National Health Outcomes Research Articles

Burden of Ischemic Heart Diseases among US States from 1990-2019.

Ischemic Heart Disease (IHD) is a leading cause of global mortality, including in the United States. Understanding the burden of IHD in the United States is crucial for informed decision-making and targeted interventions aimed at reducing morbidity and mortality associated with this leading cause of death. This study aimed to understand the burden of IHD, identify gender disparities and risk factors, explore the relationship between socioeconomic growth and IHD, and analyze risk factor distribution across the states of the United States. This study utilized data from the Global Burden of Diseases Study 2019, which provided comprehensive information on IHD from 1990 to 2019. Data related to IHD from these years were extracted using a query tool from the Institute for Health Metrics and Evaluation (IHME) website. The study assessed the relationship between IHD and socioeconomic development using the Socio-demographic Index (SDI) and measured the overall impact of IHD using Disability-adjusted Life Years (DALYs), considering premature death and disability. Additionally, the study analyzed the burden of IHD attributed to six main risk factors. Data analysis involved comparing prevalence, mortality, SDI, DALYs, attributable burden, and risk estimation among the states. Between 1990 and 2019, there was an improvement in socioeconomic development in all states. Age-standardized rates of disease burden for IHD decreased by 50% [ASDR 3278.3 to 1629.4 (95% UI: 1539.9-1712.3) per 100,000] with the most significant decline observed in Minnesota. Males had higher burden rates than females in all states, and the southeast region had the highest mortality rates. The prevalence of IHD showed a declining trend, with approximately 8.9 million cases (95% UI: 8.0 million to 9.8 million) in 2019, representing a 37.1% decrease in the Age-standardized Prevalence Rate (ASPR) from 1990. Metabolic risks were the leading contributors to the disease burden, accounting for 50% of cases, with Mississippi having the highest attributable risk. Arkansas had the highest attributable risk for high cholesterol and smoking. Conversely, Minnesota had the lowest burden of IHD among all the states. This study highlights variations in the burden of IHD across US states and emphasizes the need for tailored prevention programs to address specific risk factors and gender differences. Understanding the trend in IHD may inform policymakers and healthcare professionals in effectively allocating resources to reduce the burden of IHD and improve national health outcomes.

Leveraging Resource Centers for Strengthening Immunization Supply Chain.

The efficacy of immunization programs is critically dependent on robust supply chain management, a complex challenge exacerbated by expanding program scopes and evolving vaccine technologies. This comprehensive review underscores the pivotal role of Resource Centers in fortifying the immunization supply chain, presenting a paradigm shift toward enhanced national and global health outcomes. Through a detailed examination of their key activities, the article elucidates how these centers catalyze improvements across various facets of supply chain management - from the integration of suitable technology technologies and specialized training programs to the development of sustainable models and advocacy for policy prioritization. This further explores the multifaceted challenges these centers confront, including funding constraints, capacity building, and infrastructural gaps, alongside the burgeoning opportunities presented by new vaccine introductions, donor interest in health system strengthening, and the potential for broadened scope beyond immunization. By weaving together examples of existing centers worldwide, the review highlights their contributions towards optimizing vaccine logistics, enhancing data management, and ultimately achieving Sustainable Development Goal 3. The insights provided offer valuable guidance for planning and sustaining resource centers, positioning them as indispensable allies in the global pursuit of universal immunization coverage.

The views of family physicians on National Health Insurance in Gauteng Province, South Africa.

Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.Contribution:This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.

A Bayesian Approach to Estimate Maternal Mortality Globally Using National Civil Registration Vital Statistics Data Accounting for Reporting Errors

