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This paper aims to explore several ways to construct a scientific and comprehensive early warning system (EWS) for local government debt risk in China. In order to achieve this goal, this paper studies the local government debt risk from multiple perspectives, i.e., individual risk, contagion risk, static risk and dynamic risk. Firstly, taking China's 30 provinces over the period of 2010~ 2018 as a sample, this paper establishes early warning indicators for individual risk of local government debt, and uses the network model to establish early warning indicators for contagion risk of local government debt. Then, this paper applies the criteria importance though intercrieria correlation (CRITIC) method and coefficient of variation method to obtain the proxy variable Ⅰ, which combines the above two risks. Secondly, based on the proxy variable Ⅰ, both the Markov-switching autoregressive (MS-AR) model and coefficient of variation method are used to obtain the proxy variable Ⅱ, which comprehensively considers the individual risk, contagion risk, static risk and dynamic risk of local government debt. Finally, machine learning algorithms are adopted to generalize the EWS designed in this paper. The results show that: (1) From different perspectives of local government debt risk, the list of provinces that require early warning is different; (2) The support vector machines can well generalize our EWS., Competing Interests: The authors declare that there are no competing interests regarding the publication of this paper.

Background: Distrust, and more broadly, public perception of government's handling of a crisis, has been a widely studied topic within health crisis research and suggests that these perceptions are significantly associated with the behavior of its citizens., Purpose: To understand which aspects of the public's perception of government handling of the COVID-19 pandemic predicted engagement of protective behaviors among older adults, who are the most vulnerable to COVID-19., Methods: Participants were recruited from an ongoing biopsychosocial study on aging amongst community-dwelling older adults. There were two rounds of data collection, during the national lockdown and post-lockdown. The average length of follow-up was 5.88 months. N = 421 completed the first round of data collection and N = 318 subsequently completed the second round of questionnaires., Results: During the lockdown, perceptions that pandemic-related measures in place were sufficient, effective, timely, provided a sense of safety, important information was easily accessible, and government handling of the pandemic could be trusted, were found to significantly predict engagement in protective behaviors. During post-lockdown, only perceptions that measures in place were sufficient, provided a sense of safety, and important information was easily accessible, remained significant predictors. The perception that COVID-19 measures were clear and easy to understand now became a significant predictor., Conclusions: Public perceptions of government handling of the pandemic predicted engagement in protective behaviors but were less important during post-lockdown. To effectively engage older adults in protective behavior, our findings suggest for pandemic-related information to be accessible, introducing timely safety measures, and having easy-to-understand instructions for nuanced measures., Competing Interests: The authors have declared that no competing interests exist.

The 2016 Peace Agreement has increased access to Colombia's unique ecosystems, which remain understudied and increasingly under threat. The Colombian government has recently announced its National Bioeconomic Strategy (NBS), founded on the sustainable characterization, management, and conservation of the nation's biodiversity as a means to achieve sustainability and peace. Molecular tools will accelerate such endeavors, but capacity remains limited in Colombia. The Earth Biogenome Project's (EBP) objective is to characterize the genomes of all eukaryotic life on Earth through networks of partner institutions focused on sequencing either specific taxa or eukaryotic communities at regional or national scales. Colombia's immense biodiversity and emerging network of stakeholders have inspired the creation of the national partnership "EBP-Colombia." Here, we discuss how this Colombian-driven collaboration between government, academia, and the private sector is integrating research with sustainable, environmentally focused strategies to develop Colombia's postconflict bioeconomy and conserve biological and cultural diversity. EBP-Colombia will accelerate the uptake of technology and promote partnership and exchange of knowledge among Colombian stakeholders and the EBP's global network of experts; assist with conservation strategies to preserve Colombia's vast biological wealth; and promote innovative approaches among public and private institutions in sectors such as agriculture, tourism, recycling, and medicine. EBP-Colombia can thus support Colombia's NBS with the objective of sustainable and inclusive development to address the many social, environmental, and economic challenges, including conflict, inequality, poverty, and low agricultural productivity, and so, offer an alternative model for economic development that similarly placed countries can adopt., Competing Interests: The authors declare no competing interest., (Copyright © 2022 the Author(s). Published by PNAS.)

Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. Nepal government has developed and implemented different programs to improve infant and young child feeding practice. However, the practice remains poor and is a major cause of malnutrition in Nepal. This study aims to identify infant and young child feeding practices and its associated factors among mothers of children aged less than two years in western hilly region of Nepal. A descriptive cross-sectional study was carried out among 360 mothers of under two years' children in Syangja district. A semi structural questionnaire was used. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics were used to report the feeding practices and other independent variables. Bivariate and multivariate logistic regression model was used to establish the factors associated with infant and young child feeding practices. The prevalence of breastfeeding, timely initiation of breastfeeding, exclusive breastfeeding, timely initiation of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet (MAD) were 95.6%, 69.2%, 47.6%, 53.3%, 61.5%, 67.3% and 49.9% respectively. Normal delivery (AOR 6.1, 95% CI 1.2-31.3) and higher maternal autonomy (AOR 5.2, 95% CI 1.8-14.6) were significantly associated with exclusive breastfeeding. Similarly, crop production and food security (AOR 3.8, 95% CI 1.9-7.7), maternal knowledge on MAD (AOR 2.5, 95% CI 1.0-6.2) and maternal autonomy (AOR 4.2, 95% CI 2.1-8.4) were significantly associated with minimum acceptable diet. Factors such as maternal education, maternal health services utilization, maternal knowledge, and maternal autonomy were associated with infant and young child feeding practices, which warrants further attention to these factors to reduce malnutrition., Competing Interests: The authors have declared that no competing interests exist.

