Developing a framework to inform scale-up success for population health interventions:a critical interpretive synthesis of the literature

Background:Population health interventions(PHIs)have the potential to improve the health of large populations by systematically addressing underlying conditions of poor health outcomes(i.e.,social determinants of health)and reducing health inequities.Scaling-up may be one means of enhancing the impact of effective PHIs.However,not all scale-up attempts have been successful.In an attempt to help guide the process of successful scale-up of a PHI,we look to the organizational readiness for change theory for a new perspective on how we may better understand the scale-up pathway.Using the change theory,our goal was to develop the foundations of an evidence-based,theory-informed framework for a PHI,through a critical examination of various PHI scale-up experiences documented in the literature.Methods:We conducted a multi-step,critical interpretive synthesis(CIS)to gather and examine insights from scale-up experiences detailed in peer-reviewed and grey literatures,with a focus on PHIs from a variety of global settings.The CIS included iterative cycles of systematic searching,sampling,data extraction,critiquing,interpreting,coding,reflecting,and synthesizing.Theories relevant to innovations,complexity,and organizational readiness guided our analysis and synthesis.Results:We retained and examined twenty different PHI scale-up experiences,which were extracted from 77 documents(47 peer-reviewed,30 grey literature)published between 1995 and 2013.Overall,we identified three phases(i.e.,Groundwork,Implementing Scale-up,and Sustaining Scale-up),11 actions,and four key components(i.e.,PHI,context,capacity,stakeholders)pertinent to the scale-up process.Our guiding theories provided explanatory power to various aspects of the scale-up process and to scale-up success,and an alternative perspective to the assessment of scale-up readiness for a PHI.Conclusion:Our synthesis provided the foundations of the Scale-up Readiness Assessment Framework.Our theoreticallyinformed and rigorous synthesis methodology permitted identification of disparate processes involved in the successful scaleup of a PHI.Our findings complement the guidance and resources currently available,and offer an added perspective to assessing scale-up readiness for a PHI.

Investigation and Analysis of Lung Cancer Risk Factors in the Health Check-Up Population

Objective: To investigate and analyze the risk factors of lung cancer in the population of health checkups. Methods: A total of 500 cases of the health check-up population were selected for data study. Surveyed showed that 19 cases of lung cancer were grouped as the lung cancer group and the remaining 481 cases made up the control group, and the risk factors were analyzed. Results: Among men, there was a significant proportion of individuals aged 60-69 years old, and women aged 30-39 years old. Additionally, individuals aged 60 and above were at increased risk of developing lung cancer. The results of the multifactorial analysis were that the risk factors affecting the detection of lung cancer in healthy people were smoking history, family history of lung cancer, secondhand smoke, history of respiratory diseases, psychosomatic factors, living environment, and kitchen fumes. Conclusion: People over 60 years of age were prone to early lung cancer, followed by individuals aged 30-39 years. It is important to identify the risk factors of lung cancer to strengthen the screening of high-risk groups for early detection and treatment.

Analysis of the Prevalence Characteristics of Lung Nodules and Their Influencing Factors in The Health Check-Up Population

Objective: To study the prevalence characteristics of pulmonary nodules and their influencing factors in the health check-up population. Methods: A total of 500 cases of health checkups were selected for the data study to analyze the detection and prevalence characteristics of pulmonary nodules. The influencing factors between the pulmonary nodules group and the no pulmonary nodules group were analyzed. Results: A total of 209 cases were detected, of which there were more males than females, and for female patients, the detection rate increased with age (P < 0.05). The distribution of gender, age, smoking, respiratory symptoms, and exposure to kitchen fumes between the two groups was compared (P < 0.05). The multifactorial analysis concluded that risk factors include, respiratory symptoms, older age, exposure to kitchen fumes, and smoking. In addition, patients who exercised more had a lower risk of developing lung nodules. Conclusion: The detection rate of pulmonary nodules was high in the health check-up population and the influencing factors analyzed involved the presence of respiratory symptoms, older age, kitchen fume exposure, and smoking, while the positive influencing factor was increased exercise.

Climate change and population health research in China: Knowledge gaps and further directions

Climate change and its impact on population health have been well explored in China in recent years,especially health risk assessments such as studying its impact on the transmission and development of climate-sensitive infectious diseases and non-communicable diseases.However,knowledge gaps including using morbidity as health indicators(e.g.hospitalisations,ED visits,and ambulance call-outs),identifying disease attributable contributions to climate variability and burden of diseases due to climate change,calculating related healthcare costs,and developing climate change adaptation and mitigation strategies need to be addressed.Future research directions could focus on both mitigation and health adaptation studies,such as exploring active transportation and green hospitals,studying health co-benefits,identifying vulnerable populations,prioritizing resource allocation,building healthcare capacity and capability,evaluating intervention effect,developing tailored risk communication strategies and community health education packages for vulnerable communities in the context of climate change.

