Testing of the WHO Infection Prevention and Control Assessment Framework at acute healthcare facility level.

BACKGROUND: Monitoring and evaluation are an essential part of infection prevention and control (IPC) implementation. The authors developed an IPC assessment framework (IPCAF) to support implementation of the World Health Organization (WHO) guidelines on core components of IPC programmes in acute healthcare facilities. AIM: To evaluate the usability and reliability of the IPCAF tool for global use. METHODS: The IPCAF is a questionnaire with a scoring system to measure the level of IPC implementation according to the eight WHO core components. The tool was pre-tested qualitatively, revised and translated selectively. A convenience sample of hospitals was invited to participate in the final testing. At least two IPC professionals from each hospital independently completed the IPCAF and a usability questionnaire online. The tool's internal consistency and interobserver reliability or intraclass correlation coefficient (ICC) were assessed, and usability questions were summarized descriptively. FINDINGS: In total, 46 countries, 181 hospitals and 324 individuals participated; 52 (16%) and 55 (17%) individual respondents came from low- and lower-middle income countries, respectively. Fifty-two percent of respondents took less than 1 h to complete the IPCAF. Overall, there was adequate internal consistency and a high ICC (0.92, 95% confidence interval 0.89-0.94). Ten individual questions had poor reliability (ICC <0.4); these were considered for revision according to usability feedback and expert opinion. CONCLUSIONS: The WHO IPCAF was tested using a robust global study and revised as necessary. It is now an effective tool for IPC improvement in healthcare facilities.

Contribution to healthy places: Risks of equity free health impact assessment.

While health equity is central to health impact assessment [HIA], in reality, less is known about potential impacts of equity-free HIA on social inequalities. We assessed equity-free HIA case in a small city east of Montreal, which took place in a context of urban revitalization. We applied a combination of a quantitative review of community characteristics with a qualitative descriptive approach based on in-depth semi-structured interviews and a focus group with multiple stakeholders to shed light on the pitfalls of equity-free HIA. Our results pointed to gentrification process with a gradual relocation of low-income residents in the end. To mitigate mediating circumstances of gentrification and displacement, the municipality should support social housing or at least should ensure rent stabilization ordinance.

Validation of the 10-item Cervantes Scale in middle-aged Portuguese women: paper-and-pencil and online format assessment of menopause-related symptoms.

OBJECTIVE: The aim of the study was to validate the Portuguese language version of the 10-item Cervantes Scale (CS-10), a self-reporting instrument that assesses menopausal symptoms, and to compare the results (both symptom severity and multigroup invariance) of middle-aged women who completed the questionnaire in paper-and-pencil format (PPF) or in the online format (OF). METHODS: A total of 292 women, aged 45 to 65 years, completed the questionnaires (PPF = 66; OF = 226). Construct (factorial and convergent) and external validity, as well as reliability and psychometric sensitivity were studied. Multigroup confirmatory factor analysis was performed to compare PPF with OF, regarding the measure's invariance. RESULTS: The CS-10 showed good psychometric properties (ie, factor and external validity), as well as good sensitivity and reliability. The association with the Utian Quality of Life Scale (UQoLS) was significant and positive, though weak. The measured structure was invariant when comparing both subsamples (PPF and OF), evidencing an equivalent structure in both. No differences in reported symptoms were observed between the two subgroups. CONCLUSIONS: The Portuguese language version of the CS-10 rendered data with good psychometric properties in a sample of middle-aged Portuguese women. Therefore, it can be used in both clinical and community settings. The weak association between both instruments (UQoLS and CS-10) might be due to the different conceptualization of the quality of life construct: the CS-10 focuses on symptom severity, whereas the UQoLS assesses domains such as work-related or health-related behaviors.

The characteristics and reporting quality of research impact case studies: A systematic review.

Despite the growing expectation that researchers report the impact of their research using a case study approach, systematic reviews of research impact have focused on frameworks, indicators, methods of data collection and assessment rather than impact case studies. Our aim is to provide an overview of the characteristics of published research impact case studies, including translation activities, and their reporting quality. We searched for peer-reviewed impact studies published between 2000 and 2018 using a case study approach and selected 25 suitable papers. We applied descriptive statistics to study characteristics, conducted thematic analysis of research translation activities and assessed reporting quality using the 10-point ISRIA statement. 24 papers reported intermediate impacts, such as advocacy, or the development of statements, tools, or technology. 4 reported on longer-term societal impacts, such as health outcomes and economic return on investment. 7 reported on translation activities. Papers scored well against the ISRIA statement on 5 domains of reporting quality. Weakest scores centred around identification of stakeholder needs and stakeholder involvement, and ethics and conflict of interest. We identified the need for more consistency in reporting through a case study approach, more systematic reporting of translation pathways and greater transparency concerning estimated costs and benefits of the research and its translation and impact assessment.

