World Medical & Health Policy

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Latest documents

• Continuing Medical Education and the Marketing of Fentanyl for Breakthrough Pain: Marketing Messages in an Industry‐Funded CME Module on Breakthrough Pain

  In order to market transmucosal fentanyl products, industry‐funded medical journal articles and continuing medical education (CME) were used to persuade physicians that breakthrough pain (BTP) was a separate entity, and that rapid onset opioids were an appropriate treatment. We performed a pilot study on industry‐funded online CME modules on BTP that used perceptions of key points and text analysis to assess subtle bias. Thirty‐eight participants were randomized to read a non‐industry publication or an industry‐funded publication on opioids for managing pain. Twenty‐three participants were asked to assess key messages. A text analysis was also performed on key words and phrases. Those who read the non‐industry‐funded article noted that the effectiveness of opioids for chronic pain was unclear, whereas readers of the industry‐funded article viewed opioids more positively. Eight of twelve readers of the non‐industry‐funded article, compared to three of twelve assigned to the industry‐funded article, reported opioid abuse or addiction as a major theme. “Breakthrough pain” was mentioned 55 times in the industry‐funded article and once in the non‐industry‐funded article. The non‐industry‐funded article mentioned “death” 26 times; the industry‐funded article never mentioned “death.” Our study provides a new method of identifying subtle bias that may be useful for evaluating CME modules.

• Access to Essential Medications and Equipment for Obstetric and Neonatal Primary Care in Bombali District, Sierra Leone

  The increased demand for basic emergency obstetric and neonatal care (BEmONC) services in Sierra Leone since the launch of the nationwide free maternity care initiative in 2010 has strained the capacity of the system to provide high‐quality care. In 2014, members of our research team visited all 97 functioning primary health‐care facilities in Bombali district in the Northern Province of Sierra Leone to evaluate gaps in access to BEmONC. Although most facilities had the equipment necessary for maternal and neonatal care, these were often not in satisfactory condition. Most of the facilities did not stock all of the essential medicines for BEmONC, and less than 10 percent of the facilities had sufficient stocks of unexpired and properly stored medications. Stronger supply chains will be necessary to improve health system performance in Sierra Leone, reduce maternal mortality, increase neonatal survival, and achieve targets associated with the Sustainable Development Goals (SDGs).

• Predictors of HPV Knowledge and HPV Vaccine Awareness Among Women in Panama City, Panama

  In 2008, Panama became the first country in Latin America to offer the Human Papilloma Virus (HPV) vaccine at no cost to 10‐year‐old girls as part of its National Immunization Program. Vaccine completion rates remain suboptimal, and knowledge is limited regarding public perceptions of the HPV vaccine in Panama. A cross‐sectional survey of 333 Panamanian women aged 18–65 was conducted in Panama City, Panama. Although 93 percent of respondents had heard of HPV, only 59.8 percent had heard of the HPV vaccine. Acceptability of HPV vaccination of daughters was high (95 percent). In multivariate analyses, HPV vaccine awareness was associated with age and education, but not with income, Internet use as preferred source of health information, indigenous race, or marital status. Additionally, after controlling for age, education, income, race, and Internet use, women who completed a pap test in the past 36 months were 3.12 times more likely to have heard of the HPV vaccine when compared to those who had not (95%CI 1.04–9.34). Future efforts to educate Panamanian women about the HPV vaccine should include special attention to vulnerable populations, including those of younger age and limited education.

• Issue Information
• Editorial
• Voting Characteristics of Individuals With Traumatic Brain Injury

  Voting is the foundation of democracy. Limited data exist about voting characteristics of individuals with neurologic impairment including those living with a traumatic brain injury (TBI). To statistically examine voting characteristics using a convenience sample of registered voters with TBI during elections held in Mecklenburg County, North Carolina—2007, 2008. Data were collected on 51 participants with TBI during May 2007, 2008 general, and 2008 Presidential Election. (i) There was a significant difference between the Competence Assessment Tool for Voting (CAT‐V) total score of participants with TBI who voted and the CAT‐V total score of participants with TBI who did not vote and the CAT‐V total score predicted voting; (ii) the age of the participants with TBI was predictive of voting; and (iii) being married was inversely related to voting. We find that there is variation in voting even among this small sample interviewed for the present study, and that the variation is predictable. Those with the highest CAT‐Vs are most likely to vote. In addition, we find that traditional predictors of voting simply are not predictors among this TBI group, and even one, whether the person is married, has a negative effect on voting.

• A Review of the Forces Influencing Maternal Health Policies in Post‐War Guatemala

  Guatemala's 1996 Peace Accord ending the 36‐year civil war included the goal to lower its maternal mortality ratio (MMR). Yet, Guatemala still has one of Latin America's highest MMRs, especially among Mayan women. To improve maternal health, the professional midwife is being reintroduced in Guatemala. Meier's Linear Model of the Public Policy Process states that policymakers respond to international and society‐centered forces when making policy decisions. How have such forces influenced the creation of birth attendance policies in Guatemala from 1996 to today? Using a process tracing approach, we analyzed 132 policy documents, peer‐reviewed journal articles, and gray literature noting international and national maternal health recommendations and all birth attendance legislation passed in Guatemala from 1996 to present. International forces advocated for skilled birth attendance (SBA) to address maternal mortality. Society‐centered forces promoted intercultural care with traditional birth attendants (TBAs). Both—sometimes conflicting—forces have influenced policymakers in the creation of maternal health policies in post‐war Guatemala. Policymakers must constantly reconcile tensions between society‐centered realities and international agendas when making policies. The reintroduction of professional midwifery in Guatemala presents a means of addressing both agendas: Increasing SBA and improving intercultural care.

