Background: Due to inconsistencies in current drug policies and regulatory frameworks, there is a lack of knowledge regarding the adverse event profile of psilocybin mushrooms in Brazil. Our study investigated whether these fungi have potential for abuse and pose a risk to public health. Methods: We conducted a retrospective cross-sectional study following the STROBE Initiative guidelines, using data from the Sistema de Agravos de Notificacao (SINAN) to obtain a representative sample of adverse events reported between 2007 and 2022. Participants were divided into three groups: drug abuse, psilocybin mushrooms, and unknown mushrooms. The clinical outcomes evaluated were non-hospitalization, hospitalization, and death. To analyze associations between categorical variables, we applied the Chi-square test. Results: During the study period, 112,451 individuals sought medical attention due to adverse events associated with drug abuse. Men (n = 79.514; 70.7%), whites (n = 37.565; 33.4%), and the 26-35 age group (n = 29.163; 25.9%) were the most well-represented (p < 0.001). Alcohol (n = 71.824; 49.2%) (p < 0.001) was the primary toxic agent. Hospitalization and mortality rates in the drug abuse group were 19.5% (n = 21,923) and 1.8% (n = 2035), respectively. Psilocybin mushroom group included 13 adverse events, which represents 0.02% of all hospitalizations (n = 6; 46.2%). Unknown mushroom group accounted for 51 adverse events, comprising 0.04% of hospitalizations (n = 12; 23.5%). There were no fatalities in either the psilocybin or unknown mushroom groups. Most hospitalizations involved alcohol (45.0%) and deaths represented mainly by cocaine (33.3%). Conclusion: While our findings suggest that psilocybin mushrooms present a low-risk profile of adverse events, underreporting is a possibility. Given the increasing public interest in psilocybin mushrooms, this study underscores the importance of evidence-based regulatory discussions to prevent arbitrary arrests and ensure safe access to psilocybin for both clinical and ceremonial purposes.
{"title":"Psilocybin mushrooms and public health in Brazil: a low-risk adverse event profile calls for evidence-based regulatory discussions","authors":"Marcel Nogueira, Solimary Garcia-Hernandez, Gleicy Sotero Roberto, Leonardo Marques Zanella","doi":"10.1101/2024.07.11.24310147","DOIUrl":"https://doi.org/10.1101/2024.07.11.24310147","url":null,"abstract":"Background: Due to inconsistencies in current drug policies and regulatory frameworks, there is a lack of knowledge regarding the adverse event profile of psilocybin mushrooms in Brazil. Our study investigated whether these fungi have potential for abuse and pose a risk to public health. Methods: We conducted a retrospective cross-sectional study following the STROBE Initiative guidelines, using data from the Sistema de Agravos de Notificacao (SINAN) to obtain a representative sample of adverse events reported between 2007 and 2022. Participants were divided into three groups: drug abuse, psilocybin mushrooms, and unknown mushrooms. The clinical outcomes evaluated were non-hospitalization, hospitalization, and death. To analyze associations between categorical variables, we applied the Chi-square test. Results: During the study period, 112,451 individuals sought medical attention due to adverse events associated with drug abuse. Men (n = 79.514; 70.7%), whites (n = 37.565; 33.4%), and the 26-35 age group (n = 29.163; 25.9%) were the most well-represented (p < 0.001). Alcohol (n = 71.824; 49.2%) (p < 0.001) was the primary toxic agent. Hospitalization and mortality rates in the drug abuse group were 19.5% (n = 21,923) and 1.8% (n = 2035), respectively. Psilocybin mushroom group included 13 adverse events, which represents 0.02% of all hospitalizations (n = 6; 46.2%). Unknown mushroom group accounted for 51 adverse events, comprising 0.04% of hospitalizations (n = 12; 23.5%). There were no fatalities in either the psilocybin or unknown mushroom groups. Most hospitalizations involved alcohol (45.0%) and deaths represented mainly by cocaine (33.3%). Conclusion: While our findings suggest that psilocybin mushrooms present a low-risk profile of adverse events, underreporting is a possibility. Given the increasing public interest in psilocybin mushrooms, this study underscores the importance of evidence-based regulatory discussions to prevent arbitrary arrests and ensure safe access to psilocybin for both clinical and ceremonial purposes.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141613575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1101/2024.07.12.24309602
Alaa T Youssef, David Fronk, John Nicholas Grimes, Lina Cheuy, David B. Larson
Background: The majority of AI/M-enabled software as a medical device (SaMD) has been cleared through the FDA 510(k) pathway, but with limited transparency on algorithm development details. Because algorithm quality depends on the quality of the training data and algorithmic input, this study aimed to assess the availability of algorithm development details in the 510(k) summaries of AI/ML-enabled SaMD. Then, clinical and/or technical equivalence between predicate generations was assessed by mapping the predicate lineages of all cleared computer-assisted detection (CAD) devices, to ensure equivalence in diagnostic function. Methods: The FDA public database was searched for CAD devices cleared through the 510(k) pathway. Details on algorithmic input, including annotation instructions and definition of ground truth, were extracted from summary statements, product webpages, and relevant publications. These findings were cross-referenced with the American College of Radiology, Data Science Institute