As digital finance is widely spread and applied in China, this new format of financial technology could become a new way to reduce poverty in rural areas. By matching digital financial indexes of the prefectural-level cities with microdata on rural households from the China Household Finance Survey (CHFS) in 2017, we find that digital finance significantly suppresses absolute poverty and relative poverty among rural households in China, which is supported by a series of robustness tests, such as the instrumental variable approach, using alternative specifications, and excluding extreme observations. Additionally, we provide evidence that the poverty reduction effect of digital finance is likely to be explained by alleviating credit constraints and information constraints, broadening social networks, and promoting entrepreneurship. Our findings further complement the research field on financial poverty reduction and offer insights for the development of public financial policies of poverty reduction in other countries, especially in some developing countries., Competing Interests: The authors have declared that no competing interests exist.

The paper takes listed companies in the heavily polluting industry from 2009-2017 as a research sample to explore whether heavy pollution enterprises' environmental protection investment helps their debt financing under the institutional background of China's continuous implementation of green credit policy. It is found that, in general, the environmental protection investment of heavy pollution enterprises helps them to obtain more and relatively long-term new loans; in terms of time, this effect is more evident after the release of China's Green Credit Guidelines in 2012; in addition, the level of regional environmental pollution, the level of financial development and the green fiscal policy also have a moderating effect on this. This paper enriches the study of the economic consequences of corporate environmental protection investment from the perspective of debt financing. It examines the effects of the implementation of China's green credit policy and other institutional factors to provide a reference for the heavy pollution enterprises' environmental protection investment and the implementation of green credit policy by local governments in China., Competing Interests: The authors declare that they have no conflict of interest.

Background: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020., Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050., Findings: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied., Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all., Funding: Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests D McCracken's position was supported in part through the Wellcome Trust, and by the Department of Health and Social Care using UK aid funding managed by the Fleming Fund. R Ancuceanu reports consulting fees from AbbVie and AstraZeneca; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Sandoz, AbbVie, and Braun Medical; and support for attending meetings or travel from AbbVie and AstraZeneca, all outside the submitted work. M Ausloos and C Herteliu report grants or contracts from the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI), project number PN-III-P4-ID-PCCF-2016-0084, outside the submitted work. C Herteliu reports grants or contracts from CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351, outside the submitted work. S Bhaskar reports an unpaid leadership or fiduciary role in a board, society, committee or advocacy group, with the Rotary Club of Sydney Board of Directors, outside the submitted work. R Busse reports grants or contracts from Berlin University Alliance (COVID pre-exploration project), outside the submitted work. S M S Islam reports grants or contracts from National Health and Medical Research Council (NHMRC) and the National Heart Foundation of Australia, all outside the submitted work. K Krishan reports non-financial support from UGC Centre of Advanced Study phase II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. M J Postma reports grants or contacts from Merck Sharp & DDohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Bayer, Bristol Myers Squibb, AstraZeneca, Sanofi, IQVIA, BioMerieux, WHO, EU, Seqirus, FIND, Antilope, DIKTI, LPDP, and Budi; consulting fees from Merk Sharp & Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Quintiles, Bristol Myers Squibb, Astra Zeneca, Sanofi, Novartis, Pharmerit, IQVIA, and Seqirus; participation on a Data Safety Monitoring Board or Advisory Board to Asc Academics as Advisor; and stock or stock options in Health-Ecore and PAG, all outside the submitted work. M G Shrime reports grants or contracts from the Iris O'Brien Foundation; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Brightsight speakers; and leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid with Pharos Global Health Advisors as a board member. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, Two labs, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, WebMD, and Practice Point communications, and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings and travel from OMERACT; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with OMERACT as a member of the steering committee, with the US Food and Drug Administration Arthritis Advisory Committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a Director and Editor; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, and Charlotte's Web Holdings; and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals, all outside the submitted work. All other authors declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Intérêts concurrents: Kumanan Wilson est président-directeur général de CANImmunize Inc. Cette société ne travaille pas sur un passeport vaccinal, mais on lui a demandé de s’exprimer sur la preuve du statut d’immunisation contre la COVID-19. CANImmunize a reçu des fonds provenant de sources publiques et privées (https://www.canimmunize.ca/fr/partners). Le Dr Wilson possède des actions de CANImmunize et ne reçoit aucune rémunération pour ses activités de PDG. Il est membre du comité indépendant sur la sécurité des données pour l’essai du vaccin de Medicago contre la COVID-19. Aucun autre intérêt concurrent n’a été déclaré. Déclaration d’intérêts: Kumanan Wilson est marié à une employée du CMAJ, qui n’a pas participé au processus ayant mené au choix de cet article.

