Computer vision digitization of smartphone images of anesthesia paper health records from low-middle income countries.

BACKGROUND: In low-middle income countries, healthcare providers primarily use paper health records for capturing data. Paper health records are utilized predominately due to the prohibitive cost of acquisition and maintenance of automated data capture devices and electronic medical records. Data recorded on paper health records is not easily accessible in a digital format to healthcare providers. The lack of real time accessible digital data limits healthcare providers, researchers, and quality improvement champions to leverage data to improve patient outcomes. In this project, we demonstrate the novel use of computer vision software to digitize handwritten intraoperative data elements from smartphone photographs of paper anesthesia charts from the University Teaching Hospital of Kigali. We specifically report our approach to digitize checkbox data, symbol-denoted systolic and diastolic blood pressure, and physiological data. METHODS: We implemented approaches for removing perspective distortions from smartphone photographs, removing shadows, and improving image readability through morphological operations. YOLOv8 models were used to deconstruct the anesthesia paper chart into specific data sections. Handwritten blood pressure symbols and physiological data were identified, and values were assigned using deep neural networks. Our work builds upon the contributions of previous research by improving upon their methods, updating the deep learning models to newer architectures, as well as consolidating them into a single piece of software. RESULTS: The model for extracting the sections of the anesthesia paper chart achieved an average box precision of 0.99, an average box recall of 0.99, and an mAP0.5-95 of 0.97. Our software digitizes checkbox data with greater than 99% accuracy and digitizes blood pressure data with a mean average error of 1.0 and 1.36 mmHg for systolic and diastolic blood pressure respectively. Overall accuracy for physiological data which includes oxygen saturation, inspired oxygen concentration and end tidal carbon dioxide concentration was 85.2%. CONCLUSIONS: We demonstrate that under normal photography conditions we can digitize checkbox, blood pressure and physiological data to within human accuracy when provided legible handwriting. Our contributions provide improved access to digital data to healthcare practitioners in low-middle income countries.

Sexual and Reproductive Health and Rights for Young Migrants in Sweden: An Ideal-Type Analysis Exploring Regional Variations of Accessible Documents.

Objectives: This study aims to map sexual and reproductive health and rights (SRHR) policies, strategies, and interventions targeting young migrants and describe the patterns of organisation, resources, and services across Sweden's 21 regions. Methods: We conducted a document analysis of accessible online documents on SRHR policies, strategies, and interventions targeting young migrants in Sweden's 21 regions. We used ideal-type analysis of the documents to create a typology, which formed the basis of a ratings system illustrating variations in organisation, resources, and services across regions. Results: Findings suggest that efforts aimed at addressing young migrants' SRHR are fragmented and unequal across regions. While SRHR policies and strategies are commonplace, they routinely lack specificity. Available resources vary depending on region and resource type. Additionally, information and interventions, although common, do not consistently meet the specific needs of migrant youths. Conclusion: This study suggests that fragmented efforts are fuelling geographic inequalities in fulfilling SRHR among young migrants. There is an urgent need to improve national coordination and collaboration between national and local actors in SRHR efforts targeting young migrants to ensure equity.

Adapting multilingual vision language transformers for low-resource Urdu optical character recognition (OCR).

In the realm of digitizing written content, the challenges posed by low-resource languages are noteworthy. These languages, often lacking in comprehensive linguistic resources, require specialized attention to develop robust systems for accurate optical character recognition (OCR). This article addresses the significance of focusing on such languages and introduces ViLanOCR, an innovative bilingual OCR system tailored for Urdu and English. Unlike existing systems, which struggle with the intricacies of low-resource languages, ViLanOCR leverages advanced multilingual transformer-based language models to achieve superior performances. The proposed approach is evaluated using the character error rate (CER) metric and achieves state-of-the-art results on the Urdu UHWR dataset, with a CER of 1.1%. The experimental results demonstrate the effectiveness of the proposed approach, surpassing state of the-art baselines in Urdu handwriting digitization.

