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ObjectivesEarly smoking initiation has been associated with a higher risk of developing long-term smoking habit. There is a growing global consensus that demands raising the minimum legal age (MLA) for smoking as an approach to address this problem. Singapore successfully raised the MLA from 18 to 21 years in 2021. This study aimed to evaluate the awareness and attitude of multi-ethnic Asian youth (aged 15–24) on raising MLA to 21 and passive smoking.MethodsA cross-sectional survey comprising of 23 items was circulated via a secure internet-based platform, FORMSG between September and November 2022. Data were analyzed for descriptive statistics. Categorical variables were compared for association with receptivity toward change in MLA using Chi-Squared test and multivariable logistic regression analysis using Rstudio. Post-hoc Bonferroni correction were further utilized for pairwise comparison.ResultsMajority (80.3%) of the 608 participants expressed their support for MLA 21 implementation. Participants’ age was a significant variable as those aged 15–17 years old (OR = 2.1, 95%CI = 1.01–4.32, p = 0.048) showed a higher likelihood of supporting MLA implementation compared to those aged 21 and above. In addition, majority (89.8%) of them were also aware of the harmful effects of passive smoking. When it came to discouraging smoking among youth, family influence (64%) and school education (55.6%) emerged as the top strategies.ConclusionMost of the youth express strong support for raising the MLA to 21, with over 80% in favor of such change, reflects a significant harmony among youth in favor of tobacco-free environment.

Objective: The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms. Data Sources and Study Setting: AHRQ convened a payment and financing workgroup–the authors of this paper–as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity. Study Design: The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants. Data Collection/Extraction Methods: This paper did not require novel data collection; the authors collected the data from the existing evidence base. Principal Findings: The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools. Conclusions: Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity. [ABSTRACT FROM AUTHOR]

The implications of young childhood undernutrition on health, development and productivity are grave. In the last two decades, global and Indian studies on undernutrition in under five years have concluded that stunting and underweight rate increases steadily between 0-24 mo, and then stabilises. The available evidence highlights the significance of concentrating interventions to tackle child undernutrition in the first 1000 d of life, which should aim at universal coverage of essential nutrition interventions (ENIs) and maternal-child health care package comprising maternal nutrition care, adoption of appropriate infant and young child feeding practices (IYCF), iron-folic acid supplementation, immunization, deworming, appropriate management of childhood illness etc. Additionally, it is critical to address context specific nutrition sensitive measures such as socio-economic empowerment of women, preventing domestic violence, adolescent conception, appropriate water -sanitation-hygiene and family planning services etc. Mapping of the 'at risk' households having a member falling in the 1000 d window needs special attention and is central to the ongoing efforts in India through the National Nutrition Mission/ POSHAN Abhiyaan. However, for effective implementation, there is an urgent need to consider to shift the lead responsibility of ENIs in the first 1000 d of life to the health care system in India and strategize to integrate maternal nutrition care interventions and establishing of IYCF practices by ensuring optimum use of contacts with antenatal care and routine child immunization services. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess longitudinal primary care organization participation patterns in large-scale reform programs and identify organizational characteristics associated with multiprogram participation.Data sourcesSecondary data analysis of national program participation data over an eight-year period (2009-2016).Study designWe conducted a retrospective, observational study by creating a unique set of data linkages (including Medicare and Medicaid Meaningful Use and Medicare Shared Savings Program Accountable Care Organization (MSSP ACO) participation from CMS, Patient-Centered Medical Home (PCMH) participation from the National Committee for Quality Assurance, and organizational characteristics) to measure longitudinal participation and identify what types of organizations participate in one or more of these reform programs. We used multivariate models to identify organizational characteristics that differentiate those that participate in none, one, or two-to-three programs.Data extraction methodsWe used Medicare claims to identify organizations that delivered primary care services (n = 56 ,287) and then linked organizations to program participation data and characteristics.Principal findingsNo program achieved more than 50% participation across the 56,287 organizations in a given year, and participation levels flattened or decreased in later years. 36% of organizations did not participate in any program over the eight-year study period; 50% participated in one; 13% in two; and 1% in all three. 14.31% of organizations participated in five or more years of Meaningful Use while 3.84% of organizations participated in five years of the MSSP ACO Program and 0.64% participated in at least five years of PCMH. Larger organizations, those with younger providers, those with more primary care providers, and those with larger Medicare patient panels were more likely to participate in more programs.Conclusions and relevancePrimary care transformation via use of voluntary programs, each with their own participation requirements and approach to incentives, has failed to broadly engage primary care organizations. Those that have chosen to participate in multiple programs are likely those already providing high-quality care.

Considering the necessity of learning from past experiences and continuous improvement in order to prepare development plans, the present study examines the challenges and strategies to implement health-related provisions in the first to sixth development plans. The current research was conducted in the form of a scoping review. Studies published in English and Persian 2000 until the end of November 2021 were reviewed. The search was done in the databases (SID, Magiran, Ensani.Ir, Irandoc, Web of Science, Scopus, Google Scholar, Pubmed) and related journals. 262 studies were obtained, after removing unrelated, duplicate studies and quality assessment, finally articles were selected for final analysis. CASP checklist was used to evaluate the quality. Conventional content analysis approach with Max-QDA 12 was used for data analysis. 262 studies were obtained, finally 16 articles were selected and analyzed. Challenges and solutions related to implementing the health sector development plans of the Islamic Republic of Iran in seven main dimensions including: the program development approach; Policy makers and executives; Execution and implementation of the program, program development, program monitoring challenges; Content of the program; and Lack of following the principles of planning and 51 sub dimensions were extracted that the lack of a clear definition of the concepts of development and development planning; Non-compliance of program provisions with general policies; Lack of meaningful and developmental supervision; Multiple goals and priorities were among challenges. Also, the corresponding solutions of each challenge based on the review of studies included 47 sub dimensions that the correct implementation of the principles of coherent planning, definition of appropriate indicators, mechanisms for gathering information, evaluation of the program, political support, creating a unified understanding between stakeholders, adapting the design of executive programs to infrastructure and moving to mixed programs were among the solutions. Human-centered approaches to development place a lot of value on health and believe that unless an efficient health system governs the society, societies and nations cannot achieve their economic and social goals. Therefore, discussions and planning in this area are very important; Therefore, the identified challenges resulting from this study and the solutions to overcome them can help to formulate, implement and finally evaluate the future development plans [ABSTRACT FROM AUTHOR]

