National Health Plan Research Articles

Minimum Criteria for Brain Death Determination: Consensus Promotion and Chinese Practice

Brain death (BD), the irreversible cessation of function in the whole brain, is a well-known condition in most countries. The criteria and practical guidelines for brain death determination (BDD) in China were issued by the Brain Injury Evaluation Quality Control Center (BQCC) of the National Health and Family Planning Commission in 2013. Thereafter, we proposed a plan called the three-step quality control plan (three-step QCP) to ensure the safety and consistency of the clinical judgments regarding BD. By retrospectively reviewing this plan, we aimed to identify problems during its implementation and to provide suggestions for future work on quality control for BDD. Data were retrieved from the BQCC database. The characteristics and test results of physicians undergoing a BDD training course and the BD case records submitted by hospitals before and after receiving accreditation were analyzed. In the first step of the plan, the error rate for physicians undergoing the BDD paper test was highest for limb movement discrimination (26.29%); this error rate was correlated with age (per 10-year increase) (odds ratio = 1.262, 95% confidence interval 1.067-1.491, P = 0.007) but was nonsignificantly associated with sex, specialty category, professional level, and hospital level (P > 0.05). During the second step of the plan, the highest percentage of problems was associated with apnea testing (22.75%), followed by ancillary testing of BDD (16.17%). In the last step, the highest percentage of problems in the case records was associated with apnea testing (41.73%). The three-step QCP is of significant utility for ensuring accuracy and appropriateness in BDD. Simultaneously, this study provides important evidence for advancing quality control for BDD in the next stage.

760 Wholistic View of Autografting Patients by %TBSA Burned: Medical Chart Abstraction Integrated with Administrative Claims

IntroductionThe current literature of severe burns with autografting is scarce or limited to single data source. This study provides a wholistic view of the clinical and economic characteristics of the inpatient treatment of patients with burns using integrated medical chart abstraction with administrative claims.MethodsPatients with thermal burns undergoing inpatient autografting between July 1, 2010 and November 30, 2019 were identified from large national health plans, representing over 50 million members in the US. The first observed hospitalization with autografting was regarded as the index event. Two hundred hospital patient medical records were abstracted for the clinical characteristics, using a standardized abstraction form, which were integrated with administrative data for economic characteristics. Those with large % TBSA were oversampled. Patients were stratified into three cohorts by %TBSA burned. A Bonferroni correction of alpha 0.017 was performed for post-hoc pairwise tests.ResultsOf 200 patients, 90 were categorized as low TBSA (< 10%), 75 moderate TBSA (10 – 24%), and 35 high TBSA (25+%). Overall, the high %TBSA cohort appeared to be younger, requiring more intensive care, and thereby incurring higher costs of care. The extent of some undocumented critical fields in the medical records was significant, for example (%undocumented): donor size (80%), BMI (31%), mesh ratio (30%), etc. 1 mean (SD) * compared with low TBSA, p< 0.017ConclusionsThis study not only confirmed some conventional understanding of various TBSA cohorts, but also quantified their differences/similarities using multiple data sources. There was considerable incompleteness in many critical fields in the medical records, which limits the ability to generate broader insights. Despite the wide regard of medical records as a “gold standard” for outcomes analyses, future research should be aware of these limitations.

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017

AimsTo describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period.MethodsService data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development.ResultsRates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of − 0.14 and − 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility.ConclusionsThe majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

Application Research of Artificial Intelligence Screening System for Diabetic Retinopathy.