Exploring a revised interprofessional learning curriculum in undergraduate health education programs at Linköping University.

BACKGROUND: Interprofessional education aiming at providing competencies require evaluation in order to ensure that outcomes match the needs and ambitions. Health professionals today need a broad range of skills and competencies in order to provide high quality care, including interprofessional competence. Linköping University has been a pioneer in interprofessional learning for decades and this study provides one example of how a curriculum revision can be carried out. The aim of this study was to study the intentions and outcomes of a revised interprofessional learning curriculum in health professions education programs. METHODS: This was a qualitative study, including documents (n = 143) and complementary interviews with key individuals (n = 4). Data included syllabuses, study guides, educational program plans, supervisor guides, and interview transcripts. A qualitative document analysis and a content analysis with a directed approach was used, applying a theoretical framework for curriculum development that guided the analysis. RESULTS: The analysis resulted in one overarching theme named "A planned, lived, and attended curriculum" including four main categories inspired by a theoretical framework. The findings demonstrate a variety of aspects relating to the why and how of curriculum revision. The introduction of a programme director in interprofessional learning, with a mandate equal to respective program directors, seemed to contribute to legitimacy. Further, the partnership between the university and the healthcare sector had an impact on the curriculum revision, in that healthcare had a say in the revision regarding what suggestions to implement or not. The expectations of the teachers involved were high, although clear support structures seemed to be lacking. CONCLUSIONS: This study has identified some of the important links between teachers, organizational prerequisites, and healthcare when revising an existing fully integrated curriculum in interprofessional learning for health professions education programs. The aim of this curriculum revision was to legitimize and provide education that is up to date with current healthcare needs and to provide students with competencies to collaborate in teams to ensure patient safety. When redesigning a curriculum there seems to be a fine balance between pedagogical innovation and pragmatism. This study identified that the links provided between organizational support structures and the expectations on teachers were not aligned.

Historical Text Line Segmentation Using Deep Learning Algorithms: Mask-RCNN against U-Net Networks.

Text line segmentation is a necessary preliminary step before most text transcription algorithms are applied. The leading deep learning networks used in this context (ARU-Net, dhSegment, and Doc-UFCN) are based on the U-Net architecture. They are efficient, but fall under the same concept, requiring a post-processing step to perform instance (e.g., text line) segmentation. In the present work, we test the advantages of Mask-RCNN, which is designed to perform instance segmentation directly. This work is the first to directly compare Mask-RCNN- and U-Net-based networks on text segmentation of historical documents, showing the superiority of the former over the latter. Three studies were conducted, one comparing these networks on different historical databases, another comparing Mask-RCNN with Doc-UFCN on a private historical database, and a third comparing the handwritten text recognition (HTR) performance of the tested networks. The results showed that Mask-RCNN outperformed ARU-Net, dhSegment, and Doc-UFCN using relevant line segmentation metrics, that performance evaluation should not focus on the raw masks generated by the networks, that a light mask processing is an efficient and simple solution to improve evaluation, and that Mask-RCNN leads to better HTR performance.

Tanzania's and Germany's Digital Health Strategies and Their Consistency With the World Health Organization's Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis.

BACKGROUND: In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. OBJECTIVE: This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. METHODS: A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. RESULTS: Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. CONCLUSIONS: This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation.

A synthetic dataset of different chart types for advancements in chart identification and visualization.

We introduce a meticulously curated synthetic chart dataset designed to propel algorithm advancements in data visualization and interpretation. The dataset, tailored for training and testing purposes, encompasses a diverse array of chart types, including but not limited to Area, Bar, Box, Donut, Line, Pie, and Scatter. The data collection process involves a fully automatic low-level algorithm focused on extraction of graphical elements. The algorithm ensures efficiency by restricting input images from featuring three-dimensional representations, incorporating any 3D effects, or including multiple charts in a single image. The dataset is categorized into training and testing subsets, further subdivided based on resolutions and specific chart types. The reuse potential of this dataset is substantial. It serves as a valuable resource for driving algorithmic advancements in data visualization classification and interpretation. Researchers can leverage this dataset for training and testing deep models, enhancing the adaptability of their algorithms. Moreover, it establishes a benchmark for evaluating system performance in handling diverse chart visualizations, allowing for direct comparisons, and fostering advancements in data understanding algorithms. The versatility of the dataset, encapsulating various chart types and resolutions, provides a standardized platform for assessing and comparing the effectiveness of different systems in understanding and decomposing visualizations [1,2,3].

