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Weidner W, Amour R, Breuer E, Toit PD, Farres R, Franzon AC, Astudillo-García CI, Govia I, Jacobs R, López-Ortega M, Mateus E, Musyimi C, Mutunga E, Muyela L, Palmer T, Pattabiraman M, Ramasamy N, Robinson JN, Knapp M, Comas-Herrera A. Transforming dementia research into policy change: A case study of the multi-country STRiDE project. Dementia (London) 2024; 23:398-421. [PMID: 37247637 DOI: 10.1177/14713012231176324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
STRiDE was an ambitious four-year project in seven countries aiming to build capacity around generating and using research to support the development of policies to improve quality of life of people with dementia and their carers. The project's innovative approach combined rigorous academic research and hands-on civil society advocacy. This paper explores the project's unique strategy for policy change and compiles case-studies from several of the STRiDE countries. Finally, we share lessons learned and next steps to keep momentum for policy change going in each of these countries - and beyond.
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Affiliation(s)
| | - Rochelle Amour
- Caribbean Institute for Health Research, The University of the West Indies, Jamaica
| | - Erica Breuer
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | | | - Rosa Farres
- Mexican Alzheimer's Disease Federación, Mexico
| | - Ana C Franzon
- Federação Brasileira das Associações de Alzheimer (FEBRAZ), Brazil
| | | | - Ishtar Govia
- Caribbean Institute for Health Research, The University of the West Indies, Jamaica
| | - Roxanne Jacobs
- Alan J. Flisher Centre for Public Mental Health, University of Cape Town, South Africa
| | | | - Elaine Mateus
- Federação Brasileira das Associações de Alzheimer (FEBRAZ), Brazil
| | | | | | - Levi Muyela
- Africa Mental Health Research and Training Foundation, Kenya
| | - Tiffany Palmer
- Caribbean Institute for Health Research, The University of the West Indies, Jamaica
| | | | | | - Janelle N Robinson
- Caribbean Institute for Health Research, The University of the West Indies, Jamaica
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
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Cofie LE, LePrevost CE, Harwell EL, Bustos YY, Welborn J, Firnhaber GC, Lee JGL. "Valorar el trabajo de farmworkers": A thematic analysis of input from farmworkers, advocates, and students in a community documentary project about the future of farm work. Public Health Nurs 2024; 41:193-197. [PMID: 37994294 DOI: 10.1111/phn.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/31/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
Farm work is one of the nation's most hazardous occupations, and migrant and seasonal farmworkers face significant health inequities. Awareness and understanding of the needs of this population are crucial in assuring they receive appropriate support. Documentary programs can raise awareness of community member views to better inform services and advocacy efforts. Visions for the future of farm work were collected from farmworkers and persons supporting them through a community-based, participatory documentary project led by Student Action with Farmworkers (SAF) from 2021 to 2022. Seventy-nine submissions from participants in North and South Carolina, including text responses and file uploads, were collected and thematically analyzed. Five themes were identified: (1) employment benefits and conditions, (2) living conditions, (3) health access and quality, (4) dignity and visibility of farm work, and (5) policy change for a better future. The visions for the future of farm work expressed by these agricultural workers, advocates, and students raise important implications for agricultural communities, public health practitioners, researchers, funders, and policymakers. Application of these findings in the development and delivery of public health services for farmworkers has the potential to positively impact the morbidity and mortality rates of this at-risk population.
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Affiliation(s)
- Leslie E Cofie
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
| | | | - Emery L Harwell
- Department of Applied Ecology, NC State University, Raleigh, North Carolina, USA
| | - Yessie Y Bustos
- Student Action with Farmworkers, Durham, North Carolina, USA
| | - Joanna Welborn
- Student Action with Farmworkers, Durham, North Carolina, USA
| | - Gina C Firnhaber
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
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Thanekar U, Sacks G, Ruffini O, Reeve B, Blake MR. Local government stakeholders' perceptions of potential policy actions to influence both climate change and healthy eating in Victoria: A qualitative study. Health Promot J Austr 2024. [PMID: 38373299 DOI: 10.1002/hpja.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
ISSUE ADDRESSED Climate change is a defining public health issue of the 21st century. Food systems are drivers of diet-related disease burden, and account for 30% of global greenhouse gas emissions. Local governments play a crucial role in improving both the healthiness and environmental sustainability of food systems, but the potential for their actions to simultaneously address these two issues is unclear. This study aimed to explore the perceptions of Australian local government stakeholders regarding policy actions simultaneously addressing healthy eating and climate change, and the influences on policy adoption. METHODS We conducted 11 in-depth semi-structured interviews with stakeholders from four local governments in Victoria, Australia. Data were analysed using reflexive thematic analysis. We applied Multiple Streams Theory (MST) 'problem', 'politics and 'policy' domains to explain policy adoption influences at the local government level. RESULTS Key influences on local government action aligned with MST elements of 'problem' (e.g., local government's existing risk reports as drivers for climate change action), 'policy' (e.g., budgetary constraints) and 'politics' (e.g., local government executive agenda). We found limited evidence of coherent policy action in the areas of community gardens, food procurement and urban land use. CONCLUSION Barriers to further action, such as resource constraints and competing priorities, could be overcome by better tailoring policy action areas to community needs, with the help of external partnerships and local government executive support. SO WHAT?: This study demonstrates that Victorian local stakeholders believe they are well-positioned to implement feasible and coherent interventions that address both healthy eating and climate.
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Affiliation(s)
- Urvi Thanekar
- Sustainable Health Network, Deakin University, Melbourne, Victoria, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbpurne, Victoria, Australia
| | - Oriana Ruffini
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbpurne, Victoria, Australia
| | - Belinda Reeve
- The University of Sydney Law School, Sydney, New South Wales, Australia
| | - Miranda R Blake
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbpurne, Victoria, Australia
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Tourchian N, McCormack D, Leece P, Tadrous M, Gomes T. Patterns of publicly funded naltrexone use among patients diagnosed with alcohol use disorder in Ontario. Alcohol Alcohol 2024; 59:agad091. [PMID: 38300604 PMCID: PMC10833073 DOI: 10.1093/alcalc/agad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/20/2023] [Accepted: 12/17/2023] [Indexed: 02/02/2024] Open
Abstract
AIMS Naltrexone is recommended first-line to manage alcohol use disorder (AUD). With previous studies indicating poor retention on naltrexone, we determined duration of naltrexone use and assessed the association between prescription setting and time to discontinuation in Ontario. METHODS We conducted a retrospective population-based cohort study among Ontario public drug beneficiaries diagnosed with AUD who initiated publicly funded naltrexone from June 2018 to September 2019. The primary outcome was time to naltrexone discontinuation, with a secondary analysis assessing receipt of at least one prescription refill. We used Cox proportional hazards models and logistic regression to test the association between prescription setting and each medication persistence outcome. RESULTS Among 2531 new naltrexone patients with AUD, the median duration of naltrexone use was 31 days and 394 (15.6%) continued naltrexone for 6 months or longer. There was no association between setting of initiation and duration of naltrexone use; however, those initiating naltrexone following an acute inpatient hospital stay were more likely to fill a second prescription (aOR 1.43, 95% CI 0.96-2.14), while those initiating after an ED visit were less likely to be dispensed a second prescription (aOR = 0.69, 95% CI 0.52-0.90) compared to those starting in a physician's office. CONCLUSION Persistence on naltrexone to treat an AUD is low, regardless of the setting of initiation. Further research is needed to elucidate the barriers encountered by patients with AUD that lead to poor treatment persistence in order to develop interventions that facilitate patient-centered access to evidence-based treatment for AUD in the province.
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Affiliation(s)
- Nima Tourchian
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
| | | | - Pamela Leece
- Public Health Ontario, 480 University Ave. #300, Toronto, Ontario, M5G 1V2, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave.,Toronto, Ontario, M5G 1V7, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M7, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
- ICES, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada
- Women’s College Hospital, 76 Grenville St., Toronto, Ontario, M5S 1B2, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
- ICES, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada
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Bailey C, Guo P, MacArtney J, Finucane A, Meade R, Swan S, Wagstaff E. "Palliative care is so much more than that": a qualitative study exploring experiences of hospice staff and bereaved carers during the COVID-19 pandemic. Front Public Health 2023; 11:1139313. [PMID: 38026434 PMCID: PMC10662348 DOI: 10.3389/fpubh.2023.1139313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background The way in which end-of-life care was provided changed significantly during the first 2 years of the COVID-19 pandemic. The national lockdown restrictions reduced formal care support services and increased the burden on many carers taking on the caring role for the first time. We aimed to explore decision-making about the place of care during the COVID-19 pandemic and the impact on experience from the perspectives of carers and hospice staff caring for people at the end-of-life. Methods A qualitative study using virtual interviews was conducted between October 2020 and April 2021. Data were analyzed thematically using framework analysis, an analytical framework that enables qualitative research to be organized into defined themes derived from the research question. Findings were presented to stakeholders in policy roundtables between March 2022 and March 2023 and discussed collaboratively with staff, stakeholders, and the public to inform policy and practice change. Findings A total of 37 participants (15 bereaved carers and 22 staff) were recruited via hospice services in England and Scotland. Four key themes were identified: (1) changing preferences relating to decision-making about the place of care and the impact at the time of death and into bereavement; (2) missed opportunities related to not being there, not having others around, and being robbed of memory-making; (3) the lone carer during a period of high intensity and reduced home support; (4) process vs. person-centered care resulting from changing rules and restrictions and prioritization of regulations over essential palliative care. Conclusion The study provides valuable global implications for all involved in end-of-life care. Despite great efforts to provide dignified, quality care, palliative care during the pandemic changed, focusing on essential 'physical care'. The psychological suffering experienced by staff and carers may need longer-term support mechanisms put in place, which will benefit from a public health approach. Policymakers should consider improving carer identification and resources for wider end-of-life care education to support the needs of carers, health and social care staff, and citizens.
