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].

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.

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.

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.

Enhancing diabetic retinopathy screening:Non-mydriatic fundus photography-assisted telemedicine for improved clinical management

The utilization of non-mydriatic fundus photography-assisted telemedicine to screen patients with diabetes mellitus for diabetic retinopathy provides an accurate,efficient,and cost-effective method to improve early detection of disease.It has also been shown to correlate with increased participation of patients in other aspects of diabetes care.In particular,patients who undergo teleretinal imaging are more likely to meet Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set metrics,which are linked to preservation of quality-adjusted life years and additional downstream healthcare savings.

Exploring the Prevalence and Contributing Factors of Depression among Sickle Cell Anemia Patients in Saudi Arabia’s Jazan Region

Sickle Cell Anemia(SCA)is a prevalent genetic condition in Saudi Arabia,particularly in the Jazan region.The study’s purpose was to assess the prevalence of de-pression among individuals with SCA in this area and to identify the factors associated with this condition.The study involved 391 adult participants,all patients in the hematology center of Prince Mohammed bin Nasser Hospital(PMNH).Data was collected through an anonymous interview questionnaire–the Arabic version of the Patient Health Questionnaire-9(PHQ-9)–between March–May 2022.The questionnaire covered socio-demographic information and variables related to the participant’s SCA history,such as pain levels,frequency of pain,hospitalization duration,and frequency of blood transfusions.These variables underwent Chi-square and One-way ANOVA testing,followed by multivariate regression.The study found a 42%prevalence of depression among the SCA patients.Factors significantly linked with heightened depression levels included being widowed or divorced,experiencing frequent and severe pain,and longer duration of hospital stays.An educational level of at least a bachelor’s degree was also a significant factor.The study reveals a high prevalence of depression among SCA patients in the Jazan region.It underscores the need for policymakers to educate both physicians and patients about the importance of mental health in SCA management.The study also highlights the need for more research into the specific causes and effects of depressive symptoms in SCA patients to inform the creation of effective management plans.

Determinants of male health： the interaction of biological and social factors

This review discusses the social and biological factors that may influence male development from conception to adulthood and also underlie the development of health disorders. It will provide assistance to those who may be considering the formulation of a male health policy. It aims to emphasize that social determinants function on a bio- logical background that is profoundly influenced by a male＇s genome, inherited from his parents. The importance of the male-specific reproductive disorders is emphasized, but these also affect somatic structures through the secretion of androgens secreted from the testes. In turn, the function of the cardiovascular and nervous systems can signifi- cantly influence reproductive processes such as erectile dysfunction.

U. S. Academic Medical Centers Under the Managed Health Care Environment

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U. S. health care system through their missions of conducting cutting-edge biomedical researeh, pursuing clinical and technological innovations, Providing state-of-the-art medical care and producing highly qUalified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical sciTo survive the threats of managed care in the health care environment, acadendc medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 1h8 CEOs in all the academic medical centers in the U. S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

Kidney health for all: bridging the gap in kidney health education and literacy

The high burden of kidney disease,global disparities in kidney care,and poor outcomes of kidney failure bring a concomitant growing burden to persons affected,their families,and carers,and the community at large.Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find,understand,and use information and services to make informed health⁃related decisions and actions for themselves and others.Rather than viewing health literacy as a patient deficit,improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease.For kidney policy makers,health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care.The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders.Advances in telecommunication,including social media platforms,can be leveraged to enhance persons’and providers’education;The World Kidney Day declares 2022 as the year of“Kidney Health for All”to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy.Kidney organizations should work toward shifting the patient⁃deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers.By engaging in and supporting kidney health-centered policy making,community health planning,and health literacy approaches for all,the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.

Tell health stories comprehensively and accurately: A case study of health edition of People's Daily

