Stakeholder perspectives on factors that influence global prioritization for MNH in humanitarian settings.

Background: Maternal and newborn mortality rates are disproportionately high in crisis and conflict-affected countries. This study aims to understand factors influencing how MNH in humanitarian and fragile settings (HFS) is prioritized on the global health agenda during the Sustainable Development Goal (SDG) era. This includes examining the policies and processes driving agenda setting and decision-making, as well as the perceptions of global actors. It further reflects on the role of global milestones, reports, convenings, and high-level champions, based on the premise that global prioritization leads to increased attention and resource allocation, ultimately contributing to improved outcomes for mothers and newborns in crisis-affected areas. Methods: A qualitative study conducted from April 2022 to June 2023, employing a desk review and 23 semi-structured key informant interviews with global actors from donor agencies, implementing organizations, research institutes, United Nations agencies, professional associations, and coalitions, predominantly based in the Global North. Data were analyzed using inductive thematic analysis and the research was guided by the Walt and Gibson Health Policy Triangle framework. Results: Participants believe that global agenda-setting and investment decisions for MNH are primarily driven by UN agencies, donors, and implementing organizations at the global level. Although the Millennium Development Goal era successfully prioritized MNH, this focus has diminished during the SDGs, especially for HFS. Identified barriers include the complexity of reducing mortality rates in these contexts, limited political will, MNH investment fatigue, and a preference for quick wins. Fragmentation between humanitarian and development sectors and unclear mandates in protracted crises also hinder progress. Without enhanced global advocacy, accountability, and targeted investments in HFS, respondents deem global MNH targets unattainable. Conclusions: While waning donor interest and the siloing of HFS in global MNH decision-making pose challenges, targeted actions to address these barriers may include designating quotas for humanitarian actors in global MNH convenings, developing shared messages that convey common interests, and adopting an equity lens. Prioritizing MNH in HFS on the global agenda demands sustained commitment to ensure these settings are not an afterthought through dedicated advocacy and accountability, high-level political engagements, global milestones, and by leveraging opportunities to capture mainstream interest. Failing to shift global priorities will result in continued stagnation and worsening MNH outcomes across HFS.

Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery - a prospective cohort study.

Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32-64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien-Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68-12.76) and any complication (31.6%, 30.09-33.07). POMR stood at 1.9% (1.48-2.37), with elective and emergency surgery mortalities at 0.7% (0.40-1.23) and 3% (2.3-3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low-risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Self-medication in medical students in urban India: Exploring the extent of this dangerous practice.

Objectives: To assess the prevalence of self-medication in urban Indian medical students and explore possible factors associated with this practice. Methods: After obtaining institutional ethics approval, 180 medical students from six medical colleges in Mumbai were recruited to participate via social media. They were administered a pre-validated questionnaire that assessed self-medication as a practice, along with the perceived stress scale (PSS-10) online. Anonymity and confidentiality were maintained. Results: The prevalence of self-medication in medical students was found to be 83.9%, with no significant difference between genders or between academic years of medical education. The most used source of information for self-medicating was older prescriptions, and for procuring drugs was pharmacist stores. Common cold was the most cited indication. Anti-pyretics and anti-inflammatory drugs were the most commonly self-medicated drugs. It was found that 73.3% of medical students had self-medicated with non-over-the-counter (OTC) drugs. It was observed that 6.1% of medical students had experienced adverse drug reactions, and alarmingly, 0.6% of medical students continued self-medicating despite experiencing adverse drug reactions. Conclusions: Most of the study participants admitted to having practised self-medication. It was alarming to find that an appreciable fraction of the study population had uncontrolled access to non-OTC drugs. Thus, there needs to be a greater emphasis on the education of medical students with respect to the problems encountered by self-medicating and a need to enforce stricter regulations, as well as to establish a more watertight monitoring system, to curb this hazardous practice.

Body fluid multiomics in 3PM-guided ischemic stroke management: health risk assessment, targeted protection against health-to-disease transition, and cost-effective personalized approach are envisaged.

Because of its rapid progression and frequently poor prognosis, stroke is the third major cause of death in Europe and the first one in China. Many independent studies demonstrated sufficient space for prevention interventions in the primary care of ischemic stroke defined as the most cost-effective protection of vulnerable subpopulations against health-to-disease transition. Although several studies identified molecular patterns specific for IS in body fluids, none of these approaches has yet been incorporated into IS treatment guidelines. The advantages and disadvantages of individual body fluids are thoroughly analyzed throughout the paper. For example, multiomics based on a minimally invasive approach utilizing blood and its components is recommended for real-time monitoring, due to the particularly high level of dynamics of the blood as a body system. On the other hand, tear fluid as a more stable system is recommended for a non-invasive and patient-friendly holistic approach appropriate for health risk assessment and innovative screening programs in cost-effective IS management. This article details aspects essential to promote the practical implementation of highlighted achievements in 3PM-guided IS management. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-024-00376-2.

