Choosing indicators to evaluate Healthy Cities projects: a political task?

Ever since their beginning in 1986, Healthy Cities projects all over the world have been confronted with the issue of evaluation. However, after 20 years, many key dilemmas constantly reappear, people often looking for a kind of 'magic' list of universally applicable indicators to evaluate these initiatives. In this article we address five questions, allowing to illustrate the evaluative dilemmas the Healthy Communities movement is confronted with: Why evaluate Healthy Cities? What should be evaluated? Evaluate for who? Who should undertake the evaluation? How should the evaluation be performed? We conclude by formulating three recommendations in order to stimulate exchanges and debate. Our argument is based on a recent thorough analysis of the evaluative literature pertaining to the Healthy Cities movement, as well as on two decades of reflection on and involvement with this issue locally, nationally and internationally.     

Caring for the infirm: a task for the individual or for a social insurance programme?

In West Germany, seventy per cent of all nursing home patients receive only a pocket-money, for social health insurances are responsible only for the care of "sick" people, but not of those needing only "care". The infirm individual, however, rarely can pay for the costs of nursing homes out of his own revenue. Despite general agreement that guarding against the financial risks of becoming dependent on nursing is insufficient there is little consensus on what a new concept should look like. Some proposals are more concerned with avoiding cost-expansion than with effective health care. On the one hand, the implementation of a new branch in the social insurance system, called "nursing insurance", is demanded, which would pay for the stay in nursing homes. On the other hand, it is emphasized that the capacity for voluntary individual provision should be strengthened as well as the families' means to care for their bedridden members. This paper presents the discussion and outlines implications for health care of the various proposals.     

Does mode of administration matter? Comparison of online and face-to-face administration of a time trade-off task

Purpose  

Developments in electronic data collection methods have allowed researchers to generate larger datasets at lower costs, but relatively little is known about the comparative performance of the new methods. This paper considers the comparability of two modes of administration (face-to-face and remote electronic) for the time trade-off.     

Cooking task assessment in frail older adults: who performed better at home and in the clinic?

Abstract

Aim: The purpose of this study was to determine: (i) the proportion of frail older adults who demonstrate (a) statistically significant and (b) clinically meaningful differences between home and clinic cooking task performance; and (ii) factors associated with a better performance in each environment. Methods:Thirty-seven participants were evaluated with the Assessment of Motor and Process Skills (AMPS) in home and clinic environments using a counterbalanced design. Demographic, physical, cognitive, psychological, and environmental characteristics were also collected. Results:Thirty-three participants were retained for analysis. A statistically significant difference (> ±2 standard errors of measurement) between environments was found in 33% of the participants on the motor scale and the same proportion on the process scale. A clinically meaningful difference (based on cut-off scores predicting need for assistance) was noted in 30% of the participants. Better performance at home on the process scale was associated with a decrease in some executive functions, while better performance in the clinic on the motor scale was mostly related to a decline in grip strength. Conclusions:Our findings may help occupational therapists identify frail patients for whom home assessments would be advisable prior to discharge so that assistance provided meets their needs at home.     

Alzheimer’s disease therapeutic trials: EU/US task force report on recruitment, retention, and methodology

While we may not be able to find a cure for Alzheimer's disease (AD) in the near future, several drugs presently in trials have shown promise as possible modifiers of disease progression. However, we may not be able to demonstrate efficacy due to issues of recruitment, retention, site-to-site variability, and other methodological issues. It is thus incumbent on the scientific community to find solutions to these problems, particularly as the field moves toward preventing illness or treating the disease in its prodromal stages, where these methodological issues will become even more critical. We need to better understand why participants agree or refuse to enter drug trials, and why both primary care physicians and Alzheimer's specialists agree or refuse to involve their patients. We also need to quantify the impact of requiring imaging studies, extensive questionnaires, cognitive testing, and lumbar punctures on recruitment and retention. With these concerns in mind, an international task force meeting of experts from academia and industry in the United States, European Union, and Japan in San Diego, California on November 2, 2011 to focus on recruitment, retention and other methodological issues related to clinical trials for AD. Based on the recommendations of this Task force meeting, this Perspectives article critically reflects on the most critical and timely methodological issues related to recruitment and retention in prevention and therapeutic trials in AD, which are paralleled by a paradigm shift in the diagnostic conceptualization of this disease, as reflected by recently new proposed diagnostic criteria involving preclinical stages of the disease.     

Learning to use minimal access surgical instruments and 2-dimensional remote visual feedback: how difficult is the task for novices?

Performing minimal access surgery requires the use of 2-dimensional information to produce 3-dimensional movements, as well as precise motor control for manipulating laparoscopic tools. The added visuomotor demands of this task make it more demanding and complex than traditional open surgery. The purpose of this study was to determine the relative task difficulty of performing laparoscopic tool movements with normal vision or `laparoscopic vision' provided by a remote 2-D monitor. A second purpose of this study was to evaluate whether movement performance changes are induced by practice with normal vision (NV) and laparoscopic vision (LV). The study was also designed to determine whether order of visual condition (NV or LV) practice impacts the rate of performance acquisition when transferred to the opposing visual condition. Eleven individuals participated in this study. All subjects performed a bean grasping and a suturing task in two visual conditions: normal vision and laparoscopic vision. Results revealed that laparoscopic tools themselves do not appear to be problematic in performing minimal access surgery. Furthermore, performance ability in normal vision does not positively transfer to performance when switched to a laparoscopic vision condition. The 2-dimensional video does appear to be problematic for skill acquisition, as performance levels decreased as complexity of the task increased. This revised version was published online in June 2006 with corrections to the Cover Date.     

