A scoping review and research synthesis on financing and regulating oral care in long-term care facilities

doi: 10.1111/j.1741‐2358.2011.00575.x A scoping review and research synthesis on financing and regulating oral care in long‐term care facilities Background: Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear. Objective: This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long‐term care (LTC) facilities. Methods: We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health‐related services. Results: The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities. Conclusions: Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector.     

Epidemiological transitions, reproductive health, and the Flexible Response Model

In concert with improving standards of living since the mid-19th century, chronic and non-infectious diseases replaced infectious diseases as the major causes of mortality in more developed countries. Thus, economic development has been seen as one strategy to improve women's reproductive health. However, rates of two of the major contributors to women's illness, maternal mortality and breast cancer, do not correspond well with the level of economic development. Drawing upon our longitudinal study of reproductive functioning among rural Bolivians (Project Reproduction and Ecology in Provincia Aroma (REPA)), we propose an evolutionary model to explain variation in certain aspects of women's reproductive health. Our findings suggest new avenues of inquiry into the determinants of reproductive health and have implications for improving the well-being of women worldwide.     

Epigenetics for the social sciences: justice,embodiment, and inheritance in the postgenomic age

In this paper, I firstly situate the current rise of interest in epigenetics in the broader history of attempts to go “beyond the gene” in twentieth-century biology. In the second part, after a summary of the main differences between epigenetic and genetic mutations, I consider what kind of implications the sui generis features of epigenetic mutations may have for the social sciences. I focus in particular on two sites of investigation: (a) the blurring of the boundaries between natural and social inequalities in theories of justice and their possible implications for public policy and public health and (b) a deepening of the notion that the constitution of the body is deeply dependent on its material and socially shaped surroundings (“embodied constructivism”). In conclusion, I advance some cautionary reflections on some of the (known and unprecedented) problems that the circulation of epigenetics in wider society may present.     

Risk Analysis Modeling of Production Costs and Occupational Health Exposure of Single‐Wall Carbon Nanotube Manufacturing

Considerable uncertainty exists about occupational risks, future environmental health and safety (EHS) standards, and associated production and compliance costs for single‐wall carbon nanotube (SWNT) manufacturing processes. We propose and illustrate the use of risk analysis Monte Carlo (MC) models to assess cost and exposure trade‐offs of the high‐pressure carbon monoxide (HiPco) SWNT manufacturing process given these uncertainties. Assumptions regarding the timing, frequency, magnitude, and expense of EHS standards are modeled as stochastic events and examined for their impact on the expected values, variances, and probability distributions of total production costs and occupational exposure. With a better understanding of associated risks, these models can help policy makers and manufacturers explore potential EHS benefits, consequences, and trade‐offs. For example, results suggest that voluntary implementation of a low level of protection (rather than none at all) can lead to reduced cost and exposure uncertainty with insignificant increases in production costs, as well as lowering total manufacturing and liability costs, depending on the assumptions made. Conversely, slower implementation rates of higher standards produce greater uncertainty in long‐term costs and exposure. More generally, the results of this study underscore three important observations: (1) Expected costs alone are insufficient for informed decision making; (2) the best level of standards, overall cost, and optimal voluntary standards are highly dependent on uncertain health effects; and (3) the resultant amount of uncertainty in total costs and exposure can be extreme.     

Links between blood parasites,blood chemistry,and the survival of nestling American crows

Many studies have used the avian hemosporidians (Leucocytozoon, Plasmodium, and Hemoproteus) to test hypotheses of host–parasite co‐evolution, yet documented health and survival consequences of these blood parasites vary among studies and generalizations about their pathogenicity are debatable. In general, the negative effects of the hemosporidians are likely to be greatest during acute infections of young birds, yet most previous studies in wild passerines have examined chronic effects in adults. Here, we evaluated responses of nestling American crows (Corvus brachyrhynchos) to acute infection (prevalence and burden), as well as its short‐ and long‐term survival consequences. We used panel of nine hematological and biochemical parameters that are regularly used to evaluate the health of domestic animals, including leukocyte profiles, hematocrit, and plasma proteins. We assessed the effects of infection on survival in a mark‐recapture framework. Overall, 56% of crows (n = 321 samples) were infected by at least one of the three genera. Infections by all genera were associated with elevated plasma proteins and globulins, which could indicate an adaptive immune response. However, only Plasmodium infections were associated with low hematocrit (anemia) and lower fledging success, possibly mediated by the negative effect of low hematocrit values on body condition. Moreover, early Plasmodium infection (<40 days of age) had long‐term survival implications: it was associated with lower apparent survival probability within 3 years after fledging. These results suggest that young crows mounted an adaptive immune response to all three genera. Short‐ and long‐term pathological effects, however, were only apparent with Plasmodium infections.     

