Evaluating the impact of equity focused health impact assessment on health service planning: Three case studies

© 2014 Harris-Roxas et al. Conclusion: EFHIA has the potential to improve the consideration of health equity in health service planning processes, though a number of contextual and individual factors affect this. Current approaches can be strengthened by taking into account personal and organisational responses to the EFHIA process.Background: Health impact assessment has been identified internationally as a mechanism to ensure potential health impacts and health equity impacts of proposals are considered before implementation. This paper looks at the impact of three equity focused health impact assessments (EFHIAs) of health service plans on subsequent decision-making and implementation, and then utilises these findings to test and refine an existing conceptual framework for evaluating the impact and effectiveness of health impact assessments for use in relation to EFHIAs.Methods: Case study analysis of three EFHIAs conducted on health sector plans in New South Wales, Australia. Data was drawn from 14 semi-structured interviews and the analysis of seven related documents (draft plans and EFHIA reports).Results: The case studies showed that the EFHIAs all had some impact on the decision-making about the plans and their implementation, most clearly in relation to participants' understandings of equity and in the development of options for modifying service plans to ensure this was addressed. The timing of the EFHIA and individual responses to the EFHIA process and its recommendations were identified as critical factors influencing the impact of the EFHIAs. Several modifications to the conceptual framework are identified, principally adding factors to recognise the role individuals play in influencing the impact and effectiveness of EFHIAs

DIETA HIPOSSÓDICA AUMENTA A BIODISPONIBILIDADE DE NO E A PRODUÇÃO DE PROSTANÓIDES VASOCONSTRICTORES DA COX-2 EM RATOS ESPONTANEAMENTE HIPERTENSOS

JUSTIFICATIVA E OBJETIVOS: A restrição de sal é recomendada no tratamento da hipertensão para reduzir a pressão arterial, mas a implicação sobre os fatores de risco cardiovasculares ainda é uma questão em debate. A capacidade que a dieta com restrição de sódio tem para reduzir a incidência de mortalidade cardiovascular na hipertensão ainda não é clara. O objetivo deste estudo foi avaliar o efeito de um longo período de dieta com restrição de sal sobre a reatividade de artérias mesentéricas de ratos espontaneamente hipertensos (SHR). MATERIAL E MÉTODOS: Ratos machos SHR receberam dieta normossódica (0,3% NaCl) ou hipossódica (0,03% NaCl) durante 28 semanas. Foi isolado o terceiro ramo da artéria mesentérica para análise da influência dos mediadores da reatividade vascular: oxido nítrico (NO), ciclooxigenase-2 (COX-2), espécies reativas de oxigênio (ERO) e sistema renina-angiotensina (SRRA). RESULTADOS: Após 7 meses de dieta, o grupo SHR que recebeu dieta hipossódica apresentou redução na pressão arterial sistólica (PAS) quando comparado ao que recebeu dieta normossódica (dieta hipossódica: 169 ± 4 mmHg, normossódica: 203 ± 4,7 mmHg; P <0,05). A redução na ingestão de sal não alterou a vasoconstrição induzida pela fenilefrina, mas aumentou a vasodilatação induzida pela acetilcolina. A dieta hipossódica também aumentou os efeitos da inibição da sintase de NO com L-NAME (100 mM) sob a resposta induzida pela fenilefrina e a expressão vascular da iNOS. O inibidor da ciclooxigenase, indometacina (10 &#956;M) e o inibidor da COX-2, NS 398 (1 &#956;M) reduziram a reatividade vascular à fenilefrina no grupo de dieta hipossódica concomitante a um aumento na expressão da proteína COX-2. Não houve participação das espécies reativas de oxigênio na reatividade vascular modulada pela dieta hipossódica, quando avaliadas através do uso de bloqueadores de EROs, anion superoxido, peroxido de hidrogênio, nem com o uso dos bloqueadores de receptores da ACE e do receptor para AT1, enalapril (10 &#956;M) e losartan (10 &#956;M). A expressão da proteína do receptor AT1 também foi semelhante nos dois grupos. CONCLUSÕES: Estes resultados sugerem que a dieta hipossódica modula a reatividade mesentérica, provavelmente, pelo aumento da biodisponibilidade de NO e da produção de prostanóides vasoconstritores através da via da COX-2 em ratos espontaneamente hipertensos. As EROs e o sistema renina-angiotensina local não estão envolvidos nessa resposta vascular

From Industrial Food Waste to Bioactive Ingredients: A Review on the Sustainable Management and Transformation of Plant-Derived Food Waste

According to the United Nations, approximately one-third of the food produced for human consumption is wasted. The actual linear "Take-Make-Dispose" model is nowadays obsolete and uneconomical for societies and the environment, while circular thinking in production systems and its effective adoption offers new opportunities and benefits. Following the "Waste Framework Directive" (2008/98/CE), the European Green Deal, and the actual Circular Economy Action Plan, when prevention is not possible, recovering an unavoidable food waste as a by-product represents a most promising pathway. Using last year's by-products, which are rich in nutrients and bioactive compounds, such as dietary fiber, polyphenols, and peptides, offer a wake-up call to the nutraceutical and cosmetic industry to invest and develop value-added products generated from food waste ingredients

Patient Safety and People Who Are Incarcerated

We explore a number of key relationships between patient safety and the health status of imprisoned people. This is a conceptual study drawing connections between a number of literatures including the field of patient safety, the work done on health and illness amongst imprisoned people, their social characteristics, and the carceral environment itself. We show that this is an underexplored and under-theorised field of inquiry. It also sets the scene for further investigation of not only individual and systemic factors in the health and illness experienced by such people but the role of the carceral environment. It seems clear that the risk of ill-health rises for many people who are incarcerated. Errors of both omission and commission are common in carceral environments. Risks rise for patients in such environments due to delays in diagnosis, referral and treatment. Understanding the complex and inter-related factors that increase ill-health in individuals, groups and communities provides a starting point for understanding why, when and how imprisoned people need to access and utilise healthcare, how will they are when they do so, and how. It also opens up the question of how these factors might affect their susceptibility to medical errors and adverse events

Working in disadvantaged communities: What additional competencies do we need?

