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Protecting nutrition in a food crisis. 在粮食危机中保护营养。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-01 Epub Date: 2024-10-02 DOI: 10.2471/BLT.24.291393
Anne Marie Thompson Thow

Food insecurity and malnutrition are rising worldwide due to disruptions in food systems related to interconnected health-, climate- and conflict-related crises. Although governments globally are committed to addressing nutritional challenges, policy responses have increasingly focused on food security and, particularly, on food affordability. However, these short-term measures often overlook the necessity of integrating nutritious foods into the food system to ensure improved long-term nutrition. By drawing on the United Nations Committee on World Food Security's Voluntary guidelines on food systems and nutrition, this article outlines opportunities for policy-makers to integrate nutrition into key elements of the crisis response. Key policy areas where nutrition could be further integrated include social protection, agricultural investment, trade policy and urban planning. Strengthening the focus of nutrition in these measures will be essential to establish long-term incentives that support food systems transformation for improved nutrition. Drawing on theories of the policy process, I propose that stronger governance and cross-sectoral dialogue will be critical to achieve sustained nutritional outcomes. Health policy-makers can play a leadership role in supporting cross-sectoral policy change by carefully framing the policy issues, advocating for institutional structures that promote collaboration across sectors to prioritize nutrition, and strengthening the management of conflicts of interest in food system policy-making.

由于相互关联的健康、气候和冲突危机造成粮食系统混乱,全世界粮食不安全和营养不良现象日益严重。尽管全球各国政府都致力于应对营养挑战,但政策应对措施越来越多地侧重于粮食安全,特别是粮食的可负担性。然而,这些短期措施往往忽视了将营养食品纳入粮食系统以确保改善长期营养状况的必要性。本文借鉴联合国世界粮食安全委员会的《粮食系统与营养自愿准则》,概述了政策制定者将营养纳入危机应对措施关键要素的机会。可进一步纳入营养的关键政策领域包括社会保护、农业投资、贸易政策和城市规划。在这些措施中加强对营养问题的关注,对于建立支持粮食系统转型以改善营养状况的长期激励机制至关重要。借鉴政策过程理论,我建议加强治理和跨部门对话对于取得持续的营养成果至关重要。卫生政策制定者可以在支持跨部门政策变革方面发挥领导作用,具体做法是审慎制定政策问题,倡导建立促进跨部门合作的体制结构以优先考虑营养问题,并加强对粮食系统决策中利益冲突的管理。
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引用次数: 0
Corrigendum. 更正。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-01 DOI: 10.2471/BLT.24.101124

[This corrects the article on p. 650 in vol. 102, PMID: 39219771.].

[此处更正了第 102 卷第 650 页的文章,PMID:39219771]。
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引用次数: 0
Legal changes and evidence on unmet need for contraception, Philippines. 法律变化和避孕需求未得到满足的证据,菲律宾。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-01 Epub Date: 2024-10-02 DOI: 10.2471/BLT.23.290577
Miguel Antonio Garcia Estrada, Kent Jason Go Cheng, Rutcher Madera Lacaza

Objective: To investigate the relationship between the Responsible Parenthood and Reproductive Health Law in the Philippines and women's unmet needs for contraception.

Methods: The study involved data on women aged 18 to 49 years from the 2013 (n = 14 053), 2017 (n = 21 835) and 2022 (n = 24 253) Philippine Demographic and Health Surveys. The Responsible Parenthood and Reproductive Health Law was enacted in 2012, but not fully implemented until 2017. Survey-weighted logistic regression was used to estimate the association between variables and an unmet need for contraception, and the probability that women in different wealth quintiles would have an unmet need.

Findings: We observed a persistent gap in unmet needs between women in the lowest and highest wealth quintiles in all years. In 2013, the odds of unmet needs for women in the lowest quintile compared with those in the highest were 1.288 (standard error (SE): 0.124); and in 2022, it was 1.287 (SE: 0.113). Nevertheless, the weighted proportion of women with unmet needs declined between 2013 and 2022; in the lowest wealth quintile, it fell from 18.4% to 10.6%. Moreover, the probability of having an unmet need declined across all wealth quintiles between 2013 and 2022; the largest decline was from 0.146 (95% confidence interval, CI: 0.131-0.162) to 0.088 (95% CI: 0.079-0.098) in the lowest quintile.

Conclusion: The unmet needs for contraception declined substantially following implementation of a new reproductive health law. However, there was a persistent gap in unmet needs between the lowest and highest wealth quintiles.

