Increasing Health Insurance Enrollment in Low- and Middle-Income Countries: What Works, What Does Not, and Research Gaps: A Scoping Review.

Health insurance programs have the potential to shield individuals in low- and middle-income countries from catastrophic health expenses and reduce their vulnerability to poverty. However, the uptake of insurance programs remains low in these countries. We reviewed existing evidence from experimental studies on approaches that researchers have tested in order to raise the uptake. In the 12 studies we synthesized, educational programs and subsidies were the dominant interventions. Consistent with findings from previous studies on other health products, subsidies were effective in raising the uptake of insurance programs in many contexts. Conversely, education interventions-in their current forms-were largely ineffective, although they bolstered the effect of subsidies. Other strategies, such as the use of microfinance institutions and social networks for outreach and enrollment, showed mixed results. Additional research is needed on effective approaches to raise the uptake of insurance programs, including tools from behavioral economics that have shown promise in other areas of health behavior.

Internet de las cosas: una opción interesante para el futuro de la salud pública / Internet of things: an interesting option for the future of public health

RESUMEN Introducción: el internet de las cosas ofrece nuevas oportunidades de acceso a datos, servicios específicos en la educación, seguridad y asistencia sanitaria, entre otros campos. Objetivo: realizar una revisión de la literatura existente sobre aspectos que definen el internet de las cosas en el ámbito de la salud pública. Métodos: se realizó una investigación documental de la literatura en diversas bases de datos académicas y motores de búsqueda; (MEDLINE, Scopus, IEEE Xplore, PubMed, Science Direct, Google Scholar y Google Books) y sitios web corporativos e institucionales (Cisco, Naciones Unidas y Organización Mundial de la Salud). Se utilizaron los siguientes descriptores: internet de las cosas, conectividad, salud pública, salud móvil, epidemiología, aprendizaje automático, aprendizaje profundo e inteligencia artificial. Se revisaron documentos siguiendo el método que incluye la identificación de la pregunta de investigación (con base en el objetivo) y los estudios relevantes, seguido de la selección de los escritos y el cotejo, resumen y presentación de los resultados. Desarrollo: los conceptos y opiniones se estructuraron en tres capítulos donde se exponen las ideas esenciales relacionadas con el tema objeto de estudio: origen del internet de las cosas, el internet de las cosas en salud pública y conclusiones. Conclusiones: el internet de las cosas representa para el área de salud pública una posibilidad innovadora para entender y atender el fenómeno salud-enfermedad de las poblaciones, y proporcionar una red de colaboración entre individuos sustentado en la conformación de una arquitectura de la participación desde un enfoque inteligente.

ABSTRACT Introduction: the internet of things offers new opportunities for access to data, specific services in education, security and health care, among other fields. Objective: to carry out a review of the existing literature on aspects that define the internet of things in the field of public health. Methods: a documentary research of the literature was carried out in various academic databases and search engines; (MEDLINE, Scopus, IEEE Xplore, PubMed, Science Direct, Google Scholar and Google Books) and corporation and institutional websites (Cisco, United Nations and World Health Organization). The following descriptors were used: internet of things, connectivity, public health, mobile health, epidemiology, machine learning, deep learning, and artificial intelligence. Documents were reviewed following the method that includes the identification of the research question (based on the objective) and the relevant studies, followed by the selection of the writings and the comparison, summary and presentation of the results. Development: the concepts and opinions were structured in three chapters where the essential ideas related to the subject under study are presented: origin of the internet of things, the internet of things in public health and conclusions. Conclusions: the internet of things represents an innovative possibility for the area of public health to understand and attend to the health-disease phenomenon of populations, and to provide a network of collaboration between individuals based on the creation of an architecture of participation from a smart approach.

Rebuilding a US Federal Data Strategy After the End of the "Community Health Status Indicators".

For nearly 2 decades, the Community Health Status Indicators tool reliably supplied communities with standardized, local health data and the capacity for peer-community comparisons. At the same time, it created a large community of users who shared learning in addressing local health needs. The tool survived a transition from the Health Resources and Services Administration to the Centers for Disease Control and Prevention before being shuttered in 2017. While new community data tools have come online, nothing has replaced Community Health Status Indicators, and many stakeholders continue to clamor for something new that will enable local health needs assessments, peer comparisons, and creation of a community of solutions. The National Committee on Vital and Health Statistics heard from many stakeholders that they still need a replacement data source. (Am J Public Health. 2021;111(10):1865-1873. https://doi.org/10.2105/AJPH.2021.306437).

