Quantifying social consequences of occupational injuries and illnesses: state of the art and research agenda

BACKGROUND: Quantitative methods for describing the social effects of occupational injury and illness are evaluated including surveys of prevalence and ratings of severity of social role disability. METHODS: The reliability and validity for the injured worker population of the most commonly used general and condition-specific role disability measures is reviewed and summarized. This review is used to support the development of a prototype strategy for quantifying the social consequences of occupational injuries and to identify areas of need for further research and development. CONCLUSIONS: Research is needed to: (a) determine which of existing measures is most precise in describing the severity of dysfunction due to a specific illness or injury, (b) expand the development of measures of specific role functioning (including paid work), and (c) develop item banks to support the construction of computer adaptive assessments of role functioning.     

Psychosocial severity, length of stay and the role of social work services

Data on excess length of stay (LOS)-the difference between actual LOS and target LOS for the medical problem-were analyzed for three acute care hospitals. For a sample of 2,642 cases, 29.2% of all hospital days were excess days for patients referred to social services. For a sample of 176 social service cases, a stepwise regression yielded two statistically significant predictors of LOS: (1) Medical problem (target LOS) and (2) severity of psychosocial problem (Person-in- Environment scale). The importance of psychosocial severity as a predictor of LOS has clear implications for the role social workers can play in making health care organizations more efficient.     

损伤严重程度评分应用现状

目的分析四种常用损伤严重程度评分方法的应用现状,提高医务人员对损伤严重程度评分方法的熟悉程度和应用效果。方法总结归纳近年来国内外关于损伤严重程度评分方法的相关研究文献。结果四种常用损伤严重程度评分方法在应用中各有优缺点。损伤严重程度评分（ISS）是目前评价损伤严重程度较为通用的标准,但是对多发伤评估效果差,且需要知道所有准确的解剖伤情况;基于ICD的损伤严重程度评分（ICISS）允许所有伤参与伤情的预测,提高伤员预后的预测准确性,对医务人员不需要特别的训练和经验,但是各医院之间的ICD-9编码存在差异,且ICISS容易高估一些小伤;新的损伤严重程度评分（NISS）克服了ISS受解剖区域限制的缺陷,预测能力比ISS强,但是要求创伤专家提供准确的简明损伤定级标准（AIS）值;创伤严重程度评分（TRISS）结合解剖和生理双重指标,使大小不等的创伤中心之间的比较成为可能,同时还能用于儿童创伤患者的预后判断,但是需要一定的知识和训练理解复杂的统计术语,需要专业的创伤登记获得相关计算数据。结论一方面应加强损伤严重程度评分方法的优化,探索更标准化适应面更广的模型,另一方面应结合地区特点正确理解并合理利用这些方法,以提高创伤救治效果。     

A cross-cultural comparison of health status values.

The extent to which the values attached to health states are similar in different cultures or social groups is important for understanding health and illness behaviors and for developing standardized health status measures. A cross-cultural study was conducted to compare the health status values obtained in a United States population (Seattle, Washington) with those from another English-speaking culture (London, England) on the Sickness Impact Profile, a standardized measure composed of 136 items. London judges rated the severity of dysfunction described in each item on an equal interval scale using the same methods of scaling and analysis employed in the Seattle study. A regression of English mean item values on US mean values yielded a slope of 1.00 and an intercept of -0.07, indicating that judges gave strikingly similar ratings to most items. Agreement was higher at the more severe end of the dysfunction continuum than at the least severe end, a finding consistent with the notion that what constitutes health is more difficult to define than what constitutes illness. While a universal conception of dysfunction may exist in English-speaking societies, the social and cultural determinants of health status values deserve more systematic study.     

United Kingdom and United States healthcare providers' recommendations of abstinence versus controlled drinking

AIM: To assess whether selected characteristics of problem drinkers influence treatment goal recommendations - abstinence or controlled drinking - by healthcare providers in the UK and the US. METHODS: Sixteen case-histories, composed with varying information regarding the clients' level of problem severity, degree of social support and sex, were read by 41 UK and 31 US healthcare providers, who then gave a recommendation of controlled drinking versus abstinence for each case on a seven-point Likert scale. RESULTS: Overall, abstinence was recommended more strongly for higher-severity problem drinkers, those with higher social support (an unpredicted finding), and for female clients. Controlled drinking was more often recommended in the UK than in the US. However, the degree to which drinkers' problem severity, social support and sex each affected respondents' ratings depended on the level of one or more of the other variables and the country of the respondents. CONCLUSION: The degree to which healthcare providers recommend abstinence or controlled drinking as an outcome goal for problem drinkers varies according to both client characteristics and the country in which they work.     