It’s hard work,but it’s worth it: the task of keeping children adherent to isoniazid preventive therapy

Setting:

Isoniazid preventive therapy (IPT) offers children protection against tuberculosis (TB), but it has been difficult to implement, particularly in developing countries.

Objective:

To understand what encourages or inhibits children from adhering to IPT.

Design:

In-depth interviews were conducted with two parents of children adherent to IPT and two staff members from three primary health care clinics in high TB prevalence communities. Themes explored were knowledge and attitudes towards IPT, problems in accessing and adhering to treatment, and community responses.

Results:

Parents administering treatment valued it positively, realised their children’s risk of TB, and were positive about the clinic. Nurses acknowledged that resistance to treatment remained, with some parents not wanting to acknowledge risk nor willing to make the effort for their children; there was also considerable misinformation about IPT. Clinic nurses acknowledged problems of staff shortages, lengthy waiting times and conflict between staff and community members. Adherence was affected by social problems, stigma about TB and its link to the human immunodeficiency virus, and the extended treatment period.

Conclusion:

Parents who maintained adherence to the IPT regimen showed that it was possible even in very difficult circumstances. Further effort is required to improve some of the clinic services, correct misinformation, reduce stigma and provide support to parents.     

Identification of health problems at 18 months of age – a task for physicians or child health nurses?

BACKGROUND: Several studies have questioned the rationality of repeated routine health examinations by physicians during the first years of life. The aim of the present study was to evaluate the population-based 18-month health examination and compare the yield of new health problems identified by physicians in 1994 with the yield identified by child health centre (CHC) nurses in 2000. METHODS: Two populations of children were invited to their 18-month health examination during one year, the first in 1994 and the second in 2000. In 1994 the population consisted of 4075 and in 2000 of 2968 children who were registered in Uppsala county, Sweden, for census purposes in December 31 each year. Data from a county health register as well as child health records and information regarding referrals were analysed to categorize the health problems by type, severity and action taken. RESULTS: On the whole few new verified health problems were detected by the health examinations at the 18 month health examinations: 2.3% in 1994 and 1.7% in 2000. In 1994, when the physicians carried out the examinations, the most common health problems were somatic problems, particularly moderate transient infections. In 2000, when the nurses carried out the examinations, the dominant problems were speech problems. Peculiarly enough a couple of children with the same severe health problems, gluten allergy and problems in the autistic spectrum, were identified both in 1994 and in 2000. In addition the nurses in 2000 identified seven children with severe speech problems. No additional severe health problems were identified by the physicians in 1994. CONCLUSIONS: According to the present study, there is no evidence that health examinations carried out by nurses are of lower quality in detecting health problems than those carried out by physicians. The organization and content of the health surveillance programme ought to be reconsidered with respect to available resources and importance of the close relationship established between nurse and family already in the newborn period.     

The effect of a single dose of multivitamin and mineral combinations with and without guaraná on functional brain activity during a continuous performance task

Objectives: Relatively few studies have explored the possibility of acute cognitive effects of multivitamin ingestion. This report explores the acute brain electrophysiological changes associated with multivitamin and mineral supplementation, with and without guaraná, using the steady-state visually evoked potential (SSVEP).

Methods: Based on the known SSVEP correlates of A-X continuous performance task (CPT) performance, and sensitivity to acute psychopharmacological manipulations, the A-X CPT was adopted as a task paradigm to explore treatment-related neurophysiological changes in attentional processing. Twenty healthy non-smoking adults aged 21–39 years (mean age = 28.35 years, SD = 5.52) took part in this double-blind, placebo-controlled, randomized, balanced crossover design study.

Results: The study demonstrated both transient and tonic changes in the SSVEP response during completion of the A-X CPT following multivitamin and mineral treatment both with and without guaraná. Transient changes in SSVEP response in prefrontal regions were observed after a single dose of a multivitamin and mineral preparation indicative of enhanced activity within brain regions engaged by the attentional demands of the task. This pattern of change in frontal regions was correlated with improved behavioural performance after treatment with the multivitamin and mineral combination. Where tonic shifts in SSVEP response were investigated, multivitamin and mineral treatment was associated with a pattern of increased inhibition across posterior regions, with enhanced excitatory processing in prefrontal regions. In contrast, multivitamin and mineral treatment with additional guaraná showed a tonic shift towards greater excitatory processes after a single treatment, consistent with the caffeine content of this treatment.

Discussion: While preliminary in nature, these findings suggest a single multivitamin/mineral dose is sufficient to impact on functional brain activity in task-related brain regions.     

Bridging the gap in health inequalities with the help of health trainers: a realistic task in hostile environments? A short report for debate

BACKGROUND: From a public health theoretical perspective, there is acknowledgement that synchronized policies, which address both individual and area level risks to health, are important to reduce inequalities and improve health. Despite this, much research focuses on just one of these two approaches (often pitting them against each other) and much practice tends to focus on individual level interventions. Efforts to address health inequalities between rich and poor in the UK continue to focus on individual-based interventions, with the most recent initiative being health trainers. METHODS: In this debate piece, we will use health trainers as a specific example, and focusing primarily on levels of physical activity, we will argue that neither individual level interventions nor environmental change alone are likely to improve levels of activity or reduce health inequalities. CONCLUSIONS: We argue that synchronized policies that tackle both individual and neighbourhood environmental barriers to improving health behaviours are essential.