BACKGROUND & AIMS: BACKGROUND:Health systems globally promote appropriate prescribing by healthcare providers and safe and effective medicine use by consumers. Rx for Change, a publicly available database, provides access to systematic reviews regarding best practices for prescribing and using medicines. Despite the value of the database for improving prescribing and medicine use, its use remains suboptimal. This study aimed to develop a training program for five medicine-focused organisations in Canada and Australia to facilitate the use and understanding of the Rx for Change database. METHODS:Four steps were undertaken: 1) key informant interviews were completed across all organisations to understand the knowledge user perspective; 2) a directed content analysis was completed of the interview transcripts and proposed training was developed; 3) a second round of feedback on the proposed training by knowledge users was gathered; and 4) feedback was integrated to develop the final training. RESULTS:Sixteen key informant interviews with knowledge users were conducted. Themes for training content included the scope of, navigation and strategies for using Rx for Change (generic content) and practical examples on incorporating evidence within their workplace context (tailored content). The final training consisted of an informational video, a 60-minute face-to-face workshop and two post-training reminders. CONCLUSIONS:A method of engaging knowledge users in the development of a training program to improve the use of an on-line database of systematic reviews was established and used to design training. Next steps include the delivery and evaluation of the training.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Testing for HIV at birth has the potential to identify infants infected in utero, and allows for the possibility of beginning treatment immediately after birth; point of care (POC) testing allows rapid return of results and faster initiation on treatment for positive infants. Eswatini piloted birth testing in three public maternities for over 2 years. METHODS:In order to assess the acceptability of POC birth testing in the pilot sites in Eswatini, interviews were held with caregivers of HIV-exposed infants who were offered birth testing (N = 28), health care workers (N = 14), and policymakers (N = 10). Participants were purposively sampled. Interviews were held in English or SiSwati, and transcribed in English. Transcripts were coded by line, and content analysis and constant comparison were used to identify key themes for each respondent type. RESULTS:Responses were categorized into: knowledge, experience, opinions, barriers and challenges, facilitators, and suggestions to improve POC birth testing. Preliminary findings reveal that point of care birth testing has been very well received but challenges were raised. Most caregivers appreciated testing the newborns at birth and getting results quickly, since it reduced anxiety of waiting for several weeks. However, having a favorable experience with testing was linked to having supportive and informed family members and receiving a negative result. Caregivers did not fully understand the need for blood draws as opposed to tests with saliva, and expressed the fears of seeing their newborns in pain. They were specifically grateful for supportive nursing staff who respected their confidentiality. Health care workers expressed strong support for the program but commented on the high demand for testing, increased workload, difficulty with errors in the testing machine itself, and struggles to implement the program without sufficient staffing, especially on evenings and weekends when phlebotomists were not available. Policymakers noted that there have been challenges within the program of losing mothers to follow up after they leave hospital, and recommended stronger linkages to community groups. CONCLUSIONS:There is strong support for scale-up of POC birth testing, but countries should consider ways to optimize staffing and manage demand.

背景与目标：

BACKGROUND & AIMS: Many policy initiatives to increase health insurance coverage would subsidize employers to offer coverage or subsidize employees to participate in their employers' health plans. Using data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey, we contrast "low-wage employers" with all other employers. Employees in low-wage businesses have significantly worse access to employment-based insurance than other employees do; they are less likely to work for an employer that offers insurance, less likely to be eligible if working in a business that offers insurance, and less likely to be enrolled if eligible. Low-wage employers contribute lower shares of premiums and offer less generous benefits than other employers do. Policies that would target subsidies to selected employers to increase insurance offers to low-wage workers are difficult to design, however, because several commonly mentioned employer characteristics (including firm size) are found to be poor indicators of low-wage worker concentration. Programs that would set minimum standards for employer plans to be eligible for "buy-ins" need to base these standards on the less generous terms offered by low-wage employers in order to effectively reach low-wage workers and their dependents.