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Affiliation(s)
- Cara Bailey
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - Ping Guo
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - John MacArtney
- Unit of Primary Care, University of Warwick, Coventry, United Kingdom
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Marie Curie Hospice, Edinburgh, United Kingdom
| | - Richard Meade
- Clinical Psychology, Carers UK, Edinburgh, United Kingdom
| | - Susan Swan
- Maggie's Glasgow, Glasgow, United Kingdom
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Vaidya AS, Lee ES, Kawaguchi ES, DePasquale EC, Pandya KA, Fong MW, Nattiv J, Villalon S, Sertic A, Cochran A, Ackerman MA, Melendrez M, Cartus R, Johnston KA, Lee R, Wolfson AM. Effect of the UNOS policy change on rates of rejection, infection, and hospital readmission following heart transplantation. J Heart Lung Transplant 2023; 42:1415-1424. [PMID: 37211332 DOI: 10.1016/j.healun.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND The 2018 adult heart allocation policy sought to improve waitlist risk stratification, reduce waitlist mortality, and increase organ access. This system prioritized patients at greatest risk for waitlist mortality, especially individuals requiring temporary mechanical circulatory support (tMCS). Posttransplant complications are significantly higher in patients on tMCS before transplantation, and early posttransplant complications impact long-term mortality. We sought to determine if policy change affected early posttransplant complication rates of rejection, infection, and hospitalization. METHODS We included all adult, heart-only, single-organ heart transplant recipients from the UNOS registry with pre-policy (PRE) individuals transplanted between November 1, 2016, and October 31, 2017, and post-policy (POST) between November 1, 2018, and October 31, 2019. We used a multivariable logistic regression analysis to assess the effect of policy change on posttransplant rejection, infection, and hospitalization. Two COVID-19 eras (2019-2020, 2020-2021) were included in our analysis. RESULTS The majority of baseline characteristics were comparable between PRE and POST era recipients. The odds of treated rejection (p = 0.8), hospitalization (p = 0.69), and hospitalization due to rejection (p = 0.76) and infection (p = 0.66) were similar between PRE and POST eras; there was a trend towards reduced odds of rejection (p = 0.08). In both COVID eras, there was a clear reduction in rejection and treated rejection with no effect on hospitalization for rejection or infection. Odds of all-cause hospitalization was increased in both COVID eras. CONCLUSIONS The UNOS policy change improves access to heart transplantation for higher acuity patients without increasing early posttransplant rates of treated rejection or hospitalization for rejection or infection, factors which portend risk for long-term posttransplant mortality.
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Affiliation(s)
- Ajay S Vaidya
- Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
| | - Emily S Lee
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Eric S Kawaguchi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Eugene C DePasquale
- Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kruti A Pandya
- Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael W Fong
- Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jonathan Nattiv
- Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Sylvia Villalon
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Ashley Sertic
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Ashley Cochran
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Mary Alice Ackerman
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Marie Melendrez
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Rachel Cartus
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Kori Ann Johnston
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Raymond Lee
- Keck Medical Center of University of Southern California, Los Angeles, California
| | - Aaron M Wolfson
- Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Scott SE, Risser L, Miller-Walfish S, Marjavi A, Ali A, Segebrecht J, Branch T, Dawson S, Miller E. Policy and Systems Change in Intimate Partner Violence and Human Trafficking: Evaluation of a Federal Cross-Sector Initiative. J Womens Health (Larchmt) 2023; 32:779-786. [PMID: 37159400 DOI: 10.1089/jwh.2022.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Objectives: This study evaluates Project Catalyst's impact on policies related to Intimate Partner Violence (IV) and Human Trafficking (HT), which contribute to negative health outcomes for survivors. Methods: We utilized continuous evaluation using data from policy assessment tools and interviews with participating state leadership team (SLT) members. Results: Five SLTs reported integration of IPV into state-level initiatives. All implemented clinical practice and organizational policy recommendations. SLTs reported that Project Catalyst increased awareness of IPV/HT and health impacts and established ongoing partnerships between the three organizations. Conclusions: Funding, training, and technical assistance to encourage cross-sector collaboration at the state level can promote policy changes that support comprehensive health center responses to IPV/HT.
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Affiliation(s)
- Sarah E Scott
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lauren Risser
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Summer Miller-Walfish
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anna Marjavi
- Futures Without Violence, San Francisco, California, USA
| | - Anisa Ali
- Futures Without Violence, San Francisco, California, USA
| | - Jane Segebrecht
- US Department of Health and Human Services, Health Resources and Services Administration, Office of Women's Health, Rockville, Maryland, USA
| | - Tracy Branch
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, Maryland, USA
| | - Shawndell Dawson
- US Department of Health and Human Services, Administration for Children and Families, Family Youth Services Bureau, Family Violence Prevention and Services Program, Washington, District of Columbia, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Li Z, Tan X, Liu B. Policy Changes in China's Family Planning: Perspectives of Advocacy Coalitions. Int J Environ Res Public Health 2023; 20:5204. [PMID: 36982113 PMCID: PMC10049043 DOI: 10.3390/ijerph20065204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Studies on policy change focus on governmental decision-making from a technical rationality perspective, ignoring the fact that policy change is a complicated social construction process involving multiple actors. This study used the modified advocacy coalition framework to explain changes in China's family planning policy and discourse network analysis to show the debate on the birth control policy among multiple actors (central government, local governments, experts, media, and the public). It found that the dominant coalition and the minority coalition can learn and adjust deep core beliefs from each other; the sharing and flow of actors' policy beliefs drive change in the network structure; and actors' obvious preferential attachment when the promulgation of the central document, are all helpful in policy change. This study can explain macro-policy changes from a micro-perspective to reveal the process and mechanism of policy changes in China's authoritarian regime.
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Affiliation(s)
- Zhichao Li
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xihan Tan
- School of Public Administration and Policy, Renmin University, Beijing 100872, China
| | - Bojia Liu
- School of Political Science and Public Administration, East China University of Political Science and Law, Shanghai 201620, China
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Tscharke BJ, O'Brien JW, Ahmed F, Nguyen L, Ghetia M, Chan G, Thai P, Gerber C, Bade R, Mueller J, Thomas KV, White J, Hall W. A wastewater-based evaluation of the effectiveness of codeine control measures in Australia. Addiction 2023; 118:480-488. [PMID: 36367203 PMCID: PMC10099390 DOI: 10.1111/add.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. METHODS We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. RESULTS Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities. CONCLUSION Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.
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Affiliation(s)
- Benjamin J Tscharke
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Jake W O'Brien
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Fahad Ahmed
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Lynn Nguyen
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Maulik Ghetia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Phong Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Cobus Gerber
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Richard Bade
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Jochen Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Jason White
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Wayne Hall
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
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Cochrane AC, Batson R, Aragon M, Bedenbaugh M, Self S, Isham K, Eichelberger KY. Impact of the "39-week rule" on adverse pregnancy outcomes: a statewide analysis. Am J Obstet Gynecol MFM 2023; 5:100879. [PMID: 36708964 DOI: 10.1016/j.ajogmf.2023.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The "39-week rule," adopted by the American College of Obstetricians and Gynecologists circa 2009, discouraged routine elective induction of labor in early-term gestations (37 weeks 0 days-38 weeks 6 days) to decrease the risk of adverse neonatal outcomes. However, little research exists regarding any unintended adverse pregnancy outcomes associated with this policy shift. OBJECTIVE This study aimed to quantify the difference in incidence of adverse pregnancy outcomes before and after the implementation of the 39-week rule. STUDY DESIGN Deidentified data from all births in the state of South Carolina from 2000 to 2008 (before the 39-week rule) and from 2013 to 2017 (after statewide implementation and enforcement of the rule) were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic data and International Classification of Diseases 9/10 codes were obtained for each birth. Our primary outcome was the incidence of any of the following adverse pregnancy outcomes: cesarean delivery, hypertensive disorders, chorioamnionitis, postpartum hemorrhage, high-degree lacerations, placental abruption, and intensive care unit admission. Propensity score analysis was used to control for age, body mass index, and race. After stratification by propensity score, the Cochran-Mantel-Haenszel test was used to compare the prerule and postrule groups. RESULTS A total of 633,985 births were eligible for inclusion-412,632 from 2000 to 2008, and 221,353 from 2013 to 2017. There was a significant increase in the primary outcome in the postrule period (39.94% pre vs 42.76% post; P<.01). The incidence of all hypertensive disorders was significantly increased in the postrule period compared with the prerule period (7.75% pre vs 10.1% post; P<.01). The incidence of chorioamnionitis and cesarean delivery also increased in the postrule period (1.45% pre vs 1.92% post; P<.01; 29.6% pre vs 31.82% post; P<.01; respectively). CONCLUSION There was a significant increase in the primary outcome following the implementation of the 39-week rule. Although the policy shift was driven by a desire to decrease adverse neonatal outcomes, aggregate benefit was not observed for pregnancy outcomes.
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Affiliation(s)
| | - Ryan Batson
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
| | - Meredith Aragon
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
| | - Molly Bedenbaugh
- University of South Carolina School of Medicine, Columbia, SC (Dr Bedenbaugh)
| | - Stella Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC (Dr Self)
| | - Katheryn Isham
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
| | - Kacey Y Eichelberger
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
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11
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Crow DA, DeLeo RA, Albright EA, Taylor K, Birkland T, Zhang M, Koebele E, Jeschke N, Shanahan EA, Cage C. Policy learning and change during crisis: COVID-19 policy responses across six states. Rev Policy Res 2023; 40:10-35. [PMID: 36714158 PMCID: PMC9874426 DOI: 10.1111/ropr.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/18/2023]
Abstract
Whereas policy change is often characterized as a gradual and incremental process, effective crisis response necessitates that organizations adapt to evolving problems in near real time. Nowhere is this dynamic more evident than in the case of COVID-19, which forced subnational governments to constantly adjust and recalibrate public health and disease mitigation measures in the face of changing patterns of viral transmission and the emergence of new information. This study assesses (a) the extent to which subnational policies changed over the course of the pandemic; (b) whether these changes are emblematic of policy learning; and (c) the drivers of these changes, namely changing political and public health conditions. Using a novel dataset analyzing each policy's content, including its timing of enactment, substantive focus, stringency, and similar variables, results indicate the pandemic response varied significantly across states. The states examined were responsive to both changing public health and political conditions. This study identifies patterns of preemptive policy learning, which denotes learning in anticipation of an emerging hazard. In doing so, the study provides important insights into the dynamics of policy learning and change during disaster.
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Affiliation(s)
- Deserai A. Crow
- School of Public AffairsUniversity of Colorado DenverDenverColoradoUSA
| | - Rob A. DeLeo
- Department of Political ScienceBentley UniversityWalthamMassachusettsUSA
| | | | - Kristin Taylor
- Department of Political ScienceWayne State UniversityDetroitMichiganUSA
| | - Tom Birkland
- Department of Public AdministrationNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Manli Zhang
- School of Public AffairsUniversity of Colorado DenverDenverColoradoUSA
| | - Elizabeth Koebele
- Department of Political ScienceUniversity of Nevada RenoRenoNevadaUSA
| | - Nathan Jeschke
- School of Public AffairsUniversity of Colorado DenverDenverColoradoUSA
| | | | - Caleb Cage
- Department of Political ScienceUniversity of Nevada RenoRenoNevadaUSA
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12
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de Oliveira VH, Lee I, Quintana‐Domeque C. The effect of increasing Women's autonomy on primary and repeated caesarean sections in Brazil. Health Econ 2022; 31:1800-1804. [PMID: 35607715 PMCID: PMC9545260 DOI: 10.1002/hec.4522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
Caesarean section (C-section) rates continue to rise globally. Yet, there is little consensus about the key determinants of rising C-section rates and the sources of variation in C-section rates across the world. While C-sections can save lives when medically justified, unnecessary surgical procedures can be harmful for women and babies. We show that a state-wide law passed in São Paulo (Brazil), which increased women's autonomy to choose to deliver via C-section even when not medically necessary, is associated with a 3% increase in overall C-section rates. This association was driven by a 5% increase in primary C-sections, rather than repeated C-sections. Since the law emphasizes women's autonomy, these results are consistent with mothers' demand being an important contributor to high C-section rates in this context.