AI Central database. Predicate lineages were also manually mapped through product numbers included within the 510(k) summaries. Results: In total, 98 CAD devices had been cleared at the time of this study, with the majority being computer-assisted triage (CADt) devices (67/98). Notably, none of the cleared CAD devices provided image annotation instructions in their summaries, and only one provided access to its training data. Similarly, more than half of the devices did not disclose how the ground truth was defined. Only 13 CAD devices were reported in peer-reviewed publications, and only two were evaluated in prospective studies. Significant deviations in clinical function were seen between cleared devices and their claimed predicate. Conclusion: The lack of imaging annotation instructions and signicant mismatches in clinical function between predicate generations raise concerns about whether substantial equivalence in the 510(k) pathway truly equates to equivalent diagnostic function. Avenues for greater transparency are needed to enable independent evaluations of safety and performance and promote trust in AI/ML-enabled devices.
{"title":"Beyond the Black Box: Avenues to Transparency in Regulating Radiological AI/ML-enabled SaMD via the FDA 510(k) Pathway","authors":"Alaa T Youssef, David Fronk, John Nicholas Grimes, Lina Cheuy, David B. Larson","doi":"10.1101/2024.07.12.24309602","DOIUrl":"https://doi.org/10.1101/2024.07.12.24309602","url":null,"abstract":"Background: The majority of AI/M-enabled software as a medical device (SaMD) has been cleared through the FDA 510(k) pathway, but with limited transparency on algorithm development details. Because algorithm quality depends on the quality of the training data and algorithmic input, this study aimed to assess the availability of algorithm development details in the 510(k) summaries of AI/ML-enabled SaMD. Then, clinical and/or technical equivalence between predicate generations was assessed by mapping the predicate lineages of all cleared computer-assisted detection (CAD) devices, to ensure equivalence in diagnostic function. Methods: The FDA public database was searched for CAD devices cleared through the 510(k) pathway. Details on algorithmic input, including annotation instructions and definition of ground truth, were extracted from summary statements, product webpages, and relevant publications. These findings were cross-referenced with the American College of Radiology, Data Science Institute AI Central database. Predicate lineages were also manually mapped through product numbers included within the 510(k) summaries.\u0000Results: In total, 98 CAD devices had been cleared at the time of this study, with the majority being computer-assisted triage (CADt) devices (67/98). Notably, none of the cleared CAD devices provided image annotation instructions in their summaries, and only one provided access to its training data. Similarly, more than half of the devices did not disclose how the ground truth was defined. Only 13 CAD devices were reported in peer-reviewed publications, and only two were evaluated in prospective studies. Significant deviations in clinical function were seen between cleared devices and their claimed predicate. Conclusion: The lack of imaging annotation instructions and signicant mismatches in clinical function between predicate generations raise concerns about whether substantial equivalence in the 510(k) pathway truly equates to equivalent diagnostic function. Avenues for greater transparency are needed to enable independent evaluations of safety and performance and promote trust in AI/ML-enabled devices.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141613654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-11DOI: 10.1101/2024.07.11.24310220
James Larkin, Ciaran Prendergast, Logan T. Murry, Michelle Flood, Barbara Clyne, Sara Burke, Conor Keegan, Fiona Boland, Tom Fahey, Nav Persaud, Rose Anne Kenny, Frank Moriarty
Background The number of prescription medicines prescribed to older adults is increasing in Ireland and other countries. This is leading to higher out-of-pocket prescription medicine expenditure for older adults, which has several negative consequences including cost-related non-adherence. This study aimed to characterise out-of-pocket prescription medicine payments, and examine their relationship with entitlements, multimorbidity and adherence. Methods This cross-sectional study used 2016 data from a nationally-representative sample of adults in Ireland aged 50 years or less. Descriptive statistics and regression models were used to describe out-of-pocket prescription medicine payments and assess the association between out-of-pocket prescription medicine payments and the following variables: healthcare entitlements, multimorbidity, and cost-related non-adherence. Results There were 5,668 eligible participants. Median annual out-of-pocket prescription medicine expenditure was 144 euro (IQR: 0-312 euro). A generalised linear model showed that, amongst those with out-of-pocket prescription medicine expenditure, having fewer healthcare entitlements was associated with 4.74 (95% CI: 4.37-5.15) times higher out-of-pocket prescription medicine expenditure. Overall, 1.7% (n=89) of participants reported cost-related non-adherence in the previous year. A multivariable model found no significant associations between any variables and cost-related non-adherence. Conclusions Those with entitlements to subsidised prescription medicines had much lower out-of-pocket prescription medicine expenditure. This highlights the benefits of expanding healthcare entitlements and ensuring uptake of entitlements by those with eligibility.