Perception of residential crowding,classroom experiences,and student health

The present research is based on a typology of crowding experiences incorporating two main dimensions: neutral-personal thwartings and primary-secondary environments. The thwarting dimension concerns the degree to which crowding experiences are associated with spatial inconveniences, alone, or with spatial as well as social constraints. The environmental dimension relates to the type of setting in which crowding experiences occur. A major assumption of this typology is that crowding experiences involving social conflict will be more intense and disruptive to the individual than those in which interpersonal conflict is minimal. The reported study examined the relationship between college students' evaluations of the physical amenity, social climate, and crowdedness of their residential environments, on the one hand, and their sensitivity to crowding in a classroom situation, their academic performance, and the frequency of their visits to the campus health center, on the other. Results indicated that perceived residential crowding and negative perceptions of residential social climate were strongly associated with increased sensitivity to crowding in a classroom situation, impaired course performance, and visits to the student health center. The implications of these correlational findings for future field-experimental research are discussed.     

WPA guidance on mental health and mental health care in migrants

The purpose of this guidance is to review currently available evidence on mental health problems in migrants and to present advice to clinicians and policy makers on how to provide migrants with appropriate and accessible mental health services. The three phases of the process of migration and the relevant implications for mental health are outlined, as well as the specific problems of groups such as women, children and adolescents, the elderly, refugees and asylum seekers, and lesbian, gay, bisexual and transgender individuals. The concepts of cultural bereavement, cultural identity and cultural congruity are discussed. The epidemiology of mental disorders in migrants is described. A series of recommendations to policy makers, service providers and clinicians aimed to improve mental health care in migrants are provided, covering the special needs of migrants concerning pharmacotherapies and psychotherapies.     

Community engagement in global health research that advances health equity

Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs.     

Beliefs Underlying Dog Owners' Health Care Behaviors: Results from a Large,Self-Selected,Internet Sample

ABSTRACT

Various behaviors must be performed by owners to promote good health for their dogs. The aim in this study was to use the results of an online survey, completed by 1,016 self-selected, Australian dog owners, to investigate relationships between demographic factors, beliefs, dog–owner relationship variables, and the performance of health-promoting behaviors. Specific behaviors examined included the provision of annual vaccinations and health checkups by a veterinarian, regular grooming and exercise, and the provision of a nutritionally balanced diet. Reported compliance was high in the self-selected sample, ranging between 77.8% for annual vaccinations and 98.8% for the provision of a nutritious diet. Regression analyses revealed that all of the behaviors we measured could be predicted from beliefs relating to health care practices and dog–owner relationship variables independently of demographic factors. The extent of dog and owner interactions, as well as the extent to which owners perceived important others to be supportive of the behaviors, emerged as particularly important variables. These statistically robust findings have implications for campaigns encouraging pet health promotion by owners.     

Mycotoxin Reduction in Bt Corn: Potential Economic, Health, and Regulatory Impacts

Genetically modified (GM) Bt corn, through the pest protection that it confers, has lower levels of mycotoxins: toxic and carcinogenic chemicals produced as secondary metabolites of fungi that colonize crops. In some cases, the reduction of mycotoxins afforded by Bt corn is significant enough to have an economic impact, both in terms of domestic markets and international trade. In less developed countries where certain mycotoxins are significant contaminants of food, Bt corn adoption, by virtue of its mycotoxin reduction, may even improve human and animal health. This paper describes an integrated assessment model that analyzes the economic and health impacts of two mycotoxins in corn: fumonisin and aflatoxin. It was found that excessively strict standards of these two mycotoxins could result in global trade losses in the hundreds of millions $US annually, with the US, China, and Argentina suffering the greatest losses. The paper then discusses the evidence for Bt corn’s lower levels of contamination of fumonisin and aflatoxin, and estimates economic impacts in the United States. A total benefit of Bt corn’s reduction of fumonisin and aflatoxin in the US was estimated at $23 million annually. Finally, the paper examines the potential policy impacts of Bt corn’s mycotoxin reduction, on nations that are making a decision on whether to allow commercialization of this genetically modified crop.     

REPRODUCTIVE TOURISM IN ARGENTINA: CLINIC ACCREDITATION AND ITS IMPLICATIONS FOR CONSUMERS,HEALTH PROFESSIONALS AND POLICY MAKERS

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration given to more recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context‐specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices.     