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Affiliation(s)
| | - Ines Lee
- Faculty of EconomicsUniversity of CambridgeCambridgeUK
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13
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Agarwal M, Estrada LV, Gracner T, Dick AW, Stone PW. Nursing Home Antibiotic Stewardship Policy and Antibiotics Use: 2013-2017. J Am Med Dir Assoc 2022; 23:482-487. [PMID: 34297980 PMCID: PMC8776896 DOI: 10.1016/j.jamda.2021.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/09/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship programs is a national priority. Our aim is to evaluate the influence of antibiotic stewardship programs on antibiotic use rates in NHs over time. DESIGN Retrospective, repeated cross-sectional analysis. SETTING AND PARTICIPANTS Long-term residents not receiving hospice care in freestanding NHs that participated in 1 or both surveys in 2013 and 2017. METHODS Survey data were merged with the Minimum Data Set and the Certification and Survey Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic use. The main predictor was the NH antibiotic stewardship policy intensity. Using multivariate linear regression models adjusting for resident and facility characteristics that differed between the 2 years, we calculated antibiotic use rates in 2013 and 2017 for all residents, those with Alzheimer's disease, and those with any infection including urinary tract infections (UTIs). RESULTS Our sample included 317,003 resident assessments from 2013 and 267,537 assessments from 2017, residing in 953 and 872 NHs, respectively. NH antibiotic stewardship policy intensity increased from 2013 to 2017 (P < .01) and among all NH residents, including those with Alzheimer's disease, antibiotic use rate decreased (P < .05), with 45% of the decline attributable to strengthening stewardship programs. For most residents, policy intensity was associated with decreased usage in residents with UTI. However, among Alzheimer's disease residents with a UTI, this association did not persist. CONCLUSIONS AND IMPLICATIONS Although there was a decrease in antibiotic use in 2017, more time is needed to see the full impact of antibiotic stewardship policy into practice. Adjustments to programs that directly address barriers to implementation and appropriate UTI antibiotic use for residents with Alzheimer's disease are necessary to continue strengthening NH antibiotic stewardship and improve care.
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Affiliation(s)
- Mansi Agarwal
- Columbia University School of Nursing, Center for Health Policy, New York, NY USA
| | - Leah V. Estrada
- Columbia University School of Nursing, Center for Health Policy, New York, NY USA
| | - Tadeja Gracner
- Economics, Sociology & Statistics, RAND Corporation, Washington, DC USA
| | - Andrew W. Dick
- Economics, Sociology & Statistics, RAND Corporation, Boston, MA USA
| | - Patricia W. Stone
- Columbia University School of Nursing, Center for Health Policy, New York, NY USA
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14
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Issa R, Baker C, Spooner R, Abrams R, Gopfert A, Evans M, Aitchison G. Mapping the movement for climate change and health in England: a descriptive review and theory of change analysis. Perspect Public Health 2021; 141:328-337. [PMID: 34816775 PMCID: PMC8649450 DOI: 10.1177/17579139211058303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims: There are a growing number of organisations working to address the
connections between climate change and health. This article introduces the
concept of ‘theories of change’ – the methodology by which organisations or
movements hope to bring about social change – and applies it to the current
climate change and health movement in England. Through movement mapping, the
article describes and offers reflections on the climate change and health
ecosystems in England. Methods: Organisations working on climate change and health in England were identified
and publicly available information was collated to map movement
characteristics, target stakeholders and methodologies deployed, using an
inductive, iterative approach. Results: A total of 98 organisations working on health and climate change (and/or
sustainability) were initially identified, of which 70 met the inclusion
criteria. Most organisations target two or more stakeholders, with
healthcare workers, management structures, and government being most
commonly cited. Methodological approaches identified include Formal
education programmes; Awareness-raising; Purchasing-procurement power;
Advocacy; Financial; Media-messaging; Networking; Knowledge generation; and
Policy making, of which education, awareness-raising, and advocacy are most
commonly used. Conclusion: There is a tendency for climate change and health organisations in England to
focus on individual level and sectoral change over system change. More could
be made of the potential for the healthcare professions’ voice and messaging
for the wider climate movement. Given the rapid boom of climate change and
health organisations in recent years, a mind-set shift that recognises
different players as part of a cohesive ecosystem with better coordination
and collaboration may reduce unnecessary work, and facilitate more cohesive
outcomes.
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Affiliation(s)
- R Issa
- Department for Global Health, University College London, London WC1N 1EH, UK
| | - C Baker
- University Hospitals Sussex, Brighton, UK
| | - R Spooner
- Centre for Sustainable Healthcare, Oxford, UK
| | | | | | - M Evans
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - G Aitchison
- Politics and International Studies, Loughborough University, Loughborough, UK
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15
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Mihaylov NL. Speaking power to power: Grassroots democracy in the anti-fracking movement in Bulgaria. J Community Psychol 2021; 49:3054-3078. [PMID: 32286697 DOI: 10.1002/jcop.22358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
The anti-fracking movement (AFM) in Bulgaria, was a successful grassroots local-to-national organizing effort to change public policy. The study draws on social movements, community psychology, and grassroots democracy theory to explore, describe and critique how participants in the AFM collectively constructed meanings and practices of organizing in interaction with the sociopolitical context as they expanded their efforts from the local to the national level of policy-making. Data for the study were collected from semi-structured interviews with activists, movement documents, and participant observations. Structured and open coding followed by qualitative analyses produced descriptions and explanations of grassroots democracy in the movement. The movement was based on a prefigurative vision and practice of an antihierarchical "civic society" and was also shaped by the demands of the Bulgarian political context. Power, consent, and participation had dynamic meanings and forms that secured both grassroots democracy and effective political action. Тhe AFM resisted well-known mechanisms of hierarchization and co-optation, but it also reproduced certain inequalities of power. The findings relate to recent trends for expansion of community organizing to the national level of politics, for expansion of the community organizing models outside the United States, and for a popular grassroots preference for anti-organizational organizing.
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16
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Bogie B, Payne S, Harms S, McConnell M, Samaan Z. Leading from Behind: An Educational Intervention to Address Faculty and Learner Preparedness for Competence By Design in Psychiatry. J Multidiscip Healthc 2021; 14:2587-2595. [PMID: 34556993 PMCID: PMC8455178 DOI: 10.2147/jmdh.s325572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Residency training programs across Canada are beginning to implement the Royal College of Physicians and Surgeons of Canada’s new Competence By Design (CBD) framework in medical education. The objective of the current research was to assess faculty members’ and learners’ understanding of, and preparedness for, the national shift to CBD in psychiatry before and after an educational intervention. Methods The current research implemented a pre-test/post-test design to investigate faculty members’ and learners’ perceptions and attitudes towards competency-based medical education (CBME) and CBD before and after a one-hour educational session delivered by an expert on CBME. Results Of the 104 session attendees, 83 (79.8%) completed the pre-survey and 80 (76.9%) completed the post-survey. Both groups reported a moderate level of baseline knowledge of CBME and CBD. Knowledge of CBME improved significantly for both faculty members (p = 0.03) and learners (p < 0.01) after the education session; however, only learners showed a significant increase in knowledge of the CBD framework following the education session (p < 0.01). Further, only learners demonstrated a significant increase in perceived preparedness for CBD following the session (p = 0.02). Conclusion Overall, a brief, one-hour education session was at least somewhat effective at improving knowledge and preparedness for psychiatry’s transition to CBD. In order to facilitate the transition to CBD and to assist in the rollout of future policy changes, psychiatry departments should provide both faculty members and learners with educational sessions and resources prior to the policy implementation.
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Affiliation(s)
- Bryce Bogie
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Sarah Payne
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Harms
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Meghan McConnell
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Clinician Investigator Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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17
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Hess NR, Seese LM, Sultan I, Wang Y, Hickey GW, Kilic A. Geographic disparities in heart transplantation persist under the new allocation policy. Clin Transplant 2021; 35:e14459. [PMID: 34398485 DOI: 10.1111/ctr.14459] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study evaluated the impact of the 2018 heart allocation policy change on geographic disparities in United States orthotopic heart transplantation (OHT). METHODS The United Network for Organ Sharing registry was queried to measure geographic disparity in OHT rates between pre-policy and post-policy change eras. We performed multilevel Poisson regression to measure region-level OHT rates. We derived an allocation priority-adjusted median incidence rate ratio (MIRR) for each policy era, a measure of median change in OHT rates between regions. RESULTS 5958.78 waitlist person-years were analyzed, comprising 6596 OHT procedures (3890 pre-policy and 2706 post-policy). Median region-level OHT rate was .94 transplants/person-years before and 1.51 transplants/person-years after the policy change (P < .001). The unadjusted OHT MIRR across regions was 1.29 (95% CI 1.00-1.50) pre-policy change and 1.17 (95% CI 1.00-1.43) post-policy change, suggesting that the region-related variance in OHT rates decreased under the new allocation. After adjustment for allocation priority risk factors, the MIRR pre-policy change was 1.13 (95% CI 1.01-1.32) and post-policy change was 1.15 (95% CI 1.00-1.35). CONCLUSIONS Geography accounts for ∼10% of the disparity among United States OHT rates. Despite broader heart sharing, the updated allocation policy did not substantially alter the existing geographic disparities among OHT recipients.
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Affiliation(s)
- Nicholas R Hess
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Laura M Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gavin W Hickey
- Department of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Division of Cardiac Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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18
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Cheng Q, Kang J, Lin M. Understanding the Evolution of Government Attention in Response to COVID-19 in China: A Topic Modeling Approach. Healthcare (Basel) 2021; 9:898. [PMID: 34356277 PMCID: PMC8304999 DOI: 10.3390/healthcare9070898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/07/2021] [Indexed: 11/18/2022] Open
Abstract
The effective control over the outbreak of COVID-19 in China showcases a prompt government response, in which, however, the allocation of attention, as an essential parameter, remains obscure. This study is designed to clarify the evolution of the Chinese government's attention in tackling the pandemic. To this end, 674 policy documents issued by the State Council of China are collected to establish a text corpus, which is then used to extract policy topics by applying the latent dirichlet allocation (LDA) model, a topic modelling approach. It is found that the response policies take different tracks in a four-stage controlling process, and five policy topics are identified as major government attention areas in all stages. Moreover, a topic evolution path is highlighted to show internal relationships between different policy topics. These findings shed light on the Chinese government's dynamic response to the pandemic and indicate the strength of applying adaptive governance strategies in coping with public health emergencies.
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Affiliation(s)
| | | | - Minwang Lin
- School of Economics and Management, Fuzhou University, Fuzhou 350108, China; (Q.C.); (J.K.)
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19
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Schmid N, Haelg L, Sewerin S, Schmidt TS, Simmen I. Governing complex societal problems: The impact of private on public regulation through technological change. Regul Gov 2021; 15:840-855. [PMID: 34413894 PMCID: PMC8358951 DOI: 10.1111/rego.12314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/03/2020] [Accepted: 04/19/2020] [Indexed: 05/15/2023]
Abstract
When addressing complex societal problems, public regulation is increasingly complemented by private regulation. Extant literature has provided valuable insights into the effectiveness of such complex governance structures, with most empirical studies focusing on how public regulation influences private regulation. Conversely, the impact of private on public regulation is less well studied. Here, we investigate this impact with a focus on technological change as possible mechanism. Based on a case study of energy efficiency in buildings in Switzerland, we find evidence of a symbiotic interaction between public and private regulation that leads to ratcheting-up of regulatory stringency. We identify technological change as the mechanism linking private and public regulation. We discuss the relevance of our findings for governance literature and regulators.
