Health-related Policies Research Articles

Engaging Stakeholder Advisors Around Health-Related Social Needs Research, Policy, and Practice Priorities.

As health care systems invest significant resources to address social needs associated with poor health such as food, financial, and housing insecurity, many eligible patients are still not obtaining the resources they need. The recently initiated PURPLE Project (Promoting Understanding in Social Needs Research Projects by Listening and Engaging) engages stakeholder advisors to help address 2 challenges: (1) many patients do not accept offered assistance, and (2) of patients who accept assistance, less than half have their needs addressed. This article presents the team's engagement with local advisors, garnering real-life insights from patients with social needs, staff and leadership in public health, health care, and community service organizations. The team shares these organizations' priorities and recommendations and how these can be applied to these major challenges. This article can assist others in the social care arena who seeks to involve local partners as advisors to improve practices and policies in addressing social needs.

Promoting the systematic use of real-world data and real-world evidence for digital health technologies across Europe: a consensus framework.

Despite the acceleration in the use of digital health technologies across different aspects of the healthcare system, the full potential of real-world data (RWD) and real-world evidence (RWE) arising from the technologies is not being utilised in decision-making. We examine current national efforts and future opportunities to systematically use RWD and RWE in decision-making in five countries (Estonia, Finland, Germany, Italy and the United Kingdom), and then develop a framework for promotion of the systematic use of RWD and RWE. A review assesses current national efforts, complemented with a three-round consensus-building exercise among an international group of experts (n1 = 44, n2 = 24, n3 = 24) to derive key principles. We find that Estonia and Finland have invested and developed digital health-related policies for several years; Germany and Italy are the more recent arrivals, while the United Kingdom falls somewhere in the middle. Opportunities to promote the systematic use of RWD and RWE were identified for each country. Eight building blocks principles were agreed through consensus, relating to policy scope, institutional role and data collection. Promoting post-market surveillance and digital health technology vigilance ought to rely on clarity in scope and data collection with consensus reached on eight principles to leverage RWD and RWE.

Implementation of Prevention Science to Eliminate Health Care Inequities in Achieving Cardiovascular Health: A Scientific Statement From the American Heart Association.

Prevention of cardiovascular and related diseases is foundational to attaining ideal cardiovascular health to improve the overall health and well-being of individuals and communities. Social determinants of health and health care inequities adversely affect ideal cardiovascular health and prevention of disease. Achieving optimal cardiovascular health in an effective and equitable manner requires a coordinated multidisciplinary and multilayered approach. In this scientific statement, we examine barriers to ideal cardiovascular health and its related conditions in the context of leveraging existing resources to reduce health care inequities and to optimize the delivery of preventive cardiovascular care. We systematically discuss (1) interventions across health care environments involving direct patient care, (2) leveraging health care technology, (3) optimizing multispecialty/multiprofession collaborations and interventions, (4) engaging local communities, and (5) improving the community environment through health-related government policies, all with a focus on making ideal cardiovascular health equitable for all individuals.

Evaluating patient safety research performance in Arab world countries: Changing trends and reflections.

Patient safety is a major concern in health care. Research is an important tool to minimize preventable errors. Research performance and trends evaluation need to be identified for future guidance. Our objective was to evaluate the research performance in Arab World countries related to patient safety so that real picture is available to all stake holders for future application. This was a descriptive exploratory study carried at King Abdulaziz University Jeddah, using Bibliometric analyses on Web of Science extracted data, exploring the research publications related to Patient Safety from the Arab World in last two decades (2001-2020). Digital resources were used. Data collected was further explored to see the trends. Only 2% of total worldwide publications on Patient Safety were from Arab World. A positive trend, however, has emerged since 2015. Out of 5940 documents identified, only 383 had single authorship. Egypt and Saudi Arab were the major contributors. Other countries had less or even zero publications. Researchers are coordinating with others in Western countries to enhance the research productivity. Cairo University with 734 publications had most affiliations. Publications on safety culture and medication safety were frequent. Hospital Acquired Infections and error reporting had limited research. Researches on patient safety in the Arab World are not sufficient. Countries other than Egypt and Saudi Arabia also need to contribute more frequently. Critical problems, like Hospital Acquired Infections, should have regular research from all countries to assist those treating patients and those making health related policies.

