Needs assessment and expectations regarding evidence-based practice knowledge acquisition and training activities:A cross-sectional study of healthcare personnel in China

Objectives Evidence-based healthcare contributes to the improvement of healthcare quality and informs healthcare decision-making.The provision of timely high-quality evidence is always required to fulfil the ever-changing needs and expectations of healthcare personnel.This study aimed to assess the needs and expectations of healthcare personnel regarding evidence-based healthcare in China.Methods We conducted a cross-sectional online survey from December 8,2020 to January 15,2021 involving 901 participants across China.Healthcare providers,policy makers,researchers and educators,and full-time postgraduate medical and nursing students working/living in China were eligible to participate.A self-developed questionnaire was used.Results Participants generally agreed that health-related research evidence was beneficial.Evidence-based resources,such as Cochrane resources,were only known or used by about half of the respondents due to difficulties related to availability and accessibility.Various types of resources,topics of evidence,and themes of workshops were of particular interest to most of the participants.Conclusions The dissemination and translation of evidence,provision of more support in evidence availability,offering evidence-based training,and determining the most in-demand research areas have been identified as priority areas of work which could fulfil the needs and expectations of healthcare personnel in China.

Can Evidence-based Policy Contribute to Correcting Overreaction？--Considering Democracy and Rationalized Policy Making

This paper focuses on evidence-based policy-making and democracy, along with political overreaction. In many countries, evidence-based policy-making is a prominent aspect of administration and aims to rationalize the policy-making process. Moreover, democracy is subject to many critiques nowadays because it cannot guaxmatee good public policy-making. Under such circumstances, some researchers have suggested that democracy should be limited, especially in public policy-making processes. There axe many critiques of such arguments because they ignore the participation that is necessary for democracy. There is some hope that evidence-based policy-making can teach laypersons using evidence. However, evidence is too difficult to understand for many laypersons. In this paper, the author suggests limited participatory analysis to support evidence-based policy. In this system, only knowledge holders would be allowed to participate. If evidence-based policy meant that the formulation of policy relied only on narrower experts, it would not make a positive contribution. However, if evidence-based policy were to adopt a participatory policy-creation process, it would offer greater potential

Effects of China's National Essential Medicines Policy on the Use of Injection in Primary Health Facilities

The overuse of injection exists more than 20 years since economic reform in China.It is a persistent problem and seems becoming a new challenge in the new health reform period.This study was designed to assess the effect of national essential medicines policy(NEMP) on injection use at primary health facilities in China by investigating their prescription information.Questionnaires were designed and disseminated to collect empirical data on injection use at 120 primary health facilities in 6 provinces from January to September in 2010 and 2011.The injection use was measured as the indicator as the percentage of prescriptions with one or more injections.The results showed that the percentage of prescriptions with one or more injections was decreased from 38.91% to 36.82%(2 =11.158,P=0.001) in the all survey areas during the NEMP reform.The difference in level of the injection use in 2011 was significant among the eastern,central and western regions(2 =223.584,P=0.000);level of the injection use in western region was the lowest(27.73%),while that in the central region was the highest(43.10%).The level of the injection use in 2011 among different provinces was also of great difference(26.00%-58.25%,range:32.25%).The level of the injection use in 2011 was still much higher than the standard suggested by WHO for developing countries(13.4%-24.1%).It was concluded that NEMP has improved injection use in China,but the injection abuse situation remains serious,indicating that one of the priorities to the next stage of NEMP is to promote the rational use of drugs,especially the injection use.

The Challenges of Water Pollution, Threat to Public Health, Flaws of Water Laws and Policies in Pakistan

In an era of unprecedented urbanization, population and industrial growth pressure is serious threat for the water management in Pakistan in present days. Water pollution from raw sewage, industrial wastes, and agricultural runoff limited natural fresh water resources in the country. Human health is facing serious problems due to deteriorating drinking water quality. Current review paper provides an insight to the water quality problems in Pakistan with an attempt to emphasize the challenges of water laws enforcement. Although Pakistan has developed many water laws the state of implementation is dominant, intermediate pollution crises are still remaining. We could come to the conclusion that strictly enforcement is compulsory for water environment regulations in Pakistan. Moreover, it is necessary to establish a reliable risk assessment system for water quality, human health and ecological safety.

