Implementation of the process of ethical review of improvement activities at the Children's Hospital at Westmead

INTRODUCTION: Research in healthcare has long been very well regulated, but this is rarely the case for improvement activities. Improvement activities are activities which use data to assess the current situation to identify areas for improvement. Solutions are then developed and implemented, and later evaluated to measure their success and sustainability. There has been much discussion in the literature as to whether, like research activities, improvement activities should undergo independent ethical review. In fact, most healthcare organisations in Australia struggle with how best to manage improvement activities, despite the 2003 publication of the National Health and Medical Research Council guidelines on this subject. DISCUSSION: At The Children's Hospital at Westmead, the authors take the view supported by others that ethical review is necessary and so have developed a process which utilises the unique skills available in the Clinical Governance Unit to ensure improvement activities are reviewed for ethical considerations in an effective and efficient manner and implemented a database to approve, monitor and report on improvement activities. This has resulted in staff being increasingly satisfied with the turnaround time for approval of improvement activities they are undertaking as well as for the methodological support provided. The authors have experienced a dramatic increase in the number of improvement activities being recorded and ethically reviewed.     

Social Support,Activities, and Recovery from Serious Mental Illness: STARS Study Findings

Research on the role of social support in recovery from severe mental illness is limited and even more limited is research on the potential effects of participating in various activities. This study explores these relationships by analyzing baseline data from a 153-participant subsample in the Study of Transitions and Recovery Strategies. Higher scores on the recovery assessment scale were related to both social support/network size and engagement in more activities. The particular nature of the activities (more/less social, more/less physically active, inside/outside the home) was not important, rather, activities of any type were related to recovery. Furthermore, engagement in activities was more important as levels of social support declined. The results suggest that both social support and activities may promote recovery, and that for persons with poor social support, engagement in a variety of individualized activities may be particularly beneficial.     

Engagement in leisure and physical activities: analysing the biographical disruptions of a rare chronic disease in France

Using the biographical disruption literature, this article examines how the experience of illness – in this case, pemphigus – reconfigures engagement in leisure activities, and how these activities are integrated into the biographies of persons with a rare chronic illness. Among the changes imposed by the illness, leisure activities are especially enlightening, as they primarily depend on the body. The article is based on a study of 50 interviews of persons with pemphigus, a rare and chronic dermatological disorder. The ways in which they relate to leisure activities give a new perspective on biographical disruption. The first striking observation is how diverse they are: illness does not level social differences or lived experience, and can even further consolidate commitment to engagements. We identified four types of engagement in leisure activities: disengagement, which reveals biographical disruption; adapted engagement, leading individuals toward low-risk physical activities; engagement in medicalised normalisation; and salutary engagement.     

School-Based Mental Health Prevention Activities for Homeless and At-Risk Youth

Children who are homeless or who live in poverty face increased exposure to risk factors. Participating in mental health prevention activities may serve as a buffer against stress for these children. Schools are an optimal setting for providing prevention services. In this paper, we describe the implementation of and results from the Empowerment Zone (EZ) project, which involved providing mental health and health prevention services to children during small group and classroom activities. The EZ Project was incorporated into character education activities for a summer school program designed to improve reading and math skills for at risk elementary school age youth. The character education program is a key component in the Baltimore City schools where character traits, such as honesty, are taught through small group and classroom activities. Teachers were trained to implement mental health prevention activities; they also reported on the quality and utility of the program, after watching activities implemented by clinicians in their classrooms. Parents also had opportunities to participate in classes, which focused on teaching discipline techniques and discussing ways to improve parent-child relationships and foster children's socioemotional development. Results were positive, supporting project activities. Future empirical research evaluating the effectiveness of mental health prevention programs delivered in schools is needed.     

A review on occupational health in Yugoslavia

A review on occupational health service and activities in Yugoslavia is presented. Information on relevant legislation, organization of occupational health and worker's health care, financing, practices of occupational health units, education concerning graduate and postgraduate studies and continuous education in this field are given. Workers' morbidity pattern is also briefly discussed as well as research activities. Concluding remarks include observations on foreseeable needs and developmental orientation in occupational health in the country.     

