Policy-level Interventions Research Articles

Interventions to address cancer-related financial toxicity: Recommendations from the field.

Addressing financial toxicity among cancer patients is a complex process that requires a multifaceted approach, particularly for rural patients who may face additional cost-related barriers to care. In this study, we examined interventions being implemented by financial navigation staff at various cancer centers that help address financial toxicity experienced by oncology patients. We conducted semistructured interviews with a convenience sample of financial navigation staff across 29 cancer centers in both rural and urban areas in 7 states. Interviews were audio-recorded and transcribed. Descriptive coding and thematic analysis techniques were used to analyze the data. Thirty-five participants were interviewed, the majority of whom worked in cancer centers located in rural counties. Participants identified the use of screening tools, patient education, and access to tailored financial assistance resources as best practices. Immediate resource needs included additional financial navigation staff, including lay navigators and community health workers, to promote linkages to local resources. Suggested clinical areas for intervention included proactive and early implementation of financial assessments and discussions between providers and patients, along with training and access to regularly updated resources for those in financial navigator/counselor roles. Participants also discussed the need for policy-level interventions to reform health systems (including employment protections) and health insurance programs. Implementing proactive methods to screen for and address financial needs of patients is essential to improving cancer-related outcomes. Additional programs and research are needed to help establish systematic and standardized methods to enhance financial navigation services, especially for underserved rural communities.

The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study.

The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia. A multi-institutional, retrospective cohort study was performed at nine tertiary-level children's hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance. Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97-0.99). Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.

Trauma-informed hospital security: a policy for intimate partner violence in a pediatric healthcare setting

Background: Increasing numbers of providers are adopting “trauma-informed approaches” in patient care models to address intimate partner violence (IPV), but most hospitals’ security policies and practices do not incorporate trauma-informed approaches. Pre-existing security culture and differing approaches to trauma-informed care necessitate policy-level interventions. To support the physical and emotional safety of IPV survivors within the hospital environment, the security leaders at our tertiary-care, inner-city pediatric hospital expressed the need for a trauma-informed IPV security policy.

Abstract 10031: Gaps in Medical Therapy for Patients with Heart Failure and Reduced Ejection Fraction (HFrEF) in a Large, Diverse, Electronically Identified Cohort

Background: National registries reveal significant gaps in medical therapy for patients with heart failure and reduced ejection fraction (HFrEF), but may not completely capture the population eligible for therapy. We developed an electronic health record-based algorithm to identify eligible HFrEF patients, and used this to assess prescribing in a large, diverse, urban health system. Methods: In this cross-sectional study of NYU Langone Health outpatients (>350 sites) with EF≤40% on echocardiogram and clinic visit from 3/1/2019-2/29/2020, we assessed contraindication to and prescription of the following: beta-blocker (BB), angiotensin converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonist (MRA). Results: We electronically identified 2,732 patients for analysis. Among those eligible for each medication class, 84.8% and 79.7% were appropriately prescribed BB and ACE-I/ARB/ARNI, respectively, while only 23.9% and 22.7% were appropriately prescribed MRA and ARNI, respectively. In adjusted models (Table), younger age, cardiology visit, and lower EF were associated with increased prescribing. Medicaid insurance was associated with increased prescribing of ARNI and Black race with prescribing of MRA. Conclusions: We observed significant gaps in MRA and ARNI therapy for HFrEF patients. Medicaid insurance was associated with increased ARNI use, possibly due to lack of prior authorization requirements under New York State Medicaid policy. Our findings support system- and policy-level interventions to increase use of these life-saving therapies.

Child Poverty and Health in the United States: Introduction and Executive Summary.

Child Poverty and Health in the United States: Introduction and Executive Summary.

Soda Consumption Among Mexican Construction Workers in the Context of the Sugar-Sweetened Beverage Tax.

