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1.
Artigo em Inglês | MEDLINE | ID: mdl-36078191

RESUMO

American cities and localities have historically been places of innovation and incubation when it comes to advancing equity and inclusion. Now, local governments in many states are leading the fight for stronger public health protections against COVID-19-through mask mandates, stay-at-home orders, and paid leave provisions, among other actions. However, state lawmakers have long used preemption-state laws that block, override, or limit local ordinances-to stifle local government action, often under pressure from corporate interests and political ideology. Through preemption, state lawmakers have obstructed local communities-often majority-minority communities-from responding to the expressed needs and values of their residents through policies. In this article, we first look at the context behind preemption and its disparate effects. After establishing a conceptual framework for measuring disparities, we discuss how the current COVID-19 pandemic is disproportionately harming the same communities that have been preempted from taking local action, limiting their ability to effectively combat the public health crisis. We argue that all stakeholders interested in health equity have a role to play in addressing the misuse of state preemption.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Governo Local , Pandemias/prevenção & controle , Saúde Pública , Governo Estadual , Estados Unidos
2.
PLoS One ; 17(9): e0274828, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36125982

RESUMO

All issuers in China's local government bond market, which is nascent but growing rapidly, have the same AAA ratings. However, we provide evidence that the credit rating agency's reputation can certify differences in ratings' reliability and further impact bond pricing. On the basis of a sample of 7941 local government bonds issued from 2015 to 2021, results show that risk premium is significantly low for bonds rated by prestigious credit rating agencies, which means that issuers can save borrowing costs. Moreover, local governments regarded as less transparent in fiscal information disclosure enjoy more cost savings for their bonds by hiring more reputable agencies. Regression results are affirmed with the Heckman two-stage model, difference-in-differences regression, and machine learning method to solve the potential endogeneity issue. This paper's findings contribute to the debate on the credit rating agency's reputation hypothesis and present three implications. First, investors can rely on the credit rating agency's reputation to complement credit risk analysis. Second, local government policymakers should implement appropriate policies to reduce debt costs and improve public finance sustainability. Lastly, regulators should considerably focus on the supervision of credit rating agencies, given their substantial impact on bond pricing and the market's information asymmetry.


Assuntos
Governo Local , China , Reprodutibilidade dos Testes
3.
Int J Equity Health ; 21(1): 129, 2022 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088347

RESUMO

BACKGROUND: Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions. METHODS: The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%). RESULTS: Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities. CONCLUSIONS: The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.


Assuntos
Política de Saúde , Saúde Pública , Disparidades nos Níveis de Saúde , Humanos , Governo Local , Fatores Socioeconômicos
4.
Trials ; 23(1): 785, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109757

RESUMO

BACKGROUND: Among rural Chinese patients with non-communicable diseases (NCDs), low socioeconomic status increases the risk of developing NCDs and associated financial burdens in paying for medicines and treatments. Despite the chronic disease medicine reimbursement policy of the local government in Nantong City, China, various barriers prevent patients from registering for and benefitting from the policy. This study aims to develop a behavior science-based intervention program for promoting the adoption of the policy and to evaluate the effectiveness of the program compared with usual practices. METHODS: Barriers and opportunities affecting stakeholders in adopting the policy were identified through contextual research and summarized through behavior mapping. The intervention is designed to target these barriers and opportunities through behavior science theories and will be evaluated through a 6-month cluster randomized controlled trial in Tongzhou District, Nantong, China. A total of 30 villages from two townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual practices). Village doctors in the intervention arm (1) receive systematic training on policy details, registration procedures, and intervention protocol, (2) promote the policy and encourage registration, (3) follow up with patients in the first, third, and sixth months after the intervention, and (4) receive financial incentives based on performance. The primary outcome is policy registration rate and the secondary outcomes include the number of patients registering for the policy, medical costs saved, frequency of village doctor visits, and health measures such as blood pressure and glucose levels. DISCUSSION: This study is one of very few that aims to promote adoption of NCDs outpatient medication reimbursement policies, and the first study to evaluate the impact of these policies on patients' financial and physical wellbeing in China. The simple, feasible, and scalable intervention is designed based on the theories of behavior science and is applicable to similar low-income regions nationwide where outpatient medical costs remain a financial burden for patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04731194 , registered on 29 January 2021; Chinese Clinical Trial Registry ChiCTR2100042152 , registered on 14 January 14 2021.