Does reading keep you thin? Leisure activities,cultural tastes,and body weight in comparative perspective

While sedentary leisure-time activities such as reading, going to movies, attending cultural events, going to sporting events, watching TV, listening to music, and socialising with friends would seem to contribute to excess weight, a perspective focusing on socioeconomic status (SES) differences in cultural tastes suggests the opposite, that some sedentary activities are associated with lower rather than higher body weight. This study aims to test theories of cultural distinction by examining relationships between leisure-time activities and body weight. Using 2007 data on 17 nations from the International Social Survey Program (ISSP), the analysis estimates relationships between the body mass index and varied leisure-time activities while controlling for SES, physical activities, and sociodemographic variables. Net of controls for SES and physical activities, participation time in cultural activities is associated with lower rather than higher body weight, particularly in high-income nations. The results suggest that both cultural activities and body weight reflect forms of distinction that separate SES-based lifestyles.     

The use of craft activities as an occupational therapy treatment modality in Norway during 1952-1960

The purpose of the present study was to explore the use of craft activities as occupational therapy treatment modalities in Norway during the period 1952-1960. Data were obtained through in-depth interviews with six retired occupational therapists on their experiences in using crafts. Data were analysed through textual analysis and this resulted in four themes: craft activities identified as a therapeutic tool; ambivalence in how to frame the intervention; practice relative to power relationships; and occupational therapists and patients as equals. A limitation of the present study was that participants drew on their screened memories in the context of contemporary practice, which may omit or distort the historical truth. Further research is needed to document the effect of contemporary therapeutic use of craft activities, and to bring forward how occupational therapists and clients value the craft activities of today in the context of their lives.     

Management activities in community dietetics practice

Information on the management activities of community dietitians was obtained through a mail survey of 350 randomly selected community dietitians. Subjects provided information on their management level, the importance to their job performance of 83 management activity statements, and the percent of time they spent performing management activities in each of nine categories. Twenty-nine percent of the respondents indicated job responsibilities in lower-level management; 45% had mid-level and 26% had upper-level management responsibilities. Numbers of activities rated essential or very important increased as management levels increased. Kinds of activities changed from technical to human to conceptual as management levels increased. Mid-level management subjects, while still spending time working with clients, reported spending considerable time on coordinating, investigating, and evaluating, often reporting as much time spent on those activities as did upper-level management subjects. Definitions provided by respondents indicated great diversity in job requirements and settings.     

Disability indicators in the Spanish disability, impairment and health survey

BACKGROUND: The measurement and meaning of disability depend on the indicators used. In this study the indicators of dependency and severe residual disability are examined on two levels: in each of the 14 selected activities of daily living (ADL) and also as a summary score of the activities count. METHODS: The data are extracted of the Disability, Impairment and Health Survey (INE, 1999). The sample is composed of 8.779 entries corresponding to people over 65 years old with disability in some of the 14 selected ADL. Tables of proportions and contingency have been elaborated, statistics of association and agreement has been calculated and the dimensionality of the aggregated measures had been analyzed through the full information factor analysis. RESULTS: The main discrepancies between the indicators are concentrated on the mobility activities (kappa coefficients ranged between 0,50 to 0,75 for mobility activities and between 0,73 to 0,87 for domestic activities and self-care). Severe residual disability (indicator selected by the National Institute of Statistics) compared to dependency more inability includes more mobility disabled people and excludes more disabled people in domestic activities and self-care. Dependency more inability is the indicator with the highest validity as a summary measure of disability (two eigenvalues: 8,37 and 1,91, the first factor accounted for 56,3% of the variance, the saturations of the first factor ranged between 0,58 to 0,87). CONCLUSIONS: Dependency more inability is more valid than severe residual disability as main indicator of disability.     