Financial implications of New York City's weight management initiative.

PURPOSE: To estimate potential annual savings in medical expenditures from a subsidized weight management program from the NYC Government perspective. DESIGN: Longitudinal observational study. SETTING: Employees of New York City (NYC) government and enrolled dependents. SAMPLE: 14,946 participants with overweight and obesity. INTERVENTION: WW (formerly Weight Watchers®) 'Workshop' and 'Digital' programs. MEASURES: Participation rate, enrollment duration, weight change, and predicted gross and net total and per capita medical expenditure savings and return on investment (ROI). ANALYSIS: Participation rate, enrollment duration, weight change, and program costs are based on direct observation. Predicted savings are simulated based on published data relating weight loss to medical expenditure reductions. RESULTS: In total, 47% of participating employees and 50% of participating dependents lost weight during the enrollment period. Mean (median) enrollment duration for employees was 7.1 months (7.0) and for dependents was 6.9 months (6.0). Mean (median) weight losses for the employees in 'Workshops' and 'Digital' was 6.6 lbs (2.80) and 6.3 lbs (0.0). For dependents, weight losses were 7.4 lbs (3.59) and 11.6 lbs (2.0). Per capita and total predicted net savings to NYC Government from employees was estimated to be $120 and $1,486,102 for an ROI of 143%. Including dependents, predicted net savings increases to $1,963,431 for an ROI of 189%. Over 80% of savings came from participants in the Obese III category. CONCLUSION: An evidence-based weight management program has the potential to generate a positive ROI for employers. Future studies should validate these estimates using actual data and more rigorous designs.

Estabelecimento de metas no planejamento da aposentadoria: reflexão à luz de Imogene King / Goal setting in retirement planning: reflection in the light of Imogene King / Planificación de la jubilación y establecimiento de metas: reflexión a la luz de Imogene King

Objetivo: refletir sobre o estabelecimento de metas no planejamento da aposentadoria à luz da teoria de Imogene King, que se caracteriza por ser interacionista, pautada no cuidado de Enfermagem que não se restringe ao âmbito individual, mas pode ser prestado a um grupo social com o qual o profissional estabelece contato. Método: estudo reflexivo realizado por meio de aporte teórico relacionado à teoria do alcance de metas de Imogene King e análise reflexiva do tema planejamento da aposentadoria. Resultados: o estabelecimento de metas ocorre a partir da interação entre enfermeiro e trabalhador, em que cada indivíduo reage de forma particular à aposentadoria, influenciado por suas experiências e percepções. Compete ao enfermeiro valorizar os conhecimentos do trabalhador, a fim de estimular sua adesão ao planejamento da aposentadoria. O trabalhador possui necessidades básicas de informação sobre a aposentadoria, que devem ser fornecidas em momento oportuno pelo profissional. Conclusão: o estabelecimento de metas contribui para que o trabalhador note concretamente seus avanços até o desligamento do trabalho. A teoria de Imogene King direciona o enfermeiro do trabalho no estabelecimento de metas com trabalhadores em pré-aposentadoria.(AU)

Objective: to reflect on the establishment of goals in retirement planning in the light of Imogene King's theory, which is characterized by being interactionist, based on Nursing care that is not restricted to the individual scope, but can be provided to a social group with the which the professional establishes contact. Method: reflective study carried out through theoretical support related to the theory of goal attainment by Imogene King and reflective analysis of the theme of retirement planning. Results: the establishment of goals occurs from the interaction between nurse and employee, in which each individual reacts in a particular way to retirement, influenced by their experiences and perceptions. It is up to the nurse to value the employee's knowledge, in order to encourage their adherence to retirement planning. The employee has basic information needs about retirement, which must be provided by the professional in a timely manner. Conclusion: the establishment of goals contributes to the employee concretely noting his advances until he leaves work. Imogene King's theory directs the occupational health nurse in setting goals with preretirement employees.(AU)

