Search

In the definition of health policies and decision-making on the part of health officials, there is often a prevailing separation between clinical practice, epidemiology, and public health. Although this division is naturalized from the viewpoint of hospitals and public agencies, it is artificial in the context of concrete territories and communities, where problems are not structured according to the fragmentation of knowledge, but rather express the complexities of the problems faced by individuals and population groups. In this context, this article compiles and analyzes studies on the ecology of medical care carried out between 1928 and 2018 that have revisited the pioneering study "The ecology of medical care" by White, Williams and Greenberg. The discussion is structured around three central issues: 1) recurrent themes in studies on the ecology of medical care; 2) health information systems and health surveys; and 3) the institutional hegemony of hospitals in the health field.

Within the framework of the 2030 Agenda for Sustainable Development, goals were formulated, including those targeting to improve quality of life of people all around the world. The task was formulated to ensure universal coverage of health services. In 2019, the United Nations General Assembly noted that at least half of world's population have no access to basic health services. The study developed methodology to carry out comprehensive comparative analysis of values of individual public health indicators and amount of population payments for medications to confirm possibility of applying these indicators to monitor public health, including possibility of international comparisons. The study demonstrated inverse relationship between share of citizens' funds to pay for medications, index of universal health coverage and life expectancy. The stable direct relationship between such indicators as overall mortality rate from non-communicable diseases and likelihood of dying at the age of 30-70 years from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases.

The article discusses two main problems of organizing medical care in national health care of Russia: medical and social monitoring of morbidity and mortality; key performance indices of public health in the Russian Federation. Methodologically, the article is based on interdisciplinary scientific approach that allows to study medical, social and economic components of public health, considering observed trends: digitalization of health care and epidemic of new coronavirus infection. Based on statistical analysis of open data on morbidity and mortality of population in the Russian Federation over past few years, results were obtained indicating that collection of medical statistics is not built consistently that medical care in health care is not organized sequentially as cycle or process, but is presented in fragments. This leads to the fact that rural population has very limited access to multidisciplinary and high-tech medical services, and in structure of mortality there is high gender bias (males die more often than females in same classes of causes). Based on identified problems, two organizing solutions are proposed. The first solution is to create, on the basis of the Ministry of Health Care of Russia, special portal for complete, reliable and up-to-date medical statistics, which will be generated and processed using Big Data technologies. The second solution consists in transition from fragmentation to systematic organization of medical care in the "education and prevention-treatment-rehabilitation" continuum, while for each stage special set of key performance indices is established that allows to solve the tasks of improving public health, but also to develop harmonized social and economic public policy.

Objective: The aim: Is to examine the establishment and development of the international legal framework in the field of public health; to identify objects of public health regulation; to outline ways to improve and develop the existing public health standards, taking into account new challenges facing humanity., Patients and Methods: Materials and methods: The research is based on the analysis of international agreements of universal and regional levels on public health, and scientific achievements in this field. The methodological basis comprises special and general methods, in particular, dialectical, axiological, formal, and other methods., Conclusion: Conclusions: The international community makes significant efforts to develop regulations in the field of public health. The emergence of these acts is associated with the emergence of a problem that affects the health of many categories of people, tends to spread rapidly, and results in significant damage to public health. Unfortunately, the objects of regulation of such agreements tend to expand due to the emergence of new challenges to human health, the evolution of diseases, and the factors that determine their occurrence. It is considered necessary to unite the efforts of the world community in order to improve the situation in the field of public health. These efforts should include: greater accession to international agreements in the field of public health; organisation of international cooperation to assist in combating the spread of new diseases, including the development of medicines, vaccines, exchange of best practices in this field, etc.; carrying out preventive medical measures at the national level, educational work among the whole population on the observance of sanitary norms, norms of hygiene, consequences of use of harmful substances (narcotic and psychotropic substances, tobacco, etc.), and so on.

The assessment of medical care quality of different strata and groups of population is a priority direction of preventive medicine and public health. Nowadays, application of the riskometry theory considering external modifying factors is relevant. The registration of risk indices in the process of development of model of health preservation can be considered as a criterion of medical care quality. The purpose а study was to optimize managerial decisions in the area of increasing medical care quality related to special contingent on the basis of evaluation of carcinogenic danger and reproductive risk in conditions of anthropogenic impact. The study applied such modern research methods as social hygienic, biochemical and statistical techniques. The methodological basis of assessing reproductive risk for population in conditions of anthropogenic impact can serve as a criterion of assessing level of impact and developing management decisions in area of improving health care quality. The public health and health care organization are the fields of application of study results.

