National Health Plan Research Articles

Health promotion at local level in Portugal: is childhood obesity a concern in municipal programs?

Abstract Health promotion programs targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. There is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. This study aims to provide some input regarding this issue in Portugal. In order to achieve this goal, health enhancing programs promoted by Portuguese municipalities in which children could participate were identified. The search of such programs was limited to the municipalities that were part of the Portuguese Network of Healthy Municipalities in 2021 (N = 57). A subsequent document analysis was conducted to describe how municipalities conceptualized children’s health by retrieving information on which topics the programs were focused on, or acted upon, and identify which socio-ecological model levels of health determinants were addressed (or not) by each program. The 77 identified programs were promoted by 30 municipalities and only 11 programs addressed childhood obesity. Most programs focused on the individual health determinants (N = 27) and provided limited information overall, which hindered a more in-depth analysis. The findings suggest that Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national level, as reflected in the National Health Plans, but not perceived as such locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population’s quality of life, by addressing the social and environmental determinants of health. Hence, municipalities should instill health concerns in all their actions/interventions, taking in consideration the most recent evidence, specifically in the case of childhood obesity. Key messages • This study findings suggest that, despite childhood obesity being a major public health concern at national level, as reflected in the National Health Plans, it is not perceived as such locally. • There is a need to better understand the role of municipalities as key public health promoters considering they are responsible to intervene on the social and environmental determinants of health.

2.C. Round table: A Pandemic Treaty to deliver global health equity: negotiating under a ticking clock

Abstract Access to medical countermeasures (vaccines, therapeutics, diagnostics), fair resource allocation and a global health framework to counter future pandemics are to be provided for by the Pandemic Treaty, intensely debated in the Intergovernmental Negotiating Body (INB) over the past two years. The final negotiations round began under tremendous pressure (Apr 29, 2024), with dissonance on structural treaty elements and a ticking clock to finalise the text at the World Health Assembly (end of May 2024). At a time of shifting geopolitical powers, in a year of elections across the world, war in Europe and rising defence expenditure, countries are reluctant to commit; the draft postpones key decisions, proposing to establish two intergovernmental working groups for instruments on One Health and prevention, and on a Pathogen Access and Benefits (PABS), with technology transfer and capacity-building remain largely unaddressed, despite COVID-19 lessons. With EU and G7 countries holding to their positions on surveillance, financing, and intellectual property (IP), negotiations will continue. A more critical question remains: will the Treaty’s be adequate and timely enough to meet the challenges of inevitable future pandemics? Will it deliver the global framework of its foundational purpose of equity and justice? This RT aims to inform and involve the European public health community, continuing the series of activities embarked upon at the beginning of the pandemic, empowering its members for evidence-informed advocacy and concerted action. Following a brief presentation on the Treaty’s key provisions, each panel member will deliver a brief (2-3 min) intervention based on core expertise, with two rounds of panel questions/statements to follow, and with an interactive element to prioritise and submit questions. The first elaborating on the current provisions, linking them to the key expertise of panel members, i.e., international and EU law, public health law, One Health and infectious disease control, global health policies, technology transfer, fair pricing and access to countermeasures. The second examining what can be achieved via evidence-informed advocacy, and with a special focus on the role of the European public health community. Has it been well represented so far in negotiations? Should it be more involved? Is it well equipped to provide expert advice to Europe’s policymakers? Is there complementarity in relation to Europe’s Global Health Strategy (GHS) and national global health plans? Finally, the role of WHO will be briefly debated. How can sovereignty be safeguarded without compromising implementation? What is the role of transparency and sound governance to remain in line with national and EU laws and priorities? The last five minutes of this RT will be used to consolidate messages and share plans to inform future formal EUPHA positioning in negotiations. Key messages • Pandemic accord deliberation has have taken place under extreme urgency and geopolitical pressure. The European public health community must be informed and engaged for EU and country-level advocacy. • At a time of permacrisis, the adoption of a global framework for fair resouce allocation, access to medical countermeasures,and to strengthen health systems for future pandemics is urgently needed. Speakers/Panelists Sujitha Subramanian University of Liverpool, Liverpool, UK Dimitra Lingri European Healthcare Fraud and Corruption Network, Brussels, Belgium Debjani Muller HTAi, Edmonton, Canada Ricardo Mexia National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal Bettina Borisch WFPHA, Geneva, Switzerland

