Measuring environmentally sustainable health care: a scoping review.

Work to reduce environmental pollution from the health system is hampered by an absence of consensus on the definition of environmentally sustainable health care and the relevant measurement needed. This scoping review aims to encourage standardisation across sustainability efforts by examining how environmentally sustainable health care is defined and measured in current literature. We conducted a scoping review to identify candidate publications that included either a definition or description of environmentally sustainable health care or a measurement of the impact of health care on the environment. 328 publications were included in the final analysis. 52 publications included definitions or descriptions of environmentally sustainable health care. Results of the study highlight the heterogeneity in the current definition, measurement, and measurement calculation methods of environmentally sustainable health care in published literature. Work is needed to create more harmonised definitions and measurement to support progress and reduce environmental pollution from health care.

Bladder and Kidney Transplantation En Bloc: Review of Experience and Prospects for Development.

Although urine bladder transplantation is currently being conducted, the procedure is an incompletely resolved problem in clinical transplantology. A small number of en bloc bladder and kidney transplants from pediatric donors to adult recipients in humans have been reported. A small number of bladder transplants with and without combinations with kidneys have also been performed in experiments on different animal models. Here, we aimed to highlight the experiences of various scientists in bladder transplantation in humans and animals. We also presented our small experience in conducting transplant of 1 kidney, ureters, and a segment of the bladder in an experiment on pigs in 2023 (5 cases), which is a promising direction for further successful development of this technology in humans. In 2024, we plan to conduct another 10 transplants of a single block ofthe kidney and bladderin pigs, results of which will be published after the completion of the experimental work.

Ischemia-Free Liver Transplant: Technical Aspects and Considerations After First Case in Western Countries.

The use of marginal donor livers, particularly steatotic livers, could help to resolve the problem of organ shortage and wait list mortality. Ischemia-free liver transplant with the potential to avoid ischemiareperfusion injury and related complications, particularly early allograft dysfunction, could positively encourage the use of marginal donorlivers and extend the donor pool. Here, we describe the first case in a Western country of ischemia-free liver transplant of a marginal donor liver. To date, a research team in China is the only group to have described and used this technique. The technical and setup aspects are illustrated, and present controversies are discussed. A 58-year-old female patient received a transplant of a >60% steatotic donor liver. The transplant was accomplished with the ischemia-free liver transplant technique, and the donor liver was procured and transplanted under continuous normothermic machine perfusion. The donor liver functional parameters under normothermic machine perfusion were reassuring, and recipient recovery was uneventful. Although ischemia-free liver transplant is a technically and organizationally demanding procedure, our case demonstrates the feasibility of the ischemia-free liver transplant technique and encourages the development and expansion of its use.

Exploring the associations of food and financial insecurity and food assistance with breastfeeding practices among first-time mothers.

OBJECTIVE: Social determinants of health (SDoH), such as food and financial insecurity and food assistance, are potentially modifiable factors that may influence breastfeeding initiation and duration. Knowledge gaps exist regarding the relationship between these SDoH and infant feeding practices. We explored the relationships of food and financial insecurity and food assistance with the continuation of breastfeeding at four months postpartum among mothers and whether race and ethnicity modified these associations. DESIGN: Mothers retrospectively reported food and financial insecurity and receipt of food assistance (e.g. Women, Infants and Children and Supplemental Nutrition Assistance Program) during pregnancy with their first child and infant feeding practices (exclusive/mostly breastfeeding v. exclusive/mostly formula feeding) following the birth of their first child. Sociodemographic-adjusted modified Poisson regressions estimated prevalence ratios and 95 % CI. SETTING: Minneapolis-St. Paul, Minnesota. PARTICIPANTS: Mothers who participated in the Life-course Experiences And Pregnancy study (LEAP) (n 486). RESULTS: Ten percent of mothers reported food insecurity, 43 % financial insecurity and 22 % food assistance during their pregnancies. At four months postpartum, 63 % exclusively/mostly breastfed and 37 % exclusively/mostly formula-fed. We found a lower adjusted prevalence of breastfeeding at four months postpartum for mothers who reported experiencing food insecurity (0·65; 0·43-0·98) and receiving food assistance (0·66; 0·94-0·88) relative to those who did not. For financial insecurity (aPR 0·92; 0·78, 1·08), adjusted estimates showed little evidence of an association. CONCLUSIONS: We found a lower level of breastfeeding among mothers experiencing food insecurity and using food assistance. Resources to support longer breastfeeding duration for mothers are needed. Moreover, facilitators, barriers and mechanisms of breastfeeding initiation and duration must be identified.

