bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural Experiment on Trade and Investment Liberalization and Soft Drink Consumption
Authors: Tcholakov Y 
Published: October 2020

Abstract

Background
Globalization is recognized to as a contributing factor to a health harming environment through a variety of mechanisms including through changes in food systems and food availability. Sugar-sweetened beverage (SSB) consumption is linked to obesity and diabetes and its regulation is a key priority for public health. The Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) is an international trade agreement between 11 countries.

Methods
This project uses of natural experiment methods to predict the impact of the entry into force of the CPTPP on SSB consumption. These methods allow quantitative inferences to be drawn in the situations where the exposure is not randomly assigned. Soft drink consumption data was collected from the Euromonitor database for 80 countries from all regions. This data was used to estimate the effect of agreements similar to the TPP.

Results
Eleven country trade agreement pairs were identified. In 5 cases out of the 11, the exposed country had a higher soft drink consumption at five years after the trade agreement. The effect of the trade agreement exposure for an average country in the sample in a trade agreement was found to be 1.10 (95% CI: 1.01-1.18; p-value: 0.03) after adjusting for GDP and the involvement of the US. In 7 of the 11 member-countries soft drink consumption is expected to increase yielding an average increase of 9.0% in those countries; the changes did not yield statistically significant differences in others.

Conclusions
This projected extended the use of synthetic methods to the projection of future effects of policy implementation. While it showed that there may be increasing trend of SSB consumption in certain scenarios, this could not be generalized to all cases. This illustrates the wide range of effects of international trade liberalization and highlights that national policy probably plays a strong modulating role on the impact that it has on local food environments.

Key messages
Globalization can lead to health harming environments and its impacts should further be studied by public health professionals and researchers. Many global policies have the potential to lead to significant health impacts but are negotiated without involving public health experts.
Chilean mortality due to STEMI: analysis of a public policy using interrupted time series
Authors: Nuñez Muñoz G 
Published: October 2020

Abstract

Issue
To the end of 1990s, ST-segment elevation myocardial infarction (STEMI), along with other causes, led the causes of death in Chile. Therefore, at the beginning of 2000s, the explicit health guarantees policies were created, including the treatment of STEMI, which was implemented in first quarter of 2005, generating a series of benefits that seek to improve people's survival. However, there are few studies that show the effectiveness of interventions at the level of morbimortality, given the difficulty in database (DB) collection.

Description of the problem
The objective is to determine if the policy implemented was able to reduce the mortality associated for STEMI, evidenced in the number of cases and potential years of life lost (PYLL). The public DB of Hospital Discharges (HD) and Deaths of Chile during the periods 1997-2017 were analyzed. ICD-10 codes were identified for STEMI. An interrupted time series analysis (ITSA) was performed with Newey-West regression adjusted according to autocorrelation, using as intervention the start of the STEMI policy, both in annual and quarterly series. For PYLL calculation, life expectancies by sex, were used, available on the website of the National Institute of Statistics of Chile. The data was analyzed with Stata v15.1.

Results
27807004 HD were recorded, of which 143061 were due to STEMI, 10.9% died at the in-hospital. Regarding deaths, 1586731 occurred, of which 6.37% were secondary to STEMI. When performing ITSA, for deaths it was observed that there was a significant increase in post-intervention cases (p-value &lt;0.05), PYLL increased post intervention (p-value 0.001). HD showed a decrease in post-intervention mortality cases (p-value &lt;0.01) and PYLL showed no significative changes with respect to the pre-intervention time.

Lessons
Globally, the focus on treatment has not allowed to reduce STEMI mortality. Prevention is the key to treat Social Transmission Diseases

Key messages
ITSA is a powerful tool to analyze interventions. Prevent and treat.
Supporting implementation of resilience training among school-aged children – RESCUR in Sweden
Authors: Eriksson C , Skoog T , Kimber B 
Published: October 2020

Abstract

Issue
What is needed to facilitate implementation of an intervention when scaling up and scaling out the program?

Description of the problem
RESCUR: Surfing the Waves (Jag vill, jag kan, jag törs!) is a new resilience curriculum, developed in 2012-2015 by researchers in six European Universities, to foster the psychosocial development of children and give them tools to deal with challenging situations. It aims at increasing children's resilience, i.e. their capacity to cope with disadvantages, crises, changes and stress without breaking down. The RESCUR project in Sweden consists of a Randomized Controlled Trial among children of the ages 6-12 in schools or social services. RESCUR is a pedagogic material, which requires training before getting access to the intervention. The training consists of two days and a follow-up day as well as observation and supervision. The project has been evaluated from two perspectives: implementation and effects. For a theoretically promising method to work at all, the method must be implemented effectively and correctly. Implementation was documented through self-evaluations, reported by group leaders after six months, and observations made according to a formalized checklist. The implementation of the method is fundamental to properly evaluating the effects of the method.