Assuntos
Governo Local , Políticas , China , Doença Crônica , Glucose , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
PLoS One ; 17(9): e0273875, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36084072

RESUMO

This paper evaluates the impact of China's fiscal decentralization reform, namely the "Province-Managing-County" (PMC) fiscal reform, on local governments' regional development strategy using county-level data in China covering 2000 to 2013. Surprisingly, after implementing the PMC fiscal reform, local governments will adjust their strategy of supporting zombie firms and attracting new firms, indicating that fiscal decentralization has changed the regional development strategies of local governments. We perform a difference-in-differences (DID) analysis and find that the PMC fiscal reform materially induces an average rise of 0.131 in newly added firms, an average decline of 0.383 in zombie firms, and no significant change in other firms. There is a pronounced substitution effect between zombie firms and newly added firms. We also find evidence supporting this argument: the government's subsidy, tax treatment, and financial support. Our study provides empirical evidence that local governments' regional development strategies can be affected by fiscal decentralization.


Assuntos
Ódio , Política , China , Governo Local
7.
Eval Program Plann ; 94: 102151, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35933932

RESUMO

Evaluation of investments in tourism (as a cross-section industry) is a complex issue that needs to be addressed systematically by using a combination of quantitative and qualitative methods. This article deals with the setting of an ex-post evaluation framework for the assessment of impact interventions on the tourism sector at all its levels, especially the local one. The design of an evaluation framework for the tourism sector supported by the recommended approaches and methods is the first result of this methodically focused paper. The proposal to adopt the Method for Impact Assessment of Programmes and Projects = MAPP method into the tourism sector on a local level, including indicators, measures, and outcomes would be considered as a second significant result. The proposed evaluation framework can be used by the representatives of public institutions and organizations to measure the impact of programmes financially supported from public sources on the tourism sector in an efficient way. In particular, municipalities´ government bodies can adopt the proposed approach towards sustainable planning and development in tourism.


Assuntos
Governo Local , Turismo , Humanos , Indústrias , Avaliação de Programas e Projetos de Saúde
8.
Front Public Health ; 10: 942043, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35910915

RESUMO

It is of great reference significance for broadening the research perspective of pandemic governance, improving the efficiency of pandemic governance and the credibility of the government, to scientifically measure and analyze the public medical and health system costs. This article takes the typical case "pandemic prevention and control event of S city, China" as the research background. First, the concept of public medical and health system costs during pandemic governance is defined. Then, the public medical and health system costs are embedded into the pandemic governance system, and the generation process of the public medical and health system costs in the actual situation are investigated. Furthermore, through in-depth interview, multi-case grounded theory and fuzzy subordinate function analysis, the scientific construction of the public medical and health system cost index system are completed. Finally, based on G1 method/entropy method combined with weighting and fuzzy comprehensive evaluation method, the public medical and health system costs of the pandemic prevention and control events of S city is measured. The results show the following: (1) it is important that good single dimensions and reliable indicators are embodied in the public medical and health system costs scale. Among them, the behavioral public medical and health system costs of the masses is the largest proportion of all indicators; (2) after the pandemic prevention and control event is over, the public medical and health system cost are difficult to repair, and some lagging ideas and behaviors shown by local governments lead to a continuous expansion of the public medical and health system costs associated with pandemic governance; and (3) local governments should not conceal information asymmetry. Instead, local governments should give greater freedom to other actors to deal with pandemic governance, and governance entities should cooperate with each other. This will mitigate the effect of public medical and health system costs. Corresponding policy recommendations are proposed.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , China/epidemiologia , Humanos , Governo Local
9.
Artigo em Inglês | MEDLINE | ID: mdl-35954535

