National Public Health System Research Articles

Documenting COVID-19 for Posterity: A Review of the Types of Fitted Face Masks Worn in Albury (Australia)

As the COVID-19 pandemic begins to abate and national public health systems are treating the SARS-CoV-2 virus as endemic, many public health measures are no longer mandated but remain recommended with voluntary participation. One of these is the wearing of fitted face masks, initially mandated to contain, or at least slow, the spread of SARS-CoV-2, which is primarily transmitted via aerosols emitted while breathing, coughing, or sneezing. Although the habit of once wearing fitted face masks recedes into memory for much of the population, so does the knowledge of the various types of masks that were once en vogue. To create a record for the future, this paper provides the first comprehensive documentation of the nature and range of fitted facemasks that circulated during the COVID-19 pandemic.

ASO Visual Abstract: Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System.

ASO Visual Abstract: Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System.

The role of the high-level public health school in the development of the Center for Disease Control and Prevention

The Ministry of Education and other four departments jointly issued the Notice on the Construction of high-level schools of public Health, proposing that "it will take ten years to build a number of high-level schools of public health, and form a high-quality education development system to adapt to the construction of modern public health system". At present, the construction of high-level public health schools in various universities in China is in full swing. The high-level School of Public Health and the CDC have played an important role in constructing the national public health system and the human health community. The high-level public health schools are of strategic significance and important value to the development of the CDC. The review presents reflections and insights on the role of high-level public health schools in the development of the CDC and the challenges they might face.

Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System.

Prostate cancer (PCa) is the most common malignant tumor in males and conventional imaging does not provide accurate primary staging. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) presents superior performance and strongly affects therapeutic choice. The aim of this study was to evaluate the impact of PSMA PET, compared with conventional imaging methods, on the therapeutic approach in primary staging scenarios in patients with PCa treated at the Brazilian National Public Health System. Overall, 35 patients diagnosed with PCa were evaluated using PSMA after conventional staging imaging with multiparametric magnetic resonance (MMR) and/or total abdominal computed tomography (CT) scan and bone scintigraphy (BS). The PCa extension identified by PET was compared with conventional imaging; staging changes and the management impact were then determined. PET comparison with conventional imaging, staging, and decision-making changes was analyzed using descriptive statistics. PET revealed local disease (LD) in 15 (42.9%) patients, seminal vesicle invasion (SVI) in 5 (14.3%) patients, pelvic nodal impairment (PNI) in 7 (20%) patients, pelvic and distant nodes in 3 (8.6%) patients, pelvic nodes and bone metastasis in 4 (11.4%) patients, and pelvic and distant nodes and bone metastasis in 1 (2.8%) patient. Staging changes were observed in 60% of patients, with downstaging predominance (76.2%). Volume increase was identified in 11 (31.4%) patients (only 4 related to upstaging, 36.4%). The board changed management decisions for 60% of the patients. The main limitations of this study were the sample size and its retrospective nature. PSMA findings changed the management decisions in more than half of the patients, which made the majority eligible for locoregional treatment and avoided unnecessary procedures in the systemic disease scenario.

Enhancing the nation's public health information infrastructure: a report from the ACMI symposium.

The COVID-19 pandemic exposed multiple weaknesses in the nation's public health system. Therefore, the American College of Medical Informatics selected "Rebuilding the Nation's Public Health Informatics Infrastructure" as the theme for its annual symposium. Experts in biomedical informatics and public health discussed strategies to strengthen the US public health information infrastructure through policy, education, research, and development. This article summarizes policy recommendations for the biomedical informatics community postpandemic. First, the nation must perceive the health data infrastructure to be a matter of national security. The nation must further invest significantly more in its health data infrastructure. Investments should include the education and training of the public health workforce as informaticians in this domain are currently limited. Finally, investments should strengthen and expand health data utilities that increasingly play a critical role in exchanging information across public health and healthcare organizations.

Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems.

Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems.

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

Investigação sobre Atenção Primária durante a pandemia em territórios vulneráveis de Campinas, São Paulo e Rio de Janeiro, Brasil

Abstract The COVID-19 pandemic found favourable conditions to spread in Brazil. A lack of coordinated action by the federal government, together with already weak Primary Health Care (PHC) had consequences for workers and users. This study examined PHC management and work process in response the COVID-19 pandemic in three municipalities, in view of the history of how PHC was set up, its relationship with the national public health system (SUS), and PHC and social activism in vulnerable territories, from the perceptions of users and workers. The study included a literature search, participant observation and 97 in-depth interviews of PHC workers and users. The results were organised into four areas: PHC implementation and management in the municipalities; the PHC work process; workers’ and users’ perceptions of PHC and the SUS; and territories, organised groups and social activism. Workers faced an environment of fear, overwork and changes in their work process, none of which prevented them from persisting and reinventing their practice. Users encountered barriers to access and difficulties in complying with public health measures, but the study found experiences of organised groups that emerged as means of coping with the pandemic.