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Affiliation(s)
- Nicolas Schmid
- Department of Humanities, Social and Political SciencesEnergy Politics Group, ETH ZurichZurichSwitzerland
| | - Leonore Haelg
- Department of Humanities, Social and Political SciencesEnergy Politics Group, ETH ZurichZurichSwitzerland
| | - Sebastian Sewerin
- Department of Humanities, Social and Political SciencesEnergy Politics Group, ETH ZurichZurichSwitzerland
| | - Tobias S. Schmidt
- Department of Humanities, Social and Political SciencesEnergy Politics Group, ETH ZurichZurichSwitzerland
| | - Irina Simmen
- Department of Humanities, Social and Political SciencesEnergy Politics Group, ETH ZurichZurichSwitzerland
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20
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Smith KL, Scarfone S, Chittle L, Horton S, Dixon JC. Confusion Reigns: An Analysis of Responses to U.S. Soccer Age Cut-Off Date Policy Change. Front Sports Act Living 2021; 3:635195. [PMID: 33870186 PMCID: PMC8044793 DOI: 10.3389/fspor.2021.635195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
Relative age effects (RAEs) have been associated with the common practice of grouping athletes by chronological age. Development and selection advantages are often awarded to those who are born closer to, but following, the cut-off date employed by sport systems. In 2015, the U.S. Soccer Federation announced that it would be changing its birth-year registration cut-off date from August 1st to January 1st. This change was introduced to align the U.S. youth soccer calendar with international standards, and simultaneously provide clearer information on player birthdates to “lessen” RAEs. The magnitude of this policy change has led to considerable controversy, with members of the soccer community taking to social media and website blogs, as well as the U.S. Youth Soccer's website, to voice their opinions and general unhappiness with this decision. Thus, the purpose of this study was to provide a summary of online reactions to the policy change, with attention to the manner in which the U.S. Soccer Federation framed (i.e., the underlying rationale for the decision) and publicly communicated its decision to change the annual cut-off date. Qualitative content analysis was used to analyze data collected from 63 social media sites (websites, n = 43; forums, n = 16; blogs, n = 4). From the 3,851 pages of text derived from these sources, a total of 404 unique passages of text were identified within 262 stakeholder posts. Four categories emerged from the data: stakeholder discussion, outcomes identified by stakeholders, recommended courses of action, and communication regarding the policy change. In general, the actions of the U.S. Soccer Federation and related outcomes were negatively perceived by stakeholders at various levels of the sport. Resistance to the change may have been reduced through enhanced communication from the national level and opportunities for stakeholder input. While one objective of this policy change was to combat RAEs, previous research suggests this organizational change will only shift which group of athletes experience relative age (dis)advantages. There appears to be a disconnect between the academic literature and sport policy with respect to solutions for RAEs, which can lead to unintended consequences for various sport stakeholders.
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Affiliation(s)
- Kristy L Smith
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Sara Scarfone
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Laura Chittle
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Sean Horton
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Jess C Dixon
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
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21
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Abstract
In September 2020, Bulgaria's National Assembly (Parliament) passed legal amendments aimed at increasing kindergarten participation for children aged 4–6 in Bulgaria, with poor children standing to benefit the most. For the first time, state budget funds were set aside to relieve parents of the costs of monthly attendance fees currently collected by full-day kindergartens. It builds on evidence generated from a large-scale randomized control trial (RCT) (2014–2018) across 236 poor communities, implemented by the Trust for Social Achievement (TSA) together with the World Bank and the Abdul Latif Jameel Poverty Action Lab. This paper describes how the RCT was used by TSA to advocate for removal of fees, and how much more evidence besides the RCT needed to be generated and support needed to be mobilized to influence policy action.
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Affiliation(s)
- Eugenia Volen
- Early Learning and Care Program, Trust for Social Achievement, Sofia, Bulgaria
| | - Joost de Laat
- Utrecht Centre for Global Challenges and Utrecht School of Economics, University of Utrecht, Utrecht, Netherlands
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22
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Lombe D, Sullivan R, Caduff C, Ali Z, Bhoo-Pathy N, Cleary J, Jalink M, Matsuda T, Mukherji D, Sarfati D, Vanderpuye V, Yusuf A, Booth C. Silver linings: a qualitative study of desirable changes to cancer care during the COVID-19 pandemic. Ecancermedicalscience 2021; 15:1202. [PMID: 33889211 PMCID: PMC8043681 DOI: 10.3332/ecancer.2021.1202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction Public health emergencies and crises such as the current COVID-19 pandemic can accelerate innovation and place renewed focus on the value of health interventions. Capturing important lessons learnt, both positive and negative, is vital. We aimed to document the perceived positive changes (silver linings) in cancer care that emerged during the COVID-19 pandemic and identify challenges that may limit their long-term adoption. Methods This study employed a qualitative design. Semi-structured interviews (n = 20) were conducted with key opinion leaders from 14 countries. The participants were predominantly members of the International COVID-19 and Cancer Taskforce, who convened in March 2020 to address delivery of cancer care in the context of the pandemic. The Framework Method was employed to analyse the positive changes of the pandemic with corresponding challenges to their maintenance post-pandemic. Results Ten themes of positive changes were identified which included: value in cancer care, digital communication, convenience, inclusivity and cooperation, decentralisation of cancer care, acceleration of policy change, human interactions, hygiene practices, health awareness and promotion and systems improvement. Impediments to the scale-up of these positive changes included resource disparities and variation in legal frameworks across regions. Barriers were largely attributed to behaviours and attitudes of stakeholders. Conclusion The COVID-19 pandemic has led to important value-based innovations and changes for better cancer care across different health systems. The challenges to maintaining/implementing these changes vary by setting. Efforts are needed to implement improved elements of care that evolved during the pandemic.
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Affiliation(s)
- Dorothy Lombe
- Cancer Diseases Hospital, Lusaka, 10101, Zambia.,https://orcid.org/0000-0002-5083-1801
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, WC2R 2LS, United Kingdom
| | - Carlo Caduff
- King's College London, London, WC2R 2LS, United Kingdom
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, 00202, Kenya
| | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Jim Cleary
- Department of Medicine and IU Simon Cancer Center, IU School of Medicine, Indianapolis, IN 46202, USA
| | - Matt Jalink
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, K7L 3N6, Canada
| | - Tomohiro Matsuda
- Population-based Cancer Registry Section, Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, 104-0045, Japan
| | - Deborah Mukherji
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center (AUBMC), Beirut, 1107 2020, Lebanon
| | - Diana Sarfati
- Te Aho o Te Kahu, Cancer Control Agency, Wellington, 6011, New Zealand
| | - Verna Vanderpuye
- National Center for Oncology, Radiotherapy, and Nuclear Medicine, Accra, 00233, Ghana
| | - Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital and Research Centres, Lahore and Peshawar, 25100, Pakistan
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, K7L 3N6, Canada
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23
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Afflu DK, Diaz-Castrillon CE, Seese L, Hess NR, Kilic A. Changes in multiorgan heart transplants following the 2018 allocation policy change. J Card Surg 2021; 36:1249-1257. [PMID: 33484169 DOI: 10.1111/jocs.15356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study evaluated the impact of the heart allocation policy change in 2018 on the characteristics and outcomes of multiorgan transplants involving heart allografts. METHODS Adults undergoing multiorgan heart transplantation from 2010 to 2020 were identified from the United Network for Organ Sharing (UNOS) registry. Transplants were stratified into occurring before versus after the October 2018 heart allocation change. The primary outcome was 1-year survival following transplantation. A Cox proportional hazards model was used to evaluate the risk-adjusted effect of the allocation policy change on outcomes between cohorts. RESULTS A total of 1832 patients underwent multiorgan heart transplantation during the study period with 245 (13.37%) undergoing heart-lung transplantation, 244 (13.32%) undergoing heart-liver transplantation, and 1343 (73.31%) undergoing heart-kidney transplantation. There was a higher utilization of temporary MCSDs as well as longer ischemic times for all three types of transplantation following the policy change. Heart-lung and heart-liver recipients had a similar 1-year survival before and after the policy change (each p > .05). Renal failure requiring dialysis (29.5% vs. 39.4%, p = .001) as well as 1-year survival (88% vs. 82%; log-rank p = .01) were worse in the heart-kidney cohort after the organ allocation system modification. CONCLUSIONS This study demonstrates similar trends in multiorgan transplants as has been observed in isolated heart transplants following the allocation change, including more frequent utilization of temporary mechanical support and longer ischemic times. Although outcomes have remained comparable in the new allocation era with heart-lung and heart-liver transplants, heart-kidney recipients have a worse 1-year survival following the change.
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Affiliation(s)
- Derek K Afflu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carlos E Diaz-Castrillon
- Pediatric Cardiothoracic Surgery, Heart Institute, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Laura Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicholas R Hess
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Wireko I, Béland D, Kpessa-Whyte M. Self-undermining policy feedback and the creation of National Health Insurance in Ghana. Health Policy Plan 2020; 35:1150-1158. [PMID: 32989440 DOI: 10.1093/heapol/czaa080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2020] [Indexed: 11/13/2022] Open
Abstract
Contributing to the ongoing debate about policy feedback in comparative public policy research, this article examines the evolution of healthcare financing policy in Ghana. More specifically, this article investigates the shift in healthcare financing from full cost recovery, known as 'cash-and-carry', to a nation-wide public health insurance policy called the National Health Insurance Scheme (NHIS). It argues that unintended, self-undermining feedback effects from the existing health policy constrained the menu of options available to reformers, while simultaneously opening a window of opportunity for transformative policy change. The study advances the current public policy scholarship by showing how the interaction between policy feedbacks and other factors-particularly ideas and electoral pressures-can bring about path-departing policy change. Given the dearth of scholarship on self-undermining policy feedback effects in the Global South, this contribution's originality lies in its application of the novel theory to the sub-Saharan African context.
