Food Insecurity and Childhood Obesity: A Systematic Review.

BACKGROUND AND OBJECTIVES: Addressing food insecurity while promoting healthy body weights among children is a major public health challenge. Our objective is to examine longitudinal associations between food insecurity and obesity in US children aged 1 to 19 years. METHODS: Sources for this research include PubMed, CINAHL, and Scopus databases (January 2000 to February 2022). We included English language studies that examined food insecurity as a predictor of obesity or increased weight gain. We excluded studies outside the United States and those that only considered the unadjusted relationship between food security and obesity. Characteristics extracted included study design, demographics, methods of food security assessment, and anthropometric outcomes. RESULTS: Literature searches identified 2272 articles; 13 met our inclusion criteria. Five studies investigated the relationship between food insecurity and obesity directly, whereas 12 examined its relationship with body mass index or body mass index z-score. Three studies assessed multiple outcomes. Overall, evidence of associations between food insecurity and obesity was mixed. There is evidence for possible associations between food insecurity and obesity or greater weight gain in early childhood, for girls, and for children experiencing food insecurity at multiple time points. Heterogeneity in study methods limited comparison across studies. CONCLUSIONS: Evidence is stronger for associations between food insecurity and obesity among specific subgroups than for children overall. Deeper understanding of the nuances of this relationship is critically needed to effectively intervene against childhood obesity.

Ethical Issues and the Electronic Health Record.

Ethical issues related to electronic health records (EHRs) confront health personnel. Electronic health records create conflict among several ethical principals. Electronic health records may represent beneficence because they are alleged to increase access to health care, improve the quality of care and health, and decrease costs. Research, however, has not consistently demonstrated access for disadvantaged persons, the accuracy of EHRs, their positive effects on productivity, nor decreased costs. Should beneficence be universally acknowledged, conflicts exist with other ethical principles. Autonomy is jeopardized when patients' health data are shared or linked without the patients' knowledge. Fidelity is breached by the exposure of thousands of patients' health data through mistakes or theft. Lack of confidence in the security of health data may induce patients to conceal sensitive information. As a consequence, their treatment may be compromised. Justice is breached when persons, because of their socioeconomic class or age, do not have equal access to health information resources and public health services. Health personnel, leaders, and policy makers should discuss the ethical implications of EHRs before the occurrence of conflicts among the ethical principles. Recommendations to guide health personnel, leaders, and policy makers are provided.

Decision making for health care managers and supervisors: theory into practice.

Health care managers and supervisors make decisions throughout the day. Often, they use the common steps of decision making. This article describes common decision theories that underpin the steps. The article includes specific examples of applications of the theories and a glossary of terms. Experienced and novice health care managers and supervisors can improve their decision making by matching concepts from the decision theories to their problems.

Environmental scanning: allied health leaders' selection of strategic information.

In environmental scanning, deans and directors of allied health units face the task of making sense of volumes of information from their internal and external environments. A study was conducted to detail the information processing of 108 allied health deans and directors of institutional members of the Association of Schools of Allied Health Professions. The study was a survey that included basic demographic questions and two scenarios, each representing a strategic situation. Respondents (n = 56, 52%) rated their general perceptions of the two strategic situations and their projected use of eight types of information cues to clarify the situations. Results indicated that deans and directors had high use of all types of information cues in both strategic situations. The results for the strategic situation based on a scenario about program closure showed that use of negative information cues was associated with proportionally greater use of internal, external, and formal information cues (Pearson correlation coefficients r = 0.72, 0.80, and 0.77, respectively, all with p < 0.005). Some differences were found in types of information used by respondents in academic health centers versus non-academic health centers. The results of this study provide insights on how allied health deans and directors process information in environmental scanning.

Human experimentation: historical perspective of breaches of ethics in US health care.

Health care supervisors and managers may participate in ethical discussions and serve on ethics committees in their health care organizations. To aid them in their participation and service, this article expands upon the knowledge of ethics that they obtained in their academic training. The article provides readers with a common language based on frequently cited cases and key documents. The article traces a brief history of human experimentation, describes ethical breaches in the United States, and summarizes key documents guiding current thought on informed and voluntary consent. The article concludes with 3 common misconceptions that health care supervisors and managers will want to avoid in ethical discussions and ethical decision making. Health care supervisors and managers will be prepared to meaningfully contribute to the discussion of ethical issues and to the resolution of ethical problems in their health care organizations.

Ethical issues and the electronic health record.

Ethical issues related to electronic health records (EHRs) confront health personnel. Electronic health records create conflict among several ethical principals. Electronic health records may represent beneficence because they are alleged to increase access to health care, improve the quality of care and health, and decrease costs. Research, however, has not consistently demonstrated access for disadvantaged persons, the accuracy of EHRs, their positive effects on productivity, nor decreased costs. Should beneficence be universally acknowledged, conflicts exist with other ethical principles. Autonomy is jeopardized when patients' health data are shared or linked without the patients' knowledge. Fidelity is breached by the exposure of thousands of patients' health data through mistakes or theft. Lack of confidence in the security of health data may induce patients to conceal sensitive information. As a consequence, their treatment may be compromised. Justice is breached when persons, because of their socioeconomic class or age, do not have equal access to health information resources and public health services. Health personnel, leaders, and policy makers should discuss the ethical implications of EHRs before the occurrence of conflicts among the ethical principles. Recommendations to guide health personnel, leaders, and policy makers are provided.

Utilization of information technology in eastern North Carolina physician practices: determining the existence of a digital divide.

The United States Department of Health and Human Services (DHHS) has emphasized the importance of utilizing health information technologies, thus making the availability of electronic resources critical for physicians across the country. However, few empirical assessments exist regarding the current status of computerization and utilization of electronic resources in physician offices and physicians' perceptions of the advantages and disadvantages of computerization. Through a survey of physicians' utilization and perceptions of health information technology, this study found that a "digital divide" existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet.

