Regulating the fast-food landscape: Canadian news media representation of the Healthy Menu Choices Act

With the rapid rise of fast food consumption in Canada, Ontario was the first province to legislate menu labelling requirements via the enactment of the Healthy Menu Choice Act (HMCA). As the news media plays a significant role in policy debates and the agenda for policymakers and the public, the purpose of this mixed-methods study was to clarify the manner in which the news media portrayed the strengths and critiques of the Act, and its impact on members of the community, including consumers and stakeholders. Drawing on data from Canadian regional and national news outlets, the major findings highlight that, although the media reported that the HMCA was a positive step forward, this was tempered by critiques concerning the ineffectiveness of using caloric labelling as the sole measure of health, and its predicted low impact on changing consumption patterns on its own. Furthermore, the news media were found to focus accountability for healthier eating choices largely on the individual, with very little consideration of the role of the food industry or the social and structural determinants that affect food choice. A strong conflation of health, weight and calories was apparent, with little acknowledgement of the implications of menu choice for chronic illness. The analysis demonstrates that the complex factors associated with food choice were largely unrecognized by the media, including the limited extent to which social, cultural, political and corporate determinants of unhealthy choices were taken into account as the legislation was developed. Greater recognition of these factors by the media concerning the HMCA may evoke more meaningful and long-term change for health and food choicesYork University Librarie

Models of Concurrent Disorder Service: Policy, Coordination, and Access to Care

Background: Societal capacity to address the service needs of persons with concurrent mental health and substance-use disorders has historically been challenging given a traditionally siloed approach to mental health and substance-use care. As different approaches to care for persons with concurrent disorders emerge, a limited understanding of current models prevails. The goal of this paper is to explore these challenges along with promising models of coordinated care across Canadian provinces.Materials and methods: A scoping review of policies, service coordination and access issues was undertaken involving a review of the formal and gray literature from 2000 to 2018. The scoping review was triangulated by an analysis of provincial auditor general reports.Results: Models of concurrent disorders service were found to have evolved unevenly. Challenges related to the implementation of models of collaborative care and local networks that foster service coordination and policy accountability were found to inhibit integrated care.Conclusion: Emergent models of coordinated care were found to include collaborative care, regional networks with centralized access to care, clinical information-sharing, cross-training, improved scope of care to include psychologists and alignment of physician incentives with patient needs to better support patient care

What are the beliefs, attitudes and practices of front-line staff in long-term care (LTC) facilities related to osteoporosis awareness, management and fracture prevention?

<p>Abstract</p> <p>Background</p> <p>Compared to the general elderly population, those institutionalized in LTC facilities have the highest prevalence of osteoporosis and subsequently have higher incidences of vertebral and hip fractures. The goal of this study is to determine how well nurses at LTC facilities are educated to properly administer bisphosphonates. A secondary question assessed was the nurse's and PSW's attitudes and beliefs regarding the role and benefits of vitamin D for LTC patients.</p> <p>Methods</p> <p>Eight LTC facilities in Hamilton were surveyed, and all nurses were offered a survey. A total 57 registered nurses were surveyed. A 21 item questionnaire was developed to assess existing management practices and specific osteoporosis knowledge areas.</p> <p>Results</p> <p>The questionnaire assessed the nurse's and personal support worker's (PSWs) education on how to properly administer bisphosphonates by having them select all applicable responses from a list of options. These options included administering the drug before, after or with meals, given with or separate from other medications, given with juice, given with or without water, given with the patient sitting up, or finally given with the patient supine. Only 52% of the nurses and 8.7% of PSWs administered the drug properly, where they selected the options: (given before meals, given with water, given separate from all other medications, and given in a sitting up position). If at least one incorrect option was selected, then it was scored as an inappropriate administration. Bisphosphonates were given before meals by 85% of nurses, given with water by 90%, given separately from other medication by 71%, and was administered in an upright position by 79%. Only 52% of the nurses and 8.7% of PSWs surveyed were administering the drug properly. Regarding the secondary question, of the 57 nurses surveyed, 68% strongly felt their patients should be prescribed vitamin D supplements. Of the 124 PSWs who completed the survey, 44.4% strongly felt their patients should be prescribed vitamin D supplementation.</p> <p>Conclusion</p> <p>Bisphosphonates are quite effective in increasing the bone mineral density of LTC patients, and may reduce fracture rates, but it is only effective if properly administered. In our study, proper administration of bisphosphonate therapy was less than optimal. In summary, although the education of health providers has improved since the mid-1990's, this area still requires further attention and the subject of future quality assurance research.</p

Transnational pharmacogovernance: emergent patterns in the jazz of pharmaceutical policy convergence