Process engineering for primary care:Quality improvement and population health

A fundamental paradox of the health care delivery systems in many industrialized nations is that desired population health metrics are often not achieved despite large expenditures in the health care delivery system.For example,the United States commits nearly 18%of its GDP to the health care delivery system,the largest amount of any nation,yet is 37th in achieving health or health care delivery metrics.This article addresses how general practice can be an important driver of population health in the Chinese health care delivery system through the application of quality improvement methods.The article shows examples of how the cause-and-effect diagram,the process map,and the plan,do,study,act(PDSA)cycle are important techniques to assist primary care practitioners for improving population health.

The Accountable Care Organization results:Population health management and quality improvement programs associated with increased quality of care and decreased utilization and cost of care

Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.

Awareness of initiative practice for health in the Chinese population:A questionnaire survey based on a network platform

BACKGROUND In 2016,the Chinese government issued the Healthy China 2030 plan,which also produced the initiative practice for health(IPFH)concept.However,people’s knowledge and awareness of the IPFH are unclear.AIM To investigate awareness of IPFH in the Chinese population and explore the relevant influential factors.METHODS An internet-based self-designed questionnaire survey was used to collect respondents’demographic characteristics and awareness of health and the IPFH from March 26 to April 18,2020.IPFH consciousness was assessed by the scores for different related questions.The Student’s t test,the Chi-square test,and multiple logistic regression analysis were performed to analyze the differences and influencing factors.RESULTS A total of 2678 valid questionnaires were collected.Of the respondents,973(36.3%)had heard of the IPFH concept.In addition,89.5% of participants agreed with the view that the IPFH is beneficial to improving quality of life,and over half thought that a regular schedule,a reasonable diet,tobacco and alcohol control,a cheerful mood,specific life goals and plans,taking the initiative to accept health-related education and implement health knowledge,good interpersonal relationships,and regular physical examinations were closely related to the IPFH.The majority of respondents paid attention to their health and usually obtained health-related knowledge via social media and were also willing to promote the IPFH.Most of the participants underestimated the role of hospitals,family doctors,and health managers in promoting the IPFH.Age,monthly income,and medical-related work experience were the influencing factors for IPFH awareness.CONCLUSION The Chinese population has limited knowledge of the IPFH.People with strong IPFH awareness are older,earn more,and have medical-related work experience.

The Study of Health Effects of Vinyl Chloride AirPollution on Population

A series of indicators, including serum lysozyme activity, G-banding chromosome aberration (G-banding CA) analysis, sister chromatid exchanges (SCEs), chromosome aberration (CA), T-lymphocyte transformation rate (TcTR),-GT, GPT and AKP, were employed in the present survey among occupationally vinyl chloride (VC) exposed workers and inhabitants living in VC polluted area in a polyvinyl chloride (PVC) factory. The results showed that the serum lysozyme (S-LZM) activities in Group 3 (adult inhabitants exposed to 0.20 mg/m3 VC for at least 8 years), Group 2 (workers exposed to 4.1 mg/m3for at least 7 years occupationally), Group 1 (workers exposed to 25.7 mg/m3 for at least 2 years) were significantly higher than control. G-banding CA analysis showed that the total chromosome breakage rates in both Groups 1 and 2 were higher, but no difference existed between Group 3 and control. Only Group 1 was observed having higher SCEs, CA level and lower TcTR than control. AKP levels in Groups 1 and 2 were higher than control,but noγ-GT and GPT differences were found among groups. The study also suggests that G-banding CA analysis is more sensitive than CA and SCEs

Role of traditional Chinese medicine in the initiative practice for health

To achieve awareness of the initiative practice for health concept in the Chinese population,traditional Chinese medicine(TCM)doctors should popularize TCM culture and knowledge among young people,people with a low level of education,in low-income populations,and in rural populations.

