Multidisciplinary Partnerships Research Articles

62 Nutritional assessment of children in Hartley Bay (Gitga’at), BC

Abstract Background Hartley Bay is a small, remote Gitga’at community. As part of “Brighter Smiles”, a multidisciplinary child health partnership between the Gitga’at Nation and BC Children’s Hospital, the community requested a quality assurance project to describe the nutritional status of its children and assess the impact of the existing school based nutrition program. Objectives The community wished to explore ways in which the existing nutrition program could be optimized to further meet the nutritional needs of its children in terms of macronutrient, micronutrient and meal content and to explore food beliefs and values. Design/Methods Gitga’at health leadership guided the design of the study and community approval was sought at an early stage. All Hartley Bay families with children aged 5-18 were invited to participate. With the support of the teachers, a 24-hour dietary recall survey was completed online during school time using the WEB-Q software program. Nutritional information was then analyzed and compared. Anthropometric data (heights, weights, BMI and blood pressures) were collected during routine clinic visits in September 2018, compared with population based norms and analyzed. Results Anthropometric data was collected for 23/30 school aged children. In terms of anthropometrics, 45.5% of girls and 16.7% of boys had a body mass index (BMI) in the healthy range (3rd-85th percentile). Results showed 18.2% girls and 25% of boys had a BMI in the overweight range (85th – 97th percentile), while 36.4% of girls and 58.3% of boys respectively were in the obese or severely obese range. Blood pressures demonstrated that 75% of females and 62.5% of males were normotensive (systolic BC <87%ile). There are many accomplishments of the community highlighted in this study including attitudes towards traditional foods and harvesting, openness to try new foods and spending meal time with family. Four in 18 students were meeting the recommended 5 servings of vegetables/fruits per day. The average intake of sodium for 9-13 year olds was 3g/day (recommended upper limit is 2.2g/day). For 14-18 year olds the average sodium intake was 4.6g/day (recommended upper limit is 2.3g/day). One in 18 students met adequate intake for calcium, 2/18 for fibre and 13/18 for vitamin D. The majority of children in this community are obtaining the recommended percentage energy from fats, carbohydrates and protein. Conclusion A significant proportion of Hartley Bay children had anthropometric measurements suggesting they were at risk for long term negative health outcomes. The study also indicated areas to improve, with suboptimal micronutrient intake. Successes of the community were also highlighted. The data was presented to Hartley Bay health staff, Elders and community members so that it can be used collaboratively by the health staff and community leadership to work on community-designed programs for health promotion.