How to improve Iranians' vision health: on the national policy of preventing Iranians' blindness

AIM: To review vision health situation of Iranian community, analyze its determinants, and discuss the adopted improvement strategies by the Iran Ministry of Health and Medical Education(MOHME). METHODS: This was a rapid situation analysis with a qualitative approach in three parts of recognition, orientation and implementation. The data were gathered via review of upstream documents, national and international experiences, and experts and stakeholders' opinions. RESULTS: Eradicating trachoma, increasing human resources, increasing educational and research centers and promotion of ophthalmic technologies were important achievements in the field of vision health in Iran. Through these achievements, it seemed that the pattern of causes of blindness and low vision was similar to that of the developed countries. However, the review of Iranians' vision health indicators showed that a considerable percent of the blindness and low vision was avoidable through a national program demanding 3 types of interventions in social determinants of health(SDH), community education, and increasing the access to health care services by integrating the necessary services in primary health care system. CONCLUSION: Managing the issue requires attentions from a national committee for preventing blindness with participation of all stakeholders, implementing a national survey on vision health, preparation of the primary level health centers including employment and education of community health workers(Behvarzes), optometristsand general practitioners, fair distribution of specialized human resources and establishing at least one specialized center in each province for referring patients from the primary levels.

HEALTH SERVICE SYSTEMS IN CHINA＇S MINORITY AREAS：HEALTH POLICY DEVELOPMENT AND HEALTH STATUS

This paper discusses the development of health care system,health expenditure,disease model, and health status on the minority areas in China. The article also puts forward some policy suggestions,such as clearly defining the government responsibilities,adding the investment in the minority regions;combining the development of health service with helping-the-poor program;exploring the moderate health care system in minority rural areas;making classification instruction to PHC in minority;establishing the relevant evaluation system.

Dialectic Approaches and Public Policy Interactions for Social, Environmental and Health Problems: Challenges for Health Promotion across Territorial Scales

A constant reproduction of environmental injustices and health iniquities has demanded the employment of participatory/dialectic approaches to research and to intervene in the reality making possible the involvement of social actors in healthy public policies. On this framework, the aim of this paper is to analyse scientific production with dialectic approaches associated with public policies in the context of social, environmental and health problems, considering territorial scales of intervention and the correspondence with some relevant strategies of health promotion. A systematic bibliographic review was applied on a wide pan-disciplinary scientific data base and 36 papers were analysed and classified by their territorial scales of approach. The amount of papers found and their spread through a variety of journals showed a modest, but increasing production which has been dispersed in terms of knowledge areas. Within the classification of territorial approaches, 14 papers were classified as local, 5 as expanded and 17 as a multi-level. Although the papers classified as local approaches were in a good structure of stakeholders’ participation, they are limited to dealing with the global driving forces that reproduce the environmental injustices. Regarding this limitation, the multilevel approaches were identified as more opportune to jointly deal with social, environmental and health problems by means of allowing interaction through multiple territorial scales, fomenting the strengthening of community action, creating supportive environments, and building healthy public policies.

Use of Research Evidence in Policy and Decision-Making: Views, Attitudes and Practices of Health Policy Makers in Lusaka Province of Zambia

Background: The integration of relevant high-quality research evidence into the health decision and policy formulation process is a key strategy for improving health systems especially in developing countries such as Zambia. However, the lack of capacity to understand and value research evidence by policy and decision makers makes it difficult for them to find and use research evidence in a timely manner even when motivated to do so. This study aimed to establish the views, attitudes and practices of policy makers on the use of research evidence in policy and decision-making process in Zambia. Methodology: This descriptive cross-sectional study was conducted in Lusaka, Zambia among selected public health decision and policy making institutions. A purposive sample of 21 consenting policy makers who were working in different positions in the Ministry of Health Headquarters, Provincial and District Health Offices, Health Professions Regulatory Bodies, United Nations Agencies, International Non-Governmental Organizations and University Deans from the University of Zambia participated in the study. A self-administered questionnaire was used to collect data. The IBM? SPSS? Statistics for Windows Version 20.0 was used for data analysis. Results: The concept of Evidence Informed Health Policy was not well understood such that only less than half (47.5%) of the participants reported having heard specifically about Evidence Informed Health Policy meanwhile almost two thirds (61.9%) reported that they used research evidence in decision making and policy formulation. Similar discrepancy was expressed in the understanding of and use of rapid response mechanisms such that although (47.6%) of the participants reported having heard about it, (57%) had never used rapid response mechanisms for deci-sion-making. With regard to the sources of information, about half (52.3) of the participants reported scholarly articles as their main source of evidence. Con-clusion and Recommendations: There is need for more sensitization and ca-pacity building among the decision and policy makers on the importance of using research evidence in decision and policy making process as incorporation of relevant high-quality research evidence into the health policy making pro-cess is a key strategy for improving health systems.