This study explored the psychosocial determinants of consumption of soda and other taxed sugar-sweetened beverages (SSBs) in Mexican construction workers (CWs) and whether consumption changed as a result of the 2014 SSB tax. We conducted a qualitative case study involving in-depth interviews and focus groups (FGs) with 30 Mexican CWs; supplemented with descriptions of the food and beverages consumed during lunch breaks. We used NVivo 10 to classify information according to the analysis categories, primarily informed by the Reasoned Action Approach (RAA). CWs reported not having changed their consumption of soda and other taxed SSBs as a result of the SSB tax, despite the price increase and "knowing" the potential negative consequences of soda drinking. The most important determinants of soda consumption are a deep-seated social norm of soda drinking and use of soda drinking as part of their professional identity; their likeness for soda; a wide availability of soda in their environments; and a low perceived behavioral control (because they thought themselves as addicted to it). Participants indicated that the best way for them not to consume soda would be if it were not available. These findings lend support for the tight regulation of the availability of SSBs. To have a meaningful impact on these consumers, the SSB tax may need to be much higher. Policy-level interventions should be coupled with interventions at the individual and community levels that aim at denormalizing soda consumption, create new meanings in relation to water consumption, and develop behavioral control to decrease soda consumption.

Predictors for depressive symptoms by four types of disability

This study aimed to examine the longitudinal relationship between disability and depressive symptoms, by comparing four types of disability in community-dwelling individuals with disabilities in South Korea. A total of 3347 South Koreans with disabilities from the second wave of the Panel Survey of Employment for the Disabled was utilized. Depressive symptomatology was assessed by whether the participant had experienced depressive symptoms for more than two weeks during the past year. A multivariate logistic regression model was used to calculate the odds ratio (OR) for depressive symptoms, and a Cox proportional hazards model to calculate the hazard ratio (HR) for two-year survival analysis. Persons who acquired mental disability from accident or industrial disaster and persons with congenital physical-internal disability were at higher risk for depressive symptoms. Maintaining employment was found to be an effective way to decrease the risk of depressive symptoms in persons with physical-external disability, sensory/speech disability, or mental disability. In contrast, in physical-internal disability, retaining normal ability to work seemed to be the key to reduce the risk of depressive symptoms. Predictors of depressive symptoms were found to differ depending on the type of disability. Such differences should be reflected in clinical and policy-level interventions to address the specific psychiatric needs of persons with different disabilities.

Industrial energy behaviour model: an analysis using the TISM approach

PurposeIn the realm of energy behaviour studies, very little research has been done to understand industrial energy behaviour (IEB) that influences the willingness to adopt (WTA) energy-efficient measures. Most of the studies on energy behaviour were focused on the residential and commercial sectors where the behaviour under investigation was under volitional control, that is, where people believe that they can execute the behaviour whenever they are willing to do so. The purpose of this paper is to examine the factors influencing the industry’s intentions and behaviour that leads to enhanced adoption of energy efficiency measures recommended through energy audits. In particular, this paper aims to extend the existing behaviour intention models using the total interpretive structural modelling (TISM) method and expert feedback to develop an IEB modelDesign/methodology/approachTISM technique was used to determine the relationship between different elements of the behaviour. Responses were collected from experts in the field of energy efficiency to understand the relationship between identified factors, their driving power and dependency.FindingsThe results show that values, socialisation and leadership of individuals are the key driving factors in deciding the individual energy behaviour. WTA energy-saving measures recommended by an energy auditor are found to be highly dependent on the organisational policies such as energy policy, delegation of power to energy manager and life cycle cost evaluation in purchase policy.Research limitations/implicationsThis study has a few limitations that warrant consideration in future research. First, the data came from a small sample of energy experts based on a convenience sample of Indian experts. This limits the generalizability of the results. Individual and organizational behaviour analysed in this study looked into a few select characteristics, derived from the literature review and expert feedback, which may pose questions about the standard for behaviours in different industries.Practical implicationsReasons for non-adoption of energy audit recommendations are rarely shared by the industries and the analysis of individual and organisational behaviour through structured questionnaire and surveys have serious limitations. Under this circumstance, collecting expert feedback and using the TISM method to build an IEB model can help to build strategies to enhance the adoption of energy-efficient measures.Social implicationsVarious policy level interventions and regulatory measures in the energy field, adopted across the globe, are found unsuccessful in narrowing the energy-efficiency gap, reducing the greenhouse gas (GHG) emissions and global warming. Understanding the key driving factors can help develop effective intervention strategies to improve energy efficiency and reduce GHG emissions.Originality/valueThe industry energy behaviour model with driving, linking and dependent factors and factor hierarchy is a novel contribution to the theory of organisational behaviour. The model takes into consideration both the individual and organisational factors where the decision-making is not strictly under volitional control. Understanding the key driving factor of behaviour can help design an effective intervention strategy that addresses the barriers to energy efficiency improvement. The results imply that it is important to carry out post energy audit studies to understand the implementation rate of recommendations and also the individual and organisational factors that influence the WTA energy-saving measures.