Predicting Hearing Loss for Cancer Patients Before Treatment

Most of us will have a loved one hear the devastating words, “You have cancer.” As he or she processes this news, quick treatment decisions must be made. Cancer treatment side effects, such as hearing loss, often come with uncertainties. Our team sought to provide clarity to patients with head and neck cancer on their expected hearing loss before treatment.shutterstock/Iurii Motov, Health care, hearing loss, cancer.Figure 1: The standard model (post-treatment data) is as accurate as the predictive model (pretreatment data). Health care, hearing loss, cancer.Figure 2: Screenshot of the web-based app. Health care, hearing loss, cancer.Each year, more than half a million people develop head and neck cancer, and more than a quarter million die from it.1 Treatment options include surgery, radiation therapy, and chemotherapy (cisplatin). These therapies can cause permanent hearing loss and other side effects, including kidney damage (nephropathy), extreme dry mouth (xerostomia), and loss of healthy tissue (radiation necrosis).2-8 Despite the negative impact of hearing loss on patients’ quality of life, it can be overlooked.9 In 2014, our division of adult audiology at Washington University School of Medicine in St. Louis began providing care for head and neck cancer patients in collaboration with otolaryngology physicians. One of our team members attended a weekly multidisciplinary tumor board to better understand a patient's treatment journey and their challenges in streamlining the process for our patients. We were able to provide audiological care within existing structures to avoid disruptions by reaching out to our multidisciplinary partners. Working with the radiation oncology department, we built standard referral patterns to increase patient follow-up while reducing patient burden through same-day appointments. Baseline audiological testing was incorporated into our department's Head & Neck Cancer Multi-Disciplinary Clinic launched in 2016. The clinic allowed patients to see multiple medical professionals—a radiation oncologist, a medical oncologist, a head and neck cancer surgeon, a speech therapist, and an audiologist—all on the same day. This was appreciated by patients since they could complete their pre-treatment cancer appointments in one morning instead of a month. At these appointments, many patients often asked about what to expect of their hearing after treatment, which made us realize a gap: We could only provide general information about the effects of ototoxic medications, but couldn't address our patients’ needs. As a result, our team decided to explore options for how we could predict post-treatment hearing loss before treatment to provide better counseling. PREDICTING HEARING LOSS A literature review only revealed options that could predict hearing loss after treatment because they relied on final treatment doses. After identifying this gap in information, our team decided to create a new resource for patients. We studied 242 patients using an internal database and data from Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, the Washington University Oncology Data Services Cancer Registry, Varian (a radiation oncology treatment planning software), and AudBase (a clinical audiometric database). We collected demographic information, tobacco and alcohol use, tumor characteristics (stage, histology, and proximity to the cochlea), and treatment methods (surgery, surgery with clean margins, cisplatin treatment regimen, total cumulative cisplatin dose, and mean cochlear radiotherapy dose) for each patient. Next, we analyzed the data to determine if they could be used to predict post-treatment hearing (pure-tone average [PTA] of 1, 2, 4 kHz) and help counsel patients on their hearing before treatment. We built two key models: one that used proxy measures available before treatment (location of the tumor and planned chemotherapy treatment regimen) and another that relied on final treatment doses. The results were identical: Using pre-treatment measures was as accurate as using post-treatment measures (Fig. 1). The pretreatment factors that we found predicted hearing loss were age, pre-treatment hearing, location of the tumor, and planned treatment chemotherapy dose. Using these factors, our model explained 80 percent of a patient's post-treatment hearing (1, 2, 4 kHz PTA), had a sensitivity of 80 percent and a specificity of 75 percent for predicting post-treatment hearing loss greater or less than 35 dB HL. To our knowledge, we created the first model capable of accurately predicting post-treatment hearing loss before treatment. Our team converted the model into a user-friendly internet-based tool. To use the tool, an audiologist inputs the predictive factors into a web-based application at the baseline hearing test (Fig. 2). The audiologist can then use this information to counsel his or her patient on realistic expectations regarding the patient's post-treatment hearing; however, the model is not yet ready for widespread implementation. We are working to validate it in a new cohort of patients with head and neck cancer.10 Once completed, we plan to publish the data and share our findings to support patients across the country. Each patient we see is someone's loved one. We hope our tool makes their journey a little easier.

Privacy, confidentiality, security and patient safety concerns about electronic health records.

This study explored concerns among nurses working in the United Arab Emirates associated with the use of electronic health records, including privacy, confidentiality, security and patient safety. Given the widespread implementation of electronic health records, there are concerns about data integrity that could jeopardize healthcare quality. Addressing nurses' concerns about data integrity and safety is critical to inform health policies and promote public trust. Nurses working in healthcare settings in the United Arab Emirates (N=562) were invited to share their concerns about data integrity and patient safety using a mixed-method approach. Data were collected between January and June 2018 via questionnaires and focus group interviews. Following a survey of nurses' concerns about privacy, confidentiality, security and patient safety in electronic health records, six focus groups were held to gain deeper insights about their concerns. Major themes that emerged from the focus groups were extracted to align with the main sections of the questionnaire. Nurses expressed concern over the security of electronic health records (n=270, 48%). Administrative-related security, inadequate training and access by unauthorized users were the most frequently reported concerns. The main patient safety concerns were associated with non-technological factors, including lack of audit by staff, poor communication with technology vendors and length oftime required for documentation. The focus group results reflected similar issues, with an additional theme being inconsistency in data integrity policies. Frontline nurse managers need to integrate pragmatic policies to support staff compliance with the code of ethics when using online data. Nurses must follow workplace policies that foster reporting of risks to online incident systems to ensure data integrity. A unified health policy based on multidisciplinary partnership is critical to safeguard online data and promote public trust.