Background: Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known., Methods: Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes., Results: We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. In the context of poverty and previous experiences with the health system, participants described challenges to NCD care across three themes: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility. However, they also outlined windows of opportunity and facilitators of group medical visits and microfinance to address those challenges., Discussion: Our qualitative study revealed actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also described opportunities to address and mitigate the impact of these factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide., Competing Interests: The authors have declared that no competing interests exist.

Community water fluoridation (CWF) is the most effective and equitable approach to preventing dental caries (tooth decay). Yet millions of Americans, especially those at highest risk of caries, do not know what CWF is or its preventive benefits. State health departments are responsible for educating their respective populations. Thus, this study assessed health department websites (N = 50) to determine if CWF content existed, the ease of finding it, and if it was written in plain language and for a consumer audience. We used the web component of the HLE2: The Health Literacy Environment of Hospitals and Health Centers (HLE2) to assess how easy or difficult it was to the navigate a website and find information. Forty-one websites had CWF information; 37 states had content written for a consumer audience. HLE2 scores ranged from 0 to 54 points (60 possible). Only five states had websites with a HLE2 score of 50 or higher. SHDs with higher HLE2 scores were easy to navigate and their content was written for a consumer audience. Study findings suggest most SHDs should improve their website's CWF content and its accessibility to better promote the role of fluoridated water in preventing dental caries., Competing Interests: The authors have read the journal’s policy, and the authors of this study have the following competing interests to declare: MJ is the sole employee of Jacob Strategies LLC, a sole proprietorship, commercial company through which the author offers strategic consulting services to public health organizations. Jacob Strategies LLC did not provide any funding for the study. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Introduction: The BC Centre for Disease Control implemented the Facility Overdose Response Box (FORB) program December 1st, 2016 to train and support non-healthcare service providers who may respond to an overdose in the workplace. The program aims to support staff at non-profit community-based organizations by ensuring policy development, training, practice overdose response exercises, and post-overdose debriefing opportunities are established and implemented., Materials and Methods: Three data sources were used in this descriptive cross-sectional study: FORB site registration data; naloxone administration forms; and a survey that was distributed to FORB sites in February 2019. FORB program site and naloxone administration data from December 1st, 2016 to December 31st, 2019 were analyzed using descriptive statistics. A Cochran-Armitage test was used to assess trends over time in naloxone administration event characteristics. Site coordinator survey results are reported to supplement findings from administrative data., Results: As of December 31st, 2019, FORB was implemented at 613 sites across BC and 1,758 naloxone administration events were reported. The majority (86.3%, n = 1,517) were indicated as overdose reversals. At registration, 43.6% of sites provided housing services, 26.3% offered harm reduction supplies, and 18.6% provided Take Home Naloxone. Refusal to be transported to hospital following overdose events when emergency services were called showed an increasing trend over time. Most respondents (81.3%) reported feeling confident in their ability to respond to the overdose and 59.6% were offered staff debrief. Based on the 89 site survey responses, supports most commonly made available following an overdose were debrief with a fellow staff member (91.0%), debrief with a supervisor (89.9%), and/or counselling services (84.3%)., Conclusions: The uptake of the FORB program has contributed to hundreds of overdose reversals in community settings in BC. Findings suggest that the FORB program supports developing staff preparedness and confidence in overdose response in community-based settings., Competing Interests: The authors have declared no competing interests.

Objective: To assess implementation of the Saving Babies Lives (SBL) Care Bundle, a collection of practice recommendations in four key areas, to reduce stillbirth in England., Design: A retrospective cohort study of 463,630 births in 19 NHS Trusts in England using routinely collected electronic data supplemented with case note audit (n = 1,658), and surveys of service users (n = 2,085) and health care professionals (n = 1,064). The primary outcome was stillbirth rate. Outcome rates two years before and after the nominal SBL implementation date were derived as a measure of change over the implementation period. Data were collected on secondary outcomes and process outcomes which reflected implementation of the SBL care bundle., Results: The total stillbirth rate, declined from 4.2 to 3.4 per 1,000 births between the two time points (adjusted Relative Risk (aRR) 0.80, 95% Confidence Interval (95% CI) 0.70 to 0.91, P<0.001). There was a contemporaneous increase in induction of labour (aRR 1.20 (95%CI 1.18-1.21), p<0.001) and emergency Caesarean section (aRR 1.10 (95%CI 1.07-1.12), p<0.001). The number of ultrasound scans performed (aRR 1.25 (95%CI 1.21-1.28), p<0.001) and the proportion of small for gestational age infants detected (aRR 1.59 (95%CI 1.32-1.92), p<0.001) also increased. Organisations reporting higher levels of implementation had improvements in process measures in all elements of the care bundle. An economic analysis estimated the cost of implementing the care bundle at ~£140 per birth. However, neither the costs nor changes in outcomes could be definitively attributed to implementation of the SBL care bundle., Conclusions: Implementation of the SBL care bundle increased over time in the majority of sites. Implementation was associated with improvements in process outcomes. The reduction in stillbirth rates in participating sites exceeded that reported nationally in the same timeframe. The intervention should be refined to identify women who are most likely to benefit and minimise unwarranted intervention., Trial Registration: The study was registered on (NCT03231007); www.clinicaltrials.gov., Competing Interests: The authors have declared that no competing interests exist.

Competing Interests: Intérêts concurrents: Aucun déclaré.