The Cost of Procuring Deceased Donor Livers: Evidence From US Organ Procurement Organization Cost Reports, 2013-2018.

Deceased donor organs for transplantation are costly. Expenses include donor assessment, pre-operative care of acceptable donors, surgical organ recovery, preservation and transport, and other costs. US Organ Procurement Organizations (OPOs) serve defined geographic areas in which each OPO has exclusive organ recovery responsibilities including detailed reporting of costs. We sought to determine the costs of procuring deceased donor livers by examining reported organ acquisition costs from OPO cost reports. Using 6 years of US OPO cost report data for each OPO (2013-2018), we determined the average cost of recovering a viable (i.e., transplanted) liver for each of the 51 independent US OPOs. We examined predictors of these costs including the number of livers procured, the percent of nonviable livers, direct procurement costs, coordinator salaries, professional education, and local cost of living. A cost curve estimated the relationship between the cost of livers and the number of locally procured livers. The average cost of procured livers by individual OPO-year varied widely from $11 393 to $65 556 (average $31 659) over the six study years. An increase in the overall number of procured livers was associated with lower direct costs, administrative, and procurement overhead costs, but this association differed for imported livers. Cost per local liver decreased linearly for each additional liver, while importing more livers was only cost saving until 200 livers, with imported livers costing more ($39K vs. $31.7K). The largest predictor of variation in cost was the aggregate of direct costs (e.g., hospital costs) to recover the organ (57%). Cost increases were 2.5% per year (+$766/year). This information may be valuable in determining how OPOs might improve service to transplant centers and the patients they serve.

A global assessment of kidney care workforce.

BACKGROUND: An adequate workforce is needed to guarantee optimal kidney care. We used the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to provide an assessment of the global kidney care workforce. METHODS: We conducted a multinational cross-sectional survey to evaluate the global capacity of kidney care and assessed data on the number of adult and paediatric nephrologists, the number of trainees in nephrology and shortages of various cadres of the workforce for kidney care. Data are presented according to the ISN region and World Bank income categories. RESULTS: Overall, stakeholders from 167 countries responded to the survey. The median global prevalence of nephrologists was 11.75 per million population (pmp) (interquartile range [IQR] 1.78-24.76). Four regions had median nephrologist prevalences below the global median: Africa (1.12 pmp), South Asia (1.81 pmp), Oceania and Southeast Asia (3.18 pmp) and newly independent states and Russia (9.78 pmp). The overall prevalence of paediatric nephrologists was 0.69 pmp (IQR 0.03-1.78), while overall nephrology trainee prevalence was 1.15 pmp (IQR 0.18-3.81), with significant variations across both regions and World Bank income groups. More than half of the countries reported shortages of transplant surgeons (65%), nephrologists (64%), vascular access coordinators (59%), dialysis nurses (58%) and interventional radiologists (54%), with severe shortages reported in low- and lower-middle-income countries. CONCLUSIONS: There are significant limitations in the available kidney care workforce in large parts of the world. To ensure the delivery of optimal kidney care worldwide, it is essential to develop national and international strategies and training capacity to address workforce shortages.

Veterinary Services'use of the Global Burden of Animal Diseases to prioritise interventions, monitor impact and develop critical competencies.

Attracting and sustaining investment in Veterinary Services and animal health programmes from national government budgets, development aid and grants, and philanthropic donors requires economic rationale using relevant, reliable and validated analytical approaches. The complex interwoven relationships between animal health, livestock husbandry systems, national food security, global health security and environmental sustainability emphasise the importance of improving data governance and stewardship and applying economic analysis to understand animal disease burdens. These efforts should enable prioritised investment of limited resources and effective monitoring of the impact of programmes over time. Data governance and stewardship capacities are fundamental to development, implementation and performance monitoring of evidence-based policies in animal health. There are challenges in data availability for national and subnational livestock populations in different sectors, for disease incidence and prevalence, and for animal health expenditure in support of optimised allocation of scarce resources, be they finance, land, labour, or management attention and policy focus. Animal health data systems governance and stewardship and economic analysis are core skills for Veterinary Services in developing and applying evidence-based policy, but capability probably varies among World Organisation for Animal Health (WOAH) Members. The WOAH Performance of Veterinary Services programme has several critical competencies that are relevant to economics of animal health and to data governance and stewardship, but these have not yet been targeted for coordinated capacity development. Implementation of publicâ€"private partnership approaches for animal health programmes creates increasing expectations of robust data and methods for prioritisation, options analysis, and assessing impacts and costs. Experience and examples from national systems in New Zealand, Australia, Ethiopia and Indonesia illustrate current challenges associated with prioritisation of animal health programmes using economic analysis. The Global Burden of Animal Diseases programme intends to support WOAH Members and partners to develop capacities for and standardise approaches to economic analysis and prioritisation in animal health programmes.