High-Risk Medications in Persons Living With Dementia

Individuals with Alzheimer disease (AD) and Alzheimer disease-related dementias (ADRD) may be at increased risk for adverse outcomes relating to inappropriate prescribing of certain high-risk medications, including antipsychotics, sedative-hypnotics, and strong anticholinergic agents. To evaluate the effect of a patient/caregiver and prescriber-mailed educational intervention on potentially inappropriate prescribing to patients with AD or ADRD. This prospective, open-label, pragmatic randomized clinical trial, embedded in 2 large national health plans, was conducted from April 2022 to June 2023. The trial included patients with AD or ADRD and use of any of 3 drug classes targeted for deprescribing (antipsychotics, sedative-hypnotics, or strong anticholinergics). Patients were randomized to 1 of 3 arms: (1) a mailing of educational materials specific to the medication targeted for deprescribing to both the patient and their prescribing clinician; (2) a mailing to the prescribing clinician only; or (3) a usual care arm. Analysis was performed using a modified intention-to-treat approach. The primary study outcome was the dispensing of the medication targeted for deprescribing during a 6-month study observation period. Secondary outcomes included changes in medication-specific mean daily dose and health service utilization. Among 12 787 patients included in the modified intention-to-treat analysis, 8742 (68.4%) were female, and the mean (SD) age was 77.3 (9.4) years. The cumulative incidence of being dispensed a medication targeted for deprescribing was 76.7% (95% CI, 75.4-78.0) in the patient and prescriber mailing group, 77.9% (95% CI, 76.5-79.1) in the prescriber mailing only group, and 77.5% (95% CI, 76.2-78.8) in the usual care group. Hazard ratios were 0.99 (95% CI, 0.94-1.04) for the patient and prescriber group and 1.00 (95% CI, 0.96-1.06) for the prescriber only group compared with the usual care group. There were no differences between the groups for secondary outcomes. These findings suggest medication-specific educational mailings targeting patients with AD or ADRD and their clinicians are not effective in reducing the use of high-risk medications. ClinicalTrials.gov Identifier: NCT05147428.

The doctor vote: Interactions between political ideological preferences and healthcare reform strategies among U.S. physicians

IntroImproving the American healthcare system has consistently predominated the domestic policy agenda in the United States for decades. However, physicians have traditionally played a small role in the U.S. legislative process despite their direct observations of the obstacles that cost, access, and quality can have on their patients and their care. The goal of this study was to examine the relationship between physician political ideological preferences and health policy reform options. MethodsWe conducted a cross-sectional survey of 3,001 currently practicing U.S. physicians to predict how self-identification as liberal, moderate, or conservative impacted a physician’s policy preferences under the domains of cost, access, and quality. ResultsA total of 536 (18.8%) out of 3,001 physicians responded to the survey. Overall, 32% of physicians identified as liberal, 43% as moderate, and 22% as conservative. ConclusionLiberal-identifying physicians favored traditionally liberal reform ideas (a national health plan or public option), while conservative physicians preferred conservative policies (free market optimization). However, variation within political groups and domains of healthcare suggest that no single reform policy will be unanimously supported by every physician within a political group. Nonetheless, physicians are unanimously dissatisfied with the state of our current system, and physician-supported healthcare reform should be a national priority.

Characterizing physician directory data quality: variation by specialty, state, and insurer

BackgroundAs U.S. legislators are urged to combat ghost networks in behavioral health and address the provider data quality issue, it becomes important to better characterize the variation in data quality of provider directories to understand root causes and devise solutions. Therefore, this manuscript examines consistency of address, phone number, and specialty information for physician entries from 5 national health plan provider directories by insurer, physician specialty, and state.MethodsWe included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state.ResultsOf 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state.ConclusionsIn evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information.

