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1.
Health Promot Int ; 39(2)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38558241

RESUMO

Although digital health promotion (DHP) technologies for young people are increasingly available in low- and middle-income countries (LMICs), there has been insufficient research investigating whether existing ethical and policy frameworks are adequate to address the challenges and promote the technological opportunities in these settings. In an effort to fill this gap and as part of a larger research project, in November 2022, we conducted a workshop in Cape Town, South Africa, entitled 'Unlocking the Potential of Digital Health Promotion for Young People in Low- and Middle-Income Countries'. The workshop brought together 25 experts from the areas of digital health ethics, youth health and engagement, health policy and promotion and technology development, predominantly from sub-Saharan Africa (SSA), to explore their views on the ethics and governance and potential policy pathways of DHP for young people in LMICs. Using the World Café method, participants contributed their views on (i) the advantages and barriers associated with DHP for youth in LMICs, (ii) the availability and relevance of ethical and regulatory frameworks for DHP and (iii) the translation of ethical principles into policies and implementation practices required by these policies, within the context of SSA. Our thematic analysis of the ensuing discussion revealed a willingness to foster such technologies if they prove safe, do not exacerbate inequalities, put youth at the center and are subject to appropriate oversight. In addition, our work has led to the potential translation of fundamental ethical principles into the form of a policy roadmap for ethically aligned DHP for youth in SSA.


Assuntos
60713 , Política de Saúde , Humanos , Adolescente , África do Sul , Promoção da Saúde
2.
Front Psychol ; 15: 1358903, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38558778

RESUMO

Based on the perspective of combining informal and formal systems, this paper empirically explores the impact of neighborhood effects and policy interventions on the deviation of farmers' willingness and behavior of domestic waste separation (DWS) by using data from the China Land Economy Survey (CLES) and constructing a probit model. It should be explained that the neighborhood effect in this paper refers to the fact that the behavior of farmers is highly susceptible to the behavior of their neighbors in the process of production and living. The results of the study show that neighborhood effects and policy interventions have a significant negative impact on the deviation of farmers' willingness and behavior of DWS, respectively. Comparison of marginal effects shows that neighborhood effects > environmental advocacy > reward and punishment policies. From the interaction effects as a whole, neighborhood effects and policy interventions have complementary effects on the deviation of farmers' willingness and behavior of DWS, with the complementary effects of neighborhood effects and environmental advocacy being more significant. Heterogeneity analysis reveals that neighborhood effects completely replace the inhibitory effect of policy interventions on the deviation of high-income farmers' willingness and behavior of DWS, but have no effect on political elite farmers. The interaction between neighborhood effects and policy interventions has complementary effects on low-income farmers and ordinary farmers, with the complementary effects of neighborhood effects and environmental advocacy being more significant.

3.
Heliyon ; 10(7): e28362, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38560177

RESUMO

This study aims to investigate regional and periodic asymmetries in the impact of the outbreak of the Russia-Ukraine war on global equity markets. Employing the event study methodology, the current study examines global stock market reactions within a 61-day window centred around the event day, i.e., February 24, 2022. MSCI equity indices of 47 sample countries have been utilized to ensure uniformity in the index development methodology. They provide broader coverage of global equity markets by including large and mid-cap companies, representing approximately 85% of the free float-adjusted market capitalization for each sampled country. The study extends the event window to 61 days to assess the enduring effects of the war over a relatively longer period. The research delineates regional and periodic asymmetries and posits that the impact of the war on a market is contingent upon its geographical proximity and trade relations with Russia and Ukraine. Additionally, the impact is stronger during a shorter window surrounding the event date but diminishes over the extended period.

5.
Risk Manag Healthc Policy ; 17: 739-751, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38562249

RESUMO

Background: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25-64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value <0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25-64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.

