College and university environmental programs as a policy problem (part 2): strategies for improvement.

Environmental studies and environmental sciences programs in American and Canadian colleges and universities seek to ameliorate environmental problems through empirical enquiry and analytic judgment. In a companion article (Part 1) we describe the environmental program movement (EPM) and discuss factors that have hindered its performance. Here, we complete our analysis by proposing strategies for improvement. We recommend that environmental programs re-organize around three principles. First, adopt as an overriding goal the concept of human dignity-defined as freedom and social justice in healthy, sustainable environments. This clear higher-order goal captures the human and environmental aspirations of the EPM and would provide a more coherent direction for the efforts of diverse participants. Second, employ an explicit, genuinely interdisciplinary analytical framework that facilitates the use of multiple methods to investigate and address environmental and social problems in context. Third, develop educational programs and applied experiences that provide students with the technical knowledge, powers of observation, critical thinking skills and management acumen required for them to become effective professionals and leaders. Organizing around these three principles would build unity in the EPM while at the same time capitalizing on the strengths of the many disciplines and diverse local conditions involved.

College and university environmental programs as a policy problem (part 1): integrating knowledge, education, and action for a better world?

The environmental sciences/studies movement, with more than 1000 programs at colleges and universities in the United States and Canada, is unified by a common interest-ameliorating environmental problems through empirical enquiry and analytic judgment. Unfortunately, environmental programs have struggled in their efforts to integrate knowledge across disciplines and educate students to become sound problem solvers and leaders. We examine the environmental program movement as a policy problem, looking at overall goals, mapping trends in relation to those goals, identifying the underlying factors contributing to trends, and projecting the future. We argue that despite its shared common interest, the environmental program movement is disparate and fragmented by goal ambiguity, positivistic disciplinary approaches, and poorly rationalized curricula, pedagogies, and educational philosophies. We discuss these challenges and the nature of the changes that are needed in order to overcome them. In a subsequent article (Part 2) we propose specific strategies for improvement.

Women's health in rural Uganda: problems, coping strategies, and recommendations for change.

This study draws upon 63 semi-structured interviews with rural women in central Uganda to elicit women's health problems, coping mechanisms, and recommendations for improved health services. The health problems most commonly reported by the women were sexually transmitted diseases, especially syphilis, abdominal pain, genital sores, and mental stress. Women indicated several barriers to obtaining health care, such as inaccessibility to health-care facilities, lack of time and money, and dependence on men for permission to leave the home. In response, they had devised several coping strategies for addressing their health problems, including ignoring the problem, self-care/medication, use of herbal/traditional medicine, and secret use of family planning services. The women indicated a need for medical laboratory services; family planning services; antenatal, maternity, and gynaecological services; and health counselling. They recommended health education for both genders, particularly for men regarding family planning.

Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit.

OBJECTIVES: The objectives of the study are to observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit; to analyse the policies and procedures in the hospital and unit environments; to analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and to collect monthly specific IP&C-related anonymised data. DESIGN: In this qualitative case study analysis, a socio-ecological approach on health systems informed the research design and provided a framework to better understand the complexity of implementing effective IP&C. SETTING: The study was conducted on a surgical unit at a Netherlands' hospital that reported successful reductions in the prevalence of targeted multidrug-resistant organisms. METHODS: Research methods included unit observations (n=3), review of relevant policies and procedures, five practitioner-led photo walkabouts of the unit (n=7), three photo elicitation focus groups with practitioners (n=13) and the review of related IP&C data. RESULTS: The findings indicate some conditions and processes present that may influence the low prevalence of multidrug-resistant organisms, including the 'search and destroy' active surveillance strategy, low occupancy rates, a centralised bed cleaning system and the presence of an active grass roots Hygiene in Practice group, which engages practitioners in several ongoing activities to promote IP&C on the units. CONCLUSIONS: Further research on the benefits of practitioner-led community of practices on IP&C practices such as the Hygiene in Practice group is also recommended. Additional case studies to compare theses practices with other acute care hospital around the world would be a valuable way to better understand what IP&C programmes are most effective in which contexts and for what reasons. Further data are available by contacting the primary author directly.