Food Policy Council Self-Assessment Tool: Development, Testing, and Results.

A large number of food policy councils (FPCs) exist in the United States, Canada, and Tribal Nations (N = 278), yet there are no tools designed to measure their members' perceptions of organizational capacity, social capital, and council effectiveness. Without such tools, it is challenging to determine best practices for FPCs and to measure change within and across councils over time. This study describes the development, testing, and findings from the Food Policy Council Self-Assessment Tool (FPC-SAT). The assessment measures council practices and council members' perceptions of the following concepts: leadership, breadth of active membership, council climate, formality of council structure, knowledge sharing, relationships, member empowerment, community context, synergy, and impacts on the food system. All 278 FPCs listed on the Food Policy Network's Online Directory were recruited to complete the FPC-SAT. Internal reliability (Cronbach's α) and inter-rater reliability (AD, rWG(J), ICC [intraclass correlations][1], ICC[2]) were calculated, and exploratory and a confirmatory factor analyses were conducted. Responses from 354 FPC members from 94 councils were used to test the assessment. Cronbach's α ranged from 0.79 to 0.93 for the scales. FPC members reported the lowest mean scores on the breadth of active membership scale (2.49; standard deviation [SD], 0.62), indicating room for improvement, and highest on the leadership scale (3.45; SD, 0.45). The valid FPC-SAT can be used to identify FPC strengths and areas for improvement, measure differences across FPCs, and measure change in FPCs over time.

Civil society participation in the health system: the case of Brazil's Health Councils.

BACKGROUND: Brazil created Health Councils to bring together civil society groups, heath professionals, and government officials in the discussion of health policies and health system resource allocation. However, several studies have concluded that Health Councils are not very influential on healthcare policy. This study probes this issue further by providing a descriptive account of some of the challenges civil society face within Brazil's Health Councils. METHODS: Forty semi-structured interviews with Health Council Members at the municipal, state and national levels were conducted in June and July of 2013 and May of 2014. The geographical location of the interviewees covered all five regions of Brazil (North, Northeast, Midwest, Southeast, South) for a total of 5 different municipal Health Councils, 8 different state Health Councils, and the national Health Council in Brasilia. Interview data was analyzed using a thematic approach. RESULTS: Health Councils are limited by a lack of legal authority, which limits their ability to hold the government accountable for its health service performance, and thus hinders their ability to fulfill their mandate. Equally important, their membership guidelines create a limited level of inclusivity that seems to benefit only well-organized civil society groups. There is a reported lack of support and recognition from the relevant government that negatively affects the degree to which Health Council deliberations are implemented. Other deficiencies include an insufficient amount of resources for Health Council operations, and a lack of training for Health Council members. Lastly, strong individual interests among Health Council members tend to influence how members participate in Health Council discussions. CONCLUSIONS: Brazil's Health Councils fall short in providing an effective forum through which civil society can actively participate in health policy and resource allocation decision-making processes. Restrictive membership guidelines, a lack of autonomy from the government, vulnerability to government manipulation, a lack of support and recognition from the government and insufficient training and operational budgets have made Health Council largely a forum for consultation. Our conclusions highlight, that among other issues, Health Councils need to have the legal authority to act independently to promote government accountability, membership guidelines need to be revised in order include members of marginalized groups, and better training of civil society representatives is required to help them make more informed decisions.

Modifying the Medical Research Council grading system through Rasch analyses.

The Medical Research Council grading system has served through decades for the evaluation of muscle strength and has been recognized as a cardinal feature of daily neurological, rehabilitation and general medicine examination of patients, despite being respectfully criticized due to the unequal width of its response options. No study has systematically examined, through modern psychometric approach, whether physicians are able to properly use the Medical Research Council grades. The objectives of this study were: (i) to investigate physicians' ability to discriminate among the Medical Research Council categories in patients with different neuromuscular disorders and with various degrees of weakness through thresholds examination using Rasch analysis as a modern psychometric method; (ii) to examine possible factors influencing physicians' ability to apply the Medical Research Council categories through differential item function analyses; and (iii) to examine whether the widely used Medical Research Council 12 muscles sum score in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy would meet Rasch model's expectations. A total of 1065 patients were included from nine cohorts with the following diseases: Guillain-Barré syndrome (n = 480); myotonic dystrophy type-1 (n = 169); chronic inflammatory demyelinating polyradiculoneuropathy (n = 139); limb-girdle muscular dystrophy (n = 105); multifocal motor neuropathy (n = 102); Pompe's disease (n = 62) and monoclonal gammopathy of undetermined related polyneuropathy (n = 8). Medical Research Council data of 72 muscles were collected. Rasch analyses were performed on Medical Research Council data for each cohort separately and after pooling data at the muscle level to increase category frequencies, and on the Medical Research Council sum score in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Disordered thresholds were demonstrated in 74-79% of the muscles examined, indicating physicians' inability to discriminate between most Medical Research Council categories. Factors such as physicians' experience or illness type did not influence these findings. Thresholds were restored after rescoring the Medical Research Council grades from six to four options (0, paralysis; 1, severe weakness; 2, slight weakness; 3, normal strength). The Medical Research Council sum score acceptably fulfilled Rasch model expectations after rescoring the response options and creating subsets to resolve local dependency and item bias on diagnosis. In conclusion, a modified, Rasch-built four response category Medical Research Council grading system is proposed, resolving clinicians' inability to differentiate among its original response categories and improving clinical applicability. A modified Medical Research Council sum score at the interval level is presented and is recommended for future studies in Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy.

Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association.

Depression is commonly present in patients with coronary heart disease (CHD) and is independently associated with increased cardiovascular morbidity and mortality. Screening tests for depressive symptoms should be applied to identify patients who may require further assessment and treatment. This multispecialty consensus document reviews the evidence linking depression with CHD and provides recommendations for healthcare providers for the assessment, referral, and treatment of depression.

Putting Adolescents and Young Adults in a Room Together: Launching an Adolescent and Young Adult Oncology Council.

Purpose: This article describes the formation and first meeting of a community adolescent and young adult oncology council (AYAOC), which was created to promote patient and stakeholder involvement in research and programmatic initiatives within community-based cancer centers. Methods: The AYAOC (comprising patients/survivors, family members, researchers and clinicians) convened at a one-day workshop moderated by an Australian not-for-profit AYA cancer organization. The council shared and compared health care experiences and then identified and prioritized unmet health care needs. Workshop notes were analyzed using inductive content analysis. Results: AYAOC members identified similarities in their experiences of cancer care and priorities for improvement of the health care system. Peer connection and the creation of adolescent and young adult (AYA)-specific care facilities were identified as the most pressing needs for AYAs with cancer, closely followed by integration of complementary medicine into medical practice and government advocacy to improve the quality and consistency of AYA cancer care delivery. Themes identified from AYAOC discussion included emotional isolation, naivety with and sometimes distrust of the medical system, the lasting impact of cancer on identity, the need for emotionally safe interactions with both individual clinicians and groups of peers, and the desire to take personal action to improve care for future patients. Conclusion: AYAOC members expressed a drive to share their experiences, advocate for others, and improve health care services for the "next generation" of AYAs diagnosed with cancer. Sharing stories and connecting with peers may have personal value for individuals. Channeling the altruistic energy of AYAs and stakeholders into group advisory and advocacy efforts also has value for health care systems, allowing stakeholder insights to inform clinical service delivery and research priorities.

[Decision-making process and health management councils: theoretical approaches]. / Processo decisório e conselhos gestores de saúde: aproximações teóricas.

With the institutionalization of participation in health, through conferences and management councils at national, state, municipal and local levels, a process of democratization is initiated in the health area. However, in relation to the health councils in particular, there is still much to be done, including improving the quality of the decision-making process. This work aims to place the decision-making process in its theoretical context in terms of participatory democracy, elements which make up, factors which influence its development, and finally, to explore some possibilities of this theoretical basis to analyze the practices of the health councils in the area of health. It is hoped that it will make a theoretical contribution to the analyses carried out in this area, in order to provide a decision-making process that is more inclusive in terms of participation.

[Power relations and democracy in health councils in Brazil: a case study]. / Relaciones de poder y democracia en los consejos de salud en Brasil: estudio de un caso.

BACKGROUND: Social participation is fundamental for the consolidation of the Brazilian Health Reform, with the aim of promoting equity, universality and democratization of access to health, and the health councils are vital forums for its concretization. However, the authoritarian culture of our institutions makes effective participation in these organizations difficult. The objective of this work was to analyze the power relations which permeate the practices of a health council, seeking to understand discourse as a builder of participation in health. METHODS: A qualitative case study in a municipal health council in a Brazilian town. The discourse analysis was carried out on the minutes of two management terms, legal documents, interviews and observation during meetings. RESULTS: The quantitative presence of the user representatives does not correspond to the quality of their participation. The governmental sector uses most of the speaking turns, establishing monological relations, based on the a lack of symmetry determined by level of education, professional training, social status of the councilors and the relations of knowledge and power present in the health institutions. We identify resistances coming from the user sectors and the health professionals. However, these are scattered, fragile and not very important. CONCLUSIONS: The current practices that exist can, contrarily, go against democracy, for which is necessary to invest in the empowerment of councilors and users in the day-to-day reality of health care.

Implementing quality of programmes in three Swedish county councils: the views of politicians, managers and doctors.