Estimation and monitoring of mortality, across multiple population-periods, is vital to improving national and global health outcomes. Reducing maternal mortality is a key part of the Sustainable Development Goals (SGDs), which commit countries and international agencies to monitor progress toward improvement of global maternal health outcomes. Country-specific estimates of maternal mortality are used for monitoring country progress. Civil registration vital statistics (CRVS) data provide valuable information on maternal mortality but are often subject to substantial reporting errors due to misclassification of maternal deaths or incompleteness of CRVS-reporting on deaths to women of reproductive age. Motivated by the challenge of estimating maternal mortality using error-prone CRVS data, this article introduces a Bayesian two-stage approach to obtain country-specific trends in maternal mortality ratios (MMRs), accounting for CRVS-related misclassification errors. In the first stage, we produce country-specific trends of CRVS-related data quality metrics, in terms sensitivity and specificity, through a Bayesian hierarchical misclassification model. In the second stage, we produce data-driven country trends in MMRs and proportion maternal deaths out of all-cause deaths, which are constructed using a Bayesian maternal mortality estimation model, accounting for CRVS-related data quality assessed in Stage 1. We present the approach to estimating maternal mortality and illustrate its use for several country case studies. This approach is used by the United National Maternal Mortality Interagency Group (UN-MMEIG) to produce maternal mortality estimates for global monitoring.

5 The Relationship between National Paediatric Research Funding and Health Outcomes in Canada

Abstract Introduction The Canadian Institutes of Health Research (CIHR) is Canada's federal funding agency for health research. CIHR invests approximately $1 billion each year to support health research. A recent cross-sectional analysis of 14,060 paediatric grants from the National Institutes of Health (NIH) showed that funding for paediatric research was correlated with level of disease burden, although certain conditions were identified as either over- or under-funded. Objectives The objective of this study was to determine the relationship between national paediatric research funding and health outcomes in Canada. Methods Health research grants (project, operating, foundation, team, and catalyst grants) related to paediatrics were identified annually for each of 6 financial years (2015-16 to 2020-21) through systematic keyword searches of CIHR’s research funding database. Two researchers extracted data on the disease or topic being studied, and coded each grant according to the top 50 causes of mortality, top 10 causes of hospitalization, and 8 well-being dimensions (as defined by the Canadian Index of Child and Youth Well-being). Inter-rater reliability was first established and then 20% of grants were double-coded and reviewed for consistency. Data were then used to summarize total annual funding for paediatric research and compared to paediatric health outcomes. Results A total of 1703 grants with total funding in the amount of $702,217,490 related to paediatric research were identified in the period between 2015-16 and 2020-21 ($74,944,445 in 2015-16, $87,447,167 in 2016-17, $103,754,359 in 2017-18, $124,277,052 in 2018-19, $132,734,406 in 2019-20, and $179,060,060 in 2020-21). A total of 248 abstracts (14.6% of all included grants) were identified as focused on one of the top 4 leading causes of paediatric mortality. These included accidents ($3,709,863), intentional self-harm (suicide) ($8,529,544), congenital malformations, deformations, and chromosomal anomalies ($30,230,136), and malignant neoplasms ($61,550,990). A total of 379 grant abstracts (22.3%) were identified as focused on a leading cause of paediatric hospitalization. These included disorders related to short gestation and low birth weight ($33,381,731), mood (affective) disorders ($32,236,327), anxiety disorders ($10,445,260), and other mental health disorders ($56,584,714). The top dimensions of well-being identified as being studied were “Feeling happy and respected” (218 grants, $78,315), “Feeling protected” (89 grants, $34,166,781), and “Feeling secure” (83 grants, $27,158,835). Conclusion This analysis indicates that there is general alignment of health research funding in Canada with paediatric mortality, hospitalization, and well-being indicators. Understanding paediatric research funding patterns can help inform prioritization of specific paediatric areas for future strategic funding.

MT11 Field Testing of a Novel Holistic National Health Outcome Score: An Indicator of Health from Patient-Reported Outcomes

The field testing of a health score module (health index) via a national mHealth application provides a platform for the population to contribute information on their health status. The tool aims to promote health-seeking behavior and guide policymakers to improve health outcomes through population segmentation for targeted interventions. A preliminary national exercise was conducted to obtain behavioral insights in completing self-reported questionnaires using the tool and yielded an initial indicator of population health status.