Estimation of daily fish intake values for use with water quality criteria for human health assessments in Korea.

Daily fish intake is a key parameter of water quality criteria for protecting human health. Daily fish intake values should be representative of consumption patterns and must be practical for regulatory purposes. Thus, values must be scientifically verified and regularly updated for inclusion in water quality criteria. In Korea, four different fish intake values have been identified from food balance sheets (KREI 2000), the Korea National Health and Nutrition Examination Survey (KNHANES) II (Ministry of Health and Welfare 2002), Korean Exposure Factors Handbook (MOE 2007a), and KNHANES IV-V (CDC 2008; 2009; 2010), which have been applied to water quality standards and related national projects and regulations. This paper reviews the estimation methodologies of previous daily fish intake values from multiple sources and improvements in these values between 2000 and 2012. Finally, limitations associated with each value were examined to assist future research and regulatory management. This review provides information on changes in the daily fish intake values and their application in water quality standards in Korea.

Implementing Health Impact Assessment Programs in State Health Agencies: Lessons Learned From Pilot Programs, 2009-2011.

CONTEXT: Health Impact Assessment (HIA) has emerged as a promising tool to integrate health considerations into decision making. The growth and success of HIA practice in the United States will be dependent on building the capacity of practitioners. OBJECTIVE: This article seeks to identify the role of state health agencies (SHAs) in building capacity for conducting HIAs and the key components of initiatives that produced effective HIAs and HIA programs. The authors proposed to answer 3 research questions: (1) What can be the role of the SHA in HIA? (2) What are the characteristics of successful state HIA programs? and (3) What are some effective strategies for building capacity for HIA in SHAs and local health departments? DESIGN: The authors reviewed program reports from the ASTHO's pilot state health agencies (California, Minnesota, Oregon, and Wisconsin) that, between 2009 and 2011, created HIA programs to provide HIA training, conduct HIAs, and build practitioner networks. MAIN OUTCOME MEASURES: Program reports were examined for shared themes on the role of SHAs in a statewide HIA initiative, the characteristics of successful programs, and effective strategies for building capacity. RESULTS: Despite differences among the programs, many shared themes existed. These include stressing the importance of a basic, sustained infrastructure for HIA practice; leveraging existing programs and networks; and working in partnership with diverse stakeholders. CONCLUSIONS: SHAs can build capacity for HIA, and SHAs can both lead and support the completion of individual HIAs. States and territories interested in starting comprehensive statewide HIA initiatives could consider implementing the strategies identified by the pilot programs.

Environmental and health impact assessment for ports in Thailand.

Port development in Thailand is an essential part of the national maritime interest in connection with ship and shore activities. The growth of maritime industry and transportation has led to the expansion of ports' areas and capacity. Each port type causes different environmental impacts. Therefore, the Port Authority of Thailand has set up guidelines on ports' environmental management. This is divided into 3 major phases; namely, planning, construction and operation commencement periods. The Report of Environmental and Health Impact Assessment (EIA, HIA and EHIA) is regarded as the environmental management process in the planning period. It is a key tool to anticipate and prevent any adverse effects that might occur on the environment as well as community health resulting from the project implementation. This measure, in turn, creates advance preparation on both the preventive and problem-solving means before the project gets off the ground. At present, the majority of new projects on port development have still been in the process of information gathering for EHIA submission. Some cannot start to operate due to their EHIA failure. For example, the Tha-sala port which did not pass EHIA, mainly because emphasis had been focused on adhering to legal regulations without taking into consideration the in-depth analysis of data being conducted by community entities in the area. Thus caused the project to be finally abolished. Impact assessment on environment and health should be aimed at detailed understanding of the community in each particular area so that effective data of objective achievement in preventing environmental problems could actually be carried out and welcomed by the concerned society.

Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports.