Les investissements dans les Services vétérinaires et dans les programmes de santé animale à partir des budgets publics nationaux, des aides et subventions au développement et des fonds alloués par des donateurs philanthropiques peuvent être encouragés et pérennisés au moyen d'une argumentation économique solide fondée sur des méthodes analytiques pertinentes, fiables et validées. La complexité et l'imbrication des relations entre la santé animale, les systèmes d'élevage, la sécurité de l'approvisionnement alimentaire à l'échelle nationale, la sécurité sanitaire mondiale et la durabilité environnementale imposent d'améliorer la gouvernance et la gestion des données et de recourir à des analyses économiques pour mieux comprendre l'impact des maladies animales. Ces efforts devraient permettre de définir les investissements prioritaires dans un contexte de ressources limitées et d'assurer un suivi efficace de l'impact des programmes dans le temps. L'existence de capacités de gouvernance et de gestion des données est donc une condition essentielle pour concevoir et mettre en oeuvre des politiques de santé animale fondées sur des données factuelles et pour suivre leurs performances. Les données disponibles sur les populations d'animaux d'élevage des différentes filières aux niveaux national ou infranational, sur l'incidence et la prévalence des maladies ou sur les dépenses de santé animale sont parfois insuffisantes pour étayer une utilisation optimale de ressources limitées, qu'il s'agisse de moyens financiers, des terres, de la main-d'oeuvre, voire des efforts de gestion ou de la volonté politique. La gouvernance et la gestion des systèmes de données de santé animale et la conduite d'analyses économiques sont des compétences cruciales des Services vétérinaires, que ceux-ci mobilisent pour concevoir et mettre en oeuvre des politiques fondées sur des données factuelles ; il est néanmoins peu probable que ces capacités soient d'un niveau homogène parmi tous les Membres de l'Organisation mondiale de la santé animale (OMSA). Le Processus d'évaluation de la Performance des Services vétérinaires mis en place par l'OMSA définit un certain nombre de compétences critiques dans le domaine de l'économie de la santé animale et de la gouvernance et gestion des données, mais ces compétences n'ont pas encore été intégrées dans un effort coordonné de renforcement des capacités. Les stratégies consistant à confier la mise en oeuvre de programmes de santé animale à des partenariats public-privé suscitent des besoins accrus en données et en méthodes robustes pour l'établissement des priorités, l'analyse des options et l'évaluation des impacts et des coûts. Les auteurs mentionnent les expériences et exemples de systèmes nationaux en Nouvelle-Zélande, en Australie, en Ethiopie et en Indonésie pour illustrer les enjeux actuels liés à l'utilisation des analyses économiques pour définir les priorités des programmes de santé animale. Le programme " Impact mondial des maladies animales " vise à aider les Membres et les partenaires de l'OMSA à renforcer leurs capacités dans le domaine de l'analyse économique et de la définition des priorités des programmes de santé animale et à normaliser leurs approches en la matière.

