Increasing Health Insurance Enrollment in Low- and Middle-Income Countries: What Works, What Does Not, and Research Gaps: A Scoping Review.

Health insurance programs have the potential to shield individuals in low- and middle-income countries from catastrophic health expenses and reduce their vulnerability to poverty. However, the uptake of insurance programs remains low in these countries. We reviewed existing evidence from experimental studies on approaches that researchers have tested in order to raise the uptake. In the 12 studies we synthesized, educational programs and subsidies were the dominant interventions. Consistent with findings from previous studies on other health products, subsidies were effective in raising the uptake of insurance programs in many contexts. Conversely, education interventions-in their current forms-were largely ineffective, although they bolstered the effect of subsidies. Other strategies, such as the use of microfinance institutions and social networks for outreach and enrollment, showed mixed results. Additional research is needed on effective approaches to raise the uptake of insurance programs, including tools from behavioral economics that have shown promise in other areas of health behavior.

Internet de las cosas: una opción interesante para el futuro de la salud pública / Internet of things: an interesting option for the future of public health

RESUMEN Introducción: el internet de las cosas ofrece nuevas oportunidades de acceso a datos, servicios específicos en la educación, seguridad y asistencia sanitaria, entre otros campos. Objetivo: realizar una revisión de la literatura existente sobre aspectos que definen el internet de las cosas en el ámbito de la salud pública. Métodos: se realizó una investigación documental de la literatura en diversas bases de datos académicas y motores de búsqueda; (MEDLINE, Scopus, IEEE Xplore, PubMed, Science Direct, Google Scholar y Google Books) y sitios web corporativos e institucionales (Cisco, Naciones Unidas y Organización Mundial de la Salud). Se utilizaron los siguientes descriptores: internet de las cosas, conectividad, salud pública, salud móvil, epidemiología, aprendizaje automático, aprendizaje profundo e inteligencia artificial. Se revisaron documentos siguiendo el método que incluye la identificación de la pregunta de investigación (con base en el objetivo) y los estudios relevantes, seguido de la selección de los escritos y el cotejo, resumen y presentación de los resultados. Desarrollo: los conceptos y opiniones se estructuraron en tres capítulos donde se exponen las ideas esenciales relacionadas con el tema objeto de estudio: origen del internet de las cosas, el internet de las cosas en salud pública y conclusiones. Conclusiones: el internet de las cosas representa para el área de salud pública una posibilidad innovadora para entender y atender el fenómeno salud-enfermedad de las poblaciones, y proporcionar una red de colaboración entre individuos sustentado en la conformación de una arquitectura de la participación desde un enfoque inteligente.

ABSTRACT Introduction: the internet of things offers new opportunities for access to data, specific services in education, security and health care, among other fields. Objective: to carry out a review of the existing literature on aspects that define the internet of things in the field of public health. Methods: a documentary research of the literature was carried out in various academic databases and search engines; (MEDLINE, Scopus, IEEE Xplore, PubMed, Science Direct, Google Scholar and Google Books) and corporation and institutional websites (Cisco, United Nations and World Health Organization). The following descriptors were used: internet of things, connectivity, public health, mobile health, epidemiology, machine learning, deep learning, and artificial intelligence. Documents were reviewed following the method that includes the identification of the research question (based on the objective) and the relevant studies, followed by the selection of the writings and the comparison, summary and presentation of the results. Development: the concepts and opinions were structured in three chapters where the essential ideas related to the subject under study are presented: origin of the internet of things, the internet of things in public health and conclusions. Conclusions: the internet of things represents an innovative possibility for the area of public health to understand and attend to the health-disease phenomenon of populations, and to provide a network of collaboration between individuals based on the creation of an architecture of participation from a smart approach.

Entre a crise sanitária e o racismo institucional: a proteção da saúde da população negra no contexto da pandemia covid-19 / Between the health crisis and institutional racism: the protection of the health of the black population in the context of the covid-19 pandemic