Risk factors for major gastrointestinal bleeding in the general population in Finland

BACKGROUND Data on non-drug related risk-factors for gastrointestinal bleeding(GIB)in the general population are limited,especially for life-style factors,clinical measurements and laboratory parameters.AIM To identify and investigate non-drug risk factors for major GIB in the general population of Finland.METHODS We performed a retrospective cohort study using data from the FINRISK health examination surveys,which have been conducted every 5 years across Finland from 1987 to 2007.Participants were adults aged 25 years to 74 years,excluding those with a previous hospitalization for GIB.Follow-up from enrollment was performed through linkage to national electronic health registers and ended at an event of GIB that led to hospitalization/death,death due to any other cause,or after 10 years.Covariates included demographics,socioeconomic and lifestyle factors,clinical measurements,laboratory parameters and comorbidities.Variable selection was undertaken using Least Absolute Shrinkage and Selection Operator(LASSO)and factors associated with GIB were identified using Cox regression.RESULTS Among 33,508 participants,403(1.2%)experienced GIB[256 men(63.5%);mean age,56.0 years(standard deviation(SD)±12.1)]and 33105 who did not experience GIB[15768 men(47.6%);mean age,46.8(SD±13)years],within 10 years of follow-up.Factors associated with a significantly increased risk of GIB were baseline age[per 10-year increase;hazard ratio(HR)1.62,95%confidence interval(CI):1.42-1.86],unemployment(HR:1.70,95%CI:1.11-2.59),body mass index(BMI)(HR:1.15,95%CI:1.01-1.32),gamma-glutamyl transferase(GGT)(HR:1.05,95%CI:1.02-1.09),precursors of GIB(HR:1.90,95%CI:1.37-2.63),cancer(HR:1.47,95%CI:1.10-1.97),psychiatric disorders(HR:1.32,95%CI:1.01-1.71),heart failure(HR:1.46,95%CI:1.04-2.05),and liver disorders(HR:3.20,95%CI:2.06-4.97).Factors associated with a significantly decreased risk of GIB were systolic blood pressure(SBP)(HR:0.78,95%CI:0.64-0.96),6-10 cups of coffee a day(HR:0.67,95%CI:0.46-0.99),or>10 cups(HR:0.43,95%CI:0.23-0.81).CONCLUSION Our study confirms established risk-factors for GIB and identifies potential risk-factors not previously reported such as unemployment,BMI,GGT,SBP and coffee consumption.

Structure analysis and performance measurement of Chinese health de-livery system

Objective:Although evidence has already demonstrated that the performance of Health Deliv- ery System(HDS) varies widely across nations,relatively little is known about the factors that give rise to these variations and the key point to improve the performance besides adjusting system structure.By setup of HDS performance measurement system on the base of association of financial,social,and environmental characteristics,we construct system dynamic model of HDS to simulate the invention policies.Methods: Performance measures were collected from HDS in 31 regions of China and combined with secondary data sources.Multivariate,linear,nonlinear regression and factor analysis models were used to estimate associ- ations between system characteristics and the performance.Results:Performance varied significantly with the size,financial resources and organizational structure of HDS.Performance measurement system of health delivery system was developed to give the rank of all Chinese regions.Conclusion:Performance measurement system of HDS is the basic of HDS modeling by system dynamic.

Health Analytics, Economics and Medicine toward a 21st Century Health Care System

After a review of recent developments in precision medicine, population health sciences and innovative clinical trial designs, and in health economics and policy, we show how innovations in health analytics can capitalize on the advances in biomedicine and health economics towards developing a data-driven and cost-effective 21st century health care system. In particular, we propose a mutually beneficial public-private partnership that combines individual responsibility with community solidarity in building this health care system.

Contributions of Primary Health Care and Next Step Considerations: A Systematic Review

The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.

Comparison of Community Health between Rural and Urban Areas in View of the Impact of the COVID-19 Pandemic: Global Perspective through a Literature Review

The progressive aging of society is expected to lead to the development of effective integrated community-based care system considering the characteristics based on community environments. However, the COVID-19 pandemic has influenced population health worldwide. This study aimed to examine disparities in population health and health-related factors between rural and urban communities during the COVID-19 pandemic. A literature search was conducted using PubMed, Medline, and CINAHL for articles published up to September 2022 with the following search terms: community health, rural, urban, and COVID-19. A total of 105 articles were identified, of which three articles with a cross-sectional quantitative research design met the inclusion criteria. Two articles focused on mental health, and among them, one recognized a significant disparity between rural and urban areas. Four health-related factors in view of the COVID-19 pandemic in rural and urban areas were perceived, including knowledge, behavior, lifestyle, and social support. And, two factors: health-related knowledge and health-related behavior, were perceived as the significant disparities between rural and urban during the COVID-19 pandemic. The further efforts will be needed to pursue effective integrated community-based care system during and post-COVID-19, taking into account community environment at both community and individual levels.

