Diet Therapy and Public Health.

A major threat to the achievement of the Sustainable Development Goals and Universal Health Coverage continues to be malnutrition [...].

Framing policy objectives in the sustainable development goals: hierarchy, balance, or transformation?

Society continues to be confronted with the deep inadequacies of the current global order. Rampant income inequality between and within countries, dramatic disparities in access to resources, as seen during the COVID pandemic, persistent degradation of the environment, and numerous other problems are tied to existing systems of economy and government. Current global economic systems are implicated in perpetuating these problems. The Sustainable Development Goals (SDGs) were born out of the recognition that dramatic changes were needed to address these intersecting challenges. There is general recognition that transformation of global systems and the relationship between sectors is needed. We conduct a structured, theoretically-informed analysis of SDG documents produced by United Nations agencies with the aim of examining the framing of economic policy goals, a historically dominant domain of consideration in development policy, in relation to health, social and environmental goals. We apply a novel typology to categorize the framing of policy goals. This analysis identified that the formal discourse associated with the SDGs marks a notable change from the pre-SDG development discourse. The 'transformational' agenda issued in the SDG documents is in part situated in relation to a critique of previous and existing approaches to development that privilege economic goals over health, social and environmental goals, and position economic policy as the solution to societal concerns. At the same time, we find that there is tension between the aspiration of transformation and an overwhelming focus on economic goals. This work has implications for health governance, where we find that health goals are still often framed as a means to achieve economic policy goals. Health scholars and advocates can draw from our analysis to critically examine how health fits within the transformational development agenda and how sectoral policy goals can move beyond a crude emphasis on economic growth.

Moving toward a common goal via cross-sector collaboration: lessons learned from SARS to COVID-19 in Singapore.

BACKGROUND: The spread of COVID-19 has taken a toll on many countries and its healthcare system over the last two years. Governments have sought to mitigate the repercussions of the pandemic by implementing aggressive top-down control measures and introducing immense fiscal spending. Singapore is no exception to this trend. Owing to a whole-of-society approach, Singapore is still being lauded globally for its relatively successful record at controlling both community and trans-border spread. One notable effort by the Singapore government has taken place through its cross-sectoral collaborative partnerships with the private stakeholders behind the success. METHODS/RESULTS: In an attempt to better explain Singapore's robust yet strategic response to COVID-19, this study focuses on how the experience of the SARS outbreak has informed the government's collaborative efforts with other stakeholders in society, beyond mere transnational cooperation. Taking a comparative case study approach in the specific context of Singapore, we perform a content analysis of related government documents, mainstream newspaper articles, and academic journal articles in an inductive manner. By closely comparing two global healthcare outbreaks, we note four differences in approach. First, during the COVID-19 pandemic, Singapore has focused on securing sufficient essential healthcare resources with contingency plans to strengthen preparedness. Second, the government has actively harnessed the capacity of private entities to promote the resilience of the healthcare system and the community. Third, Singapore's management policies have been made not only in a top-down, centralized style during the initial response stage, but also with a greater proportion of bottom-up approaches, particularly as the pandemic trudges on. More interestingly, the multi-faceted repercussions of COVID-19 have gradually opened the door to a greater variety of collaborative partnerships in sectors beyond healthcare services. The participating stakeholders include, but are not limited to, local and international business actors, non-profit organizations, academia and other countries. Lastly, as the pandemic has continued, the Singapore government has managed outward to tap the expertise and knowledge of the private sector, in particular leveraging science and technology to improve control measures and putting supportive programs into practice. CONCLUSION: The evidence from our focused analyses demonstrates that the nature and scale of the COVID-19 pandemic produced more collaborative partnerships between the public and private sectors in Singapore as compared with the SARS outbreak. What is more, our findings offer evidence that through adaptive learning from the prior global healthcare outbreak, plus some trial and error during the initial phase of the ongoing pandemic, public- and private-sector partners, both in and outside of the healthcare service sector, have tended to "act alike," working together to achieve a common goal. Both have been socially responsible, providing public services to people in need to promote the rapid resilience of the community, and sharing the associated risks. Overall, this study has deep and wide implications for other governments and policy makers who are still struggling to maximize essential resources and minimize the negative impacts of the healthcare crisis.

Pirfenidone and post-Covid-19 pulmonary fibrosis: invoked again for realistic goals.