The US government maintains that local sanctuary policies prevent deportations of violent criminals and increase crime. This report tests those claims by combining Immigration and Customs Enforcement (ICE) deportation data and Federal Bureau of Investigation (FBI) crime data with data on the implementation dates of sanctuary policies between 2010 and 2015. Sanctuary policies reduced deportations of people who were fingerprinted by states or counties by about one-third. Those policies also changed the composition of deportations, reducing deportations of people with no criminal convictions by half-without affecting deportations of people with violent convictions. Sanctuary policies also had no detectable effect on crime rates. These findings suggest that sanctuary policies, although effective at reducing deportations, do not threaten public safety., Competing Interests: Competing interest statement: Until July 2019, I was an attorney at the American Civil Liberties Union’s (ACLU’s) Immigrants’ Rights Project, and I continue to consult occasionally for the ACLU and other immigrants’ rights organizations. This study is unrelated to that consulting work, but both concern immigration enforcement.

Objective: To summarize the progress toward the National Institutes of Health (NIH) Research Plan on Rehabilitation goals and the methods by which tracking occurred., Design: Each grant award was manually coded by NIH staff for research plan goals, type of science categories (eg, basic, applied, infrastructure, etc), and if applicable, training, and then validated by NIH institute and center (IC) experts. Data for years 2015 through 2017 were used to develop a coding algorithm to automatically code grants in 2018 for validation by NIH IC experts. Additional data for all years (2015-2018) were also analyzed to track changes and progress., Setting: The research utilized administrative data from NIH Reporter and internal NIH databases., Participants: The data sample included research grants and programs funded from fiscal years 2015 through 2018. The year 2015 was considered a baseline year as the research plan was published in 2016., Interventions: Not applicable., Main Outcome Measures: The primary outcome measures were substantial growth in NIH funding and numbers of awards for rehabilitation research, across most research plan goals and types of science, as well as validation of an automatic algorithm for coding grants., Results: Number of grants, funding dollars, funding mechanisms, patent data, scientific influence and translational science, research plan goals, and type of science categories were tracked across years (2015-2018). Algorithm validation is presented for 2018 data., Conclusions: NIH advanced the goals stated in the Research Plan on Rehabilitation, but gap areas remain. Though funding in this portfolio is growing, continued focus and participation by the field is needed to advance rehabilitation science., (Published by Elsevier Inc.)

Frequent claims suggest that healthcare and its production are not only different from other goods, but that they differ to such an extent that healthcare should be viewed as unique. Various features of healthcare, such as the lack of a perfect market and the existence of information asymmetry, are cited as evidence of this claim. However, such a view results from unduly emphasising the characteristics of healthcare as being atypical. This article redresses this imbalance by taking an alternative approach and examines the ways in which the economic aspects of healthcare are similar to those of other goods. It was found that the differential aspects are less distinctive than claimed and the economic aspects of healthcare are not unique., (© Copyright 2020, Sultan Qaboos University Medical Journal, All Rights Reserved.)

This article aims at giving insight into Norwegian mental health service by exploring the ideologies of two diametrical philosophers, the American Robert Nozick (1938-2002) and the German Axel Honneth (1949-). Nozick proposes as an ideal a minimal state in which citizens have a "negative right" to the absence of interference and to follow their own interests without restriction from the state. On the other side, Axel Honneth claims that there is no freedom without state interference. In his view, governmental involvement is understood as a prerequisite for personal freedom. We may call this state an opposite of the minimal state; a maximal state. To get a better understanding of these opposite philosophies, we use texts written from conversations with people suffering from mental health problems, nurses and other caregivers in four Norwegian municipalities. Nozick's notion of the minimal state and Honneth's political philosophy of freedom and recognition were used as analytical tools. Among patients and helpers, there were different opinions about good care and how much caregivers should intervene. Some emphasized autonomy, independency, minimal involvement in human contact by nurses and other caregivers, similar a minimal state. Others perceived good care as bonding between helpers and service-users. They underlined equal and personal relationships, as well as helping with practicalities, similar a maximal state. In the discussion, we focus on how people with chronic illnesses are supposed to transform themselves into self-cared individuals, able to manage their own condition successfully with minimal help from public welfare and at a lower cost. Finally, we express concerns about who will care for disempowered patients without family and other resources in a minimal state., (© 2019 John Wiley & Sons Ltd.)

Context: In 2008, the $1.2 M sexually transmitted disease (STD) services line item supporting STD clinical services by the Massachusetts Department of Public Health was eliminated, forcing the cessation of all state-supported STD service delivery., Objective: To determine the impact on community provision of STD services after the elimination of state funds supporting STD service provision., Design and Setting: Rapid ethnographic assessments were conducted in May 2010 and September 2013 to better understand the impact of budget cuts on STD services in Massachusetts. The rapid ethnographic assessment teams identified key informants through Massachusetts's STD and human immunodeficiency virus programs., Participants: Fifty providers/clinic administrators in 19 sites (15 unique) participated in a semistructured interview (community health centers [n = 10; 53%], hospitals [n = 4; 21%], and other clinical settings [n = 5; 26%])., Results: Results clustered under 3 themes: financial stability of agencies/clinics, the role insurance played in the provision of STD care, and perceived clinic capacity to offer appropriate STD services. Clinics faced hard choices about whether to provide care to patients or refer elsewhere patients who were unable or unwilling to use insurance. Clinics that decided to see patients regardless of ability to pay often found themselves absorbing costs that were then passed along to their parent agency; the difficulty and financial strain incurred by a clinic's parent agency by providing STD services without support by state grant dollars emerged as a primary concern. Meeting patient demand with staff with appropriate training and expertise remained a concern., Conclusions: Provision of public health by private health care providers may increase concern among some community provision sites about the sustainability of service provision absent external funds, either from the state or from the third-party billing. Resource constraints may be felt across clinic operations. Provision of public health in the for-profit health system involves close consideration of resources, including those: leveraged, used to provide uncompensated care, or available for collection through third-party billing.