Job redesign and the health care manager.

Health care supervisors and managers are often asked to redesign jobs in their departments. Frequently, little information accompanies the directive. This article lists sources of change in work and defines key terms. Also reviewed are factors that supervisors and managers can weigh in their redesigns. The article suggests actions aligned to common problems in the work environment. Finally, guidelines for a practical, step-by-step approach are provided. For health care supervisors and managers, the key to a successful job redesign is to achieve the unique balance of factors that matches the situation.

Coping with a turbulent health care environment: an integrative literature review.

Health care employers of allied health personnel and the academic programs producing these professionals have had to cope with an environment of major changes and ongoing turbulence. To better understand the descriptions of and research on the health care environment in relation to strategic typologies, an integrative literature review was conducted. Drawing from multiple disciplines, the information presented offers potential models and approaches to assess and respond to a turbulent health care environment for both schools of allied health and allied health practice sites. The integrative literature review revealed that innovation can enhance profitability if not pursued with fragmentation of an organization's core identity. Prospector and analyzer approaches appear to offer greater viability in a turbulent health care environment than reactor or defender types. Differentiation of services can be pursued to produce a unique reputation for a health care organization.

Environmental scanning and the health care manager.

Health care managers and supervisors work in an environment of major changes and ongoing turbulence. Basic terms and strategic approaches are described to enable managers and supervisors to better understand the process of environmental scanning in the turbulent health care environment. Drawing from multiple disciplines, the information allows health care managers and supervisors to improve their skills as environmental scanners as they develop and implement strategic plans in this environment.

Using a multipronged approach to implement organizational performance improvements.

Efforts to improve organizational performance sometimes fail. One way to increase the likelihood of a successful implementation is to adopt a multipronged approach. This article describes a multipronged approach for change management and performance improvement. The approach combines a systems implementation process with sensitivity to the human side of change. Tactics to defuse resistance are also discussed. The approach assists leaders assigned to coordinate performance improvements.

Approaches to leadership development used by deans of allied health.

Deans and directors of allied health units in member institutions of the Association of Schools of Allied Health Professions (ASAHP) were surveyed to determine their approaches to leadership development. Of 99 deans and directors surveyed, 75 (76%) responded. All respondents had held at least one academic administrative position before their current position; assistant or associate dean were the most common positions. The respondents' leadership development included participation in service to the ASAHP or another health or allied health association. More female respondents (67%) than male respondents (47%) reported being mentored. Most frequently listed programs, workshops, and activities for leadership development were Harvard University's Management Development Program, regional allied health deans groups, and institutional leadership programs. Of respondents, 60% viewed professional experience as being more beneficial in leadership development than formal programs, workshops, and activities. The most important skills directly developed from such activities were strategic planning and forecasting, having a vision, and team or collaboration building.

An investigation of telephone use among cochlear implant recipients.

The purpose of this study was to examine telephone use among cochlear implant recipients. A questionnaire was constructed and mailed to 803 adults who received a Clarion cochlear implant system manufactured by Advanced Bionics Corporation. Questionnaire recipients were implanted at least 12 months prior to receiving the questionnaire (i.e., they were implanted in 1998 or 1999). Approximately 60% (n = 478) responded, of whom 70% (n = 336) were considered "telephone users" (i.e., they answered the telephone and/or initiated calls). Telephone users were significantly younger and had significantly more daily hours of cochlear implant use than nonusers. Not surprisingly, there were differences between groups with respect to method of communication (i.e., more users employed oral communication, while more nonusers employed both oral and manual communication) and ability to understand words without lipreading (i.e., more users were able to understand). Thirty-seven percent of the telephone users were male, and 63% were female. The average age was 51.8 years (SD = 15.5). Ninety-five percent of users initiated calls to family and friends, 65% made appointments by phone, and approximately 50% asked for information about a product or service and conducted business over the phone. Over 95% of users could identify a dial tone, a busy signal, and voices. The average telephone use per week was 5.4 hr. Approximately 85% indicated that they were able to interact with strangers on the telephone within 5 months of receiving the sound processor. Approximately 30% communicated via a cellular phone for personal use. The findings of this survey suggest an increase in cochlear implant users' telephone use relative to a decade earlier. Advances in cochlear implant and telephone technologies are 2 of several factors that may contribute to the changes observed.

Health informatics: ethical issues.

Ethics is a component of the education of health care mangers and supervisors. Recent advances in the technologies of health informatics present these leader with new ethical challenges. Holding the promise of beneficence, these technologies are purported to increase access, improve quality, and decrease the costs of care. Aspects of these technologies, however, create conflicts with the ethical principles of autonomy, fidelity, and justice. Infoethics is suggested as a means to examine these conflicts. A multipronged solution that incorporates adherence to regulations and standards, promotion of codes of conduct and ethics, and creation of a culture of infoethics is recommended.

Filling the position of lead administrator in schools of allied health: the experience of search committees.

This study was conducted as the second phase of a larger study assessing leadership development in schools or units of member institutions of the Association of Schools of Allied Health Professions. A survey was mailed to the chairs of 21 search committees for the position of lead administrator (i.e., dean or director) of an allied health school or unit; 20 (95%) responded. Of the respondents, 55% reported that filling the dean/director position was very easy (15%) or moderately easy (40%). The mean number of viable candidates was 11.7, and the mean time to recruit a new dean/director was 6.9 months. Most (65%) new deans/directors had backgrounds in the health professions, with the greatest number being nursing (n = 3). The greatest proportion (30%) were assistant/associate deans before becoming dean/director. The actual experiences of search committees in this study showed a relatively adequate pool of applicants for dean/director of allied health positions.