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1.
Internet resource in English | LIS -Health Information Locator | ID: lis-49627

ABSTRACT

A JBI é uma organização global que promove e apoia decisões baseadas em evidências que melhoram a saúde e a prestação de serviços de saúde. A JBI oferece uma gama única de soluções para acessar, avaliar e aplicar as melhores evidências disponíveis.


Subject(s)
Evidence-Based Nursing , Health Policy
2.
J Health Care Poor Underserved ; 35(2): 481-502, 2024.
Article in English | MEDLINE | ID: mdl-38828577

ABSTRACT

This study analyzed electronic health record (EHR) data from 2016 through 2019 from a federally qualified health center (FQHC) serving predominantly low-income Latine immigrants in the Washington, D.C. metropolitan area to examine how changes in health insurance coverage relate to changes in health care use. Federally qualified health center clients were insured for an average of 59% to 63% of their annual visits, but about one-third had no coverage throughout the year. Findings from descriptive regression and within-client fixed effects models indicate that in years with higher proportions of insured visits, clients averaged more medical visits and interpreter services but fewer mental health and care coordination visits. Latine immigrant clients in D.C., a city with a universal health insurance option, had health insurance coverage for 89% of their visits, and averaged more medical and fewer coordination visits relative to those in a neighboring county in a state without a universal insurance option.


Subject(s)
Emigrants and Immigrants , Hispanic or Latino , Insurance Coverage , Humans , Emigrants and Immigrants/statistics & numerical data , Insurance Coverage/statistics & numerical data , Adult , Female , Male , Middle Aged , Hispanic or Latino/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Patient Acceptance of Health Care/ethnology , District of Columbia , Insurance, Health/statistics & numerical data , Young Adult , Adolescent , Poverty , Health Policy
3.
Health Aff (Millwood) ; 43(6): 791-797, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38830148

ABSTRACT

A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic. Rural communities outpaced urban ones in deaths, and many rural institutions and communities sustained significant impacts. At the same time, the pandemic prompted creative actions to meet urgent health and social needs, and it illuminated opportunities to address long-standing rural challenges. This article draws on our cross-disciplinary expertise in public health and medical anthropology, as well as our research on COVID-19 and rural health equity in northern New England. In this Commentary, we articulate five principles to inform research, practice, and policy efforts in rural America. We contend that advancing rural health equity beyond the pandemic requires understanding the forces that generate rural disparities and designing policies and practices that account for rural disadvantage.


Subject(s)
COVID-19 , Health Equity , Rural Health , Rural Population , Humans , COVID-19/epidemiology , Health Policy , United States , Healthcare Disparities , Pandemics , SARS-CoV-2 , Rural Health Services , Public Health , Health Status Disparities
4.
Health Aff (Millwood) ; 43(6): 856-863, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38830159

ABSTRACT

Indiana has a business-friendly environment, but historical underinvestment in public health has yielded poor health outcomes. In 2023, when trust in governmental public health was strained nationwide, Indiana increased public health spending by 1,500 percent. In this article, we explain how Indiana achieved this unprecedented legislative victory for public health, describing the context, approach, and lessons learned. Specifically, an Indiana University report linking economic vitality and overall health sparked the creation of a governor's commission charged with exploring ways to address Indiana's shortcomings. Working with the Indiana Department of Health, the commission developed multisectoral coalitions and business and government partnerships, and it maintained consistent and coordinated communication with policy makers. Lessons learned included the value of uncoupling public health from partisan narratives, appointing diverse commission membership with strategically selected cochairs, involving local leaders, and ensuring local decision-making control. We believe that Indiana's approach holds insights for other states interested in strengthening public health funding in the current era.


Subject(s)
Public Health , Indiana , Humans , Health Policy , Investments
5.
Health Aff (Millwood) ; 43(6): 783-790, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38830169

ABSTRACT

Reimagining public health's future should include explicitly considering spirituality as a social determinant of health that is linked to human goods and is deeply valued by people and their communities. Spirituality includes a sense of ultimate meaning, purpose, transcendence, and connectedness. With that end in mind, we assessed how recommendations recently issued by an expert panel for integrating spiritual factors into public health and medicine are being adopted in current practice in the United States. These recommendations emerged from a systematic review of empirical evidence on spirituality, serious illness, and population health published between 2000 and 2022. For each recommendation, we reviewed current federal, state, and local policies and practices recognizing spiritual factors, and we considered the ways in which they reflected the panel's recommendations. In this article, we highlight opportunities for broader application and scale while also noting the potential harms and benefits associated with incorporating these recommendations in various contexts. This analysis, while respecting the spiritual and religious diversity of the US population, identifies promising approaches for strengthening US public health by integrating spiritual considerations to inform person- and community-centered policy and practice.