Pirfenidone (PFN) is an anti-fibrotic drug with significant anti-inflammatory property used for treatment of fibrotic conditions such as idiopathic pulmonary fibrosis (IPF). In the coronavirus disease 2019 (Covid-19) era, severe acute respiratory syndrome 2 (SARS-CoV-2) could initially lead to acute lung injury (ALI) and in severe cases may cause acute respiratory distress syndrome (ARDS) which is usually resolved with normal lung function. However, some cases of ALI and ARDS are progressed to the more severe critical stage of pulmonary fibrosis commonly named post-Covid-19 pulmonary fibrosis which needs an urgent address and proper management. Therefore, the objective of the present study was to highlight the potential role of PFN in the management of post-Covid-19 pulmonary fibrosis. The precise mechanism of post-Covid-19 pulmonary fibrosis is related to the activation of transforming growth factor beta (TGF-ß1), which activates the release of extracellular proteins, fibroblast proliferation, fibroblast migration and myofibroblast conversion. PFN inhibits accumulation and recruitment of inflammatory cells, fibroblast proliferation, deposition of extracellular matrix in response to TGFß1 and other pro-inflammatory cytokines. In addition, PFN suppresses furin (TGFß1 convertase activator) a protein effector involved in the entry of SARS-CoV-2 and activation of TGFß1, and thus PFN reduces the pathogenesis of SARS-CoV-2. Besides, PFN modulates signaling pathways such as Wingless/Int (Wnt/ß-catenin), Yes-Associated Protein (YAP)/Transcription Co-Activator PDZ Binding Motif (TAZ) and Hippo Signaling Pathways that are involved in the pathogenesis of post-Covid-19 pulmonary fibrosis. In conclusion, the anti-inflammatory and anti-fibrotic properties of PFN may attenuate post-Covid-19 pulmonary fibrosis.

Modelling the microelimination of chronic hepatitis C in the canton of Bern, Switzerland: Reaching the Swiss Hepatitis Strategy goals despite the impact of the COVID 19 pandemic.

AIMS OF THE STUDY: Since 2014, the Swiss Hepatitis Strategy (SHS) has targeted the elimination of Hepatitis C Virus (HCV) in Switzerland. The epidemiology of HCV is diverse across Swiss cantons, therefore cantonal-level screening and treatment strategies should be developed. This study aimed to identify scenarios to achieve HCV elimination in the canton of Bern by 2030. METHODS: A preexisting Markov disease burden model was populated with data for Bern, and used to forecast the current and future prevalence of HCV, annual liver-related deaths (LRDs), and incidence of hepatocellular carcinoma and decompensated cirrhosis until 2030. Scenarios were developed to assess the current standard of care and potential long-term impact of the COVID-19 crisis on the HCV infected population. Additionally, potential scenarios for achieving the WHO 2030 targets and the SHS 2025 and 2030 targets (reduction of new cases of HCV, HCV-related mortality and viremic HCV cases) were identified. RESULTS: In 2019, there were an estimated 4,600 (95% UI: 3,330-4,940) viremic infections in the canton of Bern and 57% (n = 2,600) of viremic cases were diagnosed. This modelling forecasted a 10% increase in LRDs (28 in 2020 to 31 in 2030) with the current standard of care and a 50% increase in LRDs in a scenario assuming long-term delays. To achieve the WHO and SHS targets, the canton of Bern needs to increase the annual number of patients diagnosed (from 90 in 2019 to 250 per year in 2022-2024 [WHO], or 500 per year in 2022-2025 [SHS]) and treated (from 130 in 2019 to 340 per year in 2022-2024 [WHO] or 670 per year in 2022-2025 [SHS]). CONCLUSIONS: The SHS goals and the WHO targets for HCV elimination can be achieved in the Swiss canton of Bern by 2030; however, not at the current pace of screening, linkage to care and treatment.

Addressing Health Equity Goals for COVID-19 Vaccination Using Integrated Data and Mapping Tools: A Collaboration Between Academia, Public Health, and Health Care Systems in Columbus and Franklin County, Ohio.

CONTEXT: Data sharing between local health departments and health care systems is challenging during public health crises. In early 2021, the supply of COVID-19 vaccine was limited, vaccine appointments were difficult to schedule, and state health departments were using a phased approach to determine who was eligible to get the vaccine. PROGRAM: Multiple local health departments and health care systems with the capacity for mobile and pop-up vaccine clinics came together in Columbus and Franklin County, Ohio, with a common objective to coordinate where, when, and how to set up mobile/pop-up COVID-19 vaccine clinics. To support this objective, the Equity Mapping Tool, which is a set of integrated tools, workflows, and processes, was developed, implemented, and deployed in partnership with an academic institution. IMPLEMENTATION: The Equity Mapping Tool was designed after a rapid community engagement phase. Our analytical approaches were informed by community engagement activities, and we translated the Equity Mapping Tool for stakeholders, who typically do not share timely and granular data, to build capacity for data-enabled decision making. DISCUSSION: We discuss our observations related to the sustainability of the Equity Mapping Tool, lessons learned for public health scientists/practitioners, and future directions for extending the Equity Mapping Tool to other jurisdictions and public health crises.