The number of asylum seekers in Germany has increased dramatically in 2015. Their medical care includes the officially recommended vaccinations; yet, no detailed information on this is yet available in Germany. In light of the rising number of asylum seekers, we have developed a concept to facilitate their vaccination. This concept includes the coordination of different partners, the supply of vaccines and other materials through the local health office, and the cooperation with the local physicians' association. To evaluate and accelerate progress, we compared the number of vaccinations conducted by physicians independently of the vaccination concept with those conducted within the new concept. For the period of investigation, 2,256 new asylum seekers were temporarily accommodated in the facilities. The vaccination concept was applied in only some of the facilities. Twenty-eight percent of all asylum seekers (642) were vaccinated at least once; 89 % of the vaccinees (571) were vaccinated within the newly developed concept. In the facilities that were not included in this concept, only 6 % of the refugees were vaccinated, whereas in the facilities that were included up to 58 % were vaccinated. Even though the new concept has started successfully, further innovations are required to reach sufficient vaccination coverage among asylum seekers. In view of the large number of new asylum seekers expected, the adjustment and expansion of the new concept requires professional planning and coordination. Furthermore, additional resources are required.

Providing access to and utilization of medication assisted treatment (MAT) for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV) prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services) MAT with HIV prevention, care and treatment programs provides the best "one stop shopping" approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.

The '5 Moments' approach is a time–space framework that delineates when hand hygiene should be performed and provides a resource for educators and auditors. It has become the dominant paradigm for organisations, practice, policy, and research in relation to hand hygiene. It is a concept that adopts the 'precautionary principle' that if the relative risk of a specific care task is unknown, a safe system must be to treat them on an equal level. However, a literal interpretation will frequently result in an extraordinary, implausible number of hand-hygiene opportunities and if this then becomes the standard to audit practice, within a policy document that espouses zero tolerance, it is likely to generate inauthentic data. If used effectively the 5 Moments concept provides an opportunity to enhance practice and reduce healthcare-associated infections but the healthcare provider organisation must embody a 'just culture' and collect the data in a climate of openness, transparency, and learning. [ABSTRACT FROM AUTHOR]

This paper argues that accepting incommensurability can be a useful step for developing attractive hybrid theories to how to distribute scarce health-related resources. If one provides opportunity for distributive options to be incommensurable with respect to substantive criteria, one can hold on to substantive criteria while also providing room for decision processes to play a significant role. The paper also argues that the strategy of accepting incommensurability is preferable to the strategy of having substantive criteria establish sets of options that are equally, explains why incommensurability gives us reason to go hybrid, and argues that reasons grounded in decision processes have properties that make them appropriate as "tiebreakers" in choice situations characterized by incommensurability. [ABSTRACT FROM AUTHOR]

Introduction: Changing health care requires changing medical education. In this position paper it is suggested that subsequent innovations in medical education each had their specific strengths and shortcomings. What they have, however, in common is that they place the medical student and their competencies at their center. Innovation in medical education is inward looking. Discussion: The authors propose a perspective on the medical curriculum in which the patient, their family, and the surrounding community take center stage. They argue that present medical education cannot adequately respond to the great challenges to population health: an aging population, the obesity epidemic, and future pandemics of new diseases due to population growth, urbanization, and antimicrobial resistance, particularly because these challenges cannot be dealt with by the medical sciences alone but need deep understanding of the social sciences as well. In addition, the practice of health care is changing: effective health care demands a close partnership between the health care system and the medical school which is mostly lacking, cooperation with other health professions is becoming more and more necessary in response to the increasing complexity of health care, patients and their families are required to play a more active role in their health, medical error threatening patient safety is becoming to be seen as a huge problem, and the emergence of artificial intelligence in education and practice, all requiring transformation of medical education. Conclusion: The present contribution suggests eight such transformations necessary to create a truly patient- and population-centered medical curriculum. [ABSTRACT FROM AUTHOR]

The author reflects on why health communicators and researchers should prioritize documenting the impact of the work of their peers as the field continues to grow and evolve. He discusses trends and observations in the essays documenting impact, benefits and challenges of documenting impact for health communicators, and the impact of Dr. Teresa Thompson, who most of the field knows simply as Teri, on health communication research.

Research has demonstrated benefits of paternal involvement during the prenatal stage: increased prenatal visits, better adherence to postpartum best practices, and improved communication between partners. In the United States, where maternal morbidity remains higher than other advanced economies, the need for varied interventions aimed at improving the wellbeing of the entire family unit should remain a top priority. In an arena that is understandably dominated by interventions aimed at expectant mothers, scholars also advocate for including men in prenatal health care to reduce maternal morbidity and mortality. In practice, however, they are often excluded. Evidence suggests paternal prenatal health interventions can result in better outcomes for the entire family, and researchers developed Father's Playbook – a free bilingual evidence-based app for expectant fathers – in support of that goal. This article examines the creation of and lessons learned from this health communication intervention which represents a case study of implementation science in the field of health communication. This article documents how the project moved from early formative research to app development and now ongoing promotion of a state-funded health communication and public health intervention utilizing a variety of research approaches. Researchers believe this intervention can serve as a blueprint for other public health and health communication practitioners. [ABSTRACT FROM AUTHOR]

