Using Comprehensive Geriatric Assessment in Identifying Care Goals and Referral Services in a Frailty Intervention Clinic.

The proportion of older adults and frail adults in Canada is expected to rise significantly in upcoming years. Currently, a considerable number of older adults do not actively participate in developing their own care plans; prior research has indicated several benefits of patient engagement in this process. Thus, we conducted a mixed methods study that examined the prevalence of rehabilitation goals and identified these for 305 community dwelling older adults referred to a frailty intervention clinic utilizing Comprehensive Geriatric Assessment (CGA) between 2014 and 2018. Top patient concerns included mobility (84%), services, systems, and policies (51%), sensory functions and pain (50%), and self-care or domestic life (47%). The most common referrals or recommendations for patients included further follow-up with a physician or specialist (36%), referral to an onsite falls prevention clinic (31%), and medication modifications (31%). Based upon these findings, we recommend greater utilization of CGA within a team-based approach to improve patient care by allowing for greater collaboration and shared decision-making by health-care providers. Moreover, CGA can be an effective tool to meet the complex and unique health-care needs of frail patients while incorporating patient goals. This is vitally important considering the predicted growth in the population of frail and/or older patients, as well as the current challenges and shortfalls in meeting the health-care needs of this population.

Interdependence between health and peace: a call for a new paradigm.

Health and peace, and their relationships to disease/conflict/violence, are complex and multifaceted interrelated terms. Scholars have proposed a variety of definitions for health and peace. The conceptualizations of health and peace share many fundamental elements, including in their social, psychological (emotional and mental) and spiritual dimensions. We argue that health and peace are inter-dependent in a fundamental causal fashion. Health is always positively or negatively affected by conflict; peace can be directly or indirectly fostered through public health program and policy initiatives. Evidence shows that public health professionals and academics have frequently failed to recognize the inter-dependence of health and peace when conceptualizing, and addressing, issues related to health and peace. In contrast, the present article argues in support of a new paradigm for addressing public health issues related to health and peace; such a paradigm is based on the premise that health and peace are inextricably linked, requiring that they be addressed in an integrated, inter-dependent, fashion. Finally, we emphasize that fostering health and peace requires identifying and promoting positive socio-ecological influences on health, rather than limiting our focus to health deficits and obstacles at the individual or community levels.

Restraint-based three-dimensional modeling of genomes and genomic domains.

Chromosomes are large polymer molecules composed of nucleotides. In some species, such as humans, this polymer can sum up to meters long and still be properly folded within the nuclear space of few microns in size. The exact mechanisms of how the meters long DNA is folded into the nucleus, as well as how the regulatory machinery can access it, is to a large extend still a mystery. However, and thanks to newly developed molecular, genomic and computational approaches based on the Chromosome Conformation Capture (3C) technology, we are now obtaining insight on how genomes are spatially organized. Here we review a new family of computational approaches that aim at using 3C-based data to obtain spatial restraints for modeling genomes and genomic domains.

Providing information regarding exposures in pregnancy: a survey of North American Teratology Information Services.

PURPOSE: Teratology Information Services (TIS) provide information on exposures during pregnancy and breast-feeding. Maintaining ongoing funding is a challenge. The purpose was to gather descriptive information on current TIS operations. METHODS: All North American TIS (16 American, 2 Canadian) completed a detailed survey. RESULTS: Service goal ranked as most important was correction of risk misperceptions. Inquiries were primarily for medications (mean 43.5%, S.D. 14.1), lactation exposures, and workplace exposures. Median employees per TIS: three (range 1-12.5). Two TIS only counsel health care professionals (HCPs). Main callers to remaining TIS were pregnant women (mean 46.8%, S.D. 22.8), physicians, and nurses. Calls per week varied (median 20, range 4-600). Median annual budget: US dollars 69,000 (range dollars 3000-335,000). Seventeen TIS collect patient data for research. CONCLUSIONS: This survey was the first to document TIS operations in North America and demonstrates a spectrum of clinical and research activities, and provides data for a future cost-benefit analysis of TIS.

Evaluation in health promotion: principles and perspectives

Policy-makers, professionals of all kinds and the general public increasingly recognize social and economic factors as important determinants of health. Because health promotion approaches address these factors, they can play a valuable role in protecting and improving health. At the same time, funding sources demand evidence that initiatives give value for money. Health promotion initiatives need effective evaluation to realize their potential: both to prove their value as investments and to increase their effectiveness in achieving their aims. To help meet this need, the WHO European Working Group on Health Promotion Evaluation examined the current range of qualitative and quantitative evaluation methods to provide guidance to policy-makers and practitioners. This book is the result. It comprises an extensive compilation and discussion of the theory, methodologies and practice of evaluating health promotion initiatives in Europe and the Americas. The book takes three perspectives in examining the issues. It includes a retrospective examination of the evolution of health promotion evaluation. This provides the context for assessing and understanding the current state of evaluations of initiatives addressing settings, policies and systems for promoting health. Finally, the authors and the Working Group make many recommendations for improvement that provide a look into the future. This book shows how a health promotion approach offers a comprehensive framework for planning and implementing interventions that can effectively address today’s major health-related problems.