The Usage of the Term "Social" in Japanese Primary Care Literature.

INTRODUCTION: There has been a growing recognition of the importance of incorporating a "social" perspective in primary care practice. However, the specific meaning of the term "social" in the context of primary care is often not clearly defined or explained in the literature. This study aims to explore the usage and interpretation of the term "social" in primary care discourse in Japan. METHODS: We collected papers containing the term "social" ("shakai-teki" in Japanese) from 810 papers published between 2010 and 2022 in the Official Journal of the Japan Primary Care Association. Through abductive coding, we examined how the term was employed and the different meanings attributed to it. RESULTS: The instances of using the term "social" were classified into five distinct categories: (i) non-medical, (ii) emphasizing the importance of topics, (iii) public as an object, (iv) connections with people who support health and well-being, and (v) structural inequities that are detrimental to health.  Conclusion: The analysis revealed that the term "social" in the context of primary care discourse was multifaceted and characterized by ambiguity. To ensure effective communication and clarity in discussions, it is crucial for primary care professionals to have a clear understanding of the intended meaning and implications of the term "social."

Perspective of radiography science - a document analysis of dissertations.

INTRODUCTION: The aim of this study was to clarify the perspective of radiography science as an academic discipline. A discipline can be studied by discovering the collective use of concepts, especially core concepts. We have previously identified the core concepts as clinical practices in radiography, radiographers' profession, safe and high-quality radiation use, and technology in radiography. The relationships between these concepts have not been studied previously. In order to clarify the perspective of radiography science we have investigated further the core concepts, their interrelationships and interdependencies. METHODS: Altogether, 53 dissertations meeting the inclusion criteria were selected for a qualitative document analysis. The data were first analysed deductively using an extraction matrix comprising four core concepts developed from previous studies, then relational statements were synthesised, and the statements were analysed semantically. RESULTS: Analysis revealed the bilateral interrelationships between the concepts and their dependencies. All the concepts were used within healthcare. The rationale for radiography science research was the clinical practice of radiography and the improvement of services in a complex environment as a part of patients' pathways. Safe and high-quality radiation use was investigated as a means to deliver optimal services. Technology was studied as being functional or a means to deliver services. The perspective of the discipline was seen as the combination of humanistic interaction with advanced technology, where safety and quality were a necessity. CONCLUSIONS: Defining core concepts and their interrelations clarifies the perspective of the discipline and gives radiography researchers a way to argue their viewpoint.

[Competency-based learning objectives of primary qualifying nursing studies and intended task profiles]. / Kompetenzziele von primärqualifizierenden Pflegestudiengängen und intendierte Aufgabenprofile.