Para atraer y mantener las inversiones en los Servicios Veterinarios y los programas de sanidad animal procedentes de los presupuestos de los gobiernos nacionales, la ayuda para el desarrollo y las subvenciones, así como de donantes filántropos, se requiere un razonamiento económico en el que se utilicen enfoques analíticos pertinentes, fiables y validados. Las complejas relaciones entre la sanidad animal, los sistemas de ganadería, la seguridad alimentaria nacional, la seguridad sanitaria mundial y la sostenibilidad ambiental ponen de relieve la importancia de mejorar la gobernanza y la gestión de datos y de aplicar el análisis económico para comprender el impacto de las enfermedades animales. Estos esfuerzos deberían permitir establecer prioridades para la inversión de los limitados recursos y realizar un seguimiento eficaz de las repercusiones de los programas a lo largo del tiempo. Las capacidades de gobernanza y gestión de datos son fundamentales para el desarrollo y la implementación de políticas de sanidad animal con una base empírica y para el seguimiento de sus resultados. Existen dificultades en cuanto a la disponibilidad de datos sobre las cabañas ganaderas nacionales y subnacionales de los distintos sectores, la incidencia y prevalencia de las enfermedades y el gasto en sanidad animal que plantean problemas a la hora de optimizar la asignación de unos recursos que son escasos, ya sean los recursos financieros, las tierras, la mano de obra o la atención a la gestión y la orientación de las políticas. La gobernanza y la gestión de los sistemas de datos zoosanitarios y el análisis económico son competencias esenciales para que los Servicios Veterinarios elaboren y apliquen políticas con base empírica, pero es probable que la capacidad varíe entre los Miembros de la Organización Mundial de Sanidad Animal (OMSA). El Proceso de Prestaciones de los Servicios Veterinarios de la OMSA abarca varias competencias esenciales que son relevantes para la economía de la sanidad animal y para la gobernanza y la gestión de datos, pero que aún no han sido objeto de actividades coordinadas de desarrollo de capacidades. La aplicación de enfoques de asociación público-privada para los programas de sanidad animal aumenta aún más las expectativas de datos y métodos sólidos para el establecimiento de prioridades, el análisis de opciones y la evaluación de las repercusiones y los costos. La experiencia y los ejemplos de los sistemas nacionales de Nueva Zelanda, Australia, Etiopía e Indonesia ilustran los retos actuales asociados al establecimiento de prioridades en los programas de sanidad animal mediante el análisis económico. El programa sobre el impacto global de las enfermedades animales pretende ayudar a los Miembros y socios de la OMSA a desarrollar capacidades y armonizar enfoques para el análisis económico y el establecimiento de prioridades en los programas de sanidad animal.

Liver Graft Machine Perfusion: From History Perspective to Modern Approaches in Transplant Surgery.

The shortage of donor organs remains an unresolved issue in livertransplantation worldwide. Consequently, strategies for expanding the donor pool are currently being developed. Donors meeting extended criteria undergo thorough evaluation, as livers obtained from marginal donors yield poorer outcomes in recipients, including exacerbated reperfusion injury, acute kidney injury, early graft dysfunction, and primary nonfunctioning graft. However, the implementation of machine perfusion has shown excellent potential in preserving donor livers and improving their characteristics to achieve better outcomes for recipients. In this review, we analyzed the global experience of using machine perfusion in livertransplantation through the history ofthe development ofthis method to the latest trends and possibilities for increasing the number of liver transplants.

Medical device management reform, United Republic of Tanzania.

Health-care technology is central to boosting the productivity and quality of health-care systems. In many sub-Saharan African countries, however, medical device management systems are weak or absent. The aim of this article is to illustrate, using a case study, how policy reforms can help ensure policy on health-care technology is translated into everyday practice and how an integrated systems approach can enhance the operation of medical device management. Between 2011 and 2023, a plan to improve medical device management systems in the United Republic of Tanzania was developed and implemented through Swiss-Tanzanian cooperation within the Health Promotion and System Strengthening Project. The availability of biomedical engineers was increased through new training courses and the creation of permanent positions in government. Moreover, additional district and regional maintenance and repair workshops were built, and a National Centre for Calibration and Training was established to ensure the correct functioning of medical devices. The introduction of an electronic medical device management system provided health facilities and the health ministry with data on the operational status of medical devices and the need for repairs and spare parts. Every level of government was encouraged to allocate more human and financial resources to medical device management. Following this decade-long effort, the percentage of functioning equipment increased substantially, and costs were reduced by repairing rather than replacing equipment. The project also demonstrated the value of an integrated, system-strengthening approach that considered personnel, maintenance and repair facilities, documentation and management, and government policy and budgeting.