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Affiliation(s)
- Ishmael Wireko
- Government of Saskatchewan, Ministry of Energy and Resources1000, 2103 11th Avenue Regina SK S4P 3Z8, Canada
| | - Daniel Béland
- Department of Political Science, McGill University, Room 414, Leacock Building, 855 Sherbrooke Street West, Montreal, Quebec H3A 2T7, Canada
| | - Michael Kpessa-Whyte
- History and Politics Section, Institute of African Studies, Anne Jiage Road, P.O. Box LG 73, University of Ghana, Legon, Accra, Ghana
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Schwalm JD, Ivers NM, Bouck Z, Taljaard M, Natarajan MK, Dolovich L, Thavorn K, McCready T, O'Brien E, Grimshaw JM. Length of Initial Prescription at Hospital Discharge and Long-Term Medication Adherence for Elderly, Post-Myocardial Infarction Patients: Protocol for an Interrupted Time Series Study. JMIR Res Protoc 2020; 9:e18981. [PMID: 33146624 PMCID: PMC7673978 DOI: 10.2196/18981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 01/27/2023] Open
Abstract
Background Based on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer duration at discharge from hospital are associated with greater long-term medication adherence. The following is a proposal for the first interventional study to evaluate the impact of longer prescription duration at discharge post-MI on long-term medication adherence. Objective The overarching goal of this study is to reduce morbidity and mortality among post-MI patients through improved long-term cardiac medication adherence. The specific objectives include the following. First, we will assess whether long-term cardiac medication adherence improves among elderly, post-MI patients following the implementation of (1) standardized discharge prescription forms with 90-day prescriptions and 3 repeats for recommended cardiac medication classes, in combination with education and (2) education alone compared to (3) usual care. Second, we will assess the cost implications of prolonged initial discharge prescriptions compared with usual care. Third, we will compare clinical outcomes between longer (>60 days) versus shorter prescription durations. Fourth, we will collect baseline information to inform a multicenter interventional study. Methods We will conduct a quasiexperimental, interrupted time series design to evaluate the impact of a multifaceted intervention to implement longer duration prescriptions versus usual care on long-term cardiac medication adherence among post-MI patients. Intervention groups and their corresponding settings include: (1) intervention group 1: 1 cardiac center and 1 noncardiac hospital allocated to receive standardized discharge prescription forms supporting the dispensation of 90 days’ worth of cardiac medications with 3 repeats, coupled with education; (2) intervention group 2: 4 sites (including 1 cardiac center) allocated to receive education only; and (3) control group: all remaining hospitals within the province that did not receive an intervention (ie, usual care). Administrative databases will be used to measure all outcomes. Adherence to 4 classes of cardiac medications — statins, beta blockers, angiotensin system inhibitors, and secondary antiplatelets (ie, prasugrel, clopidogrel, or ticagrelor) — will be assessed. Results Enrollment began in September 2017, and results are expected to be analyzed in late 2020. Conclusions The results have the potential to redefine best practices regarding discharge prescribing policies for patients post-MI. A policy of standardized maximum-duration prescriptions at the time of discharge post-MI is a simple intervention that has the potential to significantly improve long-term medication adherence, thus decreasing cardiac morbidity and mortality. If effective, this low-cost intervention to implement longer duration prescriptions post-MI could be easily scaled. Trial Registration ClinicalTrials.gov NCT03257579; https://clinicaltrials.gov/ct2/show/NCT03257579 International Registered Report Identifier (IRRID) DERR1-10.2196/18981
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Affiliation(s)
- J D Schwalm
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.,Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Noah M Ivers
- Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Zachary Bouck
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Drug Policy and Evaluation, Unity Health Toronto, Toronto, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Toronto, ON, Canada
| | - Madhu K Natarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.,Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Kednapa Thavorn
- ICES, Toronto, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Erin O'Brien
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Levlin M, Nakeva von Mentzer C. An evaluation of systematized phonics on reading proficiency in Swedish second grade poor readers: Effects on pseudoword and sight word reading skills. Dyslexia 2020; 26:427-441. [PMID: 32989836 PMCID: PMC7702055 DOI: 10.1002/dys.1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/23/2020] [Accepted: 09/04/2020] [Indexed: 05/14/2023]
Abstract
The aim of the present study was to evaluate the effect of systematized phonics on word reading in Swedish second grade poor readers. Forty-nine children who performed at or below the 25th percentile on pseudoword reading and/or sight word reading at the beginning of second grade participated in the study. The study had a cross-over design exploring within-and between-group effects of two different conditions: systematized phonics and classroom instruction. Overall, systematized phonics proved more effective than classroom instruction. At pre-intervention, no child performed above the 30th percentile in pseudoword reading or sight word reading. At post-intervention, corresponding numbers were 69% for pseudoword reading and 35% for sight word reading. Implications for a policy change in Sweden towards mandatory systematized phonics in primary school are discussed.
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Affiliation(s)
- Maria Levlin
- Department of Language StudiesUmeå UniversityUmeåSweden
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Hess NR, Hickey GW, Sultan I, Kilic A. Extracorporeal membrane oxygenation bridge to heart transplant: Trends following the allocation change. J Card Surg 2020; 36:40-47. [PMID: 33090585 DOI: 10.1111/jocs.15118] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study compared outcomes of patients bridged with extracorporeal membrane oxygenation (ECMO) to orthotopic heart transplantation (OHT) following the recent heart allocation policy change. METHODS The United Network of Organ Sharing Registry (UNOS) database was queried to examine OHT patients between 2010 and 2020 that were bridged with ECMO. Waitlist outcomes and 1-year posttransplant survival were compared between patients waitlisted and/or transplanted before and after the heart allocation policy change. Secondary outcomes included posttransplant stroke, renal failure, and 1-year rejection. RESULTS A total of 285 waitlisted patients were included, 173 (60.7%) waitlisted under the old policy and 112 (39.3%) under the new policy. New policy patients were more likely to receive OHT (82.2% vs. 40.6%), and less likely to be removed from the waitlist due to death or clinical deterioration (15.0% vs. 41.3%; both p < .001). A total of 165 patients bridged from ECMO to OHT were analyzed, 72 (43.6%) transplanted during the old policy and 93 (56.3%) under the new. Median waitlist time was reduced under the new policy (4 days [interquartile range {IQR}: 2-6] vs. 47 days [IQR: 10-228]). Postoperative renal failure was higher in the new policy group (23% vs. 6%; p = .002), but rates of stroke and 1-year acute rejection were equivalent. One-year survival was lower the new policy but was not significant (79.8% vs. 90.3%; p = .3917). CONCLUSIONS The UNOS heart allocation policy change has resulted in decreased waitlist times and higher likelihood of transplant in patients supported with ECMO. Posttransplant 1-year survival has remained comparable although absolute rates are lower.
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Affiliation(s)
- Nicholas R Hess
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gavin W Hickey
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Cooper DG, Christens BD. Justice System Reform for Health Equity: A Mixed Methods Examination of Collaborating for Equity and Justice Principles in a Grassroots Organizing Coalition. Health Educ Behav 2020; 46:62S-70S. [PMID: 31549558 DOI: 10.1177/1090198119859411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent critiques of collective impact have provided a conceptual alternative that emphasizes the necessity of community organizing, and more explicit emphasis on advancing equitable systems and policy changes. This article reports results from a study of a citywide coalition in Chicago, IL that espoused many of these same principles. The coalition focused on justice system reform-systems and policy change that would dismantle punitive policies disproportionately affecting people of color-but also sought to connect these efforts with broader social determinants of health. The organizations that comprised the coalition were a pairing of those traditionally involved in restorative justice practice, and those traditionally involved in grassroots organizing. An action research partnership provided an opportunity to investigate processes and outcomes of a coalition created to advance equitable systems and policy changes. This analysis of the coalition's functioning employs a mixed methods approach. We utilize two waves of interorganizational social network data and qualitative data including participant observation, in-depth interviews, and archival document review to examine the coalition's successes and challenges related to each of the six core principles of Collaborating for Equity and Justice. This analysis provides practical insights into the benefits and challenges of implementing deeply participatory processes to address policy and systemic drivers of social determinants of health. Findings show that fully integrating all six principles is challenging, especially when a coalition represents broad constituencies across race, geography, and organizational philosophy. In such diverse settings, considerable time must be spent to build relationships and a strong foundation for sustainable processes.
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Abstract
Dominating headlines in the last few months, global attention has been fixed on the coronavirus pandemic given its rampaging impact on social events and human affairs. More than any other groups, older adults have been disproportionately affected by the deadly contagion. This situation poses legitimate concerns to the social work profession, whose mandate is to liberate vulnerable people and promote social development. Although the COVID-19 pandemic has continued to take a devastating toll on older adults in the short-term, its long-term consequences may be far more profound unless urgent attention is directed to mitigate this situation. Given the promulgation of social distancing and shutdowns among a number of African countries, many social workers have found it increasingly difficult to address the difficulties faced by older adults. This article canvasses for the utilization of the mass media in initiating policy response to the challenges of older adults throughout the continent.
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Benach J. We Must Take Advantage of This Pandemic to Make a Radical Social Change: The Coronavirus as a Global Health, Inequality, and Eco-Social Problem. Int J Health Serv 2020; 51:50-54. [PMID: 32746700 PMCID: PMC7404087 DOI: 10.1177/0020731420946594] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
COVID-19 not only constitutes a serious public health problem and a global major threat to the poorest and most vulnerable social groups and neighborhoods of the world, creating a potential pandemic of inequality, but also poses an enormous challenge from the perspective of public health, ethics, economy, environment, and politics. However, many of the deep and complex systemic interrelationships created and developed by this pandemic are largely hidden, unknown, or neglected, both by the hegemonic media and by a highly specialized and fragmented academic world. However, when all the available knowledge is critically integrated, the origins and effects underlying this pandemic are likely to be found in the development of neoliberal capitalism and its inherent logic of ceaseless accumulation, economic growth, large inequalities, and ecological devastation. This commentary reflects on these issues, drawing out some of the most important lessons to be learned and challenges to be faced in the COVID-19 pandemic and its aftermath, advocating for a radical social change to deal with these challenges.
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Affiliation(s)
- Joan Benach
- Health Inequalities Research Group (GREDS-EMCONET), Department of Political and Social Sciences, 16770Universitat Pompeu Fabra, Barcelona, Spain.,Johns-Hopkins-UPF Public Policy Center, Barcelona, Spain.,GinTrans2, Madrid Autonomous University (UAM), Madrid, Spain
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Wicki M, Bertholet N, Gmel G. Estimated changes in hospital admissions for alcohol intoxication after partial bans on off-premises sales of alcoholic beverages in the canton of Vaud, Switzerland: an interrupted time-series analysis. Addiction 2020; 115:1459-1469. [PMID: 31925836 DOI: 10.1111/add.14967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/18/2019] [Accepted: 01/07/2020] [Indexed: 12/26/2022]
Abstract
AIMS To estimate age-specific changes in hospital admissions for alcohol intoxication following two consecutive restrictions on off-premises alcohol sales introduced in the canton of Vaud, Switzerland. DESIGN Primary analyses used interrupted autoregressive integrated moving average (ARIMA) time-series analyses (repeated cross-sectional), with Lausanne and Vaud as experimental sites and the rest of Switzerland as the control. Secondary analyses used, for example, a different control site (other French-speaking cantons only) or a different statistical model. SETTING Switzerland between 2010 and 2016. PARTICIPANTS In-patients (i.e. patients assigned a bed overnight) hospitalized between 8 p.m. and 6 a.m. (n = 1 261 564), as documented in the Swiss Hospital Statistics. INTERVENTIONS Ban 1, only effective in the canton's capital, Lausanne, prohibited off-premises sales of all alcoholic beverages after 8 p.m. on Fridays and Saturdays from September 2013 to June 2015. In July 2015, Ban 2 replaced this, covered the whole canton and affected off-premises sales of beer and spirits (but not wine) after 9 p.m. (8 p.m. in Lausanne) every night of the week. MEASUREMENTS Proportions of monthly hospital admissions for alcohol intoxication (ICD-10 diagnoses F10.0/F10.1, T51.0) per 1000 monthly overall admissions. FINDINGS Proportions of overall hospitalizations for alcohol intoxication declined after both bans in Lausanne [ωBan1 = -0.017, 95% confidence interval (CI) = -0.025, -0.008; ωBan2 = -0.021, 95% CI = -0.030, -0.013] but only after Ban 2 in the remainder of the canton of Vaud (ωBan2 = -0.008, 95% CI = -0.014, -0.002). Estimated changes in % were largest among 16-19-year-olds. However, as admission rates for alcohol intoxication were more frequent in adulthood than adolescence, the estimated change in number of cases was also relevant to public health among 20-69-year-olds. Secondary analyses supported the findings of the primary analyses. CONCLUSION Even partial restrictions of off-premises sales of alcohol in Switzerland (only 2 days per week or only for beer and spirits) appeared to reduce hospital admissions for alcohol intoxication across a wide age range (ages 16-69 years).
