Translating Life Course Theory to Clinical Practice to Address Health Disparities

Life Course Theory (LCT) is a framework that explains health and disease across populations and over time and in a powerful way, conceptualizes health and health disparities to guide improvements. It suggests a need to change priorities and paradigms in our healthcare delivery system. In “Rethinking Maternal and Child Health: The Life Course Model as an Organizing Framework,” Fine and Kotelchuck identify three areas of rethinking that have relevance to clinical care: (1) recognition of context and the “whole-person, whole-family, whole-community systems approach;” (2) longitudinal approach with “greater emphasis on early (“upstream”) determinants of health”; and (3) need for integration and “developing integrated, multi-sector service systems that become lifelong “pipelines” for healthy development”. This paper discusses promising clinical practice innovations in these three areas: addressing social influences on health in clinical practice, longitudinal and vertical integration of clinical services and horizontal integration with community services and resources. In addition, barriers and facilitators to implementation are reviewed.     

The life and health challenges of young Malaysian couples: results from a stakeholder consensus and engagement study to support non-communicable disease prevention

Background

Malaysia faces burgeoning obesity and diabetes epidemics with a 250% and 88% increase respectively between 1996 and 2006. Identifying the health challenges of young adults in Malaysia, who constitute 27.5 % of the population, is critical for NCD prevention. The aim of the study was two-fold: (1) to achieve consensus amongst stakeholders on the most important challenge impacting the health of young adults, and (2) to engage with stakeholders to formulate a NCD prevention framework.

Methods

The Delphi Technique was utilised to achieve group consensus around the most important life and health challenges that young adults face in Malaysia. Subsequently, the results of the consensus component were shared with the stakeholders in an engagement workshop to obtain input on a NCD prevention framework.

Results

We found that life stress was a significant concern. It would seem that the apathy towards pursuing or maintaining a healthy lifestyle among young adults may be significantly influenced by the broader distal determinant of life stress. The high cost of living is suggested to be the main push factor for young working adults towards attaining better financial security to improve their livelihood. In turn, this leads to a more stressful lifestyle with less time to focus on healthier lifestyle choices.

Conclusions

The findings highlight a pivotal barrier to healthier lifestyles. By assisting young adults to cope with daily living coupled with realistic opportunities to make healthier dietary choices, be more active, and less sedentary could assist in the development of NCD health promotion strategies.

     

Premature adult mortality from non-communicable diseases (NCD) in three middle-income countries: do NCD programmes matter?

BACKGROUND In many middle-income countries, there is limited data available to evaluate the effectiveness of non-communicable disease (NCD) programmes. Since 1970, three neighbouring middle-income countries-Argentina, Chile and Uruguay-have undergone health sector reforms and reorganized their NCD programmes. In this paper, we explore whether data on premature adult mortality can be used to gauge the effectiveness of these programmes. METHODS We describe NCD programmes and examine mortality trends for the years 1970-2005 among adults aged 15-59 years. We contrast mortality trends from all-NCD to mortality trends from NCD that are avoidable through timely and effective medical care. The assumption is that if NCD programmes exert no effect, then all-NCD mortality and avoidable-NCD mortality will follow the same trend and avoidable-NCD mortality will not change at a faster pace. We used joinpoint regression analysis to describe the pace of change, measured as the geometric weighted average of the annual percentage change (AAPC). RESULTS Since the 1980s, all three countries have implemented NCD programmes delivered through health care, but only after the year 2000 did these countries begin to scale-up population-based NCD prevention programmes. In Argentina, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality, while the contrary is occurring in Chile. In Uruguay, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality among males, whereas among females, all-NCD mortality has stagnated while avoidable-NCD mortality continues to decline. CONCLUSION NCD interventions through health care have likely contributed to the reduction of premature NCD mortality in Chile and among women in Uruguay. In Argentina and among men in Uruguay, factors outside the health sector seem to have had a greater impact. This approach could be used in other countries to assess the effect of NCD interventions and raise key questions on programme effectiveness.     

Gesundheitsförderung durch Elternbildung in „Settings“

Background

Socially disadvantaged mothers and parents show the highest prevalence of health problems and diseases. This is also true for their children. For this reason, the success of prevention programs can only be achieved with the involvement of parents.

