Human rights and the olympics: from an ideological paradox to a new anti-corruption legacy.

This article aims to explore the evolution of the debates surrounding human rights in the discourse(s) of major sporting events (MSEs), particularly the Olympics. The paper will first analyse the western-centric origins of the "universality" of the Olympic philosophy and how it affected the protection and promotion of human rights, as well as addressing practical challenges or limitations faced. It will then focus on unpacking the elements of sportswashing and soft power in the multi-discursive context of sport where power, privilege, politics, and position are (re)produced. In doing so it draws upon the emergent field of Sports Diplomacy as the most appropriate explanatory framework to share in this discourse. Finally, it will explore the potential impact of anti-corruption reforms on the establishment of a meaningful human rights legacy.

Healthcare System Sustainability Challenges in Nepal and Opportunities Offered by Alternative Healthcare Delivery Arrangements.

ABSTRACT: The burden of chronic diseases in Nepal is increasing due to demographic and epidemiological transitions; alongside the persistent impact of communicable, maternal, newborn, and child health diseases, this critical situation acts as the precursor to rising healthcare costs. Nepal struggles to sustain its healthcare system amidst political instability, pandemics, natural disasters, and slow economic growth, particularly when healthcare funding is mainly dependent on out-of-pocket payments. Nepal requires lower-cost alternative healthcare delivery arrangements to provide high-value care while relieving economic sustainability pressures. Alternative healthcare delivery arrangements have a broad potential scope; they can involve strategic changes in how care is delivered and by whom, or they can also involve the application of information and communication technologies, e.g., telemedicine. This paper highlights the specific challenges to healthcare system sustainability in Nepal and the potential for high-value, lower-cost alternative healthcare delivery models to improve system performance in the longer term.

Evidence-Based Strategies for Reforming the Medical Curriculum at the National Autonomous University of Honduras: A Systematic Literature Review.

Medical education worldwide has undergone numerous stages of reform. Cultural and financial restraints have decelerated progress in developing countries. Current reforms should focus on creating integrated, competency-based, and student-centered curricula that emphasize patient-centered care. The following review of literature published between 2014 and 2023 on global curricular reforms highlighted key components, challenges, and strategies for implementing or evaluating undergraduate medical programs that prioritize student-centered approaches and competency-based models. This review also compared the current curriculum at the National Autonomous University of Honduras (UNAH) with these international experiences to suggest strategies in order to encourage significant reform. The following review identified 47 articles that provided insights into ideal contexts for curricular reforms, while 15 publications detailed the current state of the UNAH medical curriculum and its potential weaknesses. Additionally, 25 articles discussed specific reforms in other countries, offering valuable results and conclusions for consideration. Drawing from these models and experiences, strategies were proposed for UNAH's curriculum reform, including identifying basic needs, defining project vision, training teaching staff and students, and integrating multidisciplinary teams of experts. Although training all teaching staff abroad may be financially unfeasible, selecting and training key individuals to train others could be a viable alternative. Successful reform requires a comprehensive, periodic, and systematic evaluation. Despite the challenges faced by developing countries, global experiences with alternative reform models offer promising solutions, providing an opportunity for the Faculty of Medical Sciences at UNAH to overcome local limitations and fulfill the primary task of training professionals who are clinically, ethically, and adaptively competent, with a focus on patient-centered and primary care approaches.

A Study of the Connection Between Health Insurance Literacy and Health Status: Evidence from the US Healthcare Reform Monitoring Survey.

This study examines the relationship between health insurance literacy, as indicated by confidence in comprehending health insurance terms, and health status using cross-sectional data from 8 waves of the Health Reform Monitoring Survey (HRMS), covering 61,895 individuals from 2013 to 2017. An ordered logistic regression model was employed with self-rated health status on a five-point Likert scale as the dependent variable and the score of confidence in understanding health insurance terms as the primary independent variable. The model adjusts for variables such as access to care, insurance status, concerns about affordability leading to missed care, household size, family income, employment, education, race, marital status, and gender. Results suggest a positive association between higher confidence in understanding health insurance and superior health statuses. These findings underscore the significance of improving health insurance literacy and advocating for potential policy interventions to enhance public understanding of health insurance benefits and coverage options.

The British NHS at 75: Past, Contemporary, and Future Challenges.