According to the latest data from the Bureau of Disease Control and Prevention of the National Health and Family Planning Commission, China currently has 199.6 million diabetic patients and has become the world's largest country with diabetes. The prevalence rate is as high as 14.3%, which is much higher than the world average of 5.8%. The primary-level ophthalmic screening service is one of the important tasks to improve primary-level medical services, and the corresponding ophthalmic imaging diagnosis technology is an important support for primary-level medical and health services. Therefore, it is very necessary for us to study the application of artificial intelligence image recognition technology for diabetic retinopathy under the medical consortium mode and to study the precise initial diagnosis, precise referral, and precise follow-up of diabetic retina under the medical conjoined mode, so as to better promote the transformation of the ophthalmology primary service model. Based on this background, in this article, we have proposed and carried out the following solution: (1) diabetes data collation. Based on medical artificial intelligence technology, this paper collected 2,265 electronic medical records from an eye hospital in Ningbo and selected 2,000 qualified medical records for data integration and preprocessing. The contents of electronic medical records mainly include age, gender, and examination records. (2) Establish diabetic retinopathy diagnosis model based on neural network algorithm. This article first uses the classic algorithm of BP neural network for modeling, chooses the Levenberg–Marquardt method as the training function, and selects 10 hidden layer units through comparison experiments. After that, ophthalmologists assessed 80 sets of test results and determined the right diagnosis rate. Finally, this article compares and analyzes the accuracy of the two routes in 80 tests.

Risk Factors of Hipertension and Diabetes Mellitus on COVID-19 Mortality

BACKGROUND: Case fatality rate (CFR) for global COVID-19 infections since June 14, 2021 was 2.17%, while CFR for Southest Asia were 1.39%. CFR in Indonesia so far were 3.05%. This missed from the target of the 2005-2025 RPJMK (Middle long run national health planning) in achieving healthy Indonesia; handling epidemic diseases must be able to reduce the mortality rate below 1%. The government issued the Decree of the Minister of Health Republic of Indonesia No. HK.01.07/Menkes/2020 concerning the Determination of Vaccine Types for the Management of COVID-19. However, the existence of this policy did not reduce the mortality rate trend of COVID-19 in Indonesia. Hypertension and diabetes mellitus were the larger risk factors for COVID-19 mortality. Guo et al. 2020 found comorbid COVID-19 sufferers were hypertension 24.7% and diabetes mellitus 21.2%. However, Mikami et al., 2020 stated differently that hypertension and diabetes mellitus were not at risk of COVID-19 mortality. AIM: Objective of this study was to estimate the average tendency of hypertension and diabetes mellitus as risk factor for COVID-19 mortality. METHODS: Meta-analysis with 16 articles analyzed by RevMan 5.4. RESULTS: pHR for hypertension was 1.15 (95% CI 1.00 - 1.32) and diabetes mellitus was 1.21 (95% CI 1.13 - 1.29). CONCLUSION: Hypertension had risk 1.15 times and diabetes mellitus had risk 1.21 times for COVID-19 mortality.

National characteristics associated with prevalence of depression and anxiety symptoms: a cross-sectional ecological study

Cross-national comparisons of the prevalence of mental disorders have relied on lay-administered interviews scored using complex diagnostic algorithms. However, this approach has led to some paradoxical findings, with more vulnerable countries showing lower prevalence, and its appropriateness for cross-national comparisons has been questioned. This study used an alternative method involving simple questions from social surveys to assess the prevalence of specific depression and anxiety symptoms, and investigated their association with national indicators of human development, quality of government, mental health resources, and mental health governance. The study used data on the prevalence of three symptoms indicating depression or anxiety: sadness, worry, and unhappiness. These data were taken from the Gallup World Poll (142 countries) and the World Values Survey (77 countries). National characteristics examined covered indicators of human development (income, life span, education, gender equality), quality of government (human freedom, perceptions of corruption), mental health resources (per capita numbers of psychiatrists, mental health nurses, psychologists, and social workers), and mental health governance (whether there is a national mental health plan and a mental health law). All the human development and quality of government indicators, and some of the mental health resource indicators, were strongly associated with a lower prevalence of symptoms. Populations of nations with higher human development, quality of government, and mental health resources have better mental health when measured by the prevalence of specific symptoms.