Aims

Mothers and fathers with low socio-economic status cannot be successfully addressed with the strategies known so far. The article analyzes how parent education programs can be integrated into the “settings” kindergarten, school and youth and family support services in order to be accessible to families from all social classes.

Results

Using the example of three well-established parent training programs (“Lions-Quest”, “STEP” and “U-Boot”) the article demonstrates how the integration into settings can most efficiently be managed. Using the example of the parent training program STEP, it can be shown that an embedding of the programme in settings makes it easier to attract mothers and fathers from disadvantaged backgrounds.     

Mittendrin statt nur dabei…

Background

Health promotion at universities focuses on employees rather than on students as proposed by workplace health promotion.

Methods

The article presents two projects: In the course of lectures students of the bachelor degree programme “Health Promotion” (University of Education Schwäbisch Gmünd) and of the master degree programme “Health Management” (Carinthia University of Applied Sciences, CUAS) worked on topics concerning students’ health in a participative way.

Results

In the first project an anti-stress-manual entitled “Lässig statt stressig durchs Studium” (Studying without stress but with coolness) was published. The FOSH-project (Focus On Students’ Health) at the CUAS was dedicated to a comprehensive as-is-analysis, the development and implementation of an anti-stress-course for part-time students.

Discussion

The projects give example for the realisation of students’ participation in an applied way. Students’ health as an integral part of the curricula as well as the use of peer coaching have proven to be promising approaches.     

Die Quartiersdiagnose: Daten und Ansätze für ein stadtteilorientiertes Präventionsprogramm des Öffentlichen Gesundheitsdienstes

Background

The local health authority in Hamburg-Eimsbüttel has developed a prevention programme for the disadvantaged quarter “Lenzsiedlung” (Lenz residential area). This programme is implemented together with the “Round Table for Health”. As part of the main focus on “prevention research” funded by the German Federal Ministry of Education and Research (BMBF), the department of Medical Sociology of the University Medical Centre Hamburg-Eppendorf has taken on the accompanying analysis in a joint scientific-practical project.

Objectives

The research project has two basic objectives: first, the development of local health reporting for further development of the local prevention programme. Second, the programme is to be evaluated regarding its effectiveness. Here, the instrument “Capacity Building in the Quarter” is applied, which was especially designed for this project.

Results

The research project has provided a diagnosis for the quarter, which describes the health and social situation in the “Lenzsiedlung” and maps structures and capacities for health promotion and prevention. The diagnosis for the quarter provides data from secondary statistical analysis regarding population and social structure and from two primary field researches: a survey of residents asking about utilisation and evaluation of offered services as well as a survey interviewing stakeholders about the development process of structural improvements and capacity building.

Conclusion

The complex approach of the diagnosis for the quarter provides helpful and necessary findings for the stakeholders of local health authorities and their cooperation partners regarding the local social and health situation as well as the development status of activities and procedures. The results of the project were made available to the “Round Table for Health”. Currently, stakeholders are discussing the findings with regard to a continued implementation of the prevention programme. However, it is still questionable whether the public health sector has enough resources to implement such a complex approach to establish an empirically sound basis for local health promotion and prevention.     

慢性非传染性疾病费用分析及政策取向

本文对济南等６个城市进行了一次慢性非传染性疾病费用及相关卫生资源的回顾性调查，结果显示：慢性病的住院费用的增长速度大大超过卫生总费用的增长速度，预示着慢性病将消耗更多的卫生资源和吸收更多的卫生费用。然而慢性病的治疗效果甚微，成本效益很低。因此控制慢性病的政策取向，首先是通过健康教育使人们自觉地避开或减少慢性病的风险因素的影响以降低患病率，其次是通过将病人分流到基层医院和建立社区卫生服务等途径使慢性病每病例住院费用大大降低，从而提高卫生资源的使用效率。     

Prävention im Jugendsport

Background

A number of important findings from the evaluation study of “cool and clean”—a Swiss prevention programme aimed at young athletes and their coaches—are presented. Training groups participating in “cool and clean” pledge to adhere to a number of commitments regarding fairness, doping and substance abuse. The programme thus aims to enhance the generally supposed positive impact of sport on the development of adolescents.