The National Institute of Health has, for the first time, identified National Priorities for Oral Health Research, this process was carried out by the Subdirectorate of Research and Laboratories of Noncommunicable Diseases of the National Center for Public Health with the technical advice of the Directorate of Research and Innovation in Health and in coordination with the Executive Directorate of Oral Health of the General Directorate of Strategic Interventions in Public Health of the Ministry of Health, using a participatory methodology with three key actors: researchers/specialists, experts and decision-makers. This article aims to describe the process used to identify these priorities, which consisted of five phases: i) identification of the strategic objectives of the Ministry of Health, ii) identification of needs in oral health research, iii) review by experts and assessment of needs according to criteria and v) presentation of the priorities. As a result, 12 priorities were obtained, which were subsequently approved by Ministerial Resolution No. 262-2022/MINSA, for a period of 2022-2026. In addition, we provide recommendations for future processes. [ABSTRACT FROM AUTHOR]

Copyright of Revista Salud UIS is the property of Universidad Industrial de Santander 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.)

BackgroundUninsurance for young adults (YAs) was greatly reduced by the Affordable Care Act (ACA). However, reforms may not be equally beneficial for all YAs and certain policies may exacerbate, rather than resolve, pre-existing disparities.ObjectiveTo investigate inequalities in YAs' insurance coverage pre- (2000-2010) and post-federal health reforms (dependent coverage expansion, 2010-2013, and Medicaid/Marketplace expansions, 2014-2016), among a nationally representative sample.DesignA difference-in-differences estimator (controlling for sociodemographics) was used to determine the effects of the ACA for young adults (ages 19-25) compared to adolescents (ages 13-18) and older YA (ages 26-30) counterparts; triple-difference estimators quantified differential policy effects by sociodemographics.ParticipantsThree hundred eighty-seven thousand six hundred thirty-five participants in the 2000-2016 National Health Interview Survey.Main measuresRespondents reported their health insurance coverage types during the last 12 months, reasons uninsured, and detailed sociodemographics.Key resultsAn adjusted difference-in-differences estimator quantified a 12.3 percentage point increase (p

Although the micronutrient status of a population is of high national priority, as it critically impacts public health, limited data is available for quantifying the micronutrient status in Saudi Arabia. We aimed to provide comprehensive, epidemiological, descriptive data regarding micronutrient levels in Saudi adults. This cross-sectional study included 3432 adults aged ≥18 years (mean age, 37.7 ± 11.7 years; women, 51.2%) across all 13 Saudi administrative regions (March 2019–November 2021). Laboratory data for 14 micronutrients (8 vitamins, 4 minerals, and 2 nonessential heavy metals) were characterized using descriptive analysis. Vitamin D deficiency (64.3%) was the most prevalent, followed by vitamin B2 (44.9%) and A (9.6%) deficiencies. Among minerals, iron deficiency was the most prevalent (23.2%), followed by zinc (15.3%) and copper (8.7%) deficiencies. Most Saudi adults exhibited normal arsenic (99.7%) and mercury (99.9%) levels. Men exhibited significantly higher vitamin B2, B9, and D deficiencies than women, while women exhibited higher vitamin A, B12, iron, and zinc deficiencies than men. Younger adults demonstrated a significantly higher prevalence of vitamin D and iron deficiencies, whereas older adults exhibited a higher prevalence of vitamin B1 and magnesium deficiencies. As micronutrient deficiencies are a public health concern, health policies and programs need to be developed and implemented to address them. [ABSTRACT FROM AUTHOR]

Abstract Background Human Resources for Health (HRH) are crucial for improving health services coverage and population health outcomes. The World Health Organisation (WHO) promotes countries to formulate holistic policies that focus on four HRH dimensions—availability, accessibility, acceptability, and quality (AAAQ). The status of these dimensions and their incorporation in the National Health Policies of India (NHPIs) are not well known. Methods We created a multilevel framework of strategies and actions directed to improve AAAQ HRH dimensions. HRH-related recommendations of NHPI—1983, 2002, and 2017 were classified according to targeted dimensions and cadres using the framework. We identified the dimensions and cadres focussed by NHPIs using the number of mentions. Furthermore, we introduce a family of dimensionwise deficit indices formulated to assess situational HRH deficiencies for census years (1981, 2001, and 2011) and over-year trends. Finally, we evaluated whether or not the HRH recommendations in NHPIs addressed the deficient cadres and dimensions of the pre-NHPI census years. Results NHPIs focused more on HRH availability and quality compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and pharmacists in terms of total recommendations. AAAQ indices showed deficits in all dimensions for almost all HRH cadres over the years. All deficit indices show a general decreasing trend from 1981 to 2011 except for the accessibility deficit. The recommendations in NHPIs did not correspond to the situational deficits in many instances indicating a policy priority mismatch. Conclusion India needs to incorporate AAAQ dimensions in its policies and monitor their progress. The framework and indices-based approach can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies of various nations.

