Knowledge into action? understanding ideological barriers to addressing health inequalities at the local level

The objective of this study was to explore the presence of ideological barriers to addressing local health inequalities in Hamilton, Ontario, Canada. A survey of active citizens revealed low levels of awareness of the social determinants of health (SDOH) framework, and some incongruence between understanding and attitudes towards the SDOH. Support for addressing health inequalities was associated with awareness of the SDOH framework, liberal value-systems, and a cluster of socio-demographic characteristics. Liberal leaning participants were also more politically active than their conservative counterparts. Ideological barriers included lack of SDOH awareness, narrow understandings of the relative influences of the SDOH, resistance to de-prioritizing healthcare, and conservative values. Advancement of a SDOH policy agenda should incorporate wider dissemination efforts to citizens and local service providers to increase support for this framework, and utilization of existing support and political engagement from liberal-leaning demographics.     

Do the risks justify action?

The key issues that have been raised at the meeting on Cosmic Radiation Doses to Air Crew and Astronauts are identified. The paper summarizes the radiation environment and radiation risks associated with exposures to both groups. Finally, the summary concludes that the risks do justify action.     

Continuing education of graduate students: a commitment of the university?

The objective of this study is to reflect on the role of the university as a fomenter of continued education, during and after undergraduation, according to the referential of Paulo Freire. Thus, it is necessary to rescue and indicate as a goal the integration of teaching, research and extension, as well as the construction of an institutional culture committed to continued education and the development of partnerships and support group for egressed students.     

Can the socioeconomic level influence the characteristics of a group of hypertensive patients?

A total of 440 hypertensive patients participated in the study (57 years old +/-12, 66% women, 51% white, 57% married, 52% with primary school and 44% with income from 1 to 3 minimum salaries) to characterize biosocial, beliefs, attitudes and knowledge variables, absence to consultation and treatment interruption, and to associate the socioeconomic level to the variables studied. An index of accumulated goods, from the possession of household appliances converted in minimum salaries/mo., was elaborated in order to evaluate the economic status. The hypertensive people who disagreed with "there is nothing you can do to prevent high blood pressure" presented significantly higher levels of accumulated goods; those who affirmed never getting late to their consultations presented lower levels of accumulated goods; in the subjective well-being evaluation, sadness was associated to a lower accumulated goods index (p<0,05). Results showed that low economic status was associated with factors that can influence the attitude and adherence to anti-hypertensive treatment.     

What if implementation is not the problem? Exploring the missing links between knowledge and action

Given all the available knowledge about effective implementation, why do many organizations continue to have—or appear to have—an implementation problem? Analysis of a 7‐year corpus of reports by a Canadian health region's “embedded” research and evaluation unit sought to discover the source of the region's intractable difficulty implementing improvement. Findings suggested that the problem was neither a lack of knowledge (decision‐makers displayed sophisticated understanding of fundamental issues) nor an inability to take action (there existed sufficient capacity to implement change). However, managers' high‐level knowledge was not made actionable, and micro‐level decision‐making often produced piecemeal actions inadequately informed by existing knowledge. The problem arose at the stage of “operationalization”—the identification of concrete, executable actions fully informed by knowledge of complex, system‐level issues. Yet this crucial phase is a focus of neither the implementation nor knowledge translation (KT) literatures. The organizational decision‐making literature reveals how decision‐makers initiate operationalization (i.e., by setting the direction for a discovery approach) but not how they can ensure its successful completion. The focus of KT research and practice should expand to explicating and improving decision‐making, lest KT become an exercise of infusing content into a broken process. Copyright © 2014 John Wiley & Sons, Ltd.     

Mechanism of action of the Adiana(®) device: a histologic perspective

Background

The study was conducted to confirm the mechanism of action of the Adiana permanent contraception device by means of histologic analysis of long-term specimens.

Study Design

Fifteen specimens were obtained from eight subjects undergoing hysterectomy 2 to 4 years after the Adiana procedure. Serial sections were stained with hematoxylin and eosin, as well as epithelial membrane antigen immunostain.

Results

A normal foreign body reaction with minimal chronic inflammatory changes was observed in all specimens. Immunostaining for epithelial membrane antigen was absent in the interstitial tissue surrounding the matrix.

Conclusion

Histologic analysis of long-term specimens supports the mechanism of action of the Adiana permanent contraception device.     

Can a health unit take action on the determinants of health?