{"title":"Out-of-pocket prescription medicine expenditure amongst community-dwelling adults: findings from The Irish Longitudinal Study on Ageing (TILDA) in 2016","authors":"James Larkin, Ciaran Prendergast, Logan T. Murry, Michelle Flood, Barbara Clyne, Sara Burke, Conor Keegan, Fiona Boland, Tom Fahey, Nav Persaud, Rose Anne Kenny, Frank Moriarty","doi":"10.1101/2024.07.11.24310220","DOIUrl":"https://doi.org/10.1101/2024.07.11.24310220","url":null,"abstract":"Background\u0000The number of prescription medicines prescribed to older adults is increasing in Ireland and other countries. This is leading to higher out-of-pocket prescription medicine expenditure for older adults, which has several negative consequences including cost-related non-adherence. This study aimed to characterise out-of-pocket prescription medicine payments, and examine their relationship with entitlements, multimorbidity and adherence.\u0000Methods\u0000This cross-sectional study used 2016 data from a nationally-representative sample of adults in Ireland aged 50 years or less. Descriptive statistics and regression models were used to describe out-of-pocket prescription medicine payments and assess the association between out-of-pocket prescription medicine payments and the following variables: healthcare entitlements, multimorbidity, and cost-related non-adherence.\u0000Results\u0000There were 5,668 eligible participants. Median annual out-of-pocket prescription medicine expenditure was 144 euro (IQR: 0-312 euro). A generalised linear model showed that, amongst those with out-of-pocket prescription medicine expenditure, having fewer healthcare entitlements was associated with 4.74 (95% CI: 4.37-5.15) times higher out-of-pocket prescription medicine expenditure. Overall, 1.7% (n=89) of participants reported cost-related non-adherence in the previous year. A multivariable model found no significant associations between any variables and cost-related non-adherence. Conclusions\u0000Those with entitlements to subsidised prescription medicines had much lower out-of-pocket prescription medicine expenditure. This highlights the benefits of expanding healthcare entitlements and ensuring uptake of entitlements by those with eligibility.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141613576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-11DOI: 10.1101/2024.07.10.24310248
Erica N. Rosser, Sabra Klein, Richard Eric Rothman, Andrew Pekosz, Rosemary Morgan
Introduction Although they face higher occupational risk of contracting viral respiratory infections, hospital healthcare worker vaccine hesitancy persists. While most studies have used survey methods to quantify the prevalence of and reasons for healthcare worker vaccine hesitancy, this study employs a qualitative approach to understand their attitudes and beliefs associated with influenza and COVID-19 vaccination. Methods To understand frontline healthcare worker experiences and perspectives on influenza and COVID-19 vaccination, 30 semi-structured interviews were conducted in summer/fall 2022 with staff recruited from two Johns Hopkins hospitals in Maryland. An in-depth, key informant interview was conducted with an expert in public health audience engagement. Interviews were audio recorded and transcribed for thematic and Framework analysis using NVivo software (QSR International, Melbourne, Australia). Results Healthcare workers engaged in little influenza vaccine information seeking due to their familiarity with the disease and low perceived disease severity. Approximately half (n=16) of healthcare workers reported no vaccine hesitancy towards influenza or COVID-19 vaccines. No physicians or physician assistants expressed any vaccine hesitancy, while most nurses expressed some (n=10). More than half of the women (n=14) expressed COVID-19 vaccine hesitancy compared to none of the men. Structural factors including hospital tier, unit assignment, and professional role influenced perceived risk of disease exposure and subsequent healthcare worker vaccination decisions. Institutional policies, including mandates and a pro-vaccine environment encouraged vaccination uptake. Healthcare workers reported being more receptive to vaccine messaging that focused on protection from disease, scientific and public health data and their heightened occupational exposure to pathogens. Conclusions Despite their medical knowledge, healthcare workers are susceptible to vaccine hesitancy. Strategies to address specific concerns are needed and can be informed by our findings. A flexible and multi-pronged approach that considers individual anxieties, workplace structures, and the need for open communication with tailored messaging is necessary to promote vaccine acceptance in healthcare settings.
