviPBx. Our approach concentrates on “frugal technology”, intended to be affordable for low–middle income (LMIC) countries. Our project promises the wide-scale application of prostate biopsy and will foster time-efficient development and programmatic implementation of ultrasound-guided diagnostic and therapeutic interventions in Senegal and beyond.

Postmenopausal Symptoms and Management by Women in Delhi–NCR

Menopause is defined as the complete cessation of the menstrual cycle in women for twelve consecutive months. Although menopause is an important aspect of the female reproductive health cycle, it is often ignored. Women may experience different menopausal and postmenopausal symptoms ranging from mild to severe. In the present study, a cross-sectional survey of 200 women in their postmenopausal years was conducted across Delhi and the National Capital Region (NCR). A pretested questionnaire was given to a random population of postmenopausal women to record various postmenopausal symptoms and the coping strategies adopted by them. The mean age of menopause of the sample population was 47.48 years, and body mass index seemed to affect the age of onset of menopause. The majority of women experienced postmenopausal symptoms, with 95.28% experiencing more than one symptom, ranging from fatigue and sleep disturbances to severe symptoms such as anxiety attacks, palpitations and joint pains. Many women used different coping strategies, such as changes in lifestyle and social interaction with other women experiencing menopause. Very few women used hormone replacement therapy as a coping mechanism and most of them were ignorant about the same. Interestingly, both education and working status were observed to affect the adoption of coping strategies by women in Delhi–NCR. The results of the study emphasize the need of addressing the problems of the postmenopausal population and incorporating the same in the national healthcare programme.

Vitamin D: An Essential Micronutrient for Bone Health

Vitamin D is an essential micronutrient in children for bone mineralization and bone growth. There are two forms of natural vitamin D, vitamin D2 and vitamin D3. Natural vitamin D is obtained from 2 main sources, dietary vitamin D intake and cutaneous vitamin D synthesis from sunlight exposure. Natural vitamin D requires a 2-step enzymatic hydroxylation process to be turned into active form of 1,25-dihydroxyvitamin D, firstly, 25-hydroxylation in the liver, and secondly, 1α-hydroxylation in the kidneys. Although breast milk is highly nutritive containing adequate amounts of most important vitamins, it contains only a small amount of vitamin D, approximately 15-50 IU/L, which does not reach the recommended daily requirement of 400 IU for infants. Exclusively breastfed infants are at risk to develop vitamin D deficiency if sunlight exposure is limited. Despite the excess of sunshine for the whole year in Southeast Asian countries including Thailand, various studies have found that more than 30.0% of children and adolescents had vitamin D insufficiency. The factors associated with vitamin D insufficiency in children include maternal vitamin D deficiency, exclusively breastfed as infants, insufficient daytime outdoor activities, use of sunscreens, extensive skin coverage by clothing, and lack of vitamin D supplementation and dietary fortification. To prevent vitamin D deficiency in infants, a global consensus in 2016 recommended that vitamin D supplementation should be included in routine national health care programs along with other essential micronutrients and immunizations.

Nigerians crying for availability of electricity and water: a key driver to life coping measures for deepening stay at home inclusion to slow covid-19 spread

The COVID-19 pandemic is a tethering on the edge of a make or mar moment in the history of the world as it is chiefly a crisis for health and a tragedy for humanity, but it also poses economic consequences that is far-reaching. In emerging countries like Nigeria, it has already disrupted the livelihoods of millions of individuals, with uneven impact among poor and vulnerable households and small and informal industries and the disruption pace is expected to accelerate the crisis in the coming weeks. No nation or community is exempt; in oil-rich countries such as Nigeria, the challenges of COVID-19 is exacerbated by falling price in crude. The COVID-19 (SARS-CoV-2) pandemic has raised sundry questions for sectors including water and energy around the world. While workers provide services in a geographic areas, operational and systematic concerns and understandings apply across national borders. This paper draw attention to the importance of electricity and water, sanitation and hygiene in Nigeria especially in areas such as slums, given that many Nigerians live in overcrowded and deprived areas facing major socioeconomic impediments, to these efforts, the important contribution to handwashing is to help reduce disease spread and also highlight the significance of water as an industry that is so critical to the well-being of societies, economies, and the environment and key for the current health crisis. The water and electricity sector should be proactive in doing its part to address COVID-19 pandemic and the ramifications of its spread. As the continent's leaders take decisive action in the formal, informal and development sectors to save human lives and shield trades, households and geographic economies from the pandemic consequence. Therefore, the responsibility is up to all governments and their development partners to improve health care services and other measures that are critical by providing near constant electricity and water supply for its citizenry to help contribute immensely to social distancing, deepening stay at home, in order to slow the spread of COVID-19 both in the short and long run and teaching of public health that is based on systematic evidence to decrease the distress and apprehension caused by distorted and misinformation through social media. In particular, Nigerian government should act swiftly and decisively to provide robust support and not just the rhetoric of stimulus announced by the Central Bank of Nigeria for significant national public health and health care programs, development of medical countermeasure, domestic preparedness programs and response instruments and global cooperationto reduce the virus impacts. Prompt action now is needed to avoid worst case health and economic consequences.