A qualitative study of the practices and experiences of staff in multidisciplinary child sexual exploitation partnerships in three English coastal towns

AbstractThis article presents findings from a qualitative study of the practices and experiences of people working in multidisciplinary child sexual exploitation (CSE) partnerships in three coastal towns in England. The study is based on focus groups conducted with 36 practitioners from a range of professional groups, including police, social work, substance misuse, education, specialist youth workers, sexual health, and statutory and non‐statutory children's services. The article begins with an overview of the three towns and the structure of their responses to CSE. It goes on to explore a range of factors, which contribute to the local issues around CSE and which affect and direct multiagency working. These include practitioner perspectives on CSE vulnerability, the discrepancy between young peoples' and practitioners' views about “exploitation”, a discussion of how CSE perpetrators initiate and develop contact with young people and the role of incentives—including drugs and alcohol—as part of CSE exploitation. We finish by drawing out some general conclusions.

COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist.

COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist.

Processus de développement d’une trousse d’accompagnement pour l’examen médical

Alors que plus de la moitié des immigrants francophones vivant en Ontario proviennent de l’Afrique et des Caraïbes, les professionnels de la santé formés au Canada ne sont pas suffisamment familiers avec les problèmes de santé auxquels les nouveaux arrivants peuvent être confrontés. Fort de ce constat, dans un partenariat multidisciplinaire, le Centre de recherche en santé dans les milieux ruraux et du nord, le Centre de santé communautaire du grand Sudbury, l’Institut du savoir Montfort, l’École des sciences de l’activité physique de l’Université Laurentienne et un groupe d’immigrants francophones du Grand Sudbury, ont développé en utilisant l’approche de recherche collaborative, une trousse d’accompagnement pour l’examen médical du nouvel arrivant à l’attention des professionnels de la santé et des services sociaux. Le processus d’élaboration de la trousse a nécessité plusieurs étapes : 1) l’établissement d’un partenariat entre les organismes sus cités; 2) la recension des écrits pour identifier les problèmes de santé les plus fréquents; 3) la sélection des problèmes les plus fréquents et qui ne sont pas nécessairement ceux que les professionnels de santé rencontrent dans leur pratique; 4) la rédaction des versions provisoires des fiches d’information en insistant sur certains aspects importants de la maladie; 5) la validation des fiches avec les partenaires; 6) la restitution des fiches finales (25 fiches dont 3 portent sur l’examen général, 10 autres portent sur certaines maladies tropicales, 8 portent sur les signes et symptômes les plus fréquemment rencontrés et les 4 autres sur les soins de santé en Ontario); et 7) le développement d’une capsule infographique afin d’assurer une plus grande visibilité de la disponibilité de la trousse d’accompagnement pour l’examen médical des nouveaux arrivants francophones.

Lessons from a multidisciplinary partnership involving women parliamentarians to address the overuse of caesarean section in Italy

The increase of caesarean sections (CS) represents a global concern. Interventions tested to reduce unnecessary caesareans have shown limited success to date, partly because they have focused on medical perspectives...

Competencies and training of radiographers and technologists for PET/MR imaging - a study from the UK MR-PET network

BackgroundAfter the success of PET/CT as a clinical diagnostic tool, the introduction of PET/MRI is a natural development aimed at further improving combined diagnostic imaging and reduced ionising radiation dose for half-body imaging. As with PET and CT, the combination of PET and MRI presents a series of issues that need to be addressed regarding workforce training and education. At present, there is a lack of agreement over the competencies, training requirements and educational pathways needed for PET/MRI operation. In the UK, following the establishment of the MR-PET imaging network, a task force was created to investigate the status of the workforce training, identify gaps and make recommendations regarding staff training. To do this, we ran a national survey on the status of the workforce training and the local practices across the UK’s seven PET/MRI sites, reviewed the literature, and convened a panel of experts, to assess all the evidence and make recommendations regarding PET/MRI competencies and training of nuclear medicine technologists and radiographers.ResultsThere is limited literature available specifically on competencies and training for technologists and radiographers. The recommendations on the topic needed revisiting and adapting to the UK MR-PET network. The online survey confirmed the need for developing PET/MRI competencies and training pathways. Local organisational structures and practices were shared across the seven sites, based on models derived from experience outside the UK. The panel of experts agreed on the need for PET/MRI competencies and training strategies. Professional organisations started collaborative discussions with partners from both Nuclear Medicine and Radiography to set training priorities. Multidisciplinary collaboration and partnership were suggested as a key to a successful implementation of competencies and training.ConclusionsThe report identified the need for establishing competencies for the PET/MRI workforce, particularly for technologists and radiographers. It also helped defining these competencies as well as identifying the demand for bespoke training and the development of local and national courses to be implemented to fulfil this new training need.