{"title":"Vaccinating the Frontlines: A Qualitative Exploration of Hospital Healthcare Worker Perspectives on Influenza and COVID-19 Immunization","authors":"Erica N. Rosser, Sabra Klein, Richard Eric Rothman, Andrew Pekosz, Rosemary Morgan","doi":"10.1101/2024.07.10.24310248","DOIUrl":"https://doi.org/10.1101/2024.07.10.24310248","url":null,"abstract":"Introduction\u0000Although they face higher occupational risk of contracting viral respiratory infections, hospital healthcare worker vaccine hesitancy persists. While most studies have used survey methods to quantify the prevalence of and reasons for healthcare worker vaccine hesitancy, this study employs a qualitative approach to understand their attitudes and beliefs associated with influenza and COVID-19 vaccination. Methods\u0000To understand frontline healthcare worker experiences and perspectives on influenza and COVID-19 vaccination, 30 semi-structured interviews were conducted in summer/fall 2022 with staff recruited from two Johns Hopkins hospitals in Maryland. An in-depth, key informant interview was conducted with an expert in public health audience engagement. Interviews were audio recorded and transcribed for thematic and Framework analysis using NVivo software (QSR International, Melbourne, Australia). Results Healthcare workers engaged in little influenza vaccine information seeking due to their familiarity with the disease and low perceived disease severity. Approximately half (n=16) of healthcare workers reported no vaccine hesitancy towards influenza or COVID-19 vaccines. No physicians or physician assistants expressed any vaccine hesitancy, while most nurses expressed some (n=10). More than half of the women (n=14) expressed COVID-19 vaccine hesitancy compared to none of the men. Structural factors including hospital tier, unit assignment, and professional role influenced perceived risk of disease exposure and subsequent healthcare worker vaccination decisions. Institutional policies, including mandates and a pro-vaccine environment encouraged vaccination uptake. Healthcare workers reported being more receptive to vaccine messaging that focused on protection from disease, scientific and public health data and their heightened occupational exposure to pathogens. Conclusions\u0000Despite their medical knowledge, healthcare workers are susceptible to vaccine hesitancy. Strategies to address specific concerns are needed and can be informed by our findings. A flexible and multi-pronged approach that considers individual anxieties, workplace structures, and the need for open communication with tailored messaging is necessary to promote vaccine acceptance in healthcare settings.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141613577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1101/2024.07.04.24309973
Michael J Lydeamore, David Wu, Tjibbe Donker, Claire L Gorrie, Charlie Kirk Higgs, Marion Easton, Daneeta Hennessy, Nic Geard, Benjamin P Howden, Ben S Cooper, Andrew Wilson, Anton Y Peleg, Andrew J Stewardson
Carbapenemase-producing Enterobacterales (CPE) are an emerging public health concern globally as they are resistant to a broad spectrum of antibiotics. Colonisation with CPE typically requires patients to be managed under 'contact precautions', which creates additional physical bed demands in healthcare facilities. This study examined the potential impact of revised isolation guidelines introduced in late 2023 in Victoria, Australia, that relaxed the requirement for indefinite isolation of CPE-colonised patients in contact precautions, based on admission of CPE-diagnosed cases prior to the guideline change. Our analysis showed that while the changes result in modest savings in the need for dedicated isolation rooms, they could reduce the duration of time individual patients spend in isolation by up to three weeks. However, ongoing investments to expand isolation capacity would still be required to accommodate the rising incidence of CPE.