INTRODUCTION: Since the 1990s, the use of health impact assessments (HIAs) has grown for considering the potential health impacts of proposed policies, plans, programs, and projects in various sectors. Evaluation of HIA impacts is needed for understanding the value of HIAs, improving the methods involved in HIAs, and potentially expanding their application. Impact evaluations examine whether HIAs affect decisions and lead to other effects. METHODS: I reviewed HIA impact evaluations identified by literature review and professional networking. I abstracted and synthesized data on key findings, success factors, and challenges from 5 large evaluations conducted in the United States, Europe, Australia, and New Zealand and published from 2006 through 2015. These studies analyzed impacts of approximately 200 individual HIAs. RESULTS: Major impacts of HIAs were directly influencing some decisions, improving collaboration among stakeholders, increasing awareness of health issues among decision makers, and giving community members a stronger voice in local decisions. Factors that contributed to successful HIAs included engaging stakeholders, timeliness, policy and systems support for conducting HIAs, having people with appropriate skills on the HIA team, obtaining the support of decision makers, and providing clearly articulated, feasible recommendations. Challenges that may have reduced HIA success were poor timeliness, underestimation of time and resources needed, difficulty in accessing relevant data, use of jargon in HIA reports, difficulty in involving decision makers in the HIA process, and absence of a requirement to conduct HIAs. CONCLUSION: HIAs can be useful to promote health and mitigate adverse impacts of decisions made outside of the health sector. Stakeholder interactions and community engagement may be as important as direct impacts of HIAs. Multiple factors are required for HIA success. Further work could strengthen the role of HIAs in promoting equity, examine HIA impacts in specific sectors, and document the role of HIAs in a "health in all policies" approach.

[Health Impact Assessment: opportunity for participative decision-making or persuasive tool for decisions already taken?]. / Valutazione di Impatto sulla Salute: occasione per processi decisionali partecipati o strumento di persuasione per scelte già prese?

The Health Impact Assessment (HIA) has already been tested in dozens of nations, including Italy, and the reflection is now mature enough to allow a first evaluation of its effective capacity to offer an inclusive tool for prevention. The analysis focuses in particular on the HIA ability to address, through a participatory approach, one of its founding values: the democratic nature of decisions with an impact on public health. In most cases, the experiments carried out so far seem to be disappointing: the participation is often absent or performed in a rhetorical form. Sometimes the HIA has even been used in an instrumental way to justify decisions already taken, with the only result to further erode the credibility of experts and institutions. In this work, however, the author will try to show how, on the contrary, a greater involvement in the evaluation and decision-making processes could improve the effectiveness of HIA in terms of prevention, while at the same time promoting a relationship of trust between experts, institutions, and citizens on which to establish an ecologically and socially sustainable development.

[A strategy for institutionalisation of health impact assessment in Andalusia (Spain)]. / Institucionalización de la evaluación del impacto en la salud en Andalucía.

Health impact assessment (HIA) aims to incorporate people's health and wellbeing as a key feature in policy-making. Many authors believe that HIA might be systematically integrated into all decision-making processes as a way to achieve that goal. To that end, there is need to overcome a number of challenges, including the fact that Andalusia (Spain) has made HIA compulsory by law, the need for awareness of all public sectors whose decisions might have substantial impacts on health and for a methodology that would enable a comprehensive approach to health determinants and inequalities, and the training of both the public health staff and professional sectors responsible for its application. In Andalusia, a law provides mandatory and binding health impact reports for most authorisation procedures in different areas: from sectoral plans to urban planning schemes, and especially projects subject to environmental assessment. Implementation of this law has required its integration into authorisation procedures, the training of interdisciplinary working groups in public health, the preparation of technical guidelines, and the organisation of dissemination and training seminars for developers.

Health Impact Assessments, Regulation, and the Unconventional Gas Industry in the UK: Exploiting Resources, Ideology, and Expertise?