Background: Despite recommendations to deliver palliative care to cancer patients and their caregivers, their distress has not been alleviated satisfactorily. National health policies play a pivotal role in achieving a comprehensive range of quality palliative care delivery for the public. However, there is no standardised logic model to appraise the efficacy of these policies. This study aimed to develop a logic model of a national health policy to deliver cancer palliative care and to reach consensus towards specific policy proposals. Methods: A draft version of the logic model and specific policy proposals were formulated by the research team and the internal expert panel, and the independent external expert panel evaluated the policy proposals based on the Delphi survey to reach consensus. Results: The logic model was divided into three major conceptual categories: 'care-delivery at cancer hospitals', 'community care coordination', and 'social awareness of palliative care'. There were 18 and 45 major and minor policy proposals, which were categorised into four groups: requirement of government-designated cancer hospitals; financial support; Basic Plan to Promote Cancer Control Programs; and others. These policy proposals were independently evaluated by 64 external experts and the first to third Delphi round response rates were 96.9–98.4%. Finally, 47 policy proposals reached consensus. The priority of each proposal was evaluated within the four policy groups. Conclusions: A national health policy logic model was developed to accelerate the provision of cancer palliative care. Further research is warranted to verify the study design to investigate the efficacy of the logic model. [ABSTRACT FROM AUTHOR]

Objectives: Early smoking initiation has been associated with a higher risk of developing long-term smoking habit. There is a growing global consensus that demands raising the minimum legal age (MLA) for smoking as an approach to address this problem. Singapore successfully raised the MLA from 18 to 21 years in 2021. This study aimed to evaluate the awareness and attitude of multi-ethnic Asian youth (aged 15-24) on raising MLA to 21 and passive smoking., Methods: A cross-sectional survey comprising of 23 items was circulated via a secure internet-based platform, FORMSG between September and November 2022. Data were analyzed for descriptive statistics. Categorical variables were compared for association with receptivity toward change in MLA using Chi-Squared test and multivariable logistic regression analysis using Rstudio. Post-hoc Bonferroni correction were further utilized for pairwise comparison., Results: Majority (80.3%) of the 608 participants expressed their support for MLA 21 implementation. Participants' age was a significant variable as those aged 15-17 years old (OR = 2.1, 95%CI = 1.01-4.32, p  = 0.048) showed a higher likelihood of supporting MLA implementation compared to those aged 21 and above. In addition, majority (89.8%) of them were also aware of the harmful effects of passive smoking. When it came to discouraging smoking among youth, family influence (64%) and school education (55.6%) emerged as the top strategies., Conclusion: Most of the youth express strong support for raising the MLA to 21, with over 80% in favor of such change, reflects a significant harmony among youth in favor of tobacco-free environment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gunasekaran, Singh, Ng, Koh, Lee, Tan, Wang and Tan.)

HPV diseases are common infections that affect the urogenital and pharyngeal mucous membranes. Persistent infection with oncogenic strains leads to tumorigenesis. Diagnosis and treatment of HPV-related disease is often difficult to manage from perspective of the patient and family physician because it refers to symptomatic treatment of the clinical manifestation of the disease in the form of warts or genital warts. Additional treatment generally requires specialised care. The oncogene effect of HPV infection on the development of cervical, anal, vaginal, vulvar, penile, oral cavity and laryngeal cancers has been demonstrated. Each year, more than 300,000 women die worldwide from cervical cancer. At the same time, over 3,000 cases of cervical cancer are diagnosed in Poland. The primary role in limiting HPV infections is that of preventive vaccination. In Poland, the vaccination is burdened with many restrictions, and thus the vaccination ratio is significantly lower than in other European countries. Only a proper definition of limitations and a detailed attempt to spread treatment will help reduce the incidence of HPV-related cancers. In Poland, only about 20,000 HPV vaccines are performed annually. This vaccination is recommended but no reimbursement. Lack of a common immunisation programme and the high price of vaccines, as well as low public awareness, are major contributors to the low vaccination rates. General practitioners have a fundamental influence on the promotion of health. [ABSTRACT FROM AUTHOR]

Background: Human Resources for Health (HRH) are crucial for improving health services coverage and population health outcomes. The World Health Organisation (WHO) promotes countries to formulate holistic policies that focus on four HRH dimensions-availability, accessibility, acceptability, and quality (AAAQ). The status of these dimensions and their incorporation in the National Health Policies of India (NHPIs) are not well known.Methods: We created a multilevel framework of strategies and actions directed to improve AAAQ HRH dimensions. HRH-related recommendations of NHPI-1983, 2002, and 2017 were classified according to targeted dimensions and cadres using the framework. We identified the dimensions and cadres focussed by NHPIs using the number of mentions. Furthermore, we introduce a family of dimensionwise deficit indices formulated to assess situational HRH deficiencies for census years (1981, 2001, and 2011) and over-year trends. Finally, we evaluated whether or not the HRH recommendations in NHPIs addressed the deficient cadres and dimensions of the pre-NHPI census years.Results: NHPIs focused more on HRH availability and quality compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and pharmacists in terms of total recommendations. AAAQ indices showed deficits in all dimensions for almost all HRH cadres over the years. All deficit indices show a general decreasing trend from 1981 to 2011 except for the accessibility deficit. The recommendations in NHPIs did not correspond to the situational deficits in many instances indicating a policy priority mismatch.Conclusion: India needs to incorporate AAAQ dimensions in its policies and monitor their progress. The framework and indices-based approach can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies of various nations. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to identify the main prerequisites and ways of the medical reform in Ukraine under decentralization, and the emergency of fee-for-service medicine in particular. Methodology. The survey is based on the study of legally enforceable enactments which regulate medical sphere and the process of decentralization of power. Results. The article outlines the main prerequisites and ways to solve the issue of the implementation of medical reform in Ukraine under decentralization, including the emergence of fee-for-service-medicine. The problem related to health care reform in general in order to improve the availability and quality of health care have been identified. Statistical data on the main healthcare indicators in Ukraine have been presented. National healthcare accounts of Ukraine have been presented and healthcare expenditures per capita in other countries of the world has been demonstrated. Practical implications. The main steps that are necessary to undertake for implementing changes in the medical field have been determined in the article. They are the following: involvement of communities, development of social infrastructure, transportation of patients and women in labor to hospitals, involvement of social workers, support of medical institutions, and assistance by the communities in public control. It is determined that the biggest challenge for the medical sector is the reorientation to a new level of medical services. The main directions in medicine under decentralization on the implementation of material, organizational and financial conditions to provide local authorities with own and delegated powers have been emphasized. Value/originality. An approach to implementing medical reform that meets the needs of the community is developed and its essence has been explained. The complex of actions on introduction of medical reform under decentralization of the power, which has been explained as an increase in powers and financial possibilities of territorial communities has been generalized.

