Notes From the Field: Creating a Typology of Childhood Obesity Intervention Strategies

Classification systems can be useful for evaluating and communicating the impact of interventions. We describe how a typology was created to inform the development of a community intervention dose index (CIDI) intended to measure the strength of impacts attributed to multiple childhood obesity intervention strategies implemented in a large, diverse urban jurisdiction in the United States during 2000-2016. The categorization system was constructed via a three-stage process: (Stage 1) identify relevant constructs for categorizing intervention strategies; (Stage 2) review peer-reviewed literature and program requests for proposals to identify and integrate common attributes of intervention strategies based on Stage 1 constructs; and (Stage 3) vet the results from prior stages to develop a final version of the typology, slated for research application and for use in program improvement. The final system grouped strategies into four macrolevel and five microlevel categories. Macrolevel strategies included government/public institutional policies, infrastructure investments, and business practices. Microlevel strategies included group education, counseling, health communication and social marketing, home visitation, and screening and referral. Grouping intervention strategies in a purposeful, classified manner facilitated communications among researchers and practitioners during the gathering and quantifying of intervention data for the CIDI project and may be used to guide scarce public health resource allocation decisions.

The rehabilitation of the mentally disabled in the community act in Israel: Entrepreneurship, leadership, and capitalizing on opportunities in policy making

This paper examines the role of policy entrepreneurs in the formation of a rehabilitation program in the field of mental health in Israel, shedding light on their role in general and specifically in mental health policy formation. Our research is based on a historical case study. The legislation process was examined through interviews with key actors in the legislative process and archival materials. While in general our findings reinforced existing literature, our research also revealed new information on several topics: organizations as policy entrepreneurs; inter-sectorial coalitions of entrepreneurs; and possible problems arising from the concept of 'leadership by example'.

Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway - an interview study

BACKGROUND

High demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical services, the medical on-scene commander, in line with the command structure within the police and fire brigade, might support or take over command and control from the ambulance incident officer arriving as the first ambulance personnel on scene. The aim was to shed light on the emergency medical service experiences from real tunnel incidents described by the Oslo medical on-scene commanders.

METHODS

Interviews were conducted with six of the seven medical on-scene commander in Oslo, Norway. Data were analysed using a qualitative content analysis.

RESULTS

The overall theme was "A need for mutual understanding of a tunnel incident". The medical on-scene commander provided tactical support, using their special knowledge of risk objects and resources in the local area. They established operation plans with other emergency services (the police and fire brigade) in a structured and trustful way, thus creating a fluent and coordinated mission. Also, less time was spent arguing at the incident site. By socialising also outside ordinary working hours, a strong foundation of reliance was built between the different parties. A challenge in recent years has been the increasing ordinary workload, giving less opportunity for training and exchange of experiences between the three emergency services.

CONCLUSIONS

The enthusiastic pioneers within the three emergency services have created a sense of familiarity and trust. A specially trained medical on-scene commander at a tunnel incident is regarded to improve the medical management. To improve efficiency, this might be worth studying for other emergency medical services with similar conditions, i.e. tunnels in densely populated areas.

Three-Year Outcomes of a School-Hospital Partnership Providing Multitiered Mental Health Services in Urban Schools

BACKGROUND

From the perspective of schools, children's mental health is essential to academic success. Multitiered systems of support (MTSS) that provide prevention/promotion, early identification/intervention, and clinical treatment services have been embraced as a promising means to deliver mental health services in the school setting.

METHODS

A school-hospital partnership tested the implementation over 3 consecutive academic years of an MTSS model for elementary through high-school students enrolled in 6 urban public schools. The model was designed to embed whole-school and classroom-level prevention/promotion programs alongside small group and individual services for selected youth. Utilization, satisfaction, and student- and school-level outcomes were assessed.

RESULTS

Students participating in early intervention had significantly improved social-emotional competencies and coping skills (particularly those students at highest risk), and students with mental health disorders who participated in clinical treatment had significantly improved symptoms and functioning. Schools significantly enhanced their capacity to provide mental health services across prevention/promotion, early identification/intervention, and crisis management domains. These findings were replicated across 3 consecutive years of program implementation.

CONCLUSIONS

A school-hospital partnership using an MTSS model was found to be feasible, valued, and effective in improving students' mental health status and schools' capacities to provide mental health services.

