Defining and classifying public health systems: a critical interpretive synthesis.

BACKGROUND: The introduction of the determinants of health has caused a shift towards understanding health from a holistic perspective as well as increased recognition of public health's contributions to the health of the population. Several frameworks exist to conceptualise healthcare systems, highlighting the stark contrast of frameworks unique to public health systems. The objectives of this study were to define public health systems and assess differences between healthcare systems and public health systems within established health systems frameworks. METHODS: A critical interpretive synthesis was conducted. Databases searched included EBSCOhost, OVID, Scholars Portal, Web of Science, Cochrane Library and Health Systems Evidence. Data extraction, coding and analysis followed a best-fit framework analysis method. Initial codes were based on a current leading health systems and policy classification scheme - health systems arrangements (governance, financial and delivery arrangements). RESULTS: A total of 5933 unique documents were identified and 67 were included in the analysis. Definitions of public health and public health systems varied significantly as did their roles and functions across jurisdictions. Public health systems arrangements generally followed those of health systems, with the addition of partnerships (community and inter-sectoral) and communication playing a larger role in public health. A public health systems framework and conceptualisation of how public health currently fits within health systems are presented. CONCLUSIONS: Public health systems are unique and vital entities within health systems. In addition to examining how public health and public health systems have been defined within the literature, this review suggests that establishing the scope of public health is crucial to understanding its role within the larger health system and adds to the discourse around the relationship between public health, healthcare and population health. More broadly, this study addresses an important gap in understanding public health systems and provides conceptual and practical contributions as well as areas for future research.

Feasibility of describing community strengths relative to Omaha system concepts.

OBJECTIVES: The purpose was to determine the feasibility of using a standardized language, the Omaha System, to describe community-level strengths. The objectives were: (a) to evaluate the feasibility of using the Omaha System at the community level to reflect community strengths and (b) to describe preliminary results of community strengths observations across international settings. DESIGN AND SAMPLE: A descriptive qualitative design was used. The sample was a data set of 284 windshield surveys by nursing students in 5 countries: Mexico, New Zealand, Norway, Turkey, and the United States. MEASURES: An online survey included a checklist and open-ended questions on community strengths for 11 concepts of the Omaha System Problem Classification Scheme: Income, Sanitation, Residence, Neighborhood/workplace safety, Communication with community resources, Social contact, Interpersonal relationship, Spirituality, Nutrition, Substance use, and Health care supervision. Themes were derived through content analysis of responses to the open-ended questions. RESULTS: Feasibility was demonstrated: Students were able to use the Omaha System terms and collect data on strengths. Common themes were described among the five countries. CONCLUSIONS: The Omaha System appears to be useful in documenting community-level strengths. Themes and exemplar quotes provide a first step in developing operational definitions of strengths at a more granular level.

[Same words, different meanings: How epidemiological terminology struggles with population health intervention research]. / À mêmes mots, sens différents--les difficultés de la terminologie épidémiologique avec la recherche en interventions en santé des populations.

Public health research differs from clinical epidemiological research in that its focus is primarily on the population level social and structural determinants of individual health and the interventions that might ameliorate them, rather than having a primary focus on individual-level risks. It is typically concerned with the proximal and distal causes of health problems, and their location within complex systems, more than with single exposures. Thus, epidemiological terms and concepts may have very different implications when used in the context of population health. This paper considers some key differences in relation to terms like 'population', 'baseline', 'control group' 'outcome' and 'adverse effects'. Even the concept of an 'intervention' often needs careful handling. The paper concludes that there is a need for an expanded, and more realistic use of these terms in the population health intervention research context.

[Development of valorization of physical activity: the role of HIV associations]. / La construction de la valorisation de l'activité physique : le rôle des associations VIH.