INTRODUCTION: Since 2020, it has been possible in Germany to complete a primary qualifying degree in nursing in addition to vocational training in nursing. The study presented here investigates the extent to which the intended competence goals prepare students for the future fields of activity of university-qualified nurses. METHODS: The research question was answered (1) by means of a content analysis of module manuals for primary qualifying courses, specifically the information on the intended learning outcomes in the university part of the course, and (2) by evaluating the results of the analysis in focus groups with those responsible for the course. The areas of competence were used as evaluation criteria for the analysis of the module manuals. The text elements were coded using the analysis software MAXQDA. In the further course of the analysis, the competence areas were combined into three areas with a view to the task profiles (direct care, indirect care and competence area V/research competence) and the percentage weighting of the competence goals was calculated. Using study results from the project "Investigation of the implementation of the study programs within the framework of university nursing training according to the Nursing Professions Act", the hours spent in these areas and the distribution of presence and self-learning time for direct nursing were determined. The results and the reasons for the curriculum design were then discussed in focus groups with those responsible for the degree program. RESULTS: The module manuals reveal clear differences in formal design. The analysis of the learning outcomes specified in the module manuals according to the competence areas also shows considerable differences in the distribution of the percentages for the individual competence areas. In relation to direct care, the percentages range between 55% and 71%, the hours vary between 2,022 and 3,622 hours. With indirect care, the range is 246 to 520 hours. A comparatively high number of hours is planned for competence area V/research competence (869 to 1,426 hours). Also, the analysis leads to the conclusion that within the degree program with the lowest number of hours of face-to-face teaching only 690 hours of face-to-face teaching are spent on direct care, while the degree program with the highest number of hours provides 1,968 hours for face-to-face teaching. In the focus group discussions, the persons responsible for the degree program took a critical view of the hours spent on developing skills in indirect care in the primary qualifying degree programs. Those responsible for the degree programs also regard the very small number of face-to-face hours at some university locations as insufficient to develop direct care skills. DISCUSSION: The results suggest that the primary qualifying courses in some areas and at some study locations do not adequately prepare for the task profiles intended for HQP.

How did European countries set health priorities in response to the COVID-19 threat? A comparative document analysis of 24 pandemic preparedness plans across the EURO region.

The COVID-19 pandemic has forced governments across the world to consider how to prioritise the allocation of scarce resources. There are many tools and frameworks that have been designed to assist with the challenges of priority setting in health care. The purpose of this study was to examine the extent to which formal priority setting was evident in the pandemic plans produced by countries in the World Health Organisation's EURO region, during the first wave of the COVID-19 pandemic. This compliments analysis of similar plans produced in other regions of the world. Twenty four pandemic preparedness plans were obtained that had been published between March and September 2020. For data extraction, we applied a framework for identifying and assessing the elements of good priority setting to each plan, before conducting comparative analysis across the sample. Our findings suggest that while some pre-requisites for effective priority setting were present in many cases - including political commitment and a recognition of the need for allocation decisions - many other hallmarks were less evident, such as explicit ethical criteria, decision making frameworks, and engagement processes. This study provides a unique insight into the role of priority setting in the European response to the onset of the COVID-19 pandemic.

Experimenting with care and cod: On document-practices, versions of care and fish as the new experimental animal.

A key ambition in care studies has been to study care in practice and as practice. By turning towards practices, care studies has rendered visible and acknowledged important work that is not captured through looking at formal procedures or official and written materials, such as policy documents and medical protocols. In this literature, document materials and the written have often been seen as unable to demonstrate and address the 'specificities of care' (Mol et al., 2010, p. 9). We challenge this view by showing how pragmatically-oriented approaches can be extended to the procedural and formalized aspects of care practices. We draw upon fieldwork in the life sciences-comparative immunology-investigated through experiments on Atlantic cod (Gadus Morhua). How to care for fish is a contested domain; many uncertainties exist around how to care for fish so that legal requirements are met. We ask: How are existing legal and ethical principles and procedures put to work in cod immunology and animal research? By what document-practices and document-tools is care for cod in research negotiated and settled? How does the cod stand out as an object of care in the life sciences? Our article answers these questions by empirically teasing out how scientists navigate the terrain and arguing for the importance of bringing the document-based realities of animal research into analysis. We do this by delineating three different versions of care: procedural care, skilled care, and dispassionate care.

The Implementation of an Electronic Medical Record in a German Hospital and the Change in Completeness of Documentation: Longitudinal Document Analysis.