Subject(s)
Public Health , Social Determinants of Health , Spirituality , Humans , United States , Health Policy
6.
JAMA Netw Open ; 7(6): e2414650, 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38833254

ABSTRACT

Importance: As government agencies around the globe contemplate approval of the first psychedelic medicines, many questions remain about their ethical integration into mainstream medical practice. Objective: To identify key ethics and policy issues related to the eventual integration of psychedelic therapies into clinical practice. Evidence Review: From June 9 to 12, 2023, 27 individuals representing the perspectives of clinicians, researchers, Indigenous groups, industry, philanthropy, veterans, retreat facilitators, training programs, and bioethicists convened at the Banbury Center at Cold Spring Harbor Laboratory. Prior to the meeting, attendees submitted key ethics and policy issues for psychedelic medicine. Responses were categorized into 6 broad topics: research ethics issues; managing expectations and informed consent; therapeutic ethics; training, education, and licensure of practitioners; equity and access; and appropriate role of gatekeeping. Attendees with relevant expertise presented on each topic, followed by group discussion. Meeting organizers (A.L.M., I.G.C., D.S.) drafted a summary of the discussion and recommendations, noting points of consensus and disagreement, which were discussed and revised as a group. Findings: This consensus statement reports 20 points of consensus across 5 ethical issues (reparations and reciprocity, equity, and respect; informed consent; professional boundaries and physical touch; personal experience; and gatekeeping), with corresponding relevant actors who will be responsible for implementation. Areas for further research and deliberation are also identified. Conclusions and Relevance: This consensus statement focuses on the future of government-approved medical use of psychedelic medicines in the US and abroad. This is an incredibly exciting and hopeful moment, but it is critical that policymakers take seriously the challenges ahead.


Subject(s)
Consensus , Hallucinogens , Humans , Hallucinogens/therapeutic use , Health Policy , Informed Consent/ethics
7.
Int J Tuberc Lung Dis ; 28(6): 273-277, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38822485

ABSTRACT

BACKGROUNDTB remains an important cause of childhood morbidity and mortality. Underdiagnosis, underreporting and limited data on the outcomes of childhood TB have led to an underestimation of its impact.METHODSThis was a systematic review to characterise childhood TB outcomes. Studies reporting relevant epidemiological data on children between 0 and 14 years of age, with a particular focus on treatment outcomes, from countries with universal bacilli Calmette-Guérin (BCG) vaccination and conducted between 2000 and 2020 were selected. Random effects meta-analysis was performed in R software.RESULTSWe identified 1,806 references and included 35 articles. Among children with TB, the overall proportion of unfavourable outcomes was 19.5% (95% CI 14.4-25.8) and pooled case-fatality ratio was 6.1% (95% CI 4.3-8.4). The proportion of deaths observed among children between 0 and 4 years old was 6.6% (95% CI 4.9-8.7) and 4.6% (95% CI 3.1-6.9) in older children. TB and HIV co-infected children presented a case-fatality ratio of 15.1% (95% CI 7.9-27.0).CONCLUSIONSDespite the efforts made in the last decades, treatment outcomes in childhood TB are still worrisome. Efforts to fill existing gaps and design health policies targeting vulnerable populations, such as children, should be intensified to tackle the global TB burden..


Subject(s)
BCG Vaccine , Tuberculosis , Humans , BCG Vaccine/administration & dosage , Infant , Child , Child, Preschool , Tuberculosis/epidemiology , Tuberculosis/prevention & control , Adolescent , Infant, Newborn , Vaccination/statistics & numerical data , Health Policy
10.
Sci Rep ; 14(1): 13634, 2024 06 13.
Article in English | MEDLINE | ID: mdl-38871773

