Moving beyond Table 1: A critical review of the literature addressing social determinants of health in chronic condition symptom cluster research

Variability in the symptom experience in patients diagnosed with chronic conditions may be related to social determinants of health (SDoH). The purpose of this critical review was to (1) summarize the existing literature on SDoH and symptom clusters (i.e., multiple, co-occurring symptoms) in patients diagnosed with common chronic conditions, (2) evaluate current variables and measures used to represent SDoH, (3) identify gaps in the evidence base, and (4) provide recommendations for the incorporation of SDoH into future symptom cluster research. We identified 118 articles including information on SDoH in chronic condition symptom cluster research. Articles primarily focused on cancer populations. Few articles had the explicit purpose of investigating relationships between SDoH and symptom clusters, and the inclusion of SDoH was often limited to variables used to describe samples. Future studies should be designed to “move beyond Table 1” in their utilization of SDoH as variables and examine relationships between SDoH and symptom clusters. Attention should be paid to the appropriateness of measures being used to collect information on SDoH, and analysis methods that estimate causal connections between variables should be considered. Research regarding the relationship of SDoH with symptom clusters in patients with chronic conditions has the potential to reveal mechanisms of symptom disparities and guide changes to alleviate these disparities.     

The risk of falling in young adults with neurological conditions: a systematic review

Abstract

Purpose: To review systematically the literature on fall risk factors for young patients affected by neurological disorders. Method: A systematic search of all primary research-based literature on risk factors for falls or fall characteristics in young adults (mean age <55 years) published prior to July 2012 was conducted using 11 databases. Studies that focused on fall risk screening tools, fear of falling or interventions for fall prevention were excluded. Two reviewers independently agreed on eligibility and methodological quality and extracted data. Results: Twenty-three final studies were selected, including 21 observational studies; one randomised controlled trial and one qualitative study. An average of 50.2% of the 2776 total participants experienced at least one fall. Among the multiple risk factors studied, a reduced performance in balance and gait was consistently associated with falls, while the contribution of single physical and cognitive impairments was variable in different populations. Walking aids, wheelchair characteristics and environmental hazards are significant environmental risk factors. The heterogeneity of the assessment tools used to measure risk factors limited comparison across studies. Conclusion: Falling is a common problem among young patients affected by neurological disorders, although the risk of falling for a specific individual is difficult to predict and the risk of a severe fall-related injury has not yet been established.

• Implications for Rehabilitation

• Young patients with impaired gait and balance or medium to severe motor disability appear to be at increased risk of falling.

• Patients who are relatively independent and still participating in challenging activities have an increased exposure to fall-risk.

• Walking aids, wheelchair characteristics and environmental hazards are significant environmental risk factors.

• These risk factors should be monitored closely in the young neurological population to help prevent falls.

     

Integrative review of the social determinants of health in older adults with multimorbidity

Aim

To examine how the social determinants of health have been considered in conceptualizations of multimorbidity in older adults in the literature and to identify implications for nursing practice, research and healthcare planning and policy.

Background

The common conceptualization of multimorbidity is the presence of multiple chronic conditions where one is not more central than others.

Design

The integrative review methodology of Whittemore and Knafl was employed. The World Health Organization Social Determinants of Health framework was used to determine how the social determinants of health have been considered in conceptualizations of multimorbidity.

Data sources

A search of electronic databases (2000–2015) generated 22 relevant articles, including quantitative and qualitative studies and grey literature reports.

Review methods

A systematic process was used to appraise the quality of the documents, conduct qualitative data analysis procedures of data extraction, coding and theme development, and synthesize conclusions.

Results

Current conceptualizations of multimorbidity provide limited consideration of the complex interplay of multimorbidity with the broader social determinants of health. Gender, education, behaviours and the health system were the most commonly cited determinants. Ethnicity, socioeconomic status/social class and material circumstances received little attention. Most of the dimensions of socioeconomic political context were not discussed.

Conclusion

The predominant conceptualization of multimorbidity focuses on the biomedical dimensions of multimorbidity. Consequently, nursing practice, research and policy informed by this literature could inadvertently sustain the mismatch between the needs of older adults with multimorbidity and the services they receive. Future research to inform a new conceptualization is necessary.     