The Role of Policy in Global Neurosurgery.

There have been tremendous strides over the past decade to institute strong policy as means to facilitate alignment on goals and strategies for global neurosurgical systems strengthening. In this chapter, we highlight key historic policy milestones in the global neurosurgery movement. We discuss the role of international organizations in neurosurgery, and the incorporation of neurosurgery into global health agendas. We then delve into specific examples of policies that have been established (such as comprehensive recommendations for neurotrauma, spina bifida, and hydrocephalus), highlight the role of international organizations in shaping neurosurgical policies, emphasize the importance of advocacy, and explore future directions.

Healthy Ageing in Malaysia by 2030: Needs, Challenges and Future Directions.

This Editorial addresses the critical need for developing a healthy ageing society in Malaysia by 2030. With the country's elderly population projected to increase significantly, the article explores current challenges, including healthcare disparities, a shortage of geriatric specialists and malnutrition. It evaluates existing policies and highlights successful international and local initiatives, suggesting specific recommendations to improve healthcare infrastructure, healthy ageing support and technological integration. Emphasising the importance of engaging private sectors, non-governmental organisations (NGOs) and community groups, this Editorial calls for a collaborative approach to address the economic and cultural aspects of ageing. This comprehensive strategy aims to ensure a resilient, healthy and inclusive environment for Malaysia's ageing population by 2030.

State-level association between income inequality and mortality in the USA, 1989-2019: ecological study.

BACKGROUND: Prior studies have shown a positive relationship between income inequality and population-level mortality. This study investigates whether the relationship between US state-level income inequality and all-cause mortality persisted from 1989 to 2019 and whether changes in income inequality were correlated with changes in mortality rates. METHODS: We perform repeated cross-sectional regressions of mortality on state-level inequality measures (Gini coefficients) at 10-year intervals. We also estimate the correlation between within-state changes in income inequality and changes in mortality rates using two time-series models, one with state- and year-fixed effects and one with a lagged dependent variable. Our primary regressions control for median income and are weighted by population. MAIN OUTCOME MEASURES: The two primary outcomes are male and female age-adjusted mortality rates for the working-age (25-64) population in each state. The secondary outcome is all-age mortality. RESULTS: There is a strong positive correlation between Gini and mortality in 1989. A 0.01 increase in Gini is associated with more deaths: 9.6/100 000 (95% CI 5.7, 13.5, p<0.01) for working-age females and 29.1 (21.2, 36.9, p<0.01) for working-age males. This correlation disappears or reverses by 2019 when a 0.01 increase in Gini is associated with fewer deaths: -6.7 (-12.2, -1.2, p<0.05) for working-age females and -6.2 (-15.5, 3.1, p>0.1) for working-age males. The correlation between the change in Gini and change in mortality is also negative for all outcomes using either time-series method. These results are generally robust for a range of income inequality measures. CONCLUSION: The absence or reversal of correlation after 1989 and the presence of an inverse correlation between change in inequality and change in all-cause mortality represents a significant reversal from the findings of a number of other studies. It also raises questions about the conditions under which income inequality may be an important policy target for improving population health.

Mapping the migrant diagnostic radiographers in the UK: A national survey.

INTRODUCTION: The international recruitment of healthcare workers remains a UK strategy to manage workforce gaps and maintain service delivery. Although not a new phenomenon, this has been exacerbated by chronic shortages. There is a need to profile the current international recruits and identify individual motivators to understand the opportunities for future recruitment and retention initiatives. METHOD: A UK-wide electronic survey was conducted using the Jisc platform. The survey was promoted using social media and researcher networks. Eligibility criteria were diagnostic radiographers, internationally educated, and currently working in the UK. RESULTS: 226 responses were received. Most were working in England (90.7%) and 58.0% were under 35 years of age. The majority had migrated having moved to the UK since 2020 (63.7%) and the main drivers were career and/or training opportunities. Initial education was in 30 different countries, the highest number originating from Africa and Asia, with a median of 6 years post-qualification experience (IQR 4-11yrs). Despite experience, most were employed in band 5 (n = 72) or band 6 posts (n = 95). 56% had postgraduate qualifications on entry and a third had undertaken postgraduate study in the UK. CONCLUSION: Based on the survey responses, the profile of internationally recruited diagnostic radiographers is relatively young but with pre-migration experience originating all over the globe. They are motivated to work in the UK particular for career progression opportunities. IMPLICATIONS FOR PRACTICE: This study provides an insight into the motivations, demographics and employment patterns of internationally recruited radiographers working in the UK.