Creating togetherness in a historically divided maternity care system / Zusammengehörigkeit in einem historisch gespaltenen geburtshilflichen Versorgungssystem herstellen

Abstract Improving collaboration in Dutch maternity care is seen as essential to improve continuity of care and thereby safety, client satisfaction, and health outcomes. This study aims to monitor and evaluate whether the regional Maternity Care Network Northwest Netherlands (MCNNN) and its local multidisciplinary obstetric partnerships contributed to collaboration. This mixed-method study followed the methodology of reflexive monitoring in action. Data were collected from 2014 to 2016 through interviews (n=73), questionnaires (n=430), and reflection sessions (n=4) and analyzed inductively and deductively based on a model for interprofessional and interorganizational collaboration. The findings outline (1) MCNNN-activities, (2) experienced collaboration within obstetric partnerships, and (3) MCNNN as supporting structure. The findings showed improvements on both the relational and organizational level of interprofessional and interorganizational collaboration. The MCNNN’s meetings, products, and research projects facilitated knowledge development and dissemination and its obstetric partnerships fostered contact and deliberation among maternity care professionals. However, collaborative challenges were also experienced, including mistrust and difficulties in information sharing, influenced by lacking financial and organizational facilitation. The MCNNN could improve its supporting role in the system innovation toward integration in maternity care by means of a further transformation to a knowledge network that is focused on reflexively overcoming collaborative challenges at all levels in the maternity care system.

Mental and reproductive health in multisystem youth: An in-depth qualitative approach

BackgroundMultisystem youth involved in both the child welfare and juvenile justice systems report elevated rates of risky sexual behaviors, associated health problems as well as having a disproportionally higher risk for concurrent mental health disorders. ObjectiveThe current study aimed to provide in-depth nuanced insights about mental and reproductive needs and challenges of multisystem youth using a multi-informant approach (youth, parole/probation officers). Participants and settingQualitative in-depth interviews were conducted with multisystem youth (N = 15; 14–17-years-old; 40% females) and parole/probation officers (N = 20; 35–67-years-old; 33% females) working with foster care and juvenile justice systems. MethodsInformed by Socio-Ecological Theory, analyses were conducted using Thematic Network Analysis (TNA) and qualitative software Atlas.ti.7. ResultsYouth and parole/probation officers identified key challenges related to mental health (e.g., criminalization of behaviors, unstandardized screening procedures), reproductive health (e.g., abnormalization of sexual behaviors, lack of parenting and comprehensive reproductive services), and shared challenges across systems (e.g., lack of data sharing across systems, overuse of “crisis” procedures, lack of trauma-informed providers and services). ConclusionsMultisystem youth have significant mental and reproductive health needs that are not adequately met mostly due to system and institutional challenges, differences in protocols, and discontinuance of services and treatment across systems among other problems. Mental and reproductive health disparities are key factors in stigmatization, criminalization and further victimization of youth across systems. Multidisciplinary and multi-sectoral partnerships are key to advance service, protocols and procedural gaps that address the mental and reproductive health needs of multisystem youth.