Schistosomiasis was once heavily endemic in Jiangsu Province. Following the control efforts for several decades, schistosomiasis was almost eradicated in all endemic counties in Jiangsu Province in 1980, and transmission control was achieved in the province in 2011. According to the principle of "implementing the control measures with adaptation to local circumstances and guiding the control programs with classified interventions", an integrated strategy with emphasis on the management of both infectious sources and snails has been recently employed for schitsosomiasis control in Jiangsu Province. In addition, a sensitive and highly effective surveillance system has been built and the application of novel techniques and information construction has been intensified to effectively interrupt the transmission of schistosomiasis in the Province. Transmission interruption of schistosomiasis was achieved in all endemic counties in Jiangsu Province. The paper summarizes the endemic situation of schistosomiasis, progress of schistosomiasis control, and major schistosomiasis control measures implemented during the stage of transmission interruption in Jiangsu Province.

Competing Interests: Competing interests: Ceara Cunningham and Judy Seidel are employees of Alberta Health Services (AHS). Brad Bahler is remunerated through a contract with AHS. He is the medical director for Primary Care Network Evolution in Alberta and the Alberta Medical Association Accelerated Change Transformation team. No other competing interests were declared.

While road safety in the United States (U.S.) has been continually improving since the 1970's, there are indications that these improvements are becoming increasingly difficult to sustain. Strategic Highway Safety Plans (SHSPs) are prepared by States to guide road safety management, however assessing the appropriateness of these plans remains a significant challenge, especially for the future in which they are to be applied. This study developed a new methodology to assess SHSPs from the perspectives of comprehensive system-based safety management and relevant future issues that can be applied before SHSPs are implemented, thereby avoiding long periods after implementation before assessing the appropriateness of the plans. A rating scale was developed and applied to assess 48 U.S. SHSPs against two key criteria: 1. a comprehensive framework for road safety, and 2. the anticipated changing, difficult and unpredictable nature of future transport and its context. The analysis concluded that current SHSPs have good national oversight with several strengths but were weak in some areas of content and did not address future challenges. Improvements are suggested to strengthen the plans' thoroughness by being consistent with systems theory and practice, as well as ways that these SHSPs can be more resilient to future circumstances. Implementing the recommendations in this paper provides the opportunity to adopt a system-based safety management practice that has been successful in other hazardous industries. Doing so is expected to most efficiently and effectively continue the recent improvements to road safety, which is likely to be increasingly difficult otherwise., Competing Interests: The authors have declared that no competing interests exist.

Objective: to analyze the daily work of rural Family Health Strategy (FHS) nurses., Method: a qualitative, descriptive and exploratory research. The data were collected with eleven rural nurses of the city of Campina Grande, Paraíba State, through semi-structured interviews, between January and March of 2017, using Content Analysis., Results: rural nurses have a strong relationship with the population. However, they reveal a daily work with various organizational barriers that range from the team displacement to the workplace to the operationalization of health actions, which are mediated by the characteristics of rurality. Some of these barriers can be remedied by a more proactive action from the management., Final Considerations: conditioned by the characteristics of rurality, the differentiated dynamics work reveal weaknesses in the quality of nursing care and lower effectiveness of the FHS.

This article is part of a series in this regular feature which looks at new directions in health science libraries. This paper highlights new initiatives aimed at ensuring health libraries can contribute to the development of Uganda in the 21st century and the challenges facing libraries. It stresses that for libraries to be successful they need to form networks and collaborations for resource sharing; take advantage of the benefits of information technology; computerise their library systems; as well as invest in the development of staff. The paper highlights the main challenge facing the library service as inadequate funding both from government for public-funded health libraries and the private sector (for privately funded health libraries). The paper concludes that, despite the bottlenecks brought about by inadequate funding, Ugandan health libraries have taken positive steps to support health research and education, as well as patient care, not just for Uganda, but for the whole of the East African region. J.M., (© 2019 Health Libraries Group.)