BACKGROUND: Electronic medical records (EMR) are considered a key component of the health care system's digital transformation. The implementation of an EMR promises various improvements, for example, in the availability of information, coordination of care, or patient safety, and is required for big data analytics. To ensure those possibilities, the included documentation must be of high quality. In this matter, the most frequently described dimension of data quality is the completeness of documentation. In this regard, little is known about how and why the completeness of documentation might change after the implementation of an EMR. OBJECTIVE: This study aims to compare the completeness of documentation in paper-based medical records and EMRs and to discuss the possible impact of an EMR on the completeness of documentation. METHODS: A retrospective document analysis was conducted, comparing the completeness of paper-based medical records and EMRs. Data were collected before and after the implementation of an EMR on an orthopaedical ward in a German academic teaching hospital. The anonymized records represent all treated patients for a 3-week period each. Unpaired, 2-tailed t tests, chi-square tests, and relative risks were calculated to analyze and compare the mean completeness of the 2 record types in general and of 10 specific items in detail (blood pressure, body temperature, diagnosis, diet, excretions, height, pain, pulse, reanimation status, and weight). For this purpose, each of the 10 items received a dichotomous score of 1 if it was documented on the first day of patient care on the ward; otherwise, it was scored as 0. RESULTS: The analysis consisted of 180 medical records. The average completeness was 6.25 (SD 2.15) out of 10 in the paper-based medical record, significantly rising to an average of 7.13 (SD 2.01) in the EMR (t178=-2.469; P=.01; d=-0.428). When looking at the significant changes of the 10 items in detail, the documentation of diet (P<.001), height (P<.001), and weight (P<.001) was more complete in the EMR, while the documentation of diagnosis (P<.001), excretions (P=.02), and pain (P=.008) was less complete in the EMR. The completeness remained unchanged for the documentation of pulse (P=.28), blood pressure (P=.47), body temperature (P=.497), and reanimation status (P=.73). CONCLUSIONS: Implementing EMRs can influence the completeness of documentation, with a possible change in both increased and decreased completeness. However, the mechanisms that determine those changes are often neglected. There are mechanisms that might facilitate an improved completeness of documentation and could decrease or increase the staff's burden caused by documentation tasks. Research is needed to take advantage of these mechanisms and use them for mutual profit in the interests of all stakeholders. TRIAL REGISTRATION: German Clinical Trials Register DRKS00023343; https://drks.de/search/de/trial/DRKS00023343.

Al Ghazali's Concept of Diseases of the Spiritual Heart and its Significance to the DSM-5-TR Diagnosis.

The intertwined relationship between religion and mental health has been accounted for since the earliest recorded history. This study aimed to explore the relationship between the concept of diseases of the spiritual heart (DOTSH) from the Islamic-Sufi perspective and the medical-psychiatric concept of mental disorder. We examined two essential documents as our primary data sources: (1) Al Ghazali's Ihya Ulumuddin (Revivals of Religion Sciences) Volume III entitled the Quarter of the Destructive and (2) The Diagnostic and Statistical Manual, Fifth Version, Text Revision (DSM-5-TR). We employed a document analysis of the qualitative method by applying six steps of data analysis. We reviewed the English version of Al Ghazali's book to identified DOTSH. In this stage, we found six DOTSH categories which comprised of 40 DOTSH. Then, we searched the correspondence of DOTSH's categories to the DSM-5-TR criteria for mental disorders. We found that all DOTSH categories correspond to DSM-5-TR diagnostics criteria, diagnostic features or diagnostic associated features. We concluded that spiritual heart diseases not only present as symptoms but also can be regarded as mental disorder preconditions that require preventive intervention.

Civil Aviation Policies and Practices in Turkey in a Global Context Through Sustainable Aviation.