A comparison study of environmental health related issues and policies between private and public U.S. schools using multi-level data

ObjectiveLittle is known about school environmental health (EH) problems in private schools. This study identified and compared the school EH related issues and policies between private and public schools in the U.S. MethodsSchool EH information was collected from school administrators on two levels – in New York State (NYS) and nationwide. In NYS, questionnaires were developed and distributed to administrators from both public and private schools via conferences (2015–2016). Nationwide survey data were obtained from the 2014 School Health Policies and Practices Study. We compared the perceived school environment as well as policies related to identification and training on EH issues between private and public schools both in NYS and nationwide. ResultsIn NYS, both private and public schools reported limited use of proactive approaches in identifying EH issues. Compared to public schools, more private school respondents reported poorer perceived indoor air quality (IAQ) (30% vs. 0%), along with less routine training and lower use of policies that help improve air quality in school. Nationwide, fewer private schools implemented indoor air quality management programs (18% vs. 58%) and were able to always meet ventilation standards (44% vs. 64%) than public schools. Staff members in private schools received less required training on a wide range of EH issues than staff members in public schools. ConclusionU.S. private schools reported worse perceived indoor air quality than public schools and a lack of awareness and protective policies. Future environmental research and implementation of policies are needed in private schools.

Independent and interactive effects of ozone and thermal inversion exposure on the risk of gestational diabetes mellitus in Wuhan, China.

The adverse effects of exposure to thermal inversion (TI) and ozone (O3) on human health have been reported; however, there are few studies have explored the independent and potential interactive effects of them on gestational diabetes mellitus (GDM). A total of 31,262 pregnant women from the Wuhan Children's Hospital covering the period from 2017 to 2021 were included in this study. The logistic regression adjusted for the covariates was applied to explore the independent effect of exposure to O3 and TI on GDM. The relative excess risk due to the interaction (RERI) analysis was applied to assess the possible interactive effect. Per 10 μg/m3 increased in O3 (OR = 1.069, 95% CI: 1.049, 1.089) during the first trimester and per 10 days increased in TI (OR = 1.041, 95% CI: 1.005, 1.080) in the second trimester were significantly associated with the risk of GDM. The synergistic effect of exposure to TI and O3 was larger than their sum effect (RERI = 0.330, 95% CI: 0.170, 0.476). This study added further support for public health-related policy to improve maternal health by curbing TI and O3.

Circular Health: exploiting the SDG roadmap to fight AMR.

Circular Health is a novel approach to address complex health issues that is based on the expansion of the One Health Paradigm. Circular health recognizes the need for a multidisciplinary convergence effort to complement the biomedical dimension of health. Antimicrobial resistance (AMR) is one of the greatest global concerns for public health that is likely on the rise, given the extensive use of antibiotics during the early Covid-19 years. Prior to the Covid-19 pandemic, an expert group chaired by Jim O'Neill published "The Review on Antimicrobial Resistance", which contains a final report and recommendations on how to tackle AMR. The report, for the first time, considers AMR from a multi-perspective viewpoint highlighting how it cannot be successfully addressed unless there is a converging approach encompassing many dimensions of the problem. In this perspective, we propose to include the recommendations from that seminal report and other more recent reviews which include the lessons learnt from the Covid-19 pandemic, into the operational framework of the sustainable development goals (SDGs). AMR represents a perfect case study to explore how the SDG roadmap has the potential of becoming the driving force and implementation tool to address complex health issues by pursuing the optimization of resources and actions via a convergent and multi-stakeholder approach. The implementation of health-related policies through the whole spectrum of the SDGs could be both a novel and a well-established framework to inform multi-dimensional policies for more sustainable health in the future.

Suicide in veterinary medicine: A literature review.