Intersetorialidade das ações de alimentação e nutrição: relação com a prevalência de obesidade no estado da Paraíba

ABSTRACT Objective: To identify the managerial profile and forms of intersectoral articulation in the framework of food and nutrition carried out in Primary Health Care and verify its association with the prevalence of obesity in the three health macro-regions of the State of Paraíba. Methods: Cross-sectional survey carried out in 151 municipalities in Paraíba, nested in a national population-based survey. Variables related to the manager, managerial profile, intersectoral forms of articulation, and obesity rates among adults were evaluated according to data from the Food and Nutrition Surveillance System. Results: All macro-regions presented a mean of adults obesity higher than the national reference for individual over 18 years of age described in the National Health Plan 2020-2023. The presence of the technician responsible for food and nutrition actions was associated with higher rates of obesity. The performance of food and nutrition education actions, and intersectoral practices related to the Food and Nutrition Security sector were associated with lower prevalence of obesity. Conclusion: The effectiveness of the actions cannot be guaranteed by the presence of a specific position for the actions. Food and Nutrition Education actions are recommended to reduce the prevalence of obesity.

Access to school-based eye health programs: a qualitative case study, Bogotá, Colombia.

ABSTRACTObjectives.To identify barriers and enablers to accessing school-based eye health programs in Bogotá, Colombia.Methods.We undertook a qualitative case study that explored how structural factors, and social and cultural norms influence access to school-based eye health programs. We conducted focus groups discussions and interviews with a purposive sample of 37 participants: government stakeholders (n = 4), representatives from nongovernmental organizations (n = 3), and an eye-care practitioner, as well as teachers (n = 7), a school nurse, parents (n = 7), and children (n = 14) from private and public schools. Data were analyzed using a priori themes from the availability, accessibility, acceptability and quality framework.Results.Routine vision screening in schools is not currently provided nor is there a budget to support it. Lack of collaboration between the health and education ministries and the absence of national planning affected the delivery of eye care in schools. Factors related to acceptability of school-based eye health programs included: poor acceptance of training teachers as vision screeners; stigma related to wearing spectacles; and distrust of health services. The cost of spectacles and poor access to eye health information were identified as barriers to positive child eye health outcomes by socioeconomically disadvantaged parents and children.Conclusion.Our findings suggest the need for a national school eye health plan and improved cooperation between health and education ministries. Interventions to improve trust in health services, tackle the lack of human resources while respecting professional qualifications, and raise awareness of the importance of eye health are recommended.

The dementia policies in Australia relating to the COVID‐19 pandemic

BackgroundAustralia has a population of 26 million, and on January 28th 2021, 28,794 COVID‐19 infections and 909 deaths. 685 deaths were at residential aged care facilities, and data from the Australian Bureau of Statistics revealed that 72.7% of the people who died of the coronavirus in Australia (up to 31 August 2020) had at least one pre‐existing chronic condition listed on their death certificate, with dementia the most common (noted on 41% of death certificates). This presentation will present and discuss the key Australian dementia policy interventions implemented during the pandemic.MethodA scoping review of published academic, media, policy papers, white papers, and grey literature was conducted. We extracted relevant information pertaining to policies relating to dementia care during the COVID‐19 pandemic.ResultThe Australian government is managing the COVID‐19 outbreak as a health emergency, and have developed and funded a comprehensive response. For the older population and those with ADRD, the key policies include the National Health Plans, specific plans for people with disabilities, telehealth expansions, mental health and wellbeing pandemic response plans, home delivery of prescriptions, the establishment of an Aged Care Health Emergency Response Operations Centre, and a National COVID‐19 Aged Care Plan. In Victoria, the Victorian Aged Care Response Centre was established. The Pfizer/BioNTech vaccine will be given to priority groups from February 2021, which include aged care and disability care residents and workers (people with dementia account for 52% of all residents in aged care facilities). Strict policies were put in place for aged care facility visitations, and for the aged care workforce, such as the use of personal protective equipment and limiting staff to work in only one facility. Advocacy bodies were also key, and Dementia Australia and Dementia Support Australia, for example, developed advice to support people experiencing behavioural and psychological symptoms of dementia during the pandemic.ConclusionThere are currently no active cases in residential aged care in Australia, zero locally acquired cases for several weeks, with the (minimal) new cases emerging from the hotel quarantine system. Health policies have managed to limit the spread of COVID‐19 infection in Australia.