Medical education in Laos

Medical education in Laos has undergone significant developments over the last century. A transition from a foreign to locally trained medical workforce has taken place, with international partners having an ongoing presence. Undergraduate and postgraduate medical education in Laos is now delivered by a single, government administered university. The transition to locally based training has had many flow-on benefits, including the retention of Lao doctors in the country and having graduates who are familiar with the local health system. A number of challenges do however exist. Medical resources in the Lao language are limited, teacher numbers and capacity are lacking and complex factors have led to a lack of uniformity in graduate competencies. Despite these challenges, the situation for medical education in Laos is a story of great optimism. Local staff has recognized the need for simple yet innovative solutions and processes are in place for the establishment of a licensing system for medical doctors and reforming existing curricula. Sustained, long-term relationships with partner organizations along with constructive use of technology are likely to be important factors affecting the future direction of medical education in Laos.

Planning, Development, and Implementation of a University-Led, Low-Cost Employee Wellness Program in a preK-12th-Grade Public School District

BACKGROUND

A healthy preK-12th-grade school environment is critical to student well-being and success. As role models, school employees play a significant part in creating a healthy environment. Research suggests that employee wellness programs (EWPs) may help school employees adopt healthier lifestyles and, therefore, be healthier, more productive, and serve as healthy role models for students. This article describes the process by which a school district in central Texas partnered with a local university to plan, develop, and implement an affordable EWP.

METHODS

A university-led leadership team sought input from employees, including administrators, and conducted a 4-week trial. These resulted in an EWP that provided health risk appraisals, fitness testing, group exercise classes, education seminars, online wellness resources, and blood draws/analysis.

RESULTS

During the first 4 years, membership ranged from 107 to 384 (10-37%), and the annual cost of the program ranged from $49 to $116 per participating employee.

CONCLUSIONS

University-led EWP programs can support, at a low cost, the health of school employees. Despite low employee engagement, need was demonstrated and feedback was positive. Challenges identified include time demands and lack of principals' support. Future considerations include targeting principals, utilizing the Human Resources Office, and strategically building a culture of health.

Intentionally building relationships between participatory online groups and formal organisations for effective emergency response

Advances in information and communication technologies enable the public to contribute to emergency response. For instance, reporting systems set up during recent disasters allowed affected people to submit testimonies about conditions on the ground. In addition, the public has analysed data and helped to mobilise and deliver relief resources. To plan intentionally for an integrative emergency response system in the networked age, this research explores two subject areas: (i) the organisational and technical determinants of relationships forged between formal organisations and participatory online groups established by the public; and (ii) the consequences of the outcomes generated by these relationships. Four in-depth case studies were selected for the analysis, which revealed that resource dependence, shared understanding, and the use of certain types of information technology influence the formation of such relationships. Furthermore, healthy collaborative relationships increase the chances of desirable results, including inter-organisational alignment and minimal long-term harm owing to a disaster.

Developing Correctional Policy, Practice, and Clinical Care Considerations for Incarcerated Transgender Patients Through Collaborative Stakeholder Engagement

Transgender persons are at increased risk of victimization during incarceration and have unique health care needs. We convened a symposium of 27 key stakeholders to develop consensus on correctional policy, practice, and clinical care considerations for incarcerated transgender persons. Participants included formerly justice-involved transgender persons, correctional leaders, government authorities, academicians, advocates, health care providers, and expert consultants. Consensus considerations were developed in four areas: correctional practices that promote safety and respectful interactions with transgender inmates, training of correctional staff, health care delivery, and reentry to the community. Gaps in knowledge and practice in these four areas were also identified. A collaborative stakeholder model is an effective strategy to convene disparate groups who infrequently communicate with one another to help advance correctional policies and clinical care.

Celebrating partnership working between the third sector and the NHS

Emeritus Professor Alan Glasper, University of Southampton, discusses the success of partnerships between the third sector and the NHS, which is crucial to improving care for people in society.

Analysis of Pharmaceutical Industry Payments to UK Health Care Organizations in 2015

Importance

Drug company payments to health care organizations can create conflicts of interest. However, little is known about such financial relationships, especially outside the United States.

Objective

To examine the concentration and patterns of drug company payments to health care organizations in the United Kingdom.