Opportunities and challenges for psychotherapy in Aotearoa New Zealand’s new health system


 
 
 The dawning of a new national public health system in Aotearoa New Zealand offers opportunities and challenges for psychotherapists. This paper discusses these against three data sets, namely, a 2022 national District Health Board psychotherapy workforce survey, a video recording of the Psychotherapy and Public Worlds panel event at the 2022 New Zealand Association of Psychotherapists’ (NZAP) conference, and psychotherapist registration statistics supplied by The Psychotherapists Board of Aotearoa New Zealand (PBANZ). The expansion of short-term, risk-based, manualised interventions during the former DHB era did not improve mental health at a community level (Mulder et al., 2022) nor promote equity and sustainability (Berg et al., 2022). Placing Te Tiriti o Waitangi, the Treaty of Waitangi (1840) (Te Tiriti) at the centre of the new health system suits psychotherapy, whose wholistic worldview of health and wellbeing aligns with te ao Māori better than most other Western psychological approaches. Kōrero about the indigenising of psychotherapy in Aotearoa has been around since at least the 1980s. The Ministry of Health (the Ministry) has recently invited psychotherapists’ advice on workforce policy development and how to promote psychotherapy in the new health system. This task will largely fall on the psychotherapy associations and some psychotherapy training organisations. A major challenge may be whether these entities can sustain the expenditure of human and other resources necessary to represent their memberships in continuing dialogue with the Ministry and its operational partners, Te Whatu Ora, Health New Zealand (Te Whatu Ora) and Te Aka Whai Ora, Māori Health Authority (Te Aka Whai Ora). Key opportunities include the recruitment of overseas psychotherapists and the greatly expanded provision of psychotherapy student placements in public health services to stimulate new psychotherapy training programmes and workforce growth.
 
 

ELEVATING HEALTHY AGING: HOW PUBLIC HEALTH IS SUPPORTING OLDER ADULTS

Abstract Trust for America’s Health (TFAH) leads the national Age-Friendly Public Health Systems initiative which focuses on expanding the public health role in healthy aging. The roles of public health include creating and leading policy, systems, and environmental changes; connecting and convening multi-sector stakeholders to improve older adult health and well-being; and collecting and translating data on older adult health to inform interventions in communities and states. TFAH will share examples of how public health departments are elevating healthy aging as a core function.

Maternal morbidity under an absolute abortion ban: insights from a 6-year case series of fatal fetal malformations in El Salvador

A striking number of national and subnational governments that previously allowed legal abortion in cases of severe fetal anomaly have passed new legislation to explicitly remove these allowances. However, we know little about the maternal health implications of such restrictions. This study aimed to examine the health outcomes of pregnant individuals in El Salvador whose fetuses were diagnosed with a fatal congenital malformation and who were legally required to carry these nonviable pregnancies to term under the nation's absolute abortion ban. We reviewed the charts of all 239 pregnancies with fetuses classified as having 1 of 18 congenital malformations typically considered to be incompatible with extrauterine life that were evaluated at the National Women's Hospital in El Salvador between January 1, 2013 and December 31, 2018. Because regional healthcare providers who identify pregnancy complications in El Salvador are instructed to refer those patients to the National Women's Hospital, our analysis captured the total population of lethal fetal malformations treated by the national public health system. We documented pregnant patients' socioeconomic characteristics, pregnancy-related complications, and the medical procedures used to mitigate complications. Individuals who were required to carry pregnancies with severe fetal malformations to term (or until preterm labor began naturally) experienced high rates of maternal morbidity. More than half (54.9%) of pregnancies experienced at least 1 serious pregnancy-related health complication, whereas 47.9% underwent a physically-invasive medical procedure to manage complications, including cesarean deliveries, decompression amniocenteses, fetal head decompressions, and, in 1 case, a full hysterectomy. A total of 9% of patients opted to discontinue care after receiving the diagnosis of fatal fetal malformation. We also found striking variation in how physicians managed pregnancies with fatal fetal malformations, suggesting that different interpretations of the law lead to inequities in individual-level patient care. Laws prohibiting abortions in cases of severe fetal malformation can increase risks to pregnant patients by requiring clinicians to subject healthy patients to a course of treatment that generates morbidity.