Prevalence and detecting spatial clustering of anaemia among children 6–59 months in the districts of India

BackgroundAmong the developing countries, India was the largest contributor to child anaemia in the last decade. It has many harmful effects on children's lifestyle as it reduces learning capacity, attentiveness and intelligence. The study attempts to identify the spatial prevalence and detect the clustering of anaemia in India based on National Family Heath Survey-IV, 2015–16 and also tries to identify the determinants of anaemia among children (6–59 months). MethodsThe study uses spatial analysis software ArcGIS 10.8 and GeoDa1.18 including Moran's index. Logistic regression model is applied by using STATA-14, to assess the effects of socio-economic and demographic, maternal and child characteristic predictors of prevalence of anaemia among children. ResultsThe anaemia prevalence is highest in Dadra & Nagar Haveli and lowest in Meghalaya. A total of 321 districts are having more than the national level average (58.65 %) of anaemia. Study also finds 110 districts as the hot-spot areas (Moran's I = 0.63) mostly from central, western, south-western, northern and eastern parts of India. Increase of mother's age, education, receipt of full ANC and richer wealth quantile reduce the risk of childhood anaemia. On the other hand, underweight mothers, children in the age group 12–23 months, underweight children and higher birth order increase the risk of childhood anaemia. ConclusionThe study suggests targeting the hot-spot districts with a high prevalence of anaemia and policy-level interventions addressing micronutrient deficiency like the Integrated Child Development Scheme, to reduce the risk of childhood anaemia.

Sero prevalence of SARS-CoV-2 in general population of Nagpur district

Background: Population based sero-epidemiological studies help us to determine the burden of COVID-19 infection at the community level and to monitor the trends in transmission of SARS-CoV-2 infection. Antibody based sero-positivity indicates the extent of spread of infection in the given population and forms the basis for strengthening public health mitigation measures. The present study was carried out with the objective of conducting population level serosurvey in Nagpur district to understand the spread of SARS-CoV-2 and to help the designing and implementation of appropriate health system and policy level interventions. This cross-sectional study was carried out in Nagpur District over two weeks in October and November 2020. For the purpose of this survey the Nagpur district was divided into NMC area and Non NMC area.Methods: House to house survey was carried out and data was collected using Google form. For detection of SARS-CoV-2 specific antibodies venous blood was collected from each participant and electrochemiluminescence immunoassay was performed. The data was cleaned, coded and analysed using EPI INFO.Results: The total seroprevalence in Nagpur district was found to be 35.17 %. The seroprevalance in NMC area was 49.7% which was more than twice from that of Non NMC area (20.7%).Conclusions: Considerably large numbers of infections are asymptomatic, however a sizeable proportion of population is still susceptible to the infection and thus there is no time for complacency.

Did the poor gain from India\u2019s health policy interventions? Evidence from benefit-incidence analysis, 2004\u20132018

BackgroundHealth policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context.MethodsEmploying Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups.ResultsUtilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018.ConclusionsImprovement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.

Transgender Adults' Public Bathroom-Related Stressors and Their Association with Depressive Symptoms: A Nationwide Cross-Sectional Study in South Korea

