Healthcare Getting It Right : October 2022

Saturday, October 29, 2022

Women, adolescent and children healthcare

Attention to women, children and adolescent health remains noteworthy.

Global health attention [1] to women, adolescent and children health disparities is excellent. Reports are thorough and remove monotony as information is presented [2]. Additionally, recommendations are clear and achievable.

Primary care focus could include strengthened processes for credentials, training, facility construction, transportation and community health centers, complete with telehealth capabilities.
Reports could include specifics to funding strategies, both public-private and government funders.
Strategies could be outlined for food security and nutrition quality.
Priority organization across the country income ranges.

Creative strategies to attend to global health priorities while continuing liaison work with high income countries should be clear.
Global health involvement or liaison work with high-income, self-sufficient countries could examine current issues and opportunities. This work could then seek to prevent the same issues for developing countries down the line.

US national attention to women, children and adolescents is strikingly different from LMIC and other global health priorities. There are multiple US offices, associations and professional societies charged with management.

There are a lot of data sources regarding adolescent health [3] and there is a lot of research, advocacy and evaluation on the topic [4]. Health promotion and prevention recommendations for adolescents are grouped alongside the child population at the CDC [5].

It is unclear which organizations are taking the lead on national strategic plans, and it is unclear which organizations are taking the lead on policy development. This is especially true for physical fitness, health eating, dentistry and oral health, and mental health.
It is unclear how medical insurance and after school resources are being redesigned for adolescent health.
Data source comparisons and best paths forward are also confusing.
There is a lack of responsibility or designated tasking when major research reports reveal findings and make recommendations [6].
It is also unclear how research quality will be improved. This is especially significant, given the decades of repeated concerns over adolescent mental health, including military-connected youth. In fact, a recent literature review on behavioral health interventions found all the studies included to be of poor or fair methodological quality [7]. This should be embarrassing to research funders, research portfolio strategists and adolescent health strategy planners, yet there appears to be no gameplan forward.

Women’s health has dedicated offices and departments in the US. Morbidity and mortality data continues to improve through excellent initiatives [8].

It is unclear how the offices and departments are working together for streamlined assessment [9], evaluation and strategic planning across the US.
It is also unclear how women’s health experiences and satisfaction are factored into data improvement, particularly at a time when the US has made headlines for poorer experience compared to peer countries [10,11].
There is no roadmap for how physician leadership is invested in national strategic plans for women’s health improvement, across specialties. When reviewing the excellent ACP work on policy recommendations, social service responsibilities between primary care and community social service are absent [12]. Tangible, specific responsibilities within a national strategic plan could enhance effort.

Children’s health oversight is multi-faceted and multi-disciplinary. Despite the depth of strong programming, a few opportunities remain. They are not insurmountable and can be addressed.

Strategic agenda alignment between children’s health agencies, medical specialties and children’s welfare agendas [13,14,15,16,17, 18] is vague.
Alignment of data sources is opaque. Philanthropic and charitable contributions, as well as unpaid caregiver support, are not quantified.
Gaps in services or overlapping services of federal, state and local agencies are not publicly identified, nor acted upon.
Public satisfaction and experience with service navigation is also unclear.

Inclusion of the US military in women, children and adolescent health strategic plans is formally absent and informally intertwined. The US military has specific programs targeted toward children of military families [19] and some of these are addressed in some national organization resource pages. Additionally, civilian and military family comparisons continue to provide significant insight [20].

A national strategy should formally include children and adolescent health involving those in the US military. Overall, there is no strategic gameplan inclusive of military-connected children and adolescents.
A national strategy for women’s health must include active duty and military-involved women. Public health planning for women’s health services should seek this leadership at state and local levels as well. There is no strategic gameplan for women involved in the military, despite various departments and offices addressing the population.
Attention to children with special needs in the military should be a significant component to national efforts around special needs health equity.

The military has programs for children with special needs and disabilities. These departments may or may not be included in national organization messaging [21].
Special needs services for children of military families often use civilian healthcare. Civilian medicine may or may not be adequate for special needs children of active duty and reservist populations.
Outcomes and satisfaction comparisons are not available. Outcomes and satisfaction related to medical conditions that are not designated under special needs, yet require extra active duty or reservist time and resources, are unknown.

