Search

Background: Despite broad scientific consensus about the importance of the early years in the lifelong health and wellbeing of children, there is debate about whether and how healthcare professionals can optimise early child development through monitoring or screening. The evidence in support of a systematic population-level intervention is disputed, which is reflected in the diversity of approaches to developmental screening internationally. Methods: Using a case-study design, and interpretive qualitative methods, we explored how Canadian experts in child health (n=39): a) rationalise why they do, or would, pursue population-level developmental screening; b) articulate the policy goals of such an intervention, and; c) justify the practice with reference to evidence. Findings: Respondents identified three distinct framings, or policy agendas, for what developmental screening can and should seek to achieve, specifically: 1) as medical intervention, facilitating the early identification of health risk or disorder; 2) as social intervention, providing an opportunity for communication and connection with parents for all children; and 3) as political intervention, staking a claim for early child health on the broader political agenda. Discussion and conclusions: Each agenda is justified by distinct types of evidence, posing a challenge to simplistic models of evidence-based policymaking, and demonstrating that evidence is not just an input, but a contested part of a dynamic and political policymaking process.

Background: The health-care community has a responsibility to address the environmental impact of delivering health-care services. Educational programmes present ideal fora to confer 'environmental competencies' to future health system leaders, managers, practitioners and researchers. The aim of this review is to synthesise the literature on health-care competencies, education and training of relevance to issues of environmental sustainability and climate change in the health sector. Methods: We conducted a systematic review of English language articles on environmental competencies in healthcare in the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ProQuest databases published from inception to April 2019. Thematic analysis and descriptive statistics were used to synthesise the findings and develop a typology of environmental competencies. Results: Of the 902 unique citations, we identified 23 articles that met our inclusion criteria. Environmental competencies that align with general management skills were most frequent (40%), followed by research skills (37%). Three competencies specific to the environment (22%) were identified: resource stewardship (n = 16), systems thinking (n = 14) and social and environmental justice (n = 7). The majority of work was identified in nursing, medicine and public health. Competencies were most commonly embedded in existing curricula or offered as new courses or workshops. Conclusion: Incorporating environmental competencies into education programmes will serve to raise awareness of, and advance the significance of, the health sector's impact on climate change and environmental sustainability. Our findings that environmental competencies align with previously validated health-care competencies support the perspective that these competencies represent essential knowledge and skills for the health-care workforce.

In the context of continuing pressures from managerialist and neoliberal drivers of university reform in Australia, Macquarie University's recent undergraduate curriculum innovation, based on "People," "Planet," and "Participation," has resulted in the embedding and integration of experiential learning in its curriculum and institutional framework. Such an approach challenges academic and administrative staff, students, and partners in industry, the community and public sector settings, to engage and collaborate across significant boundaries. This article outlines the scope and nature of the curriculum reform, then considers the way geographers have both shaped and responded to the opportunities it created. In so doing, it proposes a number of challenges and recommendations for geographers who might seek to extend their longstanding commitment to field-based learning through similar reforms. In this regard, the discipline of geography and its tendency to engage with the "field" can offer much in fostering deeply transformative learning.

Background Respiratory care is an important site for climate action, given that common treatments for conditions such as asthma and COPD produce significant greenhouse gas emissions, even as respiratory health is negatively impacted by climate change. Clinical guidelines provide key information for healthcare professionals and can promote approaches to healthcare that can mitigate negative environmental impacts, and optimise patient treatment, care delivery, and equitable outcomes, and bring awareness and legitimacy to sustainable healthcare practices. Methods Twenty national and international clinical respiratory guidelines were purposively selected and screened for inclusion of four principles of sustainable clinical practice: prevention, patient empowerment and self-care, lean service delivery, and low carbon alternatives. A screening framework specific to respiratory care implications was developed and used to review each guideline for mention of relevant topics, recommendations, and explicit links to sustainability in relation to each principle. Findings Sustainable clinical care principles were evident in most guidelines reviewed, environmental sustainability was mentioned infrequently. Many guidelines emphasised prevention (more secondary than primary) and support for patient preference and streamlining care, yet there was rarely mention of how these recommendations could contribute to lowering the environmental impacts of health systems. Low carbon alternatives were mentioned in only three guidelines. Conclusions While many clinical respiratory guidelines make recommendations in accordance with the principles of prevention, patient empowerment and self-care, and lean service delivery, reducing the carbon footprint of healthcare was rarely mentioned in the guidelines. Including explicit attention to the environmental impact of clinical care in guidance could support efforts to reduce the wider harms of healthcare, meanwhile, noting the clinical benefits of sustainable approaches could promote the uptake of recommendations. [ABSTRACT FROM AUTHOR]