Results
The model used to train and support people who implemented the intervention seems to have worked according to the self-reports and the observations of lessons, which noted good implementation quality in the activities that were carried out every week by the majority of teachers and group leaders. The observed implementation was exemplary or very strong among 56 % in schools (n = 41) and 41 % in social services (n = 12).

Lessons
An important challenge in health promotion is ensuring that an intervention is implemented in an efficient way. Recruiting participants and training implementers are basic requirements for successful trials.

Key messages
The implementation of the health promoting method is fundamental to properly evaluating the effects of the method. Therefore, an educational and monitoring component is needed. Different implementers can achieve the high-quality implementation of an intervention. Training, observation, feedback, supervision and educational material all supported the implementation of RESCUR.
Affordable Care Act did not reduce inappropriate use of emergency room services
Authors: DeLellis N , Wilson F , Belsito F , Cunningham W 
Published: October 2020

Abstract

Background
The US Patient Protection and Affordable Care Act of 2010 (ACA) has several provisions to increase access to health insurance among Americans. Prior to ACA, emergency departments (ED) served as a safety net to uninsured as most hospitals are required to provide stabilizing treatment to patients with emergency medical conditions regardless of their ability to pay. The ACA increased the number of insured, improved access to primary care and was expected to reduce high cost ED utilization

Methods
This retrospective cross-sectional study used ED data from a US Midwest suburban medium size hospital (November 2009 - January 2017) to analyze the patterns of ER utilization pre- and post-ACA. The data (n = 423,548) excluded ambulance deliveries; 5-level Emergency Severity Index was re-coded as urgent/non-urgent for each visit. Analysis included age, sex, race, mode of arrival, disposition, insurance, visit day and time as other predictors in binary logistic regression.

Results
Non-urgent visit proportion increased from 34.5% in 2009 to 49.1% in 2016; odds of a visit being urgent are lower after ACA (Exp(B)=0.684; 95%CI 0.675,0.694) with stronger effect for pediatric (age&lt;18) population (Exp(B)=0.487, CI 0.471, 0.503). ACA did not change ED utilization by working population, however, in comparison to people with commercial insurance, patients without recorded insurance are less likely to have a true urgent visit (Exp(B)=0.845; CI 0.83, 0.86). Among other factors predicting ED visit urgency are race and insurance type.

Conclusions
Expensive ER care is still provided for non-urgent care. Access to alternative type of care and public health awareness efforts should focus on subpopulations with high inappropriate ED use.

Key messages
Affordable Care Act (2010) did not improve efficiency of emergency room utilization. Additional effort are needed to increase access to primary care and awareness of ER use for specific subpopulations.
Financial protection against out-of-pocket health expenditure in Poland
Authors: Tambor M , Pavlova M 
Published: October 2020

Abstract

Background
Protecting people against financial hardship associated with using health care, is crucial for achieving universal health coverage. Despite the significant improvement happening in the last two decades, household out-of-pocket payments in Poland account for 23% of current spending on health, which is more than in many European Union countries. This implies an incased risk of financial hardship for Polish households.

Methods
The aim of this study was to assess the extent to which people in Poland experience financial hardship when they use health services. The analysis draws on household budget survey data collected annually by the Central Statistical Office of Poland between 2005 and 2014. It focuses on two indicators of financial protection: catastrophic health spending and impoverishing health spending. The study is a part of WHO country-based studies generating new evidence on financial protection in European health systems.

Results
In 2014, 8.6% of Polish households experienced catastrophic health spending, while 3.8% of households were impoverished or further impoverished due to health spending. Financial hardship is heavily concentrated among the poorest households for whom the incidence of catastrophic spending is 30%. Outpatient medicines are the largest single driver of catastrophic health spending across all consumption quintiles except the richest. For the richest households, payments for medical products and dental care are the main causes of financial hardship. Although financial protection improved between 2005 and 2014, the improvement among the poorest was marginal.

Conclusions
Policy attention should focus on protecting households against high spending on outpatient medicines, e.g. revising patient cost-sharing for prescribed medicines and strengthen regulation for over-the-counter medicines. The protection mechanisms should be targeted at low-income households (people living on social benefits, disability or survivor's pensioners).

Key messages
Financial protection is fairly weak in Poland compared to many European Union countries. Out-of-pocket payments for medicines (prescribed and over-the-counter) are the main cause of financial hardship for Polish households.
Moving towards people–centered approach in TB Health Care System: Armenia’s Experience
Authors: Sahakyan S , Musheghyan L , Harutyunyan A , Khachadourian V 
Published: October 2020

Abstract

Background
Achieving integrated people-centered care requires interventions at various levels of the system, including policy changes and measures tailored to strengthen skills and competencies of health care providers. The national guidelines for TB care provision in Armenia provide a standardized approach for TB diagnosis and treatment, including systematic implementation of TB care services across the country. Before August 2019, the only option for drug-sensitive TB treatment was facility-based DOT.