Global diversity of dietary intakes and standards for zinc,iron, and copper

BackgroundThe essentiality of trace elements in human diets is well recognized and adequate levels are a critical component of optimal health. To date, public health efforts have focused primarily on macronutrients or trace minerals that are easily analyzed. The goal of this research is to provide assessment of the dietary standards developed for Zn, Fe, and Cu in 100+ developed, marginal, and developing countries. We summarize the current recommendations and changes from the last decade, categorize and provide scientific basis for values established, factors that affect requirements, and current global challenges.MethodsThe electronic databases of Google Scholar, PubMed, Embase, Web of Science and Cochrane Library were searched using the keywords “trace minerals,” “micronutrients, ““zinc,” “iron,” “copper,” “dietary standards” and “recommendations.” A total of 123 studies published from 1965 to 2019 were included.ResultsThe World Health Organization (WHO) has established dietary standards to address nutrient deficiencies, prevent infections and ensure basic metabolic functions; these are utilized by most developing countries. Developed countries or their alliances have established values similar to or higher than the WHO, primarily for promotion of optimal health and well-being. Transitional countries are more concerned with issues of bioavailability, food security and undernutrition. Globally, Zn and Cu recommendations are lower in women than in men; Fe requirements are higher to compensate for menstrual losses. Important considerations in establishing guidelines for these minerals include bioaccessibility, dietary practices and restrictions, food processing, interactions, and chemical forms. The global challenges of the triple burden of malnutrition, hidden hunger, increased consumption of ultra-processed foods and obesity have been associated with Zn, Fe, and Cu deficiencies.ConclusionThis research provides public policy and health professionals evidenced-based information useful for the establishment of dietary standards world-wide.     

Barriers in the mind: promoting an economic case for mental health in low- and middle-income countries

In recent years, policy makers in high-income countries have placed an increasing emphasis on the value of maintaining good mental health, recognizing the contribution that this makes to quality of life, whilst ever more mindful of the socio-economic consequences of poor mental health. The picture in many other parts of the world is much less encouraging; policy attention and resources are still directed largely at communicable diseases. We reflect on some of the challenges faced in these countries and outline the role that economic evidence could play in strengthening the policy case for investment in mental health. Clearly this should include assessment of the economic impact of strategies implemented outside, as well as within the health sector. The ways in which mental health services are delivered is also of critical importance. Non-governmental organizations (NGOs) have long been shown to be key stakeholders in the funding, coordination and delivery of these services in high-income countries. Their role in low- and middle-income countries, where infrastructure and policy focus on mental health are more limited, can be even more vital in overcoming some of the barriers to the development of mental health policy and practice.     

Mental health system in China: history, recent service reform and future challenges

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.     

Obesity and Physical and Emotional Well‐Being: Associations between Body Mass Index,Chronic Illness,and the Physical and Mental Components of the SF‐36 Questionnaire

Objective: To clarify the associations between obesity and health‐related quality of life by exploring the associations between physical and emotional well‐being in relation to obesity and the presence of other chronic illness. Research Methods and Procedures: The study data were collected as part of a postal‐survey within the old Oxford Regional Health Authority of England in 1997. Completed questionnaires were returned by 8889 of 13,800 randomly selected adults aged 18 to 64 years. The main outcome measures were body mass index in five categories (underweight, normal weight, overweight, moderately obese, morbidly obese); chronic illness status (any vs. none and number of such illnesses 0, 1 to 2, 3+); and mean SF‐36 questionnaire score in two summary component measures reflecting physical and emotional well‐being. Results: Of the subjects, 31% were overweight and an additional 11% were obese. Body mass index was significantly associated with health status, but the pattern varied according to whether the measure reflected physical or emotional well‐being. Physical, but not emotional, well‐being deteriorated markedly with increasing degree of overweight and was limited in subjects who were obese but had no other chronic condition; subjects with chronic illnesses other than obesity were compromised in both dimensions. In terms of the number of chronic illnesses reported, the additional presence of obesity was associated with a significant deterioration in physical but not emotional well‐being. Discussion: Overweight and obesity are associated with poor levels of subjective health status, particularly in terms of physical well‐being. The limitations in emotional well‐being that are reported here and in other studies may be a result of confounding by the presence of accompanying chronic illness.     