Building a roadmap for the evaluation of a National Health Plan: the experience of Portugal

Abstract Issue The National Health Plan (PNS) 2012-2016 (extended until 2020) is the Portuguese strategic health document that presents the direction of intervention within the Health System. A final evaluation of PNS was foreseen, with National Institute of Health Dr Ricardo Jorge (INSA) being responsible for carrying out this task. The experience gained by INSA in defining a roadmap to be used in this process can be important in steering other actors to policy evaluation. Description of the problem In order to analyze the impact of policies, it is necessary to collect evidence that can evaluate the results achieved, and more importantly, identify gaps in implementation and evaluation issues. Herein, we aim to present the methodological approach developed to pave the way to the final assessment of PNS. Results As part of the Biennial Collaborative Agreement 2016-2017, WHO sponsored a high-level technical consultative process with relevant experts to address the condition for defining the work plan. It was devised to undertake: i) A scoping review based upon data collected from PNS implementation evidence mapping; ii) A qualitative analysis of the perception from main stakeholders on PNS impact and their expectations. Thus, a matrix of evidence was built to analyze the alignment of PNS at national and local levels, and with the main health framework targets and indicators. Also, online surveys and face-to-face interviews were done with key stakeholders in order to identify evidence gaps and critical factors for the successful PNS implementation, among others. Lessons To characterize its implementation and impact on citizens' health, a sound PNS evaluation should be guided by clear assessment questions, supported by validated tools and complemented by international guidance. In addition, a long-term consultative process with key stakeholder support is required to properly identify opportunities, priorities, and outcomes. Key messages Institutionalization of an evaluation process as part of public policies life cycle is a powerfull tool to foster learning and crucial to achievement of proposed goals. A clear structure to support the policy evaluation approach is mandatory to guarantee impartiality, independence and transparency on the overall process.

Relationship between Climate Change and Health Sector Planning

Abstract Climate change and its impact on the environment will have negative effects on health worldwide. National health strategies and plans (NHSPs) play an essential role in defining the future of a country's health system. It remains unknown whether and how NHSPs take climate change and related health risks into account and if this is done by countries that are most affected by climate change. This study aims (1) to understand the content of NHSPs with regard to climate change, (2) to assess the characteristics of countries with NHSPs that take climate change into account and (3) to analyze the factors that influence countries addressing climate change in NHSPs. NHSPs from 101 countries were studied. Keyword searches of NHSPs were used to identify concepts linked to climate change and related health risks. NHSPs were classified into red (no consideration of climate change), yellow (discussion of climate issues) and green (yellow + discussion of adaptation strategies). Two logistic regression models were conducted to analyze the relationship between NHSP categorization and potential explanatory factors, such as wealth (GNI/capita), Climate Risk, Climate Vulnerability or Climate Change-related Health Risk. Climate change is addressed in 66 NHSPs but only 38 NHSPs propose adaptation strategies (green category). African and low-income countries tend to address climate change in their NHSPs more frequently than high-income countries. The regression analysis found that NHSPs are more likely to address climate change (green and yellow) if countries face a higher degree of climate risk and climate vulnerability. No statistically significant association was found for climate change-related health risk and gross national income. Only about one third of all analyzed NHSPs discussed both the effects of climate change and potential adaptation measures. Climate change is addressed mostly by NHSPs of countries strongly affected by climate change. Key messages NHSPs could potentially provide strategic direction for health systems to adapt to climate change. NHSPs of many countries do not discuss how to adapt the health system to climate change.

