Health promotion and health systems: some unfinished business

n/

Can stakeholders agree on how to reduce human – carnivore conflict on Namibian livestock farms? A novel Q-methodology and Delphi exercise

Conflict between carnivores and livestock farmers affects human livelihoods and predator populations. Historically, successful mitigation of this conflict has been limited, sometimes because of a lack of participation among stakeholders to create and implement agreeable and effective solutions. Finding common ground between stakeholders can, however, be difficult, partly because of the range and intensity of values held. Using a novel combination of Q-methodology and the Delphi technique, I investigated whether a diverse range of stakeholders could agree on how to mitigate conflict between carnivores and livestock farmers in Namibia. A strong consensus was reached on using conservation education and husbandry training to reduce livestock depredation. Two narratives emerged: one group preferred non-lethal methods to manage the conflict, whereas a smaller group preferred lethal measures. This new decision-making exercise has potential to be applied to other conservation conflicts to assist with participatory decision making

A psycho-educational curriculum for sport career transition practitioners: Development and evaluation

Research question: This paper is an integration of three studies. Study 1 investigates sport career transition organisational intervention programmes for high performance athletes and training and development programmes for sport career transition practitioners in order to find a research gap with regard to sport career transition supporting services. A psycho-educational curriculum was developed for sport career transition practitioner in Study 2 to fill the research gap. In Study 3, the curriculum was examined to see if the curriculum contributed to enhancing practitioners’ confidence in key competences.  Research methods: A range of methods were applied to the studies including One Group Pre- and Post-test design, Case Study, Focus Group, Semi-Structured Interview, two-round Delphi-Method and Questionnaires. The data for Study 1 collected from 19 countries worldwide and total 16 participants based in seven different countries were invited to development and evaluation of the curriculum.  Results and Findings: A novel psycho-educational curriculum for sport career transition practitioner was developed and evaluated concerning four competences as a form of curriculum package. The findings revealed that the curriculum package increased the participants’ confidence in key competences concerning sport career transition.  Implications: The findings deepen the knowledge of sport career transition in the areas of organisational intervention programmes focusing on high performance athletes and sport career transition practitioners. These findings contribute to modifying the Conceptual Model of Adaptation to Career Transition (Lavallee, Park, & Taylor, 2014) by strengthening the organisational intervention perspective and applied work in respect of sporting organisation management strategie

Assessment of possible impact of a health promotion program in Korea from health risk trends in a longitudinally observed cohort

BACKGROUND: Longitudinally observed cohort data can be utilized to assess the potential for health promotion and healthcare planning by comparing the estimated risk factor trends of non-intervened with that of intervened. The paper seeks (1) to estimate a natural transition (patterns of movement between states) of health risk state from a Korean cohort data using a Markov model, (2) to derive an effective and necessary health promotion strategy for the population, and (3) to project a possible impact of an intervention program on health status. METHODS: The observed transition of health risk states in a Korean employee cohort was utilized to estimate the natural flow of aggregated health risk states from eight health risk measures using Markov chain models. In addition, a reinforced transition was simulated, given that a health promotion program was implemented for the cohort, to project a possible impact on improvement of health status. An intervened risk transition was obtained based on age, gender, and baseline risk state, adjusted to match with the Korean cohort, from a simulated random sample of a US employee population, where a health intervention was in place. RESULTS: The estimated natural flow (non-intervened), following Markov chain order 2, showed a decrease in low risk state by 3.1 percentage points in the Korean population while the simulated reinforced transition (intervened) projected an increase in low risk state by 7.5 percentage points. Estimated transitions of risk states demonstrated the necessity of not only the risk reduction but also low risk maintenance. CONCLUSIONS: The frame work of Markov chain efficiently estimated the trend, and captured the tendency in the natural flow. Given only a minimally intense health promotion program, potential risk reduction and low risk maintenance was projected

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

OBJECTIVE: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome