Determinants of seafarers’ fatigue: a systematic review and quality assessment

Purpose

Fatigue jeopardizes seafarer’s health and safety. Thus, knowledge on determinants of fatigue is of great importance to facilitate its prevention. However, a systematic analysis and quality assessment of all empirical evidence specifically for fatigue are still lacking. The aim of the present article was therefore to systematically detect, analyze and assess the quality of this evidence.

Methods

Systematic searches in ten databases were performed. Searches considered articles published in scholarly journals from 1980 to April 15, 2016. Nineteen out of 98 eligible studies were included in the review. The main reason for exclusion was fatigue not being the outcome variable.

Results

Most evidence was available for work time-related factors suggesting that working nights was most fatiguing, that fatigue levels were higher toward the end of watch or shift, and that the 6-h on–6-h off watch system was the most fatiguing. Specific work demands and particularly the psychosocial work environment have received little attention, but preliminary evidence suggests that stress may be an important factor. A majority of 12 studies were evaluated as potentially having a high risk of bias.

Conclusions

Realistic countermeasures ought to be established, e.g., in terms of shared or split night shifts. As internal as well as external validity of many study findings was limited, the range of factors investigated was insufficient and few studies investigated more complex interactions between different factors, knowledge derived from studies of high methodological quality investigating different factors, including psychosocial work environments, are needed to support future preventive programs.

     

Can parents rate their child's health-related quality of life? Results of a systematic review

A systematic review was conducted to determine the relationship between ratings of children's health-related quality of life (HRQoL) made by parents and children. This was investigated in relation to four questions:- is agreement greater for some domains (e.g. physical HRQoL) than others?; do parents perceive illness to have a greater impact than their child?; how is agreement affected by child age, gender and illness status?; and is the relationship between proxy ratings affected by the method of data collection? Fourteen studies were identified. Consistent with previous research, there was greater agreement for observable functioning (e.g. physical HRQoL), and less for non-observable functioning (e.g. emotional or social HRQoL). Three studies assessed whether parents perceive the illness to have a greater impact than their child, but no clear conclusions could be drawn given differences in measures used. Agreement is better between parents and chronically sick children compared with parents and their healthy children, but no effects were found for age or gender. All of these results may be dependent on the specific measure of HRQoL employed. There remain strong arguments for obtaining information from both parents and children whenever possible.     

Dementia considered? Safety-relevant communication between health care settings: a systematic review

Aim

To identify literature on safety-relevant handover communication, as operationalized by an adapted Lasswell communication model, and to reveal the extent to which this literature is relevant to patients with dementia (PwD). Furthermore, the study identifies interventions that could be applicable in dementia handover communication.

Methods

A systematic review was performed. MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycInfo and GeroLit were searched for publications indexed up to and including April 2011. Forward citation tracking was conducted in January 2012 using the SCOPUS database. The inclusion criteria followed an adapted Lasswell communication model. Evidence was excluded that did not meet more than three-quarters of the critical appraisal’s 27 quality criteria. A content analysis and a critical appraisal were performed to eliminate ineligible publications.

Results

Out of 3,918 positive search results, a total of 5 publications were ultimately eligible for inclusion. Only one of them included PwD in the intervention group. However, since dementia was not the focus of the study, the paper contained no discussion of the results specifically for PwD.

Conclusion

There are several options for improving safety-relevant handover communication between settings, but strong evidence is still lacking, particularly for PwD. Research involving PwD should include topics such as the role of advanced nurse practitioners (APN), the information needs of everyone involved in the handover and appropriate involvement of informal caregivers. Responsibilities in care should be defined and specific communication processes implemented. Further investigation and application of Naylor et al.’s (2007) transitional care model could be particularly helpful in dementia research.     

Correction to: How to support dental students in reading radiographs: effects of a gaze‑based compare‑and‑contrast intervention

Advances in Health Sciences Education -     

Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003–2012

Objectives

To conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012.

Methods

Systematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria.

Results

We found evidence for lower self-reported health and significantly higher mortality risk for Roma compared to non-Roma, and greater prevalence of health risk factors for Roma children, including environmental risks, low birth weight, and lower vaccination coverage. Studies of non-communicable and infectious disease remain insufficient to make firm conclusions on disparities. Barriers to care include lack of documentation and affordability of care, though more studies on health care utilization are needed.