Health system efficiency in OECD countries: dynamic network DEA approach

BackgroundIn recent years, measuring and evaluating the efficiency of health systems has been explored in the context of seeking resources to ensure the sustainability of ‘countries’ health and social systems and addressing various crises in the health sector. The study aims to quantify and compare the efficiency of OECD health systems in 2000, 2008, and 2016. The contribution to research in the field of efficiency in the healthcare system can be seen in the application of Dynamic Network Data Envelopment Analysis (DNDEA), which help us to analyse not only the overall efficiency of the healthcare system but analyse the overall efficiency as the result of the efficiencies of individual interconnected areas (public and medical care area). By applying the DNDEA model, we can realise the analysis not only within one year, but we can find out if the measures and improvements taken in the healthcare sector have a positive impact on its efficiency in a later period (eight-year interval).MethodsThe analysis focuses on assessing the efficiency of the health systems of OECD countries over three periods: 2000, 2008, and 2016. Data for this study were derived from the existing OECD database, which provides aggregated data on OECD countries on a comparable basis. In this way, it was possible to compare different countries whose national health statistics may have their characteristics. The input-oriented Dynamic Network Data Envelopment Analysis model was used for data processing. The efficiency of OECD health systems has been analysed and evaluated comprehensively and also separately in two divisions: public health sub-division and medical care sub-division. The analysis combines the application of conventional and unconventional methods of measuring efficiency in the health sector.ResultsThe results for the public health sub-division, medical care sub-division and overall health system for OECD countries under the assumption of constant returns to scale indicate that the average overall efficiency was 0.8801 in 2000, 0.8807 in 2008 and 0.8472 in 2016. The results of the input-oriented model with the assumption of constant returns to scale point to the overall average efficiency of health systems at the level of 0.8693 during the period. According to the Malmquist Index results, the OECD countries improved the efficiency over the years, with performance improvements of 19% in the public health division and 8% in the medical care division.ConclusionsThe results of the study are beneficial for health policymakers to assess and compare health systems in countries and to develop strategic national and regional health plans. Similarly, the result will support the development of international benchmarks in this area. The issue of health efficiency is an intriguing one that could be usefully explored in further research. A greater focus on combining non-parametric and parametric models could produce interesting findings for further research. The consistency in the publication and updating of the data on health statistics would help us establish a greater degree of accuracy.

The burden of severe hypertensive disorders of pregnancy on perinatal outcomes: a nationwide case-control study in Suriname

BACKGROUNDLatin America and the Caribbean is the region with the highest prevalence of hypertensive disorders of pregnancy worldwide. In Suriname, where the stillbirth rate is the second highest in the region, it is not yet known which maternal factors contribute most substantially.OBJECTIVEThe aims of this study in Suriname were to (1) study the impact of different types of maternal morbidity on adverse perinatal outcomes and (2) study perinatal birth outcomes among women with severe hypertensive disorders of pregnancy.STUDY DESIGNA case-control study was conducted between March 2017 and February 2018 during which time all hospital births (86% of total) in Suriname were included. We identified babies with adverse perinatal outcomes (perinatal death or neonatal near miss) and women with severe maternal morbidity (according to the World Health Organization Near Miss tool). Stillbirths and early neonatal deaths (<7 days) were considered perinatal death. We defined a neonatal near miss as a birthweight below 1750 g, gestational age <33 weeks, 5-minute Apgar score <7, and preterm intrauterine growth restriction <p3. Descriptive statistics and multivariate binary logistic regression analyses were conducted.RESULTSIn the 1-year study period, adverse perinatal outcomes were reported for 638 singleton births of which 120 (18.8%) involved women with severe maternal morbidity. In most of these cases, the mother suffered severe hypertensive disorders of pregnancy (n=95/120, 79.2%). Severe hypertensive disorders of pregnancy were strongly associated with adverse perinatal outcomes (adjusted odds ratio, 11.1; 95% confidence interval, 8.3–14.9). The prevalence of severe hypertensive disorders of pregnancy in Suriname was 2.5% (234/9197). Of the 215 singleton pregnancies complicated by severe hypertensive disorders, adverse perinatal outcomes were reported for 44.2% of them (n=95/215; adjusted odds ratio, 11.1; 95% confidence interval, 8.3–14.9); perinatal death accounted for 18.1% of these cases (n=39/215; adjusted odds ratio, 8.6; 95% confidence interval, 5.8–12.7) and neonatal near miss accounted for another 26.0% (n=56/215). Women with severe hypertensive disorders of pregnancy had a preterm birth (<37 weeks) in 67.1% of the cases (n=143/215; adjusted odds ratio, 14.1; 95% confidence interval, 10.5–19.0), a baby with a low birthweight (<2500 g) in 62.2% of the cases (n=130/215; adjusted odds ratio, 10.8; 95% confidence interval, 8.1–14.5), and a baby with a low 5-minute Apgar score in 20.5% of the cases (n=43/215; adjusted odds ratio, 6.9; 95% confidence interval, 4.8–10.0).CONCLUSIONIn Suriname, severe hypertensive disorders of pregnancy are strongly associated with adverse perinatal outcomes, with an increased risk for preterm birth, low birthweight, low Apgar score, and perinatal mortality. Prevention, early diagnosis, and management of hypertensive disorders of pregnancy are expected to reduce perinatal deaths substantially. Recommendations to reduce perinatal deaths in Suriname include the establishment of a national health plan for the management of severe hypertensive disorders of pregnancy and the introduction of perinatal death and neonatal near miss reviews.