RESUMO

Voivodships are centres of economic, social, and cultural life-they gather economic and social activities. This research aimed to evaluate the spatial differentiation of the quality of life in voivodships in Poland with the use of a synthetic measure. To achieve the research objective, the research methods used were literature analysis, statistical analysis, and synthetic measure. The Technique for Order Preference by Similarity to an Ideal Solution method was used to build synthetic measures. The choice of variables in 2010-2020 was largely conditioned by the availability of data collected in the regional system at the level of voivodships at the Local Data Bank of the Central Statistical Office. As a result of the analysis of voivodships in Poland, based on the quality of life measure, four groups were distinguished (according to the value of quartiles). In the group of the best voivodeships there were: Pomerania, Masovia, Lower Silesia, and West Pomeranian in 2010, and Masovia, Pomerania, Greater Poland, Lower Silesia, and Lesser Poland in 2020, and in the IV, the weakest group: Lodz Province, Podlasie Province, Lubusz Province, and Holy Cross in 2010, and Lodz Province, Podlasie Province, Holy Cross, and Lublin Province in 2020. The synthetic quality of life ranged from 0.37 to 0.56 in 2010 and from 0.39 to 0.64 in 2020. Regional authorities, taking care to improve economic potential, cause increasing the attractiveness of the area and attracting new entrepreneurs, create new jobs, and improve the quality of life of the inhabitants. Quality of life is shaped by economic activity and working conditions, health, education, free time and social relations, economic and physical security, and the quality of the natural environment. The results of the research conducted allow local governments to make comparisons. The conclusions drawn may allow them to identify potential directions for developing policy optimization.


Assuntos
Conservação de Recursos Energéticos , Qualidade de Vida , Desenvolvimento Econômico , Governo Local , Polônia
10.
Artigo em Inglês | MEDLINE | ID: mdl-36011608

RESUMO

Green development is necessary for China to carry out high-quality economic development. As an important institutional arrangement in the vertical government structure, fiscal decentralization supports regional green development. Local government environmental preferences indicate local environmental protection awareness and affect the process of regional green development to a certain extent. Based on the review of relevant theories and literature, this study conducts an empirical analysis based on Chinese provincial panel data from 2007 to 2019 using a two-way fixed effects model and a panel threshold model. Both revenue decentralization and expenditure decentralization have a U-shaped nonlinear relationship with the green development efficiency calculated by the superefficiency SBM model, which includes undesirable output. Neither factor has a positive effect on green development efficiency at this stage, while local government environmental preferences are positively connected to green development efficiency. Furthermore, a moderating effect is observed in the relationship between fiscal decentralization and green development efficiency. Under the same level of revenue decentralization or expenditure decentralization, the stronger the environmental preferences of the local authority are, the higher the green development efficiency. This moderating effect is more significant in coastal areas than inland areas. Further research reveals a threshold for the moderating effect of local government environmental preferences on fiscal decentralization on green development. When the environmental preferences of local government are below the threshold, both revenue decentralization and expenditure decentralization significantly inhibit the improvement in green development efficiency. After the threshold is passed, the negative effects of both on green development efficiency are markedly curtailed. Then, the government performance appraisal system should be further optimized, fiscal decentralization reform should be strengthened, local financial investment in environmental protection should be expanded, and synergistic regional development should be promoted. China's green development should be promoted to an advanced stage.


Assuntos
Política , Desenvolvimento Sustentável , Conservação dos Recursos Naturais , Desenvolvimento Econômico , Governo Local
11.
BMC Health Serv Res ; 22(1): 1046, 2022 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-35974324

RESUMO

BACKGROUND: Human resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya's devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya. METHODS: We conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (n = 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis. RESULTS: Human resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency. CONCLUSIONS: Human resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.


