Managing Change in the Context of Health Reform: Lessons from Alberta

A qualitative field study of health system reform in Alberta was undertaken to identify, describe, compare and contrast the processes of change management adopted and implemented as a result of legislated health policy shift. Chairs and chief executives of the new regional health authorities and provincial leaders managing the change processes within Alberta's hearth care system were interviewed. Components of change strategies important to the structure, process and impact of the health policy shift to a regionalized system of care were identified and analyzed. Stakeholders involved in managing change inside Alberta's health care system were able to consistently identify a range of issues important to beginning and sustaining health policy shift. These issues and insights did not come from the literature, but rather from experience. To test and share this experience further, it will be important to study more consciously the management of change in relation to expected outcomes. With so many natural experiments altering health care systems across Canada and beyond, a window of opportunity exists for researching both the quality and quantity of such change, comparing and sharing findings over time and, eventually, linking process to outcome.     

Food Fortification: The Advantages,Disadvantages and Lessons from Sight and Life Programs

Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring.     

Measuring Change in Quality of Life: Bias in Prospective and Retrospective Evaluation

ObjectivesTreatment effects on health-related quality of life (QOL) often differ depending on whether they are measured prospectively (before and after treatment) or retrospectively (after treatment only). These two approaches can be subject to different sorts of bias: Prospective evaluations may be biased by scale recalibration (a changed understanding of the response scale), and retrospective evaluations may be biased by recall bias (a wrong assessment of former QOL).MethodsOn the basis of an analysis of the literature, we present an overview on possible biases in prospective and retrospective measurement of QOL and how these biases are named and defined in the literature.ResultsThe definitions of different biases are inconsistent. Many authors do not clearly distinguish measurement bias from true change. Furthermore, some consider only scale recalibration or only recall bias.ConclusionsMuch of the current discussion on bias in prospective and retrospective QOL measurement suffers from unclear definitions, especially of “response shift” and “recall bias,” or from neglecting one of the possible biases. We suggest more elaborate definitions for different types of bias and recommend taking both kinds of bias into consideration when measuring change in QOL. The relevance of the different biases depends on the type of study, and so either prospective or retrospective assessment may be more appropriate.     

九项医疗技术突破可能会改变人们的生活

“9项医疗技术突破可能会改变人们的生活”这则信息来自美国“医疗进展”（Medical Headway）公司。Medical Headway公司有一个“医学重大进展在线数据库”，该数据库提供医学进展方面的一些重要信息，从这些信息中，人们或许可以找到用传统办法不能治愈的疾病的新治疗方法。“9项医疗技术突破”的报导发表在2008年6月13日该公司的网站上。     

成都市近20年户籍人口期望寿命变化

目的分析成都市户籍人口期望寿命的变化,探讨不同年龄和死因对期望寿命变化产生的影响。方法利用1990-2010年成都市死因监测户籍人群的死亡数据,和公安局公布的同期同范围人口数,采用寿命表法计算户籍人口期望寿命,采用期望寿命的年龄分解法、期望寿命的死因分解法计算年龄别死亡率和死因别死亡率的变化对期望寿命变化的影响。结果成都市户籍人口期望寿命在提高,男女性别差异扩大;低年龄组死亡率的变化对期望寿命变化的影响逐渐减小,高年龄组死亡率变化对期望寿命变化影响增大;对期望寿命变化影响较大的疾病主要是如呼吸系统疾病、恶性肿瘤、脑血管病、心脏病等。结论降低高年龄组死亡率,加强对呼吸系统疾病、恶性肿瘤、脑血管病、心脏病的控制,降低其死亡率,有助于提高期望寿命。     

Gene-environmental interactions: Lessons from porphyria

The porphyrias are uncommon, complex, and fascinating metabolic conditions, caused by deficiencies in the activities of the enzymes of the heme biosynthetic pathway. Two cardinal symptoms of the porphyrias are cutaneous photosensitivity and neurologic disturbances. Molecular analysis of gene defects has shown that there are multiple and heterogeneous mutations in each porphyria. Patients with symptomatic porphyria can suffer greatly, and, in rare cases, may die. While congenital porphyrias are inherited, other forms of porphyria occur as acquired diseases. In addition, not all gene carriers of inherited porphyrias develop clinical disease and there is a significant interplay between the gene defect and acquired or environmental factors. The variable response of porphyrias to acquired factors may, likely reflect genetic polymorphisms in drug metabolism. The lessons from acute hepatic porphyria, such as acute intermittent porphyria, are very useful in clarifying the complex nature of the clinical expression of metabolic disorders.     