Objetivo: reflexionar sobre la planificación de la jubilación y el establecimiento de metas a la luz de la teoría de Imogene King, que se caracteriza por ser interaccionista,basada en la atención de enfermería no limitada al alcance individual sino que incluye a todo el grupo social con el cual el profesional establece contacto. Método: estudio reflexivo basado en la teoría de metas de Imogene King y análisis reflexivo de la planificación de la jubilación. Resultados: el establecimiento de metas ocurre a partir de la interacción entre el enfermero y el trabajador, en el que cada individuo reacciona de modo diferente a la jubilación, influenciado por sus experiencias y percepciones. Le corresponde al enfermero valorar el conocimiento del trabajador para fomentar su adhesión a la planificación de la jubilación. El profesional debe proporcionar de manera oportuna información básica sobre la jubilación. Conclusión: el establecimiento de metas contribuye a que el trabajador note concretamente sus avances hasta que se desvincule de su trabajo. La teoría de Imogene King orienta al enfermero de trabajo en el establecimiento de metas con los trabajadores que se preparan para la jubilación. (AU)

Estratégias para previsão da demanda por serviços odontológicos: uma revisão integrativa / Strategies for predicting demand for dental services: an integrative review / Estrategias para pronosticar la demanda de servicios dentales: una revisión integradora

ntrodução:A previsão da demanda por serviços de saúde possibilita melhorias no processo de tomada de decisões gerenciais nas organizações de saúde.Objetivo:O estudo buscou identificar, na literatura, as metodologias utilizadas para prevera demanda por serviçosodontológicos. Metodologia:Trata-se de uma revisão integrativa conduzida de acordo com o método PRISMA. A expressão de busca (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) foi aplicada em campos determinados para os repositórios Scopus Elsevier, Pubmed, BVS e IEEE Xplore.As metodologias empregadas foram categorizadas conforme a temporalidade e o instrumento empregado nosestudos. Resultados:Após aplicação do processo de seleção-exclusão baseado na recomendação PRISMA, foram selecionados 34 documentos, classificados conforme a dependência da colaboração do paciente, a procedência de auto avaliações, o direcionamento a um grupo populacional ou demanda específica, e a relação com o setor público, privado ou ambos. As metodologias identificadas foram: estudos de temporalidade transversal em que o instrumento foi a aplicação de questionário; estudos de temporalidade transversal nos quais o instrumento foi a observação; e estudo de temporalidade longitudinal onde o instrumento foi a aplicação de questionário. Conclusões:A partir dos resultados dessa revisão, foi gerado conhecimento capaz de apoiar o delineamento de estudos com potencial para aprimorar a previsibilidade da demanda por serviços odontológicos (AU).

Introduction:Forecasting the demand for health services enables improvements in the decision-makingprocess in healthcareorganizations.Objective:The present study aimed to identify in the literature the methodologies used to predict the demand for dental services.Methodology:This was an integrative review conducted in accordance with the PRISMA method. The search expression (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) was applied to fields determined for the Scopus Elsevier, PubMed, VHL, and IEEE Xplore databases.The identified methodologies were categorized according to temporality and instrument used in the studies.Results:After applying the selection-exclusion process based on Prisma, 34documents were selected, classifiedaccording to patient's collaboration dependence, self-assessments, the targeting of a specific group or demand and the relationship with public, private or both sectors. The methodologies identified were transversal temporality in which the instrument was the application of a questionnaire or observation and longitudinal temporality where the instrument was the application of a questionnaire. Conclusions:From the results of this review, insights were generatedcapable of supporting studies with potential to improve the forecast of dental services (AU).

Introducción: La predicción de la demanda de servicios de salud permite mejorar el procesode decisiones em organizaciones de salud.Objetivo: El estudio buscó identificar, en la literatura, las estrategias utilizadas para predecirla demanda deserviciosdentales.Metodología: Esta es una revisión integradora realizada de acuerdo con el método PRISMA. La expresión de búsqueda (((pronóstico * O "predicción" O "previsión") Y ("demanda" O tendencia *) Y ("servicios dentales"))) se aplicó a los campos determinados para repositorios Scopus Elsevier, Pubmed, BVS y IEEE Xplore.Las metodologías identificadas se categorizaron según la temporalidady el instrumento utilizado em los estudios.Resultados:Tras aplicar el procesode selección-exclusión basado emPrisma, se seleccionaron 34documentos, clasificadossegún la dependencia de colaboración del paciente, las autoevaluaciones a, la focalización de un grupo o demanda específica y la relación con el sector público, privado o ambos. Las metodologíasidentificadas fueron: latemporalidad transversal en los cuales el instrumento era la aplicación de un cuestionario; estudios de temporalidad transversal en los cuales la observación era el instrumento; y estudio de temporalidad longitudinal donde el instrumento fue la aplicación de un cuestionario. Conclusiones: A partir de los resultados de esta revisión se generó conocimiento capaz de sustentar el diseño de estudios con potencial para mejorar la predictibilidad de la demanda de servicios odontológicos (AU).