Methods
In order to offer an alternative treatment option- family- based DOT, and bring TB services closer to patients' needs and values, the national guideline for TB care provision was updated to institutionalize the new approach. A series of nationwide professional development trainings was launched to assure that health care providers at the inpatient and outpatient settings effectively follow the new updates in the national guideline. These evidence-based trainings specifically aimed to equip healthcare providers with the necessary tools, knowledge, and the skillset for communicating with TB patients and building relationship and trust, offering their professional support. Along with patient counselling skills, the curriculum covered recent updates on TB epidemic, its social-psychological and behavioral risk factors, and advancements in TB diagnosis and treatment. All the participants were provided with a manual and other materials regarding the program.

Results
The Ministry of Health of the RA has approved the national guidelines on TB care (No 2277 - Ô±, August 19). This document includes information on people-centered TB treatment and institutionalizes the family-based DOT in Armenia. More than 90 percent of TB healthcare providers (98 physicians and 134 nurses) throughout Armenia participated in the trainings and received certificates. The RA Ministry of Health accredited the training curriculum with 11 continuing medical education credits for participation.
Integrating psycho–social counselling in TB Services in Armenia
Authors: Musheghyan L , Sahakyan S , Harutyunyan A , Khachadourian V 
Published: October 2020

Abstract

Background
Community or family-based DOT improves clinical outcomes and quality of life of TB patients compared to facility-based DOT. Based on a previously conducted clinical trial and recommended best practice guidelines, Armenia started the institutionalization of the family-based DOT in 2019, as an important component of the integrated people-centered approach in TB treatment. Psycho-social counselling and education played a crucial role in preparing patients/family members for this new model of care.

Methods
To facilitate the family-based DOT, multidisciplinary counseling teams consisting of a TB nurse and a psychologist or a TB nurse and a social worker were formed and further incorporated into the existing TB care system. After a systematic evaluation the strongest applicants were shortlisted, interviewed, and selected. They underwent a three-day training, improving their knowledge on TB disease, its transmission, diagnosis and treatment; patient counseling with an emphasis on motivational interviewing techniques; and people-centered TB care. A comprehensive package of procedural documents was developed to facilitate the counseling teams work process, including a guideline on counseling, reporting forms, and patients' educational materials. At an early stage of TB treatment, the counseling teams provide psycho-social counselling to patients and their families, and educate them on TB risk factors and infection control.

Results
The counselling teams have been based in the National Center of Pulmonology of the RA and provide psycho-social counselling to all drug susceptible TB patients and their family members all over Armenia. The counseling teams prepare patients/family members for the family-based DOT and provide continuous support during the entire treatment. The integration of counselling teams in the TB care system has provided the required human resource and capacity for the successful adoption of a new model of people-centered TB care in Armenia.
Preparedness of outpatient health facilities for ambulatory treatment with all–oral short DR–TB treatment regimens in Zhytomyr, Ukraine: a cross–sectional study
Authors: Malakyan K , Gils T , Laxmeshwar C h , Duka M , Siomak O , Didik V , Lytvynenko N , Terleeva Y , Donchuk D , Isaakidis P 
Published: October 2020

Abstract

Introduction
Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder (AUD), are common comorbidities. As part of health reform, the country is moving from inpatient-care to ambulatory primary care for tuberculosis (TB). This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine.

Methods
This is a cross-sectional study in which routine program data was collected during June 2018 and February 2020. Before discharge of every patient from the hospital, MSF teams assess outpatient facilities available using a standardized checklist. The assessment evaluates access, human-resources, availability of medicines, infection control, laboratory and diagnostic services, and psychosocial support.

Results
We visited 90 outpatient facilities in 23 districts and 1 city between June 2018 and February 2020. Forty health posts, 27 TB-units, 23 ambulatories including two family doctors and one polyclinic were included. All facilities provided DOT, but only nine (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and limited to TB-doctors. TB-medicines and storage space were available in all facilities, but only twenty two (24%) stored ancillary medicines. HIV-patients had to visit a separate facility to access HIV-care. Personal protective equipment for infection control was unavailable in 41 (46%) facilities. Basic laboratory services were available in TB-units, but only 3 (11%) performed audiometry. Only twenty (22%) TB-units had psychosocial support available, and 1 (4%) psychiatric support.

