Systematic health, environment and safety activities: do they influence occupational environment, behaviour and health?

This study investigated the relationships between systematic health, environment and safety (HES) activities (as defined by Norway's Internal Control Regulation), the working environment, and workers' health-related behaviour and health. A questionnaire on systematic HES activities was answered by 237 managers of motor vehicle repair garages. A further questionnaire, on the working environment, health-related behaviour and health, was answered by workers (n = 2174) from the same garages. Using regression analysis, systematic HES activities were positively and significantly correlated with the following separate outcome variables, measured at an individual level: satisfaction with HES activities, physical working environment, social support, HES-related management support, health-related support, and control and workers' participation in activities related to occupational health. Workers at garages with systematic HES activities reported fewer musculoskeletal symptoms. Firm conclusions on the direction of causality are difficult to draw because of the cross-sectional design.     

Children's bone health, calcium and vitamin D--how much do nurses and health visitors know?

Two focus groups of health visitors, practice nurses and community nursery nurses were held to find out how much health visitors and nurses know about children's bone nutrition, and whether they are able to identify dietary sources of these nutrients. Results showed that these professionals spend a significant part of their time giving nutritional advice about children and young people and answering questions on a range of dietary matters. They were well informed about the importance for bone health of calcium, vitamin D, exercise and a healthy, balanced diet. The biggest misconception was that dairy products in the UK contain vitamin D. Most of the professionals knew that bone strength develops quickly during childhood, and some that it does so in adolescence but few were aware that 90% of the full genetic potential for bone strength is achieved before adulthood. The groups reported confusion over the Government's initiatives for vitamin D supplements, and lack of guidance from Primary Care Trusts on making Healthy Start vitamins available at clinics for mothers and babies. Overall, health visitors and nurses have a good knowledge of bone health but there are gaps and more educational resources are needed, including on dietary sources of vitamin D. The Government needs to give clear guidelines about its initiatives for vitamin D supplements for mothers and children aged under five years. It is disappointing that the Dairy Council's 3-a-Day message on meeting essential calcium needs through three daily servings of dairy foods has not got through.     

Economics, public health and health care purchasing: reinventing the wheel?

In this paper, a framework for using economics in health care priority setting is outlined. This framework is known as programme budgeting and marginal analysis (PBMA). Programme budgeting involves an assessment of how health care resources are currently distributed amongst programmes and within programmes. Such data can be used along with other information on local needs to decide on the main areas of change in service delivery. As resources are fixed, areas of change requiring more resources will be funded from service reductions within the same programme or within another programme. Candidates for more resources should be compared with each other and with candidates for service reduction to determine whether and what changes should go ahead. This involves 'marginal analysis' of costs and benefits of the candidates. In the paper, the problems with implementing this approach are outlined and the contribution of the other papers in the volume described.     

Global construction health and safety--what works, what does not, and why?

The marginalization of construction workers makes them especially vulnerable in terms of poor occupational health and safety standards and lax enforcement, with resulting disabilities. A sound research base is needed to rectify this situation. Efforts to raise awareness of construction hazards and ameliorate them are described.     

Games for health research—past,present, and future

Background

A substantial number of studies have been published on many games for diverse aspects of health. Despite the potential contributions of games for health (G4H), it has not been easy to obtain funding for research in this field.

Aim

This paper attempts to identify why there has been difficulty in obtaining funding for G4H research, create an awareness of the importance of evidence-based research, and provide recommendations to enhance research and understanding in this area.

Materials and methods

This article describes the past and current state of research in G4H and identifies implications for the future.

Results

The current state of research in the field of games does not match the criteria for good standards of research. The poor quality of studies limits what can be concluded about the effectiveness of G4H.

Conclusions

Outcomes research on G4H must make a quantum leap in quality to realistically assess the efficacy or effectiveness of G4H, and which aspects of G4H offer the most promise for change among which target groups. Research is also needed on the effectiveness of behavior change procedures and game mechanics within the context of games.

     

Are geoprocessing, environment, and health a possible combination?

The use of geoprocessing techniques allows one to gather socioeconomic, health, and environmental data on a spatial basis. However, interpretation of associations between epidemiological and environmental variables requires the geoprocessing system design. The study scale and object choices precede conception of the system, conditioning the possible statistical and visual results. This scale must be compatible with the phenomenon on which one intends to focus, aiming at internal homogeneity and external heterogeneity of spatial units. The interdependency of spatial processes, reflected in the spatial configuration of social, environmental, and epidemiological data distribution, affects interpretation of causes for simultaneous processes. Geoprocessing allows for knowledge of the context or situational surroundings in which the damage to health takes place.     

Can electronic medical record systems transform health care? Potential health benefits, savings, and costs

To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually--by improving health care efficiency and safety--and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.     

