ResearchPad - policy https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[China’s ‘mask diplomacy’ to change the COVID-19 narrative in Europe]]> https://www.researchpad.co/article/elastic_article_13504 <![CDATA[Rapprochement amid readjustment: how China sees issues and trends in its changing relationship with the EU]]> https://www.researchpad.co/article/elastic_article_13499 The EU-China relationship is entering a period of readjustment. On the one hand, the US-China trade war has forced China to seek closer alignment with the EU, and on the other hand, the EU has chosen a more proactive approach to tame China’s global and regional assertiveness. The European readjustment has been particularly noticeable in areas like connectivity, investment and 5G. China has noticed the European change of attitude and relates it to European uncertainties and misinterpretation of China’s development. While the new European leadership was supposed to meet their Chinese counterparts in 2020 and work out a new modus operandi, the global coronavirus pandemic has exacerbated underlying tensions in the relationship. A comprehensive deepening of the EU-China strategic partnership looks unlikely and cooperation is expected to be increasingly selective.

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<![CDATA[Telemedicine Facilitation of Transfer Coordination From Emergency Departments]]> https://www.researchpad.co/article/elastic_article_13006 Interhospital transfers are costly to patients and to the health care system. The use of telemedicine may enable more efficient systems by decreasing transfers or diverting transfers from crowded referral emergency departments (EDs) to alternative appropriate facilities. Our primary objective is to describe the prevalence of telemedicine for transfer coordination among US EDs, the ways in which it is used, and characteristics of EDs that use telemedicine for transfer coordination.MethodsWe used the 2016 National Emergency Department Inventory–USA survey to identify telemedicine-using EDs. We then surveyed all EDs using telemedicine for transfer coordination and a sample of EDs using telemedicine for other clinical applications. We used a multivariable logistic regression model to identify characteristics independently associated with use of telemedicine for transfer coordination.ResultsOf the 5,375 EDs open in 2016, 4,507 responded to National Emergency Department Inventory–USA (84%). Only 146 EDs used telemedicine for transfer coordination; of these, 79 (54%) used telemedicine to assist with clinical care for local admission, 117 (80%) to assist with care before transfer, and 92 (63%) for arranging transfer to a different hospital. Among telemedicine-using EDs, lower ED annual visit volume (odds ratio 5.87, 95% CI 2.79 to 12.36) was independently associated with use of telemedicine for transfer coordination.ConclusionAlthough telemedicine has potential to improve efficiency of regional emergency care systems, it is infrequently used for coordination of transfer between EDs. When used, it is most often to assist with clinical care before transfer. ]]> <![CDATA[Exploring the knowledge and attitudes of Cameroonian medical students towards global surgery: A web-based survey]]> https://www.researchpad.co/article/elastic_article_11233 Global surgery is a growing field studying the determinants of safe and affordable surgical care and advocating to gain the global health community's attention. In Cameroon, little is known about the level of knowledge and attitudes of students. Our survey aimed to describe the knowledge and attitudes of Cameroonian medical students towards global surgery.Materials and methodsWe performed an anonymous online survey of final-year Cameroonian medical students. Mann-Whitney U test and Spearman correlation analysis were used for bivariate analysis, and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated.Results204 respondents with a mean age of 24.7 years (±2.0) participated in this study. 58.3% were male, 41.6% had previously heard or read about global surgery, 36.3% had taken part in a global surgery study, and 10.8% had attended a global surgery event. Mercy Ships was well known (46.5%), and most students believed that surgical interventions were more costly than medical treatments (75.0%). The mean score of the global surgery evaluation was 47.4% (±29.6%), and being able to recognize more global surgery organizations was correlated with having assumed multiple roles during global surgery studies (p = 0.008) and identifying more global surgery indicators (p = 0.04). Workforce, infrastructure, and funding were highlighted as the top priorities for the development of global surgery in Cameroon.ConclusionMedical students are conscious of the importance of surgical care. They lack the opportunities to nurture their interest and should be taught global surgery concepts and skills. ]]> <![CDATA[Physicians' Difficulties Due to Patient Safety Incidents in Korea: a Cross-Sectional Study]]> https://www.researchpad.co/article/elastic_article_10905