{"title":"Changes in isolation guidelines for CPE patients results in only a mild reduction in required hospital beds","authors":"Michael J Lydeamore, David Wu, Tjibbe Donker, Claire L Gorrie, Charlie Kirk Higgs, Marion Easton, Daneeta Hennessy, Nic Geard, Benjamin P Howden, Ben S Cooper, Andrew Wilson, Anton Y Peleg, Andrew J Stewardson","doi":"10.1101/2024.07.04.24309973","DOIUrl":"https://doi.org/10.1101/2024.07.04.24309973","url":null,"abstract":"Carbapenemase-producing Enterobacterales (CPE) are an emerging public health concern globally as they are resistant to a broad spectrum of antibiotics. Colonisation with CPE typically requires patients to be managed under 'contact precautions', which creates additional physical bed demands in healthcare facilities. This study examined the potential impact of revised isolation guidelines introduced in late 2023 in Victoria, Australia, that relaxed the requirement for indefinite isolation of CPE-colonised patients in contact precautions, based on admission of CPE-diagnosed cases prior to the guideline change. Our analysis showed that while the changes result in modest savings in the need for dedicated isolation rooms, they could reduce the duration of time individual patients spend in isolation by up to three weeks. However, ongoing investments to expand isolation capacity would still be required to accommodate the rising incidence of CPE.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141569544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1101/2024.07.04.24309947
Mohua Chakraborty Choudhury, Jerry Philip George, Prashanth N Srinivas
Rare diseases aren't rare collectively, affecting around 300 million people globally and 96 million in India. In low- and middle-income countries like India, policies addressing these diseases have only recently been enacted. In 2021, India launched its first functional rare disease policy. This study comprehensively maps all stakeholders in the rare disease ecosystem in India to understand their power positions, influence, and needs, thereby enabling better implementation strategies for the rare disease policy. We conducted in-depth interviews with various stakeholders to understand their perspectives and supplemented the study with media analysis to reach those who did not respond to interview invitations. Our findings suggest a lack of awareness and knowledge about rare diseases among healthcare professionals who do not specialize in RDs. Encouraging and formalizing the involvement of rare disease patient organizations in policy-making is crucial due to their high knowledge, interest, and constructive critical capabilities despite their low power. Another important stakeholder group, local companies, can drive innovation and make treatments accessible for rare diseases but have much lower power than multinational companies, potentially leading to policies that do not favor local needs.
{"title":"Indian Rare Disease Stakeholder Mapping","authors":"Mohua Chakraborty Choudhury, Jerry Philip George, Prashanth N Srinivas","doi":"10.1101/2024.07.04.24309947","DOIUrl":"https://doi.org/10.1101/2024.07.04.24309947","url":null,"abstract":"Rare diseases aren't rare collectively, affecting around 300 million people globally and 96 million in India. In low- and middle-income countries like India, policies addressing these diseases have only recently been enacted. In 2021, India launched its first functional rare disease policy. This study comprehensively maps all stakeholders in the rare disease ecosystem in India to understand their power positions, influence, and needs, thereby enabling better implementation strategies for the rare disease policy. We conducted in-depth interviews with various stakeholders to understand their perspectives and supplemented the study with media analysis to reach those who did not respond to interview invitations. Our findings suggest a lack of awareness and knowledge about rare diseases among healthcare professionals who do not specialize in RDs. Encouraging and formalizing the involvement of rare disease patient organizations in policy-making is crucial due to their high knowledge, interest, and constructive critical capabilities despite their low power. Another important stakeholder group, local companies, can drive innovation and make treatments accessible for rare diseases but have much lower power than multinational companies, potentially leading to policies that do not favor local needs.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141577982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1101/2024.07.02.24309845
Ann-Beth Moller, Joanne Welsh, Max Petzold, Amani Siyam
A well-performing and competent health workforce (HWF) is at the core of health systems yet many countries are facing a human resources for health (HRH) crisis. A prerequisite for achieving universal health coverage, including fulfilling the Sustainable Development Goals related to women and newborns, is an adequate supply of health workers able to provide quality of care at all levels of the health system. Thus, we evaluated how HRH policies and strategies influenced trends of maternal and newborn workforce densities and assessed the association between HWF densities, service coverage and health outcomes in Benin, Malawi, Tanzania and Uganda. We applied the READ framework (Ready your materials; Extract data; Analyse data and Distil findings) for our HRH policy and strategy document analysis and conducted a comparative analysis including three HWF densities (medical doctors, nursing and midwifery personnel) two health services, and five health outcome variables. Twenty HRH policies and strategies were included in the analysis published from 2010 to 2021. The scope of the HRH policies and strategies were described in four dimensions; availability, accessibility, acceptability and quality. We found that all policies and strategies addressed aspects related to availability and accessibility as well as the need for HRH quality improvements whereas acceptability was poorly represented. The comparative analysis revealed that service coverage and health outcomes appear to be insensitive to the fluctuations in HWF densities and related HRH policies as very little or no reduction was seen in outcomes from 2010 to 2020. There is a need to tackle the availability, accessibility, acceptability and quality of the HWF. Evidence needs to be translated into policy and practice otherwise the HWF in these countries will continue to struggle, affecting progress and realizing womens’ and newborn’s human rights to health.