Background: Residents of socioeconomically disadvantaged locations are more likely to have poor health than residents of socioeconomically advantaged locations and this has been comprehensively mapped in Australian cities. These inequalities present a challenge for the public health workers based in or responsible for improving the health of people living in disadvantaged localities. The purpose of this study was to develop a generic workforce needs assessment tool and to use it to identify the competencies needed by the public health workforce to work effectively in disadvantaged communities. Methods: A two-step mixed method process was used to identify the workforce needs. In step 1 a generic workforce needs assessment tool was developed and applied in three NSW Area Health Services using focus groups, key stakeholder interviews and a staff survey. In step 2 the findings of this needs assessment process were mapped against the existing National Health Training Package (HLT07) competencies, gaps were identified, additional competencies described and modules of training developed to fill identified gaps. Results: There was a high level of agreement among the AHS staff on the nature of the problems to be addressed but less confidence indentifying the work to be done. Processes for needs assessments, community consultations and adapting mainstream programs to local needs were frequently mentioned as points of intervention. Recruiting and retaining experienced staff to work in these communities and ensuring their safety were major concerns. Workforce skill development needs were seen in two ways: higher order planning/epidemiological skills and more effective working relationships with communities and other sectors. Organisational barriers to effective practice were high levels of annual compulsory training, balancing state and national priorities with local needs and giving equal attention to the population groups that are easy to reach and to those that are difficult to engage. A number of additional competency areas were identified and three training modules developed. Conclusion: The generic workforce needs assessment tool was easy to use and interpret. It appears that the public health workforce involved in this study has a high level of understanding of the relationship between the social determinants and health. However there is a skill gap in identifying and undertaking effective intervention

The Italian Museo Nazionale dell’Antartide

These abstract proceedings were produced based on the program for the POLAR2018 SCAR/IASC Open Science Conference, updated until 25 May 2018

A four-year, systems-wide intervention promoting interprofessional collaboration

Background: A four-year action research study was conducted across the Australian Capital Territory health system to strengthen interprofessional collaboration (IPC) through multiple intervention activities. Methods: We developed 272 substantial IPC intervention activities involving 2,407 face-to-face encounters with health system personnel. Staff attitudes toward IPC were surveyed yearly using Heinemann et al’s Attitudes toward Health Care Teams and Parsell and Bligh’s Readiness for Interprofessional Learning scales (RIPLS). At study’s end staff assessed whether project goals were achieved. Results: Of the improvement projects, 76 exhibited progress, and 57 made considerable gains in IPC. Educational workshops and feedback sessions were well received and stimulated interprofessional activities. Over time staff scores on Heinemann’s Quality of Interprofessional Care subscale did not change significantly and scores on the Doctor Centrality subscale increased, contrary to predictions. Scores on the RIPLS subscales of Teamwork & Collaboration and Professional Identity did not alter. On average for the assessment items 33% of staff agreed that goals had been achieved, 10% disagreed, and 57% checked ‘neutral’. There was most agreement that the study had resulted in increased sharing of knowledge between professions and improved quality of patient care, and least agreement that between-professional rivalries had lessened and communication and trust between professions improved. Conclusions: Our longitudinal interventional study of IPC involving multiple activities supporting increased IPC achieved many project-specific goals, but improvements in attitudes over time were not demonstrated and neutral assessments predominated, highlighting the difficulties faced by studies targeting change at the systems level and over extended periods

Interaction between non-executive and executive directors in English National Health Service trust boards: an observational study

Research funded by Burdett FoundationBackground National Health Service (NHS) trusts, which provide the majority of hospital and community health services to the English NHS, are increasingly adopting a ‘public firm’ model with a board consisting of executive directors who are trust employees and external non-executives chosen for their experience in a range of areas such as finance, health care and management. In this paper we compare the non-executive directors’ roles and interests in, and contributions to, NHS trust boards’ governance activities with those of executive directors; and examine non-executive directors’ approach to their role in board meetings. Methods Non-participant observations of three successive trust board meetings in eight NHS trusts (primary care trusts, foundation trusts and self-governing (non-foundation) trusts) in England in 2008–9. The observational data were analysed inductively to yield categories of behaviour reflecting the perlocutionary types of intervention which non-executive directors made in trust meetings. Results The observational data revealed six main perlocutionary types of questioning tactic used by non-executive directors to executive directors: supportive; lesson-seeking; diagnostic; options assessment; strategy seeking; and requesting further work. Non-executive board members’ behaviours in holding the executive team to account at board meetings were variable. Non-executive directors were likely to contribute to finance-related discussions which suggests that they did see financial challenge as a key component of their role. Conclusions The pattern of behaviours was more indicative of an active, strategic approach to governance than of passive monitoring or ‘rubber-stamping’. Nevertheless, additional means of maintaining public accountability of NHS trusts may also be required