Changing needs of patients and families in the acute care hospital: implications for social work practice

Much attention has been given in recent years to changing reimbursement for hospital care, shortened lengths of stay, and changes in the delivery of health care. The corollaries to these changes are more restrictive admission criteria, increased severity of patient illness, and changes in patient care. The purpose of the present paper is to describe the inpatients who remain in the acute care hospital, and to examine both how the patients and families in need of social work consultation are identified and the implications of these methods of identification for social work practice.     

THE WINDSOR CLINIC ALCOHOL WITHDRAWAL ASSESSMENT SCALE (WCAWAS): INVESTIGATION OF FACTORS ASSOCIATED WITH COMPLICATED WITHDRAWALS

A new scale for measuring the severity of the alcohol withdrawalsyndrome has been developed. The Windsor Clinic Alcohol WithdrawalAssessment Scale (WCAWAS) has more objective criteria than itsparent scales and has high inter-rater reliability and concurrentvalidity. This article describes the development of the WCAWASand its use in an investigation of which factors were associatedwith complicated withdrawals in 142 consecutive patients admittedfor detoxification. Multivariate analyses showed that drinkingbehaviour variables and MCV were successful at predicting complicatedwithdrawals. The WCAWAS was not successful at predicting whichpatients developed convulsions. Further studies are requiredto see if the WCAWAS is more successful at predicting whichpatients will develop visual hallucinations. The WCAWAS is usefulas a teaching aid and in following the clinical course of patientsand their response to treatment.     

Development of a condition-specific measure of quality of life for children with cerebral palsy: empirical thematic data reported by parents and children

BACKGROUND: Although there is increasing recognition that quality of life (QOL) and health-related quality of life (HRQOL) are important outcome variables in clinical trials for children with cerebral palsy, there are substantial limitations in existing measures of QOL. This study identify themes of QOL for children with cerebral palsy and their parents to guide the development of a new condition-specific QOL scale. METHODS: A qualitative study of parent and child views on QOL composition was conducted, using a grounded theory framework. Families participated in semistructured interviews on QOL until thematic saturation was reached (n = 28 families). RESULTS: Overall, 13 themes emerged from the interviews: physical health, body pain and discomfort, daily living tasks, participation in regular physical and social activities, emotional well-being and self-esteem, interaction with the community, communication, family health, supportive physical environment, future QOL, provision of, and access to services, financial stability, and social well-being. CONCLUSIONS: Research with parents and children with cerebral palsy, representative of severity across the disease spectrum and socio-economic status, reinforced and expanded on the traditional themes that have underpinned QOL measurement development. This has implications not only for the development of a new QOL scale for children with cerebral palsy, but also for clinical interventions and community care management.     

Measures of agreement between many raters for ordinal classifications

Screening and diagnostic procedures often require a physician's subjective interpretation of a patient's test result using an ordered categorical scale to define the patient's disease severity. Because of wide variability observed between physicians' ratings, many large‐scale studies have been conducted to quantify agreement between multiple experts' ordinal classifications in common diagnostic procedures such as mammography. However, very few statistical approaches are available to assess agreement in these large‐scale settings. Many existing summary measures of agreement rely on extensions of Cohen's kappa. These are prone to prevalence and marginal distribution issues, become increasingly complex for more than three experts, or are not easily implemented. Here we propose a model‐based approach to assess agreement in large‐scale studies based upon a framework of ordinal generalized linear mixed models. A summary measure of agreement is proposed for multiple experts assessing the same sample of patients' test results according to an ordered categorical scale. This measure avoids some of the key flaws associated with Cohen's kappa and its extensions. Simulation studies are conducted to demonstrate the validity of the approach with comparison with commonly used agreement measures. The proposed methods are easily implemented using the software package R and are applied to two large‐scale cancer agreement studies. Copyright © 2015 John Wiley & Sons, Ltd.     

