Implementing alcohol and other drug interventions effectively: How does location matter?

Objective: To identify enabler and barrier mechanisms that impact project implementation, from a review of 127 completed projects intended to reduce harms associated with problematic alcohol and licit drug use in Australia. Design: Data comprised archival material (proposals, reports). A coding framework was developed from the literature and a sample of projects; two researchers developed and refined the framework. Open coding was used to identify factors impacting implementation, followed by pattern coding to identify underlying mechanisms. Sample: Project categories were developed from funding orientation and main activities projects were: enhancing organizational systems and processes (39), training and workforce development (18), community education and prevention (37) and client engagement and treatment (33). Thirty‐five projects (28%) were in non‐capital city locations. Results: Nine enabler and ten barrier mechanisms were identified, for example, ‘project planning and design’ and ‘wider service system challenges’. Three enabler mechanisms were more likely to be identified for non‐capital city projects; ‘external communication and relationships’ (83% vs 70%), ‘sensitivity to service users and settings’ (49% vs 40%) and ‘funding and resourcing’ (40% vs 35%). Most barrier mechanisms were identified for a higher proportion of non‐capital city projects, particularly ‘identifying and retaining personnel’ (54% vs 34%), ‘engaging communities and partners’ (46% vs 26%) and ‘organizational governance and capacity’ (29% vs 5%). Conclusions: Project implementation in non‐capital city locations requires particular attention to project planning and design, staffing and organizational well‐being. Policy initiatives and planning proposals might consider enabler mechanisms along with strategies to minimize barrier mechanisms to support successful implementation.     

Health and literacy in first- and second-generation Moroccan Berber women in the Netherlands: Ill literacy?

AIM: The present study was aimed at investigating the role of literacy and generation in the self-reported general health status of Moroccan Berber speaking women in the Netherlands. METHOD: Fifty women in our sample (N = 75) were first generation women, from which group 25 were literates and 25 illiterates. Another group of 25 literate women belonged to the second generation. The three groups were matched for demographic characteristics. Questionnaires were administered reflecting all concepts under study. We hypothesized that, within the first generation, illiterates compared with literates would report worse health. Our second hypothesis was that literates of the first generation compared with those of the second generation would have a similar health condition. RESULTS: After controlling for age, having a job, and having an employed partner, the first generation literates compared with the illiterates of the first generation indeed reported significantly better health. Additionally, we did not find any differences in health condition between both literate groups, even after controlling for age, number of children, and marital status. Health complaints that were most frequently reported by both groups, concerned pain in shoulders, back and head. CONCLUSIONS: Our results underline the importance of offering immigrants optimal access to opportunities and facilities that can improve their literacy and reading ability.     

How does the quality of care compare in five countries?

International data on quality of medical care allow countries to compare their performance to that of other countries. The Commonwealth Fund International Working Group on Quality Indicators collected data on twenty-one indicators that reflect medical care in Australia, Canada, New Zealand, England, and the United States. The indicators include five-year cancer relative survival rates, thirty-day case-fatality rates after acute myocardial infarction and stroke, breast cancer screening rates, and asthma mortality rates. No country scores consistently the best or worst overall. Each country has at least one area of care where it could learn from international experiences and one area where its experiences could teach others.     

How does race get “under the skin”?: Inflammation,weathering, and metabolic problems in late life

Using nationally representative data from the 2005–2006 U.S. National Social Life, Health, and Aging Project, this study queries the mechanisms underlying worse metabolic outcomes—blood-sugar control and cardiovascular health—among black than white men ages 57–85. Results indicate that contrary to much of the academic literature as well as media accounts—implicitly rooted in a “culture of irresponsibility” model—older black men's social isolation, poor health behaviors, or obesity may not play a major role in their worse metabolic problems. Instead, these outcomes seem to derive more consistently from a factor almost unexamined in the literature—chronic inflammation, arguably a biological “weathering” mechanism induced by these men's cumulative and multi-dimensional stress. These findings highlight the necessity of focusing attention not simply on proximal behavioral interventions, but on broader stress-inducing social inequalities, to reduce men's race disparities in health.     

Code-related aspects of emergent literacy: How prepared are preschoolers for the challenges of literacy in an EFL context?

Mauritian children are Kreol speakers who learn to read and write in English and French when they join the primary education system. The government-mandated preschool curriculum mentions the need for the preschool to prepare them for the literacy challenges of the primary school. The aim of this paper is to consider whether preschool children develop code-related literacy skills in their final year at preschool, in readiness for their first year at primary school. I refer to data collected from a longitudinal study of two comparable groups of Mauritian preschoolers. Using data from a pre-test and post-test of their code-related skills, I show how inadequately prepared they seem to be in terms of code-related skills and interest in print-related activities. Some reasons for the findings are explained, highlighting how the ‘emergent literacy’ discourse of the preschool curriculum has evaded the skill aspects of ‘emergent literacy’. Some culturally sensitive recommendations are provided.     

How can systems engineering inform the methods of programme evaluation in health professions education?