• Maternal Mortality in Nigeria: A Literature Review

  One hundred forty‐five Nigerian women die in childbirth every day. This review was conducted to evaluate the influences on maternal mortality in Nigeria. It is an analysis and synthesis of the professional literature surrounding maternal mortality in Nigeria and a review of articles in CINAHL, Health Source, Medline in EBSCO, including PubMed, ProQuest Health and Medical Complete, 2000–2015, analyzed and sorted into themes. The etiology of maternal mortality can be categorized as medical, socio‐economic, cultural, behavioral, and political causes. While some of the occurrences are predicted during routine prenatal care, most occur spontaneously without warning signs. Only one‐third of births in Nigeria occur in a health facility. To provide Emergency Obstetric Care (EmOC) in Nigeria, the community health centers and referral hospitals need to be upgraded to provide supplies, equipment, essential drugs, and blood transfusions delivered by knowledgeable staff at all hours. The vision of is that all pregnant women in Nigeria regardless of their income have access to woman‐centered obstetric care that provides a safety net in case of obstetric emergency.

• Medical and Public Health Challenges of Addiction
• Cross‐Border Reproductive Care: Two Lenses in Political Science

  Cross‐border reproductive care (CBRC)—when patients travel outside their country to seek assisted reproductive services—is a booming industry. Globalization facilitates the increase in CBRC by reducing transportation costs, removing language barriers, and liberalizing the reproductive services market. Yet global and domestic regulatory responses are failing to keep pace, raising ethical, economic, political, and social issues. Political science has been slow to contribute to our understanding of CBRC politics and policies. This article first establishes the gap in existing CBRC research, before presenting how political scientists can respond in two specific areas: 1) the role of globalization health governance in relation to CBRC and 2) the political implications and potentials of “medical necessity” in shaping patient motivations for seeking—as well as their ultimate access to—CBRC. New research in these areas will aid policymakers in recognizing the context in which they must develop CBRC regulations.

Featured documents

• Examining Joint Effects of Air Pollution Exposure and Social Determinants of Health in Defining “At‐Risk” Populations Under the Clean Air Act: Susceptibility of Pregnant Women to Hypertensive Disorders of Pregnancy

  Pregnant women are uniquely susceptible to adverse effects of air pollution exposure due to vulnerabilities and health consequences during pregnancy (e.g., hypertensive disorders of pregnancy [HDP]) compared to the general population. Because the Clean Air Act (CAA) creates a duty to protect at‐risk...

• Public Health and Corporate Avoidance of U.S. Federal Income Tax

  The amount of U.S. federal revenue affects the government's ability to provide public health services, programs, infrastructure, and research to adequately protect the public's health. Public health funding shortages are chronic. Corporate income tax avoidance is one source of unrealized federal...

• Confronting Cultural Silencing of Women: Untold Stories of Abuse and HIV Risk in Young Women in Africa and the United States

  Past research has shown that sexual abuse increases vulnerability to HIV/AIDS. However, little is known about the context of different cultural traditions and how they affect women's risk. This study used data from two studies conducted in the United States and West Africa, and purposefully...

• Indexes as a Metric for Drug and Alcohol Policy Evaluation and Assessment

  Indexes are measurement tools used to capture the multi‐dimensionality of complex issues and have been used increasingly in the contemporary evaluation of policies including in the drug and alcohol field. This article systematically reviews all published alcohol and illicit drug indexes to date in...

• Scope and Limitations of Municipal Health Councils: A Case Study

  This case study analyzed citizen participation at the Municipal Health Council (MHC) of Ribeirão Preto, in the state of São Paulo (Brazil), using a qualitative approach with a phenomenological basis and methodological triangulation: (i) analysis of the minutes of the meetings, (ii) passive...

• Women Farmers’ (Dis)Empowerment Compared to Men Farmers in Ethiopia

  In Sub‐Saharan Africa, women's farm labor is highest in Ethiopia. Using focus group discussions with 240 farmers and other research tools, our USAID‐funded Feed the Future Innovation for the Reduction of Post‐Harvest Loss—Ethiopia study explores the sources of (dis)empowerment of rural farmers in...

• Access to Essential Medications and Equipment for Obstetric and Neonatal Primary Care in Bombali District, Sierra Leone

  The increased demand for basic emergency obstetric and neonatal care (BEmONC) services in Sierra Leone since the launch of the nationwide free maternity care initiative in 2010 has strained the capacity of the system to provide high‐quality care. In 2014, members of our research team visited all 97 ...

• Do Changes in Health Insurance Coverage Explain Interstate Variation in Emergency Department Utilization?

  Emergency department (ED) utilization has increased nationally, leading to overcrowding, which in turn increases wait times, adverse clinical outcomes, and costs. We constructed a state‐level panel dataset of 50 U.S. states and the District of Columbia from 1999 to 2011 and used a first‐differencing...

• Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Latina Immigrants in the Farmworker Community

  Latina immigrants in the farmworker community are a vulnerable and understudied population at risk of acquiring HIV. Employing a CBPR framework, this pilot study was the first to evaluate the efficacy of SEPA, a CDC evidenced‐based and culturally tailored HIV risk reduction intervention on a cohort ...

• Women, HIV Prevention, and Behavioral Versus Holistic Approaches: The United States and South Africa

  This paper focuses on the dominant approaches to HIV prevention for women in the United States and South Africa. Examining the Diffusion of Evidence‐Based Interventions (DEBI) program in the United States and loveLife in South Africa, we find that the United States focuses on women's individual...