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Family Practice Dec 2018A good level of health requires the establishment of primary health care. Family physician policy (FPP) is probably one of such initiatives, which enables societies... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A good level of health requires the establishment of primary health care. Family physician policy (FPP) is probably one of such initiatives, which enables societies attaining the universal health coverage.
OBJECTIVE
The present study is the first systematic review and meta-synthesis that seeks to provide a more comprehensive understanding of the challenges for FPP in Iran.
METHOD
Several international scholarly databases (namely, ISI/Web of Sciences, PubMed/MEDLINE via Ovid, Embase, PsycINFO, Scopus and CINAHL via EBSCO), as well as three Iranian databases [MagIran, Irandoc and Scientific Information Database (SID) databases], were mined from January 2006 to December 2017. The Noblit & Hare approach was used to analyse the selected studies.
RESULTS
Based on the study inclusion criteria, seven studies were retained. Initially, 133 codes were identified. In the second step, two of the authors examined the codes and merged themes based on their similarities and shared meaning. New codes were created through discussion. In the next and final step, eight themes emerged, namely, (i) financing; (ii) motivational factors; (iii) education; (iv) referral system; (v) performance evaluation; (vi) problems with health policy; (vii) health information system; and (viii) culture-building for proper policy implementation.
CONCLUSION
Although more than 10 years have passed since the implementation of FPP in Iran, and despite its positive effects on health, there are still challenges in implementing this policy, which makes it difficult to achieve its objectives. Health decision- and policy-makers in Iran should address these challenges and use all available capacities to face them.
Topics: Administrative Personnel; Family Practice; Health Policy; Humans; Iran; Physicians, Family; Qualitative Research
PubMed: 29741692
DOI: 10.1093/fampra/cmy035 -
BMC Public Health Jun 2023From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have...
BACKGROUND
From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country.
METHODS
Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020.
RESULTS
Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home.
CONCLUSIONS
China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.
Topics: Humans; Aged; Public Policy; Aging; Alzheimer Disease; China; Educational Status
PubMed: 37391766
DOI: 10.1186/s12889-023-15583-1 -
Journal of Child Sexual Abuse 2015The media play an important role in practice, policy, and public perception of child sexual abuse, in part by the way in which news stories are framed. Child sexual... (Review)
Review
The media play an important role in practice, policy, and public perception of child sexual abuse, in part by the way in which news stories are framed. Child sexual abuse media coverage over the past 50 years can be divided into five time periods based on the types of stories that garnered news coverage and the ways in which public policy was changed. This systematic literature review of research on child sexual abuse media coverage across disciplines and geographic boundaries examines 16 studies published in the English language from 1995 to 2012. A seminal work is identified, citation network analysis is applied, and a framework model is developed.
Topics: Child; Child Abuse, Sexual; Female; History, 20th Century; History, 21st Century; Humans; Male; Mass Media; Public Policy
PubMed: 25635896
DOI: 10.1080/10538712.2015.976302 -
International Journal of Environmental... Aug 2021People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of... (Review)
Review
People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of coronaviruses either on PWUD, or on services targeted to PWUD. We report the findings of a systematic review of empirical evidence from studies which have examined the impact of coronaviruses (Severe Acute Respiratory Syndrome (SARS-CoV-1) and Middle Eastern Respiratory Syndrome (MERS-CoV) and COVID-19) on PWUD or on service responses to them. Five databases were searched (MEDLINE, PsycINFO, CINAHL, ASSIA and EMBASE) as well as COVID-19 specific databases. Inclusion criteria were studies reporting any impact of SARS, MERS or COVID-19 or any service responses to those, published between January 2000 and October 2020. Weight of Evidence judgements and quality assessment were undertaken. In total, 27 primary studies were included and grouped by seven main themes: treatment/recovery services; emergency medical settings; low-threshold services; prison setting, PWUD/substance use disorder (SUD) diagnosis; people with SUD and HIV; 'Sexual minority' men. Overall, research in the area was scant, and of average/poor quality. More robust research is required to inform on-going and future responses to coronavirus epidemics for PWUD.
Topics: COVID-19; Disease Outbreaks; Humans; Pharmaceutical Preparations; Public Policy; SARS-CoV-2
PubMed: 34444219
DOI: 10.3390/ijerph18168470 -
Gaceta Sanitaria 2018Review the price elasticity of alcoholic beverages to identify the characteristics we should take into account to make a tax policy proposal. (Comparative Study)
Comparative Study Review
OBJECTIVE
Review the price elasticity of alcoholic beverages to identify the characteristics we should take into account to make a tax policy proposal.
METHOD
Systematic review of articles in EBSCOhost that include in their abstract and title the words alcohol and elasticity and alcohol and tax, over the last 20 years in academic journals in English.
RESULTS
We found 11 references. Although price elasticity is quite similar across countries, it is heterogeneous with regard togender, age, consumption level and type of beverage. Ad-hoc policies proved ineffective due to the substitution effect, and regressive in their impact on populations with lower levels of income and consumption.
CONCLUSION
Tax policies should be applied to all alcoholic beverages based on their volume of alcohol and all measures, such as the minimum price per unit, should be complemented with other policies.
Topics: Alcohol Drinking; Alcoholic Beverages; Alcoholism; Australia; Commerce; Europe; Gross Domestic Product; Humans; Public Policy; Spain; Taxes
PubMed: 29317099
DOI: 10.1016/j.gaceta.2017.10.017 -
Public Health Sep 2020The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises...