IMPLEMENTATION CHALLENGES AND OPPORTUNITIES IN A COMMUNITY-BASED TRANSITIONAL CARE SERVICES PROGRAM

High-risk older adults (i.e., low-income, chronically ill) often have complex, costly healthcare needs and are at risk of re-hospitalization. Hospitals traditionally lead efforts to reduce readmissions, while community-based aging services organizations (e.g., Area Agency on Aging AAA) offer older adults in-home health, social support, and information/referral to community resources. Thus, creating, sustaining, and scaling up hospital-community partnerships can better meet older adults’ comprehensive needs. We evaluated efforts of a hospital-AAA project to develop and implement a local transitional care services program (TCSP) that provided in-home/phone support post-discharge for high-needs older adults. Over a four-year period, 1,921 individuals (mean= 75 years; 57% women) were referred from hospital as eligible for TCSP. After referral, however, only 22.8% were successfully connected to community-based services and men were more likely than women to complete TCSP (Χ2= 6.92; p= .009). Of those referred, only 4% were re-hospitalized, indicating potential success of TCSP. Data revealed most were unable to be contacted (27.9%), refused the program (21.6%) or utilized alternative services, including SNFs (20.3%); inconsistent data collection and procedures yielded problematic missing data and inability to assess reasons for low engagement. We also surveyed and interviewed AAA staff (n=16) and found most staff exhibited high readiness for evidence-informed practices, supported proactive data use to improve planning, advocating, and serving clients, and identified significance of multidisciplinary community partnerships. Our findings generated recommendations to enhance staff engagement in TCSP, improve data collection for transforming data utility beyond enrollment purposes, and consider programmatic modifications to reach vulnerable elders.

AN INNOVATIVE DATA-DRIVEN FALL PREVENTION COMMUNICATION TOOL FOR ADMINISTRATORS, NURSE MANAGERS, AND STAFF NURSES

Falls are the leading cause of injury among older adults, resulting in 3 million emergency department visits and 800,000 hospitalizations each year in the United States alone. In the hospital setting, falls are among the most common adverse events, causing longer stays and higher costs of care. Substantial efforts have been made to reduce falls in the past decade but with limited sustained effect. This may in part be due to limitations of existing tools for fall-risk assessment and evidence-based fall prevention. Therefore, there is a need to strengthen the evidence on risk factors for hospital-acquired falls and address barriers to translating the best available evidence into practice. To this end, we undertook the development of an innovative dissemination tool to implement fall-related evidence generated through state-of-the-art data science and information visualization approaches. Through a multidisciplinary academic-clinical partnership, we have developed an infographic to disseminate empirical evidence to nurses and administrators in the hospital setting. The infographic was developed based on principles of user-centered design and persuasive communication, and focuses on providing clear and accessible information about factors contributing to a patients’ risk of falling in the hospital. This innovative dissemination approach is intended to foster dialogue between administrators, mid-level nursing management and staff nurses as well as evidence-based practice at the bedside. Future use and evaluation of this fall prevention tool will focus on adapting the infographic as an interactive digital tool for education and engagement of patients and families in the hospital setting.

WHO Approach

Abstract Despite considerable investments into the generation of research worldwide, research is frequently not used in practice or policy. A substantial body of evidence is showing that using research requires significant and planned change at individual, organizational and systems levels. To support and guide WHO Member States in the endeavor of strengthening evidence-informed policy-making, the WHO Regional Office for Europe launched the Evidence-informed Policy Network (EVIPNet) Europe at the end of 2012. It is a capacity building initiative that aims to create, train, guide and institutionalize innovative, multisectoral and multidisciplinary partnerships and teams at the country level. Assisted by EVIPNet Europe, these teams initiate and implement national research-to-policy processes, such as developing user-friendly evidence briefs for policy on high-priority policy issues targeted and tailored to policy-makers, holding policy dialogues, and creating linkages and exchange between the research and policy communities. In this presentation, an overview of EVIPNet Europe’s mandate, approaches, tools and activities will be given. Participants will gain an understanding of how knowledge brokering and integrated, interactive mechanisms can help to bridge the gap between research and policy and improve health outcomes.

Workshop: NCDs prevention through integrated approaches: reducing obesity from individuals to populations