Recent Developments in Nanotechnology and Risk Assessment Strategies for Addressing Public and Environmental Health Concerns

Nanotechnology is a novel emerging technology that allows the manipulation of materials at the scale comparable to the size of a single molecule (i.e., < 100 nm). There have been many new developments in this technology, resulting in complex exposure and health risk implications. Nanotechnology offers major benefits to humankind; however, there is growing concern regarding the potential adverse interactions of engineered nanoparticles at cellular or sub-cellular levels. The nanotech community is therefore experiencing growing calls for legislation to minimize or prevent exposure to nanoparticles. This article focuses on recent developments in nanotechnology including current manufacturing techniques, uses of nanoscale particles, and implications for particle toxicity and human exposure pathways. Current risk assessment methods are reviewed in the context of nanoparticle exposure routes and regulation for human and environmental health protection. This study provides a better understanding of the factors governing risks from nanoparticles and current strategies for protecting environmental and public health.     

The occurrence of mites in cereal-based foods destined for human consumption and possible consequences of infestation

Seven categories of cereal-based food products purchased at food retail outlets in UK were examined for the presence of mites by analysing 20g samples using a flotation method. Mites were found in 21% of 571 samples, which were examined soon after purchase, and in 38% of 421 samples, derived from the 571 samples which were examined after 6 weeks of storage in volunteers' homes. Most of the samples where mites were detected had fewer than five mites. However, a few samples contained more than 20 mites with a maximum of 428 mites detected in a single sample. Sixteen families, genera or species of mites were recovered. The most common species were Acarus siro, Tyrophagus putrescentiae, Lepidoglyphus destructor and Glycyphagus domesticus. The level of contamination was broadly similar for each of the seven categories of products examined. It is likely that infestation occurs at every stage of food processing and storage. This is the first study of its kind and there is no reason to believe that results from similar studies carried out in other temperate countries would be markedly different. Increase in the percentage of contaminated samples following storage in a domestic situation suggests that the domestic environment is an important factor in developing infestation. The implications of mite contamination on food quality and on human health are briefly discussed.     

Coding and Reimbursement for Weight Loss Surgery: Best Practice Recommendations

Objective: To review the use and usefulness of billing codes for services related to weight loss surgery (WLS) and to examine third party reimbursement policies for these services. Research Methods and Procedures: The Task Group carried out a systematic search of MEDLINE, the Internet, and the trade press for publications on WLS, coding, reimbursement, and coding and reimbursement policy. Twenty‐eight articles were each reviewed and graded using a system based on established evidence‐based models. The Massachusetts Dietetics Association provided reimbursement data for nutrition services. Three suppliers of laparoscopic WLS equipment provided summaries of coding and reimbursement information. WLS program directors were surveyed for information on use of procedure codes related to WLS. Results: Recommendations focused on correcting or improving on the current lack of congruity among coding practices, reimbursement policies, and accepted clinical practice; lack of uniform coding and reimbursement data across institutions; inconsistent and/or inaccurate diagnostic and billing codes; inconsistent insurance reimbursement criteria; and inability to leverage reimbursement and coding data to track outcomes, identify best practices, and perform accurate risk‐benefit analyses. Discussion: Rapid changes in the prevalence of obesity, our understanding of its clinical impact, and the technologies for surgical treatment have yet to be adequately reflected in coding, coverage, and reimbursement policies. Issues identified as key to effective change include improved characterization of the risks, benefits, and costs of WLS; anticipation and monitoring of technological advances; encouragement of consistent patterns of insurance coverage; and promotion of billing codes for WLS procedures that facilitate accurate tracking of clinical use and outcomes.     

Genetics and personal responsibility for health

Advances in genetic medicine may have implications for how we should think about personal responsibility for health, because they may show how it is possible to exert some control over risk factors that were previously thought as beyond the individual's control. Although we cannot control the genes that we are born with, we can often make decisions concerning genetic testing, disease prevention, and treatment. One might argue, therefore, that individuals should be treated as morally responsible for taking effective action in response to genetic risks factors, since genetically based health risks are similar to other health risks. While this argument makes sense as an abstract, philosophical position, it is not a useful guide to public policy. Given these concerns, there is little society can or should do to encourage individuals to address their genetic risk factors, other than praising those who make prudent choices.     

The growing field of digital psychiatry: current evidence and the future of apps,social media,chatbots, and virtual reality

As the COVID‐19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies – such as smartphone apps, vir­tual reality, chatbots, and social media – have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for “digital phenotyping” and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self‐management of psychological well‐being and early intervention, along with more nascent research supporting their use in clinical management of long‐term psychiatric conditions – including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders – as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real‐world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.