Abstract Background As a transnational policy network, the International Council for Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) aligns international regulatory standards to address the pressures of globalization on the pharmaceutical industry and increase access to new medicines. Founding ICH members include regulators and pharmaceutical industry trade associations in the European Union, the United States and Japan. In this paper we explore the manner in which state interdependence fosters the conditions for regulatory harmonization by tracing the underlying parallels between ICH and member state pharmacogovernance to clarify emergent patterns in regulatory policy convergence. Results A shift to the life cycle approach to pharmaceutical regulation corresponded with international convergence in pre-market standards as emphasis shifted to post-market standards where convergence remains unresolved. Transnational pharmacogovernance was found to concentrate regulatory authority within a co-regulatory model of bilateral negotiation with pharmaceutical trade associations in defining safety and efficacy standards. Given a context of state interdependence, parallels were found between transnational and ICH member pharmacogovernance modes that guide policy development. Divergent modes of state regulatory governance that re-calibrate perceptions of risk and risk mitigation were found to coincide with post-market policy dissonance. Conclusion Although interdependence fostered harmonization in pre-market standards and aligned with increased focus on post-market approaches, the confluence of divergent state governance modes and perceptions of risk may inspire improvisation in post-market standards. As the ICH expands to an ensemble with a greater global reach, further research is needed to clarify the manner in which interdependence shapes transnational pharmacogovernance and the conditions that foster policy convergence in the public interest

Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review

Abstract Background Social accountability is a participatory process in which citizens are engaged to hold politicians, policy makers and public officials accountable for the services that they provide. In the Fifteenth Ordinary Session of the Assembly of the African Union, African leaders recognized the need for strong, decentralized health programs with linkages to civil society and private sector entities, full community participation in program design and implementation, and adaptive approaches to local political, socio-cultural and administrative environments. Despite the increasing use of social accountability, there is limited evidence on how it has been used in the health sector. The objective of this systematic review was to identify the conditions that facilitate effective social accountability in sub-Saharan Africa. Methods Electronic databases (MEDLINE, PsycINFO, Sociological Abstracts, Social Sciences Abstracts) were searched for relevant articles published between 2000 and August 2017. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a social accountability intervention in sub-Saharan Africa. Qualitative and quantitative study designs were eligible. Results Fourteen relevant studies were included in the review. The findings indicate that effective social accountability interventions involve leveraging partnerships and building coalitions; being context-appropriate; integrating data and information collection and analysis; clearly defined roles, standards, and responsibilities of leaders; and meaningful citizen engagement. Health system barriers, corruption, fear of reprisal, and limited funding appear to be major challenges to effective social accountability interventions. Conclusion Although global accountability standards play an important guiding role, the successful implementation of global health initiatives depend on national contexts

Mapping food system factors influencing antimicrobial resistance: protocol for the development of a causal loop diagram informed by an umbrella review

This is the protocol for a systematic umbrella literature review. It is the first registration for this project.CCA and TLP acknowledge internal research support from York University. This review will be undertaken as part of a project funded by the Joint Programming Initiative on Anti-Microbial Resistance (CIHR Grant #3468277)

Accountability in malaria prevention and treatment programmes: a review of current challenges

Background: Sound governance is a fundamental tenet of financial aid programmes for malaria prevention and treatment in low-income countries, yet their limited effectiveness in reducing the prevalence of malaria suggests weaknesses in the underlying accountability frameworks. Despite heightened global attention since the Roll Back Malaria Partnership was launched in 1998, 214 million new cases and 438 000 deaths due to malaria were reported in 2015. Millions of people lack access to malaria prevention and treatment services in Africa, where 80% of malaria deaths occur. We aimed to clarify accountability frameworks and mechanisms that underlie malaria prevention and treatment programmes in sub-Saharan African countries. Methods: To clarify accountability mechanisms in maternal and child health malaria programmes in Benin, Burkina Faso, and Mali, we reviewed policy reports and studies published between Jan 1, 2000, and Aug 1, 2016, and undertook semi-structured key informant interviews with national ministries of health, non-governmental organisations, WHO, and the Global Fund to fight AIDS, Tuberculosis and Malaria. We triangulated results with findings from interviews with local health professionals and pregnant women done in 2015–16. We analysed recorded and transcribed interviews through framework analysis using NVivo software. Findings: We included 15 reports, 60 studies, and 118 individual interviews in analysis. Our analysis of accountability frameworks identified general indicators of programme implementation success such as antenatal physician visit attendance. However, important limitations in programmes were also identified. These included insufficient delineation and measurement of operational aspects of programme implementation and a lack of specific measures within local health systems used to ensure target groups' access to malaria prevention and treatment. The manner in which preventable health system deficiencies, such as medication shortages, were to be addressed and evaluated were absent from current accountability frameworks. We also noted that global accountability measures were “glocalised” by national actors, since policy adoption was infused with local customs and practices. Interpretation: National health leadership is a key driver in successful health outcomes. Changes in accountability frameworks to foster sound national health governance and leadership could support development of a more comprehensive array of practices to specifically address challenges in programme implementation, including how preventable local health system deficiencies will be alleviated to meet programme goals. Country-specific programme goals should be harmonised with the goals of national health leaders. Funding: York University, ON, Canada

Additional file 1: of Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review

Table S1. Characteristics of Included Studies. A summary of the 14 studies included in our review including study design, facilitator(s) and description of accountability initiative, outcome measure(s), key outcomes, and enabling and limiting factors. (DOCX 32 kb

Additional file 2: of Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review

Table S2. Quality of Included Studies. A summary of our quality assessment of the 14 studies included in our review. (DOCX 19 kb