National Health Policy (NHP) is a guiding principle for a country to identify the priority of health-care needs, resource allocations according to prioritization, and to achieve specific health-care goals. In addition, NHP is usually wide-ranging, all-inclusive plan that pursues each and every population to move on the road to better health. NHP targets to achieve universal health coverage and delivering quality health-care services to all at inexpensive cost, through a preemptive, protective, and prophylactic health-care program in all national and international developmental policy and planning. There are quite a few constituents that are valuable in executing health policy. These elements include novelty, technical compendium, communiqué, conglomerates, administration, supervision, and political awareness and promise. Health policies can be implemented at all levels of the government system. It helps in strengthening the overall health-care system of the country by effective public–private coordination and collaboration. In the year 1990, the Government of Bangladesh (GoB) tried to promulgate an NHP. Unfortunately, the attempt failed. The health-care system of the country operated without a policy until 2011. In the year 2011, the country’s first health policy was published by the GoB. Though the country has have achieved excellent progress in providing health care, but yet Bangladesh has a few critical challenges that need immediate attention. In this article, we will try to address the pros and cons of the Bangladesh NHP 1990 and the positive aspects and challenges of NHP 2011.

Urgent care practice (UCP) is a novel concept for India. Urgent care primarily deals with injuries or illnesses requiring immediate care. Medical emergency and urgency can happen anywhere unannounced. Research has shown that 90% of the morbidities can be resolved within the community by primary care physicians lead teams. Given the changing professional demands, non-specialists tend to refer away far too many cases to specialists, undermining generalist medical care, particularly in Indian settings. The spillover of the patient load from the primary care setting to the tertiary care centers is enormous leading to resource mismatch. Family physicians and other primary care providers are best positioned to develop practices and provide good quality urgent care to society. Family physicians, general practitioners, and medical officers are already functioning as the frontline care providers for any emergency or medical urgency arising within communities. Urgent care is essentially ambulatory care or outpatient care outside of a traditional hospital emergency room. "UCP aims to provide timely support, which is easily accessible with a focus on good clinical outcomes, e.g. survival, recovery, lack of adverse events, and complications. Core interventions of urgent care are centered on the 4Rs - Rescue, Resuscitate, Relate, and Refer. At present, there are no available, established training model for future faculty, residents, and medical students on "UCP" in India.

Although the micronutrient status of a population is of high national priority, as it critically impacts public health, limited data is available for quantifying the micronutrient status in Saudi Arabia. We aimed to provide comprehensive, epidemiological, descriptive data regarding micronutrient levels in Saudi adults. This cross-sectional study included 3432 adults aged ≥18 years (mean age, 37.7 ± 11.7 years; women, 51.2%) across all 13 Saudi administrative regions (March 2019–November 2021). Laboratory data for 14 micronutrients (8 vitamins, 4 minerals, and 2 nonessential heavy metals) were characterized using descriptive analysis. Vitamin D deficiency (64.3%) was the most prevalent, followed by vitamin B2 (44.9%) and A (9.6%) deficiencies. Among minerals, iron deficiency was the most prevalent (23.2%), followed by zinc (15.3%) and copper (8.7%) deficiencies. Most Saudi adults exhibited normal arsenic (99.7%) and mercury (99.9%) levels. Men exhibited significantly higher vitamin B2, B9, and D deficiencies than women, while women exhibited higher vitamin A, B12, iron, and zinc deficiencies than men. Younger adults demonstrated a significantly higher prevalence of vitamin D and iron deficiencies, whereas older adults exhibited a higher prevalence of vitamin B1 and magnesium deficiencies. As micronutrient deficiencies are a public health concern, health policies and programs need to be developed and implemented to address them.