On September 12, 2018, President Jae-In Moon announced the Comprehensive Plan for Lifelong Care for People with Developmental Disabilities, with representatives from the associated government branches (Ministry of Health and Welfare, Ministry of Education, and Ministry of Employment and Labor) in attendance. The goals of this plan are to provide health, medical, rehabilitative, special education, and social welfare services according to the life-stages of the affected individuals; to reduce parental pressure; to promote social interventions; and to enhance community-level participation in order to create a 'welfare society in harmony.' However, in order for the plan to succeed, additional efforts must be made in the following areas. First, an epidemiological survey is needed to understand the scale, prevalence, and incidence of developmental disabilities and to establish an evidence base to support policy development. Second, accurate definitions of developmental disabilities must be established in order to avoid policy discrimination based on impairment type and age. Third, personal evaluations to assess disabled individuals' unmet needs and customized service designs to deliver those needs are required. Fourth, the plan must fulfill the goals of accessibility and fairness that the government intends to provide. Fifth, the government should consider an integrated financial support system and to propose a detailed plan for monetary distributions. Finally, an integrated system that links health, medical, employment, educational, and welfare services must be constructed.

Background: Community-based primary care focuses on health promotion, awareness raising, and illnesses treatment and prevention in individuals, groups, and communities. Community Health Workers (CHWs) are the leading actors in such programs, helping to bridge the gap between the population and the health system. Many mobile health (mHealth) initiatives have been undertaken to empower CHWs and improve the data collection process in the primary care, replacing archaic paper-based approaches. A special category of mHealth apps, known as mHealth Data Collection Systems (MDCSs), is often used for such tasks. These systems process highly sensitive personal health data of entire communities so that a careful consideration about privacy is paramount for any successful deployment. However, the mHealth literature still lacks methodologically rigorous analyses for privacy and data protection., Objective: In this paper, a Privacy Impact Assessment (PIA) for MDCSs is presented, providing a systematic identification and evaluation of potential privacy risks, particularly emphasizing controls and mitigation strategies to handle negative privacy impacts., Methods: The privacy analysis follows a systematic methodology for PIAs. As a case study, we adopt the GeoHealth system, a large-scale MDCS used by CHWs in the Family Health Strategy, the Brazilian program for delivering community-based primary care. All the PIA steps were taken on the basis of discussions among the researchers (privacy and security experts). The identification of threats and controls was decided particularly on the basis of literature reviews and working group meetings among the group. Moreover, we also received feedback from specialists in primary care and software developers of other similar MDCSs in Brazil., Results: The GeoHealth PIA is based on 8 Privacy Principles and 26 Privacy Targets derived from the European General Data Protection Regulation. Associated with that, 22 threat groups with a total of 97 subthreats and 41 recommended controls were identified. Among the main findings, we observed that privacy principles can be enhanced on existing MDCSs with controls for managing consent, transparency, intervenability, and data minimization., Conclusions: Although there has been significant research that deals with data security issues, attention to privacy in its multiple dimensions is still lacking for MDCSs in general. New systems have the opportunity to incorporate privacy and data protection by design. Existing systems will have to address their privacy issues to comply with new and upcoming data protection regulations. However, further research is still needed to identify feasible and cost-effective solutions., (©Leonardo Horn Iwaya, Simone Fischer-Hübner, Rose-Mharie Åhlfeldt, Leonardo A Martucci. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.03.2019.)

Background: Active labour market policies (ALMP) are used in advanced welfare states to support transitions to work for people who are unemployed or underemployed, including people with disabilities (PWD) in receipt of means-tested disability income support., Objective: This study explores the nature, strength, and limitations of ALMP across advanced welfare states (ALMP) for people with disabilities (PWD) in receipt of income benefits from social assistance programs., Methods: Following the eight steps of a scoping study, we identified 21 documents through a scan of eight databases and consultation with key informants. The majority of these documents are scholarly publications including seven literature reviews, two program evaluations, four social policy analyses, and two longitudinal studies., Results: We extracted key findings related to delivery of labour (re)entry interventions for people with disabilities. Six themes are identified that discuss these ALMP features: 1) welfare ideology and the role of citizenship; 2) conditionality of benefits; 3) work capacity and the need for an appropriate definition of disability; 4) the politics of employment outcomes for PWD; 5) the missing elements of a successful ALMP; and 6) moving beyond ALMP. The findings indicate that while various approaches are used in reintegrating PWD into mainstream employment, there are significant limitations that curtail the impact of these policies., Conclusions: Regardless of welfare regime, no welfare state provides a policy mix that results in long-term employment success for PWD in receipt of means-tested income benefits.

In the absence of good data on the costs and comparative benefits from investing in health emergency and disaster risk management (EDRM), governments have been reluctant to invest adequately in systems to reduce the risks and consequences of emergencies and disasters. Yet they spend heavily on their response. We describe a set of key functional areas for investment and action in health EDRM, and calculate the costs needed to establish and operate basic health EDRM services in low- and middle-income countries, focusing on management of epidemics and disasters from natural hazards.We find that health EDRM costs are affordable for most governments. They range from an additional 4.33 USD capital and 4.16 USD annual recurrent costs per capita in low-income countries to 1.35 USD capital to 1.41 USD recurrent costs in upper middle-income countries. These costs pale in comparison to the costs of not acting-the direct and indirect costs of epidemics and other emergencies from natural hazards are more than 20-fold higher.We also examine options for the institutional arrangements needed to design and implement health EDRM. We discuss the need for creating adaptive institutions, strengthening capacities of countries, communities and health systems for managing risks of emergencies, using "all-of-society" and "all-of-state institutions" approaches, and applying lessons about rules and regulations, behavioral norms, and organizational structures to better implement health EDRM. The economic and social value, and the feasibility of institutional options for implementing health EDRM systems should compel governments to invest in these common goods for health that strengthen national health security.