背景与目标： 许多增加健康保险覆盖面的政策举措将补贴雇主提供保险或补贴雇员参与其雇主的健康计划。使用1997罗伯特·伍德·约翰逊基金会雇主健康保险调查的数据，我们将 “低薪雇主” 与所有其他雇主进行了对比。低工资企业的员工获得就业保险的机会明显比其他员工差; 他们不太可能为提供保险的雇主工作，如果在提供保险的企业工作，他们不太可能有资格，如果符合条件，他们不太可能被录取。与其他雇主相比，低薪雇主贡献的保费份额较低，提供的福利也较低。但是，很难设计针对某些雇主的补贴以增加对低薪工人的保险优惠的政策，因为发现几种通常提到的雇主特征 (包括公司规模) 是低薪工人集中的不良指标。为有资格获得 “买入” 的雇主计划设定最低标准的计划需要将这些标准基于低薪雇主提供的不太慷慨的条款，以便有效地惠及低薪工人及其家属。

BACKGROUND & AIMS: BACKGROUND:Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. METHODS:We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. RESULTS:Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential 'gaming', and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI - including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for 'gaming the system'. Secondly, a tension between participants' own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants' personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. CONCLUSIONS:There are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions.

背景与目标：

BACKGROUND & AIMS: CONTEXT:Evidence to support government programs to improve public health often is weak. Recognition of this "knowledge gap" has led to calls for more and better evaluation, but decisions about priorities for evaluation also need to be addressed in regard to financial restraint. METHODS:Using England's Healthy Community Challenge Fund as a case study, this article presents a set of questions to stimulate and structure debate among researchers, funders, and policymakers and help make decisions about evaluation within and between complex public health interventions as they evolve from initial concept to dissemination of full-scale intervention packages. FINDINGS:This approach can be used to identify the types of knowledge that might be generated from any evaluation, given the strength of evidence available in response to each of five questions, and to support a more systematic consideration of resource allocation decisions, depending on the types of knowledge required. CONCLUSIONS:The principles of this approach may be generalizable, and should be tested and refined for other complex public health and wider social interventions.

背景与目标：

BACKGROUND & AIMS: :Galicia is an Autonomous Community located in the north-west of Spain. As a starting point to implement mitigation and adaptation measures to climate change, a regional greenhouse gas (GHG) inventory is needed. So far, the only regional GHG inventories available are limited to the territorial emissions of those production activities which are expected to cause major environmental degradation. An alternative approach has been followed here to quantify all the on-site (direct) and embodied (indirect) GHG emissions related to all Galician production and consumption activities. The carbon footprint (CF) was calculated following the territorial life cycle assessment (LCA) methodology for data collection, that combines bottom-up and top-down approaches. The most up-to-date statistical data and life cycle inventories available were used to compute all GHG emissions. This case study represents a leap of scale when compared to existing studies, thus addressing the issue of double counting, which arises when considering all the production activities of a large region. The CF of the consumption activities in Galicia is 17.8 ktCO2e/year, with 88% allocated to Galician inhabitants and 12% to tourist consumption. The proposed methodology also identifies the main important contributors to GHG emissions and shows where regional reduction efforts should be made. The major contributor to the CF of inhabitants is housing (32%), followed by food consumption (29%). Within the CF of tourist consumption, the share of transport is highest (59%), followed by housing (26%). The CF of Galician production reaches 34.9 MtCO2e/y, and its major contributor is electricity production (21%), followed by food manufacturing (19%). Our results have been compared to those reported for other regions, actions aimed at reducing GHG emissions have been proposed, and data gaps and limitations identified.

背景与目标： : 加利西亚是位于西班牙西北部的一个自治社区。作为实施缓解和适应气候变化措施的起点，需要区域温室气体 (GHG) 清单。迄今为止，唯一可用的区域温室气体清单仅限于那些预计会导致严重环境退化的生产活动的领土排放。这里采用了另一种方法来量化与所有加利西亚生产和消费活动有关的所有现场 (直接) 和体现 (间接) 温室气体排放。碳足迹 (CF) 是根据区域生命周期评估 (LCA) 方法进行数据收集的，该方法结合了自下而上和自上而下的方法。现有的最新统计数据和生命周期清单用于计算所有GHG排放量。与现有研究相比，该案例研究代表了规模的飞跃，从而解决了重复计算的问题，该问题是在考虑大区域的所有生产活动时出现的。加利西亚的消费活动的CF为17.8 ktCO2e/年，88% 分配给加利西亚居民，12% 分配给游客消费。拟议的方法还确定了温室气体排放的主要重要贡献者，并表明应在何处进行区域减排工作。居民CF的主要贡献者是住房 (32%)，其次是食物消费 (29%)。在游客消费的CF中，交通的份额最高 (59%)，其次是住房 (26%)。加利西亚生产的CF达到34.9 MtCO2e/y，其主要贡献者是电力生产 (21%)，其次是食品制造 (19%)。我们的结果已与其他区域报告的结果进行了比较，提出了旨在减少温室气体排放的行动，并确定了数据差距和局限性。