A Community-Wide Collaboration to Reduce Cardiovascular Disease Risk: The Hearts of Sonoma County Initiative.

PURPOSE AND OBJECTIVES: Collaboration across multiple sectors is needed to bring about health system transformation, but creating effective and sustainable collaboratives is challenging. We describe outcomes and lessons learned from the Hearts of Sonoma County (HSC) initiative, a successful multi-sector collaborative effort to reduce cardiovascular disease (CVD) risk in Sonoma County, California. INTERVENTION APPROACH: HSC works in both clinical systems and communities to reduce CVD risk. The initiative grew out of a longer-term county-wide collaborative effort known as Health Action. The clinical component involves activating primary care providers around management of CVD risk factors; community activities include community health workers conducting blood pressure screenings and a local heart disease prevention campaign. EVALUATION METHODS: The impact of the clinical improvement efforts was tracked using blood pressure data from the 4 health systems participating in HSC. Descriptive information on the community-engagement efforts was obtained from program records. Lessons learned in developing and maintaining the collaborative were gathered through document review and interviews with key informants. RESULTS: Favorable trends were seen in blood pressure control among patients with hypertension in the participating health systems: patients with controlled blood pressure increased from 58% in 2014 to 67% in 2016 (P < .001). Between 2017 and 2019, the community engagement effort conducted 99 outreach events, reaching 1,751 individuals, and conducted 1,729 blood pressure screenings, with 441 individuals referred to clinical providers for follow-up care. HSC scored highly on 6 essential elements of an effective coalition and achieved a degree of sustainability that has eluded many other collaboratives. IMPLICATIONS FOR PUBLIC HEALTH: Factors contributing to the success of HSC include 1) starting small and focused to build trust among participants and demonstrate value, 2) working within the framework of a larger effort, and 3) providing long-term, open-ended backbone support.

Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program.

INTRODUCTION: Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people's health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees. METHODS: We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods. RESULTS: Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively. CONCLUSION: Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.

Influence of subsidies and promotional strategies on outcomes in a beneficiary-based commercial weight-loss programme.

To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary-based, commercial weight-loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight change. Our independent variables were subsidy strategy (total subsidy (n = 9) vs cost sharing (n = 3)) and combination of promotional-subsidy strategies (mixed campaign + total subsidy (n = 6) vs mass media + total subsidy (n = 3)). We used logistic and linear regression analyses adjusted for beneficiary factors and clustering by organization. From 12 participating organizations, 26 068 beneficiaries registered of which 6215 initially engaged. Cost sharing was associated with significantly greater initial engagement as compared to total subsidy (OR 3.73, P < 0.001); however, no significant between-group differences existed in calls or weight change. Mass media + total subsidy group had significantly greater calls and weight loss at 12 months compared to mixed campaign + total subsidy (-2.6% vs -1.8%, P = 0.04). Cost sharing may promote greater initial engagement, although does not contribute to better participation or weight loss relative to total subsidy. If organizations elect total subsidy, then pairing this strategy with a mass media campaign may promote greater participation and weight loss among beneficiaries.

To vaccinate or not to vaccinate: A comprehensive study of vaccination-subsidizing policies with multi-agent simulations and mean-field modeling.