金砖国家卫生发展援助分析

随着金砖国家经济的快速增长以及在国际社会中发挥着越来越重要的作用,其卫生发展援助影响力也逐渐扩大。本文分析了金砖国家卫生发展援助的规模、援助地区、援助方式和特色、管理机构以及近年来金砖国家在全球卫生援助格局中的地位和作用,并为我国开展卫生发展援助提出参考意见。本文认为我国有必要设立统一的国际援助管理机构;改进卫生发展援助模式;适度增加卫生发展援助规模;利用自身发展经验和优势开展援助,发挥金砖国家合力;推动卫生发展援助数据趋于透明和公开;建立和完善卫生发展援助的评估机制。     

社会工作介入临终关怀的研究

随着人类社会的发展，人们越来越注重生活的质量，对于临终前的生命质量也提出了高的要求，这便产生了临终关怀。我国目前实施的临终关怀的形式主要有家庭型、综合医院型和专门临终机构型，而这3种形式又在不同方面存在着自己的缺陷。这就需要社会工作介入临终关怀之中。从介入理念、介入途径和方法上都可看出它的可行性和必要性。对于社会工作者在临终关怀中所担当的角色也进行了分析研究。     

Meeting the challenge of epidemic infectious disease outbreaks: an agenda for research

Challenges arising from epidemic infectious disease outbreaks can be more effectively met if traditional public health is enhanced by sociology. The focus is normally on biomedical aspects, the surveillance and sentinel systems for infectious diseases, and what needs to be done to bring outbreaks under control quickly. Social factors associated with infectious disease outbreaks are often neglected and the aftermath is ignored. These factors can affect outbreak severity, its rate and extent of spread, influencing the welfare of victims, their families, and their communities. We propose an agenda for research to meet the challenges of infectious disease outbreaks. What social factors led to the outbreak? What social factors affected its severity and rate and extent of spread? How did individuals, social groups, and the state react to it? What are the short- and long-term effects on individuals, social groups, and the larger society? What programs can be put in place to help victims, their families, and affected communities to cope with the consequences--impaired mental and physical health, economic losses, and disrupted communities? Although current research on infectious disease outbreaks pays attention to social factors related to causation, severity, rate and extent of spread, those dealing with the "social chaos" arising from outbreaks are usually neglected. Inclusion, by combining traditional public health with sociological analysis, will enrich public health theory and understanding of infectious disease outbreaks. Our approach will help develop better programs to combat outbreaks and equally important, to help survivors, their families, and their communities cope better with the aftermath.     

Sexual networks: the integration of social and genetic data

New methods for studying sexual networks are presented, drawing upon routine procedures followed in genitourinary medicine clinics in the UK for tracing partners and identifying strains of infection. The routine social procedures were developed to incorporate a structured interview. The routine microbiological diagnosis of gonorrhoea was augmented by phenotyping and the development of new genetic techniques for the fine discrimination of gonococcal strains (opa-typing). Selected results from a study in Sheffield, UK show that each method has limitations, when conducted separately, but these are minimised when the methods are combined. Moreover, the use of simple and routine methods of data collection resolve issues of scale and sample that have beset other network studies, as they provide a means of covering a larger and defined population. Popular concepts about these methods are discussed in the conclusion. The integrated approach employed in our research raises questions both about social methods, 'of people who lie, particularly when they talk about sex', and about microbiological methods, 'of genes that tell the truth' and bypass what people say and think altogether. We argue that these stereotypes are misleading insofar as they suggest that genetic techniques can substitute for the social, and we suggest that even the finest discrimination of organisms at the genetic level will never obviate the need for their interpretation in the light of social data.     

The Poverty and Housing Scale: report on a pilot study

The measurement of beliefs and attitudes on poverty and housing is important to researchers and social workers interested in examining the role that belief structures have on the development of policy and programs in these areas. This article reports pilot study findings of a new scale, The Poverty and Housing Scale (PHS), that measures this concept and evaluates its psychometric properties. Preliminary reliability was in the very good range. Examinations of content and face validity provided support of the instrument as a valid measure of beliefs and attitudes on poverty and housing. The factor analysis emerged a one factor, 13-item scale. Unlike other related scales, the PHS attempts to link the social factor of poverty and housing together. Theoretical and methodological strengths and weaknesses are considered and the implications for social work practice are discussed. The authors provide recommendations for additional testing of the instrument.     

Insights from triangulation of two purchase choice elicitation methods to predict social decision making in healthcare

Background

Discrete choice experiments (DCEs) and the Juster scale are accepted methods for the prediction of individual purchase probabilities. Nevertheless, these methods have seldom been applied to a social decision-making context.

Objective

To gain an overview of social decisions for a decision-making population through data triangulation, these two methods were used to understand purchase probability in a social decision-making context.

Methods

We report an exploratory social decision-making study of pharmaceutical subsidy in Australia. A DCE and selected Juster scale profiles were presented to current and past members of the Australian Pharmaceutical Benefits Advisory Committee and its Economic Subcommittee.