Methods

“cool and clean” is based on the national sport promotion programme “Jugend+Sport” (Youth+Sport, J+S) and targets coaches who are responsible for training groups, offer courses or organise sport camps. A total of 1289 J+S coaches were interviewed with an online-questionnaire concerning their response to problems in connection with substance abuse, violence, lack of fair play and doping.

Results

The evaluation shows that the prevention programme is well received, positively evaluated and implemented with a high degree of motivation by coaches. Experienced coaches with a longer career in sport and an above-average dedication to their sport tend to participate more often in “cool and clean” than other coaches. Participating coaches have a better knowledge of how to behave in case of problems and they know coping strategies or experts they may consult. In addition, they more often perceive themselves as role models.

Conclusions

Our results do not render possible an assessment of whether “cool and clean” has the desired impact on adolescents. Yet, the successful integration of coaches into the programme shown in the article is an important and necessary condition if a programme such as “cool and clean” is to work.

     

SSCI收录图书情报类期刊“非可被引文献”的引证特征

【目的】探讨SSCI收录图书情报类期刊“非可被引文献”（NCD）的引证特征及其意义。【方法】对SSCI收录所有图书情报类期刊2011—2012年发表的NCD进行统计,并进一步统计各类型NCD在2013年的被引量。【结果】SSCI收录的图书情报类期刊NCD类型中数量最多的是Book review,达9723篇,其次是Proceedings paper和Editorialmaterial,三者都超过了1000篇。从引证效率来说,Book的篇均被引量和文献被引量都非常高,其次为Reprint、Software review、Editorialmaterial、Bibliography、Proceedings paper、Letter,文献被引率都超过了10%。而 Biographical item和 Meeting abstract引证效率为0。【结论】我国图书情报类期刊应当立足于期刊本身,设置多样化NCD类型,吸收国内外优秀图书情报学稿源,不断提升期刊国际影响力。     

Lebenssituationen älter werdender und alter Menschen in Deutschland

This contribution aims to convey a general overview of the living conditions of ageing and old people in Germany. It introduces a series of contributions devoted to the topic “health in old age” and focuses on older people as a very heterogeneous group in society. Who exactly are these older people? We start by discussing the definition of “old age” as a stage of life and the distinction between a “third” and “fourth” age. This is followed by a presentation of some facts describing demographic change at the population level. The main body of the contribution looks at households and housing, family relations and social integration, income, life satisfaction and the health of older people. The two waves of the German Ageing Survey, a representative study of persons in the second half of life undertaken in 1996 and 2000, provide the empirical base for the paper.     

Improving performance of long‐term care networks at their initial stage: an empirical study of factors affecting results

Until now very little research has been carried out on the performance of health and human services networks in evolution. In particular, previous studies mainly referred to “centrally governed services networks” in the US context. According to Provan and Kenis (2008), these networks are “lead organization‐governed”, and are different from the “participant‐governed” model or the “network administrative organization (NAO)” solution. We focused our attention on the Apulia region care services networks (Italy). In the last few years, the governance of these networks has passed from the “participant‐governed” model to the NAO approach. We examined how the integration mechanisms work in this type of networks, and if there were challenges to tackle in order to improve their overall performance. These networks were examined at their initial stage, exactly when their governance model moved to a more integrated solution. We collected survey data from 17 health and human services networks out of 45 (38%). The research is carried out by means of statistical methods (OLS). The analysis is cross sectional. The implementation of “rational/technocratic” factors is important but not sufficient to enhance collaboration. The integration at the “professional level” should be kept in mind. In particular, the role of network (case) managers is paramount. Copyright © 2016 John Wiley & Sons, Ltd.     

Identification and ranking of specific balanced scorecard performance measures for hospitals: A case study of private hospitals in the Klang Valley area,Malaysia

Performance measurement is a necessity for private hospitals as they need to be efficient, attract customers, increase profitability, and survive in the competitive environment of the health care industry. Hospitals typically struggle to identify appropriate performance measures because of lack of reliable source of performance measures for private hospitals. Despite numerous studies on performance measurement, few studies have focused on performance measures in private hospitals. This paper aims to fill that gap by identifying and ranking a specific set of performance measures that are feasible and relevant for private hospitals. Forty‐four health care performance measures in four balanced scorecard (BSC) performance perspectives (financial, customer, internal business processes, and learning and growth) were compiled and filtered based on “feasibility” and “relevance” criteria using a questionnaire survey in private hospitals in the Klang Valley area, Malaysia. Since all collected data were in numeric format, data analysis was performed quantitatively. Consequently, 31 BSC performance measures were identified for private hospitals. Next, the 31 performance measures went through a ranking survey in Klang Valley private hospitals. Therefore, a weight between 0 and 1 with a range of 0.095 to 0.207 was obtained for each performance measure to help hospitals quantify their overall performance more accurately.     