One in every 10,000 children is born with SMA and half of them will not even live two years. It is a hereditary genetic disorder, where the muscles die. If it is discovered just after birth, newborns can get the newest medicines to maintain their health. Unlike some other common genetic diseases (e.g. Down-Syndrome), SMA can be screened prior to pregnancy to determine whether the parents are carriers. In Hungary, people have urged reform, due to the baby Zente case, whose story has reached millions. Australia and Germany have also discovered the need for screenings. However, the US has already introduced newborn screening for SMA, far ahead of European countries. National policies should adhere to the same path to contribute to appropriate family planning and to make the treatment available as soon as needed to provide a longer and better life for sick infants. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There are still large number of maternal deaths in India nearing up to 50,000 deaths in a year which is one sixth of the world. Odisha (India) is also not performing well in maternal health care management despite its commitment to MDG and SDG. Odisha constitute 23% of tribal population, where the maternal mortality is very high and difficult to provide health services, particularly maternal health services. The study aims to assess provision of necessary health services for pregnant women in an inaccessible tribal pocket. METHODS: The study was conducted in Balasore district, Odisha (India) where a sizable population consists of various indigenous tribes. The Parijata tool was used to assess various health care facilities which was developed by UNICEF and Action Research and Training for Health (ARTH), Rajasthan. The availability of basic necessities like manpower, drugs and consumables are assessed along with prescribed clinical practices and procedures. RESULTS: The study found that there is lack of provisioning of health services in healthcare facilities. Both the district hospital at Balasore and sub-district hospitals lack basic services recommended by WHO for taking care of women. Further, the effort of government to implement a uniform program across the state hinders the tailoring of services for tribal pockets. CONCLUSION: The study provides remedial measures for improving the role and functioning of grass roots workers, integrating indigenous medicine with biomedicine, and revamping health information system to incorporate cultural features, thereby improving its utilization in the study area. The study raised critical issues about potential of maternal health program to deliver effective care of pregnant women in tribal dominated areas. [ABSTRACT FROM AUTHOR]

Copyright of SMAD Revista Electronica Salud Mental, Alcohol y Drogas is the property of Universidade de Sao Paulo, Escola de Enfermagem de Ribeirao Preto 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.)

In Brazil, the National Health Plan (NHP) was the central instrument for public health planning from 2016 to 2019. In this paper, we show that there is a convergence between the Plan and the publication of scientific articles written by institutional researchers in the context of Neglected Tropical Diseases. The methodology used consisted of the following stages: identification of the universe of researchers, data collection, thematic characterization of Neglected Tropical Diseases in the Plan, organization of information, and production of indicators. In total, there were 2,719 researchers and 18,023 journal articles from 2015 to 2018. Of these, 2,541 articles, or 14.09%, were related to Neglected Tropical Diseases. Regarding the convergences, there was strong alignment with leishmaniasis, Chagas disease, dengue, leprosy, schistosomiasis, and Chikungunya fever. However, the coverage of topics by scientific publications was broader than that of the political instrument due to the inclusion of other themes: snake bites, helminthiasis and lymphatic filariasis.

Introduction: This study aimed to analyze the level of satisfaction and health effects of the National Health Insurance Scheme (NHIS) among federal civil servants employed in Bayelsa State, Southern Nigeria. Methods: A cross-sectional survey was adopted using simple random sampling to recruit 337 federal employees living in the state. A structured questionnaire was used as data collection instrument to elicit socio-demographic information and types of services enjoyed under the scheme by the participants. Satisfaction levels and self-rated health were measured as continuous variables. Data was analysed using analysis of variance (ANOVA), multiple linear regression, and chi-square test. The level of statistical significance was set at P < 0.05. Results: Satisfaction levels and self-rated health differed significantly by demographic variables and types of services enjoyed by the participants (P < 0.05). Our findings showed that malaria treatment (β = 0.737, P < 0.05), prescriptions of drugs (β = 0.187, P < 0.05) and vaccinations (β = 0.422, P < 0.05) were good predictors of satisfaction levels and self-rated health status. Malaria treatment was associated with the highest satisfaction level (β = 0.737, P < 0.05) compared to other services enjoyed under the scheme. Discussion and Conclusion: In spite of the fact that most of the services under the scheme were associated with good self-reported health status and high satisfaction level by the participants, there are still some issues concerning supply of drugs and health facilities for federal employees living in Bayelsa State. The government and key stakeholders should ensure that NHIS provides adequate provisions of drugs, skilled health professionals and equipped healthcare facilities, as proper referral systems could mitigate the effects of health conditions affecting federal civil servants and promote the quality of health-care system.

BACKGROUND: The Infant Mortality Rate (IMR) reflects the socioeconomic development of a nation. The IMR was reduced by 28% between 2015 and 2016 (National Family Health Survey-4 [NFHS-4]) as compared to 2005–2006 (NFHS-3), from 57/1000 to 41/1000 live births. The target fixed by the Government of India for IMR in 2019 is 28/1000 live births (National Health Policy, 2017). One of the most common methods of forecasting this is the autoregressive integrated moving average (ARIMA) model. A forecast of IMR can help implementation of interventions to reduce the burden of infant mortality within the target range. MATERIALS AND METHODS: The objective of the study was to give a detailed explanation of ARIMA model to forecast the IMR (2017–2025). Secondary data analysis and forecast were done for the available year and IMR data extracted from “open government data platform India” website. RESULTS: The forecast of the sample period (1971–2016) showed accuracy by the selected ARIMA (2, 1, 1) model. The postsample forecast with ARIMA (2, 1, 1) showed a decreasing trend of IMR (2017–2025). The forecast IMR for 2025 is 15/1000 live births. CONCLUSION: In the current study, long-time series IMR data were used to forecast the IMR for 9 years. The data showed that IMR would decline from 33/1000 live births in 2017 to 15/1000 live births in 2025. When the actual data for another year (2017) are available, the model can be checked for validity and a more accurate forecast can be performed.

Antimicrobial resistance (AMR) has emerged as a major threat to public health estimated to cause 10 million deaths annually by 2050. India carries one of the largest burdens of drug-resistant pathogens worldwide. NDM-1 reported in 2008, rapidly spread to other countries was named after India's capital. India is one of the largest consumers of antibiotics worldwide, and antibiotic sale is increasing rapidly. AMR develops when microbes develop mechanisms to evade the action of antimicrobials. The factors that contribute to AMR include irrational and overuse of antibiotics. In India, various actions have been taken including setting up of a National Task Force on AMR Containment (2010), “Chennai Declaration” by a consortium of the Indian Medical Societies (2012), Setting of Indian Council of Medical Research national surveillance network of laboratories, “Redline” campaign for educating public and National Action Plan on AMR 2017. There is a need integrating AMR education in medical education. India needs to start the subspecialty of infectious diseases and strengthen laboratory services. Every hospital needs to have an AMR policy including infection control, improvement in hygiene, and sanitation and antibiotic use. An element of research needs to be integrated into the AMR policy and encouragement of the pharmaceutical industry to develop “superbug antibiotics.” Unless AMR is addressed effectively the gains made in health are likely to be lost.