6.
Rev Panam Salud Publica ; 48: e25, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38562958

RESUMO

Objective: Identify and analyze the role of nursing professionals in the development and care of adolescent health in Honduras, by analyzing the curricular content of the training provided to nursing students with respect to adolescent health, and by studying policies on adolescent health. Methods: Mixed methods study, with a sequential explanatory approach, carried out from May to July 2023 through surveys of nursing schools, analysis of policy documents, a survey with nursing professionals, and a focus group. Quantitative data were analyzed using descriptive statistics and qualitative data, applying the theoretical framework of Walt and Gilson. Results: During the research, 18 documents were analyzed and seven nursing schools, 141 nurses, and 10 key actors in leadership positions participated. The results point to the need to update and disseminate the regulatory framework, ensure the necessary resources and structure to implement sustainable intersectoral programs, and train professionals. Schools are an important space for the implementation of actions; in this context, the adoption of school nursing programs could be beneficial. Nurses were identified as key figures in program implementation and should be taken into consideration when developing policies aimed at adolescents. Conclusions: Nurses participate in various stages of the policy implementation process and can make important contributions to school health at the first level of care. To this end, it is necessary to increase the capacities of nurses and nursing educators in relation to current and relevant issues in adolescent care.


Objetivo: Identificar e analisar o papel dos profissionais de enfermagem no desenvolvimento e na atenção à saúde de adolescentes em Honduras por meio de análise do conteúdo da formação dos estudantes de enfermagem em saúde de adolescentes e das políticas relacionadas aos adolescentes. Métodos: Estudo de métodos mistos, com abordagem sequencial explanatória, realizado de maio a julho de 2023 por meio de um questionário aplicado a escolas de enfermagem, análise de documentos de política, um questionário aplicado a profissionais de enfermagem e um grupo focal. Os dados quantitativos foram analisados mediante estatísticas descritivas, e os qualitativos, usando o modelo teórico de Walt e Gilson. Resultados: Durante a pesquisa, foram analisados 18 documentos. Sete escolas de enfermagem, 141 profissionais de enfermagem e 10 atores-chave em cargos de liderança participaram do estudo. Os resultados apontam para a necessidade de atualizar e divulgar o marco normativo, garantir recursos e estrutura para a implementação de programas intersetoriais e sustentáveis e capacitar os profissionais. A escola representa um espaço importante para a implementação de ações, contexto no qual a adoção da enfermagem escolar pode ser proveitosa. Os profissionais de enfermagem foram identificados como atores-chave na implementação dos programas e devem ser levados em consideração no desenvolvimento de políticas voltadas para esse público. Conclusões: Os profissionais de enfermagem estão envolvidos em vários estágios do processo de implementação de políticas e podem fazer aportes importantes para a saúde escolar no nível da atenção primária. Para isso, é necessário aumentar a capacitação dos profissionais e docentes de enfermagem em tópicos atuais e relevantes da atenção a adolescentes.

7.
J Aging Soc Policy ; : 1-17, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38564337

RESUMO

Older adults are more frequently wanting to age in place. Governments are seeking cost-effective and efficient methods of supporting aging populations. Older adults who want to stay in their homes for as long as possible encounter multiple barriers, including struggling to maintain their homes, inadequate levels of social and healthcare support, and the lack of financial capacity to pay for home support services. The Mobile Seniors' Wellness Network (MSWN), a multi-disciplinary and person-centered mobile health and social support intervention study was designed to investigate and support aging in place for older adults living in rural New Brunswick, Canada. Secondary analysis of case notes and exit interviews using content analysis revealed concerns with the lack of affordable and mobile care services for vulnerable rural older adults. Older adults revealed that their needs include "the little things" rather than grand gestures or sweeping policies to age in place such as assistance with grounds and home maintenance, in addition to relational and person-centered health and social care in the home. Reliance on private service delivery and volunteer organizations can increase the likelihood that older adults will experience a breakdown of social support networks tied together loosely by friends, family, and their communities. When services are unattainable aging in place becomes an unreachable goal.