{"title":"Human resources for health, service coverage and maternal and perinatal outcomes in Benin, Malawi, Tanzania and Uganda","authors":"Ann-Beth Moller, Joanne Welsh, Max Petzold, Amani Siyam","doi":"10.1101/2024.07.02.24309845","DOIUrl":"https://doi.org/10.1101/2024.07.02.24309845","url":null,"abstract":"A well-performing and competent health workforce (HWF) is at the core of health systems yet many countries are facing a human resources for health (HRH) crisis. A prerequisite for achieving universal health coverage, including fulfilling the Sustainable Development Goals related to women and newborns, is an adequate supply of health workers able to provide quality of care at all levels of the health system. Thus, we evaluated how HRH policies and strategies influenced trends of maternal and newborn workforce densities and assessed the association between HWF densities, service coverage and health outcomes in Benin, Malawi, Tanzania and Uganda. We applied the READ framework (Ready your materials; Extract data; Analyse data and Distil findings) for our HRH policy and strategy document analysis and conducted a comparative analysis including three HWF densities (medical doctors, nursing and midwifery personnel) two health services, and five health outcome variables. Twenty HRH policies and strategies were included in the analysis published from 2010 to 2021. The scope of the HRH policies and strategies were described in four dimensions; availability, accessibility, acceptability and quality. We found that all policies and strategies addressed aspects related to availability and accessibility as well as the need for HRH quality improvements whereas acceptability was poorly represented. The comparative analysis revealed that service coverage and health outcomes appear to be insensitive to the fluctuations in HWF densities and related HRH policies as very little or no reduction was seen in outcomes from 2010 to 2020. There is a need to tackle the availability, accessibility, acceptability and quality of the HWF. Evidence needs to be translated into policy and practice otherwise the HWF in these countries will continue to struggle, affecting progress and realizing womens’ and newborn’s human rights to health.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141577512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1101/2024.07.02.24309837
Caroline Cerilli, Varshini Varadaraj, Jennifer Choi, Fiona Sweeney, Franz Castro, Scott Landes, Bonnielin K. Swenor
National surveys are important for understanding the disparities that disabled people experience across social determinants of health; however, limited research has examined the methods used to include disabled people in these surveys. This study reviewed nationally representative surveys administered by the Centers for Disease Control and Prevention (CDC) and the U.S. Census Bureau that collected data in the past five years and sampled adults ≥18 years. Data from both publicly available online survey documents and a questionnaire emailed to survey administrators were used to determine whether surveys: 1) oversampled disabled people; 2) had a data accessibility protocol to support data collection; and 3) provided multiple data collection modalities (e.g., phone, paper). Of the 201 surveys identified, 30 met the inclusion criteria for the study. Of these 30 surveys, one oversampled disabled people, none had a data collection accessibility protocol, and 21 provided multiple data collection modalities. This study highlights barriers and opportunities to including disabled people in national surveys, which is essential for ensuring survey data are generalizable to the U.S. population.