INTRODUÇÃO: A pandemia da covid-19 trouxe ao setor saúde diversos desafios para a mitigação do vírus que se espalhava por todo o mundo. Assim, ao considerar a determinação social de saúde, observa-se que a condição de vulnerabilidade da população pode influenciar na exposição do adoecimento e de seu agravamento. Nesse caso, ressalta-se a importância de compreender as tomadas de decisões da gestão do SUS em relação à proteção da saúde da população negra. OBJETIVO: Analisar as propostas das Secretarias Estaduais da Saúde da Região Nordeste para a proteção da população negra no contexto de contingenciamento da covid-19. METODOLOGIA: Trata-se de um estudo analítico e exploratório, de abordagem qualitativa, de cunho transversal. A partir dos Boletins Epidemiológicos, Plano de Contingências Estaduais para o Enfrentamento da Covid-19 e os Planos Estaduais de Saúde das Secretarias Estaduais de Saúde da Região Nordeste. A análise de dados se deu, individualmente, por meio da análise de conteúdo e coletivamente, por meio de quadros analíticos. RESULTADO: Foram identificados 2.495 Boletins Epidemiológicos publicados no período de 27 de fevereiro de 2020 até o dia 30 de abril de 2021, 09 Planos Estaduais de Contingenciamento da Covid-19 e 08 Planos Estaduais de Saúde, os dados dos boletins retratam que a população negra foi a mais atingida pela pandemia na Região do Nordeste comparada com outras populações. Em relação às medidas de proteção para esta população, apenas um Plano de Contingência apresentou algum tipo de ação, e 5 Planos de Saúde apresentaram propostas. CONSIDERAÇÕES FINAIS: A partir dos pressupostos do racismo institucional em saúde e das consequências da covid-19 na população negra foram observados fragilidades da gestão do setor saúde no planejamento de medidas para proteção à saúde da população negra (AU).

INTRODUCTION: The covid-19 pandemic brought several challenges to the health sector for the control of the virus that spread throughout the world. Thus, when considering the social determination of health, it is observed tha the vulnerable population may be more exposed to illness and worsening of diseases. In this case, the importance of understanding SUS management decision-making in relation to the protection of the health of the black population is highlighted. GOAL: Analyze the measures proposed by the State Health Departments of the Northeast Region for the protection of the black population in the context of the Covid-19 contingency. METHODOLOGY: This is an analytical and exploratory research, with a qualitative approach, with a cross-sectional nature, based on the Epidemiological Bulletins, the State Contingency Plan for the Control of Covid-19 and the State Health Plans of the State Health Departments in the Northeast Region. Data analysis was performed through content analysis and collectively through analytical frameworks. RESULT: About 2,495 Epidemiological Bulletins published in the period from February 27, 2020 to April 30, 2021, 09 State Contingency Plans of Covid-19 and 08 State Health Plans were identified, data from bulletins show that the black population was the most affected by the pandemic in the Northeast Region compared to other populations. The protection measures for this population found, it was only in one Contingency Plan presented some type of action, and 5 Health Plans presented proposals. FINAL CONSIDERATIONS: Based on institucional racism in health and the consequences of Covid-19 on the black population, weaknesses in the management of the health sector were observed in the planning of measures to protect the health of the black population (AU).

Perceptions of the rape crisis in the Eastern Democratic Republic of Congo: A community-based approach using an opportunistic design

For almost three decades, the Democratic Republic of Congo (DRC) has experienced cycles of armed conflict, particularly in the east. During these conflicts, systematic rape has been used as a weapon of war to break women and communities. Knowledge produced about this phenomenon to date relates to the epidemiology, etiology and the consequences of these rapes, particularly on survivors in care institutions, thus ignoring the impact this phenomenon has on the communities. Our survey aims to investigate the extent to which women from the Orientale, North Kivu and South Kivu provinces experienced rape, as well as their perceptions regarding its frequency, characteristics, and repercussions for/on victims in their communities. From a sample of 1483 women, more than 99% had directly or indirectly experienced rape, on at least five occasions in three-quarters of cases. In their experience, a large proportion of the rapes took place at the victims' homes in the presence of family members and were perpetrated by members of military or paramilitary groups. Frequent health problems (several possibilities) reported include: bleeding (40.8%), pain (23.9%); unwanted pregnancies/abortions (23.4%), urogenital problems including STD (12.0%). Concerning mental health, they reported fear and anxiety (56.3%), depression and suicidal thoughts (16.8 %), insomnia (5.3%); 94.7% reported feelings of humiliation and shame and 6.9% social exclusion and stigmatization. Support for victims comes largely from NGOs (47.6%), families (27.1%) and Churches (14.3%). This is a major cultural, economic, political, human rights, and public health problem, which the authorities and international community must commit to tackling. (Afr J Reprod Health 2022; 26[4]: 42-56).