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Affiliation(s)
- Matthias Wicki
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland
| | - Nicolas Bertholet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of the West of England, Bristol, UK
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Anwar Sheluchin, Regan M. Johnston, Clifton van der Linden. Public Responses to Policy Reversals: The Case of Mask Usage in Canada during COVID-19. Can Public Policy; 46. [ DOI: 10.3138/cpp.2020-089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in rapid, substantial, and at times contradictory policy changes as public health agencies and government officials react to new information. We examine the implications of such changes for public compliance by drawing on the case of revised guidance on mask usage by asymptomatic individuals. As official recommendations on the use of masks in Canada shift from discouraged to mandatory, we draw on findings from an ongoing public opinion study to explore contemporaneous changes in rates of mask adoption and levels of public trust in government institutions. We find that Canadians exhibit high levels of compliance with changing policies on mask usage and that trust in public health officials remains consistent despite policy change.
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Podder V, Srivastava V, Kumar S, Nagarathna R, Sivapuram MS, Kaur N, Sharma K, Singh AK, Malik N, Anand A, Nagendra HR. Prevalence and Awareness of Stroke and Other Comorbidities Associated with Diabetes in Northwest India. J Neurosci Rural Pract 2020; 11:467-473. [PMID: 32753814 PMCID: PMC7394624 DOI: 10.1055/s-0040-1709369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objectives
The main purpose of this study is to investigate the prevalence of comorbid conditions in diabetic, prediabetic, and nondiabetic individuals. Additionally, the current study examines the levels of awareness of those comorbidities among North Indian population.
Methods
As a part of a national study (Niyantrit Madhumeh Bharat [NMB] screening program), different comorbidity parameters were screened in the northern part of India between April and September 2017. There were 1,215 participants recruited in this study. Biochemical analyses of hemoglobin A1c (HbA1c) were conducted on the study subjects. Subsequently, the study subjects were divided into diabetic, prediabetic, and nondiabetic groups based on their HbA1c results.
Results
The study analysis reveals a higher prevalence of peripheral vascular disease (21.2%), ocular diseases (18%), and hypertension (13.4%) in diabetics with other comorbidities. Furthermore, the study found that a vast majority of the participants were unaware of the presence of hypertension (67.2%), dyslipidemia (84.5%), kidney disease (95.2%), peripheral vascular disease (34.5%), and stroke (95.1%).
Conclusion
The study concluded that in the northern India, the prevalence of multiple comorbid conditions, such as peripheral vascular disease and hypertension, is higher among diabetic population. Also, the level of awareness of diabetic comorbidities is surprisingly low, which has implications for policymakers, health practitioners, and educators of alternate medicine to increase awareness about diabetes, comorbid conditions, health risk, and possible solution at community and rural level, such as periodic screening programs in this population.
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Affiliation(s)
- Vivek Podder
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
| | - Vinod Srivastava
- Department of Social Work, University of Kentucky, Lexington, Kentucky, United States
| | - Saurabh Kumar
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Madhava Sai Sivapuram
- Department of General Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna-Avutapalli, Krishna, Andhra Pradesh, India
| | - Navneet Kaur
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,Department of Physical Education, Panjab University, Chandigarh, India
| | - Kanupriya Sharma
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Neeru Malik
- Department of Yoga, Dev Samaj College of Education, Panjab University, Chandigarh, India
| | - Akshay Anand
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Lacy MM, McMurtry Baird S, Scott TA, Barker B, Zite NB. Statewide quality improvement initiative to implement immediate postpartum long-acting reversible contraception. Am J Obstet Gynecol 2020; 222:S910.e1-8. [PMID: 31838123 DOI: 10.1016/j.ajog.2019.11.1272] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women face barriers to obtaining contraception and postpartum care. In a review of Tennessee birth data from 2014, 56% of pregnancies were unintended, 22.7% were short-interval pregnancies, and 57.9% of women who were not intending to get pregnant were not using contraception. Offering long-acting reversible contraceptive methods in the immediate postpartum period allows women who desire these effective methods of contraception to obtain unobstructed access and lower unintended and short-interval pregnancy rates. OBJECTIVE We report the experience of Tennessee's perinatal quality collaborative that aimed to address unintended and short-interval pregnancy by increasing access to immediate postpartum long-acting reversible contraception through woman-centered counseling and ensuring reimbursement for devices. This followed a policy change in November 2017 that allowed women who were insured under Tennessee Medicaid programs (TennCare) to achieve access to immediate postpartum long-acting reversible contraception. STUDY DESIGN From March 2018 to March 2019, 6 hospital sites participated in this statewide quality improvement project that was based on the Institute of Health Improvement Breakout Collaborative model. An evidence-based toolkit was created to provide guidance to the sites. During the year of implementation, monthly huddles occurred, and each facility took a differing amount of time to implement immediate postpartum long-acting reversible contraception. Various statewide and hospital-specific barriers occurred and were overcome throughout the year. RESULTS In total, 2012 long-acting reversible contraception devices were provided to eligible and desiring women. All but 1 institution was able to offer immediate postpartum long-acting reversible contraception by March 2019. Reimbursement was the biggest statewide barrier because rates were low initially but improved through intensive intervention by dedicated team members at each site and the state level. Even with dedicated team members, false assurances were given repeatedly by billing and claims staff. CONCLUSION A statewide quality improvement project can increase access to immediate postpartum long-acting reversible contraception. Implementation and reimbursement require a dedicated team and coordination with all stakeholders. Verification of reimbursement with leaders at TennCare was essential for project sustainment and facilitated improved reimbursement rates. The impact on unintended and short-interval pregnancies requires long-term future investigation.
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Mihaylov NL. From victims to citizens: Emerging activist identities in the anti-fracking movement in Bulgaria. J Community Psychol 2020; 48:170-191. [PMID: 31730743 DOI: 10.1002/jcop.22258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/20/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
AIMS The anti-fracking movement in Bulgaria, 2011-2013, was a successful grassroots effort to influence national environmental policy. The study draws on social movements and community psychology scholarship to investigate the emergence, development, and implications of activist identities as an important force for the movement's success. METHODS Within a qualitative design, data were collected from interviews with activists, observations of organizing events, movement documents, and media publications. Structured and open coding followed by qualitative analyses produced descriptions and explanations of the construction and use of identities in the movement. RESULTS Four major identities emerged in social and discursive interactions among activists and between activists and contextual forces: Victims, Bulgarians, Nature-protectors, and Citizens. The four identities were used interchangeably and afforded differential empowerment and opportunities for participation in policy-making. CONCLUSION The emerging activist identities were processes and products of the complex relationships between agency and context. The study contributes in illuminating the links between policy context, empowerment, participation, and political action.
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Abstract
Almost three decades since the collapse of the socialist regime, Romania's farm structure is characterized by a distinct dual pattern. The far majority of farms is relatively small, while a small number manages about half of the total utilized agricultural area. Most farmers face significant constraints in creating viable farm businesses. When this is the case, it can be assumed that farmers will unite and establish agricultural service cooperatives (ASCs), as has been observed in many other parts of the world. In Romania, however, as in many other postsocialist economies, farmers tend to be reluctant to form or join formal organizations of mutual assistance. Yet there are signs of change, as first ASCs have recently been established. The objectives of this contribution are twofold: First, we discuss the major obstacles why ASCs did not develop after regime change. Second, we analyze the major reasons and influencing factors why private family farmers become more open to this type of formal organization in recent years. The analysis is based on a literature review, farm statistics, and qualitative in-depth interviews with farmers in 2018.
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Affiliation(s)
- Axel Wolz
- Department of Agricultural Policy, Leibniz Institute of Agricultural Development in Transition Economies, Halle (Saale), Germany
| | - Judith Möllers
- Department of Agricultural Policy, Leibniz Institute of Agricultural Development in Transition Economies, Halle (Saale), Germany
| | - Marius Mihai Micu
- Faculty of Management, Economic Engineering and Rural Development, University of Agronomic Sciences and Veterinary Medicine of Bucharest, Bucharest, Romania
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Agarwal M, Dick AW, Sorbero M, Mody L, Stone PW. Changes in US Nursing Home Infection Prevention and Control Programs From 2014 to 2018. J Am Med Dir Assoc 2020; 21:97-103. [PMID: 31888867 PMCID: PMC6948108 DOI: 10.1016/j.jamda.2019.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Burgeoning rates of antibiotic resistance have resulted in a shift in national focus to improve infection prevention and control programs in US nursing homes (NHs). We sought to evaluate the changes in nursing home infection prevention and control programs over time. DESIGN Retrospective comparative analysis of national nursing home survey data from 2014 and 2018. SETTING AND PARTICIPANTS We used survey data from 2 nationally representative samples of US nursing homes (945 NHs in 2014 and 888 in 2018). METHODS Three indices measuring antibiotic stewardship, outbreak control, and urinary tract infection prevention (ranging from 0 to 100) were developed to measure the change in infection prevention and control programs. Multivariable linear regression models were used to identify facility and infection preventionist characteristics associated with each index. Decomposition models were used to identify contributions of factors on the differences in each index over time. RESULTS From 2014 to 2018, we saw strengthening of antibiotic stewardship practices by 33 percentage points, outbreak control practices by 13 percentage points, and urinary tract infection prevention practices by 6 percentage points. Although we found several predictors of these improvements, much of the improvement was due to the difference in time. CONCLUSIONS AND IMPLICATIONS Policy mandates and greater national attention are likely important factors in improving nursing home infection prevention and control practices. Further work is needed to evaluate the effect of these programs on resident outcomes.
