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Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage

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Infectious Diseases of Poverty 2013年第1期2卷 166-174页

作者： Kingsley Nnanna Ukwaja Isaac Alobu Seye Abimbola Philip Christy Hopewell Department of Internal Medicine Federal Teaching HospitalAbakalikiEbonyi StateNigeria National Tuberculosis and Leprosy Control Programme Ministry of HealthAbakalikiEbonyi StateNigeria National Primary health Care Development Agency AbujaNigeria Francis J Curry International Tuberculosis Center Division of Pulmonary and Critical Care MedicineSan Francisco General HospitalUniversity of CaliforniaSan FranciscoCAUSA

Background:Studies on costs incurred by patients for tuberculosis(TB)care are limited as these costs are reported as averages,and the economic impact of the costs is estimated based on average patient/household incomes.Average expenditures do not represent the poor because they spend less on treatment compared to other economic groups.Thus,the extent to which TB expenditures risk sending households into,or further into,poverty and its determinants,is unknown.We assessed the incidence and determinants of household catastrophic payments for TB care in rural Nigeria.Methods:Data used were obtained from a survey of 452 pulmonary TB patients sampled from three rural health facilities in Ebonyi State,Nigeria.Using household direct costs and income data,we analyzed the incidence of household catastrophic payments using,as thresholds,the traditional>10%of household income and the≥40%of non-food income,as recommended by the World health Organization.We used logistic regression analysis to identify the determinants of catastrophic payments.Results:Average direct household costs for TB were US$157 or 14%of average annual incomes.The incidence catastrophic payment was 44%;with 69%and 15%of the poorest and richest household income-quartiles experiencing catastrophic activity,respectively.Independent determinants of catastrophic payments were:age>40 years(adjusted odds ratio[aOR]3.9;95%confidence interval[CI],2.0,7.8),male gender(aOR 3.0;CI 1.8,5.2),urban residence(aOR 3.8;CI 1.9,7.7),formal education(aOR 4.7;CI 2.5,8.9),care at a private facility(aOR 2.9;1.5,5.9),poor household(aOR 6.7;CI 3.7,12),household where the patient is the primary earner(aOR 3.8;CI 2.2,6.6]),and HIV co-infection(aOR 3.1;CI 1.7,5.6).Conclusions:Current cost-lowering strategies are not enough to prevent households from incurring catastrophic out-of-pocket payments for TB care.Financial and social protection interventions are needed for identified at-risk groups,and community-level interventions may reduce inefficiencies in the care-seeking pathway.These

关键词： Cost analysis Health policy Tuberculosis Regression analysis Nigeria

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Review of science and technology innovation policies in major innovative-oriented countries in response to the COVID-19 pandemic

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Biosafety and health 2023年第1期5卷 8-13页

作者： Tao Yun China Science and Technology Exchange Center Beijing 100045China

Since the coronavirus disease 2019(COVID-19)pandemic,major innovative-oriented countries have adopted various science and technology innovation(STI)policies to address global public health challenges.Using data from the Organization for Economic Co-operation and Development STI Database,this study analyzed international STI policies in response to the COVID-19 pandemic.The findings revealed that the pandemic has dramatically stimulated the application of STI policies,and there are commonalities and differences in the STI policies of different countries.Meanwhile,COVID-19 has disrupted planning for allocating resources for STIs,leading to duplication and inefficiency.Based on the findings,this study recommends increasing research investment to address the long-term challenges of major infectious diseases,strengthening support for enterprises,promoting data sharing and openness,enhancing the internationalization of scientific research,strengthening scientific consultation and communication,and devoting more policy attention to vulnerable groups.

关键词： COVID-19 Organizational innovation policy making Health policy

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The Pathway of China’s Integrated Delivery System:Based on the Analysis of the Medical Consortium Policies

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Current Medical Science 2022年第6期42卷 1164-1171页

作者： Huan GAO Xing-li DU Jia-zhi LIAO Li XIANG School of Medicine and health Management Huazhong University of Science and TechnologyWuhan430030China Tongji Hospital Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China

With the deepening of China’s health-care reform,an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system.For China’s integrated delivery system,a medical consortium plays an important role in integrating public hospitals and primary care facilities.The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system.This paper illustrates the possible future pathway of China’s medical consortium through retrospection of the 10-year process,changes of the series of policies,and characteristics of the policy issued in 2020.We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry,which would lead to the formation of a dualistic care pattern in China.

