Public's perspective on COVID-19 adenovirus vector vaccines after thrombosis with thrombocytopenia syndrome (TTS) reports and associated regulatory actions - A cross-sectional study in six EU member states.

OBJECTIVE: In 2021, thrombosis with thrombocytopenia syndrome (TTS) was confirmed by the European Medicines Agency (EMA) as a rare side effect of the COVID-19 adenovirus vector vaccines Vaxzevria® and Jcovden®. This study aimed to describe the public's knowledge of TTS and how it affected the willingness to be vaccinated with COVID-19 vaccines and other vaccines in six European countries. METHODS: From June to October of 2022, a multi-country cross-sectional online survey was conducted in Denmark, Greece, Latvia, Netherlands, Portugal, and Slovenia. The minimum target of participants to be recruited was based on the size of the country's population. The results were analysed descriptively. RESULTS: In total, 3794 respondents were included in the analysis; across the six countries, 33.3 %-68.3 % reported being familiar with signs and symptoms of TTS, although 3.1-61.4 % of those were able to identify the symptoms correctly. The reported changes in willingness to be vaccinated against COVID-19 and with other vaccines varied per country. The largest reported change in the willingness to be vaccinated with Vaxzevria® and Jcovden® was observed in Denmark (61.2 %), while the willingness to be vaccinated with other COVID-19 vaccines changed most in Slovenia (30.4 %). The smallest decrease in willingness towards future vaccination against COVID-19 was reported in the Netherlands (20.9 %) contrasting with the largest decrease observed in Latvia (69.1 %). CONCLUSION: Knowledge about TTS seemed to have influenced the public's opinion in Europe resulting in less willingness to be vaccinated with Vaxzevria® and Jcovden®. Willingness for vaccination against COVID-19 with other vaccines and widespread use of vaccines to prevent other diseases also differed and seemed to be determined by the approaches taken by national health authorities when reacting to and communicating about COVID-19 vaccination risks. Further investigation of optimal risk communication strategies is warranted.

A critical analysis of national policies, systems, and structures of patient empowerment in England and Greece.

BACKGROUND: Comparison of patient empowerment (PE) policies in European countries can provide evidence for improvement and reform across different health systems. It may also influence patient and public involvement, patient experience, preference, and adherence. OBJECTIVE: The objective of this study was to compare PE within national policies, systems, and structures in England and Greece for achieving integrated people-centered health services. METHODS: We performed a critical search and review of policy and legislation papers in English and Greek languages. This included 1) general health policy and systems papers, 2) PE, patient and/or public involvement or patients' rights policy and legislation (1990-2015), and 3) comparative or discussion papers for England and/or Greece. RESULTS: A total of 102 papers on PE policies, systems, and structures were identified initially; 80 papers were included, in which 46 were policy, legislative, and discussion papers about England, 21 were policy, legislation, and discussion papers about Greece, and 13 were comparative or discussion papers including both the countries. In England, National Health Service policies emphasized patient-centered services, involvement, and empowerment, with recent focus on patients' rights; while in Greece, they emphasized patients' rights and quality of services, with recent mentions on empowerment. The health ombudsman is a very important organization across countries; however, it may be more powerful in Greece, because of the nonexistence of local mediating bodies. Micro-structures at trusts/hospitals are comparable, but legislation gives more power to the local structures in Greece. CONCLUSION: PE policies and systems have been developed and expressed differently in these countries. However, PE similarities, comparable dimensions and mechanisms, were identified. For both the countries, comparative research and these findings could be beneficial in building connections and relationships, contributing to wider European and international developments on PE, involvement, and patients' rights and further impact on patient preferences and adherence.

Examining the changing health care seeking behavior in the era of health sector reforms in India: evidences from the National Sample Surveys 2004 & 2014.

BACKGROUND: Health policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade. It is therefore important to understand the effectiveness of recent national health policies (such as the National Rural Health Mission and the National Urban Health Mission) in addressing the varied needs of the heterogeneous population of India. METHODS: We use datasets from the National Sample Surveys carried out in 2004 and 2014 to understand the change in the health seeking behavior as a result of these policies. The choice of health care facilities and the associated expenditures are compared through descriptive analyses. A multinomial logistic regression is used to identify the significant parameters which contribute towards the share of health care providers in India. The health status of two economically disparate Indian states (Bihar and Kerala) are also compared through specific metrics of performance. RESULTS: It is seen that due to increased availability of facilities in close proximity, both rural and urban residents prefer to avail of those facilities which will result in minimization of transportation cost. The effectiveness of national health policies is found to vary on a regional scale. Literacy and health status have a strong correlation, thereby reinforcing that Bihar still lags far behind Kerala in terms of access to equitable health care. CONCLUSION: Therefore, a hierarchical system, incorporating medical pluralism and tailor-made policies targeted at diverse health care demands, needs to be put in place to achieve Goal 3 of the Sustainable Development Goals as decreed by the United Nations, i.e., "health for all".