Health system description and assessment: a scoping review of templates for systematic analyses

BackgroundUnderstanding and comparing health systems is key for cross-country learning and health system strengthening. Templates help to develop standardised and coherent descriptions and assessments of health systems, which then allow meaningful analyses and comparisons. Our scoping review aims to provide an overview of existing templates, their content and the way data is presented.Main bodyBased on the WHO building blocks framework, we defined templates as having (1) an overall framework, (2) a list of indicators or topics, and (3) instructions for authors, while covering (4) the design of the health system, (5) an assessment of health system performance, and (6) should cover the entire health system. We conducted a scoping review of grey literature published between 2000 and 2023 to identify templates. The content of the identified templates was screened, analyzed and compared. We found 12 documents that met our inclusion criteria. The building block `health financing´ is covered in all 12 templates; and many templates cover ´service delivery´ and ´health workforce’. Health system performance is frequently assessed with regard to ‘access and coverage’, ‘quality and safety’, and ‘financial protection’. Most templates do not cover ‘responsiveness’ and ‘efficiency’. Seven templates combine quantitative and qualitative data, three are mostly quantitative, and two are primarily qualitative. Templates cover data and information that is mostly relevant for specific groups of countries, e.g. a particular geographical region, or for high or for low and middle-income countries (LMICs). Templates for LMICs rely more on survey-based indicators than administrative data.ConclusionsThis is the first scoping review of templates for standardized descriptions of health systems and assessments of their performance. The implications are that (1) templates can help analyze health systems across countries while accounting for context; (2) template-guided analyses of health systems could underpin national health policies, strategies, and plans; (3) organizations developing templates could learn from approaches of other templates; and (4) more research is needed on how to improve templates to better achieve their goals. Our findings provide an overview and help identify the most important aspects and topics to look at when comparing and analyzing health systems, and how data are commonly presented. The templates were created by organizations with different agendas and target audiences, and with different end products in mind. Comprehensive health systems analyses and comparisons require production of quantitative indicators and complementing them with qualitative information to build a holistic picture.Clinical Trial Registration: Not applicable.

Optimizing the management of inherited blood disorders in a changing market: Findings from the AMCP Market Insights Program.

In this market insights program, AMCP brought together a panel of experts representing various stakeholders: national and regional health plans, integrated health care systems, employer benefits groups, clinical experts, the Centers for Disease Control and Prevention, and patient advocacy organizations. The objectives were to gain insights into the current and evolving treatments in hemophilia, sickle cell disease, and β-thalassemia; measure the effects of recently approved therapies on clinicians, payers, and patients; recognize emerging trends within the stop-loss market; address potential issues and obstacles related to monitoring and reporting outcomes; and identify concerns associated with both existing and emerging contracting and reimbursement models. This article aims to summarize expert perspectives on health care system challenges and strategies concerning the management of inherited blood disorders and to advance managed care professionals' understanding of their role in supporting care for these patients. The experts emphasized that when shaping coverage policies, a patient-centered approach is crucial, focusing on preserving organ function to maintain eligibility for future gene therapies among individuals with inherited blood disorders. These strategies, including benefit design modifications, specialized provider networks, and centralized mechanisms like registries, are vital for evaluating effectiveness, facilitating decision-making, and managing costs and risks associated with new and emerging treatment options for inherited blood disorders.

Paediatric Drug Development in China: Current Status and Future Prospects.

For more than two decades, regulatory agencies throughout the world released guidelines, rules and laws to stimulate and assist in paediatric drug development. In 2014, the National Health and Family Planning Commission (now known as the National Health Commission, NHC) and five other departments in China jointly issued 'Several Opinions on Safeguarding Medication for Children', after which several policies and regulations were issued to implement the priority review and approval of paediatric medicinal products and support the development of new drugs, including new dosage forms and strengths, for children. A total of 172 special medicinal products for children were approved from 2018 to 2022. Since 2016, the NHC, together with relevant administrative departments, has formulated and issued four paediatric drug lists containing 129 medicinal products to encourage research and development. At present, approximately 25 of these drugs (at exactly the same dosage forms and strengths as on the lists) have been approved for marketing, including antitumour drugs and immunomodulators, nervous system drugs, drugs for mental disorders and drugs for rare diseases. In this review, we analysed the regulations issued for promoting paediatric drug development in China, including the priority review and approval system, technical guidelines, data protection and financial support policies and general profiles of paediatric drug approval, clinical trials and the addition of information for children in the labels of marketed medicinal products. Finally, we discussed the challenges and possible strategies in the research and development of paediatric drugs in China.