Recommendations to address military status as a component to pediatric healthcare should be decided upon and reimbursed accordingly. The American Academy of Pediatrics has made recommendations to best support children of military families [22,23]. How these recommendations have been adopted since 2019 are unclear. Any metrics to evaluate this effort is also unclear.

The basic three screening components, may or may not be reimbursed, including 1) establish a clinical process to identify children who are military connected and document it in the electronic medical record,2) take a thorough military history, including parental deployment history, relocation, and parental mental health, and 3) integrate an evidence-based behavioral and emotional rating scale in your practice to identify children who are at risk.
Pediatrician resources and conversations around military families are not measures. It is not clear if these conversations are happening, if pediatricians feel adequately trained and if they feel they have resources or referrals should they be asked.
There appears to be no mention of oral health and dentistry, despite known disparities between military and civilian oral health coverage.

Women, adolescent and child concepts of behavioral health and stress prevention, mitigation and resilience need organization to the research. This includes definition and implementation science clarity. It is no longer enough to have a small study taking up volunteer resource and time, with potential for interventions that may or may not be adopted by a wider healthcare system.
International research continues to inform on deployment and injury impact to families and children [24]. There could be better focus and efficiency to the research strategy.

References

Monday, October 24, 2022

Patient-centered cancer care

Patient-centered care continues to transform cancer care. Approaches include patients, family and community to help steer direction. Attention to this important perspective will continue to shape best practice and best health quality of life.

Global health encourages patient-centered cancer care delivery. Assessing the needs of those affected by cancer through the new WHO global survey [1] is really, really cool.

o The involvement of cancer organizations and country distribution would be helpful to understand.

o Supplementing this survey with WHO inclusion of country patient-centered outcome work would be very supportive. It does matter if cancer patients from one country are familiar with initiatives such as PCORI [2], while patients from another country may or may not have similar resources.

o Supplementing the WHO survey with country patient advocacy groups, as well as research support organizations, would be beneficial. The American Cancer Society’s inclusion and efforts for patients may or may not be modeled elsewhere. Simultaneously, there appears to be no measure or scoring system for volume and scope of patient advocacy organizations by country. Definitions of support, care coordination, patient navigation and translator services, caregiver relief, transportation and other support could be clear. Readability and access to internet resources could also be scored. The contrast between a family member or caregiver who accesses the NCI website [3] and those without internet access should be clear.

o Supporting global health patient-centered cancer care could include a WHO metric on healthcare cancer networks. Research networks, such as the National Cancer Institute, could be included, and patient-centered work in these networks could also be scored.

o Cancer registry and surveillance support could undergo a formal global health scoring system. Additionally, best practices for patient data submission could be assessed in surveys [4]. The more surveys a patient has to handle, the more unlikely a timely response. Why not just ask how they want to submit follow up data?

o Implementation of a country’s national cancer plans should be organized and scored. It is not enough to ask whether or not a country has a national cancer plan [5], though even that question would support the patient-centered assessment.

o The definitions of outcomes could include patient-centered outcomes, so that policy analysis can appropriately address quality of life alongside medicine’s traditional [6] outcomes.

Recent global health focus on the participation and experience of people living with NCDs (PLWNCDs) is helpful [7] toward cancer care improvement.

o The report by WHO is clear and broad, and it flexes on a future guided by PLWNCDs. This is smart, and it would equally smart to have the report appropriately written for the layperson. Average reading levels should be respected right from the start of PLWNCD initiatives.

o Culture of health practices, indigenous communities and marginalized and disenfranchised communities will undoubtedly receive focus. This is excellent. Efficient inclusion could see medical research and intellectual property components. Additionally, definitions and interpretations of medical components to cancer terminology should be very clear.

o A roadmap to PLWNCD leadership in patient-centered medicine must include a pathway to clinician diplomacy. At the end of the day, cancer, oncology, internal medicine and specialties require trained medical expertise to guide best medicine. Pathways to resolve patient and physician priority differences should include time and resources for open dialogue, and should have a footpath to follow.

o Representation in the cancer journey must be heard by industry (pharmaceutical, biomedicine and healthcare delivery). Policy and practice could be accompanied by gap analysis.