ABSTRACT

The importance of integrated care for complex, multiple long term conditions was acknowledged before the COVID pandemic but remained a challenge. The pandemic and consequent development of Long COVID required rapid adaptation of health services to address the population's needs, requiring service redesigns including integrated care. This Delphi consensus study was conducted in the UK and found similar integrated care priorities for Long COVID and complex, multiple long term conditions, provided by 480 patients and health care providers, with an 80% consensus rate. The resultant recommendations were based on more than 1400 responses from survey participants and were supported by patients, health care professionals, and by patient charities. Participants identified the need to allocate resources to: support integrated care, provide access to care and treatments that work, provide diagnostic procedures that support the personalization of treatment in an integrated care environment, and enable structural consultation between primary and specialist care settings including physical and mental health care. Based on the findings we propose a model for delivering integrated care by a multidisciplinary team to people with complex multisystem conditions. These recommendations can inform improvements to integrated care for complex, multiple long term conditions and Long COVID at international level.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated , Humans , COVID-19/epidemiology , COVID-19/therapy , Delivery of Health Care, Integrated/organization & administration , SARS-CoV-2/isolation & purification , Male , Female , United Kingdom/epidemiology , Health Policy , Delphi Technique , Consensus , Middle Aged , Adult , Pandemics
11.
Health Res Policy Syst ; 22(1): 69, 2024 Jun 13.
Article in English | MEDLINE | ID: mdl-38872202

ABSTRACT

BACKGROUND: Facing global grand challenges such as coronavirus disease 2019 (COVID-19) require the participation of various actors in different sectors and systematically directing their innovative efforts. Considering the complexity, non-linear dynamics, and global extent of the COVID-19 challenge, developing and applying a multi-level, resilient, and systematic innovative framework is vital. Therefore, this study aims to apply the "innovation biosphere" framework inspired by ecological studies for examining and analysing the management dimensions of COVID-19. METHODS: In this research, based on a deductive-inductive approach, the case study methodology is used. In accordance with this strategy, the innovation biosphere metaphor is considered as the basic framework (deductive approach) and subsequently the grand challenge of COVID-19 (inductive approach) is analysed at three levels: micro, meso and macro. RESULTS: The research findings verify the correspondence between what happened in the management of COVID-19 and the proposed framework of innovation biosphere. In other words, the findings of the research show that the effect of global cooperation, role-playing and co-evolution of different actors and subsystems in facing the grand challenge of COVID-19 under an ecosystemic and eco-innovation approach has been evident. These events subsequently led to the cessation of the pandemic after about four years. CONCLUSIONS: The main policy implications include the role of self-organization, the capability of global value networks, mission orientation, and co-evolution between actors as the contributions of innovation biosphere framework for managing grand health challenges, and global cohesion, oligopoly market, supporting local innovations, the critical role of basic research, and deregulation as the contributions of the COVID-19 case study for enhancing the innovation biosphere metaphor.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Humans , Health Policy , Pandemics , Inventions , Global Health , International Cooperation
13.
Front Public Health ; 12: 1380807, 2024.
Article in English | MEDLINE | ID: mdl-38846617

ABSTRACT

Background: Universal health coverage and social protection are major global goals for tuberculosis. This study aimed to investigate the effects of an expanded policy to guarantee out-of-pocket costs on the treatment outcomes of patients with tuberculosis. Methods: By linking the national tuberculosis report and health insurance data and performing covariate-adjusted propensity-score matching, we constructed data on health insurance beneficiaries (treatment group) who benefited from the out-of-pocket payment exemption policy and medical aid beneficiaries as the control group. Using difference-in-differences analysis, we analyzed tuberculosis treatment completion rates and mortality in the treatment and control groups. Results: A total of 41,219 persons (10,305 and 30,914 medical aid and health insurance beneficiaries, respectively) were included in the final analysis (men 59.6%, women 40.4%). Following the implementation of out-of-pocket payment exemption policy, treatment completion rates increased in both the treatment and control groups; however, there was no significant difference between the groups (coefficient, -0.01; standard error, 0.01). After the policy change, the difference in mortality between the groups increased, with mortality decreasing by approximately 3% more in the treatment group compared with in the control group (coefficient: -0.03, standard error, 0.01). Conclusion: There are limitations to improving treatment outcomes for tuberculosis with an out-of-pocket payment exemption policy alone. To improve treatment outcomes for tuberculosis and protect patients from financial distress due to the loss of income during treatment, it is essential to proactively implement complementary social protection policies.