With the arrival of triple combination therapy in 1996-1997, HIV infection, considered up until then to be a life-threatening condition, changed statuses within the realm of public health actions Progressively likened to a "chronic illness", the discourse on HIV prevention targeting people living with HIV (PLHIV) began to evolve. A review of the scientific literature and the journals of four national HIV associations published between 1990 and 2010 shows that physical activities, previously discouraged because considered to be dangerous, have become increasingly presented as a means of improving quality of life and are increasingly recommended for PLHIV. This article studies this reconfiguration of the discourse on HIV prevention, as well as its effects on the discourse conveyed by HIV associations. The article shows how the new classification of HIV as a "chronic illness", on the basis of scientific expertise, has led to a modified discourse on prevention, including the recommendation of regular and controlled physical activity. This new orientation has contributed to the restructuring of HIV associations which relay this discourse and modify their organization and services, increasingly offering access to physical activities. However, this raises the question of the effects of this new representation of physical activities, as there has been little conside-ration of the difficulties encountered by PLHIV to respond to these repeated encouragements to modify their lifestyles in order to be "good" chronically ill patients. .

The Affordable Care Act's implications for a public health workforce agenda: taxonomy, enumeration, and the Standard Occupational Classification system.

The Affordable Care Act brings a renewed emphasis on the importance of public health services and those whose occupations are defined by performing the essential public health functions. The Affordable Care Act Prevention and Public Health Fund is a signal to the field that its work is important and critical to the health of the nation. Recent reports by the Institute of Medicine describe the changing dimensions of public health work in primary care integration and the need for enhanced financing of public health as investment. Gaining knowledge about the public health workforce, that is, how many workers there are and what they are doing, is of growing interest and concern for the field. Although enumeration of the public health workforce has been attempted several times by the federal government beginning as early as 1982, it was not until the year 2000 that a major effort was undertaken to obtain more complete information. Limitations that hampered Enumeration 2000 have persisted however. With implementation of the Affordable Care Act and other new ventures, key federal agencies are developing strategies to pursue a systemic and systematic enumeration and consistent taxonomy process. Included in these efforts is use of the Bureau of Labor Statistics, Standard Occupational Classification system. A clear and accurate understanding of the public health workforce and its characteristics is a major challenge. A well-constructed, systematic enumeration process can add to our understanding of the nature and functions of that workforce. In addition, discussion of enumeration must include the need for a consensus within the field that leads to a consistent taxonomy for the public health occupations. This article will provide a stage-setting brief of historical actions regarding enumeration, and it will examine selected enumeration activities taking place currently. It will discuss positive and negative implications facing public health and the potential for enhancing the existing Standard Occupational Classification system to aid enumeration studies.

Disasters and their consequences for public health.

Humanitarian emergencies, including natural and human-made disasters, conflicts and complex emergencies, constitute what has traditionally been considered the main threat to health security worldwide. Each year millions of people are affected by natural and man-made disasters around the world. Tornados, hurricanes, heavy rains and earthquakes resulted in tens of thousands of deaths and many more affected. Indeed, disasters would not be disastrous if it were not for their effect on the human population. Links between the natural environment and human health have been suggested for centuries. Disasters throughout history have had significant impact on the numbers, health status and life style of populations. It induce: Deaths, Severe injuries, requiring extensive treatments, Increased risk of communicable diseases, Damage to the health facilities, Damage to the water systems, Food shortage, Population movements. The authors focused on the natural disasters, caused by natural forces rather than by acts associated with human behavior and that affect a large population in a widespread geographic region. Describing the general effects of disasters on health, it does not pretend to cover every contingency. Review of recent literature on humanitarian emergencies has shown that the public health consequences of natural disasters are complex. Disasters directly impact the health of the population resulting in physical trauma, acute disease and emotional trauma. In addition, disasters may increase the morbidity and mortality associated with chronic disease and infectious disease through the impact on the health care system.

A global call for talaromycosis to be recognised as a neglected tropical disease.