Association between sporting event attendance and self-rated health:an analysis of multiyear cross-sectional national data in Japan

Background:This study examined the extent to which sporting event attendance is associated with self-rated health.Drawing from an economic model of health production and psychological research on the health benefits of psychosocial resources,sporting event attendance was hypothesized to have a positive relationship with selfrated health.Methods:A two-level multilevel ordered logistic regression was used to analyze multiyear cross-sectional data collected from national surveys in Japan.Results:The results demonstrate that,controlling for the effects of personal and environmental characteristics,sporting event attendance positively correlates with self-rated health over a 12-year period.Specifically,when compared to individuals who did not attend any sporting event during the past year,those who attended a sporting event were 33%more likely to indicate a higher level of self-rated health.Conclusions:These findings provide evidence for a positive association between sport spectatorship and the perception of general health and contribute to the literature examining the relationship between sport spectatorship and health outcomes.

Climate change,24-hour movement behaviors,and health:a mini umbrella review

Background:The worsening climate change and alarming prevalence of communicable and non-communicable diseases continue to threat human life and existence.Accumulating evidence suggests that favorable patterns of 24-h movement behaviors,high physical activity,low sedentary behavior,and adequate sleep,may positively contribute to achieving dual benefits of climate change mitigation and disease prevention.The purposes of this mini umbrella review were to summarize the most up-to-date,high-level evidence exploring the relationships between climate change,24-h movement behaviors,and health and elaborate on the mechanisms linking the three variables of interest.Methods:A systematic search of electronic databases was performed in PubMed and Google Scholar during March–October 2020.Inclusion criteria were:(1)systematic review;(2)reviewed relationships between climate change and movement behaviors and/or health in any directions;(3)written in English;(4)published in 2010–2020.Narrative synthesis was conducted to highlight the main relationships observed and address the current state of knowledge and priorities for future research.In order to illustrate the potential mechanisms between climate change,movement behaviors,and health,the main results from included systematic reviews were summarized and a conceptual framework was developed for future research.Results:Based on the evidence from eight systematic reviews published in the past decade,multi-directional(i.e.,uni-,bi-,or U-shaped)links were observed between climate change and varying human health outcomes.However,little is understood about the association between climate change and 24-h movement behaviors.Two reviews suggested the negative impact of climate change on sleep and bi-directional relationships between climate change and physical activity/sport.One review included two studies suggesting the unfavorable impact of climate change on sedentary behavior;however,the evidence was limited.Finally,no reviews examined the mechanisms by which climate change,movement behaviors,and health impact one another.Based on the findings of this mini umbrella review,a conceptual framework is proposed that could guide future work to unpack mechanisms between climate change,movement behaviors,and health.Conclusions:This mini umbrella review highlights the importance of better understanding the mechanisms between climate change,movement behaviors,and health in developing effective mitigation and adaptation strategies to climate change,while paying close attention to vulnerable countries/communities/population groups.

What does the development of medical tourism in Barbados hold for health equity?an exploratory qualitative case study

Background:Although the global growth of privatized health care services in the form of medical tourism appears to generate economic benefits,there is debate about medical tourism’s impacts on health equity in countries that receive medical tourists.Studies of the processes of economic globalization in relation to social determinants of health suggest that medical tourism’s impacts on health equity can be both direct and indirect.Barbados,a small Caribbean nation which has universal public health care,private sector health care and a strong tourism industry,is interested in developing an enhanced medical tourism sector.In order to appreciate Barbadians’understanding of how a medical tourism industry might impact health equity.Methods:We conducted 50 individual and small-group interviews in Barbados with stakeholders including government officials,business and health professionals.The interviews were coded and analyzed deductively using the schedule’s questions,and inductively for novel findings,and discussed by the authors.Results:The findings suggest that in spite of Barbados’universal health care and strong population health indicators,there is expressed concern for medical tourism’s impact on health equity.Informants pointed to the direct ways in which the domestic population might access more health care through medical tourism and how privately-provided medical tourism in Barbados could provide health benefits indirectly to the Barbadian populations.At the same time,they cautioned that these benefits may not materialize.For example,the transfer of public resources-health workers,money,infrastructure and equipment-to the private sector to support medical tourism with little to no return to government revenues could result in health inequity through reductions in access to and availability of health care for residents.Conclusions:In clarifying the direct and indirect pathways by which medical tourism can impact health equity,these findings have implications for health system stakeholders and decision-makers in Barbados and other countries attempting both to build a medical tourism industry and to protect health equity.