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<![CDATA[Thrive Health: a New Venture Connecting Patient Advocacy to Well-Being]]> https://www.researchpad.co/article/elastic_article_9321 As part of the British Columbia government’s response to the COVID-19 pandemic outbreak, an online self-assessment tool was launched to help with symptom assessment and to provide necessary health information for people. The tool was developed by Thrive Health, a company which has been working to improve the delivery of e-health in Canada since 2016, with an emphasis on well-being. This review captures this company’s purpose and role in addressing the needs of patients and healthcare providers in the community, to change the definition of healthcare. In pursuing this goal, Thrive Health is innovating to make the long lost connection between physical and mental health through an online app with design features supported by research around subjective well-being, as a measurement of effective community development and human progress. This very characteristic is what establishes the company’s uniqueness among other similar patient advocacy groups, and connects patient advocacy to happiness and well-being.

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<![CDATA[Health and long-term care of the elderly with dementia in rural Thailand: a cross-sectional survey through their caregivers]]> https://www.researchpad.co/article/elastic_article_9133 To describe the circumstances of the elderly with dementia and their caregivers’ characteristics in order to examine factors related to activities of daily living (ADL) and household income to propose a long-term care policy for rural areas of Thailand.SettingA cross-sectional study at the household level in three rural regions of Thailand where there were initiatives relating to community care for people with dementia.ParticipantsCaregivers of 140 people with dementia were recruited for the study.Primary and secondary outcome measuresSocioeconomic characteristics including data from assessment of ADL and instrumental ADL and the Thai version of Resource Utilisation in Dementia were collected. Descriptive statistics were used to explain the characteristics of the elderly with dementia and the caregivers while inferential statistics were used to examine the associations between different factors of elderly patients with dementia with their dependency level and household socioeconomic status.ResultsEighty-six per cent of the dementia caregivers were household informal caregivers as half of them also had to work outside the home. Half of the primary caregivers had no support and no minor caregivers. The elderly with dementia with high dependency levels were found to have a significant association with age, dementia severity, chance of hospitalisation and number of hospitalisations. Though most of these rural samples had low household incomes, the patients in the lower-income households had significantly lower dementia severity, but, with the health benefit coverage had significantly higher chances of hospitalisation.ConclusionAs the informal caregivers are the principal human resources for dementia care and services in rural area, policymakers should consider informal care for the Thai elderly with dementia and promote it as the dominant pattern of dementia care in Thailand. ]]> <![CDATA[Towards universal coverage for nutrition services in children under five years—A descriptive analysis of the capacity of level one hospitals to provide nutrition services in five provinces of Zambia]]> https://www.researchpad.co/article/elastic_article_7846 Malnutrition continues to be a major public health challenge in Zambia. To effectively address this, health systems must be well strengthened to deliver an effective continuum of care. This paper examines health systems issues and services in relation to nutritional support to children under five years, in order to identify gaps and propose interventions towards universal coverage of essential nutrition services.MethodsThis analysis utilized data from a cross sectional mixed-methods study on factors associated with Severe Acute Malnutrition (SAM) in under-five children to assess health facility nutrition services on offer at select level-one hospitals in five out of ten provinces in Zambia. Stata version 13 was used for analysis. We conducted univariate analysis to assess nutrition services offered, functionality of equipment and tools, availability of human resource and human resource development, and availability of drugs used for assessment and management of nutrition-related health outcomes.ResultsWe found large variations in the level of nutrition services on offer across districts and provinces. Eighty-eight percent of all the hospitals sampled provided group nutrition counseling and 92% of the hospitals in our sample offered individual nutrition counseling to their clients. Overall, the existence of referral and counter-referral systems between the Community Based Volunteers and hospitals were the lowest among all services assessed at 48% and 58% respectively. We also found inadequate numbers of human resource across all cadres with an exception of nutritionists as recommended by the Ministry of Health.ConclusionsThis study has revealed a number of gaps in the health system and health service delivery that requires to be addressed; most notably, a lack of tools, policies and guidelines, drugs and health specialists to help care for malnourished infants and children. Our findings also reveal inadequate referral systems between the community and health facilities in the management of severe acute malnutrition. Achieving universal coverage for nutrition services in Zambia will require a lot more attention to the health systems issues found in this study. ]]> <![CDATA[Exploring the Paradox of Increased Global Health and Degraded Global Environment: How Much Borrowed Time Is Humanity Living on?]]> https://www.researchpad.co/article/Naac92970-d402-4070-a3c1-7b4596659e95 We have overlooked the apparent paradox of increasing global health status and declining ecological and environmental qualityResource banks, and their largely undervalued nature, hold the key to understanding the global health‐environment balanceMuch more work needs to focus on ripple effects from exploitation of nonrenewable, and nonreplaceable resources