Worker notification: Lessons from the past

The methodological choices being made in current worker notification programs are influenced in both obvious and subtle ways by certain ground-breaking notifications carried out during the 1970s and 1980s. A lore has built up concerning these cases. Their names are heavy with implied meaning. As worker notification gains in acceptance and frequency, some of those newly interested in the area will be unfamiliar with these early cases, their significance, and their lessons. To help provide a context for these proceedings, six landmark worker notifications are briefly described here. Different cases might have been chosen; more cases might have been added. However, these six give a flavor of the struggles, trials, triumphs, and insights that have marked worker notification's passage through recent history. © 1993 Wiley-Liss, Inc.     

Weight Change and Health Related Quality of Life: Population-Based Longitudinal Study of the Effects of Health Related Quality of Life on the Success of Weight Management

Our aim was to investigate how health related quality of life (HRQoL) influence on the success of weight management and how to utilize this information. Population-based longitudinal study. A community sample of apparently healthy middle-aged individuals living in Western Finland were invited to clinical survey in order to assess total cardiovascular risk among people who had at least one cardiovascular risk factor but no previous diagnoses of any long-lasting disease. A total of 2,752 individuals, aged 45–70 years, enrolled. The individuals completed HRQoL questionnaire before laboratory tests were completed and overweight people were instructed to lose weight at least 5 %. A physician examined 1950 high risk people during the years 2005–2007. Three years later a trained nurse invited them for a control examination, 1,287 high risk subjects participated, 1,049 had completely filled the questionnaires and 906 of them were overweight or obese at baseline. We assessed the success in weight management in this group of participants. The subjects (53 % women with mean age of 59 ± 7 years) had mean body mass index of 39.6 ± 4.6 kg/m². During the 3 years follow-up period 18 % of them had lost weight ≥5, 70 % had stabilized their weight and 12 % had gained weight ≥5 %. Subjects who had gained weight had worse results in every item of HRQoL both mental and physical at baseline. The results of the HRQoL questionnaire suggested that obesity and deteriorating quality of life interrelate.     

青南地区生态移民生存质量及相关因素研究

目的了解青南地区生态移民生存质量及影响因素,为提高移民生存质量提供依据。方法采用多阶段整群抽样的方法,抽取海南州两个县生态移民聚居村和相邻的当地居民,采用SF-36生存质量量表及自编一般情况调查表入户调查。结果SF-36维度评分男性移民组在生理职能、躯体疼痛、精神健康维度高于非移民组。女性在生理职能、躯体疼痛和社会功能维度评分移民组高于非移民组。少数民族移民生存质量较差,且移民组和非移民组在生理机能、情感职能方面有差异。低收入移民的生存质量差异性更加明显,移民组与非移民组中生理机能、精力、社会功能差异有统计学意义。生理健康领域的影响因素为性别(OR=4.50)和受教育程度(OR=6.88),心理健康领域的影响因素为家庭月收入(OR=2.62)、婚姻(OR=1.12)和民族(OR=2.33)。结论青南地区生态移民生存质量较当地居民差,应针对性开展移民精神健康的干预,提高移民生存质量。     

Lessons Learned

Ingredients of adolescent school-based drug prevention programs needed to reduce, prevent or delay adolescent substance abuse are presented in the historical context of three meta-analyses. Non-interactive programs showed only a 4% reduction in prevalence rate, while Interactive programs showed a 21% reduction in prevalence rate. Small Interactive programs were found to be most successful; most probably due to program protocol being more closely followed. Essential program content and necessary features of the successful Interactive programs are identified.