Abstract Non-communicable diseases, the slow motion disaster, represent one of the main global threats to health in the 21st century. Overweight and obesity are major risk factors for a number of chronic diseases and obesity has nearly tripled since 1975. Obesity can be prevented through healthy food, healthy lifestyle and anti-obesogenic environments. Effective multidisciplinary and intersectorial approaches are needed now more than ever and public health strategies should tackle the social determinants of health through the adoption of a common risk factor approach, which start from the mouth to reach the rest of the body. This applies to preventive actions, investments and advocacy with the government and the food industry. This workshop aims to discuss challenges and leverages to increase integrated approaches to prevent NCDs through healthy nutrition, focusing on the need to tackle the body as a whole as well as providing the skills necessary to understand and play the power game related to food and food industry. The workshop will start with a critical analysis of the key actions and debates at the global level, focusing afterwards on the sugar-sweetened beverage (SBB) laws and the need to re-legitimate the mouth as an integral part of the body to increase the effectiveness of prevention. The country case of Italy will give an important perspective from a country that has always been associated to the healthy Mediterranean diet but has reverted the trend in the last few years, especially among children. The debate will then lead to an analysis of the effective approaches, which can be applied to fight the obesity trend with a special focus on government roles and wrestling with industry. The obesity prevention strategies as described above will be analysed through the Global Charter for the Public’s Health (The Charter) lens, a joint effort of WFPHA, multiple stakeholders, as well as the WHO, which has been developed to provide a comprehensive, clear and flexible framework to adapt today’s public health to its global context. The implementation of The Charter functions and services, through a flexible approach, paves the path to reverse the obesity trend and facilitate the development of effective measures through multidisciplinary and intersectorial partnerships and effective laws. An integral part of the process is leadership from inside and outside the health sector along with people, communities, organizations, governments, concerned corporates and citizens. This workshop will provide delegates with the information, examples and skills necessary to understand and play an active role in the “food power game” through the adoption of common risk factor approach and increased advocacy skills by applying The Charter in Europe and globally. Key messages Integrated and multidisciplinary approaches, including the common risk factors approach, and effective advocacy with governments and concerned corporates are key elements to prevent obesity and NCDs. The Charter is the flexible and innovative framework to be applied from the communities up to their governments, at national and international levels to prevent diseases such as obesity and NCDs.

Sport

PurposeThe purpose of this paper is to examine current momentum in the sport policy arena congruent with the sustainable development agenda. It presents two consensus frameworks endorsed by the UN that provide mechanism for coherent action to 2030. With a human rights backdrop it outlines the role of organisations operating in the domains of physical education, physical activity and sport (PEPAS), promoting multidisciplinary partnerships and aligning to global agendas that enhance health and well-being for all.Design/methodology/approachThis position paper is a narrative literature review reporting on the status of sports policy frameworks in the UN system of relevance to the sport sector generally. It relates these to research evidence on the interlinkage between sport, human rights, health and well-being based on critical literature.FindingsThe advent of the Agenda 2030 for Sustainable Development, the Kazan Action Plan, the WHO Global Action Plan on Physical Activity 2018–2030 and allied developments across the sports movement provides an opportunity for revisiting and realigning the definitions and policy objectives of sport and health.Research limitations/implicationsThe author’s bias as a UNESCO chair towards UN frameworks is acknowledged as is leniency towards physical education, PEPAS.Practical implicationsMultilateral agencies, health and sport authorities, are encouraged to review and leverage their resources and engage with the call for action of global agendas to improve public health.Originality/valueThis paper presents the global policy backdrop for action and investment in inclusive sport, physical education and physical activity. It presents a fresh new health and well-being perspective aligned to wider interdisciplinary agendas, on which sport organisations can make a significant contribution.

Our quest for success: Using a multidisciplinary students-as-partners model to develop an innovative online learning game

In their review of the students-as-partners literature, Mercer-Mapstone et al. (2017) found that only 5-6% of published research articles on student-partnership models focused on multidisciplinary partnerships. This case study, authored by five undergraduate students and two academics, sought to examine the utility of using a multidisciplinary students-as-partners approach to advance the development of an online learning game focused on food insecurity. The multidisciplinary nature of the partnership facilitated perceptions of an equitable partnership, contributed to innovative design ideas, and conferred several benefits to the collaborators beyond those traditionally seen in the students-as-partners literature (Mercer-Mapstone et al., 2017). However, the multidisciplinary nature of the partnership also posed unique mentoring and coordination challenges that should be considered when adopting a multidisciplinary approach to teaching innovation.