BACKGROUND & AIMS: INTRODUCTION AND AIM:Spiritual-care services and chaplaincy in the medical system are provided to people with serious illnesses, aiming to help them achieve moments of peace and acceptance while contending with illness or facing death. Chaplaincy has been available in Europe and in the U.S. for many decades, but such programs started to develop in Israel only few years ago. This paper examines the attitudes of stakeholders, directors and policymakers in the healthcare system towards the provision of spiritual care and the development of such programs. METHOD:We conducted in-depth face-to-face interviews with 16 individuals in the healthcare system. All the interviews were transcribed in full and analyzed using qualitative study methods. FINDINGS:Most of the interviewees had little knowledge of spiritual care and many mentioned barriers and challenges to its implementation in the healthcare system. These issues include: lack of knowledge and understanding about spiritual care precluding impeded their ability to evaluate its suitability for the healthcare services; confusion between spiritual care and religion; concerns about potential conflict with other professionals, especially social workers; barriers to funding of the new services; barriers to the successful integration of new ideas; and concerns about formal training and accreditation of the new profession. IMPLICATIONS FOR POLICY:Spiritual care has begun to take root in Israel's health system, but it is still at an early stage of development. Implementation must continue apace and careful consideration must be given to optimizing its acceptance by the establishment.

背景与目标：

BACKGROUND & AIMS: -2

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BACKGROUND & AIMS: BACKGROUND:Suboptimal prescribing and medications use is a problem for health systems globally. Systematic reviews are a comprehensive resource that can help guide evidence-informed decision-making and implementation of interventions addressing such issues; however, a barrier to the use of systematic reviews is their inaccessibility (due to both dispersion across journals and inaccessibility of content). Publicly available databases, such as Rx for Change, provide quick access to summaries of appraised systematic reviews of professional and consumer-oriented interventions to improve prescribing behaviour and appropriate medication use, and may help maximise the use of evidence to inform decisions. The present study aims to evaluate a training program to improve attitudes towards, confidence in skills, intentions to use, and use of systematic review evidence contained within Rx for Change. METHODS:Guided by the Knowledge to Action framework, a training program with content customised to local provider and consumer contexts was developed with knowledge user input. The training program consisted of a 6 minute information video, a 1 hour workshop with hands-on, interactive and didactic components, and two post-training reminders. Forty-nine people from five medicines-focused organisations in Canada and Australia attended one of six workshops. Participants were surveyed immediately pre and post and 3 months after training to evaluate their attitudes towards, confidence in skills, intentions to use, and use of Rx for Change, and attitudes towards and confidence in skills for using evidence for decision-making. Analyses for differences for each of the outcomes at three time points (pre, post and 3 months after training) was performed using a random effects model. RESULTS:Immediately post-training, there were higher respondent attitudes towards Rx for Change (mean increase = 0.54 out of 5, 95% CI, 0.18-0.83, P < 0.005); intention to use Rx for Change (0.53, 95% CI, 0.21-0.86, P < 0.005); confidence in skills for using Rx for Change (2.08, 95% CI, 1.74-2.42, P < 0.005); and confidence in skills for using evidence in policy decision-making (0.50, 95% CI, 0.22-0.77, P < .005) compared to pre-training. Confidence in skills for using both Rx for Change and evidence were maintained 3 months after training (both P < 0.005). CONCLUSIONS:Participants of this training program reported sustained improvements in their confidence in skills for using evidence in policy decision-making. This may have important implications for uptake of systematic review evidence promoting improved prescribing and medication use.

背景与目标：

BACKGROUND & AIMS: :The Seifu et al. article is a start to a timely inquiry on policymakers' perceptions of mathematical modeling and simulations aimed to guide obesity prevention programs. These computational tools have the potential to transform the fields of public health policy. Yet, to be effective, a broad Data and Information Literacy Initiative is needed to instill policymakers with the willingness to become life-long learners, to adapt and accept new technologies, attitudes, information, and creative ways of thinking.