Context

We evaluate programmes in health professions education (HPE ) to determine their effectiveness and value. Programme evaluation has evolved from use of reductionist frameworks to those addressing the complex interactions between programme factors. Researchers in HPE have recently suggested a ‘holistic programme evaluation’ aiming to better describe and understand the implications of ‘emergent processes and outcomes’.

Framework

We propose a programme evaluation framework informed by principles and tools from systems engineering. Systems engineers conceptualise complexity and emergent elements in unique ways that may complement and extend contemporary programme evaluations in HPE . We demonstrate how the abstract decomposition space (ADS ), an engineering knowledge elicitation tool, provides the foundation for a systems engineering informed programme evaluation designed to capture both planned and emergent programme elements.

Methods

We translate the ADS tool to use education‐oriented language, and describe how evaluators can use it to create a programme‐specific ADS through iterative refinement. We provide a conceptualisation of emergent elements and an equation that evaluators can use to identify the emergent elements in their programme. Using our framework, evaluators can analyse programmes not as isolated units with planned processes and planned outcomes, but as unfolding, complex interactive systems that will exhibit emergent processes and emergent outcomes. Subsequent analysis of these emergent elements will inform the evaluator as they seek to optimise and improve the programme.

Conclusion

Our proposed systems engineering informed programme evaluation framework provides principles and tools for analysing the implications of planned and emergent elements, as well as their potential interactions. We acknowledge that our framework is preliminary and will require application and constant refinement. We suggest that our framework will also advance our understanding of the construct of ‘emergence’ in HPE research.

     

What, how and why does the team think?

It is all very well being able to 'pick up' what team members seem to be doing and even to speculate on the reasons why. It is an entirely different exercise doing something constructive with the information you garner about team practice and performance. Michael Walton and Graham Smith, in the fourth article of their series, introduce some practical perspectives for assessing your team's performance.     

How does the business cycle affect eating habits?

As economic expansions raise employment and wages, associated shifts in income and time constraints would be expected to also impact individuals' health. This study utilizes information from the US Behavioral Risk Factor Surveillance System (1990-2009) to explore the relationship between the state unemployment rate and the consumption of various healthy and unhealthy foods in the United States. Estimates, based on fixed effects methodologies, indicate that unemployment is associated with reduced consumption of fruits and vegetables and increased consumption of "unhealthy" foods such as snacks and fast food. Heterogeneous responses are also identified through detailed sample stratifications and by isolating the effect for those predicted to be at highest risk of unemployment based on their socioeconomic characteristics. Among individuals predicted to be at highest risk of being unemployed, a one percentage point increase in the resident state's unemployment rate is associated with a 3-6% reduction in the consumption of fruits and vegetables. The impact is somewhat higher among younger, low-educated, and married adults. Supplementary analyses also explore specific mediating pathways, and point to reduced family income and adverse mental health as significant channels underlying the procyclical nature of healthy food consumption.     

Total shutdowns,targeted restrictions,or individual responsibility: How to promote social distancing in the COVID-19 Era?

We examine the impact of early state and local COVID-19 policies to encourage social distancing. Outcomes are daily foot traffic at establishments spanning ten key industries, across which transmission risk varies substantially. Policies include state of emergency declarations, blunt general restrictions such as stay-at-home (SAH) orders, and targeted rules such as restrictions on bars, restaurants, entertainment venues, and schools. Exploiting variation in the timing of policies in difference-in-difference models, we show that much of the decline in foot traffic early in the pandemic was due to private precautionary behavior. SAH orders explain almost none of the foot traffic decline in industries with high risk of virus transmission, but they do explain a substantial share of the decline in moderate- to low-risk industries such as outdoor sports and visits to parks. Targeted restrictions tend to impact intended industries, as well as complementary ones. We show that the impact of targeted restrictions is largest in counties with no SAH restrictions, suggesting that better targeting of public restrictions can have important efficiency gains.     

How much does partially hydrolyzed guar gum affect the weight, moisture and hardness of feces?

OBJECTIVE: The ministry of Health, Labor and Welfare recommends Japanese people to intake a certain amount of dietary fiber, believing that incorporating more dietary fiber into our diet can reduce the risk of colorectal cancer. The present study aimed to demonstrate and confirm the theory's validity by applying it to reality-to what extent is the intake of partially hydrolyzed guar gum (PHGG) useful in promoting bowel movements, and what problems are involved? We therefore investigated to what extent PHGG affects the weight, moisture and hardness of feces when healthy female students consumed PHGG as a supplement. METHOD: During two fourteen-day sessions in spring and autumn, 9 healthy female students took the same diets. During the first session, the students were provided a strict dietary formula, while during the second session, they were administered an amount of 12.5 g/day PHGG (purity 80%, equivalent to 10 g of dietary fiber) dissolved in adequate amount of water at the end of each meal. Feces of the subjects were collected and weighted just after defection. A moisture meter was used to measure fecal moisture and a rheometer was used to measure fecal hardness. Fecal conditions and intestinal motility were also examined. RESULTS: (1) Due to the PHGG intake, the fecal bulk increased in 4 subjects and decreased in 2 subjects, significantly, out of 9. (2) Due to the PHGG intake, the fecal condition softened in 3 subjects while significantly hardening in 4 subjects. (3) The PHGG intake induced an increased of fecal moisture in 5 subjects, while moisture decreased in 2 subjects. (4) Fecal hardness measured more than 150 g/cm when it is classified as "frozen hard". (5) A significant inverse correlation could be seen between fecal hardness and fecal bulk, and between fecal hardness and its moisture. When PHGG was administered a significant inverse correlation could be seen between fecal hardness and its moisture. CONCLUSION: The conclusion is that the PHGG intake resulted in increase of the fecal bulk for 4 subjects and fecal moisture for 5 out of 9 subjects, but decrease of fecal hardness in 3 subjects; the benefit of bowel movements provided by the PHGG intake, however, varied greatly among the subjects.     