目的:调查菲律宾《父母责任与生殖健康法》与未满足避孕需求之间的关系:调查菲律宾《父母责任与生殖健康法》与妇女避孕需求未得到满足之间的关系:研究涉及 2013 年(n = 14 053)、2017 年(n = 21 835)和 2022 年(n = 24 253)菲律宾人口与健康调查中 18 至 49 岁女性的数据。父母责任与生殖健康法》于 2012 年颁布,但直到 2017 年才全面实施。我们采用了调查加权逻辑回归法来估算各种变量与避孕需求未得到满足之间的关系,以及不同财富五分位数的妇女避孕需求未得到满足的概率:我们观察到,在所有年份中,最低和最高财富五分位数的妇女在未满足需求方面持续存在差距。2013 年,与最高财富五分位数妇女相比,最低财富五分位数妇女未满足需求的几率为 1.288(标准误差:0.124);2022 年为 1.287(标准误差:0.113)。然而,在 2013 年至 2022 年期间,需求未得到满足的妇女的加权比例有所下降;在财富最低的五分之一人口中,该比例从 18.4% 降至 10.6%。此外,在 2013 年至 2022 年期间,所有财富五分位数中未满足需求的概率都有所下降;下降幅度最大的是最低财富五分位数,从 0.146(95% 置信区间:0.131-0.162)下降到 0.088(95% 置信区间:0.079-0.098):结论:新的生殖健康法实施后,未满足的避孕需求大幅下降。结论:新的生殖健康法实施后,未满足的避孕需求大幅下降,但最低和最高财富五分位数之间在未满足需求方面仍存在差距。
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引用次数: 0
Barriers to WHO prequalification of similar biotherapeutic insulin. 世卫组织预审类似生物治疗胰岛素的障碍。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI: 10.2471/BLT.24.291804
Henry Mj Leng, Jicui Dong

Objective: To identify the barriers preventing manufacturers of similar biotherapeutic human insulin from submitting their products to the World Health Organization (WHO) for prequalification.

Methods: We used a self-administered questionnaire to collect data from companies producing similar biotherapeutic human insulin. We included questions about the insulin products manufactured, knowledge of WHO prequalification requirements, export of the products and compliance with good manufacturing practices. Companies had the possibility to provide additional relevant information. We sent the questionnaire to 20 manufacturers in total. We evaluated responses and organized the data into themes.

Results: We had a response rate of 55% (11/20 companies). Five broad themes emerged: (i) manufacturers and products; (ii) expressions of interest awareness and participation; (iii) need for technical assistance and training; (iv) market and supply chain challenges; and (v) approval for good manufacturing practices. The most important reasons for manufacturers' lack of response to WHO's expression-of-interest invitation were absence of a mechanism to guarantee return on investment, and perceived complexity of prequalification requirements for insulin-similar biotherapeutic products.

Conclusion: To encourage greater participation in the WHO prequalification programme, international procurement agencies associated with the programme should consider establishing a platform to enter into advance purchasing agreements with manufacturers. In addition, WHO's Local Production and Assistance Unit should provide companies with ongoing technical assistance on the development of their human insulin products and improvement of their production facilities to comply with the WHO requirements for good manufacturing practices.

目的确定阻碍类似生物治疗人胰岛素生产商将其产品提交世界卫生组织(WHO)进行资格预审的障碍:我们采用自填问卷的方式,从生产类似生物治疗人胰岛素的公司收集数据。其中包括有关胰岛素产品的生产、对世界卫生组织预审要求的了解、产品出口和良好生产规范的遵守情况等问题。企业还可以提供其他相关信息。我们共向 20 家制造商发出了调查问卷。我们对答复进行了评估,并将数据整理成主题:答复率为 55%(11/20 家公司)。出现了五大主题:(i) 制造商和产品;(ii) 表示有兴趣了解和参与;(iii) 对技术援助和培训的需求;(iv) 市场和供应链挑战;以及 (v) 对良好生产规范的认可。制造商对世卫组织的意向书邀请缺乏回应的最重要原因是缺乏保证投资回报的机制,以及认为胰岛素类似生物治疗产品的资格预审要求很复杂:为鼓励更多国家参与世卫组织资格预审计划,与该计划有关的国际采购机构应考虑建立一个平台,与生产商签订预购协议。此外,世卫组织的当地生产和援助股应向各公司提供持续的技术援助,帮助其开发人胰岛素产品和改进生产设施,以符合世卫组织的良好生产规范要求。
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引用次数: 0
Strengthening guideline contextualization in the WHO European Region. 加强世卫组织欧洲地区的指南背景化。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.2471/BLT.24.291779
Marge Reinap, Naomi Limaro Nathan, Natasha Azzopardi Muscat, Kaja-Triin Laisaar, Urmeli Katus, Holger J Schünemann

The World Health Organization (WHO) plays an important role in developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE-Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations.