Assuntos
Programas Governamentais , Governo Local , Humanos , Quênia , Assistência Médica , Recursos Humanos
13.
BMC Public Health ; 22(1): 1316, 2022 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-35810294

RESUMO

BACKGROUND: The use of research evidence to underpin public health practice and policy decisions in local government is strongly promoted but its implementation has not been straightforward. This study aimed to explore the factors, relationships and processes that contribute towards accessing, using, and generating research evidence that is relevant to local authority public health and social care and shapes its practice. METHODS: Semi-structured individual interviews with elected councillors, officers directly involved with public health and social care and with community members from one urban unitary authority in South England were conducted. Interviews were audio recorded, transcribed verbatim and thematically analysed. RESULTS: Fourteen participants took part in the semi-structured interviews. Local knowledge and evidence are prioritised, and anecdotal evidence is valued. The Director of Public Health was the principal source of information and support. Academics were rarely mentioned as information sources, and their involvement was ad hoc. The use of research evidence varied between individuals and departments, with wider engagement among public health specialists. Key barriers to the use of research evidence included access (not reported among public health professionals), research timeliness, local applicability, competence in finding and interpreting evidence and the role of research evidence within a political context. Public health and adult social care teams are not currently research active or research ready. Major barriers exist due to financial constraints and the socio-political context of local authorities. COVID-19 disrupted siloed ways of working, strengthening and opening potential collaborations within the local authority. This changed perspectives about the value of research but is likely time-limited unless underpinned by sustainable funding. CONCLUSION: Creating strategic level roles within local government to work with the Director of Public Health to champion the research agenda and embedding researchers within and across teams would build capacity for local authorities to sustainably co-create, undertake, and use evidence to better inform future actions.


Assuntos
COVID-19 , Medicina Estatal , Adulto , COVID-19/epidemiologia , Humanos , Governo Local , Administração em Saúde Pública , Prática de Saúde Pública
14.
Artigo em Inglês | MEDLINE | ID: mdl-35805652

RESUMO

Public health departments are on the frontlines of protecting vulnerable groups and working to eliminate health disparities through prevention interventions, disease surveillance and community education. Exploration of the roles national, state and local health departments (LHDs) play in advancing climate change planning and actions to protect public health is a developing arena of research. This paper presents insights from local public health departments in California, USA on how they addressed the barriers to climate adaptation planning with support from the California Department of Public Health's Office of Health Equity Climate Change and Health Equity Section (OHE), which administers the California Building Resilience Against Climate Effects Project (CalBRACE). With support from the U.S. Centers for Disease Control and Prevention (CDC) Climate-Ready States and Cities Initiative (CRSCI), CalBRACE initiated an adaptation project to seed climate planning and actions in county health departments. In this study, we compared the barriers and strategies of twenty-two urban and rural LHDs and explored potential options for climate change adaptation in the public health framework. Using key informant interviews and document reviews, the results showed how engagement with CalBRACE's Local Health Department Partnership on Climate Change influenced the county departments' ability to overcome barriers to adaptation through the diversification of funding sources, the leveraging strategic collaborations, extensive public education and communication campaigns, and the development of political capital and champions. The lessons learned and recommendations from this research may provide pathways and practices for national, state and local level health departments to collaborate in developing protocols and integrating systems to respond to health-related climate change impacts, adaptation and implementation.


Assuntos
Mudança Climática , Equidade em Saúde , Centers for Disease Control and Prevention, U.S. , Humanos , Governo Local , Saúde Pública/métodos , Regionalização da Saúde , Estados Unidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-35805763

RESUMO

Based on China's provincial panel data from 2007 to 2019, the authors of this paper conducted an empirical test on the direct effect of China's fiscal expenditure structure on the reduction in environmental pollution with the use of a fixed effect model. We also creatively added an interaction item comprising vertical fiscal imbalance and the expenditure structure to further study the impact of vertical fiscal imbalance on reducing environmental pollution and its effect on the fiscal expenditure structure. The study results show that a structure in favor of expenditure on people's welfare noticeably reduces environmental pollution. However, after the introduction of the vertical fiscal imbalance indicator, the pollution reduction effect decreases. That is, the vertical fiscal imbalance weakens and distorts the impact of the fiscal expenditure structure on the reduction in environmental pollution. Therefore, it is possible to further motivate local governments with incentive measures, such as fiscal decentralization and the centralization of administrative responsibilities, and regulate the environmental pollution of local governments through use of restrictive measures, such as the "green GDP" evaluation mechanism to further improve the fiscal expenditure structure of local governments, enhance the environmental pollution reduction capability of fiscal expenditure.