A systematic review of the factors - barriers and enablers - affecting the implementation of clinical commissioning policy to reduce health inequalities in the National Health Service (NHS), UK.
OBJECTIVE
The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises how these barriers and enablers affect the success of National Health Service (NHS) efforts to reduce health inequalities in the UK.
METHODS
A systematic review was conducted. We searched large biomedical bibliographic databases, namely MEDLINE, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies, conducted in the UK, that assessed the factors - barriers and enablers related to health inequalities, published from 2010 onwards and in English, and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We used Joanna Briggs Institute (JBI) Critical Appraisal and Mixed Methods Appraisal tools to assess the methodological qualities, and synthesised by performing thematic analysis. Two reviewers independently screened the articles and extracted data.
RESULTS
We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: (1) the agenda of health inequalities has not been given priority; (2) there was very little evidence for reducing health inequalities through the clinical commissioning (CC) process; (3) CC was positively associated with the restructuring of NHS; and (4) CC brings better collaboration and engagement, which led to some improvements in health services access, utilisation and delivery at the local level.
CONCLUSION
This study provides useful factors - barriers and enablers - to implement and deliver clinical commissioning policy in improving health and well-being. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities.
Topics: Health Policy; Health Status Disparities; Humans; Randomized Controlled Trials as Topic; State Medicine; United Kingdom
PubMed: 32871449
DOI: 10.1016/j.puhe.2020.07.027 -
Journal of Health Services Research &... Jul 2016To assess what is known about effective patient and public engagement in health service reconfiguration processes and identify implications for further research and... (Review)
Review
OBJECTIVE
To assess what is known about effective patient and public engagement in health service reconfiguration processes and identify implications for further research and health care practice.
METHODS
Rapid systematic review of published and grey literature to identify methods or approaches to engagement in decisions about health service reconfiguration; and to examine how engagement has worked or not worked in specific examples of system change. Following a search for literature published in English from 2000 to March 2014, eight systematic reviews, seven primary studies and 24 case studies (of which 6 were exemplars) were included. We undertook a narrative synthesis to consider five aspects of engagement with health service reconfiguration.
RESULTS
Engagement varied in nature and intensity, and efforts generally involved multiple methods. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful when started early, when led and supported by clinicians, and when it offered opportunities for genuine interaction. The impact of engagement was variably measured and demonstrated, and frequently defined as process measures rather than the outcomes of proposals for service reconfiguration. Little was reported on the potential negative impact of service user engagement.
CONCLUSIONS
Patients and the public can be engaged through various methods. Problems often arise because decision-makers paid insufficient attention to issues considered important by patients and the public. Guidance setting out the stages of reconfiguration and opportunities for service user input could be a helpful practical framework for future engagement activity. Future evaluation and explicit reporting of engagement and impact is needed.
Topics: Health Care Reform; Health Services; Humans; Patient Participation
PubMed: 26689536
DOI: 10.1177/1355819615623305 -
Advances in Nutrition (Bethesda, Md.) Jul 2016Strategic translational research is designed to address research gaps that answer specific guidance questions. It provides translational value with respect to nutrition... (Review)
Review
Strategic translational research is designed to address research gaps that answer specific guidance questions. It provides translational value with respect to nutrition guidance and regulatory and public policy. The relevance and the quality of evidence both matter in translational research. For example, design decisions regarding population, intervention, comparator, and outcome criteria affect whether or not high-quality studies are considered relevant to specific guidance questions and are therefore included as evidence within the context of systematic review frameworks used by authoritative food and health organizations. The process used in systematic reviews, developed by the USDA for its Nutrition Evidence Library, is described. An eating pattern and cardiovascular disease (CVD) evidence review is provided as an example, and factors that differentiated the studies considered relevant and included in that evidence base from those that were excluded are noted. Case studies on ω-3 (n-3) fatty acids (FAs) and industrial trans-FAs illustrate key factors vital to relevance and translational impact, including choice of a relevant population (e.g., healthy, at risk, or diseased subjects; general population or high-performance soldiers); dose and form of the intervention (e.g., food or supplement); use of relevant comparators (e.g., technically feasible and realistic); and measures for both exposure and outcomes (e.g., inflammatory markers or CVD endpoints). Specific recommendations are provided to help increase the impact of nutrition research on future dietary guidance, policy, and regulatory issues, particularly in the area of lipids.
Topics: Cardiovascular Diseases; Diet; Evidence-Based Medicine; Fatty Acids, Omega-3; Feeding Behavior; Humans; Nutritional Sciences; Recommended Dietary Allowances; Research Design; Review Literature as Topic; Trans Fatty Acids; Translational Research, Biomedical; United States; United States Department of Agriculture
PubMed: 27422509
DOI: 10.3945/an.115.010926 -
Global Health Promotion Dec 2020Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global...
Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.
Topics: Adolescent; Africa South of the Sahara; Female; Health Policy; Health Services Accessibility; Humans; Pregnancy; Reproductive Health Services; Vulnerable Populations
PubMed: 32748728
DOI: 10.1177/1757975920941435 -
Public Health Jun 2022Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public... (Review)
Review
OBJECTIVES
Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases.
STUDY DESIGN
This study was a systematic review of the literature.
METHODS
We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect.
RESULTS
Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies.
CONCLUSION
The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.
Topics: Cardiovascular Diseases; Humans; Public Policy; Smoke-Free Policy; Smoking; Sugar-Sweetened Beverages
PubMed: 35567826
DOI: 10.1016/j.puhe.2022.03.021