The mental health and wellbeing impact of a Community Wealth Building programme in England: a difference-in-differences study

Wide differences in health exist between places in the UK, underscored by economic inequalities. Preston, an economically disadvantaged city in England, implemented a new approach to economic development, known as the Community Wealth Building programme. Public and non-profit organisations modified their procurement policies to support the development of local supply chains, improve employment conditions, and increase socially productive use of wealth and assets. We aimed to investigate the effect of this programme on population mental health and wellbeing. Difference-in-differences techniques compared trends in mental health outcomes in Preston, relative to matched control areas before (2011-15) and after (2016-19) the introduction of the programme. Outcomes were antidepressant prescribing, prevalence of depression, and mental health related hospital attendance rates using data provided by National Health Service Digital, the Quality and Outcomes Framework, and the Office for National Statistics. Additional analysis compared local authority measures of life satisfaction, median wages, and employment with synthetic counterfactuals created using Bayesian Structural Time Series. The introduction of the Community Wealth Building programme was associated with reductions in the prescribing of antidepressants (1·3 average daily quantities per person [95% CI 0·72-1·78) and prevalence of depression (2·4 per 1000 population [0·42-4·46]), relative to the control areas. The local population also experienced a 9% improvement in life satisfaction (95% credible interval 0-19·6%) and 11% increase in median wages (1·8-18·9%), relative to expected trends. Associations with employment and mental health related hospital attendance outcomes did not reach statistical significance. During the period in which the Community Wealth Building programme was introduced, there were fewer mental health problems than would have been expected compared with other similar areas, as life satisfaction and economic measures improved. This approach potentially provides an effective model for economic regeneration potentially leading to substantial health benefits. National Institute for Health Research.

Child health nursing in the Solomon Islands: A qualitative evaluation of the impact of the 'Bachelor of nursing - Child health'.

To explore graduates' perceptions of the impact on nursing practice of a new postgraduate course in child health, developed and implemented in the Solomon Islands in 2016. The Bachelor of Nursing -Child Health was implemented in 2016 to develop nurses' knowledge and skills in child health and paediatric care with the intent to improve national child health outcomes. A qualitative exploratory, descriptive design was used to evaluate the impact of the Bachelor of Nursing -Child Health on graduates' nursing practice. Fourteen nurses who graduated from the first cohort of students enrolled in the child health course were purposively selected to participate. Participants engaged in individual semi-structured interviews, conducted between August and December 2018. A thematic analysis was undertaken following Braun and Clarke's six-phase process. Findings from the study demonstrate positive impacts of the course on graduates' nursing practice. These include a perceived enhanced quality of care through their commitment to evidence-based practice, the ability to contribute to capacity building of colleagues, the reinforcement of provincial public health programmes and expanded participation in managerial activities. Following graduation, most alumni took on senior roles and greater responsibilities, felt more confident in managing unwell children, felt there was better access to and quality of child health care at the community and broader country levels and felt recognised by colleagues and communities. Some graduates faced resistance from colleagues to change practice and felt that despite being given greater responsibilities, nursing levels and salaries remained unchanged. This reflected a potential lack of recognition from hospital or provincial managers, the Nursing Council as the regulatory body for the nursing profession, and the Ministry of Health and Medical Services. A lack of human and material resources also impacted quality of care. Findings from this study underline the need for the Solomon Islands National University, the Nursing Council, the Public Service and the Ministry of Health and Medical Services to concord and delineate formal accreditation standards for child health nurses. Overall, collaborative efforts and commitments at local, regional and global levels are required to support child health nurses in their ability and ambition to improve national child health outcomes. Findings from this study demonstrate positive impacts of the course on graduates' nursing practice. The impact of increasing nurses' knowledge and skills on national child health outcomes could be significant. Ongoing implementation and recognition of this course in the Solomon Islands, as well as more broadly across the Pacific region, are recommended.

Experiences and learnings of pharmacists, students, and clinical assistants working collaboratively in a COVID-19 vaccination clinic: a qualitative study