The older persons in our society are a special group of people in need of additional measures of care and protection. They have medical, financial, emotional and social needs. The novel Coronavirus disease 2019 (COVID-19) only exacerbates those needs. COVID-19 is a new disease, and there is limited information regarding the disease. Based on currently available information, older persons and people of any age who have serious underlying medical conditions may be at higher risk of severe illness from COVID-19. Family physicians provide care for individuals across their lifespan. Because geriatricians are internists or family physicians with post-residency training in geriatric medicine, they are major stakeholders in geriatric care. The authors are concerned about the absence of a COVID-19 response guideline/special advisory targeting the vulnerable population of older adults. The management and response to COVID-19 will be implemented in part based on the local context of available resources. Nigeria has been described as a resource-constrained nation. Infection prevention in older persons in Nigeria will far outweigh the possibilities of treatment given limited resources. The aim was to recommend actionable strategies to prevent COVID-19-related morbidity or mortality among older persons in Nigeria and to promote their overall well-being during and after the pandemic. These recommendations cut across the geriatric medicine domains of physical health, mental health, functioning ability and socio-environmental situation.

Objectives: The main objectives of this study were to evaluate the likely effectiveness of different types of interventions available in the literature aimed at reducing socio-economic health inequalities and highlight appropriate types of interventions to tackle health inequalities for future evidence-based policy. Methods: This study systematically reviewed 26 studies to determine the impact of interventions and policies on health inequality. Key databases were searched including EBSCO, PubMed, JSTOR, Cochrane library of databases and DHS database. Results: Interventions targeting healthy behaviors and prevention were most effective at reducing health inequalities. Interventions based on education and accesses to health care services were mostly successful in reducing health inequality. Interventions on poverty reduction showed inconclusive mixed results, but were mainly unsuccessful. Conclusion: Programs based on healthy lifestyle and behaviors, better housing and safe environment and access to health care, specifically improving distribution of health professionals in remote disadvantaged areas are effective to tackle health inequalities.

Universal Health Coverage (UHC) is now the critical yardstick for countries to measure and track progress toward the “Sustainable Development Goals (SDGs).” Being a signatory, India has started taking measures to attain the targets laid out within the SDG framework and achieving the UHC. With India's National Health Policy (NHP) – 2017 in place, the policy environment for transforming country's health landscape coincides with that of the global approach toward strengthening of health systems and achieving UHC. It is imperative that for achieving the desired outcomes laid down in the SDGs and NHP-2017, coordinated actions are required including political action for making health an individual's right; effective stewardship from the National Ministry of Health and Family Welfare; reorganization of health-care service delivery implementing a “systems approach;” ensuring financial protection against health-care costs; and enhancing community participation and accountability. Undertaking these steps, imbibing the learning, and dwelling upon global experiences can help the country strongly move forward towards achieving global and national targets, thereby ensuring UHC for all its citizens.

Urban population in our country has increased at an annual rate of 2.7% during the last decade and it is estimated that by 2031, there would be about 600 million people living in urban India. The fast pace of urbanization has come to stay with increasing proportion of urban poor and vulnerable with health indicators much worse than their rural counterparts. The need to provide health care to urban poor has been emphasized in the past in various health committees' reports and National 5-year Development Plans, but no significant dent was made to improve the urban health scenario of the country. The National Urban Health Mission launched in May 2013 provides us a concrete mechanism to address special health needs of urban population with focus on urban poor. There is a strong need to set up primary healthcare system in urban areas and systematically deal with urban health challenges in terms of vector-borne diseases, rising incidence of noncommunicable diseases, air pollution and acute respiratory infections, road traffic accidents, trauma, and injuries. The initiatives to address these challenges do not remain confined to health sector alone but also need to be supported by sectors other than health such as social welfare, women and child development, road transport and highways, school education, drinking water, and sanitation. We really need to address wider and social determinants of health to effectively improve the urban health scenario.

Urgent care practice (UCP) is a novel concept for India. Urgent care primarily deals with injuries or illnesses requiring immediate care. Medical emergency and urgency can happen anywhere unannounced. Research has shown that 90% of the morbidities can be resolved within the community by primary care physicians lead teams. Given the changing professional demands, non-specialists tend to refer away far too many cases to specialists, undermining generalist medical care, particularly in Indian settings. The spillover of the patient load from the primary care setting to the tertiary care centers is enormous leading to resource mismatch. Family physicians and other primary care providers are best positioned to develop practices and provide good quality urgent care to society. Family physicians, general practitioners, and medical officers are already functioning as the frontline care providers for any emergency or medical urgency arising within communities. Urgent care is essentially ambulatory care or outpatient care outside of a traditional hospital emergency room. "UCP aims to provide timely support, which is easily accessible with a focus on good clinical outcomes, e.g. survival, recovery, lack of adverse events, and complications. Core interventions of urgent care are centered on the 4Rs - Rescue, Resuscitate, Relate, and Refer. At present, there are no available, established training model for future faculty, residents, and medical students on "UCP" in India. [ABSTRACT FROM AUTHOR]