Talaromycosis (penicilliosis) is an invasive mycosis that is endemic in tropical and subtropical Asia. Talaromycosis primarily affects individuals with advanced HIV disease and other immunosuppressive conditions, and the disease disproportionally affects people in low-income and middle-income countries, particularly agricultural workers in rural areas during their most economically productive years. Approximately 17 300 talaromycosis cases and 4900 associated deaths occur annually. Talaromycosis is highly associated with the tropical monsoon season, when flooding and cyclones can exacerbate the poverty-inducing potential of the disease. Talaromycosis can present as localised or disseminated disease, the latter causing cutaneous lesions that are disfiguring and stigmatising. Despite up to a third of diagnosed cases resulting in death, talaromycosis has received little attention and investment from regional and global funders, policy makers, researchers, and industry. Diagnostic and treatment modalities remain extremely insufficient, however control of talaromycosis is feasible with known public health strategies. This Viewpoint is a global call for talaromycosis to be recognised as a neglected tropical disease to alleviate its impact on susceptible populations.

Hospitalization and mortality rates of malignant prostatic neoplasms in Brazil: A cross-sectional study from 2008 to 2018

Abstract Prostate cancer (PCa) is a highly prevalent condition among men worldwide, resulting in reduced quality of life and increased costs to health systems due to hospitalization and death. This study aimed to explore and understand the evolution of PCa in Brazil from 2008 to 2018. Data were obtained from the National Health System Department of Informatics (DATASUS) using code C61 for malignant prostatic neoplasms. We presented the hospitalization and mortality rates in a temporal-, regional- and age-dependent manner. From 2008 to 2018, a year-dependent increase in hospital admissions due to PCa was reported in Brazil, in which the Southeast region showed the highest prevalence. Men aged ≥80 and those 70-79 years old had similar hospitalization rates, followed by men aged 60-69, 50-59, 40-49 and 30-39 years old. Similarly, an increase in deaths due to PCa was reported during this period, with the highest rates seen in the Southeast. Men aged ≥80 years had higher mortality rates, followed by those aged 70-79, 60-69, 50-59, 40-49 and 30-39 years old. The results obtained indicate an age- and region-dependent increase in PCa morbidity and mortality in Brazil overtime and may contribute to the ongoing discussion on the role and future perspective of the health care system in Brazil

3Ts of low cure rate: taxonomy, themes and theory of low cure rate in Pakistan's TB control programme and gathering a 360-degree perspective through qualitative, in-depth interviewing approach.

OBJECTIVE: WHO recommends cure of tuberculosis (TB) as the best prevention strategy; however, information about factors associated with low cure rate in patients with drug-susceptible TB is limited in Pakistan. Therefore, the purpose of this study was to explore the factors that account for low TB cure rate. METHODOLOGY: The present qualitative study recruited diverse informants through purposive sampling to explore low cure rate situation in Badin between March and June 2017. Data were collected from clinicians, paramedics, lab technicians, district field supervisors, patients and treatment supporters through indepth and face-to-face interviews. Interviews were conducted in local languages (Urdu and Sindhi) and transcribed into English. Coding structure was developed inductively and applied on textual data to draw output at the levels of taxonomy, themes and theory, as proposed by Bradley et al. FINDINGS: Thirty-seven individuals consented to participate in this study and provided detailed account of the subject under enquiry. Review of interview data collected from a variety of informants resulted in the identification of four broad factors (taxonomy) that contributed to the situation of low cure rate in one of the districts implementing the public-private mix intervention. These factors were (1) health-seeking behaviour, (2) technical capacity of the healthcare provider, (3) managerial capacity of the healthcare provider, and (4) access to healthcare facility and services. Each factor is deconstructed into key dimensions (themes) that emerged from the dialogue between the interviewer and the respondents. Moreover, dimensions were exemplified through underlying concepts that correspond to theories for low cure rate. CONCLUSION: Change in programme reporting requirement has demeaned the significance of having cure as treatment outcome. Therefore, returning the focus to achieving cure status for TB cases will be beneficial for assessing the effectiveness of TB control efforts. In parallel to the care delivery system, a mechanism for disseminating disease-related and treatment-related information should be introduced.

Ranking community health status to stimulate discussion of local public health issues: the Wisconsin County Health Rankings.