Across the globe, spiritual care is offered by individuals, healthcare chaplains, and humanitarian, social and related spiritual groups on account of zeal, voluntary and paid services. Sometimes, services are provided without understanding the connectivity of compassion, spiritual care, and scientific protocols. There are instances where health professionals and managers disagree with spiritual caregivers or reject spiritual services because of poor service deliveries in conflict with healthcare protocols. Against this background, this article focuses on how spiritual care services can be provided scientifically to improve service delivery. It presents leading questions to link the scientific and compassionate approach to spiritual care. These include-What is science? What is compassion? What is spiritual care? What makes compassion and spiritual care scientific? Are there tenets of compassion in religions? How are compassion, science and spiritual care linked? What are the implications of the intersections for public health and safety? Hopefully, the provided answers may improve the service delivery performance of spiritual caregivers and their collaboration with healthcare professionals, social workers, and related groups. [ABSTRACT FROM AUTHOR]

Background and purpose: The European Academy of Neurology (EAN) has adhered to the global plan for reducing the burden of neurological disorders and promoting brain health launched by the World Health Organisation (WHO), the WHO Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders. This study reports the results of an EAN survey among national neurological societies (NNSs) on their awareness of brain health policies. Methods: The EAN survey on the current state of national brain health policies was conducted among the 47 presidents of the NNSs affiliated with the EAN, with the aim of developing the best strategy for close collaboration among stakeholders. Results: From June 2023 to February 2024, 36/47 responses (77%) were collected. Among respondents, 67% were in contact with their Ministry of Health and 78% were aware of and in contact with one or more national neurological patient organisation, while 17% had no contacts with any association. Ninety‐two percent declared a high to medium degree of awareness of the need to support brain health and of brain health plans and strategies in their country. Conclusions: Our findings suggest good awareness of the importance of brain health and of the strategies implemented at the national level among the EAN‐affiliated NNSs and representatives. Efforts towards improvement may be directed towards cooperation between NNSs and political institutions, as well as patient organisations, to optimise brain and global public health and neurological care in each country. [ABSTRACT FROM AUTHOR]

Aim s : Research capacity strengthening (RCS) is crucial in enhancing healthcare outcomes, particularly in low‐ and middle‐income countries (LMICs), which face challenges due to limited resources, unequal access to care and the need for evidence‐based decision‐making. We seek to move beyond a surface‐level understanding of RCS, unearthing the core attributes, the factors that precede its implementation and the transformative outcomes it generates within the LMIC healthcare landscape. Design: This study employs the Walker and Avant approach to concept analysis to comprehensively explore the dimensions and attributes of RCS as it pertains to allied and public health professionals in LMICs, propose empirical referents and suggest an operational definition. Data Sources: Ovid MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched from inception to 27 July 2023, to identify studies on RCS in LMICs. The Walker and Avant approach to concept analysis was selected because it provides a framework for systematically examining and clarifying the meaning and implications of RCS. This method involves a structured process of defining RCS, identifying its attributes, antecedents, consequences and cases, and ultimately providing a clear understanding of its meaning and implications. Identifying empirical referents offers measurable indicators that researchers and policymakers can use to assess the effectiveness of RCS initiatives in LMICs. Conclusion: RCS for health professionals in LMICs involves a sustainable process that equips them with essential research skills, fostering the ability to conduct high‐quality research and improve healthcare delivery in resource‐constrained settings. Implications: RCS aims to empower health professionals to apply evidence‐based practices, reduce disparities and enhance the well‐being of populations in LMICs. Impact: Ultimately, a concept analysis of RCS empowers us to harness the full potential of research to enhance healthcare delivery, improve patient outcomes and advance the well‐being of populations worldwide. [ABSTRACT FROM AUTHOR]

In 2020 COVID-19 cases have entered Indonesia causing public health problems and millions of deaths. To prevent transmission of COVID-19, an air purifier is needed whose function is to remove small droplets that can carry the virus. One of them is a medical device company located in Jakarta. The purpose of this research is to produce a design that can improve business processes in the health sector and achieve company goals. The current business process is not very optimal because it is still done conventionally and the existing system has not been integrated with other divisions. To achieve business goals, it is necessary to integrate business processes with information technology (IT) and technology development that will be proposed based on the design of information system architecture that will produce a blueprint and assisted by the open group architecture framework (TOGAF) framework which is very helpful in the process of analyzing company needs. In this research, data collection through interviews with directors and direct observation of health service companies. The results of this study are recommendations given to help health. [ABSTRACT FROM AUTHOR]