India, a country with rich cultural and health care heritage has progressed by leaps and bounds since independence. The health indices have improved and mortality and morbidity have come down significantly. The health care system of India is a mix of public and private sector. In 2017, there are 479 medical colleges in India with admission capacity of over 60,000 at the undergraduate level. The pattern of modern medical education is modeled after the British system and the first few medical schools were established in 19th century. Medical Council of India (MCI), the government-mandated regulatory agency for medical education, was formed in 1934. The Government of India is regularly reviewing the existing medical education policy to give it a new direction so as to make the curriculum relevant and responsive to the national needs. The MCI has also recognized the need to reduce the artificial compartmentalization of the curriculum into preclinical, para-clinical and clinical disciplines. Horizontal and vertical integration is being promoted but not practiced in most medical colleges. Instruction remains teacher-based and not much emphasis has been laid on self-directed learning. There is a paucity of innovative approaches and lack of adapting the recent technology into most medical schools in India. Skills such as related to communication and managerial domains, and professionalism are not imparted in the current curriculum. While the level of knowledge in the medical sciences is highly unsatisfactory, medical graduates are often found to be lacking in the clinical skills. So far, attempts to introduce innovations in medical education have been limited to certain institutions. Also, there is lack of adequate motivation and opportunities for faculty development. It is strongly felt that there is a need to redefine the goals of medical education in India depending upon the needs of the society. MCI has recently attempted designing a need-based curriculum. At present, medical education in India is at a significant juncture with initiatives coming from both external and internal influences, and the political will to attain the goal of health for all, India hopes to be in a better position to prepare physicians for the 21st century.

Objective: There was no national data on group B streptococcus (GBS) infections in Taiwan. Until 2012, when prenatal GBS screening was introduced to obstetric practices as a national health policy aimed at reducing neonatal GBS infections. The purpose of this study was to examine the impact of this national health policy on the incidence of maternal GBS colonization and neonatal GBS infection rate. Relatedly, the clinical characteristics of neonatal GBS infection were investigated to determine the correlations between the incidence of maternal GBS colonization and the neonatal GBS infection rate. Materials and methods: This population-based nationwide study used data for 2012–2013 from the National Health Insurance Research Database of Taiwan. A total of 789 newly diagnosed pregnant women with genital GBS infection were recruited. Results: The maternal GBS screening rate was 93.2%. The maternal colonization rate of GBS was around 8.2%, and the incidence of neonatal GBS infection was 22.6%. The data indicate that no sepsis was developed in any of the cases, while fever was found in 3 cases (3/179, 1.7%) and UTI was found in 1 case (1/179, 0.6%). Conclusions: We conclude that a policy calling for universal maternal rectovaginal cultures for GBS with intrapartum antibiotic prophylaxis is a good national policy for reducing morbidity due to GBS infections in neonates in Taiwan.

This paper analyses the impact of the financing arrangements for planned cross-border health care within the European Union. A financial arrangement is taken to provide a financial incentive but may also involve payment risks and administrative burden. For the pathways given by the Social Security Regulations (883/2004 and 987/2009) and the EU Directive 2011/24/EU, we investigate how the associated financial arrangements act on providers, patients and on publicly funded health insurance. First, the Regulations can induce cross-border health care that will increase domestic health care expenditure and may threaten national health policy by setting an incentive for patients to go abroad for health care not covered by domestic health insurance. Second, the financial arrangement of the Directive may induce cross-border health care which will lower domestic health care expenditure. However, due to considerable payment risks and administrative burden on both patients and providers, these benefits will not be reaped in full. Moreover, in the presence of national cost containment policies, the Directive may provide an incentive for cross-border health care that is too strong. Finally, due to the requirement to pay upfront, the financial arrangement also suffers from a lack of equity of access to health care provision abroad.

Family medicine or general practice is the practicing discipline of the majority doctors in India, however formal academic departments of general practice (or family medicine) do not exist in India, as it is not a mandatory requirement as prescribed by the Medical Council of India; the principal regulator of medical education. Currently India has capacity to produce more than 60,000 medical graduates per year, majority of whom are expected to become general practitoners or primary care doctors without under going any vocational training in general practice or family medicine. The 92nd parliamentary standing committee report (on health and family welfare) of the Indian Parliament recommended that Government of India in coordination with State Governments should establish robust postgraduate programs in Family Medicine and facilitate introducing Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous health care for the individuals and families. The authors concur with the parliament of India and strongly feel that “Family Medicine” (community-based comprehensive clinical practice) deserves dedicated and distinct department at all medical colleges in India in order to availability of qualified medical doctors in the community-based health system. AIIMS, New Delhi, along with other newly established AIIMS, should rise to their foundation mandate of supporting excellence in all disciplines of medical science and to this historic responsibility; and not just remain an ivory tower of tertiary care based fragmented (into sub specialties) hospital culture.