National work toward patient-centered cancer care is outstanding. To support this author’s personal belief that it is unmatched, examining US efforts and opportunities toward objective international comparison would be helpful. Additionally, objective comparison encourages collegial international improvement. Questions the United States can seek to respond to, in public spotlight with plain language, may include:

How has US leadership supported international cancer registry, surveillance and research work?
How has US patient-centered outcome research and patient-centered care coordination led alongside international peers?
Have financial setbacks, personal debt and suboptimal financial policies related to cancer expenses held US back from best practice leadership? If so, what have been the consequences and what are the recommendations?
How have non-traditional cancer components been overlooked? Inclusion of environmental components in basic health assessments, specialty medicine access or insurance assessments are ripe opportunities for medicine. Additionally, how have non-traditional medical components been incorporated into national cancer plans [8]?

o Specifically, where is the gap analyses between what individuals and communities are asking for, and what the US is responding to? These are not just EPA, water and sanitation and industrial issues. They are medical issues, and they are patient-centered care issues. They are issues in which we are expected to walk the walk.

US military and veteran [9,10] cancer care advances are outstanding.

When research indicate outcomes differences between civilian and military cancer care [11], questions should be anticipated. Questions on comparison accuracy, standardization and which agencies are tasked for analyses and improvement strategies across the civilian-military spectrum should be met with response.
How comparative outcome research incorporates health quality of life outcomes could be better organized.
The civilian-military partnership with cancer care improvement could be selected as a model use for other disease or specialty issue. Even if another model proves more effective, CQI could lead the way.
The responsible parties for tracking cancer care reimbursement payout by contracted civilian and military provider, or by contracted and military pharmacy plan, should create transparent reports.
Civilian physician and civilian health practitioner community preparedness should be clear. Who is responsible for gap analyses and follow through, and which responsibilities are led by major physician and hospital associations, should be clear. With continued contracting and collaboration.
Cancer-related medical debt, billing and co-pay differences between civilians and military members should be highlighted. The charitable and tax write-off comparisons between civilian, military and veteran cancer healthcare matter, and how is this leaned upon with federal and state budgets matters. Hospital and health management association leadership should be tasked with responsibilities to this issue.
How the NCI incorporates DoD and VA cancer research into national strategic plans around cancer should be understood. Alignment in major improvement initiatives, such as with disparity research and intervention [12], drives us forward further.

Cancer care resource need discrepancies and social service discrepancies between veterans and civilians should be clear. This includes a gap analysis that details charity organization work around cancer care and resource support (transportation, coordination, navigation) compared to reimbursed social service in healthcare.

Deployment and caregiving must be central to patient-centered care.

Caregiving and household definitions for active duty and reservists should be standard.
How deployment factors into cancer caregiving considerations is not mentioned in most cancer care reporting. There should be no laissez-faire indifference, nor disorganization, to deployment with cancer caregiving data, interventions and best practices.
Civilian healthcare must adapt deployment and caregiving considerations as a match to military cancer care. The longer civilian healthcare relies on connections to someone in military programs who can help, the longer the disorganization allows for inappropriate hot potato games with civilian healthcare responsibilities.
The main concerns and request denials experienced by active duty, reservist and veterans related to cancer or caregiving for cancer-related healthcare should be known. The interventions in place to address these concerns and denials, and how is improvement measured, should also be a measured expectation.

The question of how the military’s work with cancer diagnostics and treatments [13] translates to affordable medication for the tax-payer down the line should be asked again and again, until the public understands the very clear and simple path.

References

1. https://www.who.int/news/item/18-10-2022-who-launches-new-campaign-to-amplify-the-lived-experience-of-people-affected-by-cancer

2. https://www.pcori.org/topics/cancer

3. https://www.sciencedirect.com/science/article/abs/pii/S2213538321000230

4. https://onlinelibrary.wiley.com/doi/full/10.1002/jso.26977

5. https://www.sciencedirect.com/science/article/abs/pii/S1470204518306818

6. https://www.sciencedirect.com/science/article/abs/pii/S2213538321000230

7. https://www.who.int/publications/i/item/nothing-for-us-without-us-opportunities-for-meaningful-engagement-of-people-living-with-ncds

8. https://www.cancer.gov/about-nci/overview/strategic-planning

9. https://www.health.mil/News/Articles/2022/05/03/DOD-Cancer-Research-Program-Aims-to-End-Cancer-as-We-Know-It-Today

10. https://www.research.va.gov/topics/cancer.cfm

11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477614/

12. https://pubmed.ncbi.nlm.nih.gov/30207379/

13. https://www.health.mil/News/Articles/2021/07/14/Military-Medical-Research-Leads-to-18-New-Cancer-Drugs-other-Devices

Thursday, October 13, 2022

Global Health Aid

Keeping it simple, global aid work supports global health, and improvements to global aid support can positively impact global health. Because local, national, global and military involvement in global health are intertwined, improvement can be just as integrated.