Health and nursing policy,regulation and legislation,leadership and management

1.Healthcare system in Russian Federation System of Obligatory Health Insurance provides universal health coverage.The obligatory system is complemented by the system of Voluntary health insurance.

Health and nursing policy,regulation and legislation,leadership and management

1.Strengths·National Health Policy recognizes the need to improve Regula-tion and Quality Management of Nursing Education.·Policy also recommends development of leadership skills,Strengthening Human Resource,Governance in public Health System through establishment of robust recruitment,selection,promotion and training posting policies.

An Integrated Strategy for the Cultural Adaptation of Evidence-Based Interventions

Background: The importance of adapting evidence-based health interventions to enhance their congruence with the beliefs of ethno-cultural communities is well recognized. Although a systematic cultural adaptation process is available, it lacks specific instructions on how to adapt interventions so that they are aligned with cultural beliefs. In this paper, we present an integrated strategy that operationalizes the adaptation process by describing specific practical instructions on how to align interventions with cultural beliefs. Methods: The strategy integrates concept and intervention mapping, and uses mixed methods for gathering data from community representatives. The data pertain to a community’s cultural beliefs and values related to a health problem, acceptability of evidence-based interventions targeting the problem, and aspects of the interventions that should be modified to enhance their fit with cultural beliefs. A step-by-step protocol is described to guide application of the integrated strategy for cultural adaptation. Conclusions: The strength of the integrated strategy relies on the use of concept and intervention mapping approaches for specifying a step-by-step protocol to actively engage community representatives in the cultural adaptation of interventions. Future research should evaluate the utility of this strategy.

“No Need to Get Salty” Or Is There? Sodium Functionality as a Consideration in Nutrition Public Health Policy

Aim: Public health professionals focus on both downstream (individual) and upstream (population-level) interventions to reduce sodium consumption and prevent sodium-related chronic diseases. Effective upstream interventions specifically aimed at reducing dietary sodium intake include the implementation of comprehensive nutrition standards that restrict the amount of sodium contained in foods available for purchase. The aim of this work was to identify sought-after foods that did not meet the Philadelphia Nutrition Standards’ sodium limits and reformulate those foods to be standards-compliant and consumer-acceptable. Subject and Methods: Two foods were reformulated for compliancy with the Philadelphia Nutrition Standards’ sodium limits and consumer acceptability: the hoagie roll and soft pretzel. Reformulation included sensory testing and engaging potential manufacturing partners to investigate products’ commercial potential. Results: While hoagie roll reformulation led to a local company manufacturing and selling the reformulated product, soft pretzel reformulation stalled due to lack of consumer acceptability of the reformulated product. Salt contributes desirable characteristics in the texture, taste, and appearance of the soft pretzel, the absence of which consumers found unacceptable. Conclusion: Product reformulation holds great potential to create lower-sodium foods that otherwise have all of the characteristics of the higher-sodium “original” products but requires an understanding of the role of salt in product recipes. Reducing salt without considering its multiple functions in food may result in a product that is unacceptable or even unsafe. A simple four-step tool can help public health practitioners evaluate the extent to which products are suitable for reformulation.

Mechanisms for the Application of Health Services Marketing Policies in Algeria

In this paper, we tried to give health services marketing mix and raise patients＇ interest in health services with the contribution to highlighting the possible application mechanisms of different marketing policies on health services in Algeria. Because we see that, health foundations in Algeria like other foundations live in an environment marked with constantly economic, social, politic, and cultural changes. And to respond to change requirements, especially with the appearance of health services market liberation signs, these foundations are obliged to adapt to ensure their existence and development by giving best services to meet the patients＇ needs in order to gain their satisfaction and loyalty. These ones, who became more conscious about the quality of services they are given quantitatively, qualitatively, and timely.

Maternal Mortality: A Matter of Public Health Policies

Maternal mortality is a worldwide problem and concern, continuing to be a public health problem, the ratio of the same has been decreasing but still to those recommended by the World Health Organization. Objective: To perform a literature review, highlighting current aspects of maternal mortality. Method: The research was carried out in electronic databases Lilacs, Bireme-BVS, Scielo and BDENF, limited to the last 23 years. Those addressed pre-defined aspects of interest to the study proposal were selected—maternal mortality, public health policies, and the new approaches to the problem. Results: Maternal death is directly related to the living conditions of the population, showing variability from country to country (developed and developing), but its decrease is inherent to public policies and political will.