Achieving Long-term Goals Amidst Uncertainty: An Integrative Model for the Psychological Resources of Grit.

This article proposes an integrative model for the psychological resources of grit. The growing body of work in nursing on the topic of grit indicates considerable interest in achieving long-term goals, especially amidst uncertainty from the COVID-19 pandemic. Motivational behaviors are thought to influence engagement in continuing education in nursing, thereby improving clinical practice and patient outcomes. The model was informed by a comprehensive review of the literature. Sixteen attributes for acquiring and strengthening four psychological resources of grit were identified. Each attribute is discussed along with interrelationships and implications for professional nursing development. Given the complex demands placed on health professionals, this model is both timely and relevant for all nurse and education providers interested in enhancing personal characteristics that may mitigate against stress and build capabilities for goal achievement. [J Contin Educ Nurs. 2022;53(8):355-363.].

Self-reported Treatment Goals in Chinese Patients with Inflammatory Bowel Disease During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Inflammatory bowel disease is a chronic recurrent disease, and the treatment goals of inflammatory bowel disease are mainly based on doctors' perspective, but there are some differences between the doctor's perspective and the patient's perspective. The aim of this study is to understand the treatment goals and the related factors from the patients' perspective during the coronavirus disease 2019 pandemic. METHODS: A total of 212 participants were recruited to fill out the questionnaires including clinical characteristics and treatment goals. Eleven treatment goals were measured by a Short-Form 34 questionnaire. Univariate and multivariate regression analyses were used to explore the related factors about these treatment goals. RESULTS: A total of 212 inflammatory bowel disease patients were enrolled in this study. The most concerned treatment goal was the improvement of quality of life (mean score was 8.54), while mean score of ulcerative colitis patients and Crohn's disease patients was 9.10 and 8.45, respectively. We had also found some related factors such as the type of disease, the course of disease, the frequency of hematochezia, and defecation. CONCLUSION: Our survey showed that inflammatory bowel disease patients pay more attention to the improvement of quality of life and few drugs during the coronavirus disease 2019 pandemic. There are some related factors such as the type of disease, the course of dis- ease, the frequency of hematochezia, and defecation. Our results help clinicians understand the patients' treatment goals, which can contribute to better management of inflammatory bowel disease patients.

Citizens' Use of eHealth Services During COVID-19 in Relation to National Policy Goals.

The main goals of the Swedish eHealth strategy are to enable citizens to achieve good and equal health and welfare, and to support self-determination and increased participation in society. We analyzed the relationship between these goals and the use of eHealth services offered for citizens prior to and during the COVID-19 pandemic. Data was collected through a national citizen survey issued in 2019 and 2021 to a sample size of 15.000 representative individuals each. Results showed that the use of eHealth services was highest in the 30-49 years age group and among respondents with high education. There were no major differences between respondents with high, medium, or low income, and neither between respondents with different degrees of self-perceived health, nor between native Swedish and non-Swedish respondents. Changes in use of different eHealth services over time were most probably related to the pandemic and are not significant. All age groups showed a similar relative increase regarding their use of eHealth services, except when searching the Internet for diagnosis and treatment where persons above 75 years of age had the largest increase. Most significant were the increase in online visits and the decrease in maintaining health, training, or food diaries. Strategic goals related to equity seem to be partly met as eHealth services are used to the same degree by different socio-economic groups. However, the older population uses eHealth services less than other age groups and a deeper understanding of the relationship between specific services and their impact on strategic goals is needed.

Trusting COVID-19 vaccines as individual and social goal.

Trust in vaccines and in the institutions responsible for their management is a key asset in the global response to the COVID-19 pandemic. By means of a structured multi-scales survey based on the socio-cognitive model of trust, this study investigates the interplay of institutional trust, confidence in COVID-19 vaccines, information habits, personal motivations, and background beliefs on the pandemic in determining willingness to vaccinate in a sample of Italian respondents (N = 4096). We observe substantial trust in public institutions and a strong vaccination intention. Theory-driven structural equation analysis revealed what factors act as important predictors of willingness to vaccinate: trust in vaccine manufacturers (which in turn is supported by trust in regulators), collectivist goals, self-perceived knowledgeability, reliance on traditional media for information gathering, and trust in institutional and scientific sources. In contrast, vaccine hesitancy, while confined to a minority, is more prominent in less educated and less affluent respondents. These findings can inform institutional decisions on vaccine communication and vaccination campaigns.