Les technologies jouent un rôle crucial dans le renforcement de la productivité et de la qualité des systèmes de santé. Pourtant, dans de nombreux pays d'Afrique subsaharienne, les systèmes de gestion des dispositifs médicaux sont limités, voire inexistants. Cet article a pour but d'illustrer, au moyen d'une étude de cas, comment les réformes peuvent contribuer à faire en sorte que les politiques en matière de technologies sanitaires soient appliquées au quotidien, et comment une approche intégrée peut améliorer la gestion des dispositifs médicaux. Entre 2011 et 2023, un plan visant à développer les systèmes de gestion des dispositifs médicaux en République-Unie de Tanzanie a été défini et mis en œuvre en collaboration avec la Suisse, dans le cadre du Projet de Promotion et de Renforcement du Système de Santé. De nouvelles formations et la création de postes permanents au sein du gouvernement ont permis d'accroître la disponibilité des ingénieurs biomédicaux. En outre, des ateliers supplémentaires d'entretien et de réparation ont été construits dans différentes régions et districts, tandis qu'un Centre National d'Étalonnage et de Formation a ouvert ses portes pour assurer le bon fonctionnement des dispositifs médicaux. L'introduction d'un système électronique de gestion des dispositifs médicaux a fourni aux établissements de soins de santé et au Ministère de la Santé des données concernant le statut opérationnel de ces dispositifs, ainsi que les réparations et pièces détachées requises. Chaque niveau de pouvoir a été encouragé à attribuer davantage de ressources humaines et financières à la gestion des dispositifs médicaux. Au terme de dix ans d'efforts, le pourcentage d'équipements en état de marche a considérablement augmenté et les coûts ont diminué grâce au recours à la réparation plutôt qu'au remplacement. Le projet a également démontré l'importance d'une approche intégrée, qui consiste à renforcer le système en tenant compte du personnel, de l'entretien et des installations de réparation, de la documentation et de la gestion, mais aussi de la politique gouvernementale et du budget.

La tecnología aplicada a la atención sanitaria es fundamental para impulsar la productividad y la calidad de los sistemas sanitarios. Sin embargo, en muchos países del África subsahariana los sistemas de gestión de los productos sanitarios son deficientes o inexistentes. El objetivo de este artículo es ilustrar, mediante un estudio de caso, cómo las reformas políticas pueden ayudar a garantizar que la política sobre tecnología de la atención sanitaria se convierta en una práctica cotidiana y cómo un enfoque de sistemas integrados puede mejorar el funcionamiento de la gestión de los productos sanitarios. Entre 2011 y 2023, se elaboró un plan para mejorar los sistemas de gestión de los productos sanitarios en la República Unida de Tanzania, que se implementó a través de la cooperación suizo-tanzana en el marco del Proyecto de Promoción de la Salud y Fortalecimiento del Sistema. Se aumentó la disponibilidad de ingenieros biomédicos mediante nuevos cursos de formación y la creación de puestos permanentes en el gobierno. Además, se construyeron talleres de mantenimiento y reparación adicionales de distrito y regionales, y se estableció un Centro Nacional de Calibración y Formación para garantizar el correcto funcionamiento de los productos sanitarios. La introducción de un sistema electrónico de gestión de productos sanitarios proporcionó a los centros sanitarios y al Ministerio de Sanidad datos sobre el estado operativo de los productos sanitarios y la necesidad de reparaciones y piezas de repuesto. Se animó a todos los niveles de gobierno a asignar más recursos humanos y financieros a la gestión de los productos sanitarios. Tras este esfuerzo de una década, el porcentaje de equipos en funcionamiento aumentó notablemente y los costes se redujeron al reparar los equipos en lugar de sustituirlos. El proyecto también demostró el valor de un enfoque integrado de refuerzo del sistema que tenía en cuenta el personal, las instalaciones de mantenimiento y reparación, la documentación y la gestión, y la política y los presupuestos gubernamentales.

The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review.

The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.

Does internationalization improve environmental disclosure willingness and quality? The moderating role of green investors.

