Ten years since the crises in Syria: lessons for planetary and public health

Climate scientists have attributed the war in Syria to persistent droughts caused by damming of rivers and growing aridity due to climate change. As result of the war, there has been widespread migration, hunger, malnutrition, and a collapse of public health systems. While many climate researchers question the direct link of climate variability to civil unrest, there is no doubt that mitigating and reversing Syria’s environmental degradation, and reviving food security and public health systems will play an important role in avoiding future unrest in the region.     

八项质量管理原则在口腔医疗机构质量管理中的应用

文章对口腔医疗机构应用以顾客为关注焦点、领导作用、全员参与、过程方法、管理的系统方法、持续改进、基于事实的决策方法、互利的供方关系等ISO9000标准八项质量管理原则的作用和方法进行了讨论。     

Female gender is associated with dental care and dental hygiene,but not with complete dentition in the Swiss adult population

Aim Little is known about the impact of gender on oral health, besides the influence of reproductive factors on female dentition. The aim of this study was to analyse gender differences with regard to oral health and oral health behaviour in the Swiss adult population, using data from the Swiss Health Survey of 2002. Subjects and methods The Swiss Health Survey regularly collects detailed information on health and health determinants of a random sample of the Swiss population aged 15 years and older. A written questionnaire including items on oral health was filled in by 7,115 men and 9,026 women in 2002. Weighted prevalence rates were calculated, and multivariate logistic regression analyses used to evaluate the role of gender for complete and functional dentition and for oral health behaviour. Finally, the multivariate model was stratified for men and women and run for the outcome “complete dentition”. Results Women had a higher prevalence of visits to the dentist in the last 12 months (64% versus 60% men), of visits to dental hygienists (39% versus 34%), and of frequent tooth brushing (several times a day) (82% versus 66%). Adjusting for preventive behaviour, socio-demographic and socio-economic variables in multivariate analyses, female gender was positively associated with the prevalence of visits to the dentist (OR 1.33, 95% CI 1.24–1.43) and of frequent tooth brushing several times a day (OR 2.57, 95% CI 2.36–2.79), but not with complete dentition (OR 1.01, 95% CI 0.93–1.09). In the stratified analysis, associations of complete dentition with socio-economic status, oral hygiene and preventive behaviour were stronger in men than in women. Conclusion Gender plays an important role in oral health. Adult women report a more pronounced preventive oral health behaviour than men; their dentition, however, is not more often complete. Mechanisms involved in women’s oral health are probably more complex than those underlying men’s oral health. An in-depth gender analysis is needed to shed more light upon this issue.     

Negative trends from 2008/9 to 2011/12 seasons in influenza vaccination coverages among high risk subjects and health care workers in Spain

Objectives

We aim to describe influenza vaccination coverage for the Spanish population across four consecutive campaigns (2008/2009 to 2011/2012). The data was analyzed by high risk groups and health care workers (HCWs). Also, coverage trends were analyzed to assess uptake in post-pandemic seasons.

Methods

We used data from two nation-wide representative health surveys namely the 2009/10 European Health Interview Survey for Spain (N = 22,188) and the 2011–12 Spanish National Health Survey (N = 21,007) Influenza vaccination status was self-reported. We analyzed influenza vaccine coverage by age, sex, number of chronic conditions, being a heath care worker (HCWs) and nationality. Time trends for campaigns among high risk groups were estimated by a multivariate logistic regression model.

Results

We analyzed data from 43,072 subjects aged ≥16 years. As a whole, coverage decreased by 3.31% (22.57–19.26%) between the 2008/2009 and 2011/2012 campaigns with a significant decreasing trend (OR 0.92; 95% CI: 0.90–0.94).Coverage in people under 60 years with a chronic disease decreased significantly (OR 0.92: 95% CI: 0.85–0.99) during the analyzed period from 21.02% in 2008/2009 to 17.40% in 2011/2012. Among HCWs, the highest influenza vaccination coverage was achieved in 2009/2010 (31.08%) in the latest campaign coverage has almost halved (17.88%). For the 2011/2012 season and for all age groups the variables associated with a higher probability of having received the influenza vaccine were older age and presence of associated chronic conditions. Among those aged ≥60 years, immigrants had lower uptake (OR 0.60; 95% CI: 0.32–0.99).

Conclusions

Seasonal influenza vaccine uptake rates in the recommended target groups in Spain are unacceptably low and seem to be decreasing in the post pandemic seasons. Further studies are necessary to precisely identify reasons for non-compliance and barriers to influenza vaccination. Meanwhile urgent strategies to improve seasonal vaccination uptake must be discussed and implemented.     