Consecuencias biopsicosociales en población española afectada por un proceso de desahucio

The biopsychosocial consequences in Spanish population affected by an eviction process were described in this paper. A scoping review was conducted, consulting the following databases: PubMed, Scopus, PsycINFO, CINAHL, LILACS, CSIC, MEDES, Scielo, Dialnet, Cuiden Plus and Cochrane. The search strategy was (Eviction OR “Home eviction” OR “Housing eviction” OR “Households at risk of eviction” OR Foreclosure) AND (“Health” OR “Mental Health” OR “Psychosocial impact” OR “Impacts on health” OR “Social impact indicators” OR “Social Determinants of Health” OR “Social Indicators”).Eleven articles published between 2008 and September 2018 were selected. They followed a quantitative or qualitative methodology. The research quality was measured, and the results were organized according to the biopsychosocial model. From the physical perspective, results described a poor self-perception of health, as well as an increase of chronic diseases, pain, drug consumptions. From the psychological perspective, it was found negative thoughts, recurrent emotions and increased anxiety, depression, mental disorder and post-traumatic stress. From the social perspective, it was found that family, the offspring and the guarantor were affected, as well as the health system with greater medical visits and emergencies. This review showed worse health indicators among women, such as a headache, smoking habits, worse self-perception of health and more mental health disorders (depression, anxiety and other types of psychological distress). Daughters revealed worse self-perception of health than sons. It is necessary an approach from public health, epidemiological surveillance, action protocols and health programs, to advise, diagnose, prevent, protect and promote the health of the Spanish population affected.     

Whole System in the Room: Toward Systems Integration in Healthcare

How might systems integration be furthered in healthcare? The paper addresses this by exploring critically the potentials of appreciative inquiry for accelerating systems integration through a large group intervention. We analyze a one-day dialog workshop to get “the whole system in the room” to improve cancer care in a regional health authority in south west Sweden. Seeing systems integration as socialization and enhanced common understandings, we suggest that discourse may play a crucial role in bringing together the various stakeholders in the system. Our analysis of the group discussions of the event demonstrates however that the degree of shared understanding can vary considerably across the discussion themes of appreciative inquiry. We argue that the “patient,” as a linguistic artifact, can act as a boundary signifier that enables those present to interact in a meaningful and coherent way but that this stops short of systems integration.     

Prevention of non-communicable diseases in Pakistan: an integrated partnership-based model

Development and implementation of non-communicable disease (NCD) prevention polices in the developing countries is a multidimensional challenge. This article highlights the evolution of a strategic approach in Pakistan. The model is evidence-based and encompasses a concerted and integrated approach to NCDs. It has been modelled to impact a set of indicators through the combination of a range of actions capitalizing on the strengths of a public-private partnership. The paper highlights the merits and limitations of this approach. The experience outlines a number of clear imperatives for fostering an enabling environment for integrated NCD prevention public health models, which involve roles played by a range of stakeholders. It also highlights the value that such partnership arrangements bring in facilitating the mission and mandates of ministries of health, international agencies with global health mandates, and the non-profit private sector. The experience is of relevance to developing countries that have NCD programs running and those that need to develop them. It provides an empirical basis for enhancing the performance of the health system by fostering partnerships within integrated evidence-based models and permits an analysis of health systems models built on shared responsibility for the purpose of providing sustainable health outcomes.     