Design, Setting, and Participants

This cross-sectional study examined nonresearch payments reported in the industry-run Disclosure UK database. Companies participating in Disclosure UK in 2015 and health care organizations receiving their payments were included in the analysis. The data were analyzed descriptively at the health care organization, payment, and donor levels, considering health care organization categories, payment categories, and companies from February 5 through May 28, 2017, with follow-up checks from June 1 through August 31, 2018. Analysis was conducted from July 10 through December 20, 2018.

Main Outcomes and Measures

Share of funding and the Gini index (GI) to measure payment concentration (0 indicates perfect deconcentration [eg, all drug companies provide the same value of payments]; 1, perfect concentration [eg, 1 company provides the entire value of payments]) and median and interquartile range (IQR) to measure payment patterns.

Results

A total of 4028 health care organizations received 19 933 payments, worth US $72 110 156.6, from 100 companies. This study identified 11 categories of health care organizations, with 3-public-sector secondary and tertiary care providers, education and research providers, and professional organizations-accumulating 67.2% of funding. The health care organization categories had varying GIs (range, 0.65-0.92), medians (range, $750.3-$45 862.4), and IQRs (range, $389.1-$1843.9 to $3104.4-$199 868.2). Of 4 payment categories, the top category-donations and grants-captured 50.6% of funding. Joint working (collaborative projects with nonindustry partners) had a lower GI (0.64) than other payment categories (range, 0.79-0.84). The median and IQR were the lowest for contributions to costs of events ($366.8; IQR, $229.3-611.3) and highest for joint working ($14 903.7; IQR, $3185.0-34,748.4). The top 10 firms (58.6% of funding) had payments with varying medians (from $366.8 [IQR, $244.5-611.3] to $9781.3 [IQR, $1834.0-48 906.7]).

Conclusions and Relevance

Although organizations from across the health care system received funding, the payments were concentrated on a few large donors, payments, and recipients. Different payment and recipient categories had different patterns of payment values, suggesting that the industry has diversified its funding strategies across different parts of the health care system. These results suggest that Disclosure UK requires improved transparency, particularly by including built-in recipient categories, and that organizational conflicts of interest need more policy attention, including disclosure of payments independent of the industry.

Interhospital Transfers with Wide Variability in Emergency General Surgery

Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.

How Can We Improve the Transformation Success Rate of Research Results in the Pharmaceutical Industry? The Game Theoretic Model of Technology Transfer Subjects

University–industry technology transfer (UITT) plays an important role in the construction of the national pharmaceutical innovation system. The speculations of a faculty inventor may hinder the successful transfer of pharmaceutical research results. This paper divides the specific process of the transformation of pharmaceutical research results into two parts: (1) an evolutionary game between faculty inventors and universities; and (2) a Stackelberg game between faculty inventors and pharmaceutical companies. Further, we carry out numerical simulations to analyze the impact of transformation success rate, income distribution coefficient, and a faculty inventor’s future working years on the transformation of pharmaceutical research results. The findings indicated that whether a combination of action strategies of faculty inventors and universities can evolve to the optimal equilibrium is determined by many factors, such as the technological transaction price of the pharmaceutical company and the reward or the income obtained by the faculty inventor. The transformation success rate and the income distribution coefficient are the key factors that affect the faculty inventor’s will and the behavior of the pharmaceutical company. The conclusions of this paper contribute to the research on how we can improve the success rate of research results and avoid resource waste, and provide a decision-making reference for the management of pharmaceutical research results in universities.

Challenging dominant breast cancer research agendas: perspectives on the outcomes of the interagency breast cancer and environment research coordinating committee

BACKGROUND

As breast cancer rates increase globally, there is growing scientific consensus that greater understanding of the causes of breast cancer is needed to better prevent its occurrence. Genetics accounts for a small percentage of cases, thus environmental factors and epigenetics are increasingly suspect in breast cancer etiology. Within the breast cancer and environmental breast cancer social movements, there are longstanding calls for research and policy aimed toward the prevention of breast cancer. To better understand the opportunities and barriers to addressing environmental contributors to breast cancer, this article investigates both outcomes and perceptions of stakeholders involved in the Interagency Breast Cancer and Environment Research Coordinating Committee (IBCERCC). The IBCERCC was mandated by the 2008 U.S. Breast Cancer and Environmental Research Act, a law representing years of advocate and researcher efforts to produce national strategies and federal funding for breast cancer prevention research.