{"title":"Disability Inclusion in Federally Funded National Surveys","authors":"Caroline Cerilli, Varshini Varadaraj, Jennifer Choi, Fiona Sweeney, Franz Castro, Scott Landes, Bonnielin K. Swenor","doi":"10.1101/2024.07.02.24309837","DOIUrl":"https://doi.org/10.1101/2024.07.02.24309837","url":null,"abstract":"National surveys are important for understanding the disparities that disabled people experience across social determinants of health; however, limited research has examined the methods used to include disabled people in these surveys. This study reviewed nationally representative surveys administered by the Centers for Disease Control and Prevention (CDC) and the U.S. Census Bureau that collected data in the past five years and sampled adults ≥18 years. Data from both publicly available online survey documents and a questionnaire emailed to survey administrators were used to determine whether surveys: 1) oversampled disabled people; 2) had a data accessibility protocol to support data collection; and 3) provided multiple data collection modalities (e.g., phone, paper). Of the 201 surveys identified, 30 met the inclusion criteria for the study. Of these 30 surveys, one oversampled disabled people, none had a data collection accessibility protocol, and 21 provided multiple data collection modalities. This study highlights barriers and opportunities to including disabled people in national surveys, which is essential for ensuring survey data are generalizable to the U.S. population.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141550839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.1101/2024.06.26.24309517
Philip Clarke, Charles Rahal, Josh Knight, Veline L' Esperance, Melinda C Mills
Objectives: To replicate an analysis conducted just prior to the 1997 UK General Election on the relationship between voting patterns at the constituency level, correlations between voting patterns, measured inequality, and premature mortality. Design: Observational study using data from the Office of National Statistics. Setting: England, UK. Participants: The health and mortality co-variates come from the English population across multiple publicly available datasets from the Office of National Statistics and are cross-tabulated against members of the public who voted in the 2019 UK General Election in constituencies in England. Main Outcome Measures: Age-standardised mortality rate (ASMR) for premature deaths for 2021, Health Deprivation and Disability (HDD) and Index of Multiple Deprivation (IMD) for 2019, Slope Indices of Inequality (2001-20), Healthy Life Expectancy (2011-20). Results: When observing the proportion of the eligible vote for Labour at the constituency level, there was a strong correlation with higher ASMR in both males (r=0.707, p<0.0001) and females (r=0.6505, p<0.0001). There is a strong correlation between Labour vote share ranks and deprivation, with Spearman's rank correlation coefficients of 𝜌=-0.687 (p<0.0001) for deprivation as measured by the HDD and 𝜌=-0.695 (p<0.0001) for the IMD ranks. Slope indices of inequality (SII) remain high for males and are increasing for females. Healthy life expectancies remain stratified, and differentials across deprivation remain wide and unchanged. Conclusions: Health inequalities across constituencies and socio-economic indicators such as IMD remain high. New approaches are likely to be required to reduce inequalities in the UK. Trial Registration: N/A.
{"title":"Voting Patterns, Mortality, and Health Inequalities in England","authors":"Philip Clarke, Charles Rahal, Josh Knight, Veline L' Esperance, Melinda C Mills","doi":"10.1101/2024.06.26.24309517","DOIUrl":"https://doi.org/10.1101/2024.06.26.24309517","url":null,"abstract":"Objectives: To replicate an analysis conducted just prior to the 1997 UK General Election on the relationship between voting patterns at the constituency level, correlations between voting patterns, measured inequality, and premature mortality. Design: Observational study using data from the Office of National Statistics. Setting: England, UK. Participants: The health and mortality co-variates come from the English population across multiple publicly available datasets from the Office of National Statistics and are cross-tabulated against members of the public who voted in the 2019 UK General Election in constituencies in England.\u0000Main Outcome Measures: Age-standardised mortality rate (ASMR) for premature deaths for 2021, Health Deprivation and Disability (HDD) and Index of Multiple Deprivation (IMD) for 2019, Slope Indices of Inequality (2001-20), Healthy Life Expectancy (2011-20). Results: When observing the proportion of the eligible vote for Labour at the constituency level, there was a strong correlation with higher ASMR in both males (r=0.707, p<0.0001) and females (r=0.6505, p<0.0001). There is a strong correlation between Labour vote share ranks and deprivation, with Spearman's rank correlation coefficients of 𝜌=-0.687 (p<0.0001) for deprivation as measured by the HDD and 𝜌=-0.695 (p<0.0001) for the IMD ranks. Slope indices of inequality (SII) remain high for males and are increasing for females. Healthy life expectancies remain stratified, and differentials across deprivation remain wide and unchanged. Conclusions: Health inequalities across constituencies and socio-economic indicators such as IMD remain high. New approaches are likely to be required to reduce inequalities in the UK. Trial Registration: N/A.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141505946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1101/2024.06.30.24309732