The health ministry of India has released three National Health Policies (NHPs) since independence. These are guiding documents for the government for their health-related expenditure. Till 2017, India allocated central resources through five-year plans (FYPs) formed by the Planning Commission. Thereafter, the newly formed National Institution of Transforming India or the National Institute for Transforming India (NITI) Aayog released its first 3-year action agenda for different sectors. We study the translation of these policies in practice, by comparing policy recommendations with the FYPs. This article also compares the recommendation of the NHP, 2017 with the first 3-year agenda of the NITI Aayog. This explorative analysis also studies the cohesion between the three policies. Hence, it helps to identify five key issues in translating these policies to practise for and provides suggestions. Our study indicates that the NHPs in India need to be released frequently while incorporating tools of accountability, need to generate evidence on which policy decisions can be made, need to be inter-sectoral, but coordinated within different agencies of the government and need to have cohesion with budgetary allocations for allowing a better analysis. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Infant Mortality Rate (IMR) reflects the socioeconomic development of a nation. The IMR was reduced by 28% between 2015 and 2016 (National Family Health Survey-4 [NFHS-4]) as compared to 2005–2006 (NFHS-3), from 57/1000 to 41/1000 live births. The target fixed by the Government of India for IMR in 2019 is 28/1000 live births (National Health Policy, 2017). One of the most common methods of forecasting this is the autoregressive integrated moving average (ARIMA) model. A forecast of IMR can help implementation of interventions to reduce the burden of infant mortality within the target range. MATERIALS AND METHODS: The objective of the study was to give a detailed explanation of ARIMA model to forecast the IMR (2017–2025). Secondary data analysis and forecast were done for the available year and IMR data extracted from "open government data platform India" website. RESULTS: The forecast of the sample period (1971–2016) showed accuracy by the selected ARIMA (2, 1, 1) model. The postsample forecast with ARIMA (2, 1, 1) showed a decreasing trend of IMR (2017–2025). The forecast IMR for 2025 is 15/1000 live births. CONCLUSION: In the current study, long-time series IMR data were used to forecast the IMR for 9 years. The data showed that IMR would decline from 33/1000 live births in 2017 to 15/1000 live births in 2025. When the actual data for another year (2017) are available, the model can be checked for validity and a more accurate forecast can be performed. [ABSTRACT FROM AUTHOR]

Background: Uninsurance for young adults (YAs) was greatly reduced by the Affordable Care Act (ACA). However, reforms may not be equally beneficial for all YAs and certain policies may exacerbate, rather than resolve, pre-existing disparities.Objective: To investigate inequalities in YAs' insurance coverage pre- (2000-2010) and post-federal health reforms (dependent coverage expansion, 2010-2013, and Medicaid/Marketplace expansions, 2014-2016), among a nationally representative sample.Design: A difference-in-differences estimator (controlling for sociodemographics) was used to determine the effects of the ACA for young adults (ages 19-25) compared to adolescents (ages 13-18) and older YA (ages 26-30) counterparts; triple-difference estimators quantified differential policy effects by sociodemographics.Participants: Three hundred eighty-seven thousand six hundred thirty-five participants in the 2000-2016 National Health Interview Survey.Main Measures: Respondents reported their health insurance coverage types during the last 12 months, reasons uninsured, and detailed sociodemographics.Key Results: An adjusted difference-in-differences estimator quantified a 12.3 percentage point increase (p < 0.0001) in full-year coverage post-ACA for YAs compared to older counterparts, driven by increases in employer-sponsored private insurance while younger and older youth saw larger gains in Medicaid coverage. Triple-difference estimators identified subgroups experiencing less beneficial dependent coverage expansion effects, including females, lower socioeconomic status, non-citizens, non-English speakers, and several racial/ethnic minority groups. Later ACA reforms (Marketplace/Medicaid expansions) mitigated many of these widening disparities.Conclusion: While the ACA significantly impacted YA insurance coverage, these gains were not of equal magnitude for all YAs and disparities remain. As such, more work needs to be done to ensure optimal and equitable access to high-quality, affordable insurance for all YAs. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) has emerged as a major threat to public health estimated to cause 10 million deaths annually by 2050. India carries one of the largest burdens of drug-resistant pathogens worldwide. NDM-1 reported in 2008, rapidly spread to other countries was named after India's capital. India is one of the largest consumers of antibiotics worldwide, and antibiotic sale is increasing rapidly. AMR develops when microbes develop mechanisms to evade the action of antimicrobials. The factors that contribute to AMR include irrational and overuse of antibiotics. In India, various actions have been taken including setting up of a National Task Force on AMR Containment (2010), "Chennai Declaration" by a consortium of the Indian Medical Societies (2012), Setting of Indian Council of Medical Research national surveillance network of laboratories, "Redline" campaign for educating public and National Action Plan on AMR 2017. There is a need integrating AMR education in medical education. India needs to start the subspecialty of infectious diseases and strengthen laboratory services. Every hospital needs to have an AMR policy including infection control, improvement in hygiene, and sanitation and antibiotic use. An element of research needs to be integrated into the AMR policy and encouragement of the pharmaceutical industry to develop "superbug antibiotics." Unless AMR is addressed effectively the gains made in health are likely to be lost. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissions Database. Compared with 2009, overall 30-day rates of readmissions after TKR decreased by 15% in 2014. Rates varied by demographics: readmission rates were lower for younger patients, males, Medicare recipients, and those with higher incomes. Overall, costs rose 20% across TKR groups. This report is among the first to describe changes in hospital readmissions and costs for TKR patients in a national sample of US acute care hospitals. Findings offer hospital managers a mechanism to benchmark their facilities' performances. [ABSTRACT FROM AUTHOR]

Universal Health Coverage (UHC) is now the critical yardstick for countries to measure and track progress toward the "Sustainable Development Goals (SDGs)." Being a signatory, India has started taking measures to attain the targets laid out within the SDG framework and achieving the UHC. With India's National Health Policy (NHP) - 2017 in place, the policy environment for transforming country's health landscape coincides with that of the global approach toward strengthening of health systems and achieving UHC. It is imperative that for achieving the desired outcomes laid down in the SDGs and NHP-2017, coordinated actions are required including political action for making health an individual's right; effective stewardship from the National Ministry of Health and Family Welfare; reorganization of health-care service delivery implementing a "systems approach;" ensuring financial protection against health-care costs; and enhancing community participation and accountability. Undertaking these steps, imbibing the learning, and dwelling upon global experiences can help the country strongly move forward towards achieving global and national targets, thereby ensuring UHC for all its citizens. [ABSTRACT FROM AUTHOR]