Investigation of stillbirths in Brazil: A systematic scoping review of the causes and related reporting processes in the past decade.

Recognizing the causes of stillbirths and their associated conditions is essential to reduce its occurrence. To describe information on stillbirths in Brazil during the past decade. A literature search was performed from January 2010 to December 2020. Original observational studies and clinical trials. Data were manually extracted to a spreadsheet and descriptive analysis was performed. A total of 55 studies were included; 40 studies (72.2%) used the official data stored by national public health systems. Most articles aimed to estimate the rate and trends of stillbirth (60%) or their causes (55.4%). Among the 16 articles addressing the causes of death, 10 (62.5%) used the International Classification of Diseases; most of the articles only specified the main cause of death. Intrauterine hypoxia was the main cause reported (ranging from 14.3% to 54.9%). Having a national system based on compulsory notification of stillbirths may not be sufficient to provide quality information on occurrence and, especially, causes of death. Further improvements of the attribution and registration of causes of deaths and the implementation of educational actions for improving reporting systems are advisable. Finally, expanding the investigation of contributing factors associated with stillbirths would create an opportunity for further development of prevention strategies in low- and middle-income countries such as Brazil.

Epidemiology of hydrocephalus in Brazil

ObjectiveDescribe the epidemiological profile and social-economic burden that hydrocephalus patients represent to the national public health system, using data available at the online database of the Brazilian Health Ministry (DataSUS). MethodsThis is a populational study based on descriptive statistics of all clinical and surgical appointments included in the DataSUS database. Data included herein were collected between 2015 and 2021 and subdivided into three main groups, related to hydrocephalus incidence and mortality, hospitalizations, and financial costs. ResultsIn the study period, 3993 new cases of congenital hydrocephalus were diagnosed, with 6051 deaths overall. The mortality rate in the country was 1.5/100000 live births and the prevalence was 0.374/100000 inhabitants. The number of hospitalizations resulting from treatment procedures and complications of hydrocephalus was 137,880 and there was a reduction of up to 27.2% during the SARS-CoV-2 pandemics concerning previous years. Total costs for hydrocephalus management in the country amounted to 140,610,585.51 dollars. ConclusionsHydrocephalus has a significant impact on public health budgets and pediatric mortality rates; however, it is probably underestimated, due to the paucity of demographic data and epidemiological studies in Latin America and, specifically, in Brazil. The dataSUS also has several limitations in accessing certain data related to hydrocephalus, making it difficult to have a more assertive understanding of the disease in Brazil. The results of this study provide important guidance for future research projects in clinical and experimental hydrocephalus and also the creation of public policies for better governance and care of hydrocephalus patients.

PP13 Development Of Recommendations And Proposal For A Value-Based Managed Entry Agreement For Italian Setting

IntroductionThe continuous and pressing challenge that the drug regulatory authorities in Italy and in Europe are facing is that of guaranteeing patients’ quick access to new drugs, ensuring the economic sustainability of the system at the same time. In recent years, flexible and diversified approaches have been developed known as Managed Entry Agreements (MEA).MethodsWe performed an analysis of the Italian legislative and regulatory aspects in reference to a new Value-based Managed Entry Agreement (VBMEA) pathway. Thus, we tried to investigate the rationale for a new pathway analyzing three main dimensions related to the new medical product (MP): value; time to entry access; and, data quality and registry design. Moreover, we shared the discussion of the proposal with an international experts’ panel.ResultsThe proposal for a new pathway of VBMEA from a procedural point of view shows the novelty related to the possibility to organize joint CTS (Technical Scientific Committee) and CPR (Price and Reimbursement Committee) assessment. A 24-month contract with an ex-factory price (PP) equal to X EUR per dose and a transfer price to the National Public Health System (NPHS), following application of a confidential discount for public structures (-X%), of X EUR per dose. After 24-months, an analysis of VBMEA is carried out. The price of the MP is therefore established based on AIFA registries and VBMEA results. The cost value incurred by the NPHS, intended as the difference between the price in market (entry) access phase and the price negotiated (PVB) in the light of the VBMEA results, shall be returned by the pharmaceutical company in the form of a payback.ConclusionsCurrently, MEAs represent one of the main topics of discussion between the European National Payers Authorities. There is very little information on product performance that results from MEAs. This research project could provide advice to policy makers to decrease negotiation time by ensuring earlier access to innovation for patients.

Building a National Public Health System in the United States

(Abstracted from N Engl J Med 2022;387:385–388) This article presents the report of a blue-ribbon commission selected by the Commonwealth Fund. The first author of this report, Margaret Hamburg, is the chairman of the commission.