Health impact assessments (HIAs) across the globe may be used by governments and industries to secure approval for unconventional gas extraction developments. HIA is an umbrella term that covers an array of health review and assessment practices, ranging from the very general to quite specific and technical health studies. Our concern in this paper is principally with the specialist end of the HIA continuum and particularly its application to unconventional gas extraction in the UK. We outline the context within which HIAs in unconventional gas extraction may be conducted. We then explain what HIAs may do. HIAs are often commissioned from consultancy companies to assess unconventional gas extraction project risks and benefits and propose mitigation measures. Communities can rarely afford HIAs in the planning process and may consider them biased when commissioned by vested interests. The oil and gas industry uses these techniques for its own ends. Hiring experts, be they specialist consultants, researchers, lobbyists, ex-government officials, or regulators, to influence planning and regulation is a well-tried tactic and structural advantage exploited by industry in seeking license to operate. Equitable and ethical HIA principles are urgently needed in the UK in relation to unconventional gas to secure the integrity and probity of the emerging regulatory system and address concerns regarding unregulated practitioners.

Lessons learnt from developing a Health Impact Assessment guide in Iran.

For others wishing to develop Health Impact Assessment (HIA) guides (manuals) and to adjust them to conditions in their countries, we draw lessons from developing an HIA guide in Iran. We derive the lessons from our research comparing HIA guides found in the international literature and our experiences in adapting international experience to an HIA model for Iran that incorporates Iranian experts' opinions.

Developments in Impact Assessment of New Diagnostic Algorithms for Tuberculosis Control.

A modified presentation of the impact assessment framework is proposed that improves accessibility while continuing to provide a checklist of the evidence needed to support policy decisions on the implementation of new tools for the diagnosis of tuberculosis.

The impact of Cochrane Reviews: a mixed-methods evaluation of outputs from Cochrane Review Groups supported by the National Institute for Health Research.

BACKGROUND: The last few decades have seen a growing emphasis on evidence-informed decision-making in health care. Systematic reviews, such as those produced by Cochrane, have been a key component of this movement. The National Institute for Health Research (NIHR) Systematic Review Programme currently supports 20 Cochrane Review Groups (CRGs) in the UK and it is important that this funding represents value for money. AIMS AND OBJECTIVES: The overall aim was to identify the impacts and likely impacts on health care, patient outcomes and value for money of Cochrane Reviews published by 20 NIHR-funded CRGs during the years 2007-11. DESIGN: We sent questionnaires to CRGs and review authors, undertook interviews with guideline developers (GDs) and used bibliometrics and documentary review to get an overview of CRG impact and to evaluate the impact of a sample of 60 Cochrane Reviews. The evaluation was guided by a framework with four categories (knowledge production, research targeting, informing policy development and impact on practice/services). RESULTS: A total of 3187 new and updated reviews were published on the Cochrane Database of Systematic Reviews between 2007 and 2011, 1502 (47%) of which were produced by the 20 CRGs funded by the NIHR. We found 40 examples where reviews appeared to have influenced primary research and reviews had contributed to the creation of new knowledge and stimulated debate. Twenty-seven of the 60 reviews had 100 or more citations in Google Scholar™ (Google, CA, USA). Overall, 483 systematic reviews had been cited in 247 sets of guidance. This included 62 sets of international guidance, 175 sets of national guidance (87 from the UK) and 10 examples of local guidance. Evidence from the interviews suggested that Cochrane Reviews often play an instrumental role in informing guidance, although reviews being a poor fit with guideline scope or methods, reviews being out of date and a lack of communication between CRGs and GDs were barriers to their use. Cochrane Reviews appeared to have led to a number of benefits to the health service including safer or more appropriate use of medication or other health technologies or the identification of new effective drugs or treatments. However, whether or not these changes were directly as a result of the Cochrane Review and not the result of subsequent clinical guidance was difficult to judge. Potential benefits of Cochrane Reviews included economic benefits through budget savings or the release of funds, improvements in clinical quality, the reduction in the use of unproven or unnecessary procedures and improvements in patient and carer experiences. CONCLUSIONS: This study identified a number of impacts and likely impacts of Cochrane Reviews. The clearest impacts of Cochrane Reviews are on research targeting and health-care policy, with less evidence of a direct impact on clinical practice and the organisation and delivery of NHS services. Although it is important for researchers to consider how they might increase the influence of their work, such impacts are difficult to measure. More work is required to develop suitable methods for defining and quantifying the impact of research. FUNDING: The NIHR Health Technology Assessment programme.

The value of mainstreaming human rights into health impact assessment.