Background: Lifestyle in Western countries has significantly changed during recent decades. These and other factors have increased the prevalence of overweight and obesity, leading to a higher risk of noncommunicable diseases such as cardiovascular disease and cancer. A balanced diet has been shown to predict better health, so several public healthcare strategies aim to encourage "healthy" food choices. Objectives: To assess self-concept of knowledge about nutrition compared to factual knowledge and knowledge implementation in daily life. Design: Cross-sectional cohort study with a total of 524 Swiss women recruited, of which 447 women met the inclusion criteria for the final analysis. Methods: Main outcome measure: a self-constructed questionnaire was used to evaluate subjective and objective knowledge about healthy nutrition and its practical application. Subgroup analyses utilized Fisher's test for categorical and Mann–Whitney- U test for metric/ordinal. Results: Most participants sourced their nutritional information predominantly from nonexperts. While the majority believed they were well-educated about nutrition, this self-assessment was only partially accurate. The "nutrition pyramid" concept was widely recognized, and correct assignment of food items to dominant macronutrient components was generally accurate. However, understanding of food category ranking by optimal daily intake and composing a healthy diet was lacking. Higher education levels correlated with better objective nutrition knowledge (p < 0.001), and normal-weight women were more likely than overweight/obese women to implement nutritional knowledge daily (p = 0.021). Apart from body mass index other bio-psycho-social factors were observed. Conclusion: Recent insights show that although women perceive themselves as knowledgeable about nutrition, there are significant gaps in their objective understanding. Higher education levels improve nutritional knowledge, and normal-weight women apply this knowledge more effectively. Thus, providing accessible, high-quality expert information on nutrition is essential. Trial registration: The study has been approved by the Cantonal Ethics Committee (registration number: 2018-00358). [ABSTRACT FROM AUTHOR]

Background: COVID-19 has changed healthcare access and delivery, especially impacting older adults. The Community Paramedicine at Clinic (CP@clinic) program is a chronic disease prevention, management, and health promotion program for community-dwelling low-income older adults. We investigated a telephone-based CP@clinic program adaptation during the pandemic. Methods: Community paramedics delivered CP@clinic via telephone to residents of 36 social housing buildings. They conducted screening for COVID-19, emergency preparedness, and social health factors. Community paramedics provided education on staying safe, self-isolating, self-monitoring, and preparing for pandemics using governmental infographics. Descriptive analysis was conducted on assessments completed between March and June 2020. Paramedic documentation was thematically analyzed to identify common themes. Results: All 191 participants had ≥ 1 telephone visit and 34.6% had ≥ 2 telephone visits, 82.8% were aged 65 years and older, 30.9% had internet access, and 57.9% had cable TV (limiting exposure to COVID-19 information). The CP@clinic program infrastructure provided a platform for paramedics to swiftly contact many vulnerable older adults to screen for COVID-19, educate on safe practices, and facilitate healthcare access. One-quarter of participants screened positive for social isolation. Thematic analysis described participants' experiences adapting to daily life in the pandemic, emotional experience during the pandemic, and paramedics supporting participants during the pandemic. Conclusions: Public health interventions are needed for low-income or hard-to-reach older adults, especially during pandemics. Community paramedics were able to support vulnerable older adults living in social housing through the unique CP@clinic adaptation. This innovative program delivery increased vulnerable populations' access to public health services and information at a time of great health need. [ABSTRACT FROM AUTHOR]

Background: Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them. Methods: Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems. Results: The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant. Conclusion: ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems. [ABSTRACT FROM AUTHOR]

Polio vaccine hesitancy remains high in Pakistan due to various socio-political, religious, and economic factors. To address this, the government of Pakistan and its international partners such as UNICEF have devised a multipronged communication strategy to counter resistance to polio vaccine in hard-to-reach areas of the country. In this strategy, mainstream news media has been identified as a key stakeholder, as they have the potential to reach a wide range of population and disseminate easy to understand messages including both visuals and text. However, less scholarly attention has been paid to how mainstream news media in Pakistan frame polio and polio vaccine in their visuals. This study aims to fill this gap. Using visual framing as a theoretical framework, we analyzed 115 images from three selected newspapers published from 2010 to 2022. Our results suggest that the newspapers depicted hard-to-reach areas in Khyber Pakhtunkhwa (KP) province which were more affected by polio and highlighted the criminality and securitization of polio vaccine in the country. In addition, female polio healthcare workers, who are instrumental in eradicating the disease, have been given marginal coverage, reflecting the importance of gender sensitivity in the region. Overall, this study contributes to the fields of visual communication, health communication, and international communication, particularly related to the Global South. [ABSTRACT FROM AUTHOR]

Background: Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed. Methods: We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as "homelessness and mental health," "policy interventions for homeless populations," and "health care services costs." We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care. Results: Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve. [ABSTRACT FROM AUTHOR]