This article assesses how and why the National Health Service (NHS) has remained at the forefront of British politics and society for 75 years amid significant economic pressures, organizational strain, shifting ideological trends, ongoing reforms, and an unprecedented public health emergency. The postwar "years of consensus" evolved into alleged decline and ostensible neglect during the 1980s, while New Labour sought to rejuvenate this core public service after 1997, featuring investment and often controversial reforms that challenged the party's social democratic values. Amid the New Labour era, NHS powers filtered down to devolved administrations, while from 2008 retrenchment and austerity ensued, fueled by global recession. Austerity eventually subsided, yet from early 2020 the NHS swiftly faced the extreme conditions of the globalized Covid-19 pandemic. The service continues to face challenges regarding its longer-term viability, and this article analyzes this scenario, within the context of the NHS's 75-year historical legacy, its contemporary status, comparative international trends, and likely future evolution.

Pioneering Physician: Dr. Elizabeth Blackwell and the Path to Medical History.

Elizabeth Blackwell was a remarkable and courageous woman who made significant contributions to medicine, education, and the rights of women. Blackwell achieved significant milestones in the medical field by being the first female physician in America and the first woman to be listed on the United Kingdom medical register. Despite facing challenges, discrimination, and barriers, she founded the London School of Medicine and the New York Infirmary for Women and Children to provide better education and health benefits for women and children. She lived during a time when women were expected to stay in the home; yet, she went on to become a doctor and professor.

National centralized drug procurement and health care expenditure of households-micro-evidence from CFPS.

Objective: This paper utilizes data from the China Family Panel Studies (CFPS) to evaluate the impact of the "4 + 7" National Centralized Drug Procurement (NCDP) on Per Capita Household Health Care Expenditure (PCHHCE). Methods: The study applies the Differences-in-Differences (DID) methodology to analyze the effects of NCDP. Various robustness tests were conducted, including the Permutation test, Propensity Score Matching, alterations in regression methodologies, and consideration of individual fixed effects. Results: Research indicates that the implementation of NCDP led to a reduction of 10.6% in PCHHCE. The results remained consistent across all robustness tests. Additionally, the research identifies diversity in NCDP effects among various household characteristics, with a more significant impact on households residing in rural regions of China, enrolled in Basic Medical Insurance for urban and rural residents and urban workers, and having an income bracket of 25-75%. Conclusion: These findings carry policy implications for the future expansion and advancement of NCDP in China. The study highlights the effectiveness of NCDP in reducing healthcare expenditures and suggests potential areas for policy improvement and further research.

Barriers and Facilitators to Sustainable Technology Implementation in Care for People With Disabilities-Real World Data From a Three-Year Implementation Programme.

BACKGROUND: Implementation issues often impede the realisation of the potential benefits of technology in disability care organisations for people with disabilities. Therefore, we conducted a longitudinal study to gain insights into the barriers and facilitators to implementation. METHODS: From 2019 to 2022, data were collected using questionnaires and interviews during 28 implementation projects in 26 disability care organisations. RESULTS: Barriers and facilitators were identified using 9 themes and 26 subthemes. The main themes identified were finances, disability care organisations, internal collaborations, external collaborations, technology, care staff, project teams, people with disabilities, and context. Most factors mentioned as barriers in one organisation were mentioned as facilitators in others. This suggests that barriers can be resolved to improve implementation. CONCLUSION: A large number of barriers and facilitators spanning the organisation suggests that the implementation of technology should be considered an organisational reform. Acting upon them is crucial for the successful implementation of technology.

'Everything is Obstetric Violence Now': Identifying the Violence in 'Obstetric Violence' to Strengthen Socio-legal Reform Efforts.

Since its global uptake, 'obstetric violence' is increasingly used to capture any/all violations during reproductive healthcare, with few conceptual limits. Consequently, it runs the risk of becoming an overgeneralised concept, making it difficult to operationalise in socio-legal reform efforts. This article draws on the Latin American origins of the concept and aims to provide a theoretical framework to support a focused and coherent socio-legal reform agenda. It offers a universal definition of violence, being the violation of physical or psychological integrity, and localises this definition using the 'view from everywhere'. The article proposes that violence will qualify as 'obstetric violence' if the violation of integrity occurs in the context of antenatal, intrapartum and postnatal care. Further, the subject of the violence is the birthing woman, trans or non-binary person. Thinking in terms of a 'continuum of violence' in reproductive healthcare ensures that different forms of obstetric violence are recognised and helps envisage overlaps with other violences.