Purpose: This study assessed public bathroom-related stressors and examined their association with depressive symptoms, suicidal ideation, and suicide attempts among transgender individuals in South Korea. Methods: We analyzed data from a nationwide cross-sectional survey of 557 South Korean transgender adults (age range: 19-60 years) conducted in October 2020. Participants were asked nine yes/no questions about whether they have ever experienced public bathroom-related stressors within the last 12 months. The responses were classified into three categories: "never experienced," "avoidant behaviors alone," and "victimization experiences." Results: The proportions of participants who reported "avoidant behaviors alone" and "victimization experiences" related to public bathroom use were 47.0% and 23.0%, respectively. Past-week prevalence of depressive symptoms was 70.7%, and past 12-month prevalence of suicidal ideation and suicide attempts was 63.0% and 19.8%, respectively. Compared with participants who "never experienced" public bathroom-related stressors, the prevalence of depressive symptoms was statistically significantly higher among those who reported "avoidant behaviors alone" (adjusted prevalence ratio [aPR] = 1.22; 95% confidence interval [CI] = 1.07-1.40) and "victimization experiences" (aPR = 1.18; 95% CI = 1.01-1.38), after adjusting for covariates, including gender perception by others. In the same adjusted model, however, no significant associations of public bathroom-related stressors with suicidal ideation and suicide attempts were observed. Conclusions: Given these findings showing that public bathroom-related stressors may negatively influence transgender adults' depressive symptoms, efforts are necessary to ensure their safe access to public bathrooms in South Korea. Furthermore, policy-level interventions are needed to eliminate stigma against transgender individuals, given that public bathroom-related stressors could be considered an indicator of broader anti-transgender stigma.

An investigation on the key determinants influencing electric two-wheeler usage in urban Indian context

The promotion of electric vehicles is regarded as a critical aspect of government policy to transition towards a greener mobility system to reduce the pollution load from vehicular emission and deal with the challenges associated with future energy security for the transport sector. Motorized two-wheelers (M2W) are the popular means of personal mobility, and are accounting for nearly 32% of transportation-related greenhouse gas emissions in India. In this regard, replacing existing M2W with alternative fuelled vehicles such as the Electric Two-Wheelers (E2W) could significantly minimize the negative implications associated with the usage of M2W. Therefore, this study has attempted to identify and prioritize the key E2W specific attributes to propose necessary policy-level interventions for projecting E2W as an attractive alternative. Initially, an exhaustive set of twenty-three attributes influencing E2W-usage were identified from the literature. Subsequently, experts' opinions and users' perceptions on the importance of the identified attributes were captured and analyzed using appropriate Multi-Criteria-Decision-Making (MCDM) techniques. The Analytical Hierarchy Process (AHP) was used to analyze experts' opinions. The RIDIT (Relative to an Identified Distribution and Transformation) method was used to analyze users' perceptions. Finally, both sets of results are compared and combined to derive key E2W specific attributes based on their perceived importance by experts and users. Results indicate that the following attributes, namely, purchase cost and operation cost (Economy-related), range, top speed, battery-charging duration, and acceleration (Vehicle and battery-related), health benefits and reduction in tailpipe emission (User-perceived benefit-related), and charging infrastructure, and parking infrastructure (Transport infrastructure-related) are perceived as the key attributes influencing E2W in the typical Indian context. Based on the results, it is recommended that E2W with a longer range, higher speed, and faster acceleration rate could be promoted as a sustainable alternative to conventional M2W. The provision of adequate charging and parking infrastructure was critical for E2W usage in the Indian context.

Impact of dementia: Health disparities, population trends, care interventions, and economic costs.

The dementia experience is not a monolithic phenomenon-and while core elements of dementia are considered universal-people living with dementia experience the disorder differently. Understanding the patterning of Alzheimer's disease and related dementias (ADRD) in the population with regards to incidence, risk factors, impacts on dementia care, and economic costs associated with ADRD can provide clues to target risk and protective factors for all populations as well as addressing health disparities. We discuss information presented at the 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers, Theme 1: Impact of Dementia. In this article, we describe select population trends, care interventions, and economic impacts, health disparities and implications for future research from the perspective of our diverse panel comprised of academic stakeholders, and persons living with dementia, and care partners. Dementia incidence is decreasing yet the advances in population health are uneven. Studies examining the educational, geographic and race/ethnic distribution of ADRD have identified clear disparities. Disparities in health and healthcare may be amplified by significant gaps in the evidence base for pharmacological and non-pharmacological interventions. The economic costs for persons living with dementia and the value of family care partners' time are high, and may persist into future generations. Significant research gaps remain. Ensuring that ADRD healthcare services and long-term care services and supports are accessible, affordable, and effective for all segments of our population is essential for health equity. Policy-level interventions are in short supply to redress broad unmet needs and systemic sources of disparities. Whole of society challenges demand research producing whole of society solutions. The urgency, complexity, and scale merit a "whole of government" approach involving collaboration across numerous federal agencies.