Common goods such as air, water, climate, and other resources shared by all humanity are under increasing pressure from growing population and advancing globalization of the world economy. Safeguarding these resources is generally considered a government responsibility, as common goods are vulnerable to market failure. However, governments do not always fulfill this role, and face many challenges in doing so. This observation-that governments only sometimes address common goods problems-informs the central question of this paper: when do governments act in support of common goods? We structure our inquiry using a framework derived from three theories of agenda setting, emphasizing problem perception, the role of actors and collective action patterns, strategies and policies, and catalyzing circumstances. We used a poll of experts to identify important common goods for health: disease surveillance, environmental protection, and accountability. We then chose four historical cases for analysis: the establishment of the Epidemic Intelligence Service in the US, transport planning in London, road safety in Argentina, and air quality control in urban India. Our analysis of the collective evidence of these cases suggests that decisions to advance government action on common goods require a concisely articulated problem, a well-defined strategy for addressing the problem, and leadership backed by at least a few important groups willing to cooperate. Our cases reveal a variety of collective action patterns, suggesting that there are many routes to success. We consider that the timing of an intervention in support of common goods depends on favorable circumstances, which can include a catalyzing event but does not necessarily require one.

This article delves into the views of 72 leaders in domestic violence and sexual assault advocacy, policy, service, and research to determine their vision for the future direction of the field. Through discussions with experts, we identified numerous strategies necessary to best meet the needs of domestic violence and sexual assault victims. Common themes focused on the need to (a) examine the context of victims' and offenders' experiences; (b) increase cultural competence to adequately provide appropriate victim services and criminal justice responses for underserved, marginalized, and culturally specific populations; (c) increase reliance on victims' voices; (d) continue to develop partnerships at both the community and the state levels and ensure the role of local communities; (e) expand the concept of successful outcomes that can be reliably and validly assessed; (f) emphasize mixed-methods approaches to address these questions, in recognition that various methods complement each other; and (g) be open to novel or emerging approaches to intervention.

Unhealthy housing is a major cause of respiratory health inequity. In-home health education improves health equity for low-income and minority populations with asthma and chronic obstructive pulmonary disease. Yet, outcomes of educational interventions are limited by poor housing conditions. Federal weatherization programs represent a promising source of funding for home repairs. Innovative legislation in Washington State integrates the 2 interventions as "Weatherization Plus Health," offering environmental health education in partnership with the Weatherization Assistance Program for low-income families with respiratory disease. This practice brief describes process evaluation results of a Weatherization Plus Health program in Pierce County, Washington. Evaluation data were gathered via interviews with service providers and ethnographic observation. Workers report that the combined intervention expanded their understanding of their practice, skills, and feelings of efficacy in meeting client needs. Integrating federally funded home weatherization with health education shows promise for building public health system capacity and increasing health equity.

Safeguarding the continued existence of humanity requires building societies that cause minimal disruptions of the essential planetary systems that support life. While major successes have been achieved in improving health in recent decades, threats from the environment may undermine these gains, particularly among vulnerable populations and communities. In this article, we review the rationale for governments to invest in environmental Common Goods for Health (CGH) and identify functions that qualify as such, including interventions to improve air quality, develop sustainable food systems, preserve biodiversity, reduce greenhouse gas emissions, and encourage carbon sinks. Exploratory empirical analyses reveal that public spending on environmental goods does not crowd out public spending on health. Additionally, we find that improved governance is associated with better performance in environmental health outcomes, while the degrees of people's participation in the political system together with voice and accountability are positively associated with performance in ambient air quality and biodiversity/habitat. We provide a list of functions that should be prioritized by governments across different sectors, and present preliminary costing of environmental CGH. As shown by the costing estimates presented here, these actions need not be especially expensive. Indeed, they are potentially cost-saving. The paper concludes with case examples of national governments that have successfully prioritized and financed environmental CGH. Because societal preferences may vary across time, government leaders seeking to protect the health of future generations must look beyond electoral cycles to enact policies that protect the environment and finance environmental CGH.

In 2014, the National Institutes of Health (NIH) began funding an ambitious research program, the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, with the singular focus of advancing our understanding of brain circuits though development and application of breakthrough neurotechnologies. As we approach the halfway mark of this 10-year effort aimed at revolutionizing our understanding of information processing in the human brain, it is timely to review the progress and the future trajectory of BRAIN Initiative research., Competing Interests: The authors have declared that no competing interests exist.