电竞活动对青少年健康和功能的影响及康复干预的系统综述

目的 基于《国际功能、残疾和健康分类》(ICF),探究电竞活动对青少年的健康影响,并对健康状况和功能、干预策略和康复结局进行系统综述。方法 运用ICF对青少年从事电竞活动的身心健康和功能影响进行系统分析。采用关键词和主题检索的方式,在中国知网、维普、万方数据库、PubMed、Web of Science、EBSCO等数据库检索电竞活动、健康状况、功能、功能康复(干预)和康复结局的相关文献,检索时间为建库至2022年2月。对纳入文献进行筛选、质量评价和综述,采用ICF架构和WHO-FICs编码分析从事电竞活动的健康状况和相关的功能、干预策略以及康复(健康状况和功能)结局。结果与结论 最终纳入文献8篇,来自6个国家,主要涉及临床医学、康复科学、运动康复、运动心理学和康复心理学等研究领域,其发表日期主要集中在2015年之后,物理治疗证据数据库(PEDro)量表平均分为6.88分。根据ICF分类,青少年从事电竞活动面临的主要健康问题涉及身体层面、个体层面和环境层面。身体层面包括精神功能、感觉功能和疼痛、神经肌肉骨骼和运动有关的功能,常见的有认知障碍、情绪障碍、疲劳、睡眠障碍、抑郁和焦虑、肥胖症...     

The DASH model: Data for addressing social determinants of health in local health departments

Recent frameworks, models, and reports highlight the critical need to address social determinants of health for achieving health equity in the United States and around the globe. In the United States, data play an important role in better understanding community-level and population-level disparities particularly for local health departments. However, data-driven decision-making—the use of data for public health activities such as program implementation, policy development, and resource allocation—is often presented theoretically or through case studies in the literature. We sought to develop a preliminary model that identifies the factors that contribute to data-driven decision-making in US local health departments and describe relationships between them. Guided by implementation science literature, we examined organizational-level capacity and individual-level factors contributing to using data for decision-making related to social determinants of health and the reduction of county-level disparities. This model has the potential to improve implementation of public health interventions and programs aimed at upstream structural factors, by elucidating the factors critical to incorporating data in decision-making.     

Microcredit and the social determinants of health: a conceptual approach

Social determinants of health, such as human behavior, environment, and socioeconomics, contribute to health disparities at the individual and population levels. The association between socioeconomics and health is established, and it is acknowledged that people with a lower socioeconomic status experience poorer health. The impetus of microcredit programs is to provide financial alternatives for low-income populations, the majority of whom are women with limited or no access to traditional lending, to start small businesses, generate income, and progress toward self-sufficiency. The income-health link within the context of microcredit has been internationally acknowledged; however, there is scarce research in this area in the United States. This article presents a review of the conceptual approach used to explore the microcredit and health link from a public health nursing perspective. Establishing conceptual foundations can enhance research focused on targeted interventions aimed at lasting change in social and health status. Exploring the link between microcredit and health can enrich research efforts and may offer innovative strategies and interventions to improve health-promoting capacity in impoverished groups.     

Motivation for health behaviours: a systematic review of the nursing literature

AIMS AND RATIONALE: This research review examines nursing and allied health studies exploring motivation for health behaviours to identify the state of understanding of this construct within nursing. This review contributes to nursing science by synthesizing nursing research regarding motivation for health behaviour. METHODS: Integrative research review methodology. FINDINGS: Problems of existing research include nonprobability sampling of heterogeneous populations, low statistical power, and colinearity. Studies identifying predictors of motivation explained large proportions of variance using regression. Motivation was not a significant predictor of health behaviours for over one-third of the studies. Overall, the studies suggest that either motivation is not being effectively measured because of a lack of conceptual clarity or that motivation is not an essential determinant of health behaviours. The latter cannot be verified until psychometric research advances current measurement of motivation to a higher level. LIMITATIONS; The literature for this review was accessed through the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database. Databases for other disciplines were not included in this search. This work represents a first step towards understanding motivation for health behaviour as it is currently defined in the literature. Future studies are necessary to broaden this understanding beyond nursing. CONCLUSIONS: Motivation is a frequently cited rationale underlying the adoption and maintenance of health behaviours in research and practice. Motivation is complex and multidimensional, and clearer definitions for motivation are needed. Populations that have been underrepresented in motivation research need to be targeted in future research. Researchers and practitioners are challenged to examine carefully the role of motivation for health behaviours and explore other factors that may more strongly influence health behaviours.     