Intrahospital Mortality Rate after the Implementation of the Second Phase of the Health Sector Reform in Comparison with Before that in Iran.

Background: The second phase of the health sector reform, called the Health Sector Evolution Plan (HSEP), has been implemented in Iran since 2014, aims to improve the equity and quality of health services. In the present study, we aimed to measure the trend of hospitalization and the crude intrahospital mortality rate from 1 year before the HSEP implementation (2013) to 5 years after the HSEP implementation (2018) in public hospitals compared with profit, nonprofit, and charity hospitals, which are affiliated with the Isfahan University of Medical Sciences (MUI). Methods: In a prospective, cross-sectional study, the data related to the frequency of hospitalized patients and intrahospital mortality during the time of hospitalization were collected through census sampling from 39 public hospitals as the exposed hospitals and 20 profit, nonprofit, and charity hospitals as the control hospitals. Results: After HSEP implementation, the frequency of hospitalization increased in public hospitals by 50.45% compared with the previous period. Although the crude intrahospital mortality rate increased from 12.61 to 12.93 per 1000 hospitalized patients (an increase of 2.54%) in public hospitals, the raise was not significant (P value = 0.348). The frequency of hospitalization increased in Social Security Organization's (SSO) hospitals as well as charity hospitals. However, the percent of decrease in the intrahospital mortality rates were -42.96%, -34.76%, and -18.47% in the private, charity, and SSO hospitals, respectively, but was not significant (P value > 0.05). Conclusions: The crude intrahospital mortality rates in public hospitals affiliated with MUI did not change significantly after the implementation of the HSEP.

A study on the academic innovation ability and influencing factors of public health graduate students based on nomograms: a cross-sectional survey from Shandong, China.

Background: In recent years, the impact of the COVID-19 pandemic and various public crises has highlighted the importance of cultivating high-quality public health talents, especially those with innovative capabilities. This study focuses on the academic innovation ability of public health postgraduate students, which can provide important theoretical support for the cultivation of more public health workers with high innovative capabilities. Methods: From May to October 2022, a cluster sampling method was used to select 1,076 public health postgraduate students from five universities in Shandong Province. A self-designed questionnaire survey was conducted. A chi-square test and binary logistic regression analysis were used to analyze the influencing factors of students' academic innovation ability. Based on these factors, a nomogram was constructed to intuitively demonstrate the impact of these complex factors on students' innovation ability. Results: The results showed that gender, whether serving as a student leader, teacher-student relationship, academic motivation, learning style, academic environment, and teaching mode were the influencing factors of postgraduate students' academic innovation ability. The column-line diagram (AUC = 0.892, 95% CI = 0.803 ~ 0.833) constructed based on the above influencing factors has good differentiation. The area under the ROC curve is 0.892 (95% CI = 0.803 ~ 0.833), and the calibration curve shows that the predicted value is the same as the measured value. Conclusion: The nomogram constructed in this study can be used to predict the academic innovation level of public health graduate students, which is helpful for university education administrators to evaluate students' academic innovation ability based on nomogram scores and carry out accurate and efficient training.

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

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

Towards the new primary care reform in Greece: a focus on patients' expectations, views and perceptions from rural healthcare centres.