Recent strategic dialogue discussions between the US and WHO are a step in the right direction [1].

Strategies for WHO plans and for partnering organizations could improve alignment. For example, what is the alignment between the USAID objective “to reduce child mortality to 20 or fewer deaths per 1,000 live births in every country by 2035”, WHO and HHS maternal and child health strategies, global health objectives and nonprofit goals [2] ?
Strategies for WHO and partnering organizations could coordinate health issues organized away from the global health branches. For example, when nutrition and child development are funded separately from global health, how are opportunities to create aligned strategic objectives[3] taken?

US global health aid is outlined in national budgets, and the USAID budgets and Congressional asks are outlined really well[4].

Congress should be expected to set expectations with US taxpayer dollars across agencies that distribute aid. Congress could expect that requests for aid be set in the context of total financial support or resource support for health or other issues. For example, how much is USAID budgeting for tuberculosis in the context of how much the US is supporting tuberculosis aid from all involved US government agencies?
Congress should request clear reports with standardized methods to estimate aid provided by the military, as part of the whole US aid distributed. For example, how are the resources involved with the Department of Defense’s Global Health Engagement programs, including medical ships, factored into any diplomatic agency or national agency’s global health aid budgeting?

Evaluations on global health efforts are driven. For example, the spotlight on US global health efforts often highlights USAID, and USAID evaluations on department work are detailed [5].

Expectations on evaluations should be set. What are the expectations set by funders and multi-agency planners, or by the government? What expectations have been set toward the partnering agencies, regarding evaluations or sustainable medical home development impact evaluations? Have evaluation templates been replicated and refined for multi-agency use?

Impact evaluation work is improving. USAID Impact Evaluation work is autonomous, and development assistance evaluations seek objective accuracy [6].

IE evaluations could be mirrored. The IE improvement recommendations should be shared with partner agencies, including international partners, for potential duplication and adoption. In other words, other nonprofit peers may also value impact evaluation improvement using similar models.
IE expectations could be tied to future funding or future collaboration.
IE expectations could be the location for rejection and denial reports. USAID and other global health response should include denied and rejected requests, so that we understand where taxes did not go. Duplication and inefficiency is global aid remain, and presenting what isn’t cared for helps improvement urgency.

Federal accountability should be expected with global aid.

A federal accounting for how much money and resource is spent, per health issue or per development issue across all agencies, should be produced. This report could include biomedical research development factors, and this report should include if other nonprofits are knowingly leaned on. It matters if the government is asked for health assistance and taps a private foundation on the shoulder instead.

The updated WHO program funding site is outstanding [7]. It is nice to know which countries contribute what resources to the World Health Organization.

A program area specific to laboratory safety, a program specific to international regulation harmonization, or a program specific to biomedical research standards could be considered for potential future inclusion.
A program area that better understands medical missions trips, including evidence based practices, equipment and pharmaceutical supply, cultural consideration and impact analysis, should be initiated. This department should seek clarification on what guidelines, rules and parameters medical missions are following when entering host countries. This department should also establish frameworks for analytics on medical home models and sustained practices after guest mission departure.

The US military supports global health with direct care, and this work is impactful.

How the US military’s global health work factors into global health analyses and reports, as well as in national and USAID strategies, should be accounted for [8].

References

Saturday, October 8, 2022

Mental and Behavioral Healthcare

Mental healthcare and behavioral healthcare continue in progress, despite serious gaps to healthcare delivery, daily well-being and quality of life metric inclusion. National and global steps in the right direction are appreciated.

I. The US continues to advance behavioral and mental healthcare. Questioning can help shape healthcare response, personal attention, and, if necessary, long-term planning. Quite frankly, delegating responsible organizations to respond to the questions would also spark responsive change.