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<![CDATA[COVID-19 Community Stabilization and Sustainability Framework: An Integration of the Maslow Hierarchy of Needs and Social Determinants of Health]]> https://www.researchpad.co/article/N921ebc98-3396-4dd9-9757-8113029175b4 All levels of government are authorized to apply coronavirus disease 2019 (COVID-19) protection measures; however, they must consider how and when to ease lockdown restrictions to limit long-term societal harm and societal instability. Leaders that use a well-considered framework with an incremental approach will be able to gradually restart society while simultaneously maintaining the public health benefits achieved through lockdown measures. Economically vulnerable populations cannot endure long-term lockdown, and most countries lack the ability to maintain a full nationwide relief operation. Decision-makers need to understand this risk and how the Maslow hierarchy of needs and the social determinants of health can guide whole of society policies. Aligning decisions with societal needs will help ensure all segments of society are catered to and met while managing the crisis. This must inform the process of incremental easing of lockdowns to facilitate the resumption of community foundations, such as commerce, education, and employment in a manner that protects those most vulnerable to COVID-19. This study proposes a framework for identifying a path forward. It reflects on baseline requirements, regulations and recommendations, triggers, and implementation. Those desiring a successful recovery from the COVID-19 pandemic need to adopt an evidence-based framework now to ensure community stabilization and sustainability.

