Income and health in Canada: Canadian researchers' conceptualizations make policy change unlikely.

The research reported here identified and evaluated gaps in Canadian knowledge and research activity concerning the role of income and its distribution in influencing health outcomes. The study consisted of an analysis of 241 recent Canadian research studies, the components of which were compared with 40 U.K. and 40 Finnish studies that applied advanced conceptualizations of the income-health relationship. Canadian health researchers rarely made explicit their conceptualizations of how income was approached in their studies, and most did not identify the structural mechanisms that mediate the income-health relationship. There were few Canadian longitudinal studies capable of illuminating the role of income in health across the lifespan. Many Canadian studies identified pathways by which income might influence health, but these conceptualizations were underdeveloped. Canadian researchers need to strengthen their conceptualizations of how income and its distribution affect health. While empirical research is only one contributor to positive policy change, the narrow nature of Canadian work will do little to influence this process. Interdisciplinary work on the political, economic, and social forces that contribute to income inequalities has the potential, when combined with political and social action, to facilitate public policy in support of health.

Goblet cell mimickers in esophageal biopsies are not associated with an increased risk for dysplasia.

CONTEXT: Identification of intestinal-type goblet cells (ITGCs) in hematoxylin-eosin-stained sections of esophageal biopsies is essential for the diagnosis of Barrett metaplasia. However, we have seen cases diagnosed as Barrett metaplasia based solely on cells that pose morphologic similarity to ITGCs on hematoxylin-eosin staining or stain positive with Alcian blue. OBJECTIVE: To determine the clinical significance of goblet cell mimickers. DESIGN: Initial biopsies from 78 patients with original diagnosis of Barrett metaplasia negative for dysplasia and a mean follow-up of 72 months were reviewed and reclassified into 3 categories: (1) ITGCs, (2) goblet cell mimickers, or (3) neither. Sections from available paraffin blocks were stained with Alcian blue at pH 2.5. The presence of the different types of cells and positive Alcian blue staining were correlated with each other and evaluated for their significance as predictors of progression to dysplasia. RESULTS: Goblet cell mimickers were present in 35 cases and were associated with ITGCs in the same biopsy in 23 (66%) of these cases. Intestinal-type goblet cells were present in 56 cases, and the remaining 10 cases, although called Barrett on the original report, did not show either ITGCs or goblet cell mimickers. Only the presence of ITGCs was associated with significant risk for dysplasia (P = .008). Positive Alcian blue staining was not associated with a significant risk for dysplasia. CONCLUSIONS: Our results indicate that the diagnosis of Barrett metaplasia should be rendered with confidence only when ITGCs are identified on routine hematoxylin-eosin-stained sections.

Income and health in Canada: research gaps and future opportunities.

BACKGROUND: The goal of this research project was to identify and suggest means of filling the gaps/needs in Canadian research activity and public policy action on the income and health relationship. METHODS: The research consisted of an environmental scan and analysis of 321 empirical research pieces from Canada (n = 241), the United Kingdom (n = 40) and Finland (n = 40) followed by a systematic gaps/needs analysis of these studies by members of three advisory committees, consisting of researchers and policy advocates. These data were complemented by key informant interviews with researchers from Canada, the UK and Finland. The gaps/needs were then reviewed and assigned priority rankings by members of the three advisory committees. FINDINGS: Numerous gaps/needs in Canadian research on income and health were apparent. They fell into five main areas: (a) training and capacity building in addressing income as a health determinant; (b) developing adequate data and measures; (c) researching specific substantive health issues; (d) researching specific public policy areas; and (e) developing an understanding of the pathways and mechanisms mediating the income and health relationship. Members of the advisory committees achieved a high level of agreement concerning these gaps/needs and means of reducing them. CONCLUSIONS: The Canadian Institutes of Health Research (CIHR) and the Institute of Population Health should target specific research initiatives to help fill the identified gaps in knowledge. They should also work together with public policy institutes to synthesize findings concerning income, its distribution, and health, and help distribute these findings to the public in general and policy-makers in particular.

Researching income and income distribution as determinants of health in Canada: gaps between theoretical knowledge, research practice, and policy implementation.

The research identified gaps in Canadian knowledge and research activity concerning the roles that income and its distribution play in Canadians' population health. 241 Canadian research studies on income and health were considered along eight taxonomies: conceptualization of income or its proxies; theoretical underpinnings; income distribution measures; health measures; who/what was studied, pathways mediating between income and health; complexity of these pathways; research design; and presence of policy implications. The study identified the following areas of weakness: (a) poor conceptualization of income and the means by which it influences health; (b) lack of longitudinal studies of the impact of income-related issues upon health across the life-span; (c) lack of linked data bases that allow complex analyses of how income and related issues contribute to health and well-being, and (d) little inter-disciplinary work in identifying pathways mediating the income and health relationship. Advances in health policy to address the health effects of income and its distribution requires a research infrastructure that draws upon recent theoretical developments in the area and is able to access data sources to test these advanced conceptualizations.