Prospective Study of Engagement in Leisure Activities and All-Cause Mortality Among Older Japanese Adults

BackgroundEngagement in leisure activities among older people is associated with a lower risk of mortality. However, no studies have been conducted focusing on the difference of associations with mortality risk among multiple types of leisure activities.MethodsWe examined prospectively the association of engagement in leisure activities with all-cause mortality in a cohort of older Japanese adults. The Japan Gerontological Evaluation Study included 48,216 participants aged 65 years or older. During a mean follow-up period of 5.6 years, we observed 5,575 deaths (11.6%). We investigated the total number of leisure activities, as well as combinations of 25 different leisure activities with Cox proportional hazards models, adjusting for potential confounding factors.ResultsWe found a linear relationship between the total number of leisure activities and mortality hazard (adjusted hazard ratio, 0.93; 95% CI, 0.92–0.95). Furthermore, engagement in leisure activities involving physical activity, as well as group-based interactions, showed the strongest associations with lowered mortality. By contrast, engagement in cultural leisure activities and solitary leisure activities were not associated with all-cause mortality.ConclusionAlthough we cannot rule out residual confounding, our findings suggest that encouraging engagement in physically-active group-based leisure activities may promote longevity in older adults.Key words: aging, leisure activities, Japan, older people     

What,Why, How – Creative Activities in Occupational Therapy Practice in Sweden

Creative activities have historically been used in occupational therapy, and although their usage has declined in recent decades, they are still used in Swedish practice. The aim of this study was to better understand how occupational therapists use creative activities in practice. A web‐based survey was sent to 520 occupational therapists, of which 304 (58.5%) responded. The main reason identified for using creative activities was to strengthen the client's occupational performance, well‐being and self‐esteem. The expected outcomes of applying creative activities were to support the client in self‐expression and experiencing joy and desire. More than half of the occupational therapist respondents did not use creative activities to the extent they desired. Creative activities in occupational therapy are still used as a vital treatment to strengthen the clients' occupational performance abilities. The survey has looked at only a professional perspective on effectiveness of applying creative activities in occupational therapy. More research is needed to evaluate how occupational therapists internationally apply creative activities. There is also a need to gain information from the client's perspective on the therapeutic value of creative activities. Copyright © 2016 John Wiley & Sons, Ltd.     

Why differentiating between health system support and health system strengthening is needed

There is increasing recognition that efforts to improve global health cannot be achieved without stronger health systems. Interpretation of health system strengthening (HSS) has varied widely however, with much of the focus to‐date on alleviating input constraints, whereas less attention has been given to other performance drivers. It is important to distinguish activities that support the health system, from ones that strengthen the health system. Supporting the health system can include any activity that improves services, from distributing mosquito nets to procuring medicines. These activities improve outcomes primarily by increasing inputs. Strengthening the health system is accomplished by more comprehensive changes to performance drivers such as policies and regulations, organizational structures, and relationships across the health system to motivate changes in behavior and/or allow more effective use of resources to improve multiple health services. Even organizations that have made significant investments in health systems have not provided guidance on what HSS entails. While both supporting and strengthening are important and necessary, it is nonetheless important to make a distinction. If activities fail to produce improvements in system performance because they were incorrectly labeled as system strengthening, the value of HSS investments could quickly be discredited. Not distinguishing supportive activities from strengthening ones will lead to unmet expectations of stronger health systems, as well as neglect of critical system strengthening activities. Distinguishing between these two types of activities will improve programming impact. Copyright © 2012 John Wiley & Sons, Ltd.     

军队医院卫勤模块化保障单元模式

本文阐述了军队医院卫勤模块化保障单元模式总体构想、基本组成、保障功能和主要特点。该卫勤保障单元以“五车一队”为平台，具有机动灵活、功能配套、救治快速、利于生存等特点，对部队军事行动可实施连续有效的卫勤保障。     

Fluid management: a nursing intervention for the patient with fluid volume excess

The objective of this research is to identify which nursing activities contained in the fluid management intervention proposed by the Nursing Intervention Classification (NIC) are realized and considered important by nurses, to attend patients who received fluid volume excess as a nursing diagnosis, as proposed by the North American Nursing Diagnoses Association (NANDA). Data were collected in three hospitals. The sample included 77 nurses, who chose the best alternative on a Likert scale, to indicate the realization of which of those actives they considered important and which activities are realized in their daily care practice. It was concluded that most of the nursing activities were always considered important and were always performed by the nurses. These activities were classified as independent and dependent.     