Rebuilding a US Federal Data Strategy After the End of the "Community Health Status Indicators".

For nearly 2 decades, the Community Health Status Indicators tool reliably supplied communities with standardized, local health data and the capacity for peer-community comparisons. At the same time, it created a large community of users who shared learning in addressing local health needs. The tool survived a transition from the Health Resources and Services Administration to the Centers for Disease Control and Prevention before being shuttered in 2017. While new community data tools have come online, nothing has replaced Community Health Status Indicators, and many stakeholders continue to clamor for something new that will enable local health needs assessments, peer comparisons, and creation of a community of solutions. The National Committee on Vital and Health Statistics heard from many stakeholders that they still need a replacement data source. (Am J Public Health. 2021;111(10):1865-1873. https://doi.org/10.2105/AJPH.2021.306437).

Financial implications of New York City's weight management initiative.

PURPOSE: To estimate potential annual savings in medical expenditures from a subsidized weight management program from the NYC Government perspective. DESIGN: Longitudinal observational study. SETTING: Employees of New York City (NYC) government and enrolled dependents. SAMPLE: 14,946 participants with overweight and obesity. INTERVENTION: WW (formerly Weight Watchers®) 'Workshop' and 'Digital' programs. MEASURES: Participation rate, enrollment duration, weight change, and predicted gross and net total and per capita medical expenditure savings and return on investment (ROI). ANALYSIS: Participation rate, enrollment duration, weight change, and program costs are based on direct observation. Predicted savings are simulated based on published data relating weight loss to medical expenditure reductions. RESULTS: In total, 47% of participating employees and 50% of participating dependents lost weight during the enrollment period. Mean (median) enrollment duration for employees was 7.1 months (7.0) and for dependents was 6.9 months (6.0). Mean (median) weight losses for the employees in 'Workshops' and 'Digital' was 6.6 lbs (2.80) and 6.3 lbs (0.0). For dependents, weight losses were 7.4 lbs (3.59) and 11.6 lbs (2.0). Per capita and total predicted net savings to NYC Government from employees was estimated to be $120 and $1,486,102 for an ROI of 143%. Including dependents, predicted net savings increases to $1,963,431 for an ROI of 189%. Over 80% of savings came from participants in the Obese III category. CONCLUSION: An evidence-based weight management program has the potential to generate a positive ROI for employers. Future studies should validate these estimates using actual data and more rigorous designs.

Diálogo intercultural como herramienta de construcción en políticas de salud. Amazonía Colombiana / Intercultural dialogue as a tool for construction in health policies. Colombian Amazon

OBJETIVO: Describir el diálogo intercultural como herramienta para la construcción de políticas públicas de salud que respondan a la diversidad cultural indígena colombiana. MÉTODOS: Investigación cualitativa: observación participante, entrevistas en profundidad y análisis documental durante 2010 a 2019, desde la experiencia en la Asociación Indígena Zonal de Arica (AIZA) en la Amazonía colombiana. RESULTADOS: El diálogo intercultural en la construcción de las políticas públicas en salud relativas a los pueblos indígenas se describe a nivel comunitario, departamental y nacional. En AIZA, el diálogo se realiza entre las etnias muina, p++nemina e inga de manera constante y fluida, promoviendo el desarrollo de un proceso de salud que tiene como meta el fortalecimiento de la medicina tradicional y complementarla con la occidental. A nivel departamental, el diálogo entre las asociaciones indígenas es constructivo y colaborativo; entre asociaciones e instituciones gubernamentales, el diálogo depende de la voluntad de los funcionarios de turno. A nivel nacional, el diálogo entre las asociaciones e instituciones nacionales es precario. Las instituciones tienen objetivos de corto plazo; no comprenden que se requieren metas de largo plazo, y ello dificulta la construcción de políticas en salud pertinentes con la diversidad cultural. DISCUSIÓN: El diálogo intercultural como herramienta avanza en cada nivel, bien sea comunitario, departamental y nacional, de manera distinta y única, confluyendo diferentes factores