Protocol of digital decision support system (DDSS) embedded within a tele-primary healthcare platform in Pakistan: an assessment of usability, acceptability, effectiveness and perceived quality of care in a resource-constrained setting.

BACKGROUND: A digital decision support system in healthcare is a digital health intervention that assists healthcare professionals in decision-making by providing treatment recommendations and enhancing diagnostic accuracy and quality of care. This will be the first study in Pakistan to assess the system's usability, acceptability and effectiveness in improving healthcare outcomes while also evaluating the perceived quality of care. This comprehensive assessment will inform policy development in areas such as the scale-up of digital health interventions, data privacy and technology interoperability. Measures of effectiveness will include changes in clinical outcomes through a patient exit feedback survey. This study aims to evaluate the role of digital decision support systems in healthcare decision-making, which may be integrated into Pakistan's tele-primary healthcare system. METHODS: The study will employ a multimethod approach. The data collection tools are adapted from the WHO's digital health intervention monitoring and evaluation framework and include a technology assessment, healthcare provider surveys, patient exit interviews and focus group discussions with healthcare providers. Purposive sampling will be used for qualitative interviews with providers (doctors) and patients. Government stakeholders, private sectors, multilateral, academia and policymakers will be engaged through a consultative meeting. We will also conduct a literature review, as well as a comprehensive analysis of existing studies, documents and data relevant to digital decision support systems and digital health interventions implemented globally, and assess the performance, challenges and opportunities. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Review Committee at The Aga Khan University (2023-8514-26533). The dissemination of study findings through scientific publications and seminars will enable programme managers and policymakers to design tools to improve the quality of care provided through telemedicine platforms. This will contribute to efficient decision-making, access and quality of care for primary healthcare in low-income and middle-income countries. This study will also inform policy regarding the scale-up of decision support systems in primary care settings, data privacy and technology interoperability.

Community pharmacy & primary care integration: qualitative study on stakeholders' opinions and interventions.

Background: Health systems worldwide are under pressure. Integration seems a possible solution to improve healthcare systems efficiency. This research aims to gather stakeholders' opinions on integrating community pharmacy and the primary healthcare system and secondly to explore and prioritise interventions for an initial integration plan. Method: Using a constructivist qualitative research approach, a two-phase qualitative study was conducted in the Basque Country, Spain. Thematic analysis using NVivo® was undertaken on data gathered during focus groups and semi-structured interviews (phase 1). During phase 2, a nominal group prioritised potential integration interventions identified in phase 1. Results: The study amalgamated findings from four focus groups and nine interviews, revealing six themes. Stakeholders had a diverse understanding of integration, associating the term mainly with collaboration, communication or cooperation. Community pharmacies were positively perceived; however, their commercial and privately owned nature was of concern. Remuneration methods for pharmacists were controversial, with a suggested shift to service-based remuneration. Information availability and barriers such as interprofessional communication gaps were highlighted. The nominal group prioritised, according to importance and feasibility, bidirectional communication development, coordination in using interprofessional protocols and community pharmacist participation in primary healthcare centre meetings as interventions for integrating community pharmacies and primary healthcare centres. Conclusion: Based on the opinions of stakeholders, three interventions are proposed to initiate the integration process of community pharmacy and primary care. The implementation of these interventions will need to be negotiated with the relevant authorities and evaluated.

Impact on Fatality Rates and Years of Life Lost During the COVID-19 Pandemic: The Experience of the Mexican Public Health Incident Management Command.

BACKGROUND: The SARS-CoV-2 pandemic challenged health systems worldwide. In Mexico, the Public Health Incident Management Command (COISS) strategy was implemented to improve health care for patients with COVID-19 who required hospitalization. AIM: To evaluate the impact of the COISS strategy on case fatality rates (CFR) and years of life lost (YLL) in hospitalized patients with COVID-19. MATERIALS AND METHODS: The COISS strategy included eight actions implemented in states with high epidemic risk (COISS states). A secondary analysis of the public database from the Mexican Ministry of Health was performed considering patients with confirmed diagnoses of SARS-CoV-2 infection. The COISS strategy effectiveness was evaluated by its impact on in-hospital CFR and YLL at the beginning (T0) and end (T1) of the third wave, and at the end of the fourth wave (T2) and compared to states without intervention (non-COISS states). RESULTS: At T0, COISS states showed a higher CFR for hospitalized patients than non-COISS states, which decreased after the strategy implementation. After correction for baseline conditions, lower relative CFR at T1 and T2, compared to T0, and a protective effect in different age groups, especially in those ≥65 years, were found in hospitalized patients in COISS states. The COISS strategy was associated with lower CFR in hospitalized patients with COVID-19 at both T1 and T2. At T0, YLLs were higher in COISS states, but there were no significant differences at T1 and T2. CONCLUSIONS: COISS interventions effectively reduced CFR in hospitalized patients with COVID-19, providing protection to vulnerable patients and reducing the YLL gap.