This study aims to analyse age-specific all-cause mortality trends in the UK before and after COVID-19 emergence to determine if pre-pandemic trends contributed to increased mortality levels in the post-pandemic era. Statistical analysis of UK mortality data. We utilised age-structured population and mortality data for all UK countries from 2005 to 2023. Mortality rates were calculated for each age group, and excess mortality was estimated using the Office for National Statistics (ONS) method. Our most concerning finding is an increase in all-cause mortality rates for middle-aged adults (30–54 years) starting around 2012. The COVID-19 pandemic may have further impacted these rates, but the pre-existing upward trend suggests that current elevated mortality rates might have been reached regardless of the pandemic. This finding is more alarming than the slowdown in the decline of cardiovascular disease death rates for individuals under 75 noted by the British Heart Foundation. Our results highlight the importance of considering both immediate pandemic impacts and long-term mortality trends in public health strategies. This underscores the need for targeted interventions and improved healthcare planning to address both ongoing and future challenges. [ABSTRACT FROM AUTHOR]

Climate change is intensifying heat events, and local governments are working to absorb and mitigate the associated costs. To develop effective responses, local data on the relationship between climate and health are crucial. This study investigates the impact of heat events on unexpected mortality, focusing on deaths investigated by the Medical Examiner in Los Angeles County. A retrospective observational study. We estimate the associations between the National Weather Service's HeatRisk index and deaths investigated by the Medical Examiner in Los Angeles County using negative binomial count models with controls for time trends and seasonality. In subgroup analyses, we explore how these effects vary for those who are homeless or living in care facilities. Compared to days with no HeatRisk, days with moderate, major, or extreme HeatRisk were associated with death increases of 6.7% [CI: 1.9–11.7%], 15.3% [CI: 2.9–29.1%], and 65.5% [CI: 34.9–102.1%], respectively. Effects were more pronounced for individuals who were homeless or in care facilities. Major or extreme heat days were associated with a 59.3% [CI: 19.8–109.4%] increase in deaths among homeless individuals and a 91.4% [CI: 19.0–198.6%] increase in deaths among those in care facilities. Heat events have a significant impact on mortality investigated by the Medical Examiner, especially among vulnerable groups. Local governments may consider using the warning tools provided by the National Weather Service to focus their resources on the most intense heat events, especially to target those living in care facilities or who are homeless. [ABSTRACT FROM AUTHOR]

COP‐28, the United Nations' Climate Change Conference, hosted by the United Arab Emirates, ended on 12 December 2023. At the convention, Australia released its National Health and Climate Strategy, committing to low‐carbon, climate‐responsive care. The Strategy will need new policies, projects and investments and a fit‐for‐purpose health workforce. This is a tall order considering healthcare's challenges. Everyone has a role, including clinicians, healthcare agencies, policymakers, politicians, patients and the providers and manufacturers in the supply chain. Clinicians' groups, policymakers and federal and state departments of health have an opportunity to lead climate change reform by considering climate change impacts across clinical practice and health policy. [ABSTRACT FROM AUTHOR]

In recent years, research on tourism risks and public health safety has emerged as one of the most pressing issues in the tourism industry. This issue arose as a result of the unanticipated calamity that shook the entire world, affecting several businesses, conspicuously the travel industry, and causing nations throughout the world to experience severe and catastrophic economic collapse. The multiple interwoven elements of this industry, that is, the direct and indirect effects of the global outbreak on tourism, notably on opportunities for employment, gathered traction in the interim. Considering this, our research intends to effectively deal with the aforementioned difficulties by laying out sustainable policies that can perhaps be utilized to mitigate risks in such unforeseen situations, which could be highly beneficial in the near future. In order to achieve this goal, a knowledge-based fuzzy multi-criteria decision making (MCDM) strategy was utilized to prioritize and enhance the important networks within the travel industry. Furthermore, to deal with uncertain information, a newly developed spherical fuzzy set was combined with the analytical hierarchy process and weighted aggregated sum product assessment to examine and evaluate the five different dimensions considered. [ABSTRACT FROM AUTHOR]

