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International Journal of Health Policy... 2023Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems...
BACKGROUND
Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy.
METHODS
Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS.
RESULTS
4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use.
CONCLUSION
This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.
Topics: Humans; Health Policy; Noncommunicable Diseases; Policy Making; Obesity; Systems Analysis
PubMed: 37579437
DOI: 10.34172/ijhpm.2023.6772 -
Canadian Journal of Psychiatry. Revue... Jul 2021Concerns surrounding the mental health and well-being of Canadian postsecondary students have increased in recent years, with data suggesting increases in the prevalence... (Review)
Review
Postsecondary Mental Health Policy in Canada: A Scoping Review of the Grey Literature: Politique de santé mentale post-secondaire au Canada: un examen de la portée de la littérature grise.
OBJECTIVE
Concerns surrounding the mental health and well-being of Canadian postsecondary students have increased in recent years, with data suggesting increases in the prevalence of self-reported stress and psychological distress. Strategies to address postsecondary mental health have emerged at the national, provincial, and institutional levels. While reviews of the academic literature on the subject have been conducted, a detailed review of the grey literature has not. The objective of this study was to map the current state of grey literature related to current or recommended action supporting postsecondary mental health and well-being in Canada, with a focus on policy documents and guiding frameworks.
METHODS
We conducted a review following Arksey and O'Malley's 5-step framework for scoping reviews, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our search was restricted to documents with a primary focus on postsecondary mental health, a national or provincial scope, and publication date between 2000 and 2019.
RESULTS
While a national policy or guiding framework applicable to all postsecondary institutions across Canada does not yet exist, recommendations for policy at both the national and provincial levels were well aligned, emphasizing the need for a comprehensive approach to addressing mental health services through the use of a whole-campus approach that encompasses both upstream and downstream services.
CONCLUSION
Postsecondary sector stakeholders should consider how existing policy documents and guiding frameworks can be used to inform evidence-based, institutionally specific action on postsecondary mental health. More work is required to align the fragmented action occurring across Canada and incentivize postsecondary institutions to create a sustainable, effective strategy to address the increasingly complex and unique mental health needs of their students, staff, and faculty.
Topics: Canada; Health Policy; Humans; Mental Health Services
PubMed: 33016127
DOI: 10.1177/0706743720961733 -
Clinical Lymphoma, Myeloma & Leukemia Oct 2020Myelofibrosis (MF) is a Philadelphia chromosome-negative myeloproliferative neoplasm characterized by progressive bone marrow failure, increased risk of progression to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Myelofibrosis (MF) is a Philadelphia chromosome-negative myeloproliferative neoplasm characterized by progressive bone marrow failure, increased risk of progression to acute myeloid leukemia, and constitutional symptoms. For over 3 decades, various formulations of interferon (IFN) have been used for the treatment of MF, with variable results, and the role of IFN in the treatment of MF is evolving.
PATIENTS AND METHODS
For this systematic review and meta-analysis, Medline and Embase via Ovid, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched from inception through March 2019 for studies of pegylated IFN (peg-IFN) and non-peg-IFN in MF patients. The primary outcome of overall response rate was defined as a composite of complete response, partial response, complete hematologic response, and partial hematologic response. Random-effects models were used to pool overall response rate, and metaregression analyses were performed to compare peg-IFN and non--peg-IFN formulations.
RESULTS
Among the 10 studies with 141 MF patients included, the overall response rate was 49.9% (95% confidence interval [CI], 30.4-69.3), and there was no statistically significant difference (P = .99) between peg-IFN (50.0%; 95% CI, 26.2-73.9; I = 76.9%) and non-peg-IFN (49.6%; 95% CI, 20.5-79.0; I = 56.7%). Treatment discontinuation resulting from adverse events was common with non-peg-IFN at 35.8% (95% CI, 3.5-68.1) per year, and less in the one study on peg-IFN (0.5% per year).
CONCLUSION
IFN can lead to hematologic improvements in a subset of MF patients, but study quality is limited and heterogenous. Biomarkers predicting response to IFN and formulations with improved tolerability are needed.
Topics: Humans; Interferon-alpha; Primary Myelofibrosis
PubMed: 32669244
DOI: 10.1016/j.clml.2020.05.018 -
European Journal of Public Health Nov 2022Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability...
BACKGROUND
Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents.
METHODS
A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science).
RESULTS
Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability.
CONCLUSION
Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.
Topics: Humans; Female; Cross-Sectional Studies; Retrospective Studies; Diet; Exercise; Health Policy
PubMed: 36444105
DOI: 10.1093/eurpub/ckac053 -
International Journal of Environmental... Jan 2022Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events... (Review)
Review
A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice.
