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.

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].

Climate change,ambient air pollution,and students'mental health

The impact of global climate change and air pollution on mental health has become a crucial public health issue.Increased public awareness of health,advancements in medical diagnosis and treatment,the way media outlets report environmental changes and the variation in social resources affect psychological responses and adaptation methods to climate change and air pollution.In the context of climate change,extreme weather events seriously disrupt people's living environments,and unstable educational environments lead to an increase in mental health issues for students.Air pollution affects students'mental health by increasing the incidence of diseases while decreasing contact with nature,leading to problems such as anxiety,depression,and decreased cognitive function.We call for joint efforts to reduce pollutant emissions at the source,improve energy structures,strengthen environmental monitoring and governance,increase attention to the mental health issues of students,and help student groups build resilience;by establishing public policies,enhancing social support and adjusting lifestyles and habits,we can help students cope with the constantly changing environment and maintain a good level of mental health.Through these comprehensive measures,we can more effectively address the challenges of global climate change and air pollution and promote the achievement of the United Nations Sustainable Development Goals.

Impact of Plastic Waste on the Human Health in Low-Income Countries: A Systematic Review

Background: Plastic pollution is the accumulation of waste composed of plastic and its derivatives all over the environment. Whether in the form of visible garbage or microparticles, as it slowly degrades, plastic pollution poses significant threats to terrestrial and aquatic habitats and the wildlife that call them home, whether through ingestion, entanglement or exposure to the chemicals contained in the material. Unfortunately, there is a lack of documentation on the impact of plastic waste on human health in low- and middle-income countries (LMICs). Methods: We searched five electronic databases (PubMed, Embase, Global Health, CINAHL and Web of Science) and gray literature, following the preferred reporting elements for systematic reviews and meta-analyses (PRISMA), for the impact of plastic waste on human health in developing countries. We included quantitative and qualitative studies written in English and French. We assessed the quality of the included articles using the Mixed Methods Appraisal tool (MMAT). Results: A total of 3779 articles were initially identified by searching electronic databases. After eliminating duplicates, 3167 articles were reviewed based on title and abstract, and 26 were selected for full-text review. Only three articles were retained. The three articles dealt with practices likely to lead to oral exposure to plastic chemicals in human health, as well as the level of awareness of participants concerning the possible impact of plastic on human health, namely, the use of plastic baby bottles, the use of microwaves to cook food and reheat precooked food, the use of plastic bottles to store water in the refrigerator, water purifier containers with plastic bodies and plastic lunch boxes, the reuse of plastic bags and the inadequacy of treatment facilities. Conclusion: Plastic waste poses different risks to human health at every stage of its life cycle. Hence, strategies must be adopted to raise public awareness of the dangers of plastic waste to their health. Trial registration: The review protocol is registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42023409087).

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.

“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.

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.

Lessons for Epidemic Emergency Policy: A Scoping Review of Ebola and COVID-19 Pandemics in Africa

Ebola Virus Disease (EVD) outbreaks in Central and West Africa 2013-2020 were the deadliest, most intense and most widely spread. On top of this, the novel Corona Virus Disease 2019 (COVID-19) has given us all a new experience. It is imperative to draw lessons to prepare for future disease outbreaks. This was a scoping review, a method that allows the assessment of emerging evidence. The objectives of the review were to 1) describe the manifestation of the epidemics;2) elaborate on the social and economic effects;3) characterize the responses;and 4) draw lessons. The findings show that Ebola risk is permanent and even increasing. The next COVID-19 epidemic is around the corner. For Africa, the situation has been made worse by poverty and fragility of institutions. Africa’s incapacity to manufacture its own vaccines, medicines, diagnostics and protective wear has been detrimental in the management of epidemics. The need for personal and home hygiene has been emphatically brought to attention. The trust in the government and other agencies is the cornerstone in the management of emergencies. The use of armed soldiers should be discouraged, for they scare people from seeking help. It is much better to use trusted local leaders instead of strangers during pandemic emergencies. Understanding the local politics without getting involved in them is essential. It is critical to understand community and individual perception of the risk of the disease in question. Often neglected is the psycho-social aspect, which should be planned early. The science of response measures ought to be explained simply and transparently, as part of risk communication. Emergency funds should be raised, and made easy and quick to disburse. Mechanisms of sharing health technologies and knowledge need to be devised under the UN. People centeredness ought to guide the conduct of trans-border movements and all transactions during pandemics.

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.

Mental health implications of suicide rates in South Africa

Mental health challenges are a severe issue that could lead to suicide if not properly addressed.South Africa has a significant burden of mental health issues,which contributes to the soaring rate of suicide.Adequate mental health-care provision could reduce the high suicide rate in South Africa.Since the apartheid regime,the country has made a series of efforts to improve mental health.This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications.This study adopted a narrative review approach.Electronic databases(PubMed,Scilit,Google Scholar and Semantic Scholar)were used to identify published articles in the English language with crucial search terms that included mental health,South African mental health policy,South Africa,suicide and policy.Literature suggests that at the provincial level,there are no adequate mental health policies,and the implementation of the country’s mental health policy is faced with many challenges,such as a shortage of professionals and finances.The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health.This study concludes that the mental health treatment gap still exists in South Africa,and this needs to be tackled using effective,multi-level counselling interventions and policy initiatives.Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.

Health Impacts and Mechanisms of Per- and Polyfluoroalkyl Substances (PFAS) from Epidemiological to Toxicological

This research provides a comprehensive analysis of the health impacts of Per- and Polyfluoroalkyl Substances (PFAS) through an integration of epidemiological and toxicological studies. The study identifies significant correlations between PFAS exposure and adverse health outcomes, including thyroid dysfunction, elevated cholesterol levels, and increased risk of specific cancers. Utilizing a mixed-methods approach, the research combines a systematic review and meta-analysis of recent literature with in vitro and in vivo toxicological experiments. The epidemiological analysis reveals increased risks of thyroid dysfunction, cholesterol elevation, and certain cancers among PFAS-exposed individuals. Toxicological findings further corroborate these results, showing dose-dependent cytotoxic effects in human cell lines and endocrine disruption in rodent models. The study emphasizes the importance of regulatory measures to mitigate PFAS exposure and the urgent need for more comprehensive research into their long-term effects. The integration of epidemiological and toxicological data underscores the significant health risks posed by PFAS, highlighting the necessity of immediate action to limit exposure and develop safer alternatives.