Environmental issues have gradually become a key concern for society. The public has been paying increasing attention to corporate environmental disclosure and performance. With the "go global" trend, more and more enterprises are looking to overseas markets for new technologies and resources. Multinational enterprises (MNEs) are facing more challenges than domestic enterprises. To remain competitive and sustainable, enterprises from developing countries need to gain a foothold in developed countries. We explore how MNEs' internationalization impacts environmental disclosure, specifically focusing on the role of green investors as stakeholders. We draw evidence from Chinese-listed MNEs, with a total of 4,709 panel data observations. For the main analysis, we use a fixed effect model. The findings suggest that a higher level of internationalization can improve both the willingness and quality of environmental disclosure for MNEs, and this relationship is further strengthened by green investors. A heterogeneity analysis reveals that the positive effect of internationalization on environmental disclosure is mainly present in state-owned enterprises (SOEs) and developed host countries. We find that external pressure from host countries motivates MNEs to increase environmental disclosure willingness and quality. This study provides valuable insights for MNEs from emerging economies on how to achieve legitimacy and a positive reputation in overseas markets through environmental disclosure strategies. This study proposes the importance of green investors on environmental disclosure issues from a stakeholder perspective and provides new theoretical insights for environmental policy reform in developing countries such as China.

Investigating ethical tradeoffs in crisis standards of care through simulation of ventilator allocation protocols.

INTRODUCTION: Arguments over the appropriate Crisis Standards of Care (CSC) for public health emergencies often assume that there is a tradeoff between saving the most lives, saving the most life-years, and preventing racial disparities. However, these assumptions have rarely been explored empirically. To quantitatively characterize possible ethical tradeoffs, we aimed to simulate the implementation of five proposed CSC protocols for rationing ventilators in the context of the COVID-19 pandemic. METHODS: A Monte Carlo simulation was used to estimate the number of lives saved and life-years saved by implementing clinical acuity-, comorbidity- and age-based CSC protocols under different shortage conditions. This model was populated with patient data from 3707 adult admissions requiring ventilator support in a New York hospital system between April 2020 and May 2021. To estimate lives and life-years saved by each protocol, we determined survival to discharge and estimated remaining life expectancy for each admission. RESULTS: The simulation demonstrated stronger performance for age-sensitive protocols. For a capacity of 1 bed per 2 patients, ranking by age bands saves approximately 29 lives and 3400 life-years per thousand patients. Proposed protocols from New York and Maryland which allocated without considering age saved the fewest lives (~13.2 and 8.5 lives) and life-years (~416 and 420 years). Unlike other protocols, the New York and Maryland algorithms did not generate significant disparities in lives saved and life-years saved between White non-Hispanic, Black non-Hispanic, and Hispanic sub-populations. For all protocols, we observed a positive correlation between lives saved and life-years saved, but also between lives saved overall and inequality in the number of lives saved in different race and ethnicity sub-populations. CONCLUSION: While there is significant variance in the number of lives saved and life-years saved, we did not find a tradeoff between saving the most lives and saving the most life-years. Moreover, concerns about racial discrimination in triage protocols require thinking carefully about the tradeoff between enforcing equality of survival rates and maximizing the lives saved in each sub-population.

Health resource allocation within the close-knit medical consortium after the Luohu healthcare reform in China: efficiency, productivity, and influencing factors.

Objective: This study aims to assess the efficiency and productivity of the Luohu Hospital Group after the reform and to identify factors influencing the efficiency to support the future development of medical consortia. Methods: Data on health resources from Shenzhen and the Luohu Hospital Group for the years 2015 to 2021 were analyzed using the super-efficiency slack-based measure data envelopment analysis (SE-SBM-DEA) model, Malmquist productivity index (MPI), and Tobit regression to evaluate changes in efficiency and productivity and to identify determinants of efficiency post-reform. Results: After the reform, the efficiency of health resource allocation within the Luohu Hospital Group improved by 33.87%. Community health centers (CHCs) within the group had an average efficiency score of 1.046. Moreover, the Luohu Hospital Group's average total factor productivity change (TFPCH) increased by 2.5%, primarily due to gains in technical efficiency change (EFFCH), which offset declines in technical progress change (TECHCH). The efficiency scores of CHCs were notably affected by the ratio of general practitioners (GPs) to health technicians and the availability of home hospital beds. Conclusion: The reform in the Luohu healthcare system has shown preliminary success, but continuous monitoring is necessary. Future strategies should focus on strengthening technological innovation, training GPs, and implementing the home hospital bed policy. These efforts will optimize the efficiency of health resource allocation and support the integration and development of resources within the medical consortium.

Human resource allocation status and equity research of Centers for Disease Control and Prevention in China from 2016 to 2020.