Results

Across 66 observations derived from 11 respondents for 6 different pharmaceutical profiles, there was a small overall median difference of 0.024 in the predicted probability of public subsidy (p = 0.003), with the Juster scale predicting the higher likelihood. While consistency was observed at the extremes of the probability scale, the funding probability differed over the mid-range of profiles. There was larger variability in the DCE than Juster predictions within each individual respondent, suggesting the DCE is better able to discriminate between profiles. However, large variation was observed between individuals in the Juster scale but not DCE predictions.

Conclusions

It is important to use multiple methods to obtain a complete picture of the probability of purchase or public subsidy in a social decision-making context until further research can elaborate on our findings. This exploratory analysis supports the suggestion that the mixed logit model, which was used for the DCE analysis, may fail to adequately account for preference heterogeneity in some contexts.     

精细化分级护理在肿瘤患者PICC接触性皮炎中的应用

目的：应用精细化分级对肿瘤患者PICC置管处及其周围皮肤的接触性皮炎实施护理并评价其效果。方法：选取2012-2014年留置PICC管并在中山大学肿瘤防治中心放疗三区住院的患者326例,运用精细化分级护理处理PICC置管处及其周围皮肤接触性皮炎,并记录护理效果。结果：326例患者中74例发生接触性皮炎,发生率为22.7%。其中接触性皮炎为1级50例,2级21例,〉2级有3例,分别占接触性皮炎的67.6%、28.4%、4.1%;启用精细化分级护理,1级接触性皮炎2~4 d皮疹消退,2级7 d内皮疹消退,无复发,〉2级7~14 d皮疹消退,无复发。结论：精细化分级护理防止接触性皮炎进一步加重,促进已发生的接触性皮炎尽早痊愈,值得在临床推广。     

Detection of behavioural and emotional problems in deaf children and adolescents: comparison of two rating scales

The aim of this study was to establish rates of behavioural and emotional problems, and of social maladjustment, In a population of deaf children, particularly in relation to different methods of communication. The parents of 84 children who attended two schools for the deaf took part. They completed the parents'checklist (PCL), a behaviour rating scale for deaf children, and the Child Behaviour Checklist (CBCL), a measure widely used in the general population. The two instruments were significantly correlated on the severity of behavioural and emotional problems, but their previously established cut-off scores detected different rates of possible clinical cases, i.e. children with mental health disorders. According to the CBCL, 40|X% of children were within the clinical range, and 82|X% were socially dysfunctional compared with the general population. The PCL identified a much higher percentage (77|X%of caseness. Behavioural and emotional problems were significantly higher in Asian children. Although all subjects used sign language, the additional use of speech, which may indicate increased hearing ability, had a protective effect for adolescents. The findings are discussed in relation to the validation of the instruments and the development of intervention programmes for deaf children.     

Hospital patients'' responses to dissatisfaction

Hospitalized patients' responses to dissatisfaction in the provision of services are analysed as a function of their perceptions of the severity of the service failure and their relative social power. The analysis is based on the responses of 384 patients in a general hospital who reported experiencing at least one disturbing problem in the receipt of hospital services. Three binary dependent variables were constructed based on three dimensions of intensity of complaint behaviours: passive vs. active, non-directed vs. directed, non-formal vs. formal. The four possible response combinations created an ordinal scale of intensity of response. The set of independent variables included: perceived severity of the problem, general measures of satisfaction with services, structural po wer discrepancies, personal and situational resources of social power, and self perception of social power. The results of multivariate analyses indicate that the perceived severity of the problem best explains the intensity of response. Personal and situational social power resources and self perception of power add to the explanation. Structural power discrepancies, however, do not relate to the intensity of patients' responses to dissatisfaction.     

早期教育对婴幼儿生长发育影响的研究进展

本文从婴幼儿早期教育(以下简称“早教”)的内涵,早教对婴幼儿神经系统、运动与体格发育及社会行为发展的影响,国内发育量表应用情况六个方面进行综述。现有研究大多集中在早教对0~6岁儿童的影响,对远期影响研究较少。笔者认为早教方式、切入时机和持续时间虽各不相同,但其对婴幼儿神经系统、运动与体格发育和提高社会适应能力等方面有积极促进作用。家长认知和母婴关系对早教质量有积极影响,早教时应强化家长对早教内涵的认知。未来的研究应找寻出一种有效并持续时间长的促进婴幼儿生长发育的干预措施和方法。