Biased health perceptions and risky health behaviors—Theory and evidence

This paper investigates the role of biased health perceptions as a potential driving force of risky health behaviors. We define absolute and relative health perception biases, illustrate their measurement in surveys and provide evidence on their relevance. Next, we decompose the theoretical effect into its extensive and intensive margin: When the extensive margin dominates, people (wrongly) believe they are healthy enough to “afford” unhealthy behavior. Finally, using three population surveys, we provide robust empirical evidence that respondents who overestimate their health are less likely to exercise and sleep enough, but more likely to eat unhealthily and drink alcohol daily.     

Can contracted out health facilities improve access,equity, and quality of maternal and newborn health services? Evidence from Pakistan

Background

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

Methods

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment.

Results

Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers.

Conclusion

Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in  quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele.

     

Can contracted out health facilities improve access,equity, and quality of maternal and newborn health services? Evidence from Pakistan

Background

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

Methods

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment.

Results

Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers.

Conclusion

Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in  quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele.

     

Robustness in health research: do differences in health measures, techniques, and time frame matter?

Survey-based health research is in a boom phase following an increased amount of health spending in OECD countries and the interest in ageing. A general characteristic of survey-based health research is its diversity. Different studies are based on different health questions in different datasets; they use different statistical techniques; they differ in whether they approach health from an ordinal or cardinal perspective; and they differ in whether they measure short-term or long-term effects. The question in this paper is simple: do these differences matter for the findings? We investigate the effects of life-style choices (drinking, smoking, exercise) and income on six measures of health in the US Health and Retirement Study (HRS) between 1992 and 2002: (1) self-assessed general health status, (2) problems with undertaking daily tasks and chores, (3) mental health indicators, (4) BMI, (5) the presence of serious long-term health conditions, and (6) mortality. We compare ordinal models with cardinal models; we compare models with fixed effects to models without fixed-effects; and we compare short-term effects to long-term effects. We find considerable variation in the impact of different determinants on our chosen health outcome measures; we find that it matters whether ordinality or cardinality is assumed; we find substantial differences between estimates that account for fixed effects versus those that do not; and we find that short-run and long-run effects differ greatly. All this implies that health is an even more complicated notion than hitherto thought, defying generalizations from one measure to the others or one methodology to another.     

What is the difference? Evidence on the distribution of wealth, health, life expectancy, and health insurance coverage

There is a literature of long standing that considers the relationship between income and differentials in mortality and morbidity, but information on differentials over the distribution of accumulated wealth have been far more scarce and subject to measurement problems. This paper provides evidence from the Survey of Consumer Finances, which is designed as a survey of wealth, on the distribution of wealth and income and how those distributions have shifted in recent years. Particular attention is paid to the distribution of wealth across minority groups and across age groups. The paper also examines the relationship between wealth and health status, life expectancy, and health insurance coverage.     

Community health agency administrators’ access to public health data for program planning,evaluation, and grant preparation

The Affordable Care Act mandates that public health data be made available for community agency use. Having access to such data allows community agencies to tailor interventions, evaluations, and funding requests more effectively. This study, jointly undertaken by Syracuse University faculty and students with the New York State Perinatal Association, sought to understand community agencies’ access to requests for governmental data, as well as to identify areas for improving data access. Results from this survey of administrators from 43 agencies in New York State found that only one-half of their requests for data were successful. Difficulties in obtaining access to needed data included fiscal and staffing constraints of the state-level agencies that house the data, as well as possible overinterpretation of confidentiality policies. In addition, some of community agency respondents reported that their staff lacked skills in data analysis and would benefit from training in epidemiology and quantitative evaluation.     

Do smoking and health education influence student nurses' knowledge, attitudes, and professional behavior?

BACKGROUND: Student nurses are an important target group for smoking prevention. This study analyzes (a) the relation between student nurses' smoking behavior and their knowledge, attitudes, and behavior toward smoking prevention and (b) the effect of targeted health education in improving student nurses' knowledge, attitudes, and preventive behavior. METHODS: A controlled trial was performed with school classes as the randomization unit. One hundred fifty-five first-year students from a school in nursing in Copenhagen, Denmark, participated in a baseline study and a follow-up study 7 weeks later. The intervention included eight lectures on the health consequences of smoking. RESULTS: About 40% of student nurses in both the intervention and the control groups were smokers, and this percentage did not change during follow-up. Compared with nonsmokers, smokers had less favorable attitudes and behavior toward smoking prevention. Student nurses' knowledge about the health consequences of smoking improved during the study period in both groups, but the change was larger in the intervention group. This difference was not present in multivariate analyses that controlled for age and smoking status. During follow-up the attitude improved in the intervention classes, while it deteriorated in the controls, revealing a significant difference, which persisted after multivariate adjustment. The amount of education had no effect on student nurse's preventive behavior. CONCLUSION: Targeted health education improves knowledge and attitudes toward smoking prevention in first-year student nurses.