Systematic reviews and health policy: the influence of a project on perinatal care since 1988

Context: Interrelated publications between 1988 and 1992 have influenced health policy and clinical practice: The Oxford Database of Perinatal Trials (ODPT), Effective Care in Pregnancy and Childbirth (ECPC), A Guide to Effective Care in Pregnancy and Childbirth (GECPC), and Effective Care of the Newborn Infant (ECNI). These publications applied and advanced methods that had a substantial history in the medical, biological, physical, and social sciences. Their unique contribution was to demonstrate the feasibility of organizing and sustaining programs to conduct systematic reviews across an entire field of health care. The publications also influenced subsequent advances in the methodology of systematic reviews and contributed to their proliferation; in large measure, but not entirely, because their editors and many of the authors participated in organizing and developing the Cochrane Collaboration. This article describes how and why these publications attracted favorable attention and resources from policymakers in numerous countries. Methods: This article applies historical methods to the analysis of primary sources that help explain the influence of systematic reviews, mainly on health policy. These methods guide an analysis of the rhetoric of the two volumes of ECPC and of primary sources generated as systematic reviews influenced health policy. The analysis of rhetoric employs the methods of intellectual history and social studies of science. The analysis of policymaking uses the methods of political and policy history, political science, and public administration. Because the focus of this article is how science influenced policy it alludes to but does not describe in detail the literature on the methods, production, and publication of systematic reviews. Findings: The influence of the four publications on policy was mainly a result of (1) their powerful blending of the rhetoric of scientific and polemical discourse, especially but not exclusively in ECPC; (2) a growing constituency for systematic reviews as a source of “evidence‐based” health care among clinicians, journalists, and consumers in many countries; and (3) recognition by significant policymakers who allocate resources to and within the health sector that systematic reviews could contribute to making health care more effective and to containing the growth of costs. Conclusions: Analysis of this aspect of the history of producing and applying systematic reviews informs understanding of how knowledge derived from research informs policy.     

新医改以来四川省乡镇卫生院卫生技术人员的发展趋势研究

目的 在新医改政策背景下,探讨乡镇卫生院卫生技术人员的发展趋势。方法 梳理新医改以来与乡镇卫生院卫生人力建设相关的政策,利用2008和2013年四川省卫生服务调查数据以及2017年的现场调查数据,3次调查均采用多阶段分层整群抽样的方式,样本量分别为295、424和220,结合国家和四川省卫生统计年鉴,采用单因素方差分析及广义线性模型来分析2008 - 2017年四川省乡镇卫生院卫生技术人员的基本情况和职业认知变化。结果 从2009年到2017年,四川省每千农村人口乡镇卫生院卫生技术人员数1.04增加到1.49,工作年限少于9年的比例从32.94%上升到54.96%,本科及以上学历的比例从2.76%上升到6.97%,初级职称占比从84.47%下降到80.73%,月收入在3 000元以上的比例从0.7%升高到73.6%;卫生技术人员感知到的工作压力变小,总满意度从2013年的33.22升高到35.90分,感知的医患关系较差且呈恶化趋势。结论 新医改以来发布的与乡镇卫生院人力建设相关的政策取得了一定成效,但目前四川省乡镇卫生院卫生技术人员整体水平依然较低,且影响了乡镇卫生院医疗服务质量的提升。     

上海十年卫生改革的回顾与研究--上海卫生政策情境分析研究课题概述

该介绍了上海卫生政策情境分析研究课题的概况、主要的研究内容和研究结果。     

包钢托幼园所3～6岁儿童龋齿患病情况

目的了解包钢托幼园所3～6岁幼儿龋齿患病情况。方法对13所托幼园所的3 303名儿童龋齿资料进行调查分析。结果共查出有1 143名儿童患龋齿,患龋率为34.60%,其中男童患龋率为34.59%,女童患龋率为34.62%。男女童患龋率差异无统计学意义(P0.05),但各年龄组间差异有统计学意义(χ2=33.12,P0.01)。结论预防龋病要从儿童抓起,要从乳牙抓起,而且需要幼儿教师和家长的配合,实施龋齿防治的干预措施。     

Ten Years after the Creation of the Portuguese National Network for Long-Term Care in 2006: Achievements and Challenges

The Portuguese National Network for Long-term Integrated Care (Rede Nacional de Cuidados Continuados, RNCCI) was created in 2006 as a partnership between the Ministry of Health and the Ministry of Labour and Social Solidarity. The formal provision of care within the RNCCI is made up of non-profit and non-public institutions called Private Institutions of Social Solidarity, public institutions belonging to the National Health Service and for-profit-institutions. These institutions are organized by type of care in two main settings: (i) Home and Community-Based Services and (ii) four types of Nursing Homes to account for different care needs. This is the first study that assess the RNCCI reform in Portugal since 2006 and takes into account several core dimensions: coordination, ownership, organizational structure, financing system and main features, as well as the challenges ahead. Evidence suggests that despite providing universal access, Portuguese policy-makers face the following challenges: multiple sources of financing, the existence of several care settings and the sustained increase of admissions at the RNCCI, the dominance of institutionalization, the existence of waiting lists, regional asymmetries, the absence of a financing model based on dependence levels, or the difficulty to use the instrument of needs assessment for international comparison.     