Assuntos
Poluição Ambiental , Gastos em Saúde , China , Desenvolvimento Econômico , Poluição Ambiental/análise , Humanos , Governo Local
16.
Artigo em Inglês | MEDLINE | ID: mdl-35886478

RESUMO

Ecological civilization (EC) has been seen as the final goal of social and environmental reform within a given society. Much attention has been paid to the national governmental level in previous studies, and district- and local-level government actions have been a lower priority, which may have led to overlooking key details of management institutions and policy systems in relation to EC. In this research, we aimed to make a significant contribution to the literature by tracing the EC trajectory and policy transitions. Through bibliometric analysis of policy documents, we reviewed the EC construction system for Fujian Province from 2004 to 2020. The policy priorities, organization-functional network, and contributing factors to policy changes in each of the three phases are discussed in depth. Target setting, actors' functions, and institutional guarantees are the core elements of EC construction. This research provides a quantitative foundation for understanding policy reform and transition with regards to Chinese local governments' EC actions. The experience of Fujian Province shows trends toward legalization, multi-actor linkage, and issue refinement that may serve as a basis for other countries and regions in order to explore the promotion of sustainable development and environmental governance as pathways to EC.


Assuntos
Conservação dos Recursos Naturais , Política Ambiental , China , Ecossistema , Governo Local
17.
Artigo em Inglês | MEDLINE | ID: mdl-35886108

RESUMO

Worsening environmental problems have created more and more challenges for green development, and the government is often seen as an important guide in turning this situation around. A government generally enacts green development through green development behavior, but previous research has not revealed the mechanism of this behavior. In addition, the multi-agent interaction between the government and green development behavior also needs to be explored. Based on an integrated theoretical model, the authors of this study adopted a meta-analysis method to analyze 18 high-quality published pieces from 6 mainstream databases and described the mechanism of government green development behavior in exploring and thinking about multi-agent interactions. In addition, the authors of this study explored differences in the roles of central and local government green development behaviors and the moderating role of regional heterogeneity. The research results showed that: (1) Enterprise economic behavior, enterprise environmental behavior, enterprise social behavior, and public participation are all significantly positively affected by government green development behavior; (2) local government green development actions have stronger effects than central government actions; (3) regional heterogeneity moderates the effect of government green development behavior. Furthermore, the authors of this study propose relevant countermeasures and suggestions from the government's point of view. This research provides a theoretical and practical reference for governments to better improve their environmental systems and environmental supervision.


Assuntos
Governo , Desenvolvimento Sustentável , China , Participação da Comunidade , Humanos , Governo Local , Modelos Teóricos
18.
Int J Equity Health ; 21(1): 93, 2022 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-35820951

RESUMO

BACKGROUND: The security of medical insurance fund is very important to health equity. In China, the expenditure of medical insurance fund has increased sharply year after year, and the balance of local medical insurance fund is difficult to sustain. To realize the equitable distribution of the medical insurance burden, the central government has to continuously increase transfer payments, which causes regional unfairness in the distribution of central financial resources. This paper explores the influence of central transfer payments on the balance of medical insurance fund, influential mechanisms, and the strategic behavior of local governments. METHODS: First, we constructed a dynamic game model between central government and local governments and analyzed the mechanism of central transfer payments affecting the balance of local medical insurance fund. Then, based on the provincial panel data of 28 provincial administrative regions in China from 2004 to 2014, an empirical test was made. The spatial regression model was constructed, and the transfer payments obtained by neighboring provinces in the previous year were taken as instrumental variables. RESULTS: Central transfer payments led to strategic behaviors by local governments that resulted in increased local health insurance fund expenditures and lower balance rates. Moreover, the central transfer payments demonstrated "path dependence". Central transfer payments had a significant negative influence on the local NCMS fund balance rate. The local government subsidy and per capita GDP had a significant positive impact on the local NCMS fund balance rate. The obtained transfer payments of local governments had a significant space correlation. This study based on NCMS data remains valid. CONCLUSIONS: Central transfer payments induced the strategic behavior of local governments, which neglected to supervise the expenditure of medical insurance fund, reducing the efficiency of medical insurance fund management and use. The financial resources of medical insurance fund are unevenly distributed among provinces. Measures such as strengthening the supervision ability and initiatives of local governments, refining the central transfer payment mechanism, promoting the economic growth of western regions, and increasing rates for individual contributions appropriately can ensure that the medical insurance fund are used well and distributed equitably.


