Identifying research priorities on infections in older adults:Proceedings of an interdisciplinary workshop

Background: Infections pose a substantial burden to the health of older adults. In this report, we describe the proceedings of a workshop to formulate and prioritize research questions about infections in older adults using an interdisciplinary approach. Methods: Researchers from four sectors (basic science, clinical sciences, health services and epidemiology/determinants of health) and representatives from various Canadian local, provincial, and federal stakeholder groups were invited to a two-day workshop. Five multi-disciplinary groups and stakeholders from each of three healthcare settings (long term, acute care and community) discussed research priorities for each of the settings. Five to ten research questions were identified for each setting. Results: The research questions proposed ranged from risk factors and outcomes for different infections to the effect of nutrition on infection and the role of alternative and complementary medicine in treating infections. Health service issues included barriers to immunization, prolongation of hospital length of stay by infection, use of care paths for managing infections, and decision-making in determining the site of care for individuals with infections. Clinical questions included risk factor assessment for infection, the effectiveness of preventative strategies, and technology evaluation. Epidemiologic issues included the challenge of achieving a better understanding of respiratory infections in the community and determining the prevalence of colonization with multi-resistant bacteria. Conclusions: The questions are of direct relevance to researchers in a wide variety of fields. Bringing together a multi-disciplinary group of researchers to frame and prioritize research questions about aging is feasible, participants valued the opinions of people working in other areas.

Assessing health service needs:tools for health planning.

As fiscal pressures mount, health-planning and decision-making at smaller geographics scales must be more effective. Involving local constituents in needs assessments, it is believed, would lead to better identification and serving of regional demands and needs for health services. This article examines needs assessment as a tool to determine a community's service needs and establish priorities for the creation of programs. Various approaches used in needs assessments are described, including survey methods, structured groups and geographic information systems.

Mental health and neuroscience. A perspective from the magazine market

Mental health awareness has been rising worldwide, motivated by its social and economic costs. Despite the investment in research in neuroscience in the recent years, little is known about the underlying mechanisms in the brain that are correlated with psychiatric conditions. This project, through two feature articles suitable to be published in magazines, provides perspectives onto mental health research. First it presents an example where psychiatry joins forces with neuroscience and computer science in an interdisciplinary effort to improve the life of those affected by mental disorders. The second article gathers opinions which claim that mental health research priorities should be set by patients themselves, or even that people with lived experience of mental health issues should have an active role in that research. This project was planned and researched while I was an Erasmus student at Nottingham Trent University, in the United Kingdom.

Public health assessment : Railroad Avenue groundwater contamination, West Des Moines, Polk County, Iowa EPA facility ID: IA0001610963 (2004)

The Railroad Avenue groundwater contamination site (the site) is in West Des Moines, Polk County, Iowa. Located on approximately 120 acres. The site comprises mixed residential, industrial and commercial properties. Underneath the site, chlorinated volatile organic compounds (VOCs) have contaminatcd the shallow (i.e., 30-50 feet deep) groundwater. These compounds have compromised several shallow wells within the West Des Moines water works system. A contamination source, however, has not yet been identified. In 1993, routine water analysis by the City of West Des Moines identified 1, 2 cis-dichlorocthylcne (1, 2 cis-DCE) at a concentration of 1.2 μg/L (micrograms) per liter of water) in the water supply. Subsequently. several shallow municipal wells were found to be contaminated by VOCs, including 1. 2 cis-DCE, trichloroethylene (TCE), tetrachloroethylene (PCE) and benzene. Five of these wells have been taken out of service. Because of the impact on the West Des Moines water supply, the U.S. Environmental Protection Agency (USEPA) has assigned the site to the National Priorities List. Surface water und sediment at the site have not been impacted by the VOCs. Testing for VOCs in surface soils has not revealed any significant VOC contamination. Subsurface soils -- generally 8 feet or greater in depth -- are contaminated with VOCs, but at levels which should not present a health hazard. The past, present, and future health hazard category chosen for this site is no apparent public health hazard. This category is used when exposure to toxins might be occurring or might have occurrcd in the past, but at levels below any known health hazard. Analysis of available environmental data has not revealed that residental or commercial water customers are or have been exposed to VOCs at concentrations that might cause any adverse health effects.

