Potential meets reality: GIS and public health research in Australia

Geographical Information Systems-computerised systems for the capture, storage, retrieval, analysis and display of spatial data - have recently been promoted as important tools for the study of public health. Attention must also be given to the issues involved in this relatively new application, especially in Australian conditions. These include the coarse spatial resolution of most health and social data, the propagation of error through the need to use estimates and concordance tables to handle data in mismatched official spatial boundaries, the inflexible analytical capacity of most GIS for the needs of epidemiology, and difficulties in access to data, which are compounded by the absence of a good metadata register. The conflict between the need for spatial precision in GIS and preserving the confidentiality of health data is a salient issue. Medical geographers and public heath researchers using GIS must recognise these issues in order to work together and toward extending the use of GIS technology beyond broad ecological and accessibility studies.     

Health promotion in the Finnish shipping industry

In autumn 1997 a pilot project was started in Finland to develop methods for promoting the health of sailors. Four Finnish shipping companies, (4 cargo ships and 2 passenger-cruise ferries), with altogether 730 sailors participated in the project. Special attention was paid to individuals with health problems and those who generally did not take care of their own health or fitness. Three-quarters of the respondents saw their health as good and one fifth as fair. Thirty-four persons responded that their working capacity was poor. 154 sailors were selected into further physical fitness evaluations. The main task of the project team was to activate sailors to take care of their own health and well-being. The health-promoting activities were directed especially at those persons who needed it. Information lectures concerning healthier eating habits and meals were given. Anti-smoking and anti-alcohol drinking information was given. On board one cruise ferry a project was started on how to react as early as possible to alcohol abuse among seafarers. Courses on shore for sailors were arranged to improve their physical fitness and to increase their resting benefit between working periods at sea. The intervention time was one year. Information about smoking and alcohol led to reduced alcohol consumption. The sailors had started to exercise more often both on board ship and on shore. Those who had increased their physical exercise during free time more often found their own health and working ability to have improved than those who had not changed their exercise habits. It appeared that health intervention projects are really needed especially by older sailors. The results also showed that positive effects could be achieved in the fitness of sailors. Better fitness was good for their health and also increased the work safety.     

Health promotion research: dilemmas and challenges

OBJECTIVE: To analyse dilemmas and challenges in health promotion research, and to generate ideas for future development. METHOD: The analysis is based on authors' experiences in working in the field of research and action in health promotion and on experiences of others as found in literature. RESULTS: The assumptions underlying scientific research as based in the biomedical design are difficult to meet in community-based health promotion research. Dilemmas are identified in relation to the possibility of defining the independent and dependent variables beforehand and the intermingling of these variables (the intervention and outcome dilemma), the difficulty in quantifying the desired outcomes (the number dilemma), and the problem of diffusion of the programme to the control group (the control group dilemma). CONCLUSION: Research in health promotion has specific reasons to reconsider the approach towards research, the selection of outcome variables, and research techniques. Strategies and methods to make activities and their outcomes clear are discussed and criteria to judge confidence and applicability of research findings are presented.     

Health promotion research and the diffusion and institutionalization of interventions.

To examine the extent to which health promotion research is providing an empirical basis for the diffusion and institutionalization of effective interventions, we conducted a systematic audit of all articles in 12 public health and health promotion journals for the 1994 calendar year. We identified empirical/non-empirical and health promotion/non-health promotion articles. For each study, the health behaviours or outcomes studied, the target group, gender and setting were categorized. Each study was also categorized as belonging to one of four stages: basic research and development, innovation development, diffusion research, and research into institutionalization or policy implementation. Of all articles coded (n = 1210), 33.9% were identified as non-research, 39.5% were health promotion research and 26.6% were non-health promotion research. The vast majority of studies fell within the basic research and development stage (89.6%), with less than 1% categorized as diffusion research and only 5% as institutionalization or policy implementation research. The published studies reviewed provide a limited empirical basis for diffusion and institutionalization of health promotion programs. These findings suggest a need to more systematically monitor research input (funding) and research output (publications), and to develop a more explicit focus on the relevance of the stages of research innovation and development, the issues and/or behaviours addressed, the target population, and the research setting.     

Clinical management. Where medicine meets managements. Heroes and heroin

A Middlesbrough general practice caters exclusively for drug addicts. There is opposition to this model, with some preferring to see all practices able to care for drug misusers. Practice nurses are seen as key to good service provision in primary care.     

Clinical management. Where medicine meets management. Random factors

Care is required when applying the findings from randomised controlled trials, systematic reviews of RCTs or national 'evidence-based' guidelines to the broad groups of patients in primary care. N-of-1 trials offer a useful approach to tailor medication and improve the quality of a treatment decision in an individual patient. The length of the relationship with patients makes follow-up important.     

Clinical management. Where medicine meets management. Remote control

Remote disease monitoring uses IT to link a patient at home with medical staff and systems. The potential is to improve chronic disease management and cut costs in the long term. Despite a tough government take-up target for 2007, there is little activity in the UK.     

Clinical management. Where medicine meets management. On reflection

There is an urgent need for validated, feasible tools to assess doctors' performance. A peer-rating tool mapped to good medical practice (SPRAT) is feasible, valid and reliable. SPRAT is ideal for revalidation purposes and performs particularly well in areas that are traditionally difficult to assess. It can also inform personal development planning.     

Clinical management. Where medicine meets management. Destination unknown

A south-east London GP co-operative has expanded beyond provision of out-of-hours care. Skill mixing is to be introduced to free up GPs' time. Pilots in north-east London are working on continuity of care.     

Clinical management. Where medicine meets management. Growing pains

Commissioning arrangements are not working for tertiary paediatric sub-specialties, such as paediatric nephrology. Staff shortages are leaving nephrology centres vulnerable to total breakdown. More trained nephrologists are becoming available, but trusts do not have the funding to take them on.     

Clinical management. Where medicine meets management. Reduced circumstances

The development of effective clinical teams is vital to the delivery of quality clinical care and reducing clinical errors. Implementation of the European working-time directive will disrupt team dynamics and reduce the training opportunities for junior doctors. Funding is needed to increase further the number of doctors if the directive is not to be at the expense of patient care.     

Clinical management. Where medicine meets management. Assistants required

The use of US-trained physician assistants is addressing a GP shortage in the West Midlands and is being extended to emergency care. PAs are trained in general and first-contact medicine and undergo rigorous, regular re-certification. Birmingham University is evaluating the scheme with a view to UK-based training and accreditation.     

Clinical management. Where medicine meets management. Senior moments

Most general hospital users are older people. Standard 4 of the national service framework for older people aims to transform the whole hospital experience for this group. Trusts have yet to grasp the fundamentals of this approach, despite the fact that it will help them achieve improvements such as access targets. Investment in staff training and education is needed to achieve the necessary cultural change.