A Study on CKD Progression and Health Disparities Using System Dynamics Modeling.

Chronic kidney disease (CKD) is one of the most prevalent national health problems in the United States. According to the Center for Disease Control and Prevention (CDC), as of 2019, 37 million of the US’s adult population have been estimated to have CKD. In this respect, health disparities are major national concerns regarding the treatments for patients with CKD nationwide. The disparities observed in the healthcare interventions for patients with this disease usually indicate some significant healthcare gaps in the national public health system. However, there is a need for immediate intervention to improve the present healthcare conditions of minorities experiencing CKD nationwide. In this research, the application of system dynamics modeling is proposed to model the CKD progression and health disparities. This process is based on the health interventions administered to minorities experiencing CKD. The graphical results from the model show that there are relationships among the dynamic factors influencing the incidence and prevalence of CKD. Hence, healthcare disparities are inherent challenges in the treatment and management of this disease.

Circular Policy: A New Approach to Vector and Vector-Borne Diseases' Management in Line with the Global Vector Control Response (2017-2030).

Integrated Vector Management (IVM) has yielded exemplary results in combating and preventing vector-borne diseases (VBDs) and their vectors. It’s success and positive outcomes depend on the sound planning, implementation, enforcement, and validation of the locally adapted vector control efforts from the involved national sectors and stakeholders. Nevertheless, current realities create several implications impeding IVM’s performance. Hence, there is a need to adjust local IVM plans to several factors, such as (i) the rapidly changing and unpredictable environmental conditions (i.e., climate change, shift on species distribution, invasive species—Anopheles stephensi, Aedes aegypti and Ae. albopictus); (ii) the environmental impacts from human activities (i.e., fossil fuel use, food sources, industry, land use, urbanization and deforestation); (iii) changes in human demographics and the international movement of people (travelers and forcibly displaced persons due to conflicts and severe weather) increasing the risk of contracting and transmitting vector-borne diseases and shifting humanitarian emergencies and societal demands; (iv) the SARS-CoV2 pandemic outbreak and the implication on national public health systems; (v) the continuous flow of technological advancements and newly acquired knowledge; (vi) the realization of the strong link between planetary health and public health. Addressing these factors in IVM can become difficult, taking into consideration the numerous involved sectors, stakeholders, and fields in the management of vectors and vector-borne diseases (VBD). This document proposes and discusses the aspects and steps of a holistic approach, referenced as the Circular Policy, for national and local IVM strategies to be effective and adaptable, capable of providing the optimum outcomes.

Building a Strong Foundation for Public Health Transformation.

Building a Strong Foundation for Public Health Transformation.

EE25 Economic Evaluation on the Use of Standard Lyophilized Bacterial Lysates for Recurrent Respiratory Infections Prevention in Pediatric Patients

To develop a complete economic evaluation on the use of bacterial lysates for upper recurrent respiratory infections (URRI) prevention in pediatric patients from the Mexican national public health system.

Expenditures on the treatment of encephalon malignant neoplasia by the Brazilian public health system (2008-2017)

Introduction: Encephalon malignant neoplasia (EMN) is a harmful type of cancer and its most aggressive phenotypes lead to the demise of patients in 12-18 months despite the use of state-of-the-art therapies, which remain inefficient and expensive for patients, families and health systems. Objectives: The aim of this work was to analyze the expenditures of the Brazilian Sistema Único de Saúde (SUS), the national public health system, on EMN patients compared to all neoplasia patients over a span of ten years (2008 to 2017). Methodology and resources: Monthly data were collected from the SUS data base DATASUS from 2008 to 2017 and analyzed with regard to EMN and general neoplasia for the following categories: value of total expenditures; number of hospitalizations; mean value of hospitalizations; mean of monthly permanence time and death rate. Results: More than 0.3% of SUS costs were directed to EMN patients, although they represented 0.1% of total hospitalizations. The mean value of hospitalization of EMN patients was almost 80% that of general neoplasia patients and hospitalization time was twice that of general neoplasia patients. Moreover, EMN patients had a death rate almost four times higher than that of general neoplasia patients. Discussion and conclusion: EMN therapies remained expensive and lacked efficacy in the time period under analysis, with a disproportionate share of SUS expenditure being dedicated to these patients. Improving the effectiveness of treatment requires drug repurposing and adjuvant chemotherapy—in addition to radiotherapy and the use of monoclonal antibodies.Keywords: Encephalon malignant neoplasia; Cancer treatment costs; SUS.