We combined the elements of evolutionary game theory and mathematical epidemiology to comprehensively evaluate the performance of vaccination-subsidizing policies in the face of a seasonal epidemic. We conducted multi-agent simulations to, among others, find out how the topology of the underlying social networks affects the results. We also devised a mean-field approximation to confirm the simulation results and to better understand the influences of an imperfect vaccine. The main measure of a subsidy' performance was the total social payoff as a sum of vaccination costs, infection costs, and tax burdens due to the subsidy. We find two types of situations in which vaccination-subsidizing policies act counterproductively. The first type arises when the subsidy attempts to increase vaccination among past non-vaccinators, which inadvertently creates a negative incentive for voluntary vaccinators to abstain from vaccination in hope of getting subsidized. The second type is a consequence of overspending at which point the marginal cost of further increasing vaccination coverage is higher than the corresponding marginal cost of infections avoided by this increased coverage. The topology of the underlying social networks considerably worsens the subsidy's performance if connections become random and heterogeneous, as is often the case in human social networks. An imperfect vaccine also worsens the subsidy's performance, thus narrowing or completely closing the window for vaccination-subsidizing policies to beat the no-subsidy policy. These results imply that subsidies should be aimed at voluntary vaccinators while avoiding overspending. Once this is achieved, it makes little difference whether the subsidy fully or partly offsets the vaccination cost.

Enumerating the population eligible for funded HIV pre-exposure prophylaxis (PrEP) in New Zealand.

Background Pre-exposure prophylaxis (PrEP) became publicly funded in New Zealand (NZ) on 1 March 2018. PrEP could have a substantial population-level effect on HIV transmission if scaled up rapidly. An accurate estimate of the size of the PrEP-eligible population would guide implementation. METHODS: We drew on nine sources to estimate the PrEP-eligible population, namely Statistics NZ data, Pharmaceutical Management Agency (PHARMAC) data on adults receiving funded antiretroviral treatment (ART), expert advice, estimates of the HIV care cascade, surveillance of undiagnosed HIV in a community sample of gay and bisexual men (GBM), surveillance of HIV diagnoses, NZ Health Survey data on sexual orientation among males, behavioural surveillance among GBM and behavioural data among people living with HIV (PLWH) from the HIV Futures NZ study. From these sources we derived three estimates relating to GBM, non-GBM and total eligible population. Sensitivity analyses examined different assumptions (GBM denominators, proportion PLWH diagnosed, proportion of diagnosed PLWH treated). RESULTS: We estimated that 17.9% of sexually active HIV-negative GBM would be eligible for PrEP, equating to 5816 individuals. We estimated that 31 non-GBM individuals would be eligible for PrEP. Thus, in total, 5847 individuals would be eligible for PrEP, comprising 99.5% GBM and 0.5% non-GBM. Sensitivity analyses ranged from 3062 to 6718 individuals. CONCLUSIONS: Policy makers can use enumeration to monitor the speed and scale in coverage as implementation of publicly funded PrEP proceeds. Sexual health and primary care services can use enumeration to forecast PrEP demand and plan accordingly. Better quality data, especially on transgender adults in NZ, would improve the accuracy of estimates.

Determinants of support for government involvement in obesity control among American adults.

Obesity takes a substantial toll on society as a whole. Obesity and its health-related complications contribute significantly to healthcare costs and negatively affects almost every aspect of human life. It is therefore reasonable for the government to be involved in finding solutions to control the epidemic. This article examined factors that influence support for government intervention in the obesity epidemic in the United States. We used data from Obesity in the United States: Public Perceptions, a survey of a nationally representative sample of American adults. We conducted OLS regression analysis, to understand how three main covariates that described beliefs about causes of obesity and a series of controls impact support for government intervention in obesity control. There was a significant negative relationship between support for government intervention and beliefs about causes of obesity. Also, political ideology and party affiliation significantly influenced support for government intervention. For instance, while Democrats were more supportive of government interventions to control obesity, Republicans were not supportive of such intervention. Additionally, race and environmental characteristics of place of residence significantly influenced support for government intervention. Further, there were significant joint effects of political affiliation, race, and weight status on support for government intervention. Unlike previous studies, we find that one of the important factors that drive people to either support or abhor government intervention is the perception of what causes obesity. It is important that public health officials and other stakeholders understand the intricacies of public support for obesity control.

The Bill & Melinda Gates Foundation: An opportunity to lead innovation in global surgery.