8.
Artigo em Inglês | MEDLINE | ID: mdl-38566276

RESUMO

ISSUE ADDRESSED: Food environments in early childhood, such as early childhood education and care services, influence the development of dietary patterns and behaviours that traverse into adulthood, where they affect health and longevity. Nutrition policies are mandatory in early childhood education and care services in Australia and can positively or negatively shape the food environment. However, the quality of such nutrition policies is unknown. This study aimed to evaluate the comprehensiveness and strength of nutrition policies of early childhood education and care services among services participating in a university-community alliance in South East Queensland. METHODS: Early childhood education and care services (n = 12) in Nerang, Queensland, Australia, participated in a cross-sectional study evaluating the comprehensiveness and strength of nutrition policies across four domains (Nutrition Education, Nutrition Standards, Promoting Healthy Eating and Communication and Evaluation) of the Wellness in Child Care Assessment Tool. RESULTS: Nutrition policies evaluated in this study had median total comprehensiveness scores of 55 (out of 100) and median total strength scores of 19 (out of 100). 'Nutrition Education' had the highest median scores for comprehensiveness (67 out of 100) and strength (33 out of 100), while 'Nutrition Standards' had the lowest comprehensiveness score (41 out of 100), and 'Communication and Evaluation' had the lowest strength score (0 out of 100). CONCLUSIONS: All services have a nutrition policy, but there are opportunities to enhance both the content and linguistic strength of statements within policies related to nutrition domains. SO WHAT?: There is a clear need to improve the comprehensiveness and strength of written statements in nutrition policies across all four domains, particularly 'Nutrition Standards' and 'Communication and Evaluation'.

9.
Artigo em Inglês | MEDLINE | ID: mdl-38567538

RESUMO

To reduce the cost of healthcare expenditures in China, the government has developed a centralised volume-based procurement (CVBP) policy for medicines and medical consumables. Based on tracking the development history of centralised procurement in China, this study explores China's CVBP model. By comparing the centralised procurement models and healthcare expenditure data among China, the United States (U.S), the United Kingdom (UK), and Singapore, we find that China still faces many challenges in implementing the CVBP policy. The main challenges are as follows. First, the policy cannot be guaranteed the effectiveness of implementation without a well-coordinated regulatory mechanism. Second, the CVBP rules and quality evaluation standards are imperfect. Third, the interests of healthcare companies cannot be guaranteed. Fourth, the policy affects the benefits of medical institutions, and the government has not built a compensation mechanism for medical institutions. Fifth, it poses a challenge to the operational capacity and innovation level of Chinese companies. Therefore, this paper posits a three-stage strategy and nine measures that could benefit China's progress in implementing the CVBP policy.

10.
Artigo em Inglês | MEDLINE | ID: mdl-38567769

RESUMO

The objective of this paper is to explain the political factors determining the relatively weak performance of the Polish health care (HC) sector. This can be treated as a critical case due to several reasons: first, the Poles as patients belong to the most unsatisfied ones in the European Union (EU), second, Poland spends on its HC-related expenditures one of the lowest shares of the GDP among the OECD countries, third, the number of doctors per 1000 inhabitants remains at the lowest European level, and the life expectancy in Poland is one of the lowest in the EU and is decreasing. The Authors argue that the policy inertia in the HC sector in Poland is determined by the group of inter-related political factors that effectively block the development of any positive trajectory in the Polish HC reforms. Of the various determinants analyzed the most significant appeared to be the post-communist legacy of the organization of the HC system, which combined with a short-term approach by politicians and weak decision-making processes in HC policy, makes any changes difficult to implement.

11.
Artigo em Inglês | MEDLINE | ID: mdl-38567773

RESUMO

CONTEXT: The connection between law and political determinants of health is not well-understood, but nevertheless it is suggested that the two are inseparable, and that this represents an "upstream" level with scope for influencing other determinants of health (particularly social). Solidarity underpins European healthcare systems and given its clear link with redistribution, can be seen as a means to address health inequities. As such, solidarity may be seen as a political determinant of health in the specific context of EU competition policy. METHODS: A range of EU case law, Treaty provisions, and Commission publications relating to EU competition policy are analysed. FINDINGS: Solidarity is typically juxtaposed as antithetical to competition, thus underpins exceptions to the applicability of the prohibitions on anticompetitive agreements, abuse of dominance, and state aid. Case law indicates a further dynamic between definitions of solidarity at EU and national levels. CONCLUSIONS: This analysis leads to two groups of considerations when framing solidarity as a political determinant of health in the EU competition policy context: firstly, the predominance of solidarity suggests it may shape competition reforms, and secondly the EU-Member State dynamic which indicates less EU-level reach into national competition reforms in healthcare than may be expected.