There is growing interest in improving population health by multi-sectorial partnerships that address the determinants of health. The Leeds, Grenville and Lanark District Health Unit worked with some 80 other community agencies to form the Lanark, Leeds and Grenville Health Forum in the spring of 2000. The goals of this Health Forum were to evaluate the determinants of health of the population over a five-year period, identify activities within an overall Health Improvement Plan to address these determinants, pursue ongoing resources for interventions, assess their impact on health, and modify plans and activities accordingly. The Health Forum identified that their region had increased mortality rates from cardiovascular disease and cancers compared with the rest of Ontario. The local district health unit offered three possible determinants to explain this: socio-economic determinants (residents below provincial average for income and education), behavioural determinants (residents had higher rates of smoking, sedentary activity and high fat diets) and lack of access to health care. The Health Forum developed a Health Improvement Plan to work on each of these determinants. Throughout its lifetime, the Health Forum proved to be both active and productive, leading to many cooperative ventures. This paper provides a brief overview of the approach taken with its Health Improvement Plan, as well as the successes and limitations of this approach. The experience of the Leeds, Grenville and Lanark Health Forum offers a practical model for public health units to work with partner agencies to address the determinants of health, as well as some insights into the requirements to sustain such a model.     

Does the association between smoking and mortality differ by educational level?

Some researchers suggest that the effect of smoking on health depends on socioeconomic status; while others purport that the effect of smoking on health is similar across all social groups. This question of the interaction between smoking and socioeconomic status is important to an improved understanding of the role of smoking in the social gradient in mortality and morbidity. For this purpose, we examined whether educational level modifies the association between smoking and mortality. Information on smoking by age, gender and educational level was extracted from the Belgian Health Interview Surveys of 1997 and 2001. The mortality follow up of the survey respondents was reported until December 2010. A Poisson regression was used to estimate the hazard ratio of mortality for heavy smokers, light smokers, and former smokers compared with never smokers by educational level controlling for age and other confounders. Among men, we found lower hazard ratios in the lowest educational category compared with the intermediate and high-educated categories. For instance, for heavy smokers, the hazard ratios were 2.59 (1.18-5.70) for those with low levels of education, 4.03 (2.59-6.26) for those with intermediate levels of education and 3.78 (1.52-9.43) for the highly educated. However, the interaction between smoking and education was not statistically significant. For women, the hazard ratios were not significant for any educational category except for heavy smokers with intermediate levels of education. Also here the interaction was not statistically significant. Our results support the hypothesis that educational attainment does not substantially influence the association between smoking and mortality.     

Business planning: can the health service move from strategy into action?

Advances the case for the use of one particular business planning technique within a National Health Service Trust. At the present time, NHS trusts are required to write strategic direction statements. Evidence suggests that these documents provide an accurate account of past performance and present position of the trust, but do not express the future position intended to be achieved. These documents also tend to be lengthy and lack strategic focus, which means that they are not helpful to managers who want clear organizational goals and objectives to which to work. Attempts to address the difficulties associated with determining how existing skills and resources can be used as the platform for future growth strategies by using the Ansoff Matrix and SWOT Analysis planning tools, given the external changes in the marketplace. Also attempts to shed light on some of the important links between busines strategy and management development by extending planning theory into practice.     

Promoting healthy growth: what are the priorities for research and action?

Healthy growth from conception through the first 2 y of life is the foundation for adequate organ formation and function, a strong immune system, physical health, and neurological and cognitive development. Recent studies identified several low-cost interventions to address undernutrition during this age period and noted the lower returns on investment of intervening after this critical period. Although these interventions should be implemented widely, it is recognized that existing nutrition solutions, even if universally applied, would only avert a minority fraction of the estimated death and disability due to undernutrition. This paper reviews some of the knowledge and learning needed to close this "impact gap." Five areas are prioritized for future research: 1) study healthy growth from a lifecycle perspective, because maternal, fetal, and newborn outcomes are connected; 2) understand why growth faltering begins so early in breast-fed infants in the developing world; 3) apply new tools and technologies to study long-recognized problems such as the interaction between nutrition and infection; 4) explore new hypotheses for understanding nutrient assimilation and use to discover and develop intervention leads; and 5) understand the role of the environment in healthy growth and the potential synergistic benefits of multi-sectoral interventions. Policymakers are urged to invest in nutrition-specific and -sensitive interventions to promote healthy growth from conception through the first 2 y of life because of their immediate and long-term health and development benefits.