An epistemic community comes and goes? Local and national expressions of heart health promotion in Canada

<p>Abstract</p> <p>Background</p> <p>The objective of this study is to examine the existence and shape of epistemic communities for (heart) health promotion at the international, national, provincial and regional levels in Canada. Epistemic community may be defined as a network of experts with an authoritative claim to policy relevant knowledge in their area of expertise.</p> <p>Methods</p> <p>An interpretive policy analysis was employed using 60 documents (48 provincial, 8 national and 4 international) and 66 interviews (from 5 Canadian provinces). These data were entered into NUD*IST, a qualitative software analysis package, to assist in the development of codes and themes. These codes form the basis of the results.</p> <p>Results</p> <p>A scientific and policy epistemic community was identified at the international and Canadian federal levels. Provincially and regionally, the community is present as an idea but its implementation varies between jurisdictions.</p> <p>Conclusion</p> <p>The importance of economic, political and cultural factors shapes the presence and shape of the epistemic community in different jurisdictions. The community waxes and wanes but appears robust.</p

The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis

Abstract Background Falling accounts for a significant number of hospital and long-term care admissions in older adults. Many adults with the combination of advancing age and functional decline associated with lower extremity osteoarthritis (OA), are at an even greater risk. The purpose of this study was to describe fall and near-fall history, location, circumstances and injuries from falls in a community-dwelling population of adults over aged 65 with hip OA and to determine the ability of the timed up and go test (TUG) to classify fallers and near-fallers. Method A retrospective observational study of 106 older men and women with hip pain for six months or longer, meeting a clinical criteria for the presence of hip OA at one or both hips. An interview for fall and near-fall history and administration of the TUG were administered on one occasion. Results Forty-five percent of the sample had at least one fall in the past year, seventy-seven percent reported occasional or frequent near-falls. The majority of falls occurred during ambulation and ascending or descending steps. Forty percent experienced an injury from the fall. The TUG was not associated with history of falls, but was associated with near-falls. Higher TUG scores occurred for those who were older, less mobile, and with greater number of co-morbidities. Conclusion A high percentage of older adults with hip OA experience falls and near-falls which may be attributed to gait impairments related to hip OA. The TUG could be a useful screening instrument to predict those who have frequent near-falls, and thus might be useful in predicting risk of future falls in this population.</p

Power to the people? An international review of the democratizing effects of direct elections to healthcare organizations

Ensuring that publicly funded health systems are democratically accountable is an enduring challenge in policy and practice. One strategy for enhancing public officials' accountability is to elect members of the public to oversee their performance. Several countries have experimented with direct elections to healthcare organizations. The most directly comparable examples involve some Canadian regional health authorities, New Zealand district health boards, foundation trusts in England and health boards in Scotland. We propose three aspects of the process by which the democratizing effects of elections should be judged: authorization, accountability and influence. Evidence from these countries suggests that the democratization of health systems is a complex task, which cannot be completed simply by introducing elections

Messages that increase women’s intentions to abstain from alcohol during pregnancy: results from quantitative testing of advertising concepts

Background: Public awareness-raising campaigns targeting alcohol use during pregnancy are an important part of preventing prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. Despite this, there is little evidence on what specific elements contribute to campaign message effectiveness. This research evaluated three different advertising concepts addressing alcohol and pregnancy: a threat appeal, a positive appeal promoting a self-efficacy message, and a concept that combined the two appeals. The primary aim was to determine the effectiveness of these concepts in increasing women’s intentions to abstain from alcohol during pregnancy.Methods: Women of childbearing age and pregnant women residing in Perth, Western Australia participated in a computer-based questionnaire where they viewed either a control or one of the three experimental concepts. Following exposure, participants’ intentions to abstain from and reduce alcohol intake during pregnancy were measured. Other measures assessed included perceived main message, message diagnostics, and potential to promote defensive responses or unintended consequences.Results: The concepts containing a threat appeal were significantly more effective at increasing women’s intentions to abstain from alcohol during pregnancy than the self-efficacy message and the control. The concept that combined threat and self-efficacy is recommended for development as part of a mass-media campaign as it has good persuasive potential, provides a balance of positive and negative emotional responses, and is unlikely to result in defensive or unintended consequences.Conclusions: This study provides important insights into the components that enhance the persuasiveness and effectiveness of messages aimed at preventing prenatal alcohol exposure. The recommended concept has good potential for use in a future campaign aimed at promoting women’s intentions to abstain from alcohol during pregnanc

Proceedings of the Interprovincial Think Tank of Youth and Gambling : October 21-22, 1999, Winnipeg, Manitoba

Like the three interprovincial conferences before it, the Interprovincial Think Tank (IT) was rooted in the need to enhance understanding of gambling and problem gambling as it relates to the day-to-day work and personal experiences of Think Tank participants. From the beginning, our collective mandate has been to address problem gambling, and in doing so we have created opportunities to do two important things: share our knowledge and experiences; and broaden the base of understanding in the wider community. During this process, we have learned from each other as well as from the community at large. This ITT was a continuation of the exchange and the learning. For this Think Tank, the Planning Committee set i t s sites on the topic of youth and gambling. The need to explore this topic stems from three key realities. First, there is a public, political and interest-group expectation that the needs of youth be addressed in the context of problem gambling. Second, while prevalence data exist, there is uncertainty among those working in the problem gambling area about the meaning of the data. And third, uncertainty also exists around the importance of problem gambling as an issue for youth and of youth gambling as an issue for society. The proceedings of this ITT were not developed as a "blueprint for action." Rather, they are intended to provide information that will guide people as they work in their communities and collaboratively develop plans to address youth and problem gambling issues. As the reader will see, these proceedings accomplish this goal. They reveal the richness and diversity in the details that emerged as participants expressed their views and described their experiences in response to the discussion questions. While several themes around the topic of youth and gambling became defined, it was the diversity of the participants' perspectives that drove the conference towards its conclusion: no single formula can be presented to address the youth gambling issue across different communities. Instead, communities need to implement the strategies and approaches that make sense for them. The information garnered from this Think Tank will help to guide discussion and action across the country towards this end. It is evident that this Think Tank and the previous conferences have laid a strong foundation for continuing the country-wide exchange on problem gambling. The committee expresses its gratitude to the sponsors of this event as well as to all participants. The Think Tank would not have been the success it was without the energy, sense of humour and candidness of all those who took part