Assessing the relationships between nurse working conditions and patient outcomes: systematic literature review

bae s.-h . (2011) Journal of Nursing Management 19, 700–713
Assessing the relationships between nurse working conditions and patient outcomes: systematic literature review Aim The purpose of the study was to systematically evaluate nurse working conditions and to review the literature dealing with their association with patient outcomes. Background Improving nurse working conditions is essential to address nursing shortages. Although general reviews of the literature support the positive link between working conditions and patient outcomes, definitive evidence has been lacking. Evaluation A search of six electronic bibliographic databases was conducted for the primary research published in English, from January 2000 to October 2009. Key issues The concepts of working conditions were categorized into 10 groups of working conditions. A total of 69 relationships between working conditions and patient outcomes were examined. Conclusions Increased attention has been drawn to nurse working conditions resulting from nursing shortages. The findings of this review suggested that the evidence supporting positive relationships between working conditions and patient outcomes is inconclusive. Further studies of a longitudinal and interventional nature in various settings are needed to advance knowledge of the complex contextual and multivariate influences among nurse working conditions and patient outcomes. Implications for nursing management Efforts to improve working conditions should be made in various health-care work settings to ensure patient safety and improve patient quality of outcomes.     

The British research evidence for recovery, papers published between 2006 and 2009 (inclusive). Part One: a review of the peer-reviewed literature using a systematic approach

This paper is the first in a series of two which reviews the contemporary British evidence-base relating to recovery in mental health over a 4-year period. This review uses a systematic approach analysing the British peer-reviewed literature relating to recovery and mental health. The second paper in the series reviews the non-peer-reviewed literature. Recovery is not a new concept; however, it has recently become increasingly prevalent in practitioner, policy and research discourses. In total 12 papers met the inclusion criteria. Five main themes emerged from the analysis: hope and optimism, meaning to life, activities promoting recovery, definitions and discourses and implications for mental health practice. By including only peer-reviewed literature this paper is in a strong position to analyse the theoretical development of the recovery concept and highlight future directions for recovery in mental health services.     

Individual determinants of research utilization: a systematic review

CONTEXT: In order to design interventions that increase research use in nursing, it is necessary to have an understanding of what influences research use. OBJECTIVE: To report findings on a systematic review of studies that examine individual characteristics of nurses and how they influence the utilization of research. SEARCH STRATEGY: A survey of published articles in English that examine the influence of individual factors on the research utilization behaviour of nurses, without restriction of the study design, from selected computerized databases and hand searches. INCLUSION CRITERIA: Articles had to measure one or more individual determinants of research utilization, measure the dependent variable (research utilization), and evaluate the relationship between the dependent and independent variables. The studies also had to indicate the direction of the relationship between the independent and dependent variables, report a P-value and the statistic used, and indicate the magnitude of the relationship. RESULTS: Six categories of potential individual determinants were identified: beliefs and attitudes, involvement in research activities, information seeking, professional characteristics, education and other socio-economic factors. Research design, sampling, measurement, and statistical analysis were examined to evaluate methodological quality. Methodological problems surfaced in all of the studies and, apart from attitude to research, there was little to suggest that any potential individual determinant influences research use. CONCLUSION: Important conceptual and measurement issues with regard to research utilization could be better addressed if research in the area were undertaken longitudinally by multi-disciplinary teams of researchers.     