Objectives:People increasingly search for health information through the media and make decisions about their health based on these health stories.The mainstream media,including newspapers,are often the first source for the public to obtain health information.This study aims to assess the health stories reported in the health edition of People's Daily in 2019 with four tools of the Media Doctor Toolkit(MDT),which can be an effective tool to evaluate the quality of public health stories.Based on the results,we attempt to address the gap in media coverage in terms of reporting on public health issues,and promote media to display the image of medical staff objectively,both of which can improve relationship of doctors,nurses and patients.Methods:A prospective quantitative analysis of the quality of health stories reported in the health edition of People's Daily from 1 February to September 31,2019 was conducted.Forty-eight articles were collected and divided into four groups according to the MDT standards.Four rating tools were adapted from the MDT to assess the quality of the groups with corresponding criteria.Results:Forty-eight unique health stories were assessed with four MDT rating tools.The mean total satisfactory score was 80%.Health advice had the highest average satisfactory score,84%,compared with health policy group and public health problems and their solutions,at 80%and 77%,respectively.Health news group had the lowest score at 73%.Conclusion:This study provides a description of the quality of health stories on People's Daily.The overall quality of People's Daily was fairly good,although there was a wide range of quality between groups.The health edition of People's Daily covers a wide range of health topics such as new medical methods,doctorpatient relationship,advanced nursing practice,lifestyle change of health promotion etc.which promote excellence in providing the latest health information,representing medical staff image,resolve the disharmonious factors in the relationship between doctors and patients,and creating a good medical environment for the public.The findings of this study also provide insight into problems in health reporting of People's Daily.

Biology of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and the humoral immunoresponse:a systematic review of evidence to support global policy-level actions and research

Background Both population-level epidemiological data and individual-level biological data are needed to control the coronavirus disease 2019(COVID-19)pandemic.Population-level data are widely available and efforts to combat COVID-19 have generated proliferate data on the biology and immunoresponse to the causative pathogen,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).However,there remains a paucity of systemized data on this subject.Objective In this review,we attempt to extract systemized data on the biology and immuno-response to SARS-CoV-2 from the most up-to-date peer-reviewed studies.We will focus on the biology of the virus and immunological variations that are key for determining long-term immunity,transmission potential,and prognosis.Data Sources and Methods Peer-reviewed articles were sourced from the PubMed database and by snowballing search of selected publications.Search terms included:“Novel Coronavirus”OR“COVID-19”OR“SARS-CoV-2”OR“2019-nCoV”AND“Immunity”OR“Immune Response”OR“Antibody Response”OR“Immunologic Response”.Studies published from December 31,2019 to December 31,2020 were included.To ensure validity,papers in pre-print were excluded.Results Of 2889 identified papers,36 were included.Evidence from these studies suggests early seroconversion in patients infected with SARS-CoV-2.Antibody titers appear to markedly increase two weeks after infection,followed by a plateau.A more robust immune response is seen in patients with severe COVID-19 as opposed to mild or asymptomatic presentations.This trend persists with regard to the length of antibody maintenance.However,overall immunity appears to wane within two to three months post-infection.Conclusion Findings of this study indicate that immune responses to SARS-CoV-2 follow the general pattern of viral infection.Immunity generated through natural infection appears to be short,suggesting a need for long-term efforts to control the pandemic.Antibody testing will be essential to gauge the epidemic and inform decision-making on effective strategies for treatment and prevention.Further research is needed to illustrate immunoglobulin-specific roles and neutralizing antibody activity.

Contributions of Social Networks to Health and Care Services in Myanmar’s Older Adult Population: 2012 Myanmar Aging Study

Background: Myanmar’s National Health Plan 2017-2021 set out concrete steps to strengthen the health system on the way to achieving the goal of universal health coverage by 2030. Ensuring these steps include the 7.7 million older adults in Myanmar’s population by 2030 will require novel strategies that improve health and reduce financial burden of health expenditures. An examination of the relationship between social networks and selected health outcomes was undertaken to determine whether these networks can safeguard older adults’ continued contributions to family, society and their own health. Methods: Secondary analysis of a nationally representative study of adults aged 60 years and older. Ordered logistic regression analyses with weighted data were used to examine the relationship between a social network variable and a number of health outcomes. Findings: Stronger social networks were associated with better health outcomes like better memory (OR 1.2), lower reported walking difficulties (OR 0.58), better self-reported health (R 1.15). People with higher social ties were also more like to receive regular assistance and provide care for other household members. Interpretation: Social networks play a role in mediating health outcomes and interactions with the health care systems. Social network interventions should be explored as part of policy mechanisms to ensure universal health coverage for older adults in Myanmar.

The Affordable Care Act: Disparities in emergency department use for mental health diagnoses in young adults

BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department(ED) utilization for mental health purposes. We aimed to study the race specifi c association between the dependent coverage provision of the Affordable Care Act(ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses.METHODS: We utilized a Quasi-Experimental analysis of ED use in California from 2009–2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-indifferences approach comparing those targeted by the ACA dependent provision(19–25 years) and those who were not(27 to 31 years), evaluating changes in ED visit rates per 1 000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and gender.RESULTS: The ACA dependent provision was associated with 0.05 per 1 000 people fewer psychiatric ED visits among the treatment group(19–25 years) compared to the control group(27–31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance.CONCLUSION: The ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacifi c Islander racial groups.