Veterinarians are commonly exposed to occupational stressors, including excessive workload and financial constraints. These stressors can lead to psychological distress, which typically results in mental health disorders such as depression, anxiety, and burnout and can even culminate in suicide attempts or suicide deaths. Risk factors associated with poor mental health and high rates of suicide in veterinary practitioners include continuous exposure to challenging scenarios, such as interpersonal conflicts, performing euthanasia, and easy access to lethal means of suicide, such as opioids and anesthetics. The previous studies highlight the urgent need for a better understanding of predisposing factors, mental health-related improvements in the professional environment, and the subsequent establishment of primary mental health-related care policies. Effective ways to promote mental health and prevent suicide may include social support, resilience, developing coping skills, promoting a healthy work environment, and discouraging perfectionist behaviors. This review aimed to summarize findings in studies that have investigated mental health and suicide in veterinarians and veterinary students and highlight measures that could be implemented as options for mental health promotion and suicide prevention.

Screening infection prevention policies for equity impacts

Background: Infection prevention teams utilize policies to guide practice; however, some policies may inadvertently uphold institutional racism and discrimination. Our institution utilizes an equity impact assessment tool during new policy creation or existing policy updates to identify, reduce, eliminate, and prevent inequities in care. Methods: We reviewed all 119 current institution-wide policy documents related to or managed by the infection prevention division at Seattle Children’s Hospital using an institutional equity impact assessment tool. The tool asks 6 open-ended questions to help policy owners identify potential inequities and to evaluate how marginalized groups may be affected. Each policy was assessed for its potential to create or sustain inequities for patients, families, or staff. Policies determined to have potential inequities were examined for any language to suggest that equity considerations had been incorporated into the existing policy. Initial policy review was performed by 2 infection prevention physicians, and disagreements were resolved by consensus. We defined the presence of equity considerations as any explicit mention of disparate impact of the policy on marginalized groups or mitigation of such effect. Results: Of the 119 policies reviewed, 43 (36%) were identified as having substantial potential to impact marginalized groups and create or sustain inequities. Among them, 42 (98%) of these policies lacked existing equity considerations. The policies with potential equity implications covered the following categories: COVID-19 (including masking, workforce restriction, testing), visitor restrictions, tuberculosis, central-line–associated bloodstream infections (CLABSIs), multidrug-resistant organisms (MDROs), public health reporting, medical behavioral unit policies, off-site affiliate housing policies, special pathogens program (including Ebola, MERS, SARS), surgical-site infections, home care including dialysis, and occupational health-related policies. Examples of policies that did not highlight inequities included those pertaining to construction, water intrusion, and transmission-based precautions. One example of change driven by use of the equity impact assessment tool concerned communication with patients and families about tuberculosis isolation and resulted in creation of a standardized multidisciplinary care conference to better communicate tuberculosis isolation processes (including testing required, visitor restrictions, and anticipated duration of isolation) to families in their language of care. Conclusions: Hospital-wide infection prevention policies have the potential to create or sustain existing inequities. Systematic consideration of equity implications using an equity impact assessment framework could be the first step in mitigating these effects and can result in concrete actions to reduce systemic racism.Disclosure: None

Essential and forgotten. Domestic work and the impact of policy responses during the COVID-19 pandemic in Spain and Italy

Results from the European project RESISTIRÉ show that the pandemic outbreak and policies adopted to contain the virus have reinforced pre-existing gender inequalities, resulting in a “spiral of increasing inequalities” (Axelsson et al., 2021: 110). The care domain is a key part of this spiral and has been at the centre of debates and of some of the COVID-19 policy responses. However, for the most part, policy interventions in the care domain have focused primarily on work-life balance, neglecting the impact of health-related policy restrictions on domestic workers – a highly feminised and racialised sector. Yet these workers have been dramatically affected by the pandemic and related policies, not only in terms of exposure to infection, but also in terms of exacerbation of pre-existing and intersecting inequalities. Moreover, when policies did address the domestic sector, they often reproduced gender stereotyped understandings of the nature of care work, and reinforced racist assumptions on migration. This paper compares the policies on domestic workers enacted during the pandemic in Italy and Spain, which illustrate how public policy engages in gendering and racializing domestic workers. Drawing on Bacchi’s methodology, it seeks to unfold and problematise the representations and implicit assumptions related to care work, and the gender and racial hierarchies underpinning them.

