Development and Validation of the Food-Craving Inventory

Objective: The primary aim of this study was to develop and validate the Food-Craving Inventory (FCI), a self-report measure of specific food cravings. Research Methods and Procedures: In a preliminary study, participants (n = 474) completed the initial version of the FCI. The results from this study were used in developing the revised FCI. Participants (n = 379) completed the revised FCI in the primary study designed to develop a self-report measure of specific food cravings. Results: Common factor analysis yielded four conceptual factors (subscales) that were interpreted as high fats, sweets, carbohydrates/starches, and fast-food fats. Confirmatory factor analysis found that the four factors could be modeled as dimensions (or first-order factors) of a higher order construct—food craving. Test–retest and internal consistency analyses indicated good reliability for the total score and each of the subscales. Subscale scores were compared with scores on the Three Factor Eating Questionnaire and a conceptual measure of food craving. We found support for the content, concurrent, construct, and discriminant validity of the FCI. Discussion: The FCI was found to be a reliable and valid measure of general and specific food cravings. The FCI can be used in research related to overeating and binge eating. Also, it may be useful in treatment studies that target obesity and/or food cravings.     

乳酸菌在疾病防治和人体保健中的应用研究进展

肠道微生物在人体健康方面起着重要的作用,良好的肠道微生态环境是维持人体健康的重要因素,随着对肠道微生物越来越多的关注和研究,人们发现益生菌在肠道菌群和宿主健康之间有着复杂的关系。大量的研究发现,乳酸菌作为益生菌在人体肠道微生态平衡、疾病防治和保健中起着至关重要的作用。综述了乳酸菌对人体微生态环境的益生功能,并对乳酸菌和人体微生态环境之间的相互影响和关系,以及乳酸菌对一些常见人体疾病的预防和治疗作用的研究进展。     

芸豆功效成分的提取及活性研究进展

芸豆营养丰富,其中维生素、矿物质元素和氨基酸比较全面。目前芸豆作为普通食品供人们食用,其多种功效还未能充分认识与应用。通过对近年来芸豆活性成分的提取与功能的研究进行综述,以期为芸豆作为保健食品新资源的开发和应用提供依据。     

Development of Health Equity Indicators in Primary Health Care Organizations Using a Modified Delphi

Objective

The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations'' capacity and strategies for enhancing equity-oriented care.

Methods

Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff (n = 114) using procedures for qualitatively derived data. We used a modified Delphi process where the indicators were circulated to staff at the Health Centers who served as participants (n = 63) over two rounds. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1–9, where a higher score meant more importance.

Results

Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0) in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. In order to achieve health care equity, performance at the organizational level is as important as assessing the performance of staff. Two of the highest rated “treatment” or processes of care indicators reflects the need for culturally safe and trauma and violence-informed care. There are four indicators that can be used to measure outcomes which can be directly attributable to equity responsive primary health care.

Discussion

These indicators and subsequent development of items can be used to measure equity in the domains of treatment and outcomes. These areas represent targets for higher performance in relation to equity for organizations (e.g., funding allocations to ongoing training in equity-oriented care provision) and providers (e.g., reflexive practice, skill in working with the health effects of trauma).     

Health Literacy and Patient Empowerment: Separating Con-joined Twins in the Context of Chronic Low Back Pain

ObjectivesWhile health literacy has been widely considered key to patient empowerment, an alternative approach separates both concepts and distinguishes between dif-ferent types of patients according to their levels of health literacy and empowerment. These types are deemed to vary in their health-related actions and outcomes. In this study, we exam-ine the relationship between health literacy and patient empowerment and compare socio-demographic characteristics, health-related activities, and health outcomes in four types of pa-tients suffering from chronic low back pain (cLBP).MethodsIn a cross-sectional study, 273 cLBP patients from four Swiss can-tons (Vaud, Geneva, Fribourg, Ticino) and Lombardy (Italy) were invited by their healthcare providers to complete a self-administered paper-and-pencil questionnaire which assessed pa-tients’ health literacy, empowerment, involvement in the medical encounter, medication non-adherence, and perceived pain and functionality as a measure of health outcomes.ResultsHealth literacy and patient empowerment were not significantly correlated with each other, r(271) = .09, p > .05, allowing to differentiate be-tween four types of patients based on their levels of health literacy and patient empowerment. Subsequent chi-square tests and analyses of variances revealed significant differences among patients that could, however, only be attributed to health literacy, as in the case of age and ed-ucational attainment, or patient empowerment, as in the case of patients’ involvement in the medical encounter. No significant differences were evident for gender, medication non-adherence, and health outcomes.ConclusionThe study provides empirical evidence for the need to consider health literacy and patient empowerment as independent concepts in the context of cLBP but calls for further studies to be able to conclude on how the two concepts interact and determine health-related activities and outcomes.     

Psychometric Validation of the Japanese Version of the Neuropathic Pain Symptom Inventory

Objective

This study aimed to evaluate the validity and reliability of the Japanese version of the Neuropathic Pain Symptom Inventory (NPSI-J).

Design

Cross-sectional study design.