12.
Int J Soc Determinants Health Health Serv ; : 27551938241244695, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38557278

RESUMO

This article examines historical trends in health inequalities over the 20th and 21st centuries. Drawing on studies from the United States, United Kingdom, Sweden, and Western Europe, it concludes that there is evidence of a u-shaped curve in (relative) health inequalities. These trends in health inequalities broadly parallel those identified by economists with regards to the u-shaped curve of income and wealth inequalities across the 20th and 21st centuries. The article argues that-as with income inequalities-health inequalities generally decreased across the twentieth century through to the early 1980s. They then started to increase and accelerated further from 2010, particularly in the United Kingdom and the United States. The article sets out four distinct policy periods that shaped the evolution of trends in health inequalities: the Interbellum Era, 1920-1950; the Trente Glorieuse, 1950-1980; Neoliberalism, 1980-2010; and the Crisis Age, 2010-present. The u-shaped curve of health inequalities over this period suggests that social policies, health care access, and political incorporation have driven changes over time. Taking this long view of changes in health inequalities emphasizes the importance of politics and policy for future health improvement.

14.
Telemed J E Health ; 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38563764

RESUMO

Introduction: The surge in virtual care during the pandemic was accompanied by an increase in telehealth data of interest to policy stakeholders and other health care decision makers. However, these data often require substantial preprocessing and targeted analyses to be usable. By deliberately evaluating telehealth services with stakeholder perspectives in mind, telehealth researchers can more effectively inform clinical and policy decision making. Objective: To examine existing literature on telehealth measurement and evaluation and develop a new policy-oriented framework to guide telehealth researchers. Materials and Methods: A systematic rapid review of literature on telehealth measurement and evaluation was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The findings were analyzed and applied to the Supporting Pediatric Research on Outcomes and Utilization of Telehealth Evaluation and Measurement (STEM) Framework through the lens of key health care delivery decision makers to create a STEM Policy Framework Results: An initial search yielded 2,324 peer-reviewed articles and gray literatyre from 2012 to 2022, of which 56 met inclusion criteria. These measured and evaluated telehealth access (41.5%), quality (32.1%), cost (15.1%), experience (5.7%), and utilization (5.7%), consistent with the STEM Framework domains, but there was no universal approach. The STEM Policy Framework focuses this literature by describing data measures for each domain from the perspectives of five stakeholders. Conclusions: Literature describing measurement and evaluation approaches for telehealth is limited and not standardized, with few considering policy stakeholder perspectives. With this proposed STEM Policy Framework, we aim to improve this body of literature and support researchers seeking to inform telehealth policy through their work.

15.
LGBT Health ; 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38564182

RESUMO

Purpose: Our goal was to evaluate the impact of enumerated antibullying laws and local interventions on school affirmation, risk of physical threat or harm, and suicide attempts for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Methods: This study used cross-sectional data from three national sources that provided outcomes and potential predictors: (1) The Trevor Project National Survey 2022: based on the LGBTQ youth report, (2) Movement Advancement Project: presence of LGBTQ enumerated antibullying state laws, and (3) School Health Profiles 2020: statewide prevalence of school-level strategies to improve student wellness reported by school personnel. Bivariate and multivariable logistic regression models calculated the relative risks (RRs) for each outcome. Results: LGBTQ youth (n = 27,697) were surveyed. Youth were less likely to identify their school as nonaffirming in states with enumerated laws (RR: 0.97, confidence interval [CI]: 0.94-0.99) and in states with higher percentages of gay/straight alliances (GSAs) (RR: 0.97, 95% CI: 0.96-0.97). Youth were less likely to report a history of physical threat or harm in states with more GSAs (RR: 0.96, 95% CI: 0.95-0.97). Enumerated state laws were associated with a lower risk of suicide attempts among LGBTQ youth (RR: 0.82, 95% CI: 0.77-0.87). Universal strategies/policies not specific to LGBTQ youth did not reduce risk of physical threat/harm or suicide attempts. Conclusions: Statewide enumerated antibullying protections and the presence of a GSA were associated with a decreased risk of poor outcomes among LGBTQ youth. Longitudinal studies are needed to assess the impact of recent legislative changes.