Prevalence and correlates of lifestyle behavior,anxiety and depression in Chinese college freshman:A cross-sectional survey

Objectives:First-year college students had exposure to unhealthy lifestyle behaviors that correlate with a high prevalence of anxiety and depression.Regarding to the modifiable lifestyle behaviors factors,this study investigated the prevalence and correlation of multiple lifestyle behaviors,anxiety and depression in a sample of Chinese first-year college students.Methods:Cross-sectional data were extracted from Residents eHealth app of health lifestyle behaviors survey from September to October 2019.Anxiety,depression,eating regular meals,consumption of snacks in-between meals,consumption of fruit,dessert and sugar-sweetened beverages,smoking and secondhand smoke exposure,consuming alcohol,physical activity,sedentary time were assessed by self-report.Socio-demographic including age,gender,education,family income,religion,and health condition were captured.Logistic regression was used to explore the association of multiple lifestyle behaviors,anxiety and depression.Results:Totally 1,017 participants were included in the study.The prevalence of anxiety and depression(from mild to severe) were 40.3% and 45.3%,respectively.In multivariable analyses,religion (believe in Buddhism,OR =2.438,95%CI:1.097-5.421;believe in Christian,OR =5.886,95%CI:1.604-21.597),gender (Female,OR =1.405,95%CI:1.001-1.971),secondhand smoke exposure (OR =1.089,95%CI:1.001-1.184),and eating regular meals (OR =0.513,95%C1:0.346-0.759) were associated with anxiety.Family income (OR =0.732,95%CI:0.596-0.898),eating regular meals (OR =0.641,95%CI:0.415-0.990),frequency of breakfast (OR =0.813,95%CI:0.690-0.959),with a chronic disease (OR =1.902,95%CI:1.335-2.712),and consumption of nocturnal snack (OR =1.337,95%CI:1.108-1.612) were associated with depression.Conclusions:These results highlighted the need for early lifestyle behavior intervention,especially modifying diet patterns considering the background of religion,health condition,and social-economic status in first-year college students to improve their mental health.

Emergency department in hospitals, a window ofthe world： A preliminary comparison betweenAustralia and China

BACKGROUND： This study aimed to make a preliminary comparison of emergency department （ED） presentations between Australia and China. The comparison could provide insights into the health systems and burden of diseases and potentially stimulate discussion about the development of acute health system in China.METHODS： An observational study was performed to compare Australian ED presentations using data obtained from a single adult tertiary-referral teaching hospital in metropolitan Brisbane against Chinese ED presentations using public domain information published in existing Chinese and international medical journals.RESULTS： There are major differences in ED presentations between Australia and China. In 2008, 1） 35.4% of patients arrived at a tertiary teaching hospital ED in Brisbane, Australia by ambulance; 2） 1.7% were treated for poisoning; 3） 1.4% for cerebral vascular disease; 4） 1.7% for cardiac disease; and 5） 42.6% for trauma. The top events diagnosed were mental health problems including general psychiatric examination, psychiatric review, alcohol abuse, and counselling for alcohol abuse, which accounted for 5.5% of all ED presentations. Among ED patients in China, 6.7% arrived at a tertiary teaching hospital by ambulance in Shenyang in 1997; 3.7% were treated for poisoning in Shanxi Zhouzhi County People＇s Hospital ED in 2006; 14.9% for cerebral vascular diseases at Qinghai People＇s Hospital ED in 1993-1995; 1.7% for cardiac diseases at the Second People＇s Hospital ED, Shenzhen Longgang in 1993; and 44.3% for trauma at Shanxi Zhouzhi County People＇s Hospital ED in 2006. The top events were trauma and poisoning among the young and cerebral infarction in the older population.CONCLUSIONS： Compared with Australian, Chinese ED patients had 1） lower ambulance usage; 2） higher proportion of poisoning; 3） higher proportion of cerebral vascular diseases; 4） similar proportion of cardiac disease; 5） similar proportion of trauma; and 6） little reported mental health problems. Possible explanations for these differences in China include a pay for service pre-hospital care system, lack of public awareness about poisons, inadequate hypertension management, and lack of recognition of mental health problems.

Promoting Healthy Longevity Should Start Young: A Life Course Journey

Introduction Throughout a woman’s life,several unique health characteristics are related to an increased risk of later disease morbidity and/or premature mortality(Fig.1).For instance,these include early age at menarche1,2(ie,“short,irregular or long menstrual cycles”)3,4,a history of infertility5,pregnancy loss6,several major pregnancy complications(eg,preeclampsia,gestational hypertension,gestational diabetes mellitus(GDM)and preterm delivery)7–9,and menopause characteristics(eg,long menopause transition period,early age at menopause,and the presence of vasomotor symptoms).