关键词： health-care reform integrated delivery system medical consortium tiered health-care delivery system Health policy

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Safety and feasibility of laparoscopic surgery for colorectal and gastric cancer under the Chinese multi-site practice policy:admittance standards of competence are needed

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Gastroenterology Report 2022年第1期10卷 490-497页

作者： Zhenghao Cai Haiqin Song Zhenfeng Huang Abraham Fingerhut Ximo Xu Hao Zhong Zhigang Li Yingjie Zhang Dachong Sha Dandan Bao Haibo Wang Binghua Cai Shangbo Hua Yanhui Zhang Jianguang Sun Ke Ye Jianwen Li Yong Lu Bo Feng Department of General Surgery Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP.R.China Shanghai Minimally Invasive Surgery Center ShanghaiP.R.China Department of General Surgery People’s Hospital of Rui’anZhejiangP.R.China Section for Surgical Research Department of SurgeryMedical University of GrazGrazAustria Department of General Surgery Wuxi Huishan District People’s HospitalJiangsuP.R.China Department of General Surgery Zhoushan HospitalZhejiangP.R.China Department of General Surgery Cixi Third People’s HospitalZhejiangP.R.China Department of General Surgery People’s Hospital of WenzhouZhejiangP.R.China Department of General Surgery Chinese PLA 107 HospitalShandongP.R.China Department of General Surgery Rudong People’s HospitalJiangsuP.R.China Department of General Surgery Kunshan Hospital of Chinese MedicineJiangsuP.R.China Department of General Surgery Jingjiang Chinese Medicine HospitalJiangsuP.R.China Department of General Surgery Haiyan People’s HospitalZhejiangP.R.China Department of General Surgery Yueqing People’s HospitalZhejiangP.R.China Department of Medical Affairs Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP.R.China

Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gastric cancer(LSGC)under the Chinese MSP policy.Methods:We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital(n=573)and his MSP institutions(n=508)between January 2017 and December 2020.Baseline demographics,intraoperative outcomes,post-operative recovery,and pathological results were compared between the original hospital and MSP institutions,as well as between MSP institutions with and without specific competence(surgical skill,operative instrument,perioperative multi-discipline team).Results:In our study,690 patients underwent LSCRC and 391 patients underwent LSGC.The prevalence of post-operative complications was comparable for LSCRC(11.5%vs 11.1%,P=0.89)or LSGC(15.2%vs 12.6%,P=0.46)between the original hospital and MSP institutions.However,patients in MSP institutions without qualified surgical assistant(s)and adequate instruments experienced longer operative time and greater intraoperative blood loss.The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC(11.5%vs 21.2%,Ppolicy is safe and feasible,but relies on the precondition that the MSP institutions are equipped with qualified surgical skills,adequate operative instruments,and complete perioperative management.

关键词： Health policy gastrointestinal tumors laparoscopic surgery public health quality in health care

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Overprescription of opioid analgesia is common following ambulatory Otolaryngology—Head and Neck surgery procedures: A multicenter study

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第2期8卷 145-151页

作者： Amr F.Hamour Frederick Laliberte Jordan Levy Jason Xu Edward Park Vincent Lin John de Almeida Julie Strychowsky Antoine Eskander Eric Monteiro Department of Otolaryngology-Head and Neck Surgery University of TorontoTorontoOntarioCanada Department of Otolaryngology-Head and Neck Surgery London Health Sciences CentreLondonOntarioCanada Department of Otolaryngology-Head and Neck Surgery Mount Sinai HospitalTorontoOntarioCanada

Background: The rise in the use of prescription opioids for postoperative analgesia within surgery has mirrored an increased trend of opioid-related morbidity within Canada and the United States. This study prospectively studied daily pain levels and medication requirements postoperatively in patients undergoing elective Otolaryngology—Head and Neck surgery procedures.Methods: Patients were asked to prospectively document their pain level and medication use daily for 7 days postoperatively. A final survey was used to quantify unused medication left at home and clarify each patient's disposal plan. We included patients undergoing elective outpatient or short stay surgeries from three tertiary care centers in Toronto, Ontario from September 2016 to September 2017. Previous opioids users or patients suffering from chronic pain were excluded.Results: A final cohort of 56 eligible adult patients were included in the study. The most common procedures were thyroidectomy (n = 19), endoscopic sinus surgery (n= 10), tympanoplasty/ossiculoplasty (n= 7), and cochlear implant (n = 5). Most patients received a prescription for acetaminophen/codeine (n = 29, 51.8%) or acetaminophen/oxycodone (n = 22, 39.3%) and used on average 29% of their initial prescription. Patients most commonly opted to keep their unused narcotics at home (n = 23, 41%). A total of 710 tablets of narcotics were overprescribed in our study population, 351 of which were kept in patients'' home for future use.Conclusion: There is a clear tendency to overestimate postoperative pain resulting in significant overprescription of opioids among Otolaryngologists.