16.
Isr J Health Policy Res ; 13(1): 7, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38556863

RESUMO

BACKGROUND: Medical imaging tests are vital in healthcare but can be costly, impacting national health expenditures. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for assessing medical conditions. However, the rising demand for MRI scans has frequently strained available resources. This study aimed to estimate the prevalence of different imaging tests in individuals who eventually had an MRI, in the Israeli public health system. METHODS: An online survey of patient experience of scheduling an MRI was conducted in January-February 2023, among 557 Israeli adults, representing all four health maintenance organizations (HMOs). All participants had undergone an MRI in the public health system within the past year. RESULTS: Results showed that 60% of participants underwent other imaging tests before their MRI scan. Of those, computed tomography (CT) scans (43%), X-rays (39%), and ultrasounds (32%) were the most common additional imaging procedures. In addition, of the 60% of participants, 23% had undergone more than one prior imaging examination. CONCLUSIONS: These findings highlight the high prevalence of preliminary imaging tests prior to MRI, with many patients undergoing multiple tests for the same problem. The health system may need to evaluate whether current clinical guidelines defining the use of various imaging tests are cost-effective.


Assuntos
Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Humanos , Israel , Inquéritos e Questionários , Sistemas Pré-Pagos de Saúde
17.
BMJ Open ; 14(4): e081426, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38569677

RESUMO

INTRODUCTION: Newborn bloodspot screening (NBS) is a highly successful public health programme that uses biochemical and other assays to screen for severe but treatable childhood-onset conditions. Introducing genomic sequencing into NBS programmes increases the range of detectable conditions but raises practical and ethical issues. Evidence from prospectively ascertained cohorts is required to guide policy and future implementation. This study aims to develop, implement and evaluate a genomic NBS (gNBS) pilot programme. METHODS AND ANALYSIS: The BabyScreen+ study will pilot gNBS in three phases. In the preimplementation phase, study materials, including education resources, decision support and data collection tools, will be designed. Focus groups and key informant interviews will also be undertaken to inform delivery of the study and future gNBS programmes. During the implementation phase, we will prospectively recruit birth parents in Victoria, Australia, to screen 1000 newborns for over 600 severe, treatable, childhood-onset conditions. Clinically accredited whole genome sequencing will be performed following standard NBS using the same sample. High chance results will be returned by genetic healthcare professionals, with follow-on genetic and other confirmatory testing and referral to specialist services as required. The postimplementation phase will evaluate the feasibility of gNBS as the primary aim, and assess ethical, implementation, psychosocial and health economic factors to inform future service delivery. ETHICS AND DISSEMINATION: This project received ethics approval from the Royal Children's Hospital Melbourne Research Ethics Committee: HREC/91500/RCHM-2023, HREC/90929/RCHM-2022 and HREC/91392/RCHM-2022. Findings will be disseminated to policy-makers, and through peer-reviewed journals and conferences.


Assuntos
Genômica , Triagem Neonatal , Criança , Humanos , Recém-Nascido , Projetos Piloto , Estudos Prospectivos , Vitória
18.
BMJ Open ; 14(4): e079988, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38569688

RESUMO

BACKGROUND: HIV drug resistance (DR) is a growing threat to the durability of current and future HIV treatment success. DR testing (DRT) technologies are very expensive and specialised, relying on centralised laboratories in most low and middle-income countries. Modelling for laboratory network with point-of-care (POC) DRT assays to minimise turnaround time (TAT), is urgently needed to meet the growing demand. METHODS: We developed a model with user-friendly interface using integer programming and queueing theory to improve the DRT system in Kisumu County, Kenya. We estimated DRT demand based on both current and idealised scenarios and evaluated a centralised laboratory-only network and an optimised POC DRT network. A one-way sensitivity analysis of key user inputs was conducted. RESULTS: In a centralised laboratory-only network, the mean TAT ranged from 8.52 to 8.55 working days, and the system could not handle a demand proportion exceeding 1.6%. In contrast, the mean TAT for POC DRT network ranged from 1.13 to 2.11 working days, with demand proportion up to 4.8%. Sensitivity analyses showed that expanding DRT hubs reduces mean TAT substantially while increasing the processing rate at national labs had minimal effect. For instance, doubling the current service rate at national labs reduced the mean TAT by only 0.0%-1.9% in various tested scenarios, whereas doubling the current service rate at DRT hubs reduced the mean TAT by 37.5%-49.8%. In addition, faster batching modes and transportation were important factors influencing the mean TAT. CONCLUSIONS: Our model offers decision-makers an informed framework for improving the DRT system using POC in Kenya. POC DRT networks substantially reduce mean TAT and can handle a higher demand proportion than a centralised laboratory-only network, especially for children and pregnant women living with HIV, where there is an immediate push to use DRT results for patient case management.