BackgroundThe involvement of pharmacists and pharmacy clinical assistants (CAs) in hospital clinics has demonstrated benefits for improving medication safety and care delivery. Internationally, pharmacy staff played a crucial role in the safe storage, provision and administration of vaccines, as well as reinforcement of pharmacovigilance efforts during the COVID-19 pandemic. In Australia, healthcare providers collaborated to rapidly facilitate a phased COVID-19 vaccination program. The perspectives of the pharmacy team, including pharmacy students, involved in implementing novel health services are underexplored in the literature. ObjectiveTo describe the key learnings in how a team of pharmacists, CAs and pharmacy students contributed to the COVID-19 vaccine service, and to explore their preparedness and experiences working at a vaccination clinic within a quaternary hospital. MethodThis study involved semi-structured interviews with pharmacy students, CAs and pharmacists. All pharmacy staff who worked in the clinic were invited to participate in the study and a snowball strategy was used to maximise recruitment. The interviews were audio-recorded, transcribed, and analysed using inductive thematic techniques to identify major themes. ResultsA total of 11 participants were interviewed including: four pharmacists, four CAs and three undergraduate students. Using thematic analysis, five main themes were identified: (1) Potential for student value and experiential learning; (2) Adaptive procedures and work practices in a rapidly changing environment; (3) Clear leadership, with role clarity, role expansion and interchangeability; (4) Supportive learning environment and (5) Stakeholder drivers for service delivery and to optimise societal benefit. These five themes often interacted with each other, highlighting the complexities of implementing and operating the service. ConclusionsThe vaccine clinic service provided a novel and valuable opportunity for students, CAs, and pharmacists to work collaboratively, extending their scope of practice to contribute to better national health outcomes. Participants expressed their support for future initiatives involving pharmacy students and healthcare staff collaborating in hospital settings.

Pandemic planning: data, information and evidence.

In this article, we examine the role and effectiveness of the Centers for Disease Control and Prevention in the USA and Europe and consider possible lessons for future pandemic planning in Australia. We also 'map' the interjurisdictional communication pathways that have been secured since the election of the new Commonwealth government. We suggest a number of steps that could be taken to upgrade the collection, distribution, accessibility and timelines of key information required to improve pandemic management and national health outcomes. While it may be hard to contemplate a move to a fully integrated National capacity when we are only just emerging from the pandemic, we do have a unique opportunity to at least start the process of review. We should use the lessons we have learned to transform our systems, rather than 'tinker' with them and ensure we are better prepared for next time.

Contraceptive Prevalence, Pattern and Socio-demographic Determinants among In- Union Women of Reproductive Age (15-49 years) in Semi-urban Communities of Orlu town, Imo state, Nigeria

Introduction: The use of contraceptives is very important in controlling high and unsustainable population growth thereby reducing its attendant problems of poor national economy and health outcomes of women and children.
 Methodology: The study was a community based cross-sectional study carried out among 600 in-union women of reproductive age living in suburban communities in Orlu, Imo State, Nigeria. They were selected using multistage sampling technique. Data was collected using a pre-tested, semi-structured and interviewer administered questionnaire and was analyzed using EPI-INFO version 3.2.1. Descriptive statistics, Chi-square test and regression analysis were performed where necessary. A p-value of ≤ 0.05 was considered significant.
 Result: Contraceptive ever used and current use was 66.7% and 36.7% respectively. The commonest modern contraceptive type ever used and currently used was the oral Contraceptive pill (65% vs. 22.8%). Socio-demographic and economic factors found to influence contraceptive use among the women were; age of women (p=0.002), status of union(p˂0.0001), age at union (p = 0.043), duration of union (p = 0.002), level of education of women (p ˂ 0.0001), religion of women (p ˂ 0.0001), family size (p ˂ 0.0001), number of male children (p ˂ 0.0001), monthly income (p ˂ 0.0001) and previous use of contraceptives (p ˂ 0.0001).
 Conclusion: The use of contraceptive was low and the commonest reason for non-use was due to religious beliefs. Most of the factors influencing use can be modified by appropriate intervention programs. Thus there is need to institute intervention programs by relevant authorities of the state that can help increase contraceptive use among these women.
 Keywords: Contraceptive use, prevalence, pattern, socio-demographic, determinants, Orlu, Imo State.

Law enforcement and public health collaborations and partnerships in Africa

Though not high profile, collaborations and partnerships between law enforcement agencies (LEAs) and public health organizations do exist across Africa. Law enforcement and public health (LEPH) partnerships have been common, but not necessarily optimum, in responses to epidemics such as sexually transmissible infections, tuberculosis, and malaria, and pandemics such as HIV/AIDS and COVID-19. There are some such collaborations in responses to gender-based violence (GBV), particular socio-economic problems and challenges, counter-insurgency and terrorism (when it happens within civilian spaces), to address issues of rape, disease and death. Leadership in development of such approaches comes from a wide range: local and national governments, law enforcement agents, CSOs, regional economic bodies and United Nations agencies. They have also a wide range of success and sustainability. There are examples of excellent collaboration in partnerships with long histories and experience of working together, especially among those that have established common goals aimed at local, national and global health outcomes. However, antagonisms also exist between civil society organizations (CSOs) and LEAs, with CSOs placing blame on law enforcement agents for harms caused, and with LEAs perceiving CSOs as enemies of the state because of their work with and advocacy for the rights of culturally or politically taboo or sensitive matters, such as sex work or homosexuality. Not uncommonly, partnerships have not been formed; or where they have formed but have failed to achieve consensus and joint results, have collapsed. Much more needs to be done at all levels to achieve effective, humane and sustained joined-up responses to difficult public health issues in the African context. 

