Poverty in childhood and adverse health outcomes in adulthood

The experience of poverty during childhood is a potent predictor of a variety of adverse health outcomes during middle and late adulthood. Children who live in poverty are more likely as adults than their peers to develop and die earlier from a range of diseases. These effects are especially strong for cardiovascular disease and type II diabetes. Most disturbingly, these effects appear in large part to be biologically embedded such that later improved life circumstances have only a modest ameliorative effect. Considering these findings and the relatively high rates of child poverty in nations such as Canada, UK, and USA, those concerned with improving the health of citizens should focus their attention on advocating for public policy that will reduce the incidence of child poverty.     

The long road to semantic interoperability in support of public health: Experiences from two states

Proliferation of health information technologies creates opportunities to improve clinical and public health, including high quality, safer care and lower costs. To maximize such potential benefits, health information technologies must readily and reliably exchange information with other systems. However, evidence from public health surveillance programs in two states suggests that operational clinical information systems often fail to use available standards, a barrier to semantic interoperability. Furthermore, analysis of existing policies incentivizing semantic interoperability suggests they have limited impact and are fragmented. In this essay, we discuss three approaches for increasing semantic interoperability to support national goals for using health information technologies. A clear, comprehensive strategy requiring collaborative efforts by clinical and public health stakeholders is suggested as a guide for the long road towards better population health data and outcomes.     

Analyzing the influence of institutions on health policy development in Uganda: a case study of the decision to abolish user fees

Background

During the 2001 election campaign, President Yoweri Museveni announced he was abolishing user fees for health services in Uganda. No analysis has been carried out to explain how he was able to initiate such an important policy decision without encountering any immediate barriers.

Objective

To explain this outcome through in-depth policy analysis driven by the application of key analytical frameworks.

Methods

An explanatory case study informed by analytical frameworks from the institutionalism literature was undertaken. Multiple data sources were used including: academic literature, key government documents, grey literature, and a variety of print media.

Results

According to the analytical frameworks employed, several formal institutional constraints existed that would have reduced the prospects for the abolition of user fees. However, prevalent informal institutions such as “Big Man” presidentialism and clientelism that were both ‘competing’ and ‘complementary’ can be used to explain the policy outcome. The analysis suggests that these factors trumped the impact of more formal institutional structures in the Ugandan context.

Conclusion

Consideration should be given to the interactions between formal and informal institutions in the analysis of health policy processes in Uganda, as they provide a more nuanced understanding of how each set of factors influence policy outcomes.     

Child abuse as a life-course social determinant of adult health

Despite prevention efforts worldwide, many children today continue to experience abuse within close relationships, and many adults carry with them histories of abuse. This narrative review focuses on the growing body of research regarding the long-term health consequences of child abuse. First, the review presents a brief introduction to the phenomenon of child abuse, as well as a discussion of theoretical approaches to describing processes through which child abuse can jeopardize later adult health. The review then provides an integrative summary of studies based on community samples that examine associations between physical, psychological, and sexual abuse in childhood and adult mental and physical health. The article concludes with a discussion of conceptualizing child abuse as a life-course social determinant of adult health for both clinical and public health purposes and calls for translational research that can inform efforts to promote the health of diverse individuals and populations with histories of child abuse.     

The association of coping to physical and psychological health outcomes: a meta-analytic review

We performed a series of meta-analyses examining the associations between coping and health-related outcomes in nonclinical adult samples. Results revealed that problem-focused coping was positively correlated with overall health outcomes, whereas confrontive coping, distancing, self-control, seeking social support, accepting responsibility, avoidance, and wishful thinking were each negatively correlated with overall health outcomes. Neither planful problem solving nor positive reappraisal was significantly associated with overall health outcomes in our analyses. However, type of health outcome (i.e., physical vs. psychological) and situational characteristics (i.e., stressor type, controllability, and duration) moderated many of the overall associations.     