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<![CDATA[Prevalence of occupational exposure and its influence on job satisfaction among Chinese healthcare workers: a large-sample, cross-sectional study]]> https://www.researchpad.co/article/N9c79913e-f6c5-418a-8f8e-664736c60c1c This study had three objectives: (1) describe the prevalence of occupational exposure among Chinese medical personnel in detail, (2) verify the partial mediating role of work environment satisfaction in the relationship between occupational exposure and job satisfaction, and (3) examine if stress symptoms moderate the relationship between occupational exposure and job satisfaction.DesignA large cross-sectional online survey was conducted in July 2018 in China.SettingA survey was conducted in 54 cities across 14 provinces of China.ParticipantsA total of 12 784 questionnaires were distributed, and 9924 healthcare workers (HCWs) completed valid questionnaires. The response rate was 77.63%.Outcome measuresA confidential questionnaire was distributed to HCWs. The relationships among and the mechanisms of the variables were explored using descriptive statistical analyses, Pearson’s correlation coefficient and multiple linear regression analysis.ResultsThe most common occupational exposures among HCWs in the past 12 months were psychosocial and organisational hazards (85.93%). Overall, physicians (93.7%) and nurses (89.2%) were the main victims of occupational exposure. Occupational exposure correlated negatively with work environment satisfaction and job satisfaction, and positively with stress symptoms. Moreover, work environment satisfaction fully mediated the relationship between occupational exposure and job satisfaction, and stress symptoms moderated the relationship between occupational exposure and job satisfaction.ConclusionThe incidence of occupational exposure among HCWs is generally high. The high frequency of psychosocial and organisational hazards among physicians and nurses should be taken seriously and dealt with in a timely manner by hospital managers. The negative impact of occupational exposure on job satisfaction must be buffered by measures to reduce stress symptoms and enhance working environment satisfaction, ultimately improving the overall quality of life of HCWs and promoting comprehensive development of the medical team. ]]> <![CDATA[The VODAN IN: support of a FAIR-based infrastructure for COVID-19]]> https://www.researchpad.co/article/N1c128a03-f181-499a-a83c-3ca5e1ec8e2f <![CDATA[Assessment of Hospital Readmissions From the Emergency Department After Implementation of Medicare’s Hospital Readmissions Reduction Program]]> https://www.researchpad.co/article/Nfb136eae-d0ea-4d18-8e92-7c311f04021c The Medicare Hospital Readmissions Reduction Program (HRRP) is associated with reduced readmission rates, but it is unknown how this decrease occurred.ObjectiveTo examine whether the HRRP was associated with changes in the probability of readmission at emergency department (ED) visits after hospital discharge (ED revisits) overall and depending on whether admission is typically indicated for the patient’s condition at the ED revisit.Design, Setting, and ParticipantsThis retrospective cohort study used hospital and ED discharge data from California, Florida, and New York from January 1, 2010, to December 31, 2014. A difference-in-differences analysis examined change in readmission probability at ED revisits for recently discharged patients; ED revisits with clinical presentations for which admission is typically indicated vs those for which admission is more variable (ie, discretionary) were examined separately. Inclusion criteria were Medicare patients 65 years and older who revisited an ED within 30 days of inpatient discharge. Data were analyzed from December 18, 2018, to September 11, 2019.ExposuresBefore and after HRRP implementation among patients initially hospitalized for targeted vs nontargeted conditions.Main Outcomes and MeasuresThirty-day unplanned hospital readmissions at the ED revisit.ResultsA total of 9 914 068 index hospitalizations were identified in California, Florida, and New York from 2010 to 2014. Of 2 052 096 discharges in 2010, 1 168 126 (56.9%) discharges were women and 566 957 discharges (27.6%) were among patients older than 85 years. Among 1 421 407 patients with an unplanned readmission within 30 days of discharge, 1 266 107 patients (89.1%) were admitted through the ED. A total of 1 906 498 ED revisits were identified. After adjusting for patient demographic and clinical characteristics from the index hospitalization, HRRP implementation was associated with fewer readmissions from the ED, with a difference-in-difference estimate of −0.9 (95% CI, −1.4 to −0.4) percentage points (P < .001), or a 1.4% relative decrease from the 65.8% pre-HRRP readmission rates. Implementation of the HRRP was associated with fewer readmissions at the ED revisit involving clinical presentations for which admission is typically indicated (difference-in-differences estimate, −1.1 [95% CI, −1.6 to −0.6] percentage points; P < .001), or a 1.2% relative decrease from the 93.6% pre-HRRP rate. These results appear to be associated with patients presenting at the ED revisit with congestive heart failure (difference-in-difference estimate, −1.2 [95% CI, −2.0 to −0.4] percentage points; P = .003).Conclusions and RelevanceThese findings suggest that implementation of the HRRP was associated with a lower likelihood of readmission for recently discharged patients presenting to the ED, specifically for congestive heart failure. This highlights the critical role of the ED in readmission reduction under the HRRP and suggests that patient outcomes after HRRP implementation should be further studied. ]]> <![CDATA[Concordance Between Electronic Health Record Data and Medicare Part D Claims Data for Oral Anticancer Drug Use]]> https://www.researchpad.co/article/N1471ba53-b3db-456b-a586-1aa1e4fa1a49 This cross-sectional study determines the concordance between electronic health record and Medicare Part D claims data for the receipt of oral anticancer agents.

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<![CDATA[Potential of the economic valuation of soil-based ecosystem services to inform sustainable soil management and policy]]> https://www.researchpad.co/article/N930fd381-1759-4342-9b07-449675973e96

The concept of ecosystem services, especially in combination with economic valuation, can illuminate trade-offs involved in soil management, policy and governance, and thus support decision making. In this paper, we investigate and highlight the potential and limitations of the economic valuation of soil-based ecosystem services to inform sustainable soil management and policy. We formulate a definition of soil-based ecosystem services as basis for conducting a review of existing soil valuation studies with a focus on the inclusion of ecosystem services and the choice of valuation methods. We find that, so far, the economic valuation of soil-based ecosystem services has covered only a small number of such services and most studies have employed cost-based methods rather than state-of-the-art preference-based valuation methods, even though the latter would better acknowledge the public good character of soil related services. Therefore, the relevance of existing valuation studies for political processes is low. Broadening the spectrum of analyzed ecosystem services as well as using preference-based methods would likely increase the informational quality and policy relevance of valuation results. We point out options for improvement based on recent advances in economic valuation theory and practice. We conclude by investigating the specific roles economic valuation results can play in different phases of the policy-making process, and the specific requirements for its usefulness in this context.

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<![CDATA[Why pandemic response is unique: powerful experts and hands-off political leaders]]> https://www.researchpad.co/article/N777a5214-aec1-4675-9510-3b88967dc8c4

Purpose

The purpose of this paper is to show that 2009 H1N1 “swine” influenza pandemic vaccination policies deviated from predictions established in the theory of political survival, and to propose that pandemic response deviated because it was ruled by bureaucratized experts rather than by elected politicians.