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Affiliation(s)
- Mansi Agarwal
- Columbia University School of Nursing, New York, NY.
| | | | | | - Lona Mody
- University of Michigan, Ann Arbor, MI
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Zheng X, Lu Y, Yuan J, Baninla Y, Zhang S, Stenseth NC, Hessen DO, Tian H, Obersteiner M, Chen D. Drivers of change in China's energy-related CO 2 emissions. Proc Natl Acad Sci U S A 2020; 117:29-36. [PMID: 31871172 DOI: 10.1073/pnas.1908513117] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CO2 emissions are of global concern because of climate change. China has become the largest CO2 emitter in the world and presently accounts for 30% of global emissions. Here, we analyze the major drivers of energy-related CO2 emissions in China from 1978 when the reform and opening-up policy was launched. We find that 1) there has been a 6-fold increase in energy-related CO2 emissions, which was driven primarily (176%) by economic growth followed by population growth (16%), while the effects of energy intensity (−79%) and carbon intensity (−13%) slowed the growth of carbon emissions over most of this period; 2) energy-related CO2 emissions are positively related to per capita gross domestic product (GDP), population growth rate, carbon intensity, and energy intensity; and 3) a portfolio of command-and-control policies affecting the drivers has altered the total emission trend. However, given the major role of China in global climate change mitigation, significant future reductions in China’s CO2 emissions will require transformation toward low-carbon energy systems.
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Michaud-Létourneau I, Gayard M, Mathisen R, Phan LTH, Weissman A, Pelletier DL. Enhancing governance and strengthening advocacy for policy change of large Collective Impact initiatives. Matern Child Nutr 2019; 15 Suppl 2:e12728. [PMID: 30793547 PMCID: PMC6519038 DOI: 10.1111/mcn.12728] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/13/2018] [Accepted: 10/09/2018] [Indexed: 12/28/2022]
Abstract
Nutrition issues are increasingly being addressed through global partnerships and multi‐sectoral initiatives. Ensuring effective governance of these initiatives is instrumental for achieving large‐scale impact. The Collective Impact (CI) approach is an insightful framework that can be used to guide and assess the effectiveness of this governance. Despite the utility and widespread use of this approach, two gaps are identified: a limited understanding of the implications of expansion for an initiative operating under the conditions of CI and a lack of attention to advocacy for policy change in CI initiatives. In this paper, a case study was undertaken in which the CI lens was applied to the advocacy efforts of Alive & Thrive (A&T), UNICEF and partners. The initiative expanded into a regional movement and achieved meaningful policy changes in infant and young child feeding policies in seven countries in Southeast Asia. These efforts are examined in order to address the two gaps identified in the CI approach. The objectives of the paper are (a) to examine the governance of this initiative and the process of expansion from a national to a regional, multilayered initiative, with attention to challenges, adaptations, and key elements, and (b) to compare advocacy in the A&T–UNICEF initiative and in typical CI initiatives and gain insight into how the practice of advocacy for policy change can be strengthened in CI initiatives.
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Affiliation(s)
- Isabelle Michaud-Létourneau
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Marion Gayard
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Roger Mathisen
- Alive & Thrive, Regional Office in Southeast Asia, Hanoi, Vietnam
| | | | - Amy Weissman
- FHI 360, Asia Pacific Regional Office, Bangkok, Thailand
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Michaud-Létourneau I, Gayard M, Pelletier DL. Contribution of the Alive & Thrive-UNICEF advocacy efforts to improve infant and young child feeding policies in Southeast Asia. Matern Child Nutr 2019; 15 Suppl 2:e12683. [PMID: 30793546 PMCID: PMC6519196 DOI: 10.1111/mcn.12683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022]
Abstract
Evaluating the impact of advocacy for policy change presents many challenges. Recent advances in the field of evaluation, such as contribution analysis (CA), offer guidance on how to make credible claims regarding such impact. The purposes of this article are (a) to detail the application of CA to assess the contribution of an advocacy initiative to improve infant and young child feeding policies and (b) to present the emergent theory of change and contribution story of how progress was achieved. An evaluation applying developmental evaluation and CA was conducted on the Alive & Thrive (A&T)-UNICEF initiative in seven Southeast Asian countries to document the extent to which policy objectives were achieved and identify key drivers of policy change. A contribution story was developed based on these experiences. The advocacy approach, which involved a four-part process, contributed directly to (a) set the agenda of various actors and (b) create a strategic group; and indirectly to (a) set and maintain the issue on the agenda at all stages of the policy cycle, (b) support the government to carry out a set of critical tasks, and (c) extend commitment. All of this helped to achieve progress towards policy change. External influences were at play. The flexibility of A&T allowed key actors to utilize the positive external influences and address some of the negative ones through developing responsive strategies mitigating their effects. The emerging contribution story supports that A&T-UNICEF initiative contributed to the progress achieved in the participating countries.
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Affiliation(s)
- Isabelle Michaud-Létourneau
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Marion Gayard
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Quebec, Canada
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Goldin Evans M, Broyles S, Frederiksen B, Gee RE, Phillippi S, Sothern M, Theall KP, Wightkin J. Long-acting reversible contraceptive utilization after policy change increasing device reimbursement to wholesale acquisition cost in Louisiana. Am J Obstet Gynecol 2019; 221:128.e1-128.e10. [PMID: 31042498 DOI: 10.1016/j.ajog.2019.04.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/20/2019] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unintended pregnancies, occurring in nearly 1 out of every 2 (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives, namely intrauterine devices and implants. Inadequate reimbursement for long-acting reversible contraceptive devices may be an access barrier to long-acting reversible contraceptive uptake. In 2014, the Louisiana Department of Health Bureau of Health Services Financing implemented a policy change that increased the Medicaid reimbursement rates for acquiring long-acting reversible contraceptive devices to the wholesale acquisition cost. OBJECTIVE To examine the association of a Medicaid policy change that increased the long-acting reversible contraceptive device reimbursement rate to the wholesale acquisition cost (ie, price set by the manufacturers) on long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. MATERIALS AND METHODS This retrospective, repeated cross-sectional study used 2013-2015 Louisiana Medicaid claims data and contraceptive provision measures to assess associations between patient (age, race, urban/rural residence, postpartum status) and provider (urban/rural location, specialty) characteristics and long-acting reversible contraceptive uptake among contraceptive users (N = 193,623) using bivariate and logistic regression analyses. RESULTS After long-acting reversible contraceptive reimbursement increased, there was a 2-fold likelihood increase in use in 2015 vs 2013 (odds ratio, 2.08; 95% confidence interval, 1.69-2.55). Long-acting reversible contraceptive uptake was more likely across all patient and provider subgroups in 2015 vs 2013 but notably among patients receiving contraceptive care from family planning clinics (odds ratio, 3.93; 95% confidence interval, 2.34-6.62). CONCLUSION Removal of a provider-level financial barrier to long-acting reversible contraceptive provision was associated with increased long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. Efforts to improve long-acting reversible contraceptive access should focus on equitable healthcare reimbursement for healthcare providers of reproductive-aged women.
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Li L, Deng M, Liu Z, Rohrbaugh R. A Qualitative Study of Implementation Challenges of Mental Health Clubhouse Rehabilitation Services in China's Hunan Province. Psychiatr Serv 2019; 70:674-680. [PMID: 31035893 DOI: 10.1176/appi.ps.201800549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People's Republic of China. METHODS Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semistructured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods. RESULTS Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness. CONCLUSIONS Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment.
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Affiliation(s)
- Luming Li
- Department of Psychiatry, Yale School of Medicine, Yale New Haven Psychiatric Hospital, New Haven, Connecticut (Li, Rohrbaugh); Psychiatry Department, Second Xiangya Hospital of Central South University, Changsha, China (Deng, Liu)
| | - Mengjie Deng
- Department of Psychiatry, Yale School of Medicine, Yale New Haven Psychiatric Hospital, New Haven, Connecticut (Li, Rohrbaugh); Psychiatry Department, Second Xiangya Hospital of Central South University, Changsha, China (Deng, Liu)
| | - Zhening Liu
- Department of Psychiatry, Yale School of Medicine, Yale New Haven Psychiatric Hospital, New Haven, Connecticut (Li, Rohrbaugh); Psychiatry Department, Second Xiangya Hospital of Central South University, Changsha, China (Deng, Liu)
| | - Robert Rohrbaugh
- Department of Psychiatry, Yale School of Medicine, Yale New Haven Psychiatric Hospital, New Haven, Connecticut (Li, Rohrbaugh); Psychiatry Department, Second Xiangya Hospital of Central South University, Changsha, China (Deng, Liu)
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Vogeler CS. Market-Based Governance in Farm Animal Welfare-A Comparative Analysis of Public and Private Policies in Germany and France. Animals (Basel) 2019; 9:ani9050267. [PMID: 31121958 PMCID: PMC6562795 DOI: 10.3390/ani9050267] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Farm animal welfare policies are in transition: whereas agricultural policy is traditionally characterised by strong state steering, market actors are getting involved in this field. This study aims to improve understanding of these dynamics in the field of farm animal welfare. By conducting a comparative case study of public and private farm animal welfare policies in Germany and France, the findings illustrate how retailers are assuming a leading role in the field. By introducing animal welfare labels and purchasing guidelines, retailers react to rising societal concerns for the welfare of farmed animals. Governmental actors, conversely, are exercising restraint and engage in voluntary rather than regulatory policies. Contrary to the traditionally strong role of the state in agricultural policy, the contribution indicates a shift towards market-based governance in the field of farm animal welfare. Abstract The intensification of livestock production and the focus on economic gains of agricultural policy have resulted in animal welfare related challenges. In many countries the societal concern for the welfare of farmed animals is increasing. Whereas policymakers on the European Union’s level and in EU member states have passed specific farm animal protection laws, the existing policies do not always guarantee the welfare of farmed animals. At the same time, the engagement of market actors in the field is increasing. This article explores the development of public and private policies in two countries with very different levels of regulation. By conducting a comparative analysis of public and private policies in Germany and France, the findings illustrate that, although they have different starting points, retailers in both countries are getting increasingly involved in farm animal welfare. In addition, there is evidence that governmental policies are shifting from regulatory to voluntary approaches in cooperation with the private sector. Given that in both countries these dynamics are a very recent development, it remains to be seen whether governmental actors will (re-)assume the lead in the field, whether they will engage in cooperation with private actors, or whether they will leave the task of agricultural restructuring to the market.
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Affiliation(s)
- Colette S Vogeler
- Institute for Political Science, University of Heidelberg, Bergheimer Straße 58, D-69115 Heidelberg, Germany.
- Comparative Politics and Public Policy, University of Braunschweig, Bienroder Weg 97, D-38106 Braunschweig, Germany.
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Levesque M, Klohn M. A Multiple Streams Approach to Understanding the Issues and Challenges of Lyme Disease Management in Canada's Maritime Provinces. Int J Environ Res Public Health 2019; 16:ijerph16091531. [PMID: 31052190 PMCID: PMC6539885 DOI: 10.3390/ijerph16091531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 12/11/2022]
Abstract
This study examines potential challenges facing Lyme disease patients in Canada’s Maritime provinces—New Brunswick, Nova Scotia, Prince Edward Island—and considers how issues could be addressed. Reviews of both the academic and grey literature are complemented by surveys targeting both medical professionals and decision makers in government. Combined, the literature reviews and surveys demonstrate that there is considerable debate surrounding the effectiveness of testing, treatment options, and the existence of chronic Lyme disease. As the focus on the Maritimes demonstrates, these debates often pit the medical community against patients and patient advocates and, thus far, governments have been unable to produce policy that entirely pleases either side. Moving forward, this study recommends the creation of a discussion forum via a federal Commission of inquiry to review best practise guidelines for Lyme disease. The key is to foster an unbiased probe of central issues surrounding treatment and diagnosis without alienating stakeholders. This course of action will not necessarily solve the issue of Lyme disease, but would foster a greater understanding through dialogue that includes and validates the experiences of stakeholders, which is something that is currently missing.