OBJECTIVE: Intercultural dialogue is reported as a tool to devise public health policies that respond to the indigenous cultural reality of Colombia. METHODS: Qualitative research strategies involving participant observation, in-depth interviews and documentary analysis over the period 2010 to 2019; from the experience in the Arica Zonal Indigenous Association (AIZA) in the Colombian Amazon. RESULTS: Intercultural dialogue in the drawing up of public health policies related to indigenous peoples at community, departmental and national level. In AIZA dialogue between the muina, p++ nemina and inga ethnic groups is constant and fluid. This enables developing a healthcare process whose aim is to strengthen traditional medicine complementary to its western counterpart. At departmental level, dialogue with indigenous associations is constructive and collaborative. However, dialogue between governmental associations and institutions depends on the will of the officials on duty. At national level dialogue between national associations and institutions is precarious. Institutionalism has short term aims and there is no understanding that long term goals are required. This hinders building health policies relevant to cultural diversity. DISCUSSION: Intercultural dialogue as a tool advances at each level, be it community, departmental and national in a different and unique way where different factors converge

Estabelecimento de metas no planejamento da aposentadoria: reflexão à luz de Imogene King / Goal setting in retirement planning: reflection in the light of Imogene King / Planificación de la jubilación y establecimiento de metas: reflexión a la luz de Imogene King

Objetivo: refletir sobre o estabelecimento de metas no planejamento da aposentadoria à luz da teoria de Imogene King, que se caracteriza por ser interacionista, pautada no cuidado de Enfermagem que não se restringe ao âmbito individual, mas pode ser prestado a um grupo social com o qual o profissional estabelece contato. Método: estudo reflexivo realizado por meio de aporte teórico relacionado à teoria do alcance de metas de Imogene King e análise reflexiva do tema planejamento da aposentadoria. Resultados: o estabelecimento de metas ocorre a partir da interação entre enfermeiro e trabalhador, em que cada indivíduo reage de forma particular à aposentadoria, influenciado por suas experiências e percepções. Compete ao enfermeiro valorizar os conhecimentos do trabalhador, a fim de estimular sua adesão ao planejamento da aposentadoria. O trabalhador possui necessidades básicas de informação sobre a aposentadoria, que devem ser fornecidas em momento oportuno pelo profissional. Conclusão: o estabelecimento de metas contribui para que o trabalhador note concretamente seus avanços até o desligamento do trabalho. A teoria de Imogene King direciona o enfermeiro do trabalho no estabelecimento de metas com trabalhadores em pré-aposentadoria.(AU)

Objective: to reflect on the establishment of goals in retirement planning in the light of Imogene King's theory, which is characterized by being interactionist, based on Nursing care that is not restricted to the individual scope, but can be provided to a social group with the which the professional establishes contact. Method: reflective study carried out through theoretical support related to the theory of goal attainment by Imogene King and reflective analysis of the theme of retirement planning. Results: the establishment of goals occurs from the interaction between nurse and employee, in which each individual reacts in a particular way to retirement, influenced by their experiences and perceptions. It is up to the nurse to value the employee's knowledge, in order to encourage their adherence to retirement planning. The employee has basic information needs about retirement, which must be provided by the professional in a timely manner. Conclusion: the establishment of goals contributes to the employee concretely noting his advances until he leaves work. Imogene King's theory directs the occupational health nurse in setting goals with preretirement employees.(AU)

Objetivo: reflexionar sobre la planificación de la jubilación y el establecimiento de metas a la luz de la teoría de Imogene King, que se caracteriza por ser interaccionista,basada en la atención de enfermería no limitada al alcance individual sino que incluye a todo el grupo social con el cual el profesional establece contacto. Método: estudio reflexivo basado en la teoría de metas de Imogene King y análisis reflexivo de la planificación de la jubilación. Resultados: el establecimiento de metas ocurre a partir de la interacción entre el enfermero y el trabajador, en el que cada individuo reacciona de modo diferente a la jubilación, influenciado por sus experiencias y percepciones. Le corresponde al enfermero valorar el conocimiento del trabajador para fomentar su adhesión a la planificación de la jubilación. El profesional debe proporcionar de manera oportuna información básica sobre la jubilación. Conclusión: el establecimiento de metas contribuye a que el trabajador note concretamente sus avances hasta que se desvincule de su trabajo. La teoría de Imogene King orienta al enfermero de trabajo en el establecimiento de metas con los trabajadores que se preparan para la jubilación. (AU)

En la montaña rusa: breve historia del modelo de atención de salud mental en España. Informe SESPAS 2020 / On the roller coaster: an abridged history of mental health planning in Spain. SESPAS Report 2020