Introducing e-learning in a large multisite academic health sciences centre: a case study of e-curriculum planning and educator support /

This qualitative study investigated how a team of 7 hospital educators collaborated to develop e-curriculum units to pilot for a newly acquired learning -r management system at a large, multisite academic health sciences centre. A case study approach was used to examine how the e-Curriculum Team was structured, how the educators worked together to develop strategies to better utilize e-leaming in their ovwi practice, what e-curriculum they chose to develop, and how they determined their priorities for e-curriculum development. It also inquired into how they planned to involve other educators in using e-leaming. One set of semistructured interviews with the 6 hospital educators involved in the project, as well as minutes of team meetings and the researcher's journal, were analyzed (the researcher was also a hospital educator on the team). Project management structure, educator support, and organizational pressures on the implementation project feature prominently in the case study. This study suggests that implementation of e-leaming will be more successful if (a) educators involved in the development of e-leaming curriculum are supported in their role as change agents, (b) the pain of vmleaming current educational practice is considered, (c) the limitations of the software being implemented are recognized, (d) time is spent leaming about best practice, and (e) the project is protected as much as possible from organizational pressures and distractions.

Nutrigenomics for Global Health: Ethical Challenges for Underserved Populations

Nutrigenomics covers disparate fields of nutrition science and has been defined in many different ways. In fact, this emerging field of science has multiple facets, many of which do not generate the same ethical issues. In particular, different ethical issues emerge concerning the extent to which nutrigenomics may actually improve global health, i.e., in terms of worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders. Nutrigenomics raises many hopes and expectations on that score. However it remains unclear and controversial whether nutrigenomics studies and their actual or potential applications will actually benefit developing countries and their populations. Different forces may drive the choice of research priorities and shape the claims that are made when communicating the goals or the results of nutrigenomics studies and applications. This article proposes to assess expectations and claims in nutrigenomics, with respect to their respective potential impact on global health and the ethical issues they raise. Nutrigenomics is and should be more than premature claims and much debated promises about personalized nutritional interventions on individuals. Beyond questionable commercial claims, nutrigenomics is also knowledge about and recognition of the considerable impacts of underfeeding and malnutrition on the genome (and epigenome) integrity and stability. As such, nutrigenomics research is a valuable opportunity to revive and give strength to the debate about the unacceptable consequences of hunger and malnutrition worldwide, and to support a newly and potentially significant convergence in research priorities that could benefit both developed and developing countries.

The experiences and priorities of young people who care for their siblings in Tanzania and Uganda

This report presents key findings from a small-scale pilot research project that explored the experiences and priorities of young people caring for their siblings in sibling-headed households affected by AIDS in Tanzania and Uganda. Qualitative and participatory research was conducted with 33 young people living in sibling-headed households and 39 NGO staff and community members in rural and urban areas of Tanzania and Uganda. The report analyses the ways that young people manage transitions to caring for their younger siblings following their parents’ death and the impacts of caring on their family relations, education, emotional wellbeing and health, social lives and their transitions to adulthood. The study highlights gendered- and age-related differences in the nature and extent of young people’s care work and discusses young people’s needs and priorities for action, based on the views of young people, NGO staff and community members. Meeting the basic needs of young people living in sibling-headed households, listening to young people’s views, fostering peer support and relationships of trust with supportive adults, raising awareness and advocacy emerge as key priorities to safeguard the rights of children and young people living in sibling-headed households and challenge the stigma and marginalisation they sometimes face.

Research priorities in observing and modeling urban weather and climate

In 2007, the world reached the unprecedented milestone of half of its people living in cities, and that proportion is projected to be 60% in 2030. The combined effect of global climate change and rapid urban growth, accompanied by economic and industrial development, will likely make city residents more vulnerable to a number of urban environmental problems, including extreme weather and climate conditions, sea-level rise, poor public health and air quality, atmospheric transport of accidental or intentional releases of toxic material, and limited water resources. One fundamental aspect of predicting the future risks and defining mitigation strategies is to understand the weather and regional climate affected by cities. For this reason, dozens of researchers from many disciplines and nations attended the Urban Weather and Climate Workshop.1 Twenty-five students from Chinese universities and institutes also took part. The presentations by the workshop's participants span a wide range of topics, from the interaction between the urban climate and energy consumption in climate-change environments to the impact of urban areas on storms and local circulations, and from the impact of urbanization on the hydrological cycle to air quality and weather prediction.