Subjects and Methods

The original Neuropathic Pain Symptom Inventory (NPSI) was translated into Japanese according to published guidelines. Subsequently, an observational study of 60 Japanese patients suffering from neuropathic pain was performed to evaluate the validity and reliability of the NPSI-J.

Results

The NPSI-J exhibited a statistically significant correlation with pain intensity (Numerical Rating Scale). The Cronbach alpha value for Likert items was 0.86. Using the test–retest analysis method, the intraclass correlation coefficient between the two scores was 0.81. Factor analysis revealed that the main component of NPSI-J comprised three determinative factors.

Conclusions

The NPSI-J is a reliable and valid pain assessment tool.     

枸杞的健康保健功用和合理开发利用

对枸杞的植物形态及地理分布、化学成分及药理作用、药用功效及保健食品,以及综合利用方面进行了概述,为枸杞资源的合理开发和综合利用提供参考。     

Development of Indicators for Patient Care and Monitoring Standards for Secondary Health Care Services of Mumbai

Background

The Qualitative aspect of health care delivery is one of the major factors in reducing morbidity and mortality in a health care setup. The expanding suburban secondary health care delivery facilities of the Municipal Corporation of Greater Mumbai are an important part of the healthcare backbone of Mumbai and therefore the quality of care delivered here needed standardization.

Material and Methods

The project was completed over a period of one year from Jan to Dec, 2013 and implemented in three phases. The framework with components and sub-components were developed and formats for data collection were standardized. The benchmarks were based on past performance in the same hospital and probability was used for development of normal range. An Excel spreadsheet was developed to facilitate data analysis.

Results

The indicators comprise of 3 components - Statutory Requirements, Patient care & Cure and Administrative efficiency. The measurements made, pointed to the broad areas needing attention.

Conclusion

The Indicators for patient care and monitoring standards can be used as a self assessment tool for health care setups for standardization and improvement of delivery of health care services.     

Advances in the Clinical Care of Burned Patients

Very few areas of medical science have experienced more rapid development of new and beneficial treatment approaches during the past two decades than the disciplines required for total care of patients with major thermal injury. The introduction of a multidisciplinary scientific approach to the diagnosis and treatment of very complex postburn complications has been primarily responsible for the major advances in clinical care. This report highlights those areas of advancement which have been most significant in upgrading current inpatient therapy.     

The Ethical Self-Fashioning of Physicians and Health Care Systems in Culturally Appropriate Health Care

Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is “culturally competent.” We explore the diverse methods that cultural competence trainings use to foster a health care provider’s ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.     

Baksbat (Broken Courage): The Development and Validation of the Inventory to Measure Baksbat, a Cambodian Trauma-based Cultural Syndrome of Distress

This article outlines the development and validation of an inventory measuring a Cambodian cultural syndrome of distress called ??baksbat?? (broken courage). The inventory development phase involved ethnographic interviews with a preliminary group of 53 experts having knowledge or experience of baksbat. The initial ethnographically derived inventory with 32 items was developed and administered to a second group of 390 consecutive patients to assess factor loadings. The validation phase used confirmatory factor analysis (CFA) to test goodness-of-fit of four hypothesized factor models of the newly developed inventory in a third group of 159 participants. CFA confirms three-factor models that have the best goodness-of-fit, thus a 24-item baksbat inventory clustering of three-symptom categories was developed. Multiple regression, which assesses the relationship between the dependent variable (PTSD) and a subcluster of baksbat inventory (predictors), shows baksbat inventory accounts for 47?% of the total variance of symptoms in PTSD (R ²?=?.47). Of the three-symptom clusters, ??psychological distress?? shows significant contribution to the total variance of symptoms in PTSD (???=?.63, p?<?.001). Of significance, some symptoms of baksbat were independent from symptoms of PTSD with isolated symptoms that are culturally specific. These preliminary findings suggest that baksbat could be a potential Cambodian trauma-based syndrome with its own culturally validated inventory.     

Freedom of Conscience in Health Care: Distinctions and Limits

The widespread emergence of innumerable technologies within health care has complicated the choices facing caregivers and their patients. The escalation of knowledge and technical innovation has been accompanied by an erosion of moral and ethical consensus among health providers that is reflected in the abandonment of the Hippocratic Oath as the immutable bedrock of medical ethics. Ethical conflicts arise when the values of health professionals collide with the expressed wishes of patients or the dictates of regulatory bodies and administrators. Increasing attempts by groups outside of the medical profession to limit freedom of conscience for health providers has raised concern and consternation among some health professionals. The personal and professional impact of health professionals surrendering freedom of conscience and participating in actions they deem malevolent or unethical has not been adequately studied and may not be inconsequential when considering the recognized impact of other circumstances of coerced complicity. We argue that the distinction between the two ways that freedom of conscience is exercised (avoiding a perceived evil and seeking a perceived good) provides a rational basis for a principled limitation of this fundamental freedom.     

Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa

Background

High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions.

Methods and Findings

Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries.

Conclusions

As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement.     

American Indian Health: Innovations in Health Care, Promotion, and Policy

American Indian Health: Innovations in Health Care, Promotion, and Policy. Everett R. Rhoades. M.D., ed. Baltimore: Johns Hopkins University Press, 2000. xxiii. 459 pp.