Investigating Health Context Using a Spatial Data Analytical Tool: Development of a Geospatial Big Data Ecosystem

BackgroundEnabling the use of spatial context is vital to understanding today’s digital health problems. Any given location is associated with many different contexts. The strategic transformation of population health, epidemiology, and eHealth studies requires vast amounts of integrated digital data. Needed is a novel analytical framework designed to leverage location to create new contextual knowledge. The Geospatial Analytical Research Knowledgebase (GeoARK), a web-based research resource has robust, locationally integrated, social, environmental, and infrastructural information to address today’s complex questions, investigate context, and spatially enable health investigations. GeoARK is different from other Geographic Information System (GIS) resources in that it has taken the layered world of the GIS and flattened it into a big data table that ties all the data and information together using location and developing its context.ObjectiveIt is paramount to build a robust spatial data analytics framework that integrates social, environmental, and infrastructural knowledge to empower health researchers’ use of geospatial context to timely answer population health issues. The goal is twofold in that it embodies an innovative technological approach and serves to ease the educational burden for health researchers to think spatially about their problems.MethodsA unique analytical tool using location as the key was developed. It allows integration across source, geography, and time to create a geospatial big table with over 162 million individual locations (X-Y points that serve as rows) and 5549 attributes (represented as columns). The concept of context (adjacency, proximity, distance, etc) is quantified through geoanalytics and captured as new distance, density, or neighbor attributes within the system. Development of geospatial analytics permits contextual extraction and investigator-initiated eHealth and mobile health (mHealth) analysis across multiple attributes.ResultsWe built a unique geospatial big data ecosystem called GeoARK. Analytics on this big table occur across resolution groups, sources, and geographies for extraction and analysis of information to gain new insights. Case studies, including telehealth assessment in North Carolina, national income inequality and health outcome disparity, and a Missouri COVID-19 risk assessment, demonstrate the capability to support robust and efficient geospatial understanding of a wide spectrum of population health questions.ConclusionsThis research identified, compiled, transformed, standardized, and integrated multifaceted data required to better understand the context of health events within a large location-enabled database. The GeoARK system empowers health professionals to engage more complex research where the synergisms of health and geospatial information will be robustly studied beyond what could be accomplished today. No longer is the need to know how to perform geospatial processing an impediment to the health researcher, but rather the development of how to think spatially becomes the greater challenge.

Impact of family planning logistic management models on uptake of contraceptives in selected states in Nigeria: A comparative retrospective analysis

Background: Use of contraceptives improves individual and national health outcomes and indices as it prevents maternal mortality and morbidity, child mortality, incidence of sexually transmitted infections and retains adolescents and young girls in school with improvement in the economic earning power. Contraceptive Logistics is the supply of contraceptives in the right quantity and quality at the right place at the right time for the right cost to the right people. The Contraceptive Logistics Management System in Nigeria stipulates that to ensure uninterrupted product availability and minimal stock out, Family Planning Service Delivery Points (SDPs) are to be re-supplied on a bi-monthly basis to bring their stock level to a maximum of 4 months of stock at any given time. Method: A retrospective analysis of the impacts of the three logistic models operational in six southern states in Nigeria under the auspice of UNFPA funded family planning logistics supply chain. Three outcomes of interest used to assess the impacts were stock out rates, gaps in supply and proportion of new users of contraceptives. The three models of family planning logistics reviewed were direct government last mile distribution with external funding, direct government last mile distribution without external funding and a third party private logistic company last mile distribution Result: The stock out rates for the direct government logistics with external funding was 6-20%, the direct government logistics last mile distribution (LMD) without external funding had a stock out rate of 20-58% and the private logistic company last mile distribution had a stock out rate of 10-30%. In terms of the gap in supply, the supply gap with the direct government LMD with external funding model was 48%, while the direct government LMD with no external funding model had a supply gap of 73% and the private company LMD logistics model had a low supply gap of 28%. The proportion of FP users who were new users was 19% in the direct government LMD with external funding, 8% in direct government LMD without external funding, and 16% in private logistic company LMD. Discussion: Direct government last mile distribution (LMD) with external funding reached the highest number of new FP users followed by private logistic company LMD and therefore contributed the greatest to the reduction of unmet need in family planning and increasing the contraceptive prevalence rates. The highest stock out rate of contraceptives was associated with direct government LMD without external funding and the least stock out rate was associated with same direct government LMD but with external funding. The greatest gap in supply of contraceptives was seen with direct government LMD without external funding followed by direct government LMD with external funding. Private company LMD had the least supply gap in contraceptives.