Life story work in health and social care: systematic literature review

AIM: The aim of this paper is to review the literature on life story work in health and social care practice. BACKGROUND: Life story work as an intervention has been used with a number of health and social care clients, such as children people with learning disabilities, older people on medical wards and with older people who have dementia. It may help challenge ageist attitudes and assumptions, be used as a basis for individualized care, improve assessment, assist in transitions between different care environments, and help to develop improved relationships between care staff and family carers. However, to date there has been no attempt to collate the findings from published accounts. METHODS: A systematic search of the literature on life story work was conducted in February 2004, using nursing, medical and social science databases and a combination of thesaurus and free text search terms. This revealed over 1000 publications; the use of carefully constructed inclusion and exclusion criteria identified 51 relevant items. Fourteen were subsequently selected and reviewed using a set of reflective critical appraisal questions. FINDINGS: A range of methodological approaches has been adopted to explore the use of life story work with no one specific methodology prevailing. The work has been most frequently used with older people and people with a learning disability and life story books are the most common approach. Staff perceptions of life story work have been explored, but patient and carer views are less frequently reported. The findings of the studies are discussed in broad themes, offering some tentative recommendations for using life story work in practice. CONCLUSION: Evidence on the use of life story work is immature, leading to the recommendation for more research. Although appraising literature from a range of approaches is complex, there are some potentially far-reaching benefits of life story work in health and social care practice.     

Effectiveness of external cues to facilitate task performance in people with neurological disorders: a systematic review and meta-analysis

Purpose: To examine in people with neurological disorders, which method/s of providing external cues to improve task performance are most effective.

Methods: Medline, EMBASE, and PsycINFO were systematically searched. Two reviewers independently screened, extracted data, and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Twenty six studies were included. Studies examined a wide-range of cues including visual, tactile, auditory, verbal, and multi-component cues. Cueing (any type) improved walking speed when comparing cues to no cues (mean difference (95% confidence interval): 0.08?m/s (0.06–0.10), I²?=?68%, low quality of evidence). Remaining evidence was analysed narratively; evidence that cueing improves activity-related outcomes was inconsistent and rated as very low quality. It was not possible to determine which form of cueing may be more effective than others.

Conclusion: Providing cues to encourage successful task performance is a core component of rehabilitation, however there is limited evidence on the type of cueing or which tasks benefit most from external cueing. Low-quality evidence suggests there may be a beneficial effect of cueing (any type) on walking speed. Sufficiently powered randomised controlled trials are needed to inform therapists of the most effective cueing strategies to improve activity performance in populations with a neurological disorder.

• Implications for rehabilitation

• Providing cues is a core component of rehabilitation and may improve successful task performance and activities in people with neurological conditions including stroke, Parkinson’s disease, Alzheimer’s disease, traumatic brain injury, and multiple sclerosis, but evidence is limited for most neurological conditions with much research focusing on stroke and Parkinson’s disease.

• Therapists should consider using a range of different types of cues depending on the aims of treatment and the neurological condition. There is currently insufficient evidence to suggest one form of cueing is superior to other forms.

• Therapists should appreciate that responding optimally to cues may take many sessions to have an effect on activities such as walking.

• Further studies should be conducted over a longer timeframe to examine the effects of different types of cues towards task performance and activities in people with neurological conditions.

     

Efficacy of electrical stimulation to increase muscle strength in people with neurological conditions: a systematic review

Background and Purpose. Weakness in partially paralysed muscles is a disabling impairment for people with neurological conditions. Strength training programmes are widely administered to address this impairment. There is a common belief that the effectiveness of strength training programmes can be enhanced by the addition of electrical stimulation. The purpose of this systematic review was to assess the efficacy of electrical stimulation for increasing voluntary strength in people with neurological conditions. Method. Eligible randomized trials of electrical stimulation were identified by searches of computerized databases. The search yielded 11 267 abstracts, of which 60 were retrieved. Two assessors independently reviewed full text versions of these articles. Results. Eighteen studies satisfied the inclusion criteria. These studies involved participants with spina bifida (n = 1), cerebral palsy (n = 1), peripheral nerve lesion (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 3) and stroke (n = 11). The mean (SD) PEDro score for trial quality was 4.9 (1.0) out of 10. Meta‐analyses of studies involving similar patients were not done because of insufficient data or lack of homogeneity. The results of all studies were analysed individually. Conclusion. Several studies suggest a modest beneficial effect of electrical stimulation in patients with stroke. It is not clear whether patients with other types of neurological disabilities benefit from electrical stimulation in the same way. Copyright © 2007 John Wiley & Sons, Ltd.