Edward Mullins, Kate Womersely, Fardowsa Abdi, Celestine Donovan-Bradley, Christine Ekechi, Leah Hazard, Jane Hirst, Melanie Nana, Alison Perry, Ana-Catarina Pinho-Gomes, Katherine Ripullone, Stephanie Williams
Background The UK 2024 general election manifestos publicly set out the political parties priorities for the eventuality that they are voted into government. We determined to evaluate whether already agreed, evidenced and promoted issues affecting womens health in the UK had been included in the major parties manifestos. Methods We curated a longlist of priorities and recommendations drawn from major womens health reports, white papers, national inquiries and health strategies published in the UK over the last 10 years which are publicly available and invited our public contributors to suggest additional topics. We selected the shortlist of womens health-related priorities - our top 15 asks - using a Delphi process. We then devised a scoring system whereby manifestos were marked against the 15 priorities with a maximum of 2 points for each priority. We tested inter-rater reliability on the 2019 Manifesto. Results Overall, the limited inclusion of prominent issues for womens health in party manifestos was disappointing across the board. There was little difference between most major parties coverage of womens health in their manifestos. All were limited. Most parties addressed two issues well: childcare and women returning to work after pregnancy; and violence against women and girls and the prosecution of perpetrators. Several other issues, including assurance that all policy is built in consultation with women; decriminalisation and access to abortion; and womens health hubs for reproductive, menopause and lifelong health, were considered by none or only one of the major parties. Discussion Womens health remains a fringe issue in UK politics, despite the efforts of patients, advocates and healthcare professionals to highlight the suffering that many women live with every day, and at particularly vulnerable and high risk periods of their life such as in pregnancy and the postpartum. Our analysis highlights the importance of developing previous efforts in womens health to strengthen existing infrastructure, collaboration and innovation. The next government should build on the work in progress, such as delivering the Womens Health Strategy (2022) rather than starting afresh.
{"title":"Womens Health And Manifestos (WHAM): UK General Election 2024, a rapid voter information study","authors":"Edward Mullins, Kate Womersely, Fardowsa Abdi, Celestine Donovan-Bradley, Christine Ekechi, Leah Hazard, Jane Hirst, Melanie Nana, Alison Perry, Ana-Catarina Pinho-Gomes, Katherine Ripullone, Stephanie Williams","doi":"10.1101/2024.06.30.24309732","DOIUrl":"https://doi.org/10.1101/2024.06.30.24309732","url":null,"abstract":"Background\u0000The UK 2024 general election manifestos publicly set out the political parties priorities for the eventuality that they are voted into government. We determined to evaluate whether already agreed, evidenced and promoted issues affecting womens health in the UK had been included in the major parties manifestos. Methods\u0000We curated a longlist of priorities and recommendations drawn from major womens health reports, white papers, national inquiries and health strategies published in the UK over the last 10 years which are publicly available and invited our public contributors to suggest additional topics. We selected the shortlist of womens health-related priorities - our top 15 asks - using a Delphi process. We then devised a scoring system whereby manifestos were marked against the 15 priorities with a maximum of 2 points for each priority. We tested inter-rater reliability on the 2019 Manifesto.\u0000Results\u0000Overall, the limited inclusion of prominent issues for womens health in party manifestos was disappointing across the board. There was little difference between most major parties coverage of womens health in their manifestos. All were limited. Most parties addressed two issues well: childcare and women returning to work after pregnancy; and violence against women and girls and the prosecution of perpetrators. Several other issues, including assurance that all policy is built in consultation with women; decriminalisation and access to abortion; and womens health hubs for reproductive, menopause and lifelong health, were considered by none or only one of the major parties. Discussion\u0000Womens health remains a fringe issue in UK politics, despite the efforts of patients, advocates and healthcare professionals to highlight the suffering that many women live with every day, and at particularly vulnerable and high risk periods of their life such as in pregnancy and the postpartum. Our analysis highlights the importance of developing previous efforts in womens health to strengthen existing infrastructure, collaboration and innovation. The next government should build on the work in progress, such as delivering the Womens Health Strategy (2022) rather than starting afresh.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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