Exploratory analysis on payment mechanisms to Community Mental Health Centers in Chile using mixed grounded theory.

Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

Influence of health insurance type on time to breast cancer diagnosis and treatment among members of a large national payor.

e23049 Background: Delays in breast cancer diagnosis and treatment can decrease early screening benefits. This study investigates the relationship between health insurance type and time from cancer screening to biopsy and biopsy to treatment initiation in members of a national health plan diagnosed with breast cancer. Methods: De-identified administrative records of Medicare, Medicaid and Commercial fully insured (C-FI) members with a claim for breast cancer between January 2020 and December 2022 were retrospectively analyzed. Poisson regression modeling determined duration (days) from screening to biopsy and biopsy to treatment initiation by insurance type group controlling for covariates. Between-group differences in duration were estimated by exponentiating the model estimate and converting to a percentage change, which was then applied to the mean days to event. P< 0.05 was considered significant. Results: 29,731 members (C-FI: 5,256; Medicare: 22,304; Medicaid: 2,171) with a diagnosis of breast cancer were evaluated. Mean duration from screening to biopsy was 21.5 days (95% confidence interval [CI]: 20.9-22.0). Insurance type was associated with time from screening to biopsy. Compared to C-FI members, Medicaid members experienced a longer duration between screening and biopsy by +12.6 days (95% CI: 11.7-13.6; P< 0.0001). Compared to C-FI members, Medicare members received biopsies 3.4 days sooner (95% CI: 3.0-3.8; P< 0.0001). Mean duration from biopsy to treatment was 35.4 days (95% CI: 34.9-35.9) with similar differences by insurance type. Compared to C-Fl members, Medicaid members experienced a longer duration between biopsy and treatment by +7.9 days (95% CI: 6.9-9.0; P< 0.0001). Compared to C-FI, Medicare members received treatment 3.6 days sooner (95% CI: 3.0-4.1; P< 0.0001). Conclusions: Health insurance type appears to impact time from breast cancer screening to biopsy and treatment initiation. Medicaid members may experience longer duration for both time from screening to biopsy and biopsy to treatment. Future studies will explore if these variations translate to clinically meaningful health outcomes and identify opportunities to provide additional support for individuals experiencing breast cancer.

Influence of sociodemographic factors on time to diagnosis and treatment among members of a large national payor diagnosed with lung cancer.

e23048 Background: Diagnostic and treatment delays may be associated with later stage lung cancer diagnosis. This study explores the time from lung cancer screening to biopsy and biopsy to treatment in members of a national health plan diagnosed with lung cancer. Methods: De-identified administrative records of Medicare, Medicaid and Commercial fully-insured (C-FI) members with a claim for lung cancer between January 2020 and December 2022 were retrospectively analyzed. Poisson regression modeling determined duration (days) from screening to biopsy and biopsy to treatment initiation by insurance type group controlling for covariates. Between-group differences in duration was estimated by exponentiating the model estimate and converting to a percentage change, which was then applied to the mean days to event. Time-to-event modelling was conducted with Cox Proportional and Aelen’s Additive Hazard models. P< 0.05 was considered significant. Results: 8,221 members (C-FI: 402; Medicare: 7,103; Medicaid: 716) with a diagnosis of lung cancer were evaluated. Mean duration between screening and biopsy was 34.3 days (95% confidence interval [CI]: 32.8-35.8). Compared to C-FI members, Medicaid and Medicare members experienced shorter duration between screening to biopsy by -14.0 days (95% CI: 13.1-14.9) and -18.9 days (95% CI: 18.2-19.5), respectively (both P< 0.0001). Gender, language, age, and race were associated with time to biopsy (all P< 0.001). Mean duration between biopsy and treatment was 37.9 days (95% CI: 36.8-39.0). Compared to C-FI members, Medicare and Medicaid members experienced a longer duration between biopsy to treatment by +14.6 days (95% CI: 12.1-17.3) and +22.5 days (95% CI: 19.4-25.8), respectively (both P< 0.0001). Compared to C-FI members, Medicaid members had a higher risk of not receiving treatment (Hazard ratio [HR] = 0.831; 95% CI: 0.735-0.939; P= 0.003). Among the total sample, males were more likely to receive treatment at any time compared to females (HR = 1.067; 95% CI: 1.021-1.114; P= 0.0035). Conclusions: This real-world evaluation suggests that insurance type is associated with the timeline of screening to biopsy and biopsy to treatment initiation. Medicaid and Medicare members had a shorter time from screening to biopsy compared to C-FI; however, a longer duration from biopsy to treatment initiation was experienced. Future studies will explore if these differences translate to variations in health outcomes and identify potential interventions that aim to improve time from biopsy to treatment initiation.