METHODS

To understand the meaning and impact of the IBCERCC advisory committee and final report, Prioritizing Prevention, I draw on fifteen confidential semi-structured interviews with members of the twenty-five person IBCERCC, in addition to six confidential semi-structured interviews with key breast cancer funders, advocates, and researchers affiliated with national reports on environmental contributors to cancer. I examine media coverage, congressional hearing transcripts, and official responses to the release of the IBCERCC report by governmental and non-governmental organizations.

RESULTS

Interviews and publicly available documents reveal a set of direct and indirect outcomes of the 2013 IBCERCC report. Interviewees in government positions perceived the 2014 renewal of the Breast Cancer and the Environment Research Program to result from IBCERCC efforts, notable in the context of declining U.S. federal research funding. Interviews also revealed a suite of potential barriers to the implementation of report recommendations including: distinct interpretations of the federal mandate, disparate assessments of scientific evidence, government funding crises, and lack of specificity around responsibility for implementation of report findings.

CONCLUSION

This article examines efforts to shift institutional research and funding priorities in cancer research towards prevention. Social science research can support efforts to shift institutional priorities by identifying broader social contexts and underlying values typically unnamed in scientific discourse.

Leaders' Experiences in Planning, Implementing, and Evaluating Complex Public Health Nutrition Interventions

OBJECTIVE

To explore California local health department leaders' experiences planning, implementing, and evaluating nutrition promotion and obesity prevention programs for low-income families.

DESIGN

Qualitative, cross-sectional study using semi-structured in-depth interviews and panel interviews conducted in 2015-2016.

SETTING

California local health departments (LHDs) funded by the California Department of Public Health to implement Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

PARTICIPANTS

The authors recruited SNAP-Ed leaders from all 58 California LHDs implementing SNAP-Ed. Leaders from 49 LHDs participated: 36 in hour-long, in-depth interviews and 13 in 1 of 3 90-minute group panel interviews.

PHENOMENON OF INTEREST

Processes, facilitators, and barriers connected to delivering SNAP-Ed reported by leaders in planning, implementing, and evaluating local programs.

ANALYSIS

Interviews were transcribed, coded, and analyzed using Dedoose software.

RESULTS

Leaders grappled with introducing, implementing, and integrating policy, systems, and environmental change interventions (PSEs). Information used to make planning decisions varied widely across LHDs. Partnership with nontraditional organizations was described as a resource- intensive, nonlinear process with recognized potential for benefit. Rural programs reported specific and different experiences compared with their urban counterparts.

CONCLUSIONS AND IMPLICATIONS

Implementing new, complex interventions to improve diet and activity environments and behaviors is both exciting and challenging for local leaders. They expressed a desire for additional resources and capacity building to facilitate success, particularly related to policy, systems, and environmental change programs. Attention to the specific needs of rural counties is needed.

Evaluation of Pharmaceutical Company Payments and Conflict of Interest Disclosures Among Oncology Clinical Practice Guideline Authors in Japan

IMPORTANCE

Clinical practice guidelines (CPGs) are important in advancing the quality of medical care. Financial relationships between physicians and pharmaceutical companies may influence clinical practice. In accordance with the Japan Pharmaceutical Manufacturers Association guidelines for transparency, pharmaceutical company payments to physicians have been disclosed since 2013. The distribution of pharmaceutical company payments among CPG authors in Japan has not been studied.

OBJECTIVES

To determine the characteristics and distribution of payments made by pharmaceutical companies to authors of oncologic CPGs in Japan and to assess the transparency of policies associated with conflict of interest (COI) disclosures in CPGs.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cross-sectional study of 326 authors from 6 prominent oncologic CPGs from Japan included annual payment data for 2016 from 78 pharmaceutical companies during varying times from January 1, 2016, through September 30, 2017.

MAIN OUTCOMES AND MEASURES

Amount and proportion of payments made by pharmaceutical companies to the authors; amount and proportion of payments made to the authors of each guideline; and information on policies for disclosing COIs in CPGs (Japanese yen were converted to US dollars based on the February 20, 2019 exchange rate of 110 yen per 1 US dollar).