Health Workers’ Perceptions of Italian Female Adolescents: A Qualitative Study About Sexuality,Contraception, and Caring Practices in Family Health Centers

Our aim was to explore health workers’ perceptions of providing sexuality and contraception care for female adolescents within family health centers. We interviewed 26 volunteer health workers and analyzed the interviews using thematic analysis. We identified three main themes: (a) “adolescents and sexuality,” with the subthemes “initiation rite,” “me like the others,” and “just for fun”; (b) “adolescents and contraception,” with the subthemes “omnipotent adolescents,” “aware adolescents,” and “women's responsibility”; and (c) “health workers and adolescents,” with the subthemes “to put in order,” “to catch,” and “to teach to take care of themselves.” Our results provided an interesting picture of health workers’ perceptions of their work with Italian female adolescents regarding sexuality and contraception.     

The optics of noncommunicable diseases: from lifestyle to environmental toxicity

Until recently, the noncommunicable disease (NCD) category was composed of four chronic diseases (cancer, cardiovascular disease, diabetes and chronic respiratory disease) and four shared, ‘modifiable’ behavioural risk factors (smoking, diet, physical activity and alcohol). In late 2018, the NCD category was expanded to include mental health as an additional disease outcome and air pollution as an explicit environmental risk factor. The newly-expanded NCD category connects behavioural and environmental readings of risk and shifts attention from individual acts of consumption to unequal and inescapable conditions of environmental exposure. It thus renders the increasing ‘toxicity’ of everyday life amid ubiquitous environmental contamination a new conceptual and empirical concern for NCD research. It also, as this paper explores, signals a new ‘optics’ of a much-maligned disease category. This is particularly significant as chronic disease research has long been siloed between public and environmental health, with each discipline operationalising the notion of the ‘environment’ as a source of disease causation in contrasting ways. Given this, this paper is positioned as a significant contribution to both research on NCDs and environmental risk, bringing these interdisciplinary domains into a new critical conversation around the concept of toxicity.     

社区卫生服务人员体育运动影响因素及促进策略分析

目的 了解社区卫生服务人员体育运动现状及影响因素,为提升社区卫生服务人员“体育人口”比例,落实“体卫融合”促进人群健康提供依据。方法 按照分层随机抽样方法,从烟台市253个社区卫生服务机构抽取3 061名社区卫生工作人员进行问卷调查。运用χ²检验、多因素logistic回归探索影响社区卫生服务人员参与体育运动的因素。结果3 061名调查对象中,体育健身知识丰富603人(19.70%),热爱体育运动2 267人(74.06%),达到“体育人口”标准721人(23.55%)。不同性别、年龄、文化程度、工作年限、体育健身知识、“运动处方”知识、体育运动态度、“体卫融合”态度、体质监测情况、工作地点健身设施配备之间“体育人口”比例差异均有统计学意义(χ²分别为38.925、51.053、39.953、47.812、219.604、257.246、218.309、94.682、474.972、91.669,均P<0.05);logistic回归分析发现：性别(OR=1.493,95%CI:1.217～1.832)、年龄(OR=1.425,95%C...     

A survey exploring knowledge and perceptions of general practitioners towards the use of generic medicines in the northern state of Malaysia

ObjectivesThe objective of this study was to evaluate the general practitioners’ (GPs’) knowledge and perceptions towards generic medicines in a northern state of Malaysia.MethodA postal cross-sectional survey involving registered GPs in Penang, Malaysia was undertaken. A 23-item questionnaire was developed, validated and administered on the GPs. Eighty-seven GPs responded to the survey (response rate 26.8%).ResultsThe majority of the respondents (85.1%) claimed that they actively prescribed generic medicines in their practice. On the other hand, only 4.6% of the respondents correctly identified the Malaysia's National Pharmaceutical Control Bureau's bioequivalence standard for generic products. There were misconceptions among the respondents about the concepts of “bioequivalence”, “efficacy”, “safety”, and “manufacturing standards” of generic medicines. GPs in this survey believed that a standard guideline on brand substitution process, collaboration with pharmacists, patient education and information on safety and efficacy of generic medicines were necessary to ensure quality use of generics. Furthermore, advertisements and product bonuses offered by pharmaceutical companies, patient's socio-economic factors as well as credibility of manufacturers were factors reported to influence their choice of medicine.ConclusionAlthough it appeared that GPs have largely accepted the use of generic medicines, they still have concerns regarding the reliability and quality of such products. GPs need to be educated and reassured about generic products approval system in Malaysia concerning bioequivalence, quality, and safety. The current findings have important implications in establishing generic medicines policy in Malaysia.