Interventions designed to address COVID-19 needed to be rapidly scaled up to the population level, and to address health equity by reaching historically marginalized populations most affected by the pandemic (e.g., racial/ethnic minorities and rural and low socioeconomic status populations). From February 2021 to June 2022, SCALE-UP Utah used text messaging interventions to reach 107 846 patients from 28 clinics within seven safety-net health care systems. Interventions provided informational and motivational messaging regarding COVID-19 testing and vaccination, and were developed using extensive community partner input. (Am J Public Health. 2024;114(11):1207–1211. https://doi.org/10.2105/AJPH.2024.307770) [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyze the Indian public healthcare delivery system and compare it with other countries based on their gross domestic product (GDP) classification. Materials and Methods: The study was conducted to assess the Indian healthcare delivery system and the GDP among global nations based on their GDP potential as criteria. The data from 24 high-, middle-, and low-income countries were gathered from the World Bank from year 2018 to 2021. The parameters included GDP, GDP per capita, total number of population, and healthcare delivery system. The data were collected from various electronic sources of the World Health Organization, the International Monetary Fund, and the US Census Bureau's international data, National Health Profile 2021. The collected data were compiled and tabulated. The descriptive analysis was done using Microsoft Excel version 2016 and SPSS version 20. Results: India ranks in the high-income group based on the GDP, whereas when ranked based on GDP per capita, it drops down to the lower-middle-income group. This lag may be because of a larger population and lack of priority in public health delivery. In terms of overall expenditure, India spends US$63 million in total health expenditure, of which only US$20 million is spent by the government sector. On the other hand, the United States holds the highest rank with US$10,921 million of total health expenditure, of which US$5,552 million spent by the government sector and US$5,368 million by the private sector. Conclusion: The Indian healthcare delivery system is suffering from a shortage of public health workforce and infrastructure. In the last decade, India has seen remarkable economic development, particularly in terms of the GDP growth rate. Unfortunately, this progress does not accompany with the Indian healthcare delivery system. Still there is a shortage in public health workforce and infrastructure. India should prioritize the expenditure in healthcare delivery. [ABSTRACT FROM AUTHOR]

The article investigates the impact of the COVID-19 pandemic on tuberculosis (TB) trends in Mongolia. Topics include the effect of COVID-19 interventions like social distancing and masking on TB transmission, the disruption of TB healthcare services during the pandemic, and the study's methodology, which compares TB data before and after the onset of COVID-19 using national surveillance data.

Aim: The aim of this study was to evaluate outpatient and inpatient dental care for patients with disabilities from 2014 to 2023. Material and methods: A time series analysis was carried out with data from Brazil's public healthcare system, considering the outpatient productivity of Special Needs Dentistry specialists and hospitalizations (inpatient admissions) of patients with disabilities for dental procedures, both normalized to every 100,000 inhabitants (incidence). The significance level was set at 5%. Results: In the last 10 years, 22,420,859 procedures were carried out and 89,380 hospitalizations were approved. Trend analysis showed no significant temporal variation in the incidence of both variables. Regarding the procedures, the majority were low‐complexity (82.1%, p <.001) and clinical (71.2%, p <.001). Periodontal (19.9%) and restorative (19.5%) procedures were the most frequent. Considering the hospitalizations, almost (R$) 40 million was allocated, and the majority were classified as elective (71.9%, p =.002) and of short duration (less than a day). Conclusion: Dental care for patients with disabilities presented patterns related to the types of procedures, complexity and circumstance, in addition to not showing significant temporal variation over the last 10 years. [ABSTRACT FROM AUTHOR]

Purpose: COVID-19 has profoundly shaped human interactions, and, within public healthcare systems, care relations. Through the lens of social suffering, this study explores how employee innovation is shaped by the pandemic crisis and different managerial approaches in the context of public geriatric care in Northeast Italy. Design/methodology/approach: This study adopts a qualitative methodology. A total of 29 semi-structured, open-ended interviews were conducted with 23 healthcare professionals involved in geriatric care, with managerial and without managerial positions. Observation was integrated as auxiliary research to further capture on an operational level the interactions among the actors involved. Findings: The COVID-19 crisis significantly shaped employee innovation for healthcare professionals, as the suffering it provoked in the system motivated and urged them to engage in innovative initiatives. Where employees' engagement in innovation was recognized by the management, it was found that the suffering was mitigated, and creativity and solidarity emerged in the innovation process. Where top-down approaches did not recognize employees' efforts and innovative initiatives, need-driven innovation and greater tensions came forward, enhancing the overall suffering in care relations and resulting in some employees considering leaving their profession. Research limitations/implications: This study is based on a single case study. Practical implications: This study further highlights the employee participation in innovation as a crucial practical implication for sustaining the quality of public care and assistance. A practical implication emerging from this study suggests that "ordinary" healthcare professionals' engagement in innovative initiatives and in their operationalization should be encouraged by the organization. In a system as complex as the public healthcare one, valuing the bottom-up, clinical inputs appears fundamental if innovation is to move away from mere technological adaptation to embrace a more comprehensive process, involving the professionals who are engaging in innovative endeavors. From a managerial point of view, adopting an approach that recognizes, supports and provides coordination to employee innovation seems instrumental to nurture an environment where employee voices feel heard, and creativity, solidarity and overall positive collaboration can occur. Thus, another significant practical implication includes the retention of healthcare professionals in the public sector in times of crisis. Originality/value: With the outbreak of the COVID-19 pandemic, the necessity to explore the "human side" of innovation and its connection to emerging human needs during a crisis is growing. This study focuses on employee participation in innovation processes due to COVID-19, thus contributing to the employee-driven innovation (EDI) literature. Through the lens of social suffering, it scrutinizes the interactions between bottom-up perceptions and responses and top-down strategies in a public healthcare setting. Hence, this study addresses two major gaps present in EDI literature, for the most part focused on the private sector and on the managerial structures, tools and interventions. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Chengdu University (Social Science) is the property of Journal of Chengdu University (Social Science Edition) Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Decentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level. Methods: Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software. Findings: The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs. Conclusion: The findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support. [ABSTRACT FROM AUTHOR]