The use of dental services for children: Implications of the 2010 dental reform in Israel

Routine dental examinations for children are important for early diagnosis and treatment of dental problems. The level of dental morbidity among Israeli children is higher than the global average. A July 2010 reform of Israel's National Health Insurance Law gradually offers free dental services for children up to age 12.The study examines the use of dental services for children and the factors affecting mothers’ decision to take their children for routine checkups. In addition, the study examines the impact of the reform on dental checkups for children in various populations groups.A national representative sample comprising 618 mothers of children aged 5–18 was surveyed by telephone. The survey integrated the principles of the health beliefs model and socio-demographic characteristics.The results show that mothers’ decision to take their children for dental checkups is affected by their socio-demographic status and by their health beliefs with respect to dental health. After the reform, the frequency of children's dental checkups significantly increased among vulnerable populations. Therefore, the reform has helped reduce gaps in Israeli society regarding children's dental health. Raising families’ awareness of the reform and of the importance of dental health care together with expanding national distribution of approved dental clinics can increase the frequency of dental checkups among children in Israel.     

Pay-for-performance step-by-step: introduction to the MIMIQ model

Objectives

Pay-for-performance is increasingly used as a system intervention to support quality improvement. Programs are however developed, implemented and evaluated in a heterogeneous way. This is partly due to the broad and disparate theoretical and empirical foundation of P4P practice, which is rapidly evolving.This paper guides the reader through the essential steps which should be taken into consideration when setting up a P4P program. To this end a model called ‘Model for Implementing and Monitoring Incentives for Quality’ (MIMIQ) is presented.

Methods

Literature review was performed with a search of multiple databases, reference screening and expert consultation.

Results

Central to the step-by-step approach is a Plan-Do-Check-Act cycle which incorporates communication, implementation and evaluation as key phases next to program development. In addition, the model explains how the decision making and results of each phase is modified by contextual factors. The model puts emphasis on quality and quality measurement as first items to develop. Only after these are in place, the development of the incentive component can be addressed.

Conclusions

The model presents guidance for designing and implementing P4P programs in a practically structured way. According to future findings the MIMIQ model will continuously evolve as an up to date P4P policy and practice tool.     

Twenty years since Ottawa and Epp: researchers' reflections on challenges, gains and future prospects for reducing health inequities in Canada

November 2006 marked the 20-year anniversary of the Ottawa Charterfor Health Promotion and Canada's Epp Report. Encapsulatingthe tenets of health promotion (HP), these publications articulateda vision for reducing health inequities, and described a policyframework for achieving this vision, respectively. These documentsalso triggered the launch of the population health (PH) field,focused on elucidating the empirical relationships between socioeconomicgradients and population health inequities. Over two decades,a rich HP/PH theoretical and evidentiary base on socioeconomicgradients in health has established. Yet, despite valuable contributionsfrom Canadian researchers, insufficient headway has been madein this country to achieve the Charter's vision. There are numerous challenges to reducing population healthinequities in Canada. Informational challenges include complexityof HP/PH evidence, and inadequate knowledge translation beyondtraditional targets. Institutional challenges include the relativeimmunity of the healthcare sector to funding reductions, andthe organization of policy responsibilities into silos. Concernsfrom non-healthcare sectors of ‘health imperialism’,and inter-governmental tensions are interest-related challenges,while ideological challenges include lack of media discourseon health inequities and a strong neo-liberal political climate. Gains have been made in Canada towards reducing health inequities.The HP/PH discourses are firmly entrenched in academic and policyspheres across the country, while several inter-sectoral policyinitiatives are currently underway. HP/PH researchers couldbe more proactive in the knowledge-translation sphere by engagingother researchers outside of medicine and health, non-healthcarepolicy-makers, and the general public, vis-à-vis themedia, on the health inequities knowledge base. Ultimately,significant and sustained progress will only be made if researchersand other champions recognize the inherently political aspectof their work and understand how to overcome ideologically drivenresistance.     