The US continues to work with coverage and access to pharmaceutical and non-pharmaceutical interventions. What is the accurate picture around coverage and access to behavioral and mental healthcare (pharmaceutical and non-pharmaceutical) in the US? How is coverage and access by demographic and insurance status, how much is the out of pocket expense and what does the denial claim pool look like? Pertaining to lack of access for care, how are metrics around negative outcomes accumulated and analyzed? What are estimated costs associated with caregiving support or lack of transportation?
The US justice system is specifically tuned into prisons, jails and drug courts. Where are we, nationally, as a united front alongside clinicians, courts, law and law schools, advocacy groups and the health industry? What is the plan for incarceration and drug courts when behavioral health care is unavailable? With consensus from all these agencies, what is the national plan to measure and improve mental healthcare for the incarcerated? How will local jails and various jurisdictions be held to new healthcare plans?
What does public health need to better account for mental and behavioral health outside of current data systems, Medicaid and Medicare data and prescription metrics? How do counseling, NAMI efforts, encounters with law enforcement, prison health, drug court data, denials and unaccessed care factor into public health metrics? What are the plans for expanded stakeholders at the state public health planning table?
The US health system has sought to improve medication adherence for those with mental health and behavioral health diagnoses. Where is the ambulatory care and private clinician medication adherence piece with national quality groups?
How will academics, education, certification and reimbursement align for clear scope of practice borders across states and territories?
What is the recommendation for defining deliberate mental health injury related to the workplace, and what is the plan to hold employers accountable through labor law enforcement?
The US has excellent support through nonprofits. There are several major national mental health organizations that support advocacy, policy and research, including NAMI, Mental Health America, NIMH, SAMSHA. And, there are many national organizations that support clinicians with mental health and behavioral health resources [1].

It’s unclear how these organizations work together for cohesive, efficient planning, identification and interventions for gaps in research and healthcare delivery, despite clear messaging by each separately. Is there a plan to streamline and form consensus with unity?

The US has made space for clinician advocacy. Decision-making on psychiatry, psychology and other expert advocacy positions continues [2,3]. Physician and non-physician associations, hospital and acute care, ambulatory care, government and other stakeholders are at the table. How can these organizations address the advocacy with decisiveness? Would scope of practice and telehealth decisions be a decent start?
The national research agenda around mental health has focused on both brain and biological research as well as behavioral intervention. Recent NIMH, NIH, federal and private partnerships have been phenomenal in response to mental health research needs. How are private and nonprofit research institutions aligning so that the research portfolio strategy is most effective? How is quality of research supported through academia, publication and implementation science partners?
What is the national plan for primary care and mental healthcare integration in regards to physician training, referral metrics (wait times, distance, network), reimbursement, quality accreditation, data aggregation, electronic medical record build and out-of-pocket considerations? What is the gameplan for streamlined terminology, including health quality of life associated with behavioral health and including improved diagnostic coding?
What are the plans, if any, to address a behavioral health or emotional health metric alongside vital signs? We did so for pain, the ‘sixth’ vital sign. Why wouldn’t we ask about emotion or mental health?

II. The US Department of Defense, US Veterans Affairs and healthcare partners have been sincerely dedicated to improving behavioral and mental healthcare for service members. Civilian healthcare is connected and should increase partnership visibility.

The US military [4-7] and Veterans Affairs [8] offer substantial resources and care for mental health. Utilization, rerouting or navigation issues, wait times, denials, out-of-pocket pay, satisfaction and comparisons to contracted care and civilian healthcare are often discussed in literature. Labor and staffing are also sporadically reported on. Perhaps standards around performance measures tracked, a transparent dashboard for behavioral and mental health, or means to most up to date data, could be a shared civilian-military accountability.
Professional mental health nonprofits and veteran organizations offer continued mental health support, as well [9,10,11].How this support is funded, reimbursed and navigated belongs in military and veteran behavioral health analyses.

Research involving veteran and military service personnel involves behavioral and mental healthcare. There are thousands of small VA and other research studies on mental and behavioral health. Both the VA and the DHA allocate research funding to the topic. Third party commissioned reports offer excellent analyses of behavioral and mental components to veteran and military health and wellbeing [12-19] as well. Again, questions can help steer response and build long-term plans. Questions may include:

There are 678 reviews and systematic reviews on PubMed for “military + mental + health” and there are 1,192 for “veteran + mental + health” since 2001. How is funding tied to quality of research, and how is synthesis, meta-analysis and literature review assured? What is the gameplan for layperson translation of research, particularly when the research population is representative?
Once research recommendations have been made, what is the strategic NIH, VA, DoD and charitable contribution plan for a behavioral and mental health research gameplan?
There are 51 evidence-based synthesis reports involving keyword “mental” and 13 reports involving “behavioral” on the VA ESP list [20]. Some of these reports are not applicable to mental and behavioral health.