Gender medicine:Lessons from COVID-19 and other medical conditions for designing health policy

Gender-specific differences in the prevalence,incidence,comorbidities,prognosis,severity,risk factors,drug-related aspects and outcomes of various medical conditions are well documented.We present a literature review on the extent to which research in this field has developed over the years,and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens,guidelines and into gender-oriented preventive strategies and health policies.Subsequently,through the lens of gender,we describe these domains in detail for four selected medical conditions:Asthma,obesity and overweight,chronic kidney disease and coronavirus disease 2019.As some of the key gender differences become more apparent during adolescence,we focus on this developmental stage.Finally,we propose a model which is based on three influential issues:(1)Investigating gender-specific medical profiles of related health conditions,rather than a single disease;(2)The dynamics of gender disparities across developmental stages;and(3)An integrative approach which takes into account additional risk factors(ethnicity,socio-demographic variables,minorities,lifestyle habits etc.).Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines,already among adolescents,may reduce inequities,facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.

Civic and Social Applications to Support Public Policies on Health

The discussion with emphasis on social control is expressed in new guidelines for its effectiveness through normative instruments and the legal creation of institutional spaces that guarantee the participation of organized civil society in the direct supervision of the executive in the three spheres of government.Social participation for the strengthening of public health in Brazil has undergone complex processes of change,which have resulted in an increasingly qualified,deliberative,independent,and representative social control system.However,policy makers need to identify new technologies and carefully analyze their potential before they begin to exert their breaking power in the economy and society.Mobility and unlimited connectivity deserve special attention from the public power for the ability to achieve the digital inclusion of the citizen through smartphones.This requires a transformation of the governance structure into a platform that is based on the tripod transparency,participation,and collaboration,which relies on the Internet,social networks and connectivity.

Is Evidence-Based Conservation Applied in Urban Forestry? A Case Study from Toronto, Canada

Evidence-based conservation seeks to incorporate sound scientific information into environmental decision making. The application of this concept in urban forest management has tremendous potential, but to date has been little applied, largely because existing scientific studies emphasize the importance of urban forests in large-scale ecological and anthropogenic processes, but in practice, scientific evidence is ostensibly incorporated into North American urban forest management only when deciding the fate of individual trees. Even under these disjunctive conditions, the degree to which evidence influences tree-level decisions remains debatable. In analyzing preliminary data from a case study from Toronto, Canada, we sought to test if and how scientific evidence factored into the decision to remove or preserve 53 trees, located in close proximity to a provincially significant area of natural and scientific interest (ANSI). We found that by far the strongest tree-level correlate of the recommendation to remove or preserve trees was whether or not an individual tree was in conflict with proposed development. In comparison, species identity, tree condition, and suitability for conservation were statistically unrelated to the final recommendation. Our findings provide the basis to expand our analysis to multiple case studies across Canada, and internationally. Furthermore, when interpreted with available research and policy, our preliminary (and future) analysis highlights clear opportunities where scientific evidence can and should be readily incorporated into urban forestry management and policy.

Health Technology and U.S. Medicare Policy in the Late 20th Century

Much of the history of the American Social Welfare movement has been directed to the identification and development of entitlement programs needed to strengthen the health and economy of even the neediest members of the society. The emergence of health technologies have precipitated and supported policy advances. The Medicare Act （Title XVIII the United States Social Security Act of 1935） as such an entitlement program, was originally directed to resolving the health coverage concerns of the elderly without families or finances to afford coverage. The program entered crises periods over rising costs and continuity of funding concerns. Many have been assisted, in the U.S., in addition to the aged population, by the development of Medicare entitlements. These entitlements have emerged during periods of social need often accompanied by health technology or service delivery innovation. The program benefits more than its constituents and contributes to the health of the overall society. This paper will provide both a historical overview of the conflicts and uncertainties weathered by the Medicare Act in the later quarter of the 20th Century in the U.S. （United States of America）. The paper will also explore the implications of changes in the technology of federal and state funding mechanisms along with demographic changes that offered the greatest challenges to the continuation of the Medicare Act as a mainstay of stable health coverage to millions of needy Americans, into the 21st century.

Health Systems Strengthening to Tackle the Global Burden of Pediatric and Congenital Heart Disease: A Diagonal Approach

1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].

Developing Rational Empathy in Health Care Policy:The Usefulness of Online Comments

Studies of interactions have gained an increasing importance in research related to healthcare.Most empirical studies have explored the dynamics of exchanges between patients and practitioners(Barry et al.,2001,Beach et al.,2001).This study is devoted to the analysis of discussions in two forums to investigate how to develop what we call‘a rational empathy’so as to understand the attitudes and beliefs which constitute the basis of these opinions.