United Health Foundation's America's Health Rankings, which ranks the states from "least healthy" to "healthiest," receives wide press coverage and promotes discussion of public health issues. The University of Wisconsin Population Health Institute used the United Health Foundation's model to develop the Wisconsin County Health Rankings ("Health Rankings") from existing county-level data. The institute first released the rankings in 2004. A survey of the Wisconsin county health officers indicated that they intend to use the rankings for needs assessment, program planning, and discussion with county health boards. The institute implemented many of the health officers' suggestions for improvement of the rankings in subsequent editions. The methods employed to create the rankings should be applicable in other states.

Relationships between nurse- and physician-to-population ratios and state health rankings.

OBJECTIVE: To evaluate the relationship between nurse-to-population ratios and population health, as indicated by state health ranking, and to compare the findings with physician-to-population ratios. DESIGN: Secondary analysis correlational design. SAMPLE: The sample consisted of all 50 states in the United States. Data sources included the United Health Foundation's 2006 state health rankings, the 2004 National Sample Survey for Registered Nurses, and the U.S. Health Workforce Profile from the New York Center for Health Workforce Studies. RESULTS: Significant relationships between nurse-to-population ratio and overall state health ranking (rho=-.446, p tf?>=.001) and 11 of the 18 components of that ranking were found. Significant components included motor vehicle death rate, high school graduation rate, violent crime rate, infectious disease rate, percentage of children in poverty, percentage of uninsured residents, immunization rate, adequacy of prenatal care, number of poor mental health days, number of poor physical health days, and premature death rate, with higher nurse-to-population ratios associated with higher health rankings. Specialty (public health and school) nurse-to-population ratios were not as strongly related to state health ranking. Physician-to-population ratios were also significantly related to state health ranking, but were associated with different components than nurses. CONCLUSIONS: These findings suggest that greater nurses per capita may be uniquely associated with healthier communities; however, further multivariate research is needed.

Naming and the Public Health Roles of Physicians.

Resources from the American Medical Association (AMA) Archives facilitate historical consideration of how physicians' authority has been exercised in naming diseases, epidemics, and other health-related issues of national importance. Selected images emphasize physicians' roles in motivating public health initiatives through public service posters, advertisements, and minutes of the AMA House of Delegates meetings.

Use of medication and associated factors in adults living in Rio Branco, Acre. Use of medication in adults

Abstract We analyzed use of medication and associated factors in adults aged 18-59 years living in Rio Branco, Acre. This is a cross-sectional and population-based study that used a probabilistic sample of the population from rural and urban areas of the city of Rio Branco, Acre. The Prevalence Ratio (PR) was calculated with 95% confidence intervals and associations were estimated by Poisson regression. This study found a 29.4% prevalence ratio of use of medication among individuals aged from 18 to 59 years (685 adults: 473 women and 212 men; producing estimates for 211,902 adults: 110,769 women and 101,133 men). After adjusted analysis, their use was associated with: age (50-59 years, PR: 2.36; 95%CI: 2.29-2.43); women (PR: 1.25; 95%CI: 1.23-1.27); up to elementary school (PR: 1.13; 95%CI: 1.11-1.15); and poor or very poor self-rated health (PR: 1.47; 95%CI: 1.43-1.51). The health conditions associated with use of medication were: number of comorbidities, hypertension, diabetes, insomnia, depression, number of health complaints and use of health services. The most frequently used drugs were those belonging to the following ATC categories: alimentary tract and metabolism, cardiovascular system, nervous system, and the musculoskeletal system.

Feasibility of Describing Wellbeing and Strengths at the Community Level Utilizing the Omaha System.

Capturing strengths at the community level offers an emergent perspective to a strength-based approach for population health. The Omaha System standardized terminology has been found feasible to describe individual strengths in patient care planning. This study depicts results of using the Omaha System to capture strengths at the community level. Descriptive statistics and visualization were used to examine patterns of strengths and signs/symptoms by Omaha System Problem concept based on the secondary data analysis from 118 student-generated community assessments. Results suggest that it is feasible to use the Omaha System as a method classifying strengths and problems at the community level. The relationship between strengths and signs/symptoms is consistent with the pattern observed at the individual-level. Utilizing a strength-based model may provide robust information about community strengths leading to new approaches to population health management in support of community wellbeing.