Health impact assessment (HIA) is increasingly being used to predict the health and social impacts of domestic and global laws, policies and programs. In a comprehensive review of HIA practice in 2012, the authors indicated that, given the diverse range of HIA practice, there is an immediate need to reconsider the governing values and standards for HIA implementation [1]. This article responds to this call for governing values and standards for HIA. It proposes that international human rights standards be integrated into HIA to provide a universal value system backed up by international and domestic laws and mechanisms of accountability. The idea of mainstreaming human rights into HIA is illustrated with the example of impact assessments that have been carried out to predict the potential effects of intellectual property rights in international trade agreements on the availability and affordability of medicines. The article concludes by recommending international human rights standards as a legal and ethical framework for HIA that will enhance the universal values of nondiscrimination, participation, transparency and accountability and bring legitimacy and coherence to HIA practice as well.

Quantifying uncertainty in health impact assessment: a case-study example on indoor housing ventilation.

Quantitative health impact assessment (HIA) is increasingly being used to assess the health impacts attributable to an environmental policy or intervention. As a consequence, there is a need to assess uncertainties in the assessments because of the uncertainty in the HIA models. In this paper, a framework is developed to quantify the uncertainty in the health impacts of environmental interventions and is applied to evaluate the impacts of poor housing ventilation. The paper describes the development of the framework through three steps: (i) selecting the relevant exposure metric and quantifying the evidence of potential health effects of the exposure; (ii) estimating the size of the population affected by the exposure and selecting the associated outcome measure; (iii) quantifying the health impact and its uncertainty. The framework introduces a novel application for the propagation of uncertainty in HIA, based on fuzzy set theory. Fuzzy sets are used to propagate parametric uncertainty in a non-probabilistic space and are applied to calculate the uncertainty in the morbidity burdens associated with three indoor ventilation exposure scenarios: poor, fair and adequate. The case-study example demonstrates how the framework can be used in practice, to quantify the uncertainty in health impact assessment where there is insufficient information to carry out a probabilistic uncertainty analysis.

Health equity impact assessment.

The World Health Organization's Commission on Social Determinants of Health has called for 'health equity impact assessments' of all economic agreements, market regulation and public policies. We carried out an international study to clarify if existing health impact assessment (HIA) methods are adequate for the task of global health equity assessments. We triangulated data from a scoping review of the international literature, in-depth interviews with health equity and HIA experts and an international stakeholder workshop. We found that equity is not addressed adequately in HIAs for a variety of reasons, including inadequate guidance, absence of definitions, poor data and evidence, perceived lack of methods and tools and practitioner unwillingness or inability to address values like fairness and social justice. Current methods can address immediate, 'downstream' factors, but not the root causes of inequity. Extending HIAs to cover macro policy and global equity issues will require new tools to address macroeconomic policies, historical roots of inequities and upstream causes like power imbalances. More sensitive, participatory methods are also required. There is, however, no need for the development of a completely new methodology.

Health impact assessment in a network of European cities.

The methodology of health impact assessment (HIA) was introduced as one of four core themes for Phase IV (2003-2008) of the World Health Organization European Healthy Cities Network (WHO-EHCN). Four objectives for HIA were set at the beginning of the phase. We report on the results of the evaluation of introducing and implementing this methodology in cities from countries across Europe with widely differing economies and sociopolitical contexts. Two main sources of data were used: a general questionnaire designed for the Phase IV evaluation and the annual reporting template for 2007-2008. Sources of bias included the proportion of non-responders and the requirement to communicate in English. Main barriers to the introduction and implementation of HIA were a lack of skill, knowledge and experience of HIA, the newness of the concept, the lack of a legal basis for implementation and a lack of political support. Main facilitating factors were political support, training in HIA, collaboration with an academic/public health institution or local health agency, a pre-existing culture of intersectoral working, a supportive national policy context, access to WHO materials about or expertise in HIA and membership of the WHO-EHCN, HIA Sub-Network or a National Network. The majority of respondents did not feel that they had had the resources, knowledge or experience to achieve all of the objectives set for HIA in Phase IV. The cities that appear to have been most successful at introducing and implementing HIA had pre-existing experience of HIA, came from a country with a history of applying HIA, were HIA Sub-Network members or had made a commitment to implementing HIA during successive years of Phase IV. Although HIA was recognised as an important component of Healthy Cities' work, the experience in the WHO-EHCN underscores the need for political buy-in, capacity building and adequate resourcing for the introduction and implementation of HIA to be successful.