Diverging Trends in the Incidence of Occupational and Nonoccupational Injury in Ontario, 2004–2011

Objectives. We describe trends in occupational and nonoccupational injury among working-age adults in Ontario.Methods. We conducted an observational study of adults aged 15 to 64 over the period 2004 through 2011, estimating the incidence of occupational and nonoccupational injury from emergency department (ED) records and, separately, from survey responses to 5 waves of a national health interview survey.Results. Over the observation period, the annual percentage change (APC) in the incidence of work-related injury was −5.9% (95% confidence interval [CI] = −7.3, −4.6) in ED records and −7.4% (95% CI = −11.1, −3.5) among survey participants. In contrast, the APC in the incidence of nonoccupational injury was −0.3% (95% CI = −0.4, 0.0) in ED records and 1.0% (95% CI = 0.4, 1.6) among survey participants. Among working-age adults, the percentage of all injuries attributed to work exposures declined from 20.0% in 2004 to 15.2% in 2011 in ED records and from 27.7% in 2001 to 16.9% in 2010 among survey participants.Conclusions. Among working-age adults in Ontario, nearly all of the observed decline in injury incidence over the period 2004 through 2011 is attributed to reductions in occupational injury.Although most developed countries have made progress in improving population health over the past 2 decades, reductions in the burden of mortality, morbidity, and disability attributed to injury have been uneven.1 In the United States, the age-standardized death rate from motor vehicle collisions declined by 30% between 1990 and 2010. By contrast, the age-standardized death rate from falls and poisonings increased by 71% and 128%, respectively, over the period 2000 through 2009.2 A recent surveillance report on injury mortality in Canada found that the share of all-cause mortality attributed to injury increased over the period 2001 through 2007.3 Injury remains the leading cause of death among persons aged younger than 45.4The burden of injury among working-age adults arises from occupational and nonoccupational exposures. Although the reduction in hazardous exposures arising from work has been listed as among the 10 most important public health contributions to the improvement in population health over the past 100 years,5 work exposures continue to cause a large fraction of injury morbidity, responsible for as much as 25% of the burden of injury in working-age adults.6The objective of surveillance in public health and occupational health is the systematic and ongoing assessment of population health status, based on the timely collection, analysis, and dissemination of information on health status and health risks.7 Over the past 2 decades, the population surveillance of injury morbidity has made strengthened use of health interview surveys6,8,9 and administrative records of health care utilization, particularly emergency department (ED) records.10–17 These data sources can be used effectively to identify important trends in injury incidence and, if well-designed, can document occupational and nonoccupational injury causation.We estimated trends in the incidence of occupational and nonoccupational injury in Ontario over the period 2004 through 2011 for adults aged 15 to 64, drawing on a census of ED records and participants in national health interview surveys.     

Invited commentary: How early in life does the risk of obesity originate?

Mothers and fathers influence the risk of obesity in their children through genetic, environmental, and behavioral factors. Unique to the mother, however, is the intrauterine environment in which the fetus develops, and it is during this time in the uterus that the risk of later obesity in the child may develop. In this issue of the Journal, Fleten et al. (Am J Epidemiol. 2012;176(2):83-92) investigate whether the intrauterine environment plays a role in the development of adiposity by comparing the association between maternal prepregnancy body mass index (BMI; measured as weight in kilograms divided by height in meters squared) and offspring BMI at 3 years of age with the paternal-offspring association at the same age in the Norwegian Mother and Child Cohort Study. In that large study of stable, relatively healthy and well-educated families, significant differences in maternal-offspring and paternal-offspring BMI associations were not identified. These findings are interpreted as indicating that the influence on the child's BMI of the intrauterine environment is less important than that of genetics and shared environment. Results from that study suggest that further consideration should be given to the specificity of the fetal overnutrition hypothesis in terms of which aspects of the intrauterine environment may influence offspring adiposity and when across the life course these effects may manifest themselves.     

How much does the public know about health reform?

With federal action on major health reform set to take place in 1994, a recent survey of 1,200 adults found major gaps in Americans' understanding of what the problems are or how major legislative proposals would address them. While the public is primarily concerned about how health reform will affect them personally, their current lack of knowledge heightens the impact that political advertising, media coverage, and public education campaigns will have.     

How useful are the SF-36 sub-scales in older people? Mokken scaling of data from the HALCyon programme

Purpose  

To evaluate two psychometric properties of SF-36, namely unidimensionality and reliability.