Subject(s)
Health Expenditures , Tuberculosis , Humans , Republic of Korea , Female , Male , Tuberculosis/economics , Tuberculosis/mortality , Middle Aged , Health Expenditures/statistics & numerical data , Adult , Aged , Health Policy , Propensity Score , Insurance, Health/statistics & numerical data , Insurance, Health/economics , Universal Health Insurance/economics , Universal Health Insurance/statistics & numerical data , Treatment Outcome , Adolescent , Financing, Personal/statistics & numerical data , Young Adult
14.
PeerJ ; 12: e17394, 2024.
Article in English | MEDLINE | ID: mdl-38827296

ABSTRACT

The increasing frequency of zoonotic spillover events and viral mutations in low and middle-income countries presents a critical global health challenge. Contributing factors encompass cultural practices like bushmeat consumption, wildlife trade for traditional medicine, habitat disruption, and the encroachment of impoverished settlements onto natural habitats. The existing "vaccine gap" in many developing countries exacerbates the situation by allowing unchecked viral replication and the emergence of novel mutant viruses. Despite global health policies addressing the root causes of zoonotic disease emergence, there is a significant absence of concrete prevention-oriented initiatives, posing a potential risk to vulnerable populations. This article is targeted at policymakers, public health professionals, researchers, and global health stakeholders, particularly those engaged in zoonotic disease prevention and control in low and middle-income countries. The article underscores the importance of assessing potential zoonotic diseases at the animal-human interface and comprehending historical factors contributing to spillover events. To bridge policy gaps, comprehensive strategies are proposed that include education, collaborations, specialized task forces, environmental sampling, and the establishment of integrated diagnostic laboratories. These strategies advocate simplicity and unity, breaking down barriers, and placing humanity at the forefront of addressing global health challenges. Such a strategic and mental shift is crucial for constructing a more resilient and equitable world in the face of emerging zoonotic threats.


Subject(s)
Developing Countries , Zoonoses , Humans , Animals , Zoonoses/prevention & control , Zoonoses/virology , Zoonoses/epidemiology , Zoonoses/transmission , Mutation , Health Policy/legislation & jurisprudence , Global Health , Communicable Diseases, Emerging/prevention & control , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/virology , Communicable Diseases, Emerging/transmission
15.
J Health Care Poor Underserved ; 35(2): 439-464, 2024.
Article in English | MEDLINE | ID: mdl-38828575

ABSTRACT

Between 1990 and 2020, 334 rural hospitals closed in the United States, and since 2011 hospital closures have outnumbered new hospital openings. This scoping review evaluates peer-reviewed studies published since 1990 with a focus on rural hospital closures, synthesizing studies across six themes: 1) health care policy environment, 2) precursors to rural hospital closures, 3) economic impacts, 4) effects of rural hospital closures on access to care, 5) health and community impacts, and 6) definitions of rural hospitals and communities. In the 1990s, rural hospitals that closed were smaller, while rural hospitals that closed in the 2010s tended to have more beds. Many studies of the health impacts of rural hospital closures yielded null findings. However, these studies differed in their definitions of "rural hospital closure." Given the accelerated rate of hospital closures, more attention should be paid to hospitals that serve rural communities of color and low-income communities.


Subject(s)
Health Facility Closure , Health Services Accessibility , Hospitals, Rural , Humans , United States , Health Policy
16.
AMA J Ethics ; 26(6): E472-478, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38833422

ABSTRACT

Poor-quality antimicrobial medicines continue to proliferate across supply chains, threatening patients' health and safety, especially in low- and middle-income regions. This article discusses consequences and risks of antimicrobial resistance and other ways in which antimicrobial medicines can be of poor quality and recommends regulatory and policy reforms to help maintain supply chain resilience and quality of antimicrobial medicines.


Subject(s)
Anti-Infective Agents , Humans , Anti-Infective Agents/therapeutic use , Global Health , Drug Resistance, Microbial , Health Policy
17.
Medwave ; 24(5): e2920, 2024 Jun 04.
Article in English, Spanish | MEDLINE | ID: mdl-38833661

ABSTRACT

Introduction: Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. Methods: A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Results: Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. Conclusions: A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.