Digital health, digital medicine, and digital therapeutics in cardiology: current evidence and future perspective in Japan.

Ten years passed since Japan set out the Action Plan of Growth Strategy that declared the initiatives of digitalization for medicine, nursing care, and healthcare to achieve the world's most advanced medical care. The initiatives formed the foundation of the Japanese national strategy and have been continuously refined, resulting in the current environment of digital health and digital medicine. Digital health-related terminologies are organized, such as "digital health," "digital medicine," and "digital therapeutics" (DTx), as well as several common digital technologies, including artificial intelligence, machine learning, and mobile health (mHealth). DTx is included in mHealth and is a novel disease treatment option. Also, this article thoroughly describes DTx in Japan and compares it with those in the US and Germany, the leading countries in digital health-related policies, regulations, and their development status. In Japan, two of three DTx applications that have been approved and reimbursed by the Ministry of Health, Labor, and Welfare are explained in detail in relation to cardiovascular medicine. When added to a standard smoking cessation program, the DTx system for nicotine dependence significantly improved the continuous abstinence rate. Moreover, the DTx for hypertension together with the guideline-based hypertension management was effective in patients aged 65 years or younger who were diagnosed with essential hypertension without antihypertensive agents, and it was also found to be cost-effective. DTx in cardiovascular medicine, with consideration on safety, efficacy, and cost-effectiveness, could be widely used not only through basic experiments and clinical studies but also through social implementation.

Social capital and loneliness among older adults in community dwellings and nursing homes in Zhejiang Province of China.

Loneliness is an important problem afflicting the health of older adults, and has been proven to be associated with social capital. Previous research in China rarely investigated the differences of social capital and loneliness between older adults living in community dwellings and nursing homes. This study aims to examine the status of social capital and loneliness among older adults living in community dwellings and nursing homes, and analyze the relationship between them. A total of 1,278 older adults were recruited for the study from the cities of Hangzhou, Huzhou, and Lishui in Zhejiang Province of China from July to October 2021 by using multi-stage stratified random sampling. Questionnaires were used to collect data on the participants' sociodemographic characteristics, social capital, and loneliness. Hierarchical multiple regression was used to examine the relationship between social capital and loneliness. The interaction of social capital and institutionalization on loneliness was also explored. Compared with community-dwelling older adults, institutionalized older adults had higher levels of loneliness and lower degrees of social support, social connection, trust, cohesion, and reciprocity. A further analysis of the social capital showed that low levels of social support, trust, and cohesion were related to high levels of loneliness among adults in both community dwellings and nursing homes. Social connection was negatively correlated with loneliness among older adults living in community dwellings. Institutionalization itself demonstrated a strong effect on loneliness. Health-related policies should help older adults gain more social support, trust and cohesion to alleviate their loneliness. This is particularly crucial for older adults living in nursing homes, as they have higher levels of loneliness and lower levels of social capital than noninstitutionalized older adults.

Moving towards social dentistry: How do dentists perceive the Montreal-Toulouse model?