This articles deals with quality assurance within the Swedish health care system at the regional and local levels. The overriding issue concerns the degree to which changes in Swedish health care in recent years with respect to increased freedom of choice for the individual, the purchaser-provider split and new forms of financial reimbursement have affected quality assurance. Special attention is directed toward the relationship between the political-administrative level in the county councils and the medical profession at the local level. Since political responsibility for health care is strongly decentralized and different organizational solutions can be found, Sweden offers a good opportunity for systematic comparisons within the health care sector. Following an overview of certain national initiatives with regard to the quality of health care, three Swedish county councils are compared. The aim is not to provide a general overview of the situation in Sweden with regard to quality assurance, but to compare the strategies and outcomes in county councils with different organizational configurations. The study is based on 35 interviews conducted in 1995 with health care politicians, health care administrators, hospital directors and clinical department heads. The article concludes that indirect incentives can be very strong factors in affecting care providers' active interest in quality assurance. This interest is aroused when providers feel they are in competition in that the number of patients decreases, or in that their activities are being called into question, such as in the form of discussions about possible structural changes in the county council.

[The limits of collective action in municipal health councils]. / Os limites da ação coletiva nos Conselhos Municipais de Saúde.

This article addresses the collective actions of participation in the municipal health councils. The underlying research sought to establish the performance of the councilors in the municipal health councils in the Metropolitan Region of Belém in the State of Pará. A survey of documents for the 2005-2010 period, structured interviews and observations with counselors in sessions of meetings of the boards of three counties were analyzed. An indicator of three levels of participation centered on the legal functions of the health councils and based on the theory of social groups as its analytical principle was constructed. The results indicate that the activities of the councils are marked by the co-option of councilors and the definition of deliberative agendas on the part of representatives of management, in which individual interests predominate over the collective interests of the councilors in the deliberations. The conclusion is that such behavior is contrary to the principles of the Unified Health System - SUS and weakens the social image of the councils, in addition to opening up a new analytical perspective.

Bogus neurosurgeon beats system hands down.

The Health Professions Council of South Africa (HPCSA)'s top management has ordered a probe of all foreign-qualified specialist registrations going back at least a decade, and instituted a 'double verification' mechanism for all future such applications following a dramatic system failure.

[The role of management councils of public policies: a debate on practices in the Municipal Councils of Chapecó, Santa Catarina State]. / O papel dos conselhos gestores de políticas públicas: um debate a partir das práticas em Conselhos Municipais de Chapecó (SC).

In this work we analyze the effectiveness of social control from a study of attributions of Municipal Councils of: social assistance, children and teenagers' rights, health and, education in Chapecó city. The data was collected by the reading of official documents, application of questionnaires, systematic observation and a meeting in which the focus group technique was used. Five categories of action were found: to deliberate, to supervise, to regulate, to give assistance, to communicate, and other less frequents actions. The analysis of information revels an overcharge of attributions of bureaucracy, restricting the political debate on the role of councilors. Besides this, we question the legitimacy of the conferred attributions, considering the objective conditions of its participation: the volunteer character, non-remunerated; the restrict time of the meetings the lack of qualified and self-made physical and operational structure, and others. The Management Councils are the spaces of citizenship practice, what requires a bigger actuation in creation and strength of dialogue processes with different social actors, establishing a connection in the partner net in favor of dealing with social problems of the city and the construction of favorable conditions for life.

Nuevas recomendaciones para el consejo anticonceptivo basadas en el estilo de vida. Resultados de un estudio Delphi / New lifestyle-based recommendations for contraceptive counseling. A Delphi study

Objetivo. Elaborar un listado de condiciones más allá de las condiciones médicas de la OMS que puedan ayudar en la toma de decisiones durante el proceso de asesoría anticonceptiva. Métodos. Estudio Delphi en el que 27 expertos contestaron a 24 preguntas planteadas por los coordinadores del estudio. Se requirió un nivel de consenso igual o superior al 50% del total de expertos consultados en cada una de las preguntas con respuesta de escala nominal formulada. Resultados. Tras el proceso Delphi se realizaron 20 recomendaciones sobre cuestiones relacionadas con el consejo anticonceptivo: condiciones médicas, época de la vida, estilo de vida, estado laboral, nivel académico, nivel económico, actividad sexual, métodos anticonceptivos y cumplimiento con el régimen anticonceptivo. Conclusiones. El consejo anticonceptivo debe de contemplar, además de las condiciones médicas, los aspectos relacionados con el estilo de vida de la mujer para mejorar la adherencia al método anticonceptivo más adecuado (AU)

Objective. To present a list of factors that go beyond the medical conditions established by the World Health Organization to assist decision-making during the process of contraceptive counseling. Methods. A Delphi study was carried out, in which 27 experts responded to 24 questions posed by the study coordinators. At least 50% agreement among the experts on a nominal scale was required in each of the questions. Results. After the Delphi process, 20 recommendations were made on issues related to contraceptive counseling: medical conditions, stage of life, lifestyle, employment status, educational level, economic status, sexual activity, contraceptive methods and contraceptive adherence. Conclusions. In addition to medical conditions, contraceptive counseling should include issues related to women's lifestyles in order to improve adherence to the most appropriate contraceptive method (AU)