Design/methodology/approach

Focussing on the 2009 H1N1 pandemic, the paper employs descriptive statistical analysis of vaccination policies in nine western democracies. To probe the plausibility of the novel explanation, it uses quantitative and qualitative content analyses of media attention and coverage in two deviant cases, the USA and Denmark.

Findings

Theories linking political survival to disaster responses find little empirical support in the substantial cross-country variations of vaccination responses during the 2009 H1N1 pandemic. Rather than following a political logic, the case studies of media coverage in the USA and Denmark demonstrate that the response was bureaucratized in the public health agencies (CDC and DMHA, respectively). Hence, while natural disaster responses appear to follow a political logic, the response to pandemics appears to be more strongly instituted in the hands of bureaucratic experts.

Research limitations/implications

There is an added value of encompassing bureaucratic dynamics in political theories of disaster response; bureaucratized expertise proved to constitute a strong plausible explanation of the 2009 pandemic vaccination response.

Practical implications

Pandemic preparedness and response depends critically on understanding the lessons of the 2009 H1N1 pandemic; a key lesson supported by this paper is that expert-based agencies rather than political leaders are the pivotal actors.

Originality/value

This paper is the first to pinpoint the limitations of political survival theories of disaster responses with respect to the 2009 pandemic. Further, it is among the few to analyze the causes of variations in cross-country pandemic vaccination policies during the 2009 H1N1 pandemic.

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<![CDATA[The “wicked problems” of governing UK health security disaster prevention]]> https://www.researchpad.co/article/Nb3e15b1a-82be-4f74-92da-aab246f1f583

Purpose

The purpose of this paper is to examine the governance and policy-making challenges in the context of “wicked problems” based on the case of pandemic influenza.

Design/methodology/approach

The case study research is based on an analysis of official documentation and interviews with policy elites at multiple levels of UK governance.

Findings

Results of this study show that policy actors regard risk communication, the dynamics of international public policy and UK territorial governance as the main governance challenges in the management of influenza at a macro-level. The paper also serves to identify that although contingencies management for epidemiological issues require technical and scientific considerations to feature in governance arrangements, equally there are key “wicked problems” in the context public policy that pervade the health security sector.

Practical implications

The study indicates the need to build in resources at a national level to plan for policy coordination challenges in areas that might at first be seen as devoid of political machinations (such as technical areas of public policy that might be underpinned by epidemiological processes). The identification of the major governance challenges that emerge from the pandemic influenza case study is a springboard for a research agenda in relation to the analysis of the parallels and paradoxes of governance challenges for health security across EU member states.

Originality/value

This paper provides a novel interrogation of the pandemic influenza case study in the context of UK governance and public policy by providing a strategic policy lens from perspective of elites.

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<![CDATA[Sanitation and Health]]> https://www.researchpad.co/article/5989db0cab0ee8fa60bca73f

As one article in a four-part PLoS Medicine series on water and sanitation, David Trouba and colleagues discuss the importance of improved sanitation to health and the role that the health sector can play in its advocacy.

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<![CDATA[Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures]]> https://www.researchpad.co/article/Ncae74e08-5dde-4a90-914b-9e21318d7056

International travel–related nonpharmaceutical interventions (NPIs), which can include traveler screening, travel restrictions, and border closures, often are included in national influenza pandemic preparedness plans. We performed systematic reviews to identify evidence for their effectiveness. We found 15 studies in total. Some studies reported that NPIs could delay the introduction of influenza virus. However, no available evidence indicated that screening of inbound travelers would have a substantial effect on preventing spread of pandemic influenza, and no studies examining exit screening were found. Some studies reported that travel restrictions could delay the start of local transmission and slow international spread, and 1 study indicated that small Pacific islands were able to prevent importation of pandemic influenza during 1918–19 through complete border closure. This limited evidence base indicates that international travel-related NPIs would have limited effectiveness in controlling pandemic influenza and that these measures require considerable resources to implement.

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<![CDATA[Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures]]> https://www.researchpad.co/article/N69a2c7f7-bb8e-4949-b84c-c99ef7e99363

There were 3 influenza pandemics in the 20th century, and there has been 1 so far in the 21st century. Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in nonhealthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.

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