剖析医疗纠纷提高医疗服务质量管理水平

目的 探讨影响医疗质量的因素和提高医疗质量的方法。方法 对2000年至2005年度医疗纠纷来访总量和分类情况进行统计和分析。结果 患者的维权意识不断增强;社会对医疗服务的要求不断提高;医务人员的法律意识及自我保护意识相对滞后;患者对医生在医疗活动中发挥的作用期望较高,但却忽略了医疗活动的高风险;医患间存在的最大障碍是相互沟通不够;当医务人员认清了医疗活动也是服务活动后,其价值逐渐被社会认可。结论 医务人员要增强法律意识,提高执业能力;医务人员要重视与患者的沟通,眼中不能只有“病”,更要有“人”,在医疗活动中强调“以人为本”;医务人员要强化医疗风险的防范意识,认真讨论风险防范和处理预案,不断提高医疗质量。     

Homosexuality and bisexuality in different populations

The general public as well as the scientific community have use for accurate data on the size(s) of the heterosexual, homosexual, and bisexual populations. Uses include political, legal, medical, and social. The data upon which the typically used figures are dependent have come under scrutiny. This review of studies from the U.S. and elsewhere indicate that it is unreasonable to consider the often-used figure of 10% of the male population as more or less regularly engaging in same-sex activities. The figure is closer to half that. And the figure for the lesbian population is even smaller. Further, routinely exclusive or predominantly exclusive homosexual activities are more common than bisexual activities.     

Creating optimal hygienic conditions for students' activities

Optimization of the preparation of school-children for the working activity may be presented as a model consisting of 4 blocks. Socially significant functions are system-forming factors of this model, i.e. the functions of an organism with which successful implementation of the major types of activities is associated. System approach to the management of schoolchildren's activities based on the dynamic control of socially significant functions and on selective influence on external and internal factors with the help of prophylactic and corrective activities make it possible to maintain its hygienic optimization.     

Use of qualitative methods to map job tasks and exposures to occupational hazards for commercial fishermen

BACKGROUND: Understanding job tasks and estimating occupational exposures is difficult for self-employed or autonomous workers, who tend to be dispersed, with no fixed workplace, employment records, or historical exposure measurements. METHODS: We used ethnographic methods to collect work information for southern commercial fishermen. Major activities were mapped using the seasonal round, an anthropological tool that records activities of groups whose lifeways depend on natural cycles. RESULTS: Fishermen's work schedules depended on boat size, gear, market fluctuations, and regulations, as well as season. The seasonal round guided the analysis of qualitative data on annual cycles of activities increasing understanding of exposures and their variation. CONCLUSIONS: Combined with detailed exposure information this framework for organizing and categorizing seasonal activities could improve accuracy of exposure information and guide quantitative analysis in work settings that challenge standard exposure assessment methods.     

Perceived exertion of physical activity: negative association with self-rated fitness

INTRODUCTION: In epidemiological studies information on physical activity is often obtained by self-report questionnaires, assessing the type of activities performed, the absolute metabolic demand (metabolic equivalents), and the duration and frequency of the activities. As health benefits from physical activity are coupled to the relative intensity of the physical effort, we wanted to relate perceived exertion to self-reported fitness. AIM: To use a questionnaire for obtaining information on perceived exertion of physical activity in a population sample and to evaluate whether perceived exertion is associated with self-reported fitness. METHODS: A total of 42 specific physical activities were included in a perceived exertion questionnaire that was sent by mail to 2,543 randomly selected men and women between 19 and 60 years of age. The participants were asked to rate activities by degree of perceived exertion on an 11-point box-scale. General linear regression analyses were undertaken with perceived exertion of the specific physical activities as outcome variables and age and self-rated fitness as determinants. RESULTS: The response rate was 61.7% (n = 1,568) and 54.3% of the respondents were women. In men and women both, the perceived exertion of 40 out of 42 specific physical activities of low, moderate, and high absolute intensity was negatively associated with self-rated fitness level. CONCLUSION: Perceived exertion is significantly associated with self-rated fitness level in both genders after adjustment for age. Self-rated fitness level seems to determine perception of exertion in leisure time, occupation, household, and transportation activities, whether of low, moderate, or high absolute intensity.