Women Trafficking Problem in Assam

The increasing numbers of newspaper reports on disappearing women from the north eastern state of Assam and especially from the economically backward areas of the state in recent years deserve close attention from both researchers' points of view as well as policy-level intervention of the larger community along with the government. This study makes an attempt to operate upon the menace area through the scalpel of game theory under the light of both primary and secondary data collected from the study area. It is an attempt to outline conscious human behaviour that leads to crimes such as women trafficking and identify the parameters controlling or affecting which types of crimes can be controlled. In order to do so, different distinct entities associated with the problem have been considered as different players leading to the concluding indication of prevailing flaws in the legal system of the country along with lack of employment opportunities and mass ignorance about the problem in hand among common people as the major reasons.

Prevalence of diarrhoea among under five children in India and its contextual determinants: A geo-spatial analysis

BackgroundDiarrheal diseases which is one of the leading reason behind global mortality and morbidity is more threatening for infants and young children. Childhood diarrhoea is becoming increasingly prevalent disease in developing countries like India. Moreover, it is a major cause of malnutrition that contributes towards third major cause of under 5 mortalities. This has raised a serious concern in the domain of public health. ObjectivesThe present study attempts to identify the spatial prevalence and clustering of diarrhoea in India based on National Family and Heath Survey (NFHS-4, 2015–16) and also tries to identify the association of prevalence of diarrheal disease among under 5 children with socio-economic factors. MethodsThe study applies spatial analysis software i.e ArcGIS 10.8 and GeoDa 1.18 including Moran's index and logistics regression to show the spatial prevalence and auto-correlation of diarrhoea among neighbourhood districts and their contextual determinants. FindingsThe study finds a total of 71 districts belong to the hot spot area are mostly from central and eastern costal part of India. Analysis of socio-economic determinants show prevalence of diarrhoea among under 5 children is higher in rural areas, among children not staying in Pacca house, living with unimproved sanitation facilities, belonging to under privileged community (highest among OBC followed by SC/STs), children of younger mothers (<25 years) and “poor’ households considering the wealth index. ConclusionThe study recommends to target hot-spot districts with high prevalence of diarrhoea and policy level interventions like improved sanitation to reduce the risk of childhood diarrhoea.

Risk Factors for Premature Myocardial Infarction: A Systematic Review and Meta-analysis of 77 Studies.

ObjectiveTo evaluate the magnitude of the association between risk factors and premature myocardial infarction (MI) (men aged 18-55 years; women aged 18-65 years).Patients and MethodsWe searched MEDLINE and other databases from inception through April 30, 2020, as well as bibliography of articles selected for data extraction. We selected observational studies reporting the magnitude of the association of at least 1 risk factor (demographic characteristics, lifestyle factors, clinical risk factors, or biomarkers) with premature MI and a control group. Pooled risk estimates (random effects) from all studies unadjusted and adjusted for risk factors were reported as summary odds ratios (ORs) with 95% CIs.ResultsFrom 35,320 articles of 12.7 million participants, we extracted data on 19 risk factors from 77 studies across 58 countries. Men had a higher risk of premature MI (OR, 2.39; 95% CI, 1.71 to 3.35) than did women. Family history of cardiac disease was associated with a higher risk of premature MI (OR, 2.67; 95% CI, 2.29 to 3.27). Major modifiable risk factors associated with higher risk were current smoking (OR, 4.34; 95% CI, 3.68 to 5.12 vs no/former), diabetes mellitus (OR, 3.54; 95% CI, 2.69 to 4.65), dyslipidemia (OR, 2.94; 95% CI, 1.76 to 4.91), and hypertension (OR, 2.85; 95% CI, 2.48 to 3.27). Higher body mass index carried higher risk (OR, 1.46; 95% CI, 1.24 to 1.71 for ≥25 kg/m2 vs <25 kg/m2). Biomarkers associated with 2- to 3-fold higher risk were total cholesterol levels greater than 200 mg/dL, triglyceride levels higher than 150 mg/dL, and high-density lipoprotein cholesterol levels less than 60 mg/dL (to convert to mmol/L, multiply by 0.0259).ConclusionMajor risk factors for premature MI are mostly amenable to patient, population, and policy level interventions. Mild elevations in body mass index and triglyceride levels were associated with higher risk, which has implications for the growing worldwide epidemic of cardiometabolic diseases.