Positivist Typologies of the Right to Health Norms

As the cornerstone of the rule of law in public health,the right to health is an important human right recognized by international covenants of human rights and widely absorbed by foreign constitutions and laws.In international covenants on human rights,the right to health is regarded as a social right,and its core connotation is“the right to the highest attainable standard of health,”which has been recognized by many global and regional human rights conventions.Correspondingly,it has become a norm for this right to be included in constitutions around the world,especially those in the emerging countries that became independent after World War II and is often embodied within the framework of the law.Take China as an example,the right to health in our legal system is included in the Constitution,and has been substantiated in the Law of the People’s Republic of China on the Promotion of Basic Medical and Health Care and the Civil Code in the mode of“the same channel protection of public and private laws”.The rule of law and public policy are important means of substantiating the right to health(norms).The right to health in this category is confirmed and shaped by the policybased legal principles such as the principle of human rights protection,the principle of fairness,the principle of non-discrimination and the principle of due process,and covers the welfare policy and the health service system in modern countries.

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.

Why Multi-Sectoral Approaches Are Rarely Applied in Community Health Interventions in Some Countries in Sub-Saharan Africa?

The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and plans available online in seven countries from four regions of Sub-Saharan Africa. Thus, two main reasons have been highlighted. First, national strategic plans and policies for health development, in their formulation, neither sufficiently emphasize multisectoral approaches, nor sufficiently make these approaches operational in strategies and activities. Second, the mindset of health professionals due to their initial training orientation based on the biomedical approach, stands that disease is only a result of a physiological imbalance in the body;therefore, to restore health, such an imbalance only needs sophisticated procedures and interventions to be overcome. Such an orientation completely ignores the social, cultural and economic context in which the individual lives, which has an irretrievable influence on the health imbalance. However, health, influenced by the conditions in which people are conceived, born, grow, live, work and aged, cannot be effectively improved in a sustainable way without taking into account all these conditions. Whence the importance of approaches based on every sector of human activity that influences the living conditions.

Perinatal mental health in China:views of health system professionals in Shanghai

Background:Mental health has recently been receiving a growing amount of attention in China's Mainland,with mental disorders increasingly being recognized as a major public health concern.However,the treatment gap for mental health care is markedly high in China.Previous research and clinical practice have focused on high-risk physical disorders but overlooked psychosocial factors,especially during the perinatal period.Aims:To explore Chinese professionals'perception and attributions of perinatal mental health in China.Method:The study was conducted in Shanghai,China,in 2018,drawing on interviews with 15 key informants including health professionals,government officials,and policymakers recruited through snowball sampling.Content analysis of the semi-structured interviews was performed.Results:The study yielded insights into the perceptions of perinatal mental health among health professionals in Shanghai.Three themes emerged from the informants'reports:(1)mental health influenced by tradition—describing traditions affecting the perception of mental health at both the societal and individual level;(2)societal changed contributing perinatal mental health problems—referring to a rapidly changing cultural and economic backdrop as a source of stress leading to mental health problems;and(3)existing and required resources—demonstrating a lack of professional training,staff shortages,and inadequacy of resources to provide the required mental health care.Conclusion:Our results provide new insights into key health professionals'perceptions of mental health problems in Shanghai.Hesitation to seek care owing to a lack of knowledge,and resource shortages in health care systems are obstacles to improve mental health among women in urban China.

Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area

BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Factors acting as barriers to organ donation registration have been classified as:(1)Bodily integrity;(2)medical mistrust;(3)“ick”-feelings of disgust towards organ donation;and(4)“jinx”-fear that registration may result in one dying due to premeditated plans.We predict that by providing necessary information and education about the donation process via a short video,individuals will be more willing to register as organ donors.AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.METHODS This study was approved by the Institutional Review Board at Northwell Health.The approval reference number is No.19-0009(as presented in Supplementary material).Eligible participants included Hispanic New York City(NYC)residents,18 years of age and above,who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents.The survey an 85-item Redcap survey measured participant demographics,attitudes,and knowledge of organ donation as well as the intention to register as an organ donor.Attention checks were implemented throughout the survey,and responses were excluded for those who did fail.Participants were randomly assigned two-between subject conditions:To view a short video on organ donation and then proceed to complete the survey(i.e.,video first)and view the same video at the end of the survey(video last).No intra-group activities were conducted.This study utilized an evidenced-based emotive educational intervention(video)which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles.Results were analyzed using Jamovi statistical software.Three hundred sixty-five Hispanic individuals were included in the analysis.Once consent was obtained and participants entered the survey(the survey sample is presented in Supplementary material),participants were asked to report on demographic variables and their general impression of organ donation after death.The video depicted stories regarding organ donation after death from various viewpoints,including from the loved ones of a deceased person who died waiting for a transplant;from the loved ones of a deceased person whose organs were donated upon death;and,from those who were currently waiting for a transplant.RESULTS Using a binomial logistic regression,the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors.The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions(odds ratio:2.05,95%confidence interval:1.06-3.97).Motivations for participation in organ donation were also captured with many stating the importance of messages coming from“people like me”and a message that highlights“the welfare of those in need”.Overall,the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous.Future studies should explore using targeted messaging that resonates with specific cultural groups,highlighting the welfare of others.CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.

The Effect of Coding Method on Cause-of-Death Rankings

Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, while other countries use an automated coding system. The outcome of these two different methods in terms of the selected underlying cause of death for statistics may vary considerably. Therefore, this study explores the effect of coding method on the ranking of countries by major causes of death. Method: Age and sex standardized rates were extracted for 33 European (related) countries from the cause-of-death registry of the European Statistical Office (Eurostat). Wilcoxon’s rank sum test was applied to the ranking of countries by major causes of death. Results: Statistically significant differences due to coding method were identified for dementia, stroke and pneumonia. These differences could be explained by a different selection of dementia or pneumonia as underlying cause of death and by a different certification practice for stroke. Conclusion: Coding method should be taken into account when constructing or interpreting rankings of countries by cause of death.

Improving the Use of Insecticide-Treated Nets among Children under Five Years Old in Benin, West Africa

Background: In Benin, malaria represents the first cause of consultation and hospitalization (48% for children under 5 years old) in health units. It also accounts for 23.1% of deaths recorded in health facilities (MoH, 2019). Between the two main components of vector control adopted by Benin government, the mass distribution campaigns of Insecticide-Treated Nets (ITNs) remained the only proven cost-effective way to rapidly achieve high and equitable coverage (WHO, 2017). After the fourth mass distribution campaign conducted in 2017, the Demographic and Health Survey (DHS) data indicated that the percentage of children who slept under an ITN has increased from 20% in 2006 to 70% in 2011-2012 and to 76% in 2017-2018 while the incidence of malaria (tested positive) is increasing rapidly among children under 5 years old, growing from 36.5% in 2009 to 28.8% in 2012 and then to 51.4% in 2019. This study aims to understand this contrast by identifying the origin of the increase in ITN use over time among children under five years old and the factors which determine this use. Methods: Data from the Demographic and Health Survey (DHS) conducted in Benin respectively in 2006 and in 20018 were used during the analysis, which covered 13,445 children under five years old from 2006 DHS and 12,255 children from 2017-2018 DHS. Firstly, the data were analyzed using decomposition method to highlight the origin of the increase of ITN use over time among children under five years old. Secondly, the chi-square test analysis estimated the association between ITN use and some characteristics (wealth index, maternal or caregiver education level and child age). Finally, the logistic regression model was used to identify the main factors, which influence the net use over the study period. Results: This study shows that the improvement of basic conditions is the main origin of behavior change in the use of ITNs among children under five years old. This improvement of the basic conditions consists of making ITNs available in households and informing household members about the benefits of ITN use. So, the free ITN distribution campaigns, routine distribution, awareness campaigns about the benefits of ITN use are the strategies, which increase the household capacities and knowledge, allowing household members to make their children sleep under net. The analysis also shows that region of residence, wealth index of household, household size, religion, and child age continue to determine the ITN use among children under age 5 years old and MNCP will integrate the factors in malaria prevention strategies in order to achieve universal use of ITNs. Conclusions: Although, sleeping under ITN behavior has indeed spread among children under 5 years old, policymakers and other stakeholders should design strategies to maintain and improve the current level of ITN use to reach the collective protection threshold (80% according to WHO). Therefore, to address the challenges of universal use of ITN, the study recommends expanding the routine distribution system to private sector health centers;discussing issues related to health service utilization (particularly ITN use) within a consultation framework at the communal level. In addition, collecting qualitative and quantitative data in the Oueme region will allow better understanding of all aspects of the ITN use gap among children under 5 years.