关键词： analgesia Health policy opioid quality improvement quality of life

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

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Congenital Heart Disease 2024年第2期19卷 131-138页

作者： Dominique Vervoort Amy Verstappen Sreehari Madhavankutty Nair Chong Chin Eu Bistra Zheleva Institute of Health policy Management and EvaluationUniversity of TorontoTorontoCanada Division of Cardiac Surgery University of TorontoTorontoCanada Global Alliance for Rheumatic and Congenital Hearts PhiladelphiaUSA Department of health Services Government of KeralaKeralaIndia Ministry of health PutrajayaMalaysia Children’s HeartLink MinneapolisUSA

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].

关键词： Congenital heart disease pediatric heart disease global health health systems Health policy

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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

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Global health Journal 2022年第1期6卷 38-43页

作者： Shalini Nair Xinguang Chen Department of Epidemiology University of Florida2004 Mowry RoadGainesvilleFlorida32610USA

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 effect

关键词： Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Coronavirus disease 2019(COVID-19) Immunoresponse Antibody Global health Health policy Decision-making Serology testing

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国外健康促进政策对我国心理健康服务体系建设的启示

心理学

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心理学 2008年第12期 48-53页

作者：罗鸣春苏丹

健康促进是解决全球健康问题的新策略。美国和世界卫生组织健康促进政策对我国心理健康服务体系建设的启示主要包括以下内容：(1)美国健康促进政策的连续性、科学性、法制性、可操作性以及灵活性值得我们借鉴；(2)转变心理健康服务观念... 详细信息

健康促进是解决全球健康问题的新策略。美国和世界卫生组织健康促进政策对我国心理健康服务体系建设的启示主要包括以下内容：(1)美国健康促进政策的连续性、科学性、法制性、可操作性以及灵活性值得我们借鉴；(2)转变心理健康服务观念，树立以人为本的健康价值观；(3)加强心理健康服务体系的理论研究；(4)完善组织管理体制，建立国家健康促进委员会统一规划指导全国的健康促进工作；(5)建立高效务实的心理健康服务体系，实现人人健康目标。

关键词：健康促进心理健康服务体系健康政策 health promotion mental health service system Health policy

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

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International Journal of Nursing Sciences 2020年第S01期7卷 46-51页

作者： Shiyu Liu Linjie Dai Jing Xu School of Journalism and Communication Peking UniversityBeijingChina

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 pati

关键词： Communication Health policy Newspaper article Public health Physician-patient relations Media doctor toolkit

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

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肾脏病与透析肾移植杂志 2022年第1期31卷 1-8页

作者： Robyn G.Langham Kamyar Kalantar-Zadeh Ann Bonner Alessandro Balducci Li-Li Hsiao Latha A.Kumaraswami Paul Laffin Vassilios Liakopoulos Gamal Saadi Ekamol Tantisattamo Ifeoma Ulasi Siu-Fai Lui for the World Kidney Day Joint Steering Committee St.Vincent’s Hospital Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia Division of Nephrology Hypertension and Kidney TransplantationDepartment of MedicineUniversity of California IrvineOrangeCaliforniaUSA School of Nursing and Midwifery Griffith UniversitySouthportQueenslandAustralia Italian Kidney Foundation RomeItaly Brigham and Women’s Hospital Renal DivisionDepartment of MedicineBostonMassachusettsUSA Tamilnad Kidney Research(TANKER)Foundation The International Federation of Kidney Foundations-World Kidney Alliance(IFKF-WKA)ChennaiIndia International Society of Nephrology BrusselsBelgium Division of Nephrology and Hypertension 1st Department of Internal MedicineAHEPA HospitalAristotle University of ThessalonikiThessalonikiGreece Nephrology Unit Department of Internal MedicineFaculty of MedicineCairo UniversityGizaEgypt Renal Unit Department of MedicineCollege of MedicineUniversity of NigeriaItuku-OzallaEnuguNigeria International Federation of Kidney Foundations-World Kidney Alliance The Jockey Club School of Public Health and Primary CareThe Chinese University of Hong KongHong KongChina The World Kidney Day Joint Steering Committee is listed in the Appendix

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.

关键词： educational gap empowerment health literacy Health policy information technology kidney health partnership prevention social media

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