Background: In recent years, the development of global public health has become a matter of great concern and importance for governments worldwide. China, as the largest developing country, plays a crucial role in shaping the development of the public health and its ability to respond to sudden public health emergencies through the fairness of its human resource allocation in center for disease control and prevention (CDC). Objective: This study aims to analyze the situation of health human resource allocation in the China Centers for Disease Control and Prevention (China CDCs), assess the fairness of the allocation, and provide reference for the rational allocation of human resources. Methods: We selected data from the China Health Statistics Yearbook on healthcare technical personnel, other technical personnel, managerial personnel, and workforce technical personnel of China CDCs for the period of 2016-2020. We utilized the Health Resource Density Index to evaluate the level of human resource allocation in China CDCs. Additionally, we used the Gini coefficient and Theil index to assess the fairness of human resource allocation in China CDCs from both a population and geographical perspective. Results: Firstly, the educational qualifications and professional titles of CDC staff have improved, but the workforce is aging. Secondly, HRDI development trends vary among different personnel types and regions with varying levels of economic development. Finally, the results of the Gini coefficient and Theil index indicate that population distribution fairness is better than geographical distribution fairness. Overall, the unfair population distribution is primarily due to regional disparities. Conclusion: The China CDCs should tailor different standards for the allocation of health human resources based on regional characteristics, aiming to enhance the accessibility of health human resources in various regions and achieve equitable allocation.

Food poverty among children aged 6-59 months in Brazil: results from the Brazilian National Survey on Child Nutrition (ENANI-2019).

OBJECTIVE: To describe the prevalence of food poverty according to dimensions of socio-economic inequality and the food groups consumed by Brazilian children. DESIGN: Dietary data from a structured qualitative questionnaire collected by the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The new UNICEF indicator classified children who consumed 3-4 and <3 out of the eight food groups as living in moderate and severe food poverty, respectively. The prevalence of consumption of each food group and ultra-processed foods (UPF) was estimated by level of food poverty according to age categories (6-23; 24-59 months). The most frequent combinations of food groups consumed by children living in severe food poverty were calculated. Prevalence of levels of food poverty were explored according to socio-economic variables. SETTING: 123 municipalities of the five Brazilian macro-regions. PARTICIPANTS: 12 582 children aged 6-59 months. RESULTS: The prevalence of moderate and severe food poverty was 32·5 % (95 % CI 30·1, 34·9) and 6·0 % (95 % CI 5·0, 6·9), respectively. Children whose mother/caregiver had lower education (<8 years) and income levels (per capita minimum wage <») had the highest severe food poverty prevalence of 8·3 % (95 % CI 6·2, 10·4) and 7·5 % (95 % CI 5·6, 9·4), respectively. The most consumed food groups among children living in food poverty in all age categories were 'dairy products', 'grains, roots, tubers, and plantains' and 'ultra-processed foods'. CONCLUSION: Food poverty prevalence was high among Brazilian children. A significant occurrence of milk consumption associated with grains and a considerable prevalence of UPF consumption were found among those living in severe food poverty.

Private Equity Acquisitions Of Hospices Are Increasing; Ownership Remains Opaque.

Private equity ownership across the US health care system is rapidly increasing, yet ownership structures are complex and opaque. We used an economic data set tracking mergers and acquisitions linked to Medicare data to identify private equity hospice acquisitions. Given the influence of for-profit ownership on hospice quality, transparent data on private equity investment are fundamental to ensuring high-quality end-of-life care.

Late presentation of chronic myeloid leukaemia patients in a low-income country: the prognostic implications and impact on treatment outcome.