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Affiliation(s)
- Mario Levesque
- Department of Politics and International Relations, Mount Allison University, 144 Main St., Sackville, NB E4L 1A7, Canada.
| | - Matthew Klohn
- Department of Politics and International Relations, Mount Allison University, 144 Main St., Sackville, NB E4L 1A7, Canada.
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Affiliation(s)
- Keshia M Pollack Porter
- 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 2 Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3 Policy Change Workgroup, Bloomberg American Health Initiative, Baltimore, MD, USA
| | - Lainie Rutkow
- 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3 Policy Change Workgroup, Bloomberg American Health Initiative, Baltimore, MD, USA
| | - Emma E McGinty
- 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 2 Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3 Policy Change Workgroup, Bloomberg American Health Initiative, Baltimore, MD, USA
- 4 Johns Hopkins Center for Mental Health and Addiction Policy Research, Baltimore, MD, USA
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Martins D, Khuu W, Tadrous M, Juurlink DN, Mamdani MM, Paterson JM, Gomes T. Impact of delisting high-strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada. Pharmacoepidemiol Drug Saf 2019; 28:726-733. [PMID: 30873707 PMCID: PMC6518867 DOI: 10.1002/pds.4764] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/04/2019] [Accepted: 02/14/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE High-strength opioid formulations were delisted (removed) from Ontario's public drug formulary in January 2017, except for palliative patients. We evaluated the impact of this policy on opioid utilization and dosing. METHODS We conducted a longitudinal study among patients receiving publicly funded, high-strength opioids from August 2016 to July 2017. The primary outcome measure was weekly median daily opioid dose (in milligrams of morphine or equivalent; MME) of (1) publicly funded and (2) all opioid prescriptions irrespective of funding source, evaluated using interrupted time series analyses and stratified by palliative care status. RESULTS Following policy implementation, the weekly median daily dose of publicly funded opioids decreased immediately among non-palliative patients by 10 MME (95% confidence limit [CL], -16.8 to -3.1) from a pre-intervention dose of 424.5 MME (95% CL, 417.8-431.2) and fell gradually among palliative patients by 3.9 MME per week (95% CL, -5.5 to -2.3) from a pre-intervention dose of 450.1 MME (95% CL, 432.5-467.7). In contrast, among all opioid prescriptions, gradual reductions in weekly median daily doses were observed only for non-palliative patients, which decreased by 0.7 MME per week (95% CL, -1.3 to -0.2) from a pre-intervention dose of 426.2 MME (95% CL, 420.9-431.5). CONCLUSION The delisting of publicly-funded, high-strength opioids was accompanied by changes in funding source and small reductions in the weekly median daily doses dispensed. Although observed dose reductions of less than 1 MME weekly are likely not clinically relevant, safety implications of these changes require further monitoring.
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Affiliation(s)
- Diana Martins
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Mina Tadrous
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - David N Juurlink
- ICES, Toronto, Ontario, Canada.,The Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad M Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - J Michael Paterson
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Michaud‐Létourneau I, Gayard M, Pelletier DL. Strengthening advocacy and policy change for infant and young child feeding. Matern Child Nutr 2019; 15 Suppl 2:e12749. [PMID: 30793545 PMCID: PMC6519243 DOI: 10.1111/mcn.12749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/07/2018] [Indexed: 12/26/2022]
Abstract
The creation of environments that are more supportive of optimal infant and young child feeding (IYCF) requires countries to enact policies, such as those related to the Maternity Protection Convention, the International Code of Marketing of Breast-milk Substitutes (the Code), and the Baby-Friendly Hospital Initiative. However, challenges are experienced in the translation of international policy standards into national legal measures, and there is an important gap in understanding how countries achieve progress. Policy advocacy is a nearly universal feature, but there are methodological challenges and few studies evaluating strategies and effects. The purpose of this supplement to Maternal & Child Nutrition is to address those gaps. This supplement contains three papers that present findings from a real-time evaluation of the advocacy efforts of Alive & Thrive (A&T), United Nations International Children's Emergency Fund (UNICEF), and partners, that sought to support governments in fostering enabling environment for optimal IYCF in Southeast Asia (SEA) and Africa. A combination of two emergent, theory-based evaluation approaches was used: developmental evaluation and contribution analysis. The overall objective of the evaluation was to document the extent to which policy objectives were or were not achieved in each country and to identify the key drivers of policy change. One contribution of the supplement is a distinction between and illustration of triggers and drivers of policy change. Three main drivers of policy change were identified: (a) the use of an explicit advocacy approach; (b) the creation of a strategic group of actors; and (c) the realization of 15 critical tasks (more specifically for the Code). Each of the critical tasks has been identified as having triggered progress on the Code in those countries. This supplement provides evidence that the advocacy efforts of A&T, UNICEF, and partners contributed to enhanced IYCF policies in SEA and reveals how it helped to achieve progress. The insights contained in this supplement can serve as a guide for policy advocates for enhanced IYCF policies. A short communication puts findings into perspective within global context.
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Affiliation(s)
- Isabelle Michaud‐Létourneau
- Department of Social and Preventive Medicine, School of Public HealthUniversité de MontréalMontrealQuebecCanada
- Department of Family Medicine and Emergency MedicineUniversité de SherbrookeLongueuilQuebecCanada
| | - Marion Gayard
- Department of Family Medicine and Emergency MedicineUniversité de SherbrookeLongueuilQuebecCanada
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Hopkins ZH, Secrest AM. Public Health Implications of Google Searches for Sunscreen, Sunburn, Skin Cancer, and Melanoma in the United States. Am J Health Promot 2018; 33:611-615. [PMID: 30428681 DOI: 10.1177/0890117118811754] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Google Trends (GT) offers insights into public interests and behaviors and holds potential for guiding public health campaigns. We evaluated trends in US searches for sunscreen, sunburn, skin cancer, and melanoma and their relationships with melanoma outcomes. DESIGN Google Trends was queried for US search volumes from 2004 to 2017. Time-matched search term data were correlated with melanoma outcomes data from Surveillance Epidemiology and End Results Program and United States Cancer Statistics databases (2004-2014 and 2010-2014, respectively). SETTING Users of the Google search engine in the United States. PARTICIPANTS Google search engine users in the United States. This represents approximately 65% of the population. MEASURES Search volumes, melanoma outcomes. ANALYSIS Pearson correlations between search term volumes, time, and national melanoma outcomes. Spearman correlations between state-level search data and melanoma outcomes. RESULTS The terms "sunscreen," "sunburn," "skin cancer," and "melanoma" were all highly correlated ( P < .001), with sunscreen and sunburn having the greatest correlation ( r = 0.95). Sunscreen/sunburn searches have increased over time, but skin cancer/melanoma searches have decreased ( P < .05). Nationally, sunscreen, sunburn, and skin cancer were significantly correlated with melanoma incidence. At the state level, only sunscreen and melanoma searches were significantly correlated with melanoma incidence. CONCLUSIONS We conclude that online skin cancer prevention campaigns should focus on the search terms "sunburn" and "sunscreen," given the decreasing online searches for skin cancer and melanoma. This is reinforced by the finding that sunscreen searches are higher in areas with higher melanoma incidence.
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Affiliation(s)
| | - Aaron M Secrest
- 2 Department of Dermatology and Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Rychert M, Wilkins C. Understanding the development of a regulated market approach to new psychoactive substances (NPS) in New Zealand using Punctuated Equilibrium Theory. Addiction 2018; 113:2132-2139. [PMID: 29744945 DOI: 10.1111/add.14260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/24/2018] [Accepted: 04/25/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS The short-lived regulated legal market for new psychoactive substances (NPS) in New Zealand marked a radical departure from the traditional prohibition-based approach to drugs. This paper aimed to enhance understanding of this policy change using Punctuated Equilibrium Theory (PET). METHODS The analysis draws on 3 years of evaluative research, including interviews with key stakeholders, analysis of legislation and policy documents and academic and grey literature. RESULTS The reframing of the NPS issue from one of drug control to the need for stricter market regulation was achieved by the efforts of strategic policy entrepreneurs, including the legal high industry, drug law reform advocates, influential politicians and an independent legal advisory institution. This reframing was aided by the perceived saliency of the NPS problem and ineffectiveness of previous prohibition-based responses. In the absence of any political opposition to the regulatory approach, the Psychoactive Substances Act rapidly progressed through the Parliament. However, once the interim legal market was established, portrayal of the issues shifted away from experts and lobbyists to critique from local communities, local government, animal rights activists and the media, who viewed the new regime as a source of social and health problems. The mobilization of criticism ('Schattschneider mobilization') drew on ideas of animal welfare and community safety. With a looming national election, the government responded by ending the interim market with the urgent passage of amendment legislation. CONCLUSIONS Punctuated Equilibrium Theory (PET) helps explain how New Zealand's Psychoactive Substances Act (PSA) policy first emerged on the political agenda and how the initial positive tone of expert support for reform shifted to a tide of popular criticism during the interim regime. However, with its emphasis on explaining agenda-setting, PET does not account for the legislative design shortcomings of the PSA.
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Affiliation(s)
- Marta Rychert
- SHORE and Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- SHORE and Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Wall KM, Bayingana R, Ingabire R, Ahlschlager L, Tichacek A, Allen S, Karita E. Rwandan stakeholder perspectives of integrated family planning and HIV services. Int J Health Plann Manage 2018; 33:e1037-e1049. [PMID: 30047594 PMCID: PMC6289844 DOI: 10.1002/hpm.2586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022] Open
Abstract
The purpose of this qualitative study was to understand the knowledge, attitudes, and practices among key Rwandan policymakers and stakeholders related to family planning (FP) and integrated HIV/FP services. Motivational in-depth interview format and content was developed after an extensive policy review. A convenience sample of 10 high-level HIV and FP Rwandan policymakers and stakeholders completed the interview. Stakeholders demonstrated strong foundational knowledge of HIV and FP. Given the choice, stakeholders would allocate more monies to FP and less to HIV than currently distributed. Respondents felt that improved FP method knowledge, especially long-acting reversible contraception, among clients/couples and providers, was needed to address myths, misconceptions, and biases. The most often cited way to integrate HIV/FP services was development of integrated tools (eg, training materials, data collection tools, and advocacy and policy guidance). We recommend strategies for policy advancement supportive of HIV/FP service integration inclusive of couples and long-acting reversible contraception methods.
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Affiliation(s)
- Kristin M. Wall
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Roger Bayingana
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityKigaliRwanda
| | - Rosine Ingabire
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityKigaliRwanda
| | - Lauren Ahlschlager
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Etienne Karita
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityKigaliRwanda
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