Combining hydraulic modelling with partnership working: towards practical natural flood management

The UK government’s Future Flooding Inquiry called for more integrative methods to respond to flood risk management challenges. The 25-year plan for the environment, A Green Future (published by the UK Department for Environment, Food and Rural Affairs in 2018), has reiterated the requirement for integrated catchment management. There is growing acceptance that natural flood management (NFM) can complement traditional urban flood defence schemes. This paper examines the outcomes of a knowledge transfer partnership (KTP) between Waterco Consultants and the University of Liverpool which explores some of the challenges of implementing what appear to be relative simple NFM measures. Through a multidisciplinary partnership, the KTP project explored multiple delivery challenges. Using case study evidence from north-west England, the paper demonstrates the need for combining partnership working with more traditional hydraulic modelling approaches that can predict the potential flood risk reduction benefits of multiple NFM features, combined with the need to design structurally resilient interventions, so that appropriate permits can be approved. One of the key findings is that while NFM can contribute to flood risk alleviation, with multiple socio-environmental benefits, NFM can only be part of a more holistic approach. Primary evidence for hard and soft engineering measures, combined with use of automated attenuation management, could provide opportunities for more significant integrated flood risk benefits.

Utilizing Student Health and Academic Data: A County-Level Demonstration Project.

Students with chronic health conditions miss more school days than their peers and are at increased risk for performing worse on standardized tests and not completing a high school degree. University-based researchers, state government leaders, and a local county school system collaborated to use existing health and academic data to (1) evaluate the strength of the relationship between health status and school performance (absenteeism, grades) and (2) describe the health status of students who are chronically absent. Analyses included descriptive statistics, chi-square tests, negative binomial regression models, and estimated marginal means. The most common health conditions among the 3,663 kindergarten through Grade 12 students were ADD (attention deficit disorder)/ADHD (attention deficit hyperactivity disorder), asthma, migraine headaches, mental health conditions, and eczema/psoriasis/skin disorders. After controlling for covariates, having asthma or a mental health diagnosis was positively associated with absences; and having an ADD/ADHD or mental health diagnosis was negatively associated with GPA (grade point average). Chronically absent students had significantly lower GPAs, and a higher number of health conditions than other students. The success of this demonstration project encourages strengthening existing collaborations and establishing new multidisciplinary partnerships to analyze existing data sources to learn more about the relationship between student health and academic achievement. Moreover, connecting health status to academic achievement might be a chief tactic for advocating for additional resources to improve the care and management of chronic disease conditions among students.

Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access.

Aiming to increase care access, the national Primary Care-Mental Health Integration (PC-MHI) initiative of the Veterans Health Administration (VHA) embedded specialists, care managers, or both in primary care clinics to collaboratively care for veterans with psychiatric illness. The initiative's effects on health care use and cost patterns were examined among 5.4million primary care patients in 396 VHA clinics in 2013-16. The median rate of patients who saw a PC-MHI provider was 6.3percent. Each percentage-point increase in the proportion of clinic patients seen by these providers was associated with 11percent more mental health and 40percent more primary care visits but also with 9percent higher average total costs per patient per year. At the mean, 2.5 integrated care visits substituted for each specialty-based mental health visit that did not occur. PC-MHI was associated with improved access to outpatient care, albeit at increased total cost to the VHA. Successful implementation of integrated care necessitates significant investment and multidisciplinary partnership within health systems.

Antimicrobial resistance \u2013 moving forward?

BackgroundWhen microorganisms (such as bacteria or viruses) are highly exposed to antimicrobial drugs, they can develop the capacity to defeat the drugs designed to eradicate them. Long-term accumulation of adaptations to survive drug exposure can lead to the development of antimicrobial resistance (AMR). The success of antibiotics has led to their widespread overuse and misuse in humans, animals and plants.Main textAMR is a global concern and solutions are not vertical actions in a single buy business model.Even if a transectoral approach is key, there is a lack of multi-disciplinary partnerships that allow for strategic cooperation between different sectors such as the pharmaceutical industry, agro-alimentary complex, patient care and education, NGOs and research and development. Global public health voices should lead this integration to align the progress of existing AMR successes. Maintaining the public’s trust in preventive medicine, health systems and food production safety, together with public health driven, non-profit drug development, is a key factor. In its “Call for integrated action on AMR”, signed by about 70 national and international organizations the World Federation of Public Health Associations (WFPHA) called “on all governments, the private sector, non-governmental organizations, health professionals, public and private research organizations, and all stakeholders to ensure that public health remains at the centre of all policy and scientific endeavours in the field of antimicrobial resistance”.ConclusionsThe “Global Charter for the Public’s Health”, developed by the WFPHA in association with WHO, is proposed in this article as a tool for implementation of complex public health actions such as AMR.