背景与目标： : Seifu等人的文章是对决策者对旨在指导肥胖预防计划的数学建模和模拟的看法的及时调查的开始。这些计算工具具有改变公共卫生政策领域的潜力。然而，为了有效，需要一个广泛的数据和信息素养倡议，以灌输决策者成为终身学习者的意愿，以适应和接受新技术，态度，信息和创造性思维方式。

BACKGROUND & AIMS: :In Nigeria, the lack of adequate understanding of the complex nature of translating research into policy and the incompatibility existing between researchers and policymakers constitute a great challenge to evidence-informed policymaking. To address these challenges a one-day evidence-to-policy training workshop was organised for policymakers, researchers and other major stakeholders in the health sector in southeastern Nigeria. Of the 104 individuals invited to the workshop 87 (83.6%) attended. The workshop training sessions focused on capacity development for evidence-informed health policy-making and building effective linkages/partnerships. The post-workshop assessment indicated significant improvements in participants' knowledge, their understanding of the health policymaking process and the use of evidence compared to their pre-workshop status. Using a focus group discussion, major strategies identified by participants that can bridge the gap between health policymakers and researchers included: involving both parties in planning and execution of health research and health programmes; promoting dialogue between researchers and policymakers; institutionalising research grants and commissioning research in health ministries; and ensuring that researchers are made to focus on the core needs of policymakers. There is need for further discussion and debate on the researchers and policymakers partnership concept in low income settings.

背景与目标： : 在尼日利亚，对将研究转化为政策的复杂性缺乏足够的理解，以及研究人员和决策者之间存在的不兼容性，对循证决策构成了巨大挑战。为了应对这些挑战，为尼日利亚东南部卫生部门的决策者，研究人员和其他主要利益相关者组织了为期一天的证据到政策培训讲习班。在应邀参加研讨会的104个人中，有87 (83.6%) 人参加了会议。讲习班培训班的重点是为循证卫生政策制定和建立有效联系/伙伴关系的能力发展。讲习班后评估表明，与讲习班前的状况相比，参加者的知识，对卫生决策过程的理解以及证据的使用有了显着改善。通过重点小组讨论，与会者确定了可以弥合卫生政策制定者和研究人员之间差距的主要战略包括: 让双方参与卫生研究和卫生方案的规划和执行; 促进研究人员和政策制定者之间的对话; 将研究赠款制度化，并委托卫生部进行研究; 并确保研究人员专注于政策制定者的核心需求。需要就低收入环境下的研究人员和政策制定者伙伴关系概念进行进一步的讨论和辩论。

BACKGROUND & AIMS: :The General Agreement on Trade in Services (GATS), created under the auspices of the World Trade Organization, aims to regulate measures affecting international trade in services-including health services such as health insurance, hospital services, telemedicine, and acquisition of medical treatment abroad. The agreement has been the subject of great controversy, for it may affect the freedom with which countries can change the shape of their domestic health care systems. We explain the rationale behind the agreement and discuss its scope. We also address the major controversies surrounding the GATS and their implications for the U.S. health care system.

背景与目标： : 在世界贸易组织主持下制定的《服务贸易总协定》 (GATS) 旨在规范影响国际服务贸易的措施，包括健康保险，医院服务，远程医疗和在国外获得医疗等卫生服务。该协议一直是引起巨大争议的主题，因为它可能会影响各国改变其国内医疗保健系统形状的自由。我们解释协议背后的理由，并讨论其范围。我们还解决了围绕GATS的主要争议及其对美国医疗保健系统的影响。