Introduction: This position paper summarizes the development and the present status of Department of Defense (DoD) and other government policies and guidances regarding cloud computing services. Due to the heterogeneous and growing biomedical big datasets, cloud computing services offer an opportunity to mitigate the associated storage and analysis requirements. Having on-demand network access to a shared pool of flexible computing resources creates a consolidated system that should reduce potential duplications of effort in military biomedical research., Methods: Interactive, online literature searches were performed with Google, at the Defense Technical Information Center, and at two National Institutes of Health research portfolio information sites. References cited within some of the collected documents also served as literature resources., Results: We gathered, selected, and reviewed DoD and other government cloud computing policies and guidances published from 2009 to 2017. These policies were intended to consolidate computer resources within the government and reduce costs by decreasing the number of federal data centers and by migrating electronic data to cloud systems. Initial White House Office of Management and Budget information technology guidelines were developed for cloud usage, followed by policies and other documents from the DoD, the Defense Health Agency, and the Armed Services. Security standards from the National Institute of Standards and Technology, the Government Services Administration, the DoD, and the Army were also developed. Government Services Administration and DoD Inspectors General monitored cloud usage by the DoD. A 2016 Government Accountability Office report characterized cloud computing as being economical, flexible and fast. A congressionally mandated independent study reported that the DoD was active in offering a wide selection of commercial cloud services in addition to its milCloud system. Our findings from the Department of Health and Human Services indicated that the security infrastructure in cloud services may be more compliant with the Health Insurance Portability and Accountability Act of 1996 regulations than traditional methods. To gauge the DoD's adoption of cloud technologies proposed metrics included cost factors, ease of use, automation, availability, accessibility, security, and policy compliance., Conclusions: Since 2009, plans and policies were developed for the use of cloud technology to help consolidate and reduce the number of data centers which were expected to reduce costs, improve environmental factors, enhance information technology security, and maintain mission support for service members. Cloud technologies were also expected to improve employee efficiency and productivity. Federal cloud computing policies within the last decade also offered increased opportunities to advance military healthcare. It was assumed that these opportunities would benefit consumers of healthcare and health science data by allowing more access to centralized cloud computer facilities to store, analyze, search and share relevant data, to enhance standardization, and to reduce potential duplications of effort. We recommend that cloud computing be considered by DoD biomedical researchers for increasing connectivity, presumably by facilitating communications and data sharing, among the various intra- and extramural laboratories. We also recommend that policies and other guidances be updated to include developing additional metrics that will help stakeholders evaluate the above mentioned assumptions and expectations.

This paper assesses the extent to which patent renewal data is associated with government funding in a university context by focusing on the relationship between the funded patentees and renewal decisions of their patents. The aim of this paper is to show whether receiving funding from government contributes to high-value patents as measured by the patent renewal decisions made by their owners. Our observations of academic nanotechnology patents in Canada discovered a positive relationship between funded researchers and the rate of patent renewal after 4 years. Further analysis is also undertaken into the relative impact on patent renewal after 8 years and 12 years. Our results suggest that the length of patent renewal in numbers of years can be related to levels of government funding received by their inventors., Competing Interests: The authors have declared that no competing interests exist.

This article takes stock of the implementation of Brazil's public health system in the period since the promulgation of the 1988 Constitution, which enshrines the right to health. It analyzes issues affecting the organizational effectiveness of health service provision such as funding and relations between different spheres of government. It focuses on the role of local government, the centralization of legislative powers, which has been shown to weaken the member states, and the financial dependence of local and state governments on federal government and how this has affected policy implementation. It also touches on other issues such as regionalization, poor planning, federal centralism, and Ministry of Health-local government relations, which have hampered state coordination of regional health systems. To close, we put forward some final considerations for improving the implementation of policies oriented towards the development of SUS structures.

Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health improvements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors.

In November 2017, following a military intervention, Robert Mugabe was forced to resign as president of Zimbabwe - where he had ruthlessly ruled since 1980. Mugabe's regime was responsible for destroying the country's excellent health system. I argue that this is a unique moment for health reform in Zimbabwe. This reform should focus on three areas: (1) repairing relationships with the international community by focusing on human rights and eliminating corruption, (2) strengthening the health workforce through retention strategies, training, and non-specialist providers, and (3) community engagement. The future of Zimbabwe's health system is in limbo, and now is a unique opportunity to make positive change.

Universal Health Coverage (UHC) is one of the targets for the United Nations Sustainable Development Goal 3. The impetus for UHC has led to an increased demand for time-sensitive tools to enhance our knowledge of how health systems function and to evaluate impact of system interventions. We define the field of "health system modeling" (HSM) as an area of research where dynamic mathematical models can be designed in order to describe, predict, and quantitatively capture the functioning of health systems. HSM can be used to explore the dynamic relationships among different system components, including organizational design, financing and other resources (such as investments in resources and supply chain management systems) - what we call "inputs" - on access, coverage, and quality of care - what we call "outputs", toward improved health system "outcomes", namely increased levels and fairer distributions of population health and financial risk protection. We undertook a systematic review to identify the existing approaches used in HSM. We identified "systems thinking" - a conceptual and qualitative description of the critical interactions within a health system - as an important underlying precursor to HSM, and collated a critical collection of such articles. We then reviewed and categorized articles from two schools of thoughts: "system dynamics" (SD)" and "susceptible-infected-recovered-plus" (SIR+). SD emphasizes the notion of accumulations of stocks in the system, inflows and outflows, and causal feedback structure to predict intended and unintended consequences of policy interventions. The SIR + models link a typical disease transmission model with another that captures certain aspects of the system that impact the outcomes of the main model. These existing methods provide critical insights in informing the design of HSM, and provide a departure point to extend this research agenda. We highlight the opportunity to advance modeling methods to further understand the dynamics between health system inputs and outputs., (Copyright © 2017 Elsevier Ltd. All rights reserved.)