INTRODUCTION
Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters.
OBJECTIVE
There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition.
METHODS
A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported.
RESULTS
The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort.
CONCLUSION
This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.
Topics: Firefighters; Humans; Military Personnel; Prevalence; Public Policy; Stress Disorders, Post-Traumatic
PubMed: 35162587
DOI: 10.3390/ijerph19031565 -
Narra J Dec 2023Treatment recommendations for cancer patients are carried out according to clinical assessment, type and stage of cancer and treatment guidelines. However, many patients...
Treatment recommendations for cancer patients are carried out according to clinical assessment, type and stage of cancer and treatment guidelines. However, many patients do not accept the recommendations. This raises obstacles in managing of cancers, which not only affects the patients, but also the family and people around the patients. This problem could increase morbidity, mortality and recurrence rate, which might result in lower quality of life. Since this condition is a complex problem, there is necessity to explore and determine various determinants from different levels. The aim of this systematic review was to explore the acceptances of cancer treatments among cancer patients and its associated determinants. Articles published from 2010 to 2023 were searched in four databases: ScienceDirect, Medline, Google Scholar and PubMed. Articles written in English and focussing on three main cancer treatments (surgery, chemotherapy and radiotherapy) were eligible. A narrative approach was used and the data were analysed into selected themes. Data suggest that several factors influence patient acceptance for cancer therapy including sociodemographic, economic and spiritual cultural backgrounds; patient knowledge and perceptions; community support, as well as policy and availability of health facilities. The determinants consist of individual, interpersonal, institutional, community and public policy level and interaction between levels are contributing to cancer treatment acceptance. In conclusion, cancer treatment acceptance remains a problem in particular in low middle income countries. In addition, the data on radiotherapy referral acceptance were limited and needed further study.
PubMed: 38450342
DOI: 10.52225/narra.v3i3.197 -
International Journal of Prisoner Health Jul 2020This paper aims to determine whether criminal justice (CJ) stigma affects health outcomes and health care utilization. (Review)
Review
PURPOSE
This paper aims to determine whether criminal justice (CJ) stigma affects health outcomes and health care utilization.
DESIGN/METHODOLOGY/APPROACH
The authors reviewed medical and public health literature through May 2020. Structured terms were used to search four databases identifying articles that related to CJ stigma. Included articles were in English, examined CJ stigma and had people with CJ involvement as subjects. The studies without health outcomes were excluded. Quantitative and qualitative studies were reviewed and assessed for bias. Results were synthesized into a systematic review.
FINDINGS
The search yielded 25 studies relating to CJ stigma and health. Three stigma domains were described in the literature: perceived or enacted, internalized and anticipated stigma. Tenuous evidence linked CJ stigma to health directly (psychological symptoms) and indirectly (social isolation, health care utilization, high-risk behaviors and housing or employment). Multiple stigmatized identities may interact to affect health and health care utilization.
RESEARCH LIMITATIONS/IMPLICATIONS
Few studies examined CJ stigma and health. Articles used various measures of CJ stigma, but psychometric properties for instruments were not presented. Prospective studies with standard validated measures are needed.
PRACTICAL IMPLICATIONS
Understanding whether and how CJ stigma affects health and health care utilization will be critical for developing health-promoting interventions for people with CJ involvement. Practical interventions could target stigma-related psychological distress or reduce health care providers' stigmatizing behaviors.
ORIGINALITY/VALUE
This was the first systematic review of CJ stigma and health. By providing a summary of the current evidence and identifying consistent findings and gaps in the literature, this review provides direction for future research and highlights implications for policy and practice.
Topics: Criminal Law; Humans; Patient Acceptance of Health Care; Prospective Studies; Public Health; Social Stigma
PubMed: 33634660
DOI: 10.1108/IJPH-01-2020-0005 -
International Journal of Environmental... Jul 2021Public health challenges such as physical inactivity are multiplex and cannot be effectively addressed by single organizations or sectors. For this reason, public health... (Review)
Review
Public health challenges such as physical inactivity are multiplex and cannot be effectively addressed by single organizations or sectors. For this reason, public health policies have to involve various sectors and foster partnerships among organizations. Social network analysis (SNA) provides a methodological toolkit that enables the investigation of relationships between organizations to reveal information about the structure and cooperation within networks. This systematic review provides an overview of studies utilizing SNA to analyze the structure of networks that promote physical activity, including the structural set-up, types, and conditions of cooperation, the existence or absence of key actors, the characteristics of organizations working together, and potential barriers limiting collaboration. In total, eight eligible studies were identified. To evaluate the quality of these studies, a quality assessment tool for SNA was created. Relevant aspects from each study were systematically outlined using a data extraction template developed for network studies. The studies reported low to moderate density scores with many ties not being realized. Organizations tend to work side by side than as real partners, whereas organizations of the same type are more strongly connected. Most of the studies identified governmental health organizations as key players in their networks. Network maturity influences network outcomes. Shared goals and geographic proximity are potential facilitators for network development. For future research, more sophisticated methods and longitudinal studies are required to describe how networks, with the aim of promoting physical activity, develop and change to identify predicting factors for an effective network structure.