The negative environmental effects of global civil aviation growth since the 19th century lead to the emergence of the "sustainable aviation" concept. This study aims to determine the current status of sustainability discussions in developing Turkish civil aviation and its alignment with global sustainable aviation policies. The research data are collected through document analysis and key expert interviews. Document analysis is to review reports on sustainable aviation and to compare two cases of AirFrance-KLM and Turkish Airlines. Semi-structured interviews are conducted with key experts from airline companies, public institutions, and subsidiary services in the Turkish aviation sector. The analysis results are presented under the themes of "institutional, conceptual, Turkey's current situation, motivations, role of international organizations, cooperation and coordination, problems and obstacles." The results show that the Turkish civil aviation industry is enthusiastic about catching up with international standards and is successful in keeping up with the latest technologies. The private sector is leading the sector by targeting global competitiveness. Current deficiencies stem from legislation, incentives, obligations, resources, and environmental awareness. The main contribution is to be the first source and guide for future studies that aim to shed light on policymaking in Turkey as an emerging country case.

Enhancing public health resilience in urban disaster settings: A study protocol on civil-military coordination in Malaysia.

In Malaysia, the increasing frequency and severity of disasters emphasize the urgent need for enhancing disaster management. Given their significant impact on public health and healthcare, effective disaster management becomes a top priority. This study focuses on urban disasters and aims to identify health needs, assess multi-sectorial response gaps, and propose civil-military coordination mechanisms. To achieve this, a qualitative single-case approach will be employed, involving document reviews, in-depth interviews, and focus group discussions with representatives from key governmental agencies responsible for disaster management. The study will specifically concentrate on Kuala Lumpur, the densely populated and commercially active city. Thematic analysis will be used to systematize and verify the collected data, providing comprehensive insights into the current state of civil-military coordination in disaster response and management from stakeholders' perspectives. By examining their perceptions and experiences, the study will identify existing gaps and challenges in civil-military coordination. Ultimately, the findings will contribute to evidence-based policies and strategies aimed at improving disaster management coordination throughout Malaysia.

Faculty publication trends in a Japanese national university: a diachronic document analysis.

BACKGROUND: We previously demonstrated that in a Japanese national university's medical faculty, overall paper publication frequency increased between 1979-1980 and 2017-2018, while original paper publication did not increase. Further, publication language changed from predominantly Japanese to English. However, whether these trends are specific to medicine or representative of other faculties remains unclear. METHODS: We diachronically analyzed annual university library-produced publication reports for four pharmaceutical and three medical units between 1979-1980 and 2019-2020, elucidating how publication frequency, type, and language medium changed. RESULTS: All publication types increased for the pharmaceutical faculty, from 2.87 per faculty member per year to 10.77. Publication of original papers more than doubled, from 1.06 per faculty member per year to 2.37. This increase was exclusively in English publication, with no publication of Japanese original papers in 2019-2020. This contrasts with medicine, which, while it demonstrated similar increases in all publication types combined, from 4.92 papers per faculty member per year to 12.78, did not demonstrate as striking an increase in total original paper publication (English and Japanese), from 1.21 papers per faculty member per year to 1.30. However, these two faculties observed similar trends in that English largely replaced Japanese original paper publication. That both faculties' Japanese original paper publication decreased suggests English language original paper publication comes at the expense of publishing in Japanese. Concerning both faculties together, the increase in publishing frequency for all publication types more than tripled from 4.01 to 12.38. This was largely driven by changes in conference paper publication for the pharmaceutical sciences faculty, where English publication increased 2,775% (0.06 to 1.7 papers per faculty member per year) and Japanese language publication 258% (1.33 to 4.77). While conference paper publication did increase for the medical sciences, its change in total publication frequency was largely driven by 'other' types of publication, which increased from 0.51 publications per faculty member per year in 1979-1980 to 5.41 in 2019-2020, largely driven by Japanese language publication. CONCLUSION: In 2019-2020, pharmaceutical sciences faculty members largely published original papers in English, so postgraduate education should consider the future likelihood of graduates needing to publish in English.

Government, governance, and place-based approaches: lessons from and for public policy.