BACKGROUND: In Nigeria, since 2002, Imatinib mesylate (glivec®) has been available freely to chronic myeloid leukaemia (CML) patients but only at a tertiary health care centre in the southwestern part of the country. Despite this, it is not readily accessible to many patients due to the distance and other challenges including low socioeconomic status and political problems, preventing timely access to specialist care. This study evaluated the effect of the baseline characteristics on the prognostic implication and treatment outcome of CML patients in Nigeria. METHOD: This study retrospectively evaluated the baseline characteristics, clinical presentations and treatment outcomes of 889 CML patients over 18 years (2002-2020). Of these, 576 (65%) patients had complete information with up-to-date BCR::ABL1 records. These 576 patients were categorized based on their responses to Imatinib therapy into three groups viz.; Optimal response (OR) defined as BCR::ABL1 ratio of < 0.1% or major molecular remission (≥ 3-log reduction of BCR::ABL1 mRNA or BCR::ABL1 ratio of < 0.1% on the International Scale), Suboptimal response (SR) with BCR::ABL ratio of 0.1-1%, and Treatment failure (TF) when MMR has not been achieved at 12 months. The variables were analyzed using descriptive and inferential statistics and a p-value < 0.05 was considered statistically significant. RESULTS: The result revealed a median age of 37 years at diagnosis with a male-to-female ratio of 1.5:1. The majority (96.8%) of the patients presented with one or more symptoms at diagnosis with a mean symptom duration of 12 ± 10.6 months. The mean Sokal and EUTOS scores were 1.3 ± 0.8 and 73.90 ± 49.09 respectively. About half of the patients presented with high-risk Sokal (49%) and EUTOS (47%) scores. Interestingly, both the Sokal (r = 0.733, p = 0.011) and EUTOS (r = 0.102, p = 0.003) scores correlated positively and significantly with the duration of symptoms at presentation. Based on response categorization, 40.3% had OR while 27.1% and 32.6% had SR and TF respectively. CONCLUSION: This study observed a low optimal response rate of 40.3% and treatment failure rate of 32.6% in our CML cohort while on first-line Imatinib therapy. This treatment response is strongly attributable to the long duration of symptoms of 12 months or more and high Sokal and EUTOS scores at presentation. We advocate prompt and improved access to specialist care with optimization of tyrosine kinase inhibitor therapy in Nigeria.

A scoping review of early childhood caries, poverty and the first sustainable development goal.

BACKGROUND: Poverty is a well-known risk factor for poor health. This scoping review (ScR) mapped research linking early childhood caries (ECC) and poverty using the targets and indicators of the Sustainable Development Goal 1 (SDG1). METHODS: We searched PubMed, Web of Science, and Scopus in December 2023 using search terms derived from SDG1. Studies were included if they addressed clinically assessed or reported ECC, used indicators of monetary or multidimensional poverty or both, and were published in English with no date restriction. We excluded books and studies where data of children under 6 years of age could not be extracted. We charted the publication year, study location (categorized into income levels and continents), children age, sample size, study design, measures of ECC, types and levels of poverty indicators and adjusted analysis. The publications were also classified based on how the relation between poverty and ECC was conceptualized. RESULTS: In total, 193 publications were included with 3.4 million children. The studies were published from 1989 to 2023. Europe and North America produced the highest number of publications, predominantly from the UK and the US, respectively. Age-wise, 3-5-year-olds were the most studied (62.2%). Primary studies (83.9%) were the majority, primarily of cross-sectional design (69.8%). Non-primary studies (16.1%) included reviews and systematic reviews. ECC was mainly measured using the dmf indices (79.3%), while poverty indicators varied, with the most common used indicator being income (46.1%). Most studies measured poverty at family (48.7%) and individual (30.1%) levels. The greatest percentage of publications addressed poverty as an exposure or confounder (53.4%), with some studies using poverty to describe groups (11.9%) or report policies or programs addressing ECC in disadvantaged communities (11.4%). In addition, 24.1% of studies requiring adjusted analysis lacked it. Only 13% of publications aligned with SDG1 indicators and targets. CONCLUSION: The ScR highlight the need for studies to use indicators that provide a comprehensive understanding of poverty and thoroughly examine the social, political, and economic determinants and impact of ECC. More studies in low and middle-income countries and country-level studies may help design interventions that are setting- and economic context-relevant.

Concurrent disease burden from multiple infectious diseases and the influence of social determinants in the contiguous United States.

Social determinants of health are known to underly excessive burden from infectious diseases. However, it is unclear if social determinants are strong enough drivers to cause repeated infectious disease clusters in the same location. When infectious diseases are known to co-occur, such as in the co-occurrence of HIV and TB, it is also unknown how much social determinants of health can shift or intensify the co-occurrence. We collected available data on COVID-19, HIV, influenza, and TB by county in the United States from 2019-2022. We applied the Kulldorff scan statistic to examine the relative risk of each disease by year depending on the data available. Additional analyses using the percent of the county that is below the US poverty level as a covariate were conducted to examine how much clustering is associated with poverty levels. There were three counties identified at the centers of clusters in both the adjusted and unadjusted analysis. In the poverty-adjusted analysis, we found a general shift of infectious disease burden from urban to rural clusters.