Epidemiology and Prevention of Tuberculosis and Chronic Hepatitis B Virus Infection in the United States.

Tuberculosis (TB) and chronic hepatitis B virus (CHB) infection can be prevented with treatment and vaccination, respectively. We reviewed epidemiology and guidelines for TB and CHB to inform strategies for reducing United States (U.S.) burden of both infections. Non-U.S.-born, compared to U.S.-born, persons have a 15-, 6-, and 8-fold higher TB incidence and latent TB infection (LTBI) and CHB prevalence, respectively; all infections disproportionately impact non-U.S.-born Asians. TB and CHB each are associated with ~ 10% mortality that results in 7- and 14-years per life lost, respectively. LTBI and CHB have significant gaps in their care cascade as 40% of LTBI and 20% of CHB patients are diagnosed, and 20% of LTBI and CHB diagnosed patients receive treatment. Reducing TB and CHB burden will require healthcare provider-, system-, and policy-level interventions, and increased funding and collaboration between public health departments and healthcare systems.Institutional Review Board Statement: Since this review article did not include primary data on patients and only focused on reviewing published data, approval by an institutional review board was not needed.

Adaptive Governance and Resilience Capacity of Farms: The Fit Between Farmers’ Decisions and Agricultural Policies

Greater resilience is needed for farms to deal with shocks and disturbances originating from economic, environmental, social and institutional challenges, with resilience achieved by adequate adaptive governance. This study focuses on the resilience capacity of farms in the context of multi-level adaptive governance. We define adaptive governance as adjustments in decision-making processes at farm level and policy level, through changes in management practices and policies in response to identified challenges and the delivery of desired functions (e.g. private and public goods) to be attained. The aim of the study is twofold. First, we investigate how adaptive governance processes at farm level and policy level influence the resilience capacity of farms in terms of robustness, adaptability and transformability. Second, we investigate the “fit” between the adaptive governance processes at farm level and policy level to enable resilience. We study primary egg and broiler production in Sweden taking into consideration economic, social and environmental challenges. We use semi-structured interviews with 17 farmers to explain the adaptive processes at farm level and an analysis of policy documents from the Common Agricultural Policy program 2014–2020, to explain the intervention actions taken by the Common Agricultural Policy. Results show that neither the farm level nor policy level adaptive processes on their own have the capacity to fully enable farms to be robust, adaptable and transformable. While farm level adaptive processes are mainly directed toward securing the robustness and adaptability of farms, policy level interventions are targeted at enabling adaptability. The farm- and the policy level adaptive processes do not “fit” for attaining robustness and transformability.

Behavioral Economic Approaches to Childhood Obesity Prevention Nutrition Policies: A Social Ecological Perspective.

Childhood obesity is a significant public health concern associated with the development of the leading causes of death. Dietary factors largely contribute to childhood obesity, but prevention interventions targeting these factors have reported relatively small effect sizes. One potential explanation for the ineffectiveness of prevention efforts is lack of theoretical grounding. Behavioral economic (BE) theory describes how people choose to allocate their resources and posits that some children place higher value on palatable foods (relative reinforcing value of food) and have difficulty delaying food rewards (delay discounting). These seemingly individual-level decision making processes are influenced by higher-level variables (e.g., environment/policy) as described by the social ecological model. The purpose of this manuscript is to provide a theoretical review of policy-level childhood obesity prevention nutrition initiatives informed by BE. We reviewed two policy-level approaches: (1) incentives-/price manipulation-based policies (e.g., sugary drink tax, SNAP pilot) and (2) healthful choices as defaults (Healthy Hunger Free Kids Act/National School Lunch Program, advertising regulations, default items). We review current literature as well as its limitations and future directions. Exploration of BE theory applications for nutrition policies may help to inform future theoretically grounded policy-level public health interventions.