The Impact of Information and Communication Technologies (ICTs) on Health Outcomes: A Mediating Effect Analysis Based on Cross-National Panel Data.

When ICTs (Information and Communications Technologies) are combined with healthcare, they can make a key contribution to gradually improve national health outcomes. The global outbreak of COVID-19 in 2020 further highlighted the important role of e-Health and m-Health service modes. This research structures a mediated effect model to explore dynamic relationships between ICT factors, ICT impacts, and national health outcomes, among which ICT factors are independent variables; ICT impacts are mediating variables, and national health outcome indicators selected from United Nations Millennium Development Goals (MDGs) and World Development Indicators are dependent variables. The fixed effect model is used to process a set of 141 countries' panel data from 2012 to 2016 from World Bank and World Economic Forum, while the classical three-step test method and Sobel test combined with fixed effects are used to test the mediated effects of the panel data. The results show that there are significant associations between ICT factors and national health outcome indicators, while only some of the partial mediated effects are proved. ICT environment and ICT usage can influence both the under-five mortality rate and adolescent fertility rate via ICT social impact. However, the mediated effect of ICT social impact on maternal mortality ratio and life expectancy at birth has not been confirmed. Meanwhile, the mediated effect of ICT economic impact has not been proven. This research is an interdisciplinary research in the field of information and communication technology and public health and reveals the path and mechanism whereby ICT factors improve national health outcomes, which can help global policymakers drive the next phase of the implementation of the Sustainable Development Goals (SDGs) and continue to improve the overall health at the national level.

National Health Spending, Health-Care Resources, Service Utilization, and Health Outcomes.

Cross-national studies of the linkage of health-care spending with population health have found surprisingly limited evidence of benefits. In this study, we investigated associations between national health spending and key health resources (numbers of hospital beds, physicians, and nurses) and utilization of cost-effective health services (antenatal care, attendance of trained staff at childbirth, and measles vaccination), sometimes in ways that curtail the benefits of that expenditure. Using annual panel data from 1990-2014 covering 140 countries, we show that variation in health spending as a share of gross domestic product is not associated with decreased mortality rates. It is also very weakly associated with increased health-care resources and health service utilization (elasticity smaller than 0.08), with the association being close to 0 in low-income countries. In addition, countries with a higher share of out-of-pocket spending have a significantly lower level of health resources and service utilization. These findings, rather than the ineffectiveness of health care, could explain the lack of impact of health spending. In contrast, gross domestic product per capita is significantly associated with increased health resources, a higher rate of service utilization, and lower mortality rates, suggesting that income is an important determinant of public health.