Community-based sexual health services are recommended to increase sexually transmitted disease (STD) testing among men who have sex with men (MSM). Pilot study data from multiple sites found that MSM in Guangzhou who use public STD clinics were found to have different sociodemographic characteristics, lower community engagement, and increased social cohesion, compared to MSM who use MSM-led clinics. [ABSTRACT FROM AUTHOR]

Background: The increasing frequency of terrorist events has led to a growing need for healthcare services. Indeed, the unexpected nature of terrorist attacks affects the healthcare system. The number of deaths among victims admitted to healthcare facilities calls into question the ability of health systems to cope with shocks. This article aims to strengthen the understanding of the resilience processes of healthcare systems and identify support strategies for other systems facing significant shocks. Methods: A scoping review included empirical research on health system resilience and terrorism threats from peer-reviewed literature was conducted. A comprehensive search strategy was conducted in four electronic databases (Medline/PubMed, CINAHL, Global Health, and PsycInfo) in January 2023. The data was thematically analysed using the Braun and Clarke approach. This enabled us to map, organise and synthesise the results using the WHO building blocks as a framework for analysis. Results: We screened 37 papers and then completed a full-text review of 35 identified as relevant. A total of 33 papers were retained for analysis. The results indicate that when health service utilization and stress are associated with service delivery, human resource capacity erodes, compromising system functioning. In most cases, health services were surprised by events because they lacked a minimum emergency preparedness plan. These systemic shocks reinforced the need to strengthen the health systems? resilience. However, the practical application of interventions to make systems resilient has yet to be clearly defined. Moreover, the absorptive capacities of the healthcare system enable an immediate response to a crisis, drawing on available human and organizational resources. It is also clear that by remaining flexible in organizing services, healthcare systems can strengthen their adaptive capacities to ensure better service delivery. Conclusions: Bringing order to the chaos following a terrorist attack requires discipline and a well-prepared, professional healthcare team. [ABSTRACT FROM AUTHOR]

Background: Vulnerable social groups have greater difficulty in accessing care and a lower quality of care. Health systems focused on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care are persisting. We focused on primary care screening for cervical cancer through Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing disease incidence and mortality. In this study, we aimed to investigate the characteristics of women who undergo CUS according to the category of health professionals (general practitioners or gynaecologists) performing CUS and to analyse potential differences in access to care in terms of socioeconomic and geographical characteristics. Methods: This was a retrospective observational study based on data from the main health insurance schemes in France, allowing analysis of health care consumption according to socioeconomic levels and proximity to health care services. We included women aged 25 to 64 years in 2012 for whom CUS would be a relevant procedure (695,694). The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed using multinomial logistic regression. Results: A total of 202,271 (29%) patients underwent CUS; of whom 68% underwent CUS administered by gynaecologists and 28% were administered by general practitioners (GPs). However, inequalities in CUS screening rates were observed, with a decrease in the number of CUSs performed with increased age, a rural location, deprivation, and sparse health care provisions. Deprived people seemed less penalised by GPs. Conclusions: Involvement of General Practitioners may improve cervical screening equality in France. The organisation of health systems around primary care may allow a better access to care and to account for the specific needs of deprived populations. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The 'Breastfeeding – a good start together' intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022–2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention. Methods: The study was guided by the Medical Research Council's guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8). Results: Overall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families' chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers' context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high. Conclusions: Health visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts. Trial registration: Clinical Trials: NCT05311631. First posted April 5, 2022. [ABSTRACT FROM AUTHOR]

The article reflects on the 2022 Mpox outbreak, focusing on the public health response, clinical management, and the impact of stigma within affected communities. Topics include the challenges in managing Mpox as a high-consequence infectious disease, the role of stigma in exacerbating health impacts, and the importance of culturally sensitive healthcare responses for affected populations.