Introducción: La investigación sobre desinstitucionalización psiquiátrica ha descuidado el hecho que las reformas en este campo se anidan en un sistema de salud que se ha sometido a reformas financieras. Esta subordinación podría introducir incentivos desalineados con las nuevas políticas de salud mental. Según el Plan Nacional de Salud Mental de Chile, este sería el caso en los centros de salud mental comunitaria. El objetivo es comprender cómo el mecanismo de pago al centro de salud mental comunitaria es un potencial incentivo para la salud mental comunitaria. Métodos: Este es un estudio mixto cuantitativo-cualitativo convergente, que utiliza la teoría fundamentada. Recolectamos datos administrativos de producción entre 2010 y 2020. Siguiendo la teoría de mecanismo de pago, entrevistamos a 25 expertos de los ámbitos pagador, proveedor y usuario. Integramos los resultados a través de la codificación selectiva. Este artículo presenta los resultados relevantes de la integración selectiva mixta. Resultados: Reconocimos siete mecanismos de pago implementados heterogéneamente en los centros de salud mental comunitaria del país. Estos, responden a tres esquemas supeditados a límites de tarifa y presupuesto público prospectivo. Se diferencian en la unidad de pago. Se asocian con la implementación del modelo de salud mental comunitaria afectando negativamente a los usuarios, los servicios provistos, los recursos humanos disponibles, la gobernanza adoptada. Identificamos condiciones de gobernanza, gestión y unidad de pago que favorecerían el modelo de salud mental comunitaria. Conclusiones: Un conjunto desarticulado de esquemas de pago implementados heterogéneamente, tiene efectos negativos para el modelo de salud mental comunitaria. Es necesario y posible formular una política de financiación explícita para la salud mental complementaria a las políticas existentes.


Subject(s)
Community Mental Health Centers , Grounded Theory , Reimbursement Mechanisms , Chile , Humans , Community Mental Health Centers/economics , Community Mental Health Centers/organization & administration , Health Policy , Deinstitutionalization/economics , Health Care Reform , Community Mental Health Services/economics , Community Mental Health Services/organization & administration
18.
Nurs Sci Q ; 37(3): 291-294, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38836488

ABSTRACT

The purpose of this paper is to discuss heuristics, guided by Parse's (2021a) community model, to understand how health policies emerge from the unique values and beliefs of community constituents. Within this paper, there is a discussion about heuristics, health policy, Parse's humanbecoming paradigm, and policy implications reflected upon with the change concepts of the humanbecoming community model.


Subject(s)
Health Policy , Heuristics , Humans , Health Policy/trends , Humanism
19.
J Korean Med Sci ; 39(21): e166, 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38832476

ABSTRACT

BACKGROUND: The Korea Expert Committee on Immunization Practices (KECIP) is a key advisory body the government to develop guidelines and provide technical advisory activities on immunization policies in Korea. A recent policy study, inspired by global best practices, aims to enhance KECIP's functionality for providing timely and transparent recommendations in the face of evolving vaccine science and emerging infectious diseases like COVID-19. METHODS: This study reviewed the current status of KECIP and collected expert opinions through surveys and consultations. Among the 40 panel members who were surveyed, 19 responded to a questionnaire specifically designed to assess the potential areas of improvement within KECIP. RESULTS: The majority of respondents favored maintaining the current member count and emphasized the need for a subcommittee. Opinions varied on issues such as the length of KECIP's term, the representation of vaccine manufacturers' perspectives, and the chairperson's role. However, there was a consensus on the importance of expertise, transparency, and fair proceedings within the committee. CONCLUSION: This study underscores the pivotal role of KECIP in shaping national immunization policies, emphasizing the necessity for informed guidance amidst evolving vaccine science and emerging infectious diseases. Furthermore, it stressed the importance of enhancing KECIP's capacity to effectively address evolving public health challenges and maintain successful immunization programs in South Korea.


Subject(s)
COVID-19 , Consensus , Humans , Republic of Korea , COVID-19/prevention & control , Surveys and Questionnaires , Immunization , Advisory Committees , SARS-CoV-2 , Health Policy , COVID-19 Vaccines
20.
J Natl Cancer Inst Monogr ; 2024(63): 45-50, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38836525

ABSTRACT

Cancer is a stigmatized disease in many countries that impacts the quality of life and mental health of people affected by cancer. This commentary examines some dimensions of cancer stigma and has been developed based on insights from participants in a Union for International Cancer Control program dedicated to cancer patient organizations in low- and middle-income countries. Aimed at program managers and policy makers, this commentary highlights the importance of developing strategies to reduce cancer stigma in cancer control programs in different contexts, working closely with community-based civil society organizations and those with lived experience of cancer to understand, evaluate, and take action regarding the impact of cancer stigma on health-seeking behavior and patients' quality of life.


Subject(s)
Health Policy , Neoplasms , Quality of Life , Social Stigma , Humans , Neoplasms/psychology , Neoplasms/therapy
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