The WHO essential medicines list AWaRe book: from a list to a quality improvement system

Antibiotics are often prescribed inappropriately, either when they are not necessary or with an unnecessarily broad spectrum of activity. AWaRe (AccessWatchReserve) is a system developed by WHO to classify antibiotics based on their spectrum of activity and potential for favouring the development of antibiotic resistance (Access: narrow spectrum/low potential for resistance; Watch: broader spectrum/higher potential for resistance; Reserve: last resort antibiotics to use very selectively). The WHO target is that by 2023, at least 60% of prescribed antibiotics globally should be from the Access category. The WHO AWaRe Book aims to improve empiric antibiotic prescribing by providing simple guidance for common infections based on the principles of AWaRe in alignment with the Model Lists of Essential Medicines for adults and children.     

Quality-of-life outcomes of a weight management program for adolescents based on motivational interviewing

Objective

To compare motivational interviewing (MI) with conventional care regarding the health-related quality-of-life (HRQoL) of adolescents with overweight/obesity.

中国2009-2019年的精神卫生政策与实施

精神健康是健康的重要组成部分,我国严重精神障碍患者数量庞大,常见精神障碍和心理行为问题逐渐突显。近年来,我国高度重视精神卫生工作,不断出台系列政策措施,如将社区精神卫生服务推广至全国,完善精神卫生服务体系,建立精神卫生综合管理机制,从重视疾病预防向促进全民心理健康发展等,以提高服务的公平性和可及性。本文对2009-2019年我国重要精神卫生政策与实施进行梳理与分析,旨在帮助精神卫生人员熟悉现行精神卫生政策的发展脉络,了解工作中的薄弱环节,明确下一步工作重点。     

Doctors as patients: a systematic review of doctors' health access and the barriers they experience

BACKGROUND: The need to improve doctors' access to health care by reducing the barriers they experience has been regularly described in the literature, yet the barriers experienced are not well defined, despite the volume of expert opinion in this area. AIM: To define what is known about doctors' access to health care from the data within the current literature. DESIGN OF STUDY: A systematic review of studies of doctors' health access. METHOD: A systematic search of MEDLINE and CINAHL, supplemented by citation searches and searches of the grey literature, identified both quantitative and qualitative studies. Two reviewers used specific criteria for inclusion of studies and quality assessment. The data were tabulated and analysed. RESULTS: Twenty-six articles met the inclusion criteria. The paucity of data and the overall poor quality of those data are highlighted. Despite this, many doctors appear to have a GP, but this does not ensure adequate health access. Systemic barriers to healthcare access (long hours and cultural issues) are more significant than individual barriers. CONCLUSION: Expert opinion in this field is supported by poor-quality data. The current knowledge reveals important similarities between doctors and the general population in their healthcare access, especially with mental health issues. Understanding this may help the medical profession to respond to these issues of 'doctors' health' more effectively.     

A scope review on the global impact of COVID-19 lockdown on adolescents' health

BackgroundThe implementation of COVID-19 lockdown measures across the globe could affect adolescents'' health.ObjectiveThis review was conducted to assess the impact of the COVID-19 lockdown on the health of the adolescents.MethodologyWe conducted this study using the scope reviews methodological framework. We searched for articles on the effects of COVID-19 lockdown among adolescents on four databases; MedLine, PubMed, Directory of Open Access Journals and Google Scholar. Screening of articles was done for relevance to the study objective.ResultsThe positive effects of the COVID-19 lockdown on adolescents included increased physical activity for adolescents 17 years and below, increased resource mobilization for healthy lifestyle, and psychosocial support programs for schools. The negative effects of the lockdown period were decreased physical activity with resulting disruptive sleep patterns; increased screen time, behavioral addictive disorder from excessive use of the internet, increased levels of domestic abuse, and worsening of existing mental health disorders. Overall, the COVID-19 lockdown period has had considerable adverse effects on adolescents'' health.ConclusionTo curb the negative effects of the COVID-19 lockdown, we recommend parental supervision of adolescents'' screen time. Adolescent health should be prioritized by policymakers to ensure that future lockdown does not adversely affect them.     