El cambio efectivo de la salud mental en España se inició en 1985 con el Informe de la Comisión Ministerial para la Reforma Psiquiátrica, que recomendaba integrar la asistencia psiquiátrica dentro de sistema sanitario general, proveer una atención integral en el entorno del paciente y atender a grupos diagnósticos específicos. El Informe SESPAS 2002 analizó la reforma y recomendó crear una comisión ministerial permanente, diseñar un mapa nacional de servicios sociosanitarios de salud mental, crear una agencia de coordinación y de promoción de la salud mental, y analizar la financiación de los recursos y la investigación. Desde 2004, el Comité Técnico de la Estrategia de Salud Mental impulsó la elaboración de un marco teórico y normativo que desafortunadamente no se siguió de una hoja de ruta para la mejora del sistema. Después de 2011, el impulso inicial se disipó y el Ministerio de Sanidad declinó liderar la transformación del sistema partiendo de la evidencia informada. Actualmente, el modelo de salud mental comunitaria de 1985 sigue vigente con la adición de algunas mejoras derivadas del modelo de la recuperación (Recovery) y en línea con el modelo del equilibrio de la atención (Balance of care). Asimismo, se ha avanzado en el desarrollo de métodos de evaluación de sistemas y de modelación basada en datos. Sin embargo, la brecha entre la atención general y la de salud mental ha vuelto a aumentar y no se ha avanzado en el desarrollo de una nueva estrategia de salud mental en España

Effective mental health change in Spain started in 1985 with the Report of the Ministerial Commission for the Psychiatric Reform that recommended integrating psychiatric care into the general health system, providing care in the patient's context and for specific diagnoses. The SESPAS 2002 Report carried out an analysis of this reform and recommended the creation of a permanent ministerial commission, the design of a national map of socio-sanitary mental health services, the creation of a coordination and promotion agency for and carrying out a financial analysis of resource provision and research. Since 2004, the Technical Committee for the Mental Health Strategy boosted the elaboration of a theoretical and normative framework that unfortunately did not lead to a road map for the improvement of the system. After 2011, during the financial crisis, the Ministry of Health lost the opportunity to lead a second phase of change of the mental health care, which was evidence-based: no key technical reports were published nor was an action plan based on data developed. Currently, the 1985 community mental health model is still the general framework of mental health care with the addition of aspects related to the recovery model and the balance of care model. Significant progress has been made in developing care systems assessment methods and data-based models that could advance mental health planning. The gap between general health attention and mental health care has increased and the expected reform of the mental health system will not take place in the near future

Todo está en el mapa: Atlas Integrales de Salud Mental para la planificación de servicios. Informe SESPAS 2020 / Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020

OBJETIVO: Este artículo revisa y evalúa el uso de los Atlas Integrales de Salud Mental como herramientas de apoyo a la planificación de servicios dentro del modelo de investigación de ecosistemas de atención de salud. MÉTODO: Se describen los tipos de atlas y el procedimiento para su elaboración. Se presentan los realizados en España y se evalúa su impacto en la planificación de servicios de salud mental. Los atlas agregan información sobre las características locales del sistema de atención, la disponibilidad geográfica de recursos recogida mediante el instrumento DESDE-LTC, y su uso. Utilizan un sistema de información geográfica y otras herramientas visuales. Siguen una metodología de abajo arriba con colaboración de personas decisoras de agencias de planificación para su elaboración y validación externa. RESULTADOS: Desde 2005 se han realizado Atlas Integrales de Salud Mental en nueve comunidades autónomas que comprenden alrededor del 65% de la población de España. Los atlas han tenido un impacto desigual en la planificación de servicios, con un mayor impacto en Cataluña, Vizcaya y Guipúzcoa, y Andalucía, donde responsables sociales han participado activamente en su codiseño y su aplicación a la planificación de servicios sociosanitarios. CONCLUSIONES: Los atlas permiten detectar carencias o duplicidades en la atención, monitorizar cambios a lo largo del tiempo, realizar comparaciones nacionales e internacionales, modelar la eficiencia y hacer análisis benchmark. Este conocimiento puede incorporarse a los sistemas de apoyo a la decisión para una más eficaz planificación de los servicios de salud mental basada en evidencia informada

OBJECTIVE: This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. METHOD: This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. RESULTS: Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. CONCLUSIONS: Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy

Prevención del suicidio, revisión del modelo OMS y reflexión sobre su desarrollo en España. Informe SESPAS 2020 / Suicide prevention, review of the WHO model and reflection on its development in Spain. SESPAS Report 2020

En los últimos años, la conciencia sobre el impacto de la conducta suicida en nuestra sociedad ha ido en aumento, así como el interés por las medidas dirigidas a prevenirlo o reducir el daño causado. Tomando como hoja de ruta el modelo multidisciplinario de prevención del suicidio que promueve la Organización Mundial de la Salud, este artículo hace una revisión no exhaustiva de la evidencia que lo respalda, repasa algunas iniciativas destacadas y reflexiona sobre el desarrollo de este modelo en España. Se han consultado webs de bases de datos biomédicas, instituciones y centros de documentación de referencia en prevención del suicidio, y se han hallado y revisado informes técnicos y artículos de revisión sistemática publicados desde 2010. Se identifican numerosas lagunas en el conocimiento. La evidencia parece ser más sólida y contrastada en favor de intervenciones de tipo sanitario con pacientes de riesgo (prevención indicada), si bien este enfoque resultaría insuficiente para hacer frente al fenómeno. Evidencias relativamente recientes y prometedoras muestran el potencial de otras formas de prevención, en particular de modelos multidisciplinarios que incorporan la acción sobre grupos vulnerables en la comunidad y toda la sociedad (prevención selectiva y universal), y que serían más acordes con la naturaleza compleja y multifactorial del suicidio. La aplicación de estos modelos es todavía muy escasa en nuestro país, donde ha predominado el modelo asistencial-sanitario. Sería conveniente dar un mayor protagonismo a los profesionales de salud pública a fin de potenciar el desarrollo de estos enfoques, con los que están más habituados a trabajar

In recent years, awareness of the impact of suicidal behavior on our society has been increasing, as well as the interest in measures aimed at preventing it or reducing the damage caused. Having the multidisciplinary suicide prevention model promoted by the World Health Organization as a road map, this article makes a non-exhaustive review of the evidence behind the different types of intervention within the model, reviews some outstanding initiatives and reflect on the development of this model in our country. Websites of biomedical databases, institutions and reference documentation centers in suicide prevention have been consulted, identifying and reviewing technical reports and systematic review articles published since 2010. Numerous knowledge gaps have been identified. The evidence seems to be more solid and contrasted in favor of health-type interventions with patients at risk (indicated prevention), although this approach would be insufficient to face the phenomenon. Relatively recent and promising evidence shows the potential of other forms of prevention, particularly multidisciplinary models that incorporate action on vulnerable groups in the community and throughout society (selective and universal prevention), and that would be more in line with the complex and multifactorial nature of suicide. The application of these models is still very scarce in our country, in which the healthcare-health model has predominated. It would be convenient to give greater prominence to public health professionals in order to promote the development of these approaches, with which they are more used to working

Estratégias para previsão da demanda por serviços odontológicos: uma revisão integrativa / Strategies for predicting demand for dental services: an integrative review / Estrategias para pronosticar la demanda de servicios dentales: una revisión integradora

ntrodução:A previsão da demanda por serviços de saúde possibilita melhorias no processo de tomada de decisões gerenciais nas organizações de saúde.Objetivo:O estudo buscou identificar, na literatura, as metodologias utilizadas para prevera demanda por serviçosodontológicos. Metodologia:Trata-se de uma revisão integrativa conduzida de acordo com o método PRISMA. A expressão de busca (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) foi aplicada em campos determinados para os repositórios Scopus Elsevier, Pubmed, BVS e IEEE Xplore.As metodologias empregadas foram categorizadas conforme a temporalidade e o instrumento empregado nosestudos. Resultados:Após aplicação do processo de seleção-exclusão baseado na recomendação PRISMA, foram selecionados 34 documentos, classificados conforme a dependência da colaboração do paciente, a procedência de auto avaliações, o direcionamento a um grupo populacional ou demanda específica, e a relação com o setor público, privado ou ambos. As metodologias identificadas foram: estudos de temporalidade transversal em que o instrumento foi a aplicação de questionário; estudos de temporalidade transversal nos quais o instrumento foi a observação; e estudo de temporalidade longitudinal onde o instrumento foi a aplicação de questionário. Conclusões:A partir dos resultados dessa revisão, foi gerado conhecimento capaz de apoiar o delineamento de estudos com potencial para aprimorar a previsibilidade da demanda por serviços odontológicos (AU).