Conclusions
Outpatient facilities in Zhytomyr oblast are not yet fully prepared to provide comprehensive care for DR-TB patients. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential to establish high quality, patient-centered care.
Austria
Authors: Falkenbach M , Heiss R 
Published: October 2020

Abstract

Background
Health policy research tends to focus on medical care practices and disease prevention while the emphasis on political determinants of health is thin at best. Within this case study, we look at Austria's Freedom Party (FP&Ouml;), a Populist Radical Right (PRR) party, and their impact on health policies. Existing conceptualizations suggest three key dimensions of PRR parties: People centrism (nativism), vertical exclusion (ant-political elite), and horizontal exclusion (immigrants). We explore how these conceptualizations are applicable to the health policy choices of the FP&Ouml;.

Methods
We conducted a review of available primary sources (legal and policy documents) and secondary literature (academic, press, and think-tank publications). Resulting data were analysed thematically.

Results
In the years 2000 to 2003 and 2017 to 2019, the FP&Ouml;, in a coalition government with the ÖVP, was in charge of the health ministry. The biggest changes came about in 2017 where 1) the FP&Ouml; reneged on the smoking ban set to have been implemented in May 2018. 2) the FP&Ouml; led the consolidation of the 21 separate health insurance companies to five, stating that it would bring patients €1 billion. However, the current government is now confronted with a budget deficit of the ÖGK. 3) the FP&Ouml; promoted social policies reducing the social benefits for immigrants who showed insufficient language skills.

Conclusions
The case analysis suggests that the FP&Ouml;'s health policy choices, described above, may be explained through the people centrist, nativist, and anti-elitist tendencies of PRR parties. 1) reneging on the smoking ban can be interpreted as an anti-scientific and pro “ordinary citizen” action. 2) the health insurance mergers, can be explained as being a strike against the economic and political elites, who allegedly used the complex structure for their own benefit (clientelism). 3) attacking the socio-economic status of immigrants, a social determinant of general health.
Improving Gender Equality & Nutrition Data for Women and Children
Authors: Ferne J 
Published: October 2020

Abstract
Empowerment of women and girls is identified as an important nutrition-sensitive strategy to address malnutrition in low- and middle-income countries. Minimizing the data gaps and advancing knowledge of the relationship of gender equality and women's empowerment and nutrition is relevant to inform local women's groups and host country response to policy and advocacy. Good nutrition and gender equality are mutually reinforcing: improving nutrition is critical to achieving gender equality, and vice versa. Simpler tools to generate timelier and better quality data using gender equality indicators for nutrition program delivery and performance can guide program managers, partner and government access to program monitoring data at reduced cost, leading to strengthened gender responsive services and more effective and time-sensitive decision making. This innovation has developed a framework for measuring and linking gender and nutrition-related outcomes, as well as a predictive model incorporating potential links between gender inequality, increased nutritional needs, and inequitable access to nutrition and health services. Through identifying simple yet appropriate indicators and tools of gender equality, it has tested this model and tools in current nutrition program settings across sub Saharan Africa, to ensure that emerging nutrition experts understand and can apply these models and tools.
Action against environmental pollution through a healthy, green and just recovery in Europe
Authors: Stauffer A 
Published: October 2020

Abstract

Issue
With the COVID-19 pandemic, the European Union (EU) is faced with an unprecedented crisis with huge effects on every aspect of our society. As European countries start easing lockdowns, discussions on recovery and investment plans pick up the pace, but it will be vital not to repeat mistakes of the past but focus on a healthy, green and just recovery to increase overall health preparedness and resilience in the face of future pandemics.

Description of the problem
The recovery from the COVID-19 crisis is the litmus test how serious policy-makers are about the EGD, if they take it as the blueprint for rebuilding or continue investing into yesterday's polluting industries and economies. While at EU level there is a strong commitment for the EGD to be the principle in economic recovery, decisions and bailouts at national level do not necessarily follow suit (yet). One of the actions that are needed is defining conditions for all recovery and investment money being spent.

Results
With EU Commission President's van der Leyen's proposal for a 750 billion EUR recovery fund was presented end of May (1). The European Green Deal (EGD) proposal (2) shows that European Commission has understood the importance of a healthy planet for healthy people. If successfully implemented, this deal has the potential to achieve major health improvements in the near term while reducing the growing health risks from climate change (3,4), air and chemical pollution.

Lessons
Shifting from a polluting to a green and healthy economy, with the European Green Deal at the core is possible. The EGD already foresees a zero pollution ambition for the EU: preventing all pollution in order to protect health is the much needed goal upon which European and national leaders must base all recovery actions.

Key messages
A green recovery can give the necessary financial support for upgrading and modernising our cities and sustainable urban planning. Through the imminent recovery decisions, policy-makers need to seize the historic opportunity to reduce the pressure on the planet’s and people’s health.