Topics: Exercise; Health Promotion; Humans; Organizations; Public Health; Public Policy
PubMed: 34299760
DOI: 10.3390/ijerph18147306 -
Journal of Alzheimer's Disease Reports Oct 2020Cognitive aging is a dynamic process in late life with significant heterogeneity across individuals. (Review)
Review
BACKGROUND
Cognitive aging is a dynamic process in late life with significant heterogeneity across individuals.
OBJECTIVE
To review the evidence for latent classes of cognitive trajectories and to identify the associated predictors and outcomes.
METHODS
A systematic search was performed in MEDLINE and EMBASE for articles that identified two or more cognitive trajectories in adults. The study was conducted following the PRISMA statement.
RESULTS
Thirty-seven studies were included, ranging from 219 to 9,704 participants, with a mean age of 60 to 93.4 years. Most studies ( = 30) identified distinct cognitive trajectories using latent class growth analysis. The trajectory profile commonly consisted of three to four classes with progressively decreasing baseline and increasing rate of decline-a 'stable-high' class characterized as maintenance of cognitive function at high level, a 'minor-decline' class or 'stable-medium' class that declines gradually over time, and a 'rapid-decline' class with the steepest downward slope. Generally, membership of better classes was predicted by younger age, being female, more years of education, better health, healthier lifestyle, higher social engagement and lack of genetic risk variants. Some factors (e.g., education) were found to be associated with cognitive function over time only within individual classes.
CONCLUSION
Cognitive aging in late life is a dynamic process with significant inter-individual variability. However, it remains unclear whether similar patterns of cognitive aging are observed across all cognitive domains. Further research into unique factors which promote the maintenance of high-cognitive function is needed to help inform public policy.
PubMed: 33283167
DOI: 10.3233/ADR-200232 -
JMIR Rehabilitation and Assistive... Nov 2023Assistive technology (AT) refers to assistive products (AP) and associated systems and services that are relevant for function, independence, well-being, and quality of... (Review)
Review
BACKGROUND
Assistive technology (AT) refers to assistive products (AP) and associated systems and services that are relevant for function, independence, well-being, and quality of life for individuals with disabilities. There is a high unmet need for AT for persons with disabilities and this is worse for persons with cognitive and mental or psychosocial disabilities (PDs). Further, information and knowledge on AT for PDs is limited.
OBJECTIVE
The aim of this review was to explore the pattern of AT use among persons with PDs and its associated socioeconomic and health benefits.
METHODS
The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), and we conducted systematic searches in the 4 databases: PubMed, Embase.com, APA PsycInfo (Ebsco), and Web of Science (Core Collection) with the following index terms: "Assistive Technology," "Self-Help Devices," "Quality of Life," "Activities of Daily Living," "Mental Disorders." We included only AT individuals with PDs can independently use without reliance on a provider. Identified papers were exported to EndNote (Clarivate) and we undertook a narrative synthesis of the included studies.
RESULTS
In total, 5 studies were included in the review which reported use of different AT for schizophrenia, bipolar disorder, depression and anxiety disorders. The APs described in the included studies are Palm tungsten T3 handheld computer, MOBUS, personal digital assistant, automated pill cap, weighted chain blankets, and smartphone function. All the AT products identified in the studies were found to be easily usable by individuals with PDs. The APs reported in the included studies have broad impact and influence on social function, productivity, and treatment or management. The studies were heterogeneous and were all conducted in high-income countries.
CONCLUSIONS
Our study contributes to and strengthens existing evidence on the relevance of AT for PDs and its potential to support socioeconomic participation and health. Although AT has the potential to improve function and participation for individuals with PDs; this review highlights that research on the subject is limited. Further research and health policy changes are needed to improve research and AT service provision for individuals with PDs especially in low-income settings.
TRIAL REGISTRATION
PROSPERO CRD42022343735; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343735.
PubMed: 37966875
DOI: 10.2196/49750