This study aimed to understand the perspectives of dentists towards the Montreal-Toulouse model, an innovative approach that encompasses person-centredness and social dentistry. This model invites dentists to take three types of actions (understanding, decision-making, intervening) on three overlapping levels (individual, community, societal). This study aimed to understand (a) How dentists perceived the Montreal-Toulouse model as a framework for the practice of dentistry and (b) What parts of this model they were ready to adopt in their own practice. A qualitative descriptive study was conducted based on semi-structured interviews with a sample of dentists in the Province of Quebec, Canada. A combination of maximum variation and snowball sampling strategies was employed and 14 information-rich participants were recruited. The interviews were conducted and audio-recorded through Zoom and lasted approximately 1 h and a half. The interviews were transcribed verbatim and thematically analysed through a combination of inductive and deductive coding. The participants explained they valued person-centred care and tried to put the individual level of the Montreal-Toulouse model into practice. However, they expressed little interest in the social dentistry aspects of the model. They acknowledged not knowing how to organize and conduct upstream interventions and were not comfortable with social and political activism. According to them, advocating for better health-related policies, while a noble act, 'was not their job'. They also highlighted the structural challenges that dentists face in fostering biopsychosocial approaches such as the Montreal-Toulouse model. To promote the Montreal-Toulouse model and empower dentists to address social determinants of health, an educational and organizational 'paradigm shift' towards social accountability might be necessary. Such a shift requires curricular modifications and reconsidering traditional teaching approaches in dental schools. Moreover, dentistry's professional organization could facilitate dentists' upstream actions through proper resource allocation and openness to collaboration with them.

Cerebral palsy as a public health indicator.

Cerebral palsy as a public health indicator.

A Review on Community Care for Chronic Disease Management Based on Digital Health Care: For Elderly Living Alone

In the face of aging, it can be difficult for the elderly to accept and cope with changes. During the coronavirus disease 2019 (COVID-19) pandemic, changes in the medical service market for health care such as non-face-to-face treatment implementation, education and counseling, seminars, and camps have accelerated. Changes in medical use through mobile phones, tablet PCs, wearable devices, etc. were inevitable. It is important to study how the current early elderly population maintains change in daily life and the extent to which elderly people living alone can participate in such change. This review aims to answer the question, “What should we consider when treating and consulting patients regarding use of the vastly changing medical environment?” In particular, the study focuses on digital healthcare and community care and related health and welfare policies with consideration of aging and increasing chronic diseases.

Expanding school wellness policies to encompass the Whole School, Whole Community, Whole Child model.

Schools influence children's developmental outcomes across multiple domains, including academic, social, emotional, behavioral, and physical. School district wellness policies are powerful mechanisms that set clear expectations for health-related practices in school buildings and the surrounding community. A current challenge is that many health-related school policies are narrow, siloed, and reactive instead of proactive. In this paper, we: (a) describe how written food, nutrition, and physical activity district and state policies were strengthened in the United States in response to specific concerns about childhood obesity; (b) present how schools have historically addressed policies concerning children's social, emotional, and behavioral health; and (c) propose using the Whole School, Whole Community, Whole Child (WSCC) model to strengthen the coordination and integration of school wellness policies. We conclude by describing recently developed tools to assist school districts in implementing the WSCC model. The Wellness School Assessment Tool (WellSAT) WSCC is a quantitative measure that districts can use to code their current written policies for alignment with the WSCC model. The WSCC Policy and Practice Blueprints are action planning tools that lead school and district leaders through a series of activities to strengthen the implementation of coordinated and integrated policies and practices. By using the WSCC model and accompanying implementation tools, schools can support the development of the whole child.

Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa

BackgroundOut of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women’s decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women’s decision-making autonomy and health insurance enrollment. We, therefore, investigated the association between married women’s household decision making autonomy and health insurance enrollment in SSA.MethodsDemographic and Health Survey data of 29 countries in SSA conducted between 2010 and 2020 were analyzed. Both bivariate and multilevel logistic regression analyses were carried out to investigate the relationship between women’s household decision-making autonomy and health insurance enrollment among married women. The results were presented as an adjusted odds ratio (AOR) and the 95% confidence interval (CI).ResultsThe overall coverage of health insurance among married women was 21.3% (95% CI; 19.9-22.7%), with the highest and lowest coverage in Ghana (66.7%) and Burkina Faso (0.5%), respectively. The odds of health insurance enrollment was higher among women who had household decision-making autonomy (AOR = 1.33, 95% CI; 1.03–1.72) compared to women who had no household decision-making autonomy. Other covariates such as women’s age, women’s educational level, husband’s educational level, wealth status, employment status, media exposure, and community socioeconomic status were found to be significantly associated with health insurance enrollment among married women.ConclusionHealth insurance coverage is commonly low among married women in SSA. Women’s household decision-making autonomy was found to be significantly associated with health insurance enrollment. Health-related policies to improve health insurance coverage should emphasize socioeconomic empowerment of married women in SSA.