A review of twenty-first century developments in paediatric surgery in Africa.

This review explores the significant advancements in paediatric surgery in Africa during the twenty-first century, with a particular focus on capacity-building, education, infrastructural development, and research. Historically, paediatric surgery has been an overlooked sector, especially in low-and-middle-income countries in Africa. However, recent years have seen considerable progress. Collaborative efforts such as the Global Initiative for Children's Surgery, and the formation of the Pan African Paediatric Surgery Association, the College of Surgeons of East, Central and Southern Africa and the West African College of Surgeons have facilitated knowledge sharing, collaboration, and advocacy for enhancing surgical standards. Local training programmes, including Master of Medicine programmes and fellowships, have been instrumental in building a skilled workforce. These initiatives have been complemented by infrastructural developments through non-governmental organisations like Kids Operating Room, which have expanded access to paediatric surgical care. Technological advancements, particularly in telemedicine, have further enhanced accessibility. Task-sharing strategies, where non-specialist physicians are trained in paediatric surgical skills, have also been utilised to address the shortage of specialised surgeons. Research in paediatric surgery has experienced an upswing, with local health professionals taking the lead. Research has been crucial for understanding the epidemiology of paediatric surgical conditions, and developing prevention strategies, and is increasingly leading to the inclusion of paediatric surgery in national health plans. Despite the progress, challenges remain, including the need for sustainable funding, continued investment in infrastructure, and training and retention of healthcare professionals. The review emphasises the importance of ongoing efforts in community engagement, innovative technologies, and health systems strengthening for the sustainable development of paediatric surgical services in Africa.

Measuring population health using health expectancy estimates from morbidity and mortality databases.

The progressive incorporation of quality of life indicators in health planning meets a critical need: The evaluation of the performance of health services, which are under stress by multiple causes, but in particular by an ageing population. In general, national health plans rely on health expectancies obtained using the Sullivan method. The Sullivan health expectancy index combines age-specific mortality rates and age-specific prevalence of healthy life, obtained from health surveys. The objective of this work is to investigate an equivalent estimation, using available information from morbidity and mortality datasets. Mortality and morbidity information, corresponding to years 2016 and 2017, was obtained for the population of the county of Baix Empordà (Catalonia), N = 91,130. Anonymized individual information on diagnoses, procedures and pharmacy consumption contained in the individual clinical record (ICD and ATC codes), were classified into health states. Based on the observed health transitions and mortality, life expectancies by health state were obtained from a multistate microsimulation model. Healthy life expectancies at birth and 65 years for females and males were respectively HLE0female = 39.94, HLE0male = 42.87, HLE65female = 2.43, HLE65male = 2.17. These results differed considerably from the Sullivan equivalents, e.g., 8.25 years less for HLE65female, 9.26 less for HLE65male. Point estimates for global life expectancies at birth and 65 years of age: LE0female = 85.82, LE0male = 80.58, LE65female = 22.31, LE65male = 18.86. Health indicators can be efficiently obtained from multistate models based on mortality and morbidity information, without the use of health surveys. This alternative method could be used for monitoring populations in the context of health planning. Life Expectancy results were consistent with the standard government reports. Due to the different approximation to the concept of health (data-based versus self-perception), healthy life expectancies obtained from multistate micro simulation are consistently lower than those calculated with the standard Sullivan method.

National public health institutes in the Eastern Mediterranean Region: Insights from experts in the field

National public health institutes (NPHIs) are crucial to the effectiveness of public health systems, including delivering essential public health functions and generating evidence for national health policies, strategies and plans....