Newborn bloodspot screening is one of the most enduring and successful population screening initiatives. Yet technological innovation to permit simultaneous measurement of multiple biomarkers-and potentially, entire genomes-has spurred expansion and debate. Through a cross-jurisdictional comparison, we describe the varied roles and reach of screening-related governance structures in the United States, the United Kingdom, New Zealand and Canada, and highlight the distinct values and resources brought to bear by the genetics, public health and maternal-child health communities in adjudicating the benefits and burdens of expanded newborn screening. We call for the expansion of formal governance structures that are balanced in resources and perspective and mandated to ensure that the organization and delivery of newborn screening achieves optimal quality. KEY WORDS: Mass screening; public health administration; public health; preventive medicine; health services administration; infant; newborn Le depistage des taches de sang chez les nouveau-nes est une des initiatives de depistage de masse les plus durables et fructueuses. Pourtant, l'innovation technologique pour permettre la mesure simultanee de multiples marqueurs biologiques, et peut-etre des genomes entiers, a suscite une expansion et un debat. Nous decrivons au moyen d'une comparaison inter competence la variete de roles et la portee des structures de gouvernance du depistage aux Etats-Unis, au Royaume-Uni, en NouvelleZelande et au Canada, et soulignons les valeurs et ressources distinctes mises a profit par les communautes de la genetique, de la sante publique et de la sante maternelle et enfantine en jugeant les benefices et le fardeau du depistage elargi chez les nouveau-nes. Nous demandons une expansion des structures de gouvernance officielles qui soit equilibree en termes de ressources et de perspective et ayant le mandat de s'assurer que l'organisation et la prestation du depistage chez les nouveau-nes soient d'une qualite optimale. MOTS CLES : depistage de masse; administration de la sante publique; sante publique; medecine preventive; administration des services de sante; nourrisson; nouveau-ne Can J Public Health 2015;106(4):e244-e248 doi: 10.17269/CJPH.106.4897, Newborn bloodspot screening (NBS) programs have expanded markedly in recent years, motivated by technological developments that have increased the number of conditions detectable and an accompanying press of parent and [...]

Background: Decision impact studies have become increasingly prevalent in genomic medicine, particularly in cancer research. Such studies are designed to provide evidence of clinical utility for genomic tests by evaluating their impact on clinical decision-making. This paper offers insights into understanding of the origins and intentions of these studies through an analysis of the actors and institutions responsible for the production of this new type of evidence. Methods: We conducted bibliometric and funding analyses of decision impact studies in genomic medicine research. We searched databases from inception to June 2022. The datasets used were primarily from Web of Science. Biblioshiny, additional R-based applications, and Microsoft Excel were used for publication, co-authorship and co-word analyses. Results: 163 publications were included for the bibliometric analysis; a subset of 125 studies were included for the funding analysis. Included publications started in 2010 and increased steadily over time. Decision impact studies were primarily produced for proprietary genomic assays for use in cancer care. The author and affiliate analyses reveal that these studies were produced by 'invisible colleges' of researchers and industry actors with collaborations focused on producing evidence for proprietary assays. Most authors had an industry affiliation, and the majority of studies were funded by industry. While studies were conducted in 22 countries, the majority had at least one author from the USA. Discussion: This study is a critical step in understanding the role of industry in the production of new types of research. Based on the data collected, we conclude that decision impact studies are industry-conceived and -produced evidence. The findings of this study demonstrate the depth of industry involvement and highlight a need for further research into the use of these studies in decision-making for coverage and reimbursement. [ABSTRACT FROM AUTHOR]