O efeito da municipalização no sistema hospitalar brasileiro: os hospitais de pequeno porte / The effect of municipalization in the Brazilian hospital system: the small-sized hospitals

Resumo A atenção hospitalar tem sido responsável por parte do aumento de custos em saúde. Países adequaram suas políticas para o setor hospitalar, concentrando a atenção em centros de maior porte, após estudos dos anos 1990 demonstrarem que hospitais menores de 200 leitos apresentam redução da eficiência. Em 2017 existiam no Brasil 6.787 hospitais, sendo 62,3% deles com menos de 50 leitos. O presente estudo avaliou a Política Nacional para os Hospitais de Pequeno Porte (PNHPP), publicada em 2004, e seu impacto no setor hospitalar brasileiro. A adesão à PNHPP ocorreu em 12 dos 27 estados brasileiros. Na ausência de diretrizes que privilegiassem a integralidade das ações, com hospitais inseridos em uma rede, a municipalização gerou a pulverização da atenção hospitalar. Este foi o modo encontrado pelos gestores municipais para o atendimento às necessidades de saúde. Houve aumento dos hospitais municipais, com redução de porte, chegando à média de 50 leitos/hospital. A reversão desse cenário envolve ações que passam por políticas indutoras de qualificação da atenção hospitalar até o entendimento de que as quase 5.000 unidades hospitalares de pequeno porte existentes no país configuram um amplo conjunto a ser estudado em profundidade, subdividindo-o em grupos menores, com vocações distintas.

Abstract Hospital care accounts for part of increased health care costs. Countries have adapted their public policies to the hospital sector, focusing on larger centers, after studies of the 1990s have shown that hospitals with less than 200 beds have reduced efficiency. A total of 6,787 hospitals in Brazil were recorded in 2017, 62.3% of which had less than 50 beds. This study evaluated the National Policy for Small-sized Hospitals (PNHPP) published in 2004, and its impact on the Brazilian hospital sector. Twelve of the 27 states adhered to the PNHPP. In the absence of policies to induce the establishment of a networked hospital system, favoring comprehensive actions, the municipalization pulverized hospital care. Municipal managers believed that this was the best path to meet health needs. The number of municipal hospital units increased and their size was reduced, reaching a mean capacity of 50 beds per hospital. The reversal of this scenario involves policies that induce the qualification of hospital care until the understanding that the almost 5,000 small-sized hospital units in the country are a broad set to be studied, subdividing it into smaller groups, with different specialties.

Tendências da atenção hospitalar no SUS da Bahia: uma análise de 2006 a 2009 / Trends of hospital healthcare at sus in Bahia state:an analysis from 2006 to 2009 / Tendencias de la atención hospitalaria en el SUS da la Bahía: un analísis de 2006 a 2009

A criação de ofertas de cuidados de saúde substitutivos à necessidade de internação,com redução da utilização de leitos para a prestação desses cuidados, tem evidenciado o novopapel que o hospital passa a desempenhar no sistema de saúde e implica em mudanças em seu perfil assistencial, de forma a facilitar e produzir maior articulação com a rede de serviços desaúde nos diversos níveis de atenção. O objetivo do presente artigo é discutir a situação atual e as tendências da atenção hospitalar do Sistema Único de Saúde (SUS) na Bahia, com base na análise da quantidade dos leitos ofertados ao SUS, porte e natureza dos estabelecimentos,frequência de internações, média de permanência e taxa de ocupação apuradas nos sistemas de informação oficiais do SUS. Seu objetivo específico é compreender o quanto as características atuais e modificações da oferta de serviços hospitalares no período estão compatíveis com as tendências da atenção hospitalar apresentada na literatura de referência.

The creation of offers of health care substitutes for the need of admission, with a reduction in the use of hospital beds to provide such care, has shown the new role that the hospital plays in the healthcare system which involves changes in its profile of care, to facilitate and produce more inter-connection with the health services network at various levels of care. The aim of this paper is to discuss the current situation and trends in hospital care at the Unified Health System (SUS) in Bahia, based on an analysis of the amount of hospital beds offered to SUS, size and nature of the facilities, frequency of hospitalizations, average length of stay and occupancy rate calculated from SUS information systems. Its specific objective is to understand how current conditions and changes in the supply of hospital services in the period are consistent with the trends of hospital care provided in the reference literature. It is an exploratory analysis of official public health databases. The results were compared with the available literature, seeking to identify their suitability to de-hospitalization trends in other countries and with the Ministry of Health guidelines for hospital care in Brazil. In Bahia, the reduction of SUS beds in the private sector is consistent with the rest of the country. By 2009, even though there having been an increase of beds in publichospitals of larger size and resolvability (34.2percent), there remained a large concentration of beds offered by small hospitals (33.9percent), exceeding by almost double the number seen in the rest of Brazil.

La creación de ofertas de cuidados de salud substitutivos a la necesidad de la internación, con la reducción de la utilización de lechos para la oferta de esos cuidados, há evidenciado el nuevo papel que el hospital pasa a desempeñar en el sistema de salud e implica en cambios en su perfil asistencial, facilitando y produciendo mayor articulación con la red de servicios de salud en los diversos niveles de atención. El objetivo del presente artículo es discutir la actual situación y las tendencias de la atención hospitalaria en el Sistema Único de Salud (SUS), em la Bahía, con base en el análisis de la cantidad de lechos ofrecidos al SUS, porte y naturaleza de los establecimientos, frecuencia de internaciones, promedio de permanencia y tasa de ocupación registradas en los sistemas oficiales de información del SUS. Su objetivo específico es comprender el grado de compatibilidad de las características actuales y las modificaciones de la oferta de los servicios en el período, con las tendencias de atención hospitalaria presentada en la literatura de referencia. Se trata de un análisis exploratorio con base en datos oficiales del SUS. Los resultados fueron comparados con la literatura disponible, buscando identificar su adecuación con tendências de la deshospitalización en otros países y con las directrices del Ministerio de la Salud para la atención hospitalaria en Brasil. En la Bahía, la retracción de lechos del SUS en el sector privado es coherente con el resto del país. Hasta 2009, aunque haya habido un crecimiento de lechos em hospitales públicos de mayor porte y resolutividad (34,2por ciento), prevaleció una gran concentración de lechos en aquellos de pequeño porte (33,9por ciento), superando en casi dos veces lo observado en el resto del Brasil.