Assuntos
Infecções por HIV , Laboratórios , Criança , Humanos , Feminino , Gravidez , Quênia , Infecções por HIV/tratamento farmacológico , Sistemas Automatizados de Assistência Junto ao Leito , Engenharia , Testes Imediatos
19.
BMJ Open ; 14(4): e080756, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38569712

RESUMO

OBJECTIVE: There are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China's household registration system. The Equalization of Basic Public Health and Family Planning Services (EBPHFPS) policy aims to reduce disparities among populations by enhancing the migrant population's access to basic public health services. The aim of this study is to examine the relationship between the EBPHFPS targeted at the floating population and the disparities in access to and utilisation of NEPHS between registered residents and the floating population. DESIGN: A cross-sectional study. SETTING: 8 cities (regions, autonomous prefectures) in China. PARTICIPANTS: 13 998 floating population and 14 000 registered residents in eight cities (regions, autonomous prefectures) were included in the analysis. OUTCOME MEASURES: Three binomial variables, including awareness of NEPHS, acceptance of health education and establishment of health records, were used as outcome indicators to examine the relationship between the EBPHFPS and the disparities between the floating and registered populations. METHODS: A linear regression model, fairness gap calculation and propensity score matching were used to explore the associations. RESULTS: The areas that implemented EBPHFPS exhibited an 8.3% increase in awareness of the NEPHS (p<0.01) and a 4.0% increase (p<0.05) in the likelihood of individuals having received health education within the previous year compared with the areas without the policy implementation. In contrast to registered residents, however, the floating population still faces significant disparities in NEPHS awareness and utilisation. Compared with areas without the equalisation policy, the inequality of opportunity in health education of the floating population in implementation areas is significantly lower (p<0.01), whereas no significant difference is observed in the inequality of opportunity regarding NEPHS awareness among the floating population (p>0.1). The floating population in the pilot areas of the policy encountered greater disparities in the establishment of health records (p<0.01). CONCLUSIONS: Positive associations between the EBPHFPS policy and NEPHS awareness and utilisation among the floating population were demonstrated to some extent; however, the floating population was still confronted with a degree of inequality of opportunity. The government needs to develop target-oriented policies and a guaranteed mechanism to ensure access to NEPHS among the floating population.


Assuntos
Serviços de Planejamento Familiar , Política Pública , Humanos , Estudos Transversais , China/epidemiologia , Saúde Pública
20.
Am J Clin Nutr ; 119(4): 990-1006, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38569789

RESUMO

BACKGROUND: Consumption of sugar-sweetened beverages (SSBs) has been linked to several adverse health outcomes, thus many countries introduced taxation to reduce it. OBJECTIVES: To summarize national SSB taxation laws and to assess their association with obesity, overweight and diabetes. METHODS: We conducted a systematic scoping review up to January 2022 on PubMed, Web of Science, Embase, and Google Search to identify taxes on SSBs. An interrupted time series analysis (ITSA) was conducted on 17 countries with taxation implemented in 2013 or before to evaluate the level and slope modifications in the rate of change of standardized prevalence rates of overweight, obesity, and diabetes. Random-effects meta-regression was used to assess whether year of entry into force of the law, national income, and tax design affected observed results. RESULTS: We included 76 tax laws issued between 1940 and 2020 by 43 countries, which were heterogeneous in terms of tax design, amount, and taxed products. Among children and adolescents, ITSA showed level or slope reduction for prevalence of overweight and obesity in 5 (Brazil, Samoa, Palau, Panama, Tonga) and 6 (El Salvador, Uruguay, Nauru, Norway, Palau, Tonga) countries out of 17, respectively. No clear pattern of modification of results according to investigated factors emerged from the meta-regression analysis. CONCLUSIONS: Taxation is highly heterogeneous across countries in terms of products and design, which might influence its effectiveness. Our findings provide some evidence regarding a deceleration of the increasing prevalence rates of overweight and obesity among children occurring in some countries following introduction of taxation. PROSPERO registration number: CRD42021233309.


Assuntos
Diabetes Mellitus , Bebidas Adoçadas com Açúcar , Adolescente , Criança , Humanos , Sobrepeso/epidemiologia , Bebidas Adoçadas com Açúcar/efeitos adversos , Obesidade/epidemiologia , Obesidade/etiologia , Impostos , Bebidas/efeitos adversos
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