Civic knowledge and self-reported political astuteness of academic nurse educators in the United States.

BACKGROUND: A nurse's perspective is unique and invaluable to health policy. Although political astuteness is essential for nurses and nurse educators to be effective participants in health policy, there is a gap in the nursing literature on civic knowledge and its potential relationship to political astuteness. PURPOSE: This research aimed to assess the civic knowledge and self-reported political astuteness of academic nurse educators, their associated factors, and the relationship between these two concepts. METHODS: This cross-sectional study used a national sample of academic nurse educators who answered 10 questions taken from the United States Citizenship and Immigration Services (USCIS) Naturalization test and completed the Political Astuteness Inventory (PAI). RESULTS: Over 51 % of the sample (n = 122) did not provide enough correct answers to pass the Naturalization test and over 35 % were determined to be either completely or slightly unaware politically. There was a medium positive correlation (r = 0.313, p < .001) between civic knowledge and self-reported political astuteness. CONCLUSION: Although nurse educators could be well-positioned to impact health policy, they may not have the knowledge or skills to fulfill this potential. Strategies for improving political astuteness include increasing civic knowledge and encouraging professional collaboration to promote nursing solidarity, influence, and power.

Association between neighborhood greenspace and child protective services involvement.

BACKGROUND: Child maltreatment and child protective service (CPS) involvement negatively impacts families, and disproportionately impact families of color. Urban neighborhood greenspace is associated with improved mental health and decreased community violence, however correlations between greenspace and CPS involvement have not been evaluated. OBJECTIVE: To examine the association between greenspace and CPS involvement. METHODS: This is a secondary analysis of City of Philadelphia CPS report data from 2008 to 2018. Logistic regression was used to determine associations between greenspace and 3 CPS outcomes (substantiated reports, cases accepted for CPS services, and foster care placements) at the census block level, adjusting for sociodemographic information and area deprivation index, a composite measure combining education, employment, housing, and poverty characteristics at the census block group level. 13,336 census blocks were included, which had key exposure, covariate, and outcome data, and had a child population of at least 1. RESULTS: 66,043 CPS reports were included. In the adjusted model, compared to blocks with >30 % greenspace, blocks with <10 % greenspace had 1.52 times the odds of a substantiated report (95 % CI 1.30-1.76, p < 0.001) and 1.52 times the odds of a case accepted for CPS services (95 % CI 1.30-1.77, p < 0.001). Blocks with less greenspace had increased odds of foster care placement than blocks with >30 % greenspace, however the correlation was less strong. CONCLUSION: Increased density of neighborhood greenspace is associated with decreased risk of substantiated child maltreatment and cases accepted for CPS services, suggesting that greenspace may confer protection against CPS involvement.

Past, present, and future policy considerations regarding meningococcal vaccination in the United States.

INTRODUCTION: In 2005, the United States Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination against invasive meningococcal disease (IMD) caused by serogroups A, C, W, and Y (MenACWY) for all 11-12-year-olds, as well as 2-10-year-olds at high risk. In 2010, a booster dose was recommended for all 16-year-olds, as well as for high-risk patients every 3-5 years. In 2015, optional (as opposed to routine) vaccination against meningococcal serogroup B (MenB) at the preferred age of 16-18 years was recommended (Category B, later changed to shared clinical decision-making). In 2023, a vaccine (MenABCWY) against the five serogroups primarily responsible for IMD in the U.S. became available. AREAS COVERED: This review summarizes the evolution of public policy that led to each milestone vaccine recommendation, reviews epidemiologic data published following the recommendations, and discusses the current state of meningococcal immunization policy. EXPERT OPINION: The use of MenABCWY has the potential to consolidate policy, improve coverage rates for the five serogroups, address disparities in vaccination coverage, and simplify vaccine delivery.

Assessing support for substance use policies among the general public and policy influencers in two Canadian provinces.

BACKGROUND: Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables. METHODS: Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables. RESULTS: Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education. CONCLUSIONS: The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada.

Children's Health in London and Luton (CHILL) cohort: a 12-month natural experimental study of the effects of the Ultra Low Emission Zone on children's travel to school.

BACKGROUND: The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school. METHODS: CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6-9 years attending 84 primary schools within or with catchment areas encompassing London's ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school 'today' (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored. RESULTS: Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21-10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05-0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87-19.68) compared to those living closer (OR 1.43, 0.27-7.54). CONCLUSIONS: Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.