Research objectives and general considerations for pragmatic clinical trials of pain treatments: IMMPACT statement.

Many questions regarding the clinical management of people experiencing pain and related health policy decision-making may best be answered by pragmatic controlled trials. To generate clinically relevant and widely applicable findings, such trials aim to reproduce elements of routine clinical care or are embedded within clinical workflows. In contrast with traditional efficacy trials, pragmatic trials are intended to address a broader set of external validity questions critical for stakeholders (clinicians, healthcare leaders, policymakers, insurers, and patients) in considering the adoption and use of evidence-based treatments in daily clinical care. This article summarizes methodological considerations for pragmatic trials, mainly concerning methods of fundamental importance to the internal validity of trials. The relationship between these methods and common pragmatic trials methods and goals is considered, recognizing that the resulting trial designs are highly dependent on the specific research question under investigation. The basis of this statement was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) systematic review of methods and a consensus meeting. The meeting was organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership. The consensus process was informed by expert presentations, panel and consensus discussions, and a preparatory systematic review. In the context of pragmatic trials of pain treatments, we present fundamental considerations for the planning phase of pragmatic trials, including the specification of trial objectives, the selection of adequate designs, and methods to enhance internal validity while maintaining the ability to answer pragmatic research questions.

Higher education students’ perceptions of issues related to Covid-19: A study on three Portuguese-speaking countries

In early 2020, a pandemic caused by the new coronavirus SARS-CoV-2 affected the world and all countries had to adopt important measures to face a disease named COVID-19. This paper aims at investigating the perceptions about key issues related to COVID-19 held by students attending the third year of three different areas of undergraduate studies at higher education institutions of three Portuguese-speaking countries: Brazil, Mozambique and Portugal. Four hundred and forty university students participated in the study by answering to a questionnaire. They were attending undergraduate programs in the areas of education/pedagogy, natural sciences, and social sciences. Differences emerged among participants of different nationalities and areas of study. Brazilians and education undergraduates showed perceptions that are more consistent with the knowledge base available so far. Health related policies and local culture seem to influence participants’ perceptions regarding COVID-19 issues, which are not directly related to the extent of the science component of participants’ study programs. The latter relationship should be further studied, in order to uncover what needs to be improved in undergraduates’ education to ensure that they develop a good awareness of socio-scientific issues that are relevant for their personal and societal lives.

The Role of Wellness Teams in Promoting Health and Wellness Implementation Strategies in Elementary Schools in Chicago.

Strategies used by wellness teams (WTs) to foster local wellness policy (LWP) implementation have been documented, yet there remains a need to better understand how WTs respond to district-level LWP requirements, particularly when bundled with additional health-related policies. This study's goal was to explore how WTs implement Healthy Chicago Public School (CPS), a district-led initiative focused on both LWP and other health policy implementation in the CPS district, one of the most diverse in the nation. Eleven discussion groups were conducted with WTs in CPS. Discussions were recorded, transcribed, and thematically coded. Six overarching strategies used by WTs in working to achieve Healthy CPS include: (1) using district guides and resources to support planning, progress monitoring, and reporting; (2) under the leadership of wellness champions, as required by the district, facilitating engagement among staff, students, and/or families; (3) taking district guidance and adapting and integrating it into their schools' existing structures, curricula, and practices, often taking a holistic approach; (4) fostering linkages in the communities surrounding their schools to supplement internal school capacities; and (5) stewarding resources, time, and staff for sustainability. Strategies for LWP implementation by WTs in urban and diverse schools include planning for staff turnover, integrating health and wellness into existing curricula and structures, and leveraging relationships with the local community. WTs can play a critical role in supporting schools in diverse, urban districts to implement district-level LWP and the plethora of related policies that schools are subject to at the federal, state, and district levels.