RESULTS

Of 326 eligible authors, 255 (78.2%) received payments from pharmaceutical companies in 2016. The total number of payments was 3947, and the total amount was $3 444 193 (¥378 861 220), including $2 696 777 for speaking, $181 944 for writing, $554 381 for consulting, and $11 091 for unclear fees. The median payment amount was $3233 (interquartile range [IQR], $506-$10 873), and the mean (SD) payment amount was $10 565 ($20 059); 84 authors (25.8%) received more than $10 000. The largest proportions of CPG authors receiving at least 1 payment were those for gastric carcinoma (92%) and colorectal carcinoma (92%). The median payment was highest for authors of colorectal carcinoma guidelines ($7781; IQR, $2506-$18 633), whereas it was lowest for authors of pancreatic carcinoma guidelines ($2207; IQR, $304-$9240). Only breast carcinoma CPGs published the authors' individual COI disclosure in an identifiable matter; guidelines for lung, colorectal, pancreatic, and hepatocellular carcinomas disclosed the financial relationships between the authors and companies anonymously; and the gastric carcinoma CPGs did not have a COI disclosure section.

CONCLUSIONS AND RELEVANCE

Most oncologic CPG authors received payments from pharmaceutical companies, and COI disclosure methods appeared to be insufficient. Given the possibility of bias in guideline content if authors have any financial relationships with pharmaceutical companies, CPGs from Japan may require improved transparency.

The impact of integration on outpatient chemotherapy use and spending in Medicare

Hospital-physician integration has substantially grown in the United States for the past decade, particularly in certain medical specialties, such as oncology. Yet evidence is scarce on the relation between integration and outpatient specialty care use and spending. We analyzed the impact of oncologist integration on outpatient provider-administered chemotherapy use and spending in Medicare, where prices do not depend on providers' integration status or negotiating power. We addressed oncologists' selective integration and patients' nonrandom choice of oncologists using an instrumental variables method. We found that integrated oncologists reduced the quantity of outpatient chemotherapy drugs but used more expensive treatments. This led to an increase in chemotherapy-drug spending after integration. These findings suggest that changes in treatment patterns-treatment mix and quantity-may be an important mechanism by which integration increases spending. We also found that integration increased spending on chemotherapy administration (the act of injection). This is because integration shifted billing of chemotherapy to hospital outpatient departments, where Medicare payments for chemotherapy administration are higher than those in physician offices. As integration increases, efforts should continue to assess how integration influences patient care and explore policy options to ensure desirable outcomes from integration.

[Interinstitutional Collaboration for Molecular Tumor Boards]

In Japan, "Designated Core Hospitals for Cancer Genomic Medicine" as leading hospitals on cancer genomic medicine and "Cooperative Hospitals for Cancer Genomic Medicine" which conduct cancer genomic medicine in each region are working together to promote cancer genomic medicine. Eleven institutions as the former and 135 institutions as the latter are currently designated. It is essential to hold a molecular tumor board, which is called "Expert Panel" in Japan, to provide cancer genomic medicine for patients. In the Expert Panel, the results of tumor sequencing are interpreted with clinical information, then recommended treatment and genetic information to be provided are determined. Holding Expert Panels is a duty of Designated Core Hospitals for Cancer Genomic Medicine and Cooperative Hospitals need to participate in it. In order to facilitate the Expert Panel, it is effective to share patient's information using well-managed Web system. Besides that, there are many tasks to be addressed by cooperation of Designated Core Hospitals and Cooperative Hospitals such as registration of patient's information in the Center for Cancer genomics and Advanced Therapeutics(C-CAT), correspondence to increasing genomic testing and nurturing specialized human resources involved in cancer genomic medicine. Interinstitutional collaboration should be more encouraged to propagate cancer genomic medicine.

Partnering to Develop Online Teaching Skills for Master of Science in Nursing Education Students

BACKGROUND

The continued growth of online programs in nursing education creates a demand for faculty who are familiar with the best practices in online pedagogy. However, the opportunity to become familiar with, and then apply, these best practices is often not available to students enrolled in Master of Science in Nursing (MSN) nursing education programs.

METHOD

An innovative partnership with The Center for Instructional Design's Teaching Online Academy over the past few years has provided the opportunity for students in the MSN Nursing Education program at The University of Texas at El Paso to learn and then apply best practices in online pedagogy.

RESULTS

Over the past 1.5 years, 50 students have participated and provided highly enthusiastic feedback about the experience.

CONCLUSION

The results of the partnership were beneficial to participants in both the Nursing Education program and the Teaching Online Academy. The process could be easily adapted to other settings. [J Nurs Educ. 2019;58(4):240-242.].

Contextual design choices and partnerships for scaling early child development programmes

Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.