The Effect of the COVID-19 Pandemic on the Factors Influencing Iranian Medical Residents' Specialty Selection: A Qualitative Study.

Medical students' specialty selection influences the composition of the physician workforce and the effectiveness of health systems. Therefore, the identification of factors that influence the choice of specialty is critical for an evidence-based health policy. This study aimed to investigate the effect of the Coronavirus Disease 2019 (COVID-19) pandemic on the determinants of specialty choice among Iranian medical residents. In early 2022, this qualitative study was conducted among Iranian medical residents in seven provinces, including Tehran, Isfahan, Fars, Khorasan Razavi, Kerman, Kermanshah, and Khuzestan. The participants were selected using a purposeful sampling method. Data were collected using 74 semi-structured in-depth face-to-face interviews. Finally, a thematic content analysis (conventional content analysis) method was applied for data synthesis. The participant's mean age was 28.7±2.5 years, and more than 52% (N=39) were men. Following data synthesis, 10 sub-themes and four main themes were identified, including educational aspects affected by the pandemic, career-related hazards, personal and professional lifestyles affected by the disease, and experiences and beliefs regarding the pandemic. The COVID-19 pandemic has had a significant impact on medical students' educational, professional, and personal aspects of specialty choices. This study demonstrated how the disease affected the choice of specialty. Therefore, the findings could be used for developing national health policy and planning.

Unmet Healthcare Needs and Their Determining Factors: Addressing Inequalities in Access to Healthcare in Myanmar

Myanmar aims to achieve universal health coverage by 2030 through the 2017–2021 National Health Plan while providing nearly cost-free healthcare services at public facilities. Nonetheless, concerns regarding healthcare access persist. This study examined healthcare access in Myanmar by identifying the prevalence, determinants, and reasons behind unmet healthcare needs (UHN), which occur when an individual needs healthcare but cannot access it. Descriptive statistical analysis and binary logistic regression were employed using data obtained from 318 residents of Tat Kon Township, Nay Pyi Taw. Among the participants, 23.6% experienced UHN. Specifically, individuals with low income, daily-waged workers, rural residents, younger individuals, and females reported high UHN. The primary reason was the unavailability of healthcare facilities (46.7%), followed by competing personal priorities (19%) and treatment or transportation costs (14%). The government could consider expanding public healthcare infrastructure and implementing a nationwide health insurance system. Continuing the geographic expansion of health services to address the needs of rural residents and extending service hours to accommodate individuals engaged in daily-waged or full-time employment are recommended. These efforts could be complemented by improving public transportation infrastructure, promoting income security, and supporting gender equity to facilitate access to healthcare services.

Challenging the role of resilience and vulnerability in narratives of well-being

We analyse prevailing discourse on resilience and vulnerability amid the COVID-19 pandemic, with a focus on well-being. This involves a critical review of the Australian Governmental National Mental Health and Wellbeing Pandemic Response Plan, and the enforced lockdown of inner-Melbourne public housing tours by the Victorian Government. We explore these issues within the framework of neoliberal processes that responsibilise individuals for their own well-being. We suggest that Contemporary forms of discourse on resilience are actually unable to address the core issue they seek to confront; vulnerability. We argue that locating responsibility for resilience and well-being with individuals may well exacerbate their vulnerability and ignores any sense of collective responsibility for the well-being of marginalised groups. We propose that the connection between vulnerability and well-being is a moral concern that should be incorporated into political agendas and policies. These should affirm collective responsibility for well-being. Drawing on relational autonomy theorists, we assert that vulnerability is intrinsic to human flourishing, shaped by relational dynamics. Instead of using vulnerability as a tool to justify neoliberal agendas, we advocate for a transformation in our shared narrative of well-being. This shift should focus on embracing vulnerability as an integral part of well-being in relationships, rather than fixating on resilience and well-being as an individual responsibility.

