Delivery of health informatics education and training

An overview is provided of education and training in health information management in the context of national information strategies. Although the article focuses upon British programmes, there are examples from North America, Australasia and other countries. Reference is made to international activities in the development of generic courses for education and training, the need for education and training, the content of courses, and methods of delivery, including Internet-based training and education. Governments and health authorities in many countries have recognized the urgent need for a highly educated and trained workforce in information management, but universities have been slow to respond, until the last few years. However, there is now a plethora of education and training programmes in North America, most European countries, and Australasia.     

Pervasive Heavy Alcohol Use and Correlates of Increasing Levels of Binge Drinking among Men Who Have Sex with Men,San Francisco, 2011

Heavy episodic drinking, “binge drinking”, is highly prevalent among men who have sex with men (MSM) and is associated with sexual risk behaviors and HIV seroconversion in this population. We characterized the magnitude of binge drinking and explored correlates of increasing levels of binge drinking among MSM in San Francisco. In this study, 67 % of MSM reported binge drinking in the prior year. The mean number of drinking days in the past month was 11.6. On average, we estimate that 2,699,372 drinks are consumed by MSM in San Francisco every month. Increasing levels of binge drinking was independently associated with younger age, modest income, being born in the United States, never accessing alcohol treatment and reporting unprotected insertive anal intercourse. Our findings underscore the need to target effective strategies to address heavy alcohol consumption and highlight the urgent need to develop novel interventions beyond traditional alcohol treatment settings among MSM.     

Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil,Peru and the United Republic of Tanzania.

OBJECTIVE: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. METHODS: We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years. FINDINGS: In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied. CONCLUSION: Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most.     

Parenting Programmes: The Best Available Evidence

Parenting programmes have been provided to a wide range of child and parent groups across a number of countries, but are they effective? This aim of this paper is to examine the findings from a number of systematic reviews that summarise the best available research evidence on the impact of these programmes on a range of parental and child outcomes. In addition to examining the findings from systematic reviews, the paper also takes a selective look at the uptake of parenting programmes in the United Kingdom, the evidence for effectiveness and the efficacy of adopting a population‐based approach to parent education.

The findings from systematic reviews indicate that parenting programmes can have a positive impact on a range of outcomes, including improved child behaviour, increased maternal self‐esteem and relationship adjustment, improved mother–child interaction and knowledge and decreased maternal depression and stress. While there is a need for greater evaluation of the long‐term impact of these programmes, preliminary evidence indicates that these positive results are maintained over time, with group‐based, behaviourally orientated programmes tending to be more effective.

While several recent trials indicate that that these programmes can be effective within the United Kingdom, high drop‐out rates may mean that they only reach a minority of parents. However, multi‐level parent education strategies such as the Australian Triple P Positive Parenting Strategy that incorporate an array of mediums aimed at different levels of need may provide an opportunity to reach a wider range of parents. This approach is currently being evaluated in order to ascertain whether it is effective in improving child outcomes in the general population.

While there is no coherent strategy for parent training across the United Kingdom, within the Northern Ireland context there is a move towards the development of a family support strategy. While uptake of parent education and training is currently unknown the best available evidence highlights the positive impact that parent training can have, suggesting the importance of including parent education as one aspect of this strategy.     

INVITED REVIEW: MANAGEMENT OF ALCOHOL PROBLEMS: THE ROLE OF THE GENERAL PRACTITIONER

Some 23% of men and 8% of women in the United Kingdom are consumingalcohol at levels that are of risk to their health, or are experiencingsome problems related to their alcohol use. Traditionally, generalpractitioner efforts have focused on diagnosing and treatingpatients with a substantial history of dependence, and relativelylittle attention has been given to early intervention, withat-risk drinkers identified in general practice through screeningor case finding programmes. Evidence indicates that early interventionsby general practitioners are effective in reducing alcohol consumptionamong at-risk patients. Further work is still needed on themost effective ways of supporting general practitioners in thistask.     

WHO Guide for standardisation of economic evaluations of immunization programmes

Traditional EPI vaccines are considered to be among the most efficient uses of scarce health care resources. Today, there are many under-used and new vaccines available. In the short- to medium-term, these vaccines will not cost the few cents per dose the traditional vaccines do, but will be ‘multi-dollar’ vaccines. Decision-makers will need information, among other things, on their relative cost-effectiveness. A number of reviews have indicated that there is scope for improving the transparency, completeness and comparability of economic evaluations of vaccination programmes. Thus, there is a need to improve the quality of economic evaluations of vaccination programmes. Adherence to general guidelines would increase the quality, interpretability and transferability of future analyses. However, there is reason to believe that there might also be a need for more specific advice for vaccination programmes. For example, there are inconsistencies in the methods used to estimate the future benefits of vaccination programmes and the relative efficiency of these programmes can be sensitive to some of the more controversial aspects of general guidelines, such as the inclusion of indirect costs and the discounting of health outcomes. This guide has been developed in order to meet the needs of decision-makers for relevant, reliable and consistent economic information. They aim to provide clear and concise, practical and high quality guidance for those who conduct economic evaluations.     

Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist--a UK perspective

Improved clinical outcome, patient safety, cost savings and a reduction in the burden of antimicrobial resistance are outcomes associated with optimizing antimicrobial use. Despite this, the misuse of antimicrobials in the hospital setting remains a huge problem. The development of antimicrobial management teams and the promotion of the role of the clinical pharmacist in antimicrobial prescribing are recommended strategies for improving prescribing practice. It is recognized that there is a lack of published evidence-based research looking at the effects of antimicrobial control programmes and there is a need for more data. In the UK, the role of the hospital pharmacist in promoting responsible antimicrobial prescribing has been largely undervalued and needs to be encouraged and formalized in line with current directives. Managerial structures within hospitals need to endorse multidisciplinary antimicrobial management schemes with appropriate authoritative, administrative and information technology support.     

Primary schoolchildrens' perceptions of smoking: implications for health education.

This paper suggests that there is a need, as early as Reception, to implement smoking intervention programmes in the local school curriculum. Findings from a cross-sectional study have shown that primary schoolchildren (4-8 years old) possess negative attitudes and beliefs about smoking, have as yet to establish regular patterns of smoking behaviour, and have a broad understanding of the nature of smoking. Health educators need to capitalize on this negative disposition toward smoking via early intervention; however, to date, there are no smoking-specific health education measures for this age group. The implementation of proactive programmes, before the habit manifests itself, has many supporters but little research has been conducted. This study was devised to fill this significant gap in the literature on smoking. Data was collected on a representative sample of primary schoolchildren in the city of Liverpool. A triangular methodology was adopted consisting of questionnaires (N = 1701), the Draw and Write investigative technique (N = 976), and semi-structured interviews (N = 50). The results highlight the need to implement smoking intervention programmes from Reception onward, the importance of developing a model that is more than just knowledge based and the necessity of involving the family in any school-based health education strategies.     

Equality and difference: persisting historical themes in health and alcohol policies affecting Indigenous Australians

Disseminating national health and alcohol policies to Aboriginal and Torres Strait Islander people in Australia has been a challenging task for governments and public servants. This has been for a number of reasons, including the enduring (negative) legacy of past "Aboriginal affairs" policies, the fact that Indigenous health programmes and alcohol programmes have been treated separately since the 1970s, and a more recent context in which the recognition of cultural difference was privileged. Confronted with the politics of difference, health departments were slow to examine avenues through which best practice advice emanating from WHO, and alcohol policies such as harm minimisation and early identification and treatment in primary health care, could be communicated in culturally recognisable ways to independent Indigenous services. In addition, there was hostility towards harm minimisation policies from Indigenous service providers, and Indigenous treatment programmes remained largely committed to abstinence-oriented modalities and the disease model of alcoholism, despite moves away from these approaches in the mainstream. However, genuinely innovative acute interventions and environmental controls over alcohol have been developed by Indigenous community-based organisations, approaches that are reinforced by international policy research evidence.     

Secondary prevention: an approach to improve the German drug abuse prevention system

Drug prevention in Germany traditionally focuses on primary prevention programmes for children without any drug experience. Only a few programmes have been specifically developed for drug-taking youth, although especially children and adolescents at high risk for drug problems need intervention services which provide helpful support to reduce drug misuse. Empirical studies in two German cities show that prevention services are not available for the high-risk population of drug-taking youth. On an international level several projects are testing out new approaches for drug use prevention for at-risk youth. The primary goal of such secondary prevention programmes is to reduce the incidence and prevalence of drug use and abuse through early detection and intervention strategies. These programmes aim at preventing adolescents who are experimenting with drugs from progressing to misuse or addiction. Testing new prevention strategies to support drug-taking youth in Germany is likely to produce a valuable contribution to our knowledge of effective drug prevention.     

Are support and parenting programmes of value for teenage parents? Who should provide them and what are the main goals?

OBJECTIVE: To review the evidence on what works in teenage parent support programmes; to determine the key elements of successful teenage parent support and parenting programmes; and to determine the gaps in the evidence. METHODS: Databases were searched, using a specific search strategy, for systematic reviews and randomised controlled trials, to ascertain whether social support, parenting programmes, or both, are effective in improving maternal or infant outcomes. The findings were summarized. RESULTS: Only one systematic review specifically addressed interventions among teenage parents and their children, although several randomised trials have since been published. CONCLUSIONS: Key questions remain for future support and parenting programmes. Social support and parenting interventions improve maternal-child interactions and child cognitive development, but do not reduce low-birth weight, stillbirth or neonatal death. Social support and parenting programmes need to be combined with measures to increase the minimum income, reduce smoking in pregnancy and increase breast-feeding rates. Robust evaluations of packages of care in the UK are needed to inform national and local teenage pregnancy strategies.     