Introduction:Forecasting the demand for health services enables improvements in the decision-makingprocess in healthcareorganizations.Objective:The present study aimed to identify in the literature the methodologies used to predict the demand for dental services.Methodology:This was an integrative review conducted in accordance with the PRISMA method. The search expression (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) was applied to fields determined for the Scopus Elsevier, PubMed, VHL, and IEEE Xplore databases.The identified methodologies were categorized according to temporality and instrument used in the studies.Results:After applying the selection-exclusion process based on Prisma, 34documents were selected, classifiedaccording to patient's collaboration dependence, self-assessments, the targeting of a specific group or demand and the relationship with public, private or both sectors. The methodologies identified were transversal temporality in which the instrument was the application of a questionnaire or observation and longitudinal temporality where the instrument was the application of a questionnaire. Conclusions:From the results of this review, insights were generatedcapable of supporting studies with potential to improve the forecast of dental services (AU).

Introducción: La predicción de la demanda de servicios de salud permite mejorar el procesode decisiones em organizaciones de salud.Objetivo: El estudio buscó identificar, en la literatura, las estrategias utilizadas para predecirla demanda deserviciosdentales.Metodología: Esta es una revisión integradora realizada de acuerdo con el método PRISMA. La expresión de búsqueda (((pronóstico * O "predicción" O "previsión") Y ("demanda" O tendencia *) Y ("servicios dentales"))) se aplicó a los campos determinados para repositorios Scopus Elsevier, Pubmed, BVS y IEEE Xplore.Las metodologías identificadas se categorizaron según la temporalidady el instrumento utilizado em los estudios.Resultados:Tras aplicar el procesode selección-exclusión basado emPrisma, se seleccionaron 34documentos, clasificadossegún la dependencia de colaboración del paciente, las autoevaluaciones a, la focalización de un grupo o demanda específica y la relación con el sector público, privado o ambos. Las metodologíasidentificadas fueron: latemporalidad transversal en los cuales el instrumento era la aplicación de un cuestionario; estudios de temporalidad transversal en los cuales la observación era el instrumento; y estudio de temporalidad longitudinal donde el instrumento fue la aplicación de un cuestionario. Conclusiones: A partir de los resultados de esta revisión se generó conocimiento capaz de sustentar el diseño de estudios con potencial para mejorar la predictibilidad de la demanda de servicios odontológicos (AU).

Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program.

INTRODUCTION: Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people's health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees. METHODS: We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods. RESULTS: Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively. CONCLUSION: Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.

A Community-Wide Collaboration to Reduce Cardiovascular Disease Risk: The Hearts of Sonoma County Initiative.

PURPOSE AND OBJECTIVES: Collaboration across multiple sectors is needed to bring about health system transformation, but creating effective and sustainable collaboratives is challenging. We describe outcomes and lessons learned from the Hearts of Sonoma County (HSC) initiative, a successful multi-sector collaborative effort to reduce cardiovascular disease (CVD) risk in Sonoma County, California. INTERVENTION APPROACH: HSC works in both clinical systems and communities to reduce CVD risk. The initiative grew out of a longer-term county-wide collaborative effort known as Health Action. The clinical component involves activating primary care providers around management of CVD risk factors; community activities include community health workers conducting blood pressure screenings and a local heart disease prevention campaign. EVALUATION METHODS: The impact of the clinical improvement efforts was tracked using blood pressure data from the 4 health systems participating in HSC. Descriptive information on the community-engagement efforts was obtained from program records. Lessons learned in developing and maintaining the collaborative were gathered through document review and interviews with key informants. RESULTS: Favorable trends were seen in blood pressure control among patients with hypertension in the participating health systems: patients with controlled blood pressure increased from 58% in 2014 to 67% in 2016 (P < .001). Between 2017 and 2019, the community engagement effort conducted 99 outreach events, reaching 1,751 individuals, and conducted 1,729 blood pressure screenings, with 441 individuals referred to clinical providers for follow-up care. HSC scored highly on 6 essential elements of an effective coalition and achieved a degree of sustainability that has eluded many other collaboratives. IMPLICATIONS FOR PUBLIC HEALTH: Factors contributing to the success of HSC include 1) starting small and focused to build trust among participants and demonstrate value, 2) working within the framework of a larger effort, and 3) providing long-term, open-ended backbone support.