Assuntos
Financiamento Governamental , Seguro Saúde , China , Gastos em Saúde , Humanos , Governo Local
19.
J Environ Public Health ; 2022: 3393532, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35844942

RESUMO

Urbanization has accelerated China's economic growth, but it has also brought many sustainability issues. This paper selected a random forest model to study the impact of local government-led urbanization on urban sustainable development. Urbanization affected urban sustainable development through government revenue expansion, land resources mismatch, and industrial structure adjustment. The results showed that the adjustment of industrial structure has the greatest impact on urban sustainable development, and the importance of the average output of industrial enterprises confirms it. Government revenue expansion and land resources mismatch are more important to the sustainable development of representative urban agglomerations. The goodness of fit of the random forest model is better than the multiple linear regression (MLR) model and the extreme gradient boosting (XGBoost) model. The generalization ability of the model is improved with the optimization of variables. The main contribution of this paper is that we have established a complete information dynamic game model on government revenue expansion, land resource mismatch, industrial structure adjustment, and urban sustainable development. And the random forest model is used to study the relationship between the above variables.


Assuntos
Desenvolvimento Sustentável , Urbanização , China , Cidades , Conservação dos Recursos Naturais , Desenvolvimento Econômico , Indústrias , Governo Local
20.
BMC Health Serv Res ; 22(1): 871, 2022 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-35791014

RESUMO

BACKGROUND: Bi-annual high dose vitamin A supplements administered to children aged 6-59 months can significantly reduce child mortality, but vitamin A supplementation (VAS) coverage is low in Nigeria. The World Health Organization recommends that VAS be integrated into other public health programmes which are aimed at improving child survival. Seasonal malaria chemoprevention (SMC) provides a ready platform for VAS integration to improve health outcomes. This study explored the feasibility and acceptability of integrating VAS with SMC in one local government area in Sokoto State. METHODS: A concurrent QUAN-QUAL mixed methods study was used to assess the feasibility and acceptability of co-implementing VAS with SMC in one LGA of Sokoto state. Existing SMC implementation tools and job aids were revised and SMC and VAS were delivered using a door-to-door approach. VAS and SMC coverage were subsequently assessed using questionnaires administered to 188 and 197 households at baseline and endline respectively. The qualitative component involved key informant interviews and focus group discussions with policymakers, programme officials and technical partners to explore feasibility and acceptability. Thematic analysis was carried out on the qualitative data. RESULTS: At endline, the proportion of children who received at least one dose of VAS in the last six months increased significantly from 2 to 59% (p < 0.001). There were no adverse effects on the coverage of SMC delivery with 70% eligible children reached at baseline, increasing to 76% (p = 0.412) at endline. There was no significant change (p = 0.264) in the quality of SMC, measured by proportion of children receiving their first dose as directly observed treatment (DOT), at baseline (54%) compared to endline (68%). The qualitative findings are presented as two overarching themes relating to feasibility and acceptability of the integrated VAS-SMC strategy, and within each, a series of sub-themes describe study participants' views of important considerations in implementing the strategy. CONCLUSION: This study showed that it is feasible and acceptable to integrate VAS with SMC delivery in areas of high seasonal malaria transmission such as northern Nigeria, where SMC campaigns are implemented. SMC-VAS integrated campaigns can significantly increase vitamin A coverage but more research is required to demonstrate the feasibility of this integration in different settings and on a larger scale.


Assuntos
Malária , Vitamina A , Quimioprevenção , Criança , Suplementos Nutricionais , Estudos de Viabilidade , Humanos , Governo Local , Malária/prevenção & controle , Nigéria , Estações do Ano
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