Conclusions

Roma youth and adults are in need of programs that reduce health disparities and their increased mortality risk. Reducing exposure to risk factors such as smoking, obesity, and poor living conditions may be a target for interventions. More intervention studies and rigorous evaluations are needed.     

Is quality of life a suitable measure of patient decision aid effectiveness? Sub-analysis of a Cochrane systematic review

Quality of Life Research - Patient decision-aids (PtDAs) help patients make informed treatment decisions incorporating their values. Health-related quality of life (HRQOL) is sometimes an outcome...     

Efficiency measurement of health care: a review of non‐parametric methods and applications

There has been increasing interest in measuring the productive performance of health care services, since the mid-1980s. This paper reviews this literature and, in particular, the concept and measurement of efficiency and productivity. Concerning measurement, we focus on the use of Data Envelopment Analysis (DEA), a technique particularly appropriate when multiple outputs are produced from multiple inputs. Applications to hospitals and to the wider context of general health care are reviewed and the empirical evidence from both the USA and Europe (EU) is that public rather than private provision is more efficient. This revised version was published online in July 2006 with corrections to the Cover Date.     

Health-related quality of life among children,adolescents, and adults with bladder exstrophy–epispadias complex: a systematic review of the literature and recommendations for future research

Quality of Life Research - Bladder exstrophy–epispadias complex (BEEC) is a rare spectrum of genitourinary malformations. Children risk long-term urinary and genital dysfunctions. To achieve...     

The relationship between physical and mental health multimorbidity and children’s health-related quality of life

Quality of Life Research - To examine the relationships between physical health problems, and borderline or clinical levels of mental health symptoms and children’s health-related quality of...     

Work ethics and general work attitudes in adolescents are related to quality of life,sense of coherence and subjective health – a Swedish questionnaire study

Background  

Working life is an important arena in most people's lives, and the working line concept is important for the development of welfare in a society. For young people, the period before permanent establishment in working life has become longer during the last two decades. Knowledge about attitudes towards work can help us to understand young people's transition to the labour market. Adolescents are the future workforce, so it seems especially important to notice their attitudes towards work, including attitudes towards the welfare system. The aim of this study was to describe and analyse upper secondary school students' work attitudes, and to explore factors related to these attitudes.     

Health-related quality of life of children and their parents 6 months after children’s critical illness

Quality of Life Research - This study aimed to examine health-related quality of life (HRQoL) of children and their parents, 6 months after the child’s admission to the Pediatric...     

Preschool children in out-of-hours primary care – a questionnaire-based cross-sectional study of factors related to the medical relevance of health problems

Background

Out-of-hours primary care (OOH-PC) is intended to provide medical care services for health problems that cannot wait until normal office hours. Children under five years of age represent about 19% of all OOH-PC contacts in Denmark, and the frequency of calls assessed as severe by health professionals is markedly lower for children than for other age groups. Several studies have questioned the appropriateness of the parents’ use of OOH-PC. We aimed to identify factors associated with calls from parents of pre-school children concerning perceived non-severe health problems that were ranked by the triaging GPs as more appropriate for GP office hours (defined as ‘medically irrelevant’).

Methods

We used data from a cross-sectional study performed in the Central Denmark Region for a 1-year period during 2010–2011. GPs in the OOH-PC assessed random contacts, and a questionnaire was subsequently sent to registered patients. Associations between different factors and the medical irrelevance of contacts were estimated with a generalised linear model to calculate the prevalence ratio (PR).

Results

Among all included 522 telephone consultations and 1226 face-to-face consultations, we identified 71 (13.6%) telephone consultations and 95 (7.8%) face-to-face consultations that were both assessed as non-severe by the parents and more appropriate for GP office hours by the GPs. For telephone consultations, contacts at other times than 4–8 pm on weekdays were statistically significantly associated with medical irrelevance. Additionally, symptoms of longer duration than 24 h were statistically significantly associated medical irrelevance.

Conclusions

A large part of the calls to the Danish OOH-PC concern children. The results indicate that some of these calls are made for other than strictly medical reasons. To achieve more effective use of available resources, it might seem relevant to aim at directing more contacts directly to daytime care. However, future studies to enhance our knowledge on parents’ motivation and behaviour would be recommendable.

     

Use of online health information to manage children’s health care: a prospective study investigating parental decisions

Background

The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents’ decisions to use online information to manage their child’s health care, a behaviour which has not yet been explored systematically.

Methods

Parents (N?=?391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child’s health care during the previous 2 months.