Influence of subsidies and promotional strategies on outcomes in a beneficiary-based commercial weight-loss programme.

To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary-based, commercial weight-loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight change. Our independent variables were subsidy strategy (total subsidy (n = 9) vs cost sharing (n = 3)) and combination of promotional-subsidy strategies (mixed campaign + total subsidy (n = 6) vs mass media + total subsidy (n = 3)). We used logistic and linear regression analyses adjusted for beneficiary factors and clustering by organization. From 12 participating organizations, 26 068 beneficiaries registered of which 6215 initially engaged. Cost sharing was associated with significantly greater initial engagement as compared to total subsidy (OR 3.73, P < 0.001); however, no significant between-group differences existed in calls or weight change. Mass media + total subsidy group had significantly greater calls and weight loss at 12 months compared to mixed campaign + total subsidy (-2.6% vs -1.8%, P = 0.04). Cost sharing may promote greater initial engagement, although does not contribute to better participation or weight loss relative to total subsidy. If organizations elect total subsidy, then pairing this strategy with a mass media campaign may promote greater participation and weight loss among beneficiaries.

To vaccinate or not to vaccinate: A comprehensive study of vaccination-subsidizing policies with multi-agent simulations and mean-field modeling.

We combined the elements of evolutionary game theory and mathematical epidemiology to comprehensively evaluate the performance of vaccination-subsidizing policies in the face of a seasonal epidemic. We conducted multi-agent simulations to, among others, find out how the topology of the underlying social networks affects the results. We also devised a mean-field approximation to confirm the simulation results and to better understand the influences of an imperfect vaccine. The main measure of a subsidy' performance was the total social payoff as a sum of vaccination costs, infection costs, and tax burdens due to the subsidy. We find two types of situations in which vaccination-subsidizing policies act counterproductively. The first type arises when the subsidy attempts to increase vaccination among past non-vaccinators, which inadvertently creates a negative incentive for voluntary vaccinators to abstain from vaccination in hope of getting subsidized. The second type is a consequence of overspending at which point the marginal cost of further increasing vaccination coverage is higher than the corresponding marginal cost of infections avoided by this increased coverage. The topology of the underlying social networks considerably worsens the subsidy's performance if connections become random and heterogeneous, as is often the case in human social networks. An imperfect vaccine also worsens the subsidy's performance, thus narrowing or completely closing the window for vaccination-subsidizing policies to beat the no-subsidy policy. These results imply that subsidies should be aimed at voluntary vaccinators while avoiding overspending. Once this is achieved, it makes little difference whether the subsidy fully or partly offsets the vaccination cost.

Enumerating the population eligible for funded HIV pre-exposure prophylaxis (PrEP) in New Zealand.

Background Pre-exposure prophylaxis (PrEP) became publicly funded in New Zealand (NZ) on 1 March 2018. PrEP could have a substantial population-level effect on HIV transmission if scaled up rapidly. An accurate estimate of the size of the PrEP-eligible population would guide implementation. METHODS: We drew on nine sources to estimate the PrEP-eligible population, namely Statistics NZ data, Pharmaceutical Management Agency (PHARMAC) data on adults receiving funded antiretroviral treatment (ART), expert advice, estimates of the HIV care cascade, surveillance of undiagnosed HIV in a community sample of gay and bisexual men (GBM), surveillance of HIV diagnoses, NZ Health Survey data on sexual orientation among males, behavioural surveillance among GBM and behavioural data among people living with HIV (PLWH) from the HIV Futures NZ study. From these sources we derived three estimates relating to GBM, non-GBM and total eligible population. Sensitivity analyses examined different assumptions (GBM denominators, proportion PLWH diagnosed, proportion of diagnosed PLWH treated). RESULTS: We estimated that 17.9% of sexually active HIV-negative GBM would be eligible for PrEP, equating to 5816 individuals. We estimated that 31 non-GBM individuals would be eligible for PrEP. Thus, in total, 5847 individuals would be eligible for PrEP, comprising 99.5% GBM and 0.5% non-GBM. Sensitivity analyses ranged from 3062 to 6718 individuals. CONCLUSIONS: Policy makers can use enumeration to monitor the speed and scale in coverage as implementation of publicly funded PrEP proceeds. Sexual health and primary care services can use enumeration to forecast PrEP demand and plan accordingly. Better quality data, especially on transgender adults in NZ, would improve the accuracy of estimates.