Turnover among Australian general practitioners: a longitudinal gender analysis

BackgroundLittle is known about gender differences in general practitioner (GP) turnover. It is important to understand potential divergence given both the feminization of the Australian GP workforce and projected shortages of GPs.ObjectiveThere is increasing evidence that national health outcomes are related to the extent to which health care systems incorporate high quality primary care. Quality primary care is, in turn reliant on a stable general practice (GP) workforce. With the increasing feminization of medical schools, we sought to identify correlates of turnover in the GP workforce, separately for women and men, focusing particularly on part-time employment and child-rearing, and distinguishing effects related to either planned or unplanned turnover.MethodsAnnual responses from cohorts of at least 1900 women GPs and 2000 men GPs are used for up to eight waves of the Medicine in Australia—Balancing Employment and Life (MABEL) longitudinal survey of doctors. Descriptive and bivariate correlations are provided. Random effects ordered logit is applied to dependent variables for turnover intentions measuring intent to “leave direct care” or “leave medicine”. A behavioral measure of turnover is used in random effects logit regressions, with the exclusion or inclusion of the confounding intentions variables revealing correlates of unplanned or planned turnover.ResultsPart-time employment is associated with turnover intentions among both women (84% or 94% increase in the odds ratios or ORs) and particularly men (414% or 672%), and with actual turnover for women (150% or 49%) and for men (160% or 107%). Women GPs engage in more unplanned turnover than men: they are 85% more likely to engage in turnover after controlling for intentions. Unplanned turnover is concentrated among women below 40 years of age and with young children, even though both groups report below average turnover intentions.ConclusionAlthough further studies are needed to identify specific factors associated with GP turnover among women, the analysis highlights the need to focus on women GPs who are either young or have young children. Given the substantial personal and social investment required to produce GPs, it is wasteful to lose so many young women early in their careers.

Weather shocks, climate change and human health

Abstract We examine the effect of short-run weather shocks and long-run climate change on a variety of national health outcomes for a sample of 170 countries between 1960 and 2016. We find that changing climate conditions – especially in the form of increasing temperatures – lead to health losses (e.g., increased infant mortality and lower life expectancy) both in the short and long run. The adverse effect of increasing temperatures is much more strongly felt in relatively poor countries, indicating that these countries are more vulnerable. Predicted health losses in poor countries due to weather shocks and climate change have already been substantial. Future health losses especially in less developed countries will likely also be considerable unless adequate adaptation and mitigation efforts are undertaken.

National health screening may reduce cardiovascular morbidity and mortality among the elderly

ObjectivesSince 2007, the Korean government has provided a free health screening to the elderly starting at the age of 66 years. The purpose of this study was to evaluate the association between this general health screening and the incidences of stroke and myocardial infarction and mortality. Study designThe study design used in this study is a retrospective cohort study. MethodsThe study was conducted using the universe of insurance claims data of Korea and followed a cohort of individuals aged 66 years in 2009 from 2006 through 2016 (n = 354,194). We assessed the association between receipt of the national health screening and health outcomes using propensity matching and Cox proportional hazard models. ResultsWe found that the receipt of the national health screening was associated with a reduction in negative health outcomes. The hazard ratio for stroke was 0.89 (P < 0.001), 0.88 (P < 0.001) for myocardial infarction and 0.58 for death (P < 0.001). ConclusionKorea's national health screening was associated with reductions in cardiovascular morbidity and mortality in the elderly.

"Katz activities of daily living disability in older cancer survivors by age, stage, and cancer type".

The purpose of this study was to describe ADL impairments using the Katz ADL Index by cancer type, stage, and age in older cancer survivors. Cross-sectional data from cohorts 9-14 (year 2006-2013) of the Surveillance, Epidemiology and End Results national cancer registry and Medicare Health Outcomes Survey linkage were used to describe ADL performance using the Katz ADL Index. Mean Katz scores and frequency of ADL disability were reported across cancer types for all eight cancers (colon, lung, breast, prostate, bladder, kidney, non-Hodgkin's lymphoma, uterine) and by stage and age for the four large cancers (colon, lung, breast, prostate). In this sample of 6,973 cancer survivors, ADL deficits were the greatest in uterine cancer survivors (μ = 4.72, SD = 1.44). When considering age, Katz scores were most impaired in breast (μ = 3.90, SD = 1.93) and prostate survivors (μ = 4.35, SD = 1.84) age > 85 years. When considering stage, Katz scores were most impaired in stage four survivors of prostate (μ = 4.14, SD = 1.82) or breast (μ = 4.43, SD = 2.05) cancer. Across all cancer types and age groups, with the exception of stage 4 prostate cancer, ADL deficits were consistently impaired in the same order, from most impaired to least: continence, transfers, bathing, dressing, toileting, and, lastly, feeding. Screening for ADL impairments is needed for older cancer survivors as Katz ADL disability differs by cancer type, stage, and age with greater impairment with advanced age and stage. Interventions to address ADL limitations should be considered for older cancer survivors.