BACKGROUND: The Bill and Melinda Gates Foundation has made unparalleled contributions to global health and human development by bringing together generous funding, strategic partnerships, and innovative leadership. For the last twenty years, the Gates Foundation has supported the expansion of programs that directly address the fundamental barriers to the advancement of marginalized communities around the globe, with a transformative focus on innovations to combat communicable diseases and to ensure maternal and child health. Despite the wide spectrum of programs, the Gates Foundation has not, as of yet, explicitly supported the development of surgical care. METHODS: This article explores the pivotal role that the Gates Foundation could play in advancing the emerging global surgery agenda. First, we demonstrate the importance of the Gates Foundation's contributions by reviewing its history, growth, and evolution as a pioneering supporter of global health and human development. Recognizing the Foundation's use of metrics and data in strategic planning and action, we align the priorities of the Foundation with the growing recognition of surgical care as a critical component of efforts to ensure universal health care. RESULTS: To promote healthy lives and well-being for all, development of quality and affordable capacity for surgery, obstetrics and anesthesia is more important than ever. We present the unique opportunity for the Gates Foundation to bring its transformative vision and programing to the effort to ensure equitable, timely, and quality surgical care around the world.

Role of laser refractive surgery in cross-subsidization of nonprofit humanitarian eyecare and the burden of uncorrected refractive error in Nepal: Pilot project.

PURPOSE: To establish a refractive surgery unit at Tilganga Institute of Ophthalmology through support from international donations and provide knowledge transfer for doctors and management to make the unit self-sustaining, nonprofit laser refractive surgery, and financial support for other eyecare projects at Tilganga. SETTING: Tilganga Institute of Ophthalmology, Kathmandu, Nepal. DESIGN: Retrospective study. METHODS: A foundation was created to establish a refractive surgery unit using a cost-recovery model; that is, patients are charged according to their financial status to cover running costs, patients without funds to pay for surgery, and other eyecare projects for the underprivileged population of Kathmandu, Nepal. Donations were obtained to fund refurbishment within Tilganga Hospital and purchase equipment and technology. A Nepalese surgeon was selected from Tilganga and completed an 8-month fellowship and proctorship of the first series of surgeries. The refractive surgery unit was opened in January 2012, and the cost-recovery model was evaluated up to December 2016. RESULTS: During the period evaluated, 74.8% of patients were treated at full cost, 17.2% at subsidized cost, and 8.6% free of charge. The refractive surgery unit generated a profit representing 28% of the running cost in this period, which was used to reduce the deficit of the main hospital. Surgical outcomes achieved were comparable to those reported by groups in the developed world. CONCLUSION: A self-sustaining nonprofit laser refractive surgery clinic, operating with high quality, was successfully implemented supported by international donations for initial setup costs and a cost-recovery model thereafter.

The Likely Impact of Congenital Zika Syndrome on Families: Considerations for Family Supports and Services.

Congenital Zika virus infection has obvious implications for infants, and considerable research has addressed the nature and consequences of congenital Zika syndrome (CZS). Children with classic CZS meet the criteria for "children with medical complexity," and ongoing research is required to understand the range of needs and optimal treatment options. Far less attention has been given to the consequences of CZS for families, which are both immediate and lifelong. Although families of children with CZS have much in common with families of other children with disabilities, at least 4 features of CZS have special family implications: (1) the severity of the impact on children with obvious abnormalities at birth, coupled with the anticipation of a lifetime of caregiving and economic burdens; (2) uncertainty about the unfolding consequences, both for obviously affected children and for exposed children with no symptoms at birth; (3) a lack of specialized professional knowledge about the course of the disease or treatment options; and (4) social isolation, a lack of social or community supports, and potential stigma. Supporting families will require a family-centered approach to services, extensive care coordination, access to evolving new information, ongoing surveillance, formal and informal supports, and individualized child and family services.

Resource Allocation Strategies to Increase the Efficiency and Sustainability of Gavi's Health System Strengthening Grants.

BACKGROUND: Despite the increase in Health System Strengthening (HSS) grants, there is no consensus among global health actors about how to maximize the efficiency and sustainability of HSS programs and their resulting gains. To formally analyze and compare the efficiency and sustainability of Gavi's HSS grants, we investigated the factors, events and root causes that increased the time and effort needed to implement HSS grants, decreased expected outcomes and threatened the continuity of activities and the sustainability of the results gained through these grants in Cameron and Chad. METHODS: We conducted 2 retrospective independent evaluations of Gavi's HSS support in Cameroon and Chad using a mixed methodology. We investigated the chain of events and situations that increased the effort and time required to implement the HSS programs, decreased the value of the funds spent and hindered the sustainability of the implemented activities and gains achieved. RESULTS: Root causes affecting the efficiency and sustainability of HSS grants were common to Cameroon and Chad. Weaknesses in health workforce and leadership/governance of the health system in both countries led to interrupting the HSS grants, reprogramming them, almost doubling their implementation period, shifting their focus during implementation toward procurements and service provision, leaving both countries without solid exit plans to maintain the results gained. CONCLUSIONS: To increase the efficiency and sustainability of Gavi's HSS grants, recipient countries need to consider health workforce and leadership/governance prior, or in parallel to strengthening other building blocks of their health systems.