INTRODUCTION: Patient perception of quality of care is an essential component in evaluating healthcare delivery. This article reports data from primary health care (PHC) centers before Greece's most recent PHC reform. The study was undertaken to offer some baseline information about patient experience, support the decision-making processes taking place, and provide valuable input for future policy-making comparisons in Greece. METHODS: The research was conducted across the 16 PHC centers of Epirus, a region of north-western Greece, from June to September 2017, with 532 patients rating the importance of different aspects of three main healthcare domains (clinical behavior, support and services, and organization of care) of PHC provision. The Greek version of the European Task Force on Patient Evaluations of General Practice (EUROPEP) questionnaire was implemented for research purposes. Univariate comparisons were performed for patients with and without chronic disease, using Pearson's χ2 test for categorical data. RESULTS: Study findings support that the organization of care domain is of highest importance and priority, with clinical behavior and support and services following closely. Among recruited patients, on average, only 2.1% of patients with a chronic disease were satisfied (rated 4 or 5 on the Likert scale) with the organization of care aspects under consideration, compared to 18.4% of patients without a chronic disease. Furthermore, only 4% of patients with a chronic disease were satisfied with the aspects examined in the clinical behavior domain, compared to 27% of patients without a chronic disease. Finally, 18% of sampled patients with a chronic disease reported being satisfied with the quality of support and services provided, compared to 38% of patients without a chronic disease. CONCLUSION: It is necessary to back up available past information to afterwards estimate reform imprinting on expectations and perceptions. The items and aspects of EUROPEP, in line with the new tasks of the personal doctor within the PHC system that patients perceive as most essential, can be used to prioritize quality improvement activities to strengthen PHC delivery in Greece. Communication skills, practices, and behavioral change skills seem to need more attention for an efficient PHC model.

On the Use and Misuses of Preregistration: A Reply to Klonsky (2024).

In his commentary, Klonsky outlines several arguments for why preregistration mandates (PRMs) will have a negative impact on the field. Klonsky's overarching concern is that when preregistration ceases to be a tool for research and becomes an indicator of quality itself (a primary example being preregistration badges), it loses its intended benefits. Separate from his concerns surrounding policies such as preregistration badges, Klonsky also critiques the practice of preregistration itself, arguing that it can impede our use of other valuable research tools (e.g., multiverse analyses and exploratory analyses). We provide a response to Klonsky's concerns about preregistration and related policies. First, we provide conceptual clarification on the purpose of preregistration, which was missing in Klonsky's commentary. Second, with a clearer conceptual framework, we not only highlight where some of Klonsky's concerns are warranted but also highlight where Klonsky's concerns, critiques, and proposed alternatives to the use of preregistration fall short. Third, with this conceptual understanding of preregistration, we briefly outline some challenges related to the effective implementation of preregistration in psychological science.

Medical Malpractice in Otolaryngology within the United States: A LexisNexis-Based Demographic Analysis.

OBJECTIVE: Otolaryngologists are at a significantly greater risk of being sued than most other physicians. To date, there is a lack of studies characterizing trends in otolaryngology malpractice claims. To assess these trends and risk variables, this study examined malpractice claims against otolaryngologists. STUDY DESIGN: Retrospective database review. SETTING: LexisNexis Jury Verdicts and Settlements. METHODS: The LexisNexis legal database was used to locate jury verdicts and settlements related to medical malpractice in otolaryngology, from 2018 to 2024. The study did not include any claims covered by the Social Security Disability Insurance, Workers' Compensation, Healthcare Law, or Criminal Law and Procedure categories. Temporal trends were evaluated, and logistic regression was used to identify independent risk factors. RESULTS: Out of 903 items, 79 reported malpractice cases were included (mean age 44.5; 60.3% female). The most sued subspecialty was head and neck oncology (32.5%). Negligence (93.7%) was the primary cause of action. Of cases sent to the jury, 87.7% of them resulted in a verdict in favor of the defendant. The mean plaintiff verdict payout was $7,432,508.06 and the mean identified settlement amount was $1,562,500.00. Physical injury (62.0%) was the highest type of harm. Regional analysis indicated a higher percentage of cases from New York favored the defendant (21.1% vs 13.6%; P = .034). CONCLUSION: This study highlights key trends in otolaryngology malpractice claims, emphasizing the prevalence in cases of head and neck surgery, primarily attributed to negligence. By identifying trends and risk factors, otolaryngologists can get a better understanding of the dynamics surrounding malpractice.

How do we fund Public Health in Australia? How should we?