The provision of accessible, acceptable health care in rural remote areas and the right to health: Bedouin in the North East region of Jordan

Provision of accessible acceptable health care in remote rural areas poses a challenge to health care providers. This case study of formal and informal health care provision for Bedouin in North East Jordan is based on interviews conducted in 2007-2008 involving clinic providers, policymakers and Bedouin as part of an EC funded study from 2006 to 2010. The paper explores to what extent the right to health as set out in UN General Comment 14 (on Article 12 and 12.2 of the International Covenant on Social Economic and Cultural Rights on the right to health) can provide a framework for considering the availability, accessibility and acceptability of current provision in a rural setting in Jordan. Health care is provided in the public sector by the Ministry of Health and the Royal Medical Services to a dispersed population living in encampments and villages over a large rural area. There are issues of accessibility in terms of distance, and of acceptability in relation to the lack of local and female staff, lack of cultural competencies and poor communication. We found that these providers of health care have a developing partnership that could potentially address the challenge of provision to this rural area. The policymakers have an overview that is in line with applying the concept of health care justice for a more equitable distribution of resources and adjustment of differential access and availability. The health providers are less aware of the right to accessible acceptable health care in their day to day provision whilst the Bedouin population are quite aware of this. This case study of Bedouin in North East Jordan has particular relevance to the needs of populations - both pastoralists and non pastoralists living in remote and rural areas.     

农村卫生人力可及性探讨

强基层作为我国医改的一个重要原则,目的是为了增强基层医疗卫生机构服务能力,而增加农村医疗卫生领域人力资源的可及性是强基层的重要策略,对实现卫生服务均等化具有重要意义。从薪酬、教育培训、政策支持等方面分析影响我国卫生人力可及性的因素,探讨相应的改进农村适宜卫生人力短缺的策略,以满足农村医疗保健的需求。     

农村卫生人力可及性探讨

强基层作为我国医改的一个重要原则,目的是为了增强基层医疗卫生机构服务能力,而增加农村医疗卫生领域人力资源的可及性是强基层的重要策略,对实现卫生服务均等化具有重要意义。从薪酬、教育培训、政策支持等方面分析影响我国卫生人力可及性的因素,探讨相应的改进农村适宜卫生人力短缺的策略,以满足农村医疗保健的需求。     

Ten years of Pan-InfORM: modelling research for public health in Canada

Modelling and simulation methods can play an important role in guiding public health responses to infectious diseases and emerging health threats by projecting the plausible outcomes of decisions and interventions. The 2003 SARS epidemic marked a new chapter in disease modelling in Canada as it triggered a national discussion on the utility and uptake of modelling research in local and pandemic outbreaks. However, integration and application of model-based outcomes in public health requires knowledge translation and contextualization. We reviewed the history and performance of Pan-InfORM (Pandemic Influenza Outbreak Research Modelling), which created a national infrastructure in Canada with a mandate to develop innovative knowledge translation methodologies to inform policy makers through modelling frameworks that bridge the gaps between theory, policy, and practice. This review demonstrates the importance of a collaborative infrastructure as a “Community of Practice” to guide public health responses, especially in the context of emerging diseases with substantial uncertainty, such as the COVID-19 pandemic. Dedicated resources to modelling and knowledge translation activities can help create synergistic strategies at the global scale and optimize public health responses to protect at-risk populations and quell socioeconomic and health burden.     

Measuring the Burden of Disease in Korea, 2008-2018

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.     

Organisational factors affecting performance in delivering influenza vaccination to staff in NHS Acute Hospital Trusts in England: A qualitative study

Health care workers are a priority group for seasonal influenza vaccination, which is recommended by the World Health Organisation. There is a wide variation in uptake between and within countries. England has achieved 69.5% of health care workers vaccinated overall in 2017/18 across NHS acute and community health care settings, but it varies between Trusts from 50% to over 92.3%. While attitudinal factors have been well researched, there is limited evidence on organisational factors associated with high uptake. In England, most NHS Trusts are now implementing a similar range of interventions as part of their flu programme, and it remains unclear why performance remains so variable. This qualitative study is the first to explore reasons for this variation and provide recommendations for lower performing Trusts on how to improve. Fifty-seven interviews of managers and vaccinators were conducted in nine hospitals with flu vaccination uptake ranging from just over 55% to above 90%. Our study found that while Trusts deployed a wide range of both demand generating and supply interventions to increase uptake, there were marked differences in the organisational and delivery models utilised. Our study suggests that organisational culture was possibly the most important ingredient when trying to differentiate between high and low performing Trusts. We found that a positive culture aimed at fostering continuous improvement and favouring non-coercion on balance yielded more adherence from staff. Where influenza vaccination was embedded in the organisation wellbeing strategy, rather than executed as a siloed seasonal programme, this tended to foster good performance. Improving performance of influenza vaccination in health care workers will involve not only deploying the right interventions, and following “best practices”. It will require the adaptation of flu progamme delivery strategies to the organisation context, and embedding vaccination into the organisational culture, thus supporting the normalisation of yearly vaccination.