Health promotion in the occupational setting: what are the prospects in the Italian situation?

Over the past decades advances in sciences and medicine have improved living and health conditions and lengthened life expectancy. These benefits are associated with an increase in prevalence of chronic degenerative diseases. With their multi-factorial aetiology these diseases are influenced by life styles and personal habits and require prolonged medical care and high social costs. Now days health is no longer considered as the absence of disease but a state of mental, physical and social well-being. The World Health Organization has defined health promotion as "the process of enabling people to increase control over and to improve health". Since the 70s in the USA many health promotion programmes have been proposed, especially by large corporations, in order to ensure a more efficient, productive and motivated work-force, to reduce health insurance costs and to provide a better company image. Workplaces,--particularly when the working population is relatively stable--are excellent areas for health promotion programmes because workers can be monitored over a long period of time. The most successful programmes are aimed at modifying behaviour in risk patterns (smoking, alcohol abuse, eating disorders, etc.) through information, active participation, screening, follow-up, personalized programmes, changes in the working environment, physical exercise programmes. These health promotion programmes are extremely hard to develop for Italian workers. Most firms are small or very small and much still remains to be done to eliminate well-known occupational risk factors. The current flexibility of modern work patterns could constitute a further obstacle.     

Debate. Public discourse on alcohol

There are many and varied voices in the public discourse on alcohol: those of the public health interests; those of the vested interest groups; and those of the media themselves. The concerns of those in the field of public health are to prevent any increase and, where possible, reduce the harms which are experienced from alcohol use. Occupying a somewhat different position in the public discourse are the voices of the distributors and producers of alcohol. While there is some shared concern about the adverse consequences of alcohol use, the primary interest of these groups is to protect the return on the investment of their shareholders. Among those with a stake in alcohol industry profits, there is a reluctance to accept the use of public policies which have a direct impact on overall consumption and drinking behaviour. The preference of the vested interest groups is that the public discourse be aimed at informing and persuading the individual drinker (and future drinker) to behave in a certain way. These groups want the role of the public health interests to the use of educational programmes, while at the same time utilising the mass media to inform and persuade in the form of direct and indirect advertising campaigns which promote the use of alcohol. Other aspects of the public discourse on alcohol are disseminated in the entertainment, news and editorial pages of newspapers and content of television programmes. Here too there are conflicting messages about alcohol, with coverage of the public health issues being juxtaposed alongside the perspectives of the alcohol producers and distributors and other vested interest groups such as the advertising industry. The media are key players in the public discourse on alcohol. Alcohol policy issues have long been hotly contested and in the 1990s much of the debate is shaped by the portrayal of alcohol and alcohol policy in the mass media. There has always been a considerable imbalance between the resources available for the promotion of alcohol use and those to moderate it, and it is concluded that access to the mass media by public health voices is essential if public health goals are to be achieved.     

Alcohol use in China

AIMS: Over recent decades there has been a striking increase in alcohol consumption and related problems in China. As China holds over 22% of the world's population this has a significant potential impact on world health. Here we review English- and Chinese-language publications on the prevalence of alcohol consumption and related problems in China, and treatment and control measures to reduce these. METHODS: Medline search 1976-2002 and search of the China National Knowledge Infrastructure database 1996-2002. RESULTS: While alcohol is a traditional part of Chinese life, commercial alcohol production in China has increased more than 50-fold per capita since 1952. In parallel there is evidence of a marked increase in prevalence of alcohol dependence, which has moved from the ninth to the third most prevalent mental illness. The public health response to increase in alcohol-related disorders has commenced but is in need of further development. CONCLUSIONS: There is a need for increased policies and public health programmes to reduce alcohol related harm, and evaluation of outpatient treatment potential.     

Development of national animal genetic resource programs

Globally, animal genetic resources are contracting due to economic forces. As a result, during the 1990s there was a dramatic increase in national animal genetic resource activities. Many national programmes were initiated and the Food and Agriculture Organisation of the United Nations played a prominent role in coalescing national actions. Nationally, programmes have been initiated that comprise of in situ, ex situ and information-exchange efforts. A critical element to national conservation efforts is the development of cryopreserved collections of germplasm. Several countries have initiated substantial multispecies collections of cryopreserved germplasm. The selection of animals within breeds of interest is an important consideration in building cryopreserved collections. Animal selection should be based on a lack of genetic relationship, with sufficient numbers of animals to ensure the capture of rare alleles. Major issues facing repository development and genetic conservation are: (1) that all breeds are in need of genetic diversity management; (2) a better understanding of in situ breed population dynamics is needed; and (3) the concept that repository collections can be used by a broad range of clientele across time as well as during emergency situations.     