The Effect of Cost Sharing on an Employee Weight Loss Program: A Randomized Trial.

PURPOSE: To test the effects of employer subsidies on employee enrollment, attendance, and weight loss in a nationally available weight management program. DESIGN: A randomized trial tested the impact of employer subsidy: 100%; 80%, 50%, and a hybrid 50% subsidy that could become a 100% subsidy by attaining attendance targets. TRIAL REGISTRATION: NCT01756066. SETTING AND PARTICIPANTS: Twenty three thousand twenty-three employees of 2 US companies. MEASURES: The primary outcome was the percentage of employees who enrolled in the weight management program. We also tested whether the subsidies were associated with differential attendance and weight loss over 12 months, as might be predicted by the expectation that they attract employees with differing degrees of motivation. Analysis and Results: Enrollment differed significantly by subsidy level ( P < .0001). The 100% subsidy produced the highest enrollment (7.7%), significantly higher than each of the lower subsidies (vs 80% subsidy: 6.2%, P = .002; vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Enrollment in the 80% subsidy group was significantly higher than both lower subsidy groups (vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Among enrollees, there were no differences among the 4 groups in attendance or weight loss. CONCLUSION: This pragmatic trial, conducted in a real-world workplace setting, suggests that higher rates of employer subsidization help individuals to enroll in weight loss programs, without a decrement in program effectiveness. Future research could explore the cost-effectiveness of such subsidies or alternative designs.

Análise de implantação do núcleo de apoio à saúde da família em três municípios da Zona da Mata norte de Pernambuco / Analysis of family health support center implementation in three municipalities in the northern Zona da Mata of Pernambuco

Este estudo teve como objetivo avaliar a implantação do Núcleo de Apoio à Saúde da Família (NASF) em três municípios da Zona da Mata Norte de Pernambuco, determinando o grau de implantação do NASF nesses municípios, a partir das dimensões estrutura e processo e analisando a influência do contexto político e estrutural na variação do grau de implantação. Trata-se de uma pesquisa avaliativa do tipo análise de implantação 1-b, desenvolvida no período de março a agosto de 2015, com os profissionais do NASF, coordenadores da AB e secretários de saúde. Os NASF dos municípios A, B e C obtiveram um grau de implantação de 72% (parcialmente implantado), 81% (implantado) e 68% (parcialmente implantado), respectivamente. Na análise do contexto, houve uma coerência nos resultados, pois o único município onde o NASF foi considerado implantado foi o mesmo que apresentou um contexto mais favorável. Da mesma forma, o município com o grau de implantação mais baixo foi o que obteve um contexto mais desfavorável. Observou-se que uma gestão que proporciona condições adequadas para realização das atividades pelos profissionais, sejam elas relacionadas à estrutura ou ao processo, influencia positivamente a implantação da intervenção.

This study aimed to evaluate the implementation of the Family Health Support Center (FHSC) in three municipalities in the Northern Zona da Mata of Pernambuco, determining the degree of FHSC implementation in these municipalities from the structure and process dimensions, and analyzing the influence of the political and structural context in the variation of the degree of implementation. This is an evaluative study, type 1b implementation analysis, developed in the period from March to August 2015 with FHSC professionals, coordinators from AB, and secretaries of health. The FHSC from the A, B, and C municipalities obtained a degree of implementation of 72% (partially implemented), 81% (implemented), and 68% (partially implemented), respectively. In the context analysis there was a consistency in the results, because the only region where the FHSC was considered implemented was the same one that presented a more favorable context. In similar fashion, the region with the lowest degree of implementation was the one that had a more unfavorable context. It was observed that management that provides suitable conditions for carrying out activities by professionals, whether related to the structure or the process, positively influences the implementation of the intervention.