Chronic Diseases: Chronic Diseases and Development 2 Health, agricultural, and economic effects of adoption of healthy diet recommendations

Transition to diets that are high in saturated fat and sugar has caused a global public health concern as the pattern of food consumption is a mayor modifiable risk factor for chronic non-communicable diseases Although agri food systems are intimately associated with this transition, agriculture and health sectors are largely disconnected in their priorities policy, and analysis with neither side considering the complex inter relation between agri trade patterns of food consumption health, and development We show the importance of connection of these perspectives through estimation of the effect of adopting a healthy diet on population health, agricultural production trade the economy and livelihoods, with a computable general equilibrium approach On the basis of case studies from the UK and Brazil we suggest that benefits of a healthy diet policy will vary substantially between different populations, not only because of population dietary intake but also because of agricultural production trade and other economic factors

Population health and wellbeing: identifying priority areas for Victorian children

Background
Population health information, collected using soundly-designed methodologies, is essential to inform policy, research, and intervention programs. This study aimed to derive policy-oriented recommendations for the content of a health and wellbeing population survey of children 0–12 years living in Victoria, Australia.

Results
Qualitative interviews were conducted with 54 academic and policy stakeholders, selected to encompass a wide breadth of expertise in areas of public health and inter-sectoral organisations relevant to child health outcomes, including universities, government and non-government agencies across Victoria. These stakeholders were asked to provide advice on strategic priorities for child health information (data) using a structured interview technique. Their comments were summarised and the major themes were extracted. The priority areas of health and wellbeing recommended for regular collection include obesity and its determinants, pregnancy and breastfeeding, oral health, injury, social and emotional health and wellbeing, family environment, community, health service utilisation, illness, and socioeconomic position. Population policy questions for each area were identified.

Conclusion
In contrast to previous population survey programs nationally and internationally, this study sought to extract contemporary policy-oriented domains for inclusion in a strategic program of child health data collection, using a stakeholder consultation process to identify key domains and policy information needs. The outcomes are a rich and relevant set of recommendations which will now be taken forward into a regular statewide child health survey program.

Global priority setting for Cochrane systematic reviews of health promotion and public health research

Background: Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers.

Aims: To identify global priorities for Cochrane systematic reviews of public health topics.

Methods: Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities.

Results: 26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations.

Discussion: The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.

Attaching unit costs to Australia`s national survey of mental health and wellbeing

Background: In mental health, policy-makers and planners are increasingly being asked to set priorities. This means that health economists, health services researchers and clinical investigators are being called upon to work together to define and measure costs. Typically, these researchers take available service utilisation data and convert them to costs, using a range of assumptions. There are inefficiencies, as individual groups of researchers frequently repeat essentially similar exercises in achieving this end. There are clearly areas where shared or common investment in the development of statistical software syntax, analytical frameworks and other resources could maximise the use of data.

Aims of the Study: This paper reports on an Australian project in which we calculated unit costs for mental health admissions and community encounters. In reporting on these calculations, our purpose is to make the data and the resources associated with them publicly available to researchers interested in conducting economic analyses, and allow them to copy, distribute and modify them, providing that all copies and modifications are available under the same terms and conditions (i.e., in accordance with the `Copyleft' principle). Within this context, the objectives of the paper are to: (i) introduce the `Copyleft' principle; (ii) provide an overview of the methodology we employed to derive the unit costs; (iii) present the unit costs themselves; and (iv) examine the total and mean costs for a range of single and comorbid conditions, as an example of the kind of question that the unit cost data can be used to address.

Method: We took relevant data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), and developed a set of unit costs for inpatient and community encounters. We then examined total and mean costs for a range of single and comorbid conditions.

Results: We present the unit costs for mental health admissions and mental health community contacts. Our example, which explored the association between comorbidity and total and mean costs, suggested that comorbidly occurring conditions cost more than conditions which occur on their own.

Discussion: Our unit costs, and the materials associated with them, have been published in a freely available form governed by a provision termed `Copyleft'. They provide a valuable resource for researchers wanting to explore economic questions in mental health.

Implications for Health Policies: Our unit costs provide an important resource to inform economic debate in mental health in Australia, particularly in the area of priority-setting. In the past, such debate has largely been based on opinion. Our unit costs provide the underpinning to strengthen the evidence-base of this debate.