제5차 국민건강증진종합계획(HP2030)에서의 ‘건강형평성’ 목표: HP2020에 대한 평가와 국외 사례고찰을 바탕으로

Objectives: This study was conducted to enhance our understanding and execution of the National Health Plan 2030 (HP2030) by analyzing its health equity goals, based on an evaluation of the National Health Plan 2020 (HP2020) and international cases. Methods: The degree of change in the health gap based on gender, income, and region of the leading health indicators in HP2020 was analyzed. In addition, the National Health Plans of the United States, China, and Japan were comparatively analyzed from the perspective of health equity. Finally, health equity in the HP2030 was analyzed focusing on vision, basic principles, performance indicators, and target values. Results: Health disparities according to gender, income, and region were observed for all indicators of the HP2020. Moreover, for the United States, China, and Japan, there was a common emphasis on data monitoring, to identify vulnerable groups. Furthermore, they focused on social and national responsibilities for improving health levels and achieving health equity. In the HP2030, it was confirmed that health equity was considered for the entire process of planning, including the selection of vision, basic principles, key projects, performance indicators, and target values. Conclusion: For the success of the HP2030, it is necessary to establish an effective action plan, strengthen the policy feedback function, improve communication and legal systems for linkage and cooperation, and establish a sustainable monitoring system.

Guidelines for the Diagnosis and Treatment of Dengue in China

Abstract Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease. As a dengue non-endemic country, China has experienced several dengue outbreaks in recent years. However, dengue patients in China display clinical characteristics that are distinct from those of patients in dengue-endemic countries. To standardize the diagnosis and treatment of dengue fever, the experts at the Society of Infectious Diseases, Society of Tropical Medicine and Parasitology of the Chinese Medical Association, and the Society of Emergency Medicine of China Association of Chinese Medicine have developed a guideline after reviewing the following guidelines and data: guidelines for diagnosis, treatment, prevention, and control of dengue (World Health Organization, 2009); the guidelines for diagnosis and treatment of dengue (National Health and Family Planning Commission of the People's Republic of China, 2014, Edition 2); health industry standard of the People's Republic of China “diagnosis for dengue fever (WS216-2018)”; and systemic reports on dengue. The new guideline includes eight aspects: introduction, terminology, epidemiology and prevention, etiology and pathogenesis, clinical features, diagnosis, treatment, and problems to be solved.

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

BackgroundInclusive engagement in healthcare policies and decision-making is essential to address the needs of patients and communities, reduce health inequities and increase the accountability of the government. In low income countries such as Malawi, with significant health challenges, stakeholder inclusion is particularly important to improve performance and service delivery. The 2017 National Health Plan II (NHP II) and accompanying Health Sector Strategic Plan II (HSSP II) aimed to improve the functioning of the healthcare system. The Ministry of Health for Malawi intended to involve all key health sector stakeholders in their development. This study explores the extent of stakeholder engagement in the health policy process through local level stakeholders’ perceptions of their involvement in the NHP II and HSSP II.MethodsA qualitative study design was used. Interviews were conducted with 19 representatives of organisations operating at the local level, such as CSOs and local government. Open questions were asked about experiences and perceptions of the development of the NHP II and HSSP II. Inductive content analysis was performed.ResultsStakeholders perceived barriers to inclusive and meaningful engagement in the health policy process. Five categories were identified: tokenistic involvement; stakeholder hierarchy; mutual distrust; preferred stakeholders; no culture of engagement.ConclusionsSerious challenges to the meaningful and equitable engagement of local level stakeholder groups in the health policy process were identified. Issues of trust, accountability and hierarchy in donor-citizen-government relations must be addressed to support stakeholder engagement. Engagement must go beyond tokenism to embed a range of stakeholders in the process with feedback mechanisms to ensure impact from their contributions. Local level stakeholders can be empowered to advocate for and participate in consultation exercises alongside greater top-down efforts to engage stakeholders via diverse and inclusive methods. These issues are not unique to Malawi or to health policy-making.

Medical Imaging: The Missing Element of National Health Plans

Purpose: Radiology global outreach programs have increased in recent years but progressed more slowly than other specialties. Establishing radiology services is increasingly recognized as a priority in resource-limited settings. Myanmar has a tremendous disease burden that is treatable with interventional radiology (IR) techniques, and aims to grow and effectively integrate this service into its public healthcare sector. Through collaborations between Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and Myanmar Radiological Society (MRS), the field of IR has grown exponentially over recent years. This study aims to provide a Myanmar national IR report on the current trends and future challenges. Methods and materials: Descriptive variables across five domains (facility and equipment, workforce, supplies, infrastructure, and casemix) from the four public sector hospitals with IR capability were obtained between 2016-2019. The four hospitals were Yangon General Hospital (YGH), Yangon Specialty Hospital (YSH), Mandalay General Hospital (MGH), and Defense Services General Hospital (DSGH). Data were analyzed to demonstrate progress in IR and the differing casemix. Results: There are currently four IR-capable hospitals and nine interventional radiologists across Myanmar’s public healthcare sector. IR case volumes tripled from 514 cases in 2016 to more than 1,500 cases in 2019. The three most common procedures performed were trans-arterial chemoembolization (TACE, 63%), bronchial arterial embolization (BAE, 7.7%), and drainages (7.7%). Significant challenges to the growth and adoption of IR services span the domains of infrastructure, equipment and supplies, workforce, and IR awareness, among other clinical specialties. Conclusion: Myanmar’s healthcare priorities, coupled with international radiological outreach programs, have led to rapid growth of IR. The exponential growth in case volumes is promising for Myanmar and other developing countries. But to widen the scope of practice and integrate the service within local clinical workflows, a holistic effort that addresses multiple domains is needed in the future.

RETRACTED ARTICLE: Human–Computer Interaction on IoT-Based College Physical Education

AbstractCollege physical education system is an essential component of the national health plan. Promoting the technical and modernized construction of the physical education curriculum in colleges and universities is crucial to enhance higher education's science and performance. In this technological era, the Internet of Things (IoT) is used in physical education to train and record physical activities. In this research, the AI-based IoT system (AI-IoTS) Wearable technology is promoted for IoT-based Human–Computer Interaction for College Physical education. This AI-IoTS consist of a Cloud Platform and three layers of AI. The AI-IoTS recognizes the data required for the students. Collect the data from the cloud using an IoT platform and processes it with the help of AI. The student can train themselves using wearable technology without the help of the Physical instructor. The simulation method of the proposed framework "AI-IoTS" proved that it could collect and teach students independently. The proposed AI-based IoT System (AI-IoTS) Wearable technology for IoT-based Human–Computer Interaction for College Physical education has been validated based on the optimization parameter, which outperforms conventional methods.

Using Nomogram to Predict the Hospitalization Forgone Among Internal Migrants in China: A Nationally Representative Cross-Sectional Secondary Data Analysis.