Gaining and maintaining commitment to large-scale change in healthcare organizations.

Healthcare administrators have sought to improve the quality of healthcare services by using organizational change as a lever. Unfortunately, evaluations of organizational change efforts in areas such as total quality management (TQM), continuous quality improvement (CQI), and organizational restructuring have indicated that these change programmes have not fulfilled their promise in improving service delivery. Furthermore, there are no easy answers as to why so many large-scale change programmes are unsuccessful. The aim of this analysis is to provide insights into practices that may be utilized to improve the chances of successful change management. It is proposed that in order to effect change, implementers must first gain commitment to the change. This is done by ensuring organizational readiness for change, surfacing dissatisfaction with the present state, communicating a clear vision of the proposed change, promoting participation in the change effort, and developing a clear and consistent communication plan. However gaining commitment is not enough. Many change programmes have been initially perceived as being successful but long-term success has been elusive. Therefore, maintaining commitment during the uncertainty associated with the transition period is imperative. This can be done by successfully managing the transition using action steps such as consolidating change using feedback mechanisms and making the change a permanent part of the organization's culture.     

Disease management: definitions, difficulties and future directions.

The last decade has seen a wide range of experiments in health care reform intended to contain costs and promote effectiveness. In the USA, managed care and disease management have been major strategies in this endeavour. It has been argued that their apparent success has strong implications for reform in other countries. However, in this paper we ask whether they are so easily exportable. We explain the concepts involved and set the development of managed care and disease management programmes in the context of the USA. The constituent elements of disease management are identified and discussed. Disease management is considered from the perspectives of the major stakeholders in the United Kingdom, and the differences between the models of health care in the United Kingdom's National Health Service and the USA are noted. A review is presented of evaluations of disease management programmes and of the weaknesses they highlight. The prospects for disease management in Europe are also discussed.     

Mentorship in postgraduate training programmes: views of Canadian programme directors

Objectives  Many academic training programmes have developed mentorship programmes for postgraduate doctors in training, but little is known about the factors that influence their establishment.
Methods  Canadian postgraduate training directors were surveyed to determine views on mentorship and factors associated with the establishment of these programmes.
Results  A total of 199 of 344 (58%) programme directors completed an online survey. Overall, 65% of respondents reported that their training programmes had a mentorship programme and 40% felt there was a need for more structured mentorship in training programmes. Univariate analysis showed that mentorship programmes were present significantly more often in larger programmes, internal medicine-based training programmes, and in programmes where the acting programme director had either been part of a mentorship programme during his or her own training or felt that mentorship had played an important role in his or her professional development. In adjusting for covariates using a logistic regression analysis, only those factors directly attributable to a programme director's personal mentoring experiences remained significantly associated with having a mentorship programme. Those who felt that mentorship had played a role in their own careers ( P  = 0.008, odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.7–6.6) or who had been part of a mentorship programme during their own training ( P  = 0.01, OR = 6.6, 95% CI 1.4–30.1) were more likely to have an active mentorship programme at their institution.
Conclusions  A need for more structured mentorship was identified for many training programmes. Overall, programme directors' previous mentoring experiences were independently associated with having a mentorship programme.     

Quality in health promotion

Less health finance and the competitive contract culture areleading many health services to adopt quality methods to proveand improve their quality. Health promotion programmes facesimilar changes, but have not made great use of modern qualitymanagement methods. In part this has been because the definitionsand approaches to quality have not appeared to be relevant tohealth promotion. Practitioners need to consider which methodsand approaches are most suited to their programmes. This papershows that many quality ideas and methods are congruent withgood practice in health promotion, and may help to implementsuch practices more widely as well as to develop theory andpractice. There is a danger that inappropriate ways of defining, specifyingand assuring quality will be imposed on programmes. Practitionersneed to consider which methods and approaches are most suitedto their programmes. This paper seeks to stimulate debate aboutthe need to prove and improve quality in health promotion, andabout how best to do so. It considers definitions of quality,measurement, competing quality paradigms, quality in contractingand concepts of process and system in the context of healthpromotion programmes.     

Improving hospital antibiotic use

Improving antibiotic use is an important component of efforts to prevent the emergence and spread of multi-resistant microorganisms in hospitals. There are many complex factors that influence clinical decision making such as antibiotic prescribing in hospitals. Guidelines for antibiotic use should be easily accessible and hospitals should develop their own antibiotic policies appropriate to their institutions. Effective implementation of guidelines requires support with strategies such as education, audit and feedback. Infection control practitioners (ICPs) need to be aware of the strategies used to improve hospital antibiotic use and may have an expanded role to play in the successful implementation of these programmes.