Socioeconomic disparities in health in the US: an agenda for action.

Inequality of income and wealth in the US has been growing rapidly since 1972. Evidence of socioeconomic effects on health is documented for many endpoints, and there is evidence that socioeconomic disparities in health are increasing. In Europe, equity in health and health care is a target of the World Health Organization, and has led to a variety of activities to reduce socioeconomic disparities in morbidity and mortality. In the US, activities in the public and private sectors have increased in recent years but attention, especially among the public-at-large in addition to elites, needs to be shifted to socioeconomic disparities. The paper suggests action strategies drawn from the European experience and other US efforts to place public health priorities on the policy agenda. A first step is to create a climate of unacceptability for socioeconomic disparities in health. Recommended activities include improvement and utilization of existing data; dissemination to broad audiences; building on existing initiatives; creating multi-sectoral alliances; formation of state and community task forces; attention to human capital as well as social justice issues; creative use of media; attraction of new funders; and implementation of quantitative targets.

[A prerequisite to the development of community health: the mobilization of professionals and residents in Saint-Herblain]. / Un préalable à une démarche de santé communautaire: la mobilisation des professionnels et des habitants à Saint-Herblain.

In 1990-1991, the city of Saint-Herblain (Loire-Atlantique) has been involved in a method of a social development of the area. As part of it, an health project has been made in order to associate the residents. Through a question: "what is health as for you?", residents and professionals have expressed themselves about the neighbourhood sources before identifying the problems and difficulties. This "positive" method has let a dynamics to be carried out and professionals and inhabitants go on participating in it.

[Aggressive behaviour and the public health condition]. / Zachowania agresywne a stan zdrowia spoleczenstwa.

Aggressive behaviour should be considered as the feedback in relation with the health condition of society. Aggression may be considered as instinct behaviour or acquired social behaviour. If we are studying the theory of aggressive behaviour, we should take into consideration psychosocial and biological features, the influence of neurotransmitters: seratonin, dopamine and some biochemical markers just like the level of cholesterol, troigliceroids and testosterone. Aggressive behaviour, physical and mental violence has negative influence on physical health, fitness and efficiency. Fright, depression, psychosis and isolation are the irreparable changes in a man's psyche. Autoaggressive behaviours: selfhurting, suicide attempts and committed suicides are external forms of aggression. The suicide rate shows the level of physical and mental health of society. The higher the suicide rate is, the worse the state of health is. 20 per cent of Polish patients are those with autodestructive behaviours. They are treated because of psychical disorders. They are treated because of mental disorders. The state of health, and stress cause social and family isolation. These lead to depression and somatic diseases, like blood circling, breathing and digestive disorders. Violence in family, murders are often result of mental disorders, unbalanced psyche or alcoholism, diseases of nervous system. II person often becomes aggressive because he wants to relieve his emotions caused by bad health condition.

[Parabolic parables: predictive genetic testing, social constructions of risk, and the relation between health-care professionals and the mass media]. / Parábolas, parabólicas: testagens genéticas preditivas, construções sociais de risco e a relação profissionais da saúde/meios de comunicação de massa.

The article examines conceptual topics underlying construction of the "new public health" and epidemiology, particularly its molecular branch and the idea of genetic risk, in the face of issues raised by new technologies, globalization, today's vast increase in communication strategies, and the weakening of identity links. Problems related to the creation of new interdisciplinary fields are also considered, such as epidemiology and molecular genetics. The repercussions of the social communication of genetic contents (especially predictive genetic testing and the cloning of mammals) are also analyzed.

[Classification and organization technologies in public health]. / O klassifikatsii organizatsionnykh tekhnologii v zdravookhranenii.

The authors discuss the impact and main characteristics of organization technologies in public health and the processes of their development and evaluation. They offer an original definition of the notion "organization technologies" with approaches to their classification. A system of logical bases is offered, which can be used for classification. These bases include the level of organization maturity and stage of development of organization technology, its destination to a certain level of management, type of influence and concentration of trend, mechanism of effect, functional group, and methods of development.