Some ESP reports, including suicide prevention strategies for veterans, are dated as far back as 2009. What is the criteria that requires an ESP update?
VA ESP reports seek good quality evidence when reviewing pertinent studies [21]. How does this compare with EQUATOR definitions of quality? How is research funded to ensure quality to current and future studies, so that research studies are usable and are not excluded from synthesis?
Neither VA ESP guidance nor any other evidence guidance create an automatic build for healthcare delivery. What is the internal process between the DoD, VA and civilian healthcare to ensure that all service members and veterans are provided behavioral and mental healthcare rooted in best practice? How is reimbursement matched? How are AMA, American Psychological Association, American Psychiatric Association, National Association of Social Workers (NASW) and other professional organizations participating in - and held to - these standards? How are contracted civilian healthcare providers ready with evidence-based guidance?

Once interventions and clinical guidelines have been set, who is ensuring DoD, VA and contracted civilian healthcare partnerships are meeting the criteria?
Where is the implementation science report on any recruitment screening and pre-deployment mental health recommendations yet to be implemented at the DoD? How can civilian healthcare and social support assist?
How have DoD and military courts aligned with US justice, including with drug courts? How have DoD and military prisons aligned with US prisons for mental health treatment?
What are the data sources that federal, state and local health oversight use for mental health statistics? Which data sources account for current or prior military service? How can surveys and data sources align to account for prior military service? How can data sources be designed to account for dishonorably discharged/other discharge with previous military experience?
Third party reports paid for by veteran charities and interested nonprofits provide detailed insight. How have NIH and partners examined this funding, so that space is made for future portfolio allocation? If it is unacceptable to federal research organizations, military leadership and taxpayers that charitable nonprofits are paying for RAND analysis [16] without any recommendation follow-up assurance, how can infrastructure step in? If it is unacceptable that national hospital, medical and social support organizations push research recommendations to the military instead of assuming ownership, who can assist in accountabilities?

III. The World Health Organization (WHO) has taken an outstanding lead in mental health. The 2020 WHO Mental Health Atlas is a great step forward [22]. We can best support this work.

Stakeholders should support by asking what funding is necessary to ensure consistent, expected Mental Health Atlas updates.

The 2022 WHO mental health report is comprehensive [23]. We can continue to support global mental health progress by addressing details. Some details for progress improvement could include:

Recommendations for coding improvements in healthcare billing, ICD, definitions and application around mental health.
Epidemiological improvements in data, including improved quality and improved methodology to account for cultural conceptualization of mental health disorders.
Improved streamlining of terminology. For example, heart disease and cancer have clear medical diagnoses across borders. Behavioral and mental health conditions should be afforded the same professionalism. Helpful standards would include training and education of the clinician, messaging from public health and authorities, and adherence to diagnostic coding.
Clarity on the strategic directions based on country income level. For example, 13% of the global population lives with mental health disorder and poverty disadvantage is a main risk examined by WHO. High income countries are demonstrating higher percentages on the report, without stratification to poverty level and without specific low and middle income country data gap acknowledgements. Clarity on where we are and where we want to be using country income level and poverty level within the country may assist.
Clarity to the gaps in mental health resources, services, information and governance listed. Is it possible to list how the gaps will be measured moving forward and who will assist in coordinated annual feedback?
Intervention and improvement monitoring of the three foci listed in the WHO plan.
How pharmaceutical access, coverage and research planning will include private and public stakeholders with consistency.
Strategic recommendations for policy analysis and policy implementation, including efficiency to research or modeling.
Acknowledgment of prison and drug use, and acknowledgement of special courts
Occupational Health and Safety review diligence [24,25]. The workplace component to the 2022 plan is strategic and wise.

How does military service factor into occupational health and safety in world health definition? What terminology will be used to include, not ignore, military service as an occupation vulnerable to mental health injury?
How would deliberate harm to mental health be defined, particularly for civilian occupational health, and how could that be worded?

References

Healthcare Getting It Right

Saturday, October 29, 2022

Women, adolescent and children healthcare

Monday, October 24, 2022

Patient-centered cancer care

Thursday, October 13, 2022

Global Health Aid

Saturday, October 8, 2022

Mental and Behavioral Healthcare

Malaria

Blog Archive