BACKGROUND: Place-based approaches are increasingly applied to address the determinants of health, many of which are complex problems, to ultimately improve population health outcomes. Through public policy, government actions can affect the effectiveness of place-based approaches by influencing the conceptualisation, development, implementation, governance, and/or evaluation of place-based approaches. Despite the important role of public policy, there has been limited examination of public policy related to place-based approaches. We add to the limited knowledge base by analysing Australian national public policy, to explore: (1) the definitions, conceptualisations, and characteristics of place-based approaches in public policy; (2) the government's perception and communication of its role in place-based approaches; and (3) the extent to which government policy reflects the necessary conditions for successful place-based governance developed by Marsh and colleagues, namely localised context, embedded learning, and reciprocal accountability. METHODS: This research was underpinned by the Theory of Systems Change and methodologically informed by the READ approach to document analysis. Ritchie and Spencer's framework method was utilised to analyse the data. RESULTS: We identified and reviewed 67 policy documents. In terms of conceptualisation, common characteristics of place-based approaches related to collaboration, including community in decision-making, responsiveness to community needs, and suitability of place-based approaches to address complex problems and socio-economic determinants of health. Three roles of government were identified: funder, partner, and creator of a supportive policy environment. From the three criteria for successful place-based governance, localised context was the most dominant across the documents and reciprocal accountability the least. CONCLUSIONS: Based on our findings, we drew key implications for public policy and research. There was a disproportionate emphasis on the bottom-up approach across the documents, which presents the risk of diminishing government interest in place-based approaches, potentially burdening communities experiencing disadvantage beyond their capacities. Governments engaged in place-based approaches should work towards a more balanced hybrid approach to place-based approaches that maintain the central functions of government while allowing for successful place-based governance. This could be achieved by promoting consistency in conceptualisations of 'place-based', employing an active role in trust building, advancing the creation of a supportive policy environment, and embedding 'learning' across place-based approaches.

The Concept of Active Longevity in Russia's Policy on Aging.

Since the 1960s, the goal of active longevity has been mentioned repeatedly in Russian policy documents on aging and aging-related research. Analyzing current policy documents revealed divergences in the ways the term was interpreted, which in turn allowed for aging policy to develop in more than one direction. One policy development path considers active longevity to be more or less synonymous with the active aging concept. It focuses on older people's potential, and measures policy progress according to the Active Longevity Index (ALI). Another takes a more holistic approach, seeing active longevity as a policy goal in itself, alongside healthy aging, employment, social participation, and older people's contribution to society in ways that suit them. The latter approach accords with previous policy implementations in Russia and with extensive research data collected from various Russian regions since the 1940s. Preliminary observations on active longevity policy implementations show progress in health-care development and multiple opportunities for older people` social participation. However, data on older people's employment and life expectancy challenge the effectiveness of policy and cast doubt on the reliability of the ALI. A more flexible approach and the application of accumulated data and knowledge may assist in achieving active longevity policy goals.

Social determinants of health in non-communicable diseases prevention policies in South Africa.

BACKGROUND:  The South African government has developed many policies for the prevention and control of non-communicable diseases. However, non-communicable diseases remain among the major causes of morbidity and mortality in South Africa. Although these diseases are linked to interaction of multiple risk factors, many of which are modifiable, they continue to cause much suffering particularly among the marginalised and people from the lower socio-economic status. OBJECTIVES:  The objective of this research was to explore and present the inclusion of social determinants of health in the policies meant for the prevention and control of non-communicable diseases in South Africa. METHOD:  The qualitative document analysis approach was used to conduct policy analysis of purposefully selected policies for prevention and control of cancers, obesity and mental and behavioural disorders in South Africa. RESULTS:  The analysis revealed that policies for prevention and control of cancers, obesity and mental and behavioural disorders included policy intervention activities that focused on five social determinants of health: (1) governance, (2) social policies, (3) public policies, (4) material circumstances and (5) health system. CONCLUSION:  Excluding most of the important social determinants of health in the policies for prevention and control of non-communicable diseases means that these policies would continue to fail in preventing these diseases from the root causes.Contribution: This article points out weaknesses in the policies meant for prevention and control of obesity, cancers and mental and behavioural disorders. This article further suggests policy improvement strategies that may be considered to effectively address these diseases.