世界卫生组织(WHO)在制定以证据为基础、符合道德规范的指导方针方面发挥着重要作用,以帮助卫生工作者、计划管理者和政策制定者,尤其是在制定能力有限的国家。虽然这些指导方针的制定遵循严格的方法,但为了确保其在国家层面的适用性、可行性和可接受性,往往有必要根据具体情况提出建议。全球指导方针的调整和采用应以透明、系统和参与性的方式进行,以保持可信度,同时确保实施所需的自主权。在此,我们以爱沙尼亚为例,介绍通过有效的因地制宜来实施世卫组织指导方针的过程、要求和结果。爱沙尼亚的工作表明,因地制宜可以缩短指南制定时间并降低成本。为支持各国根据当地情况制定指南,包括世卫组织制定的指南,同时保持可信度和相关性,世卫组织欧洲区域办事处根据GRADE-Adolopment方法编写了一本手册,以指导这一过程。此外,对世卫组织欧洲地区 53 个成员国中的 21 个国家进行的快速评估显示,许多国家需要指导和支持,以建设指南因地制宜的能力。为解决能力差距问题,我们提出了一条前进之路,包括四个方面的进一步工作:方法标准化;指南计划和倡议制度化;促进持续和共同学习;以及提供支持和确定资源。加强各国根据具体情况制定全球指南的能力至关重要,在未来出现流行病、气候变化和冲突局势等健康威胁时,这种能力将变得尤为重要。
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引用次数: 0
Adapting emergency care guidance for better outcomes. 调整紧急护理指南,以取得更好的成果。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.2471/BLT.24.021024

A toolkit for emergency care is being adapted for use across a wide range of countries and is having a significant impact on outcomes. Gary Humphreys reports.

一个急救护理工具包被广泛应用于多个国家,并对治疗效果产生了重大影响。Gary Humphreys 报道。
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引用次数: 0
Using the WHO-INTEGRATE framework to develop a COVID-19 guideline for schools, Germany. 利用世界卫生组织-国际综合框架为学校制定 COVID-19 指南,德国。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-27 DOI: 10.2471/BLT.24.291550
Eva A Rehfuess, Lisa Pfadenhauer, Monika Nothacker, Brigitte Strahwald

Problem: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reliable, globally applicable recommendations for safe and continuous school operations were lacking.

Approach: In October 2020, the German Association of Scientific Medical Societies' task force for COVID-19 guidelines and public health researchers at Ludwig-Maximilians-Universität München initiated the rapid development of a living evidence- and consensus-based guideline to reduce severe acute respiratory syndrome coronavirus 2 transmission in schools. To facilitate transparent, structured and comprehensive decision-making with a whole-of-society perspective, they applied the WHO-INTEGRATE evidence-to-decision framework. This framework supported a broad, multisectoral composition of the guideline panel. The panel used newly synthesized evidence on nine school measures. Participating medical societies or the guideline secretariat completed evidence-to-decision tables. They also drafted recommendations for the guideline panel, who discussed and revised them during moderated consensus conferences.

Local setting: In Germany, each state is responsible for organizing schooling. The German Association of Scientific Medical Societies coordinates development of evidence- and consensus-based guidelines.

Relevant changes: The first version of the guideline was published in February 2021, and the guideline dissemination created much media attention. Of the 16 state education ministries, almost all knew about the guideline, nine recognized it as a relevant source of information and five used it to check existing directives.

Lessons learnt: The WHO-INTEGRATE framework facilitated a comprehensive assessment of school measures from the start of guideline development, considering the broad societal impact of the measures. Using the framework in rapid mode was feasible, but it fell short of its potential.

问题:在冠状病毒病 2019(COVID-19)大流行之初,缺乏可靠的、全球适用的学校安全和持续运营建议:2020 年 10 月,德国科学医学协会 COVID-19 指南工作组和慕尼黑路德维希-马克西米利安大学的公共卫生研究人员启动了一项以证据和共识为基础的活指南的快速开发工作,以减少严重急性呼吸系统综合征冠状病毒 2 在学校的传播。为了从全社会的角度促进透明、有序和全面的决策,他们采用了世界卫生组织的 "从证据到决策"(WHO-INTEGRATE evidence-to-decision)框架。该框架支持指导小组的广泛、多部门组成。该小组使用了九项学校措施的最新综合证据。参与的医学协会或指南秘书处完成了证据到决策表格。他们还为指南小组起草了建议,并在主持的共识会议上进行了讨论和修订:在德国,各州负责组织学校教育。相关变更:该指南的第一版于 2021 年 2 月发布,指南的传播引起了媒体的广泛关注。在 16 个州的教育部中,几乎所有部委都知道该指南,9 个承认它是相关的信息来源,5 个利用它来检查现有的指令:世卫组织综合框架有助于在制定指导方针之初就对学校措施进行全面评估,并考虑 到这些措施的广泛社会影响。在快速模式下使用该框架是可行的,但没有发挥其潜力。
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引用次数: 0
Challenges for impact evaluation of WHO's normative output. 世卫组织规范性产出影响评估面临的挑战。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.2471/BLT.24.292518
Catherine Regis, Gaelle Foucault, Jean-Louis Denis, Pierre Larouche, Miriam Cohen
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引用次数: 0
Measuring the value of the WHO Model list of essential medicines. 衡量世界卫生组织基本药物示范清单的价值。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.2471/BLT.24.292521
Elizabeth F Peacocke, Elina Dale, Amani Thomas Mori, Augustina Koduah, Unni Gopinathan
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引用次数: 0
Public health round-up. 公共卫生综述。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.2471/BLT.24.011024
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引用次数: 0
期刊
Bulletin of the World Health Organization
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