BackgroundMigrants are one of the most vulnerable populations facing many health issues. Inadequate health care access and unequal insurance are the most challenging. This study aimed to construct a nomogram to predict the risk of hospitalization forgone among internal migrants in China.MethodsWe analyzed the 2014 Mobile Population Social Integration and Mental Health Survey (MPSIMHS) launched by National Health and Family Planning Commission. Using the Probability Proportionate to Size Sampling method (PPS), MPSIMHS sampled from eight cities (districts) with a total sample size of 15,999. Of total 589 patients who were diagnosed with hospitalization requirement, 116 forwent their hospitalization, 473 had no forgone. Demographics, socioeconomic status, and health conditions were analyzed using univariate analysis and multivariate logistic regression. A nomogram was built and validated by applying bootstrap resampling.ResultsAfter model selection, gender, age group, marital status, migration range, insurance (having NRMI), and self-evaluated health were chosen into the nomogram to predict the risk of hospitalization forgone. The nomogram that predicted the risk of hospitalization forgone was validated for discrimination and calibration using bootstrap resampling. The calibration curves illustrated optimal agreement between the actual and predicted probabilities of the nomogram. The value of C-index from bootstrap was 0.80 (95% CI: 0.76–0.85).ConclusionThis study identified some possible factors contributing to migrant’s hospitalization forgone: being single, male and middle-aged, having fixed health insurance, and having bad or great self-evaluated health. By integrating significant and easy-to-get prognostic factors, a nomogram was developed to estimate an individual patient’s risk of hospitalization forgone, which might have practical utility and the potential to assist clinicians in making hospitalization recommendations.

Analysis of gross radioactivity in drinking water around Tianwan Nuclear Power Plant from 2016 to 2018

Objective To understand the background level of total radioactivity in drinking water around Tianwan Nuclear Power Plant. Methods According to the original plan of the National Health and Family Planning Commission of China, the monitoring of gross α and gross β radioactivity levels in drinking water during dry and rain periods around Tianwan Nuclear Power Plant, and water samples were collected including source water, factory water, peripheral water and reservoir water. Results A gross of 200 water samples were monitored at 35 sampling sites from 2016 to 2018. The gross α and gross β radioactivity levels in the dry period were (0.038 ± 0.033) Bq/L and (0.11 ± 0.03) Bq/L. The gross α and gross β radioactivity levels in the wet period were (0.038 ± 0.024) Bq/L and (0.11 ± 0.03) Bq/L. There were statistically significant differences in gross α and gross β radioactivity levels between the source water and the other water during the dry season ( P < 0.05). There were statistically significant differences in gross α and gross β radioactivity levels in different years ( P < 0.05). There were statistically significant differences in gross α and gross β radioactivity levels at different distances from the nuclear power plant ( P < 0.05). Conclusion The gross α level and gross β level of radioactivity in drinking water around Tianwan Nuclear Power Plant are in line with the standard of drinking water, regular, fixed and continuous monitoring should be carried out, and radionuclide monitoring and radiological investigation should be carried out on this basis. In view of the density of personnel in the vicinity of nuclear power plants in China, nuclear emergency preparedness training should also be strengthened. 摘要： 目的 了解田湾核电站周边的饮用水中总放射性本底水平。 方法 根据原国家卫生计划委员会方案要求在田 湾核电站周围开展枯水期、丰水期饮用水中总 α、总 β 放射性水平监测, 采集水样包括水源水、出厂水、末梢水及水库 水。 结果 2016—2018 年共 35 个采样点监测水样 200 份。枯水期总 α、总 β 放射性水平分别为 (0.038 ± 0.033) Bq/L、(0.11 ± 0.03) Bq/L, 丰水期总 α、总 β 放射性水平分别为 (0.038 ± 0.024) Bq/L、(0.11 ± 0.03) Bq/L。枯水期的水源水其 他水中总 α、总 β 放射性水平差异有统计学意义 ( P < 0.05)。不同年份的水中总 α、总 β 放射性水平差异有统计学意义 ( P < 0.05)。距核电站不同距离的水中总 α、总 β 放射性水平差异有统计学意义 ( P < 0.05)。 结论 田湾核电站周边的 饮用水中总 α、总 β 放射性水平均符合生活饮用水标准, 应坚持定期、定点、持续开展监测, 并在此基础上开展放射性 核素监测和放射生态学调查等研宄。考虑到我国核电站周边人员密集, 应加强人员的核应急培训。