As the field evolves as a doctoring profession, the role and scope of physical therapist practice must also grow to meet important and urgent public health needs. Scalable, population-level interventions must be prioritized to the same degree as tailored, individual-level care. Drawing from public health frameworks, this perspective proposes an approach to population–level physical therapist care delivery that aims to mitigate disease and disability and improve health outcomes by expanding access, decreasing cost, and improving quality of care for those facing the greatest health disparities. Application of these frameworks prompts the development of novel approaches to rehabilitation service delivery to advance twin goals of promoting access to care and reducing health disparities. This paper describes how a population health framework and public health approach can be used to support necessary evolution and innovation within the field of physical therapy and to improve rehabilitation service delivery. Rapid developments in the digital and virtual health space have created a unique opportunity for physical therapists to lean into a new vision of their role as clinicians within the broader health ecosystem. This paper will provide clinicians with a broader perspective of physical therapist expertise and describe opportunities for the development and application of a physical therapist skill set toward driving population health outcomes. Real-world examples will guide clinicians to consider opportunities in their own practice for implementing this public health approach and potentially addressing various contributors to persistent health disparities. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases are a considerable burden to health systems, communities, and patients. Much of this burden, however, could be prevented if interventions effective in reducing chronic disease risks were routinely implemented. Aims: The aim of this paper is to discuss the role of public health agencies in preventing chronic disease through the application of learning health system (LHS) approaches to improve the implementation of evidence‐based interventions. Materials and Methods: We draw on the literature and our experience operating a local LHS in Australia that has achieved rapid improvements in the implementation of chronic disease prevention interventions. Results: The proposed LHS framework has been adapted to be both implementation and chronic disease prevention focused. The framework describes both broad improvement processes, and the infrastructure and other support (pillars) recommended to support its core functions. Conclusion: The framework serves as a basis for further exploration of the potentially transformative role LHS's may have in addressing the chronic disease health crisis. [ABSTRACT FROM AUTHOR]

Objective: The causal effect of successive population-wide lockdowns in response to increased COVID-19 cases on mental health has yet to be examined using robust methods. A natural experiment design underpinned by objective data can improve our understanding surrounding the definitive impact of social distancing restrictions. Methods: The study employed a natural experiment design underpinned by objective data. Health service cost for visits to general practitioners and psychologists and medication dispensing costs served as objective measures of mental health. Difference-in-difference (DID) estimators, which in this study quantify differences in spending changes between groups over time, were produced based on three comparisons: Victoria 2020 lockdown comparison, Victoria 2021 lockdown comparison, and New South Wales (NSW) 2021 lockdown comparison. Specifically, differences in public health service spending during lockdown periods and the same timeframe in 2019 for Victoria and NSW, and control groups (remaining states and territories), were compared. Results: Positive estimator values indicate that public health service spending for Victoria and NSW increased more during lockdown periods compared to control states and territories. The Victorian lockdowns of 2020 and 2021, but not the NSW lockdown of 2021, resulted in increased public spending for general practitioner mental health consults (2020 DID estimator: $8498.96 [95% CI $4012.84, $12,373.57], 2021 DID estimator: $6630.06 [95% CI $41.27, $13,267.20], all monetary values in AUD$) and short visits to psychologists (2020 DID estimator: $628.82 [95% CI $466.25, $796.00], 2021 DID estimator: $230.11 [95% CI $47.52, $373.98]). The first Victorian lockdown in 2020 and the NSW lockdown in 2021 resulted in greater spending on short visits to clinical psychologists. Spending on long visits to psychologists and clinical psychologists and medication spending did not change. Conclusions: Strict lockdowns can have an adverse impact on population mental health. The impact is particularly evident in those who have a history of previous mental health concerns but does not necessitate extra use of medications, suggesting that psychological care can address the adverse impact of the lockdowns. What is known about the topic? Previous research varied in methodology, using self-reports and healthcare data to understand COVID-19 social distancing public health measures' effects on mental health. What does this paper add? This study introduces robust, objective data via a natural experiment design, examining the impact of successive lockdowns on mental health service usage and medication expenditures in specific Australian regions. What are the implications for practitioners? Findings highlight the need for flexible mental health services that can swiftly respond to increased demands during prolonged restrictions, without necessarily increasing medication use, guiding future policy and resource allocation. [ABSTRACT FROM AUTHOR]

Objective: Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions. Conclusions: The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions. [ABSTRACT FROM AUTHOR]

Using the United Nations' 'leave no one behind' framework for the achievement of sustainable development goals, this article underscores the key role of geography as one of the core factors why certain people are left behind, deprived, and continue to experience inequality in terms of access to (quality) health care facilities and services. This article specifically examines the consequences of physical inaccessibility to health outcomes and health-seeking behavior in geographically isolated and disadvantaged areas (GIDAs) in the Philippines. This article illustrates that physical accessibility is an ignored aspect of the public health paradigm. For that reason, public health facilities, no matter how critical the facility is to a person's care, are not an immediate option for GIDA residents who seek medical aid. Responsive policy measures are vital to address this seemingly paradigmatic error. Subsidizing transportation costs and allocating funds for road improvements are called for, among other changes. The government must act on the people's right to ease of access as part of fulfilling fundamental health-related state obligations. But for the government to act, it will be crucial for claimants to health rights to proactively demand these changes. The latter is key for the fulfillment of the affected people's right to get easier access to meaningful health care. [ABSTRACT FROM AUTHOR]