Implications for Further Research: We would encourage other Australian researchers to make use of our unit costs in order to foster comparability across studies. We would also encourage Australian and international researchers to adopt the `Copyleft' principle in equivalent circumstances. Furthermore, we suggest that the provision of `Copyleft'-contingent funding to support the development of enabling resources for researchers should be considered in the planning of future large-scale collaborative survey work, both in Australia and overseas.

Promoting comprehensive sun protection policies and practices in outdoor sports: a qualitative study of perceived priorities and practicalities

Sun protection policies, environments, practices, and attitudes in sporting club contexts might be significant determinants of sun exposure among adult sporting participants. Face-to-face interviews, using standardised, open-ended questions were conducted with 20 club officials from four sports: soccer, hockey, tennis and surf lifesaving. Thematic content analysis identified a number of salient themes. Formal sun protection policies were well-implemented in surf lifesaving, but less so in soccer, hockey and tennis clubs, which often had informal sun protection practices in place. Officials perceived sun protection to be important, which was related to perceived exposure levels, the type of sport, length of time played and the season. Consistent logistical and practical considerations emerged, including limited resources, availability of shade, and lack of control over sporting facilities, uniform regulations and games scheduling. Sun protection efforts often focused on children more than adult players. Reciprocal responsibility was an important theme, where it was perceived that responsibility for sun protection should be equally shared between the club and the member. In this study it was found that reciprocal responsibility, duty of care and sport-specific practical requirements might significantly influence the success of policy, environmental and education initiatives for sun protection in sporting settings.

Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Skill shortages in health : innovative solutions using vocational education and training

Introduction: This article reports findings of a project funded by the Australian National Council for Vocational Education Research. The project explores solutions to current and projected skills shortages within the health and community services sector, from a vocational education and training perspective. Its purpose is to locate, analyse and disseminate information about innovative models of health training and service delivery that have been developed in response to skill shortages.

Methods: The article begins with a brief overview of Australian statistics and literature on the structure of the national health workforce and perceived skill shortages. The impact of location (state and rurality), demographics of the workforce, and other relevant factors, on health skill shortages is examined. Drawing on a synthesis of the Australian and international literature on innovative and effective models for addressing health skill shortages and nominations by key stakeholders within the health sector, over 70 models were identified. The models represent a mixture of innovative service delivery models and training solutions from Australia, as well as international examples that could be transposed to the Australian context. They include the skill ecosystem approach facilitated by the Australian National Training Authority Skill Ecosystem Project. Models were selected to represent diversity in terms of the nature of skill shortage addressed, barriers overcome in development of the model, healthcare specialisations, and different customer groups.

Results: Key barriers to the development of innovative solutions to skills shortages identified were: policy that is not sufficiently flexible to accommodate changing workplace needs; unwillingness to risk take in order to develop new models; delays in gaining endorsement/accreditation; current vocational education and training (VET) monitoring and reporting systems; issues related to working in partnership, including different cultures, ways of operating, priorities and timelines; workplace culture that is resistant to change; and organisational boundaries. For training-only models, additional barriers were: technology; low educational levels of trainees; lack of health professionals to provide training and/or supervision; and cost of training. Key enhancers for the development of models were identified as: commitment by all partners and co-location of partners; or effective communication channels. Key enhancers for model effectiveness were: first considering work tasks, competencies and job (re)design; high profile of the model within the community; community-based models; cultural fit; and evidence of direct link between skills development and employment, for example VET trained aged care workers upskilling for other health jobs. For training only models, additional enhancers were flexibility of partners in accommodating needs of trainees; low training costs; experienced clinical supervisors; and the provision of professional development to trainers.

Conclusions: There needs to be a balance between short-term solutions to current skill shortages (training only), and medium to longer term solutions (job redesign, holistic approaches) that also address projected skills shortages. Models that focus on addressing skills shortages in aged care can provide a broad pathway to careers in health. Characteristics of models likely to be effective in addressing skill shortages are: responsibility for addressing skills shortage is shared between the health sector, education and training organisations and government, with employers taking a proactive role; the training component is complemented by a focus on retention of workers; models are either targeted at existing employees or identify a target group(s) who may not otherwise have considered a career in health.