Results

We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents’ intentions to use online information to manage their child’s health care, with further support found for intentions, but not PBC, in predicting parents’ behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents’ decisions to engage in this child health management behaviour.

Conclusions

This theory-based investigation to understand parents’ motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.

     

Health-related quality of life in mothers of children with epilepsy: 10 years after diagnosis

Purpose

Epilepsy in childhood extends far beyond seizures and affects child and parental well-being. The long-term impact of childhood-onset epilepsy on parental well-being is unknown. This study assessed health-related quality of life (HRQOL) in mothers 10 years after their child’s diagnosis of epilepsy.

Methods

Data come from the Health-Related Quality of Life in Children with Epilepsy Study, a multicenter prospective cohort study of children with newly diagnosed epilepsy. Mothers completed a mailed questionnaire at the 10-year follow-up, which included the Short-Form Health Survey (SF-12-v2) to evaluate the physical and mental health components of their HRQOL. Block-wise linear regressions identified child/epilepsy, maternal/family, and maternal psychosocial factors associated with mothers’ HRQOL.

Results

A total of 159 mothers participated in this study (46% of the sample assessed at baseline). At follow-up, 69% of youth had been seizure free for the past 5 years. Mothers scored similarly to population norms (mean: 50, SD: 10) on the mental health subscale (mean: 49.5, SD: 9.3) and significantly better on the physical health subscale (mean: 53.0, SD: 7.6). Better family resources were associated with higher (better) scores on the physical health subscale (B?=?0.20; 95% CI 0.03, 0.36). Better family functioning (B?=?0.34; 95% CI 0.06, 0.62), fewer maternal depressive symptoms (B?=?0.33; 95% CI 0.20, 0.47), and perception of less stress (B?=?0.70; 95% CI 0.52, 0.88) were associated with higher (better) scores on the mental health subscale.

Conclusion

Ten years after the diagnosis of epilepsy in children, the HRQOL of mothers was similar to reports from women in the general population. This study identified factors contributing to better maternal HRQOL and highlights the importance of family environment over epilepsy-related variables.

     

Price: a market signal of quality in health care insurance policies?

Choosing a good quality health insurance policy is important for most individuals in this country. The choice task is however, made quite complicated by the existence of many alternative policies which are each characterized by multiple attributes. This paper examines whether the price (i.e., premium) of a health insurance plan can give a reliable signal about the objective quality level of the plan. Empirical analysis of real-world data shows that overall, price is positively correlated with such quality. Statistical significance tests are conducted to separately evaluate such correlations for different categories of health insurances. Finally, the empirical results are used to indicate implications for consumer decision making.     

Profiling quality of care: Is there a role for peer review?

Background

We sought to develop a more reliable structured implicit chart review instrument for use in assessing the quality of care for chronic disease and to examine if ratings are more reliable for conditions in which the evidence base for practice is more developed.

Methods

We conducted a reliability study in a cohort with patient records including both outpatient and inpatient care as the objects of measurement. We developed a structured implicit review instrument to assess the quality of care over one year of treatment. 12 reviewers conducted a total of 496 reviews of 70 patient records selected from 26 VA clinical sites in two regions of the country. Each patient had between one and four conditions specified as having a highly developed evidence base (diabetes and hypertension) or a less developed evidence base (chronic obstructive pulmonary disease or a collection of acute conditions). Multilevel analysis that accounts for the nested and cross-classified structure of the data was used to estimate the signal and noise components of the measurement of quality and the reliability of implicit review.

Results

For COPD and a collection of acute conditions the reliability of a single physician review was quite low (intra-class correlation = 0.16–0.26) but comparable to most previously published estimates for the use of this method in inpatient settings. However, for diabetes and hypertension the reliability is significantly higher at 0.46. The higher reliability is a result of the reviewers collectively being able to distinguish more differences in the quality of care between patients (p < 0.007) and not due to less random noise or individual reviewer bias in the measurement. For these conditions the level of true quality (i.e. the rating of quality of care that would result from the full population of physician reviewers reviewing a record) varied from poor to good across patients.

Conclusions

For conditions with a well-developed quality of care evidence base, such as hypertension and diabetes, a single structured implicit review to assess the quality of care over a period of time is moderately reliable. This method could be a reasonable complement or alternative to explicit indicator approaches for assessing and comparing quality of care. Structured implicit review, like explicit quality measures, must be used more cautiously for illnesses for which the evidence base is less well developed, such as COPD and acute, short-course illnesses.