Design and implementation of a national public health surveillance system in Jordan

Understanding and improving the health status of communities depend on effective public health surveillance. Adoption of new technologies, standardised case definitions and clinical guidelines for accurate diagnosis, and access to timely and reliable data, remains a challenge for public health surveillance systems however and existing public health surveillance systems are often fragmented, disease specific, inconsistent and of poor quality. We describe the application of an enterprise architecture approach to the design, planning and implementation of a national public health surveillance system in Jordan. This enabled a well planned and collaboratively supported system to be built and implemented using consistent standards for data collection, management, reporting and use. The system is case-based and integrated and employs mobile information technology to aid collection of real-time, standardised data to inform and improve decision-making at different levels of the health system.     

Self-efficacy as a predictor of adult adjustment to sickle cell disease: one-year outcomes

OBJECTIVE: The present study prospectively investigated the role of self-efficacy in predicting disease symptomatology and health services utilization for adult patients with sickle cell disease. METHODS: These data are derived from a 12-month prospective cohort study of African American adults with sickle cell disease. Disease-specific perceptions of coping self-efficacy and indices of disease severity, health care utilization, and psychosocial adjustment were assessed by use of standardized questionnaires administered by trained clinicians. RESULTS: Perceptions of self-efficacy for coping with sickle cell disease were moderately stable across the 12-month study period. At baseline (N = 147), significant inverse relationships, measured with Pearson correlations, were noted between self-efficacy and the following variables: physical symptoms, psychological symptoms, pain severity, and number of physician visits over the preceding 12 months (p <.01). Similar relationships with self-efficacy were noted at the 1-year follow-up (N = 104) period for measures of physical symptoms, psychological symptoms, and pain severity (p <.01). In multiple-regression models, baseline self-efficacy scores predicted changes over the 1-year study period in physical and psychological sickle cell disease symptomatology. Moreover, changes in self-efficacy from baseline to 1-year follow-up were significantly and independently related to changes in physical symptoms, psychological symptoms, and pain ratings from baseline to 1-year follow-up. CONCLUSIONS: Self-efficacy beliefs among African American adults with sickle cell disease are inversely related to reported disease symptomatology, and these relationships persist across time. Future investigations should examine the mechanisms through which relationships between self-efficacy and adjustment to sickle cell disease are effected, as well as the feasibility and effectiveness of enhancing self-efficacy beliefs as a means of improving adjustment to sickle cell disease.     

Leveraging health informatics to foster a smart systems response to health disparities and health equity challenges

Informaticians are challenged to design health information technology (IT) solutions for complex problems, such as health disparities, but are achieving mixed results in demonstrating a direct impact on health outcomes. This presentation of collective intelligence and the corresponding terms of smart health, knowledge ecosystem, enhanced health disparities informatics capacities, knowledge exchange, big-data, and situational awareness are a means of demonstrating the complex challenges informatics professionals face in trying to model, measure, and manage an intelligent and smart systems response to health disparities. A critical piece in our understanding of collective intelligence for public and population health rests in our understanding of public and population health as a living and evolving network of individuals, organizations, and resources. This discussion represents a step in advancing the conversation of what a smart response to health disparities should represent and how informatics can drive the design of intelligent systems to assist in eliminating health disparities and achieving health equity.     

Scenario-based design: a method for connecting information system design with public health operations and emergency management

Responding to public health emergencies requires rapid and accurate assessment of workforce availability under adverse and changing circumstances. However, public health information systems to support resource management during both routine and emergency operations are currently lacking. We applied scenario-based design as an approach to engage public health practitioners in the creation and validation of an information design to support routine and emergency public health activities. Methods: Using semi-structured interviews we identified the information needs and activities of senior public health managers of a large municipal health department during routine and emergency operations. Results: Interview analysis identified 25 information needs for public health operations management. The identified information needs were used in conjunction with scenario-based design to create 25 scenarios of use and a public health manager persona. Scenarios of use and persona were validated and modified based on follow-up surveys with study participants. Scenarios were used to test and gain feedback on a pilot information system. Conclusion: The method of scenario-based design was applied to represent the resource management needs of senior-level public health managers under routine and disaster settings. Scenario-based design can be a useful tool for engaging public health practitioners in the design process and to validate an information system design.