BACKGROUND & AIMS: BACKGROUND:An intervention's success depends on how participants interact with it in local settings. Process evaluation examines these interactions, indicating why an intervention was or was not effective, and how it (and similar interventions) can be improved for better contextual fit. This is particularly important for innovative trials like Supporting Policy In health with Research: an Intervention Trial (SPIRIT), where causal mechanisms are poorly understood. SPIRIT was testing a multi-component intervention designed to increase the capacity of health policymakers to use research. METHODS:Our mixed-methods process evaluation sought to explain variation in observed process effects across the six agencies that participated in SPIRIT. Data collection included observations of intervention workshops (n = 59), purposively sampled interviews (n = 76) and participant feedback forms (n = 553). Using a realist approach, data was coded for context-mechanism-process effect configurations (retroductive analysis) by two authors. RESULTS:Intervention workshops were very well received. There was greater variation of views regarding other aspects of SPIRIT such as data collection, communication and the intervention's overall value. We identified nine inter-related mechanisms that were crucial for engaging participants in these policy settings: (1) Accepting the premise (agreeing with the study's assumptions); (2) Self-determination (participative choice); (3) The Value Proposition (seeing potential gain); (4) 'Getting good stuff' (identifying useful ideas, resources or connections); (5) Self-efficacy (believing 'we can do this!'); (6) Respect (feeling that SPIRIT understands and values one's work); (7) Confidence (believing in the study's integrity and validity); (8) Persuasive leadership (authentic and compelling advocacy from leaders); and (9) Strategic insider facilitation (local translation and mediation). These findings were used to develop tentative explanatory propositions and to revise the programme theory. CONCLUSION:This paper describes how SPIRIT functioned in six policy agencies, including why strategies that worked well in one site were less effective in others. Findings indicate a complex interaction between participants' perception of the intervention, shifting contextual factors, and the form that the intervention took in each site. Our propositions provide transferable lessons about contextualised areas of strength and weakness that may be useful in the development and implementation of similar studies.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In Nigeria, interest in the evidence-to-policy process is gaining momentum among policymakers involved in maternal, newborn and child health (MNCH). However, numerous gaps exist among policymakers on use of research evidence in policymaking. The objective of this study was to assess the perception of MNCH policymakers regarding their needs and the barriers and facilitators to use of research evidence in policymaking in Nigeria. METHODS:The study design was a cross-sectional assessment of perceptions undertaken during a national MNCH stakeholders' engagement event convened in Abuja, Nigeria. A questionnaire designed to assess participants' perceptions was administered in person. Group consultations were also held, which centred on policymakers' evidence-to-policy needs to enhance the use of evidence in policymaking. RESULTS:A total of 40 participants completed the questionnaire and participated in the group consultations. According to the respondents, the main barriers to evidence use in MNCH policymaking include inadequate capacity of organisations to conduct policy-relevant research; inadequate budgetary allocation for policy-relevant research; policymakers' indifference to research evidence; poor dissemination of research evidence to policymakers; and lack of interaction fora between researchers and policymakers. The main facilitators of use of research evidence for policymaking in MNCH, as perceived by the respondents, include capacity building for policymakers on use of research evidence in policy formulation; appropriate dissemination of research findings to relevant stakeholders; involving policymakers in research design and execution; and allowing policymakers' needs to drive research. The main ways identified to promote policymakers' use of evidence for policymaking included improving policymakers' skills in information and communication technology, data use, analysis, communication and advocacy. CONCLUSION:To improve the use of research evidence in policymaking in Nigeria, there is a need to establish mechanisms that will facilitate the movement from evidence to policy and address the needs identified by policymakers. It is also imperative to improve organisational initiatives that facilitate use of research evidence for policymaking.

背景与目标：

BACKGROUND & AIMS: :Patient advocacy groups play an important role in supporting patients with chronic diseases and promoting better care. The aim of this patient-physician initiative was to gather perceptions from European idiopathic pulmonary fibrosis (IPF) patient advocacy groups regarding inequalities and unmet needs in IPF care, in order to develop a Patient Charter to advocate for better care.In total, 11 European patient advocacy groups were interviewed regarding the care of patients with IPF in their countries. Interview feedback was presented to a Working Group including patient advocacy group representatives and IPF specialists; key areas of agreement were developed into the European IPF Patient Charter.The interviews identified five key themes that fed into the final Charter: the need for improved diagnosis, treatment access, holistic care, disease awareness and palliative care. The final Charter was endorsed by patient advocacy groups and presented to 26 Members of the European Parliament in September 2014. It has received >8900 signatures to date.This patient-physician initiative highlights the inequalities and unmet needs in IPF care across Europe, and demonstrates how this insight can inform the development of a Patient Charter, designed as a call to action for healthcare policymakers to drive improvement in European IPF care.

背景与目标： : 患者倡导团体在支持慢性病患者和促进更好的护理方面发挥着重要作用。这项患者-医生倡议的目的是收集欧洲特发性肺纤维化 (IPF) 患者倡导团体对IPF护理中的不平等和未满足的需求的看法，以便制定一项患者宪章来倡导更好的护理。总的来说，11个欧洲患者倡导团体接受了有关其国家IPF患者护理的采访。采访反馈被提交给包括患者倡导小组代表和IPF专家在内的工作组; 协议的关键领域被纳入《欧洲IPF患者宪章》。访谈确定了纳入最终宪章的五个关键主题: 改善诊断的需求，治疗机会，整体护理，疾病意识和姑息治疗。最终宪章得到了患者倡导团体的认可，并提交给了2014年9月欧洲议会的26名成员。迄今为止，它已收到> 8900个签名。该患者-医生倡议突出了欧洲IPF护理中的不平等和未满足的需求，并展示了这种见解如何为制定患者章程提供信息，该章程旨在呼吁医疗保健政策制定者采取行动，以推动欧洲IPF护理的改善。