The effect of vine tea (Ampelopsis grossedentata) extract on fatigue alleviation via improving muscle mass

Ethnopharmacological relevanceVine Tea (VT, Ampelopsis grossedentata), boasts a venerable tradition in China, with a recorded consumption history exceeding 1200 years. Predominantly utilized by ethnic groups in southwest China, this herbal tea is celebrated for its multifaceted therapeutic attributes. Traditionally, VT has been employed to alleviate heat and remove toxins, exhibit anti-inflammatory properties, soothe sore throats, lower blood pressure, and fortify bones and muscles. In the realm of functional foods derived from plant resources, VT has garnered attention for its potential in crafting anti-fatigue beverages or foods, attributed to its promising efficacy and minimal side effects. Currently, in accordance with the Food Safety Standards set forth by the Monitoring and Evaluation Department of the National Health and Family Planning Commission in China, VT serves as a raw material in various beverages. Aim of the studyVT has an anti-fatigue or similar effect in folk. However, the underlying molecular mechanisms contributing to VT's anti-fatigue effects remain elusive. This study endeavors to investigate the influence of Vine Tea Aqueous Extract (VTE) on fatigue mitigation and to elucidate its operative mechanisms, with the objective of developing VTE as a functional beverage. Materials and methodsThe preparation of VTE involved heat extraction and freeze-drying processes, followed by the identification of its metabolites using UPLC-QTOF-MS to ascertain the chemical composition of VTE. A fatigue model was established using a forced swimming test in mice. Potential molecular targets were identified through network pharmacology, transcriptome analysis, and molecular docking. Furthermore, RT-PCR and Western blot techniques were employed to assess mRNA and protein expressions related to the AMPK and FoxO pathways. ResultsVTE significantly prolonged the duration of swimming time in an exhaustive swimming test in a dose-dependent manner, while simultaneously reducing the concentrations of blood lactic acid (LA), lactate dehydrogenase (LDH), serum urea nitrogen (SUN), and creatine kinase (CK). Notably, the performance of the high-dose VTE group surpassed that of the well-recognized ginsenoside. VTE demonstrated a regulatory effect akin to ginsenoside on the AMPK energy metabolism pathway and induced downregulation in the expression of Gadd45α, Cdkn1a, FOXO1, and Fbxo32 genes, suggesting an enhancement in skeletal muscle mass. These findings indicate that VTE can improve energy metabolism and muscle mass concurrently. ConclusionsVTE exhibits significant anti-fatigue effects, and its mechanism is intricately linked to the modulation of the AMPK and FoxO pathways. Crucially, no caffeine or other addictive substances with known side effects were detected in VTE. Consequently, vine tea shows substantial promise as a natural resource for the development of anti-fatigue beverages within the food industry.

Engagement of private health sector in communicable disease and immunization programmes in Pakistan.

In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision. To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage. We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes. Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government. We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases.

Let's talk about recovery in mental health: an international Delphi study of experts by experience.

The concept of recovery is featured in the strategic plans of the World Health Organization as well as in other national mental health plans; however, there have been differing interpretations of what it means. This article aims to achieve a consensus on the key aspects of recovery in mental health from the perspective of movements of users and survivors of psychiatry at an international level. Four specific objectives were proposed in this study: (1) to identify what recovery in mental health means, (2) to identify the indicators that a person is progressing in their recovery, (3) to determine the factors that facilitate the recovery process, and (4) to determine the factors that hinder the recovery process. A three-round e-Delphi study was conducted with the participation of 101 users and survivors of psychiatry, adhering to the CREDES checklist to ensure methodological rigour. The results reveal 26 key aspects that define recovery, 31 indicating that a person is progressing in their recovery process, 8 that facilitate recovery and 12 that hinder recovery. The most agreed-upon statements for defining recovery highlight the importance of empowerment, leading a fulfilling life, ensuring safe-living conditions and acknowledging individuals as holders of rights. Similarly, empowerment and agency were highly agreed upon as relevant recovery indicators. Key findings underscore the significance of a supportive and respectful social environment in facilitating recovery, while coercion, discrimination and lack of support from significant others hinder recovery. Despite cultural differences and recovery's subjective nature, our results demonstrate that an international consensus on critical recovery aspects is attainable. Highlighting a significant shift, we emphasize the 'Transition' process to signify moving away from the biomedical model approach and advocating for collective rights. Our findings advocate for empowerment, users' rights and the move towards person-centred care that integrates social, political and economic contexts. These consensus statements lay the groundwork for future research across diverse regions and cultures, offering insights into recovery's meaning and potential for innovative approaches in diagnosis, intervention and evaluation.