OBJECTIVE: To map how public health is funded in Australia. To assess whether changes to funding methods might improve system performance. METHODS: Review of publicly accessible documents and discussions with public health key informants. RESULTS: Australia spent $140 per person on public health in 2019-20, (1.8% of total health spending). But there is considerable state and territory variation. This money flows through multiple channels and payment mechanisms. Responsibility for what is funded is largely delegated to authorities close to the problems. This makes it easier to choose the best mechanism for funding an activity. Much information is hidden from view, however. This makes it impossible to assess whether the potential for population benefit is fully realised. CONCLUSIONS: Australia avoids some of the difficulties experienced elsewhere because funding is largely devolved to states in block grants; they shape their own investments. The US, by contrast, prefers categorical funds for specific purposes. Three suggestions for making the funding system here more visible, useful and accountable are canvassed, including 'satellite accounts'. IMPLICATIONS FOR PUBLIC HEALTH: Funding needs to be more transparent before it is possible to assess whether public health system performance could be improved through changes to the way public health is funded.

PULSE Ambassadors program: empowering departments to transform STEM education for inclusion and student success.

The Partnership for Undergraduate Life Sciences Education (PULSE) is a non-profit educational organization committed to promoting the transformation of undergraduate STEM education by supporting departments in removing barriers to access, equity, and inclusion and in adopting evidence-based teaching and learning practices. The PULSE Ambassadors Campus Workshop program enables faculty and staff members of host departments to 1) develop communication, shared leadership, and inclusion skills for effective team learning; 2) implement facilitative leadership skills (e.g., empathic listening and collaboration); 3) create a shared vision and departmental action plan; and 4) integrate diversity, equity, and inclusion practices in the department and curriculum. From the first workshop in 2014, teams of trained Ambassadors conducted workshops at 58 institutions, including associate, bachelor, master, and doctoral institutions. In their workshop requests, departments cited several motivations: desire to revise and align their curriculum with Vision and Change recommendations, need for assistance with ongoing curricular reform, and wish for external assistance with planning processes and communication. Formative assessments during and immediately following workshops indicated that key outcomes were met. Post-workshop interviews of four departments confirm progress achieved on action items and development of individual department members as agents of change. The PULSE Ambassadors program continues to engage departments to improve undergraduate STEM education and prepare departments for the challenges and uncertainties of the changing higher education landscape.

Florence Nightingale (1820-1910): The Founder of Modern Nursing.

Florence Nightingale, a pioneering figure in the field of nursing during the 19th century, revolutionized medical practices through her innovative approaches to healthcare and dedication to improving patient outcomes. Her advocacy for sanitation significantly reduced mortality rates among patients. Nightingale's pioneering use of data analysis in healthcare and her establishment of nursing education standards laid the foundation for the nursing profession as we know it today. Her contributions continue to resonate in the field of medicine to this day. This paper is a theoretical reflection on Florence Nightingale's contributions to health and nursing, based on a review of literature from PubMed and Google Scholar databases.

Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries.

Central and Eastern European (CEE) countries have recently implemented reforms to health care provider payment systems, which include changing payment methods and related systems such as contracting, management information systems, and accountability mechanisms. This study examines factors influencing provider payment reforms implemented since 2010 in Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. A four-stage mixed methods approach was used: developing a theoretical framework and data collection form using existing literature, mapping payment reforms, consulting with national health policy experts, and conducting a comparative analysis. Qualitative analysis included inductive thematic analysis and deductive approaches based on an existing health policy model, distinguishing context, content, process, and actors. We analyzed 27 payment reforms that focus mainly on hospitals and primary health care. We identified 14 major factor themes influencing those reforms. These factors primarily related to the policy process (pilot study, coordination of implementation systems, availability of funds, IT systems, training for providers, reform management) and content (availability of performance indicators, use of clinical guidelines, favorability of the payment system for providers, tariff valuation). Two factors concerned the reform context (political willingness or support, regulatory framework, and bureaucracy) and two were in the actors' dimension (engagement of stakeholders, capacity of stakeholders). This study highlights that the content and manner of implementation (process) of a reform are crucial. Stakeholder involvement and their capacities could influence every dimension of the reform cycle. The nine countries analyzed share similarities in barriers and facilitators, suggesting the potential for cross-country learning.

Time is money: An analysis of cost drivers in ambulatory sinus surgery.

BACKGROUND: Functional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability. METHODS: We performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed. RESULTS: A total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n = 99) of nasal polyps and 31.2% (n = 69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p = 0.04), in addition to presence of nasal polyps ($531.96, p = 0.04). There was no significant association between total costs and the remaining clinical and demographic factors. CONCLUSIONS: Costs associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost-related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence-based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.