Exposure to life adversity in high school and later work participation: A longitudinal population-based study

This paper investigates whether exposure to violence, sexual abuse, or bullying is associated with later work participation and whether high school completion has a potential mediating role. Self-reported junior high school questionnaire data were linked for eight consecutive years to prospective registry data for the demographics, educational progress, employment activity, and social benefits of 11,874 individuals. Ordinal regression analysis showed that violence and/or bullying at 15 years of age predicted negative work participation outcomes eight years later, independent of high school completion and other relevant factors. Although increasing educational level may have some preventive effect, these results indicate that prevention efforts should be initiated at an early age and should target adverse life experiences.     

User participation in healthcare IT development: A developers’ viewpoint in Finland

Background and purposeRecent research showed that physicians in Finland were highly critical of their information technology (IT) systems. They were also critical of the methods of collaboration with the developers of the health IT systems (HITS) in use at the time of the questionnaire. This study turned the set-up around and asked systems developers the same questions about collaboration. What is developers’ view on end user participation in HITS development at the moment? How would developers wish end users to participate in systems development? Do the developers’ views differ from the physicians’ (end users’) views of the current state of collaboration in developing IT systems?MethodsA web-based questionnaire study was conducted in one of the major HITS provider companies in Finland among all developers, including software developers and customer support and sales personnel. Both quantitative and free-text questions of a previous study were adapted for the purpose. The responses were analyzed with qualitative and basic quantitative methods.ResultsThe response rate of the questionnaire was 37% and 136 responses were received. The developers who responded were experienced workers; 81% of the respondents had 6 years or more of work experience in IT systems development and 35% of them had 6 years or more of work experience in the healthcare domain. Almost three-quarters (72%) of the respondents agreed with the statement ‘I work with users’. Almost all the developers (90%) thought that they are interested in user feedback and also 81% thought that they take the end users’ opinions and experiences into account when developing software. A majority of the developers (57%) considered that corrections and modifications are currently not implemented quickly enough. The most popular means of user participation were that ‘users would present their work and needs related to it in their workplace’ (76%), followed by user groups (75%). The developers suggested many traditional user-centered and usability design methods, too.The developers’ views were compared to the views of the physicians who primarily used the case company's products. The views were in direct opposition on whether developers are interested in end users’ views (90% of the developers agreed, vs. 60% of the physicians disagreed) and take them into account (81% of the developers agreed, vs. 63% of the physicians disagreed), as well as on user groups (favored by 75% of the developers vs. 14% of the physicians). The majority of the respondents, both developers (57%) and physicians (74%), were dissatisfied with the pace of implementation of corrections and modifications.ConclusionsBoth physicians and developers seem to be “willing but not able” to collaborate with each other. Possible reasons for the differences in views include the fact that there is no return channel of communication on what happened to the end users’ feedback, and that developers collaborate with customer representatives who are not end users. It is obvious that there are one or more spots along the route between the “end developers” and end users where there is a breakdown of the information flow.     

Motives for Participating in a Web-Based Nutrition Cohort According to Sociodemographic,Lifestyle, and Health Characteristics: The NutriNet-Santé Cohort Study

Background

In traditional epidemiological studies, participants are likely motivated by perceived benefits, feelings of accomplishment, and belonging. No study has explored motives for participation in a Web-based cohort and the associated participant characteristics, although such information is useful for enhancing recruitment and improving cohort retention.

Objective

We aimed to evaluate the relationships between motives for participation and sociodemographic, health, and lifestyle characteristics of participants in the NutriNet-Santé Web-based cohort, designed to identify nutritional risk or protective factors for chronic diseases.

Methods

The motives for participation were assessed using a specifically developed questionnaire administered approximately 2 years after baseline. A total of 6352 completed the motives questionnaire (43.34%, 6352/15,000 randomly invited cohort participants). We studied the associations between motives (dependent variables) and individual characteristics with multivariate multinomial logistic regression models providing odds ratios and 95% confidence intervals.

Results

In total, 46.45% (2951/6352) of participants reported that they would not have enrolled if the study had not been conducted on the Internet, whereas 28.75% (1826/6352) were not sure. Men (OR 1.21, 95% CI 1.04-1.42), individuals aged 26-35 years (OR 1.51, 95% CI 1.20-1.91), and obese participants (OR 1.30, 95% CI 1.02-1.65) were more inclined to be motivated by the Internet aspect. Compared with younger adults and managerial staff, individuals >55 years (OR 0.60, 95% CI 0.48-0.45) and employees/manual workers were less likely motivated by the Internet aspect (OR 0.77, 95% CI 0.63-0.92). Regarding reasons for participation, 61.37% (3898/6352) reported participating to help advance public health research on chronic disease prevention; 22.24% (1413/6352) to help advance nutrition-focused research; 6.89% (438/6352) in response to the call from the media, after being encouraged by a close friend/associate, or a medical provider. Individuals >45 years (vs younger participants) were more likely (OR 1.62, 95% CI 1.07-2.47), whereas overweight and obese participants (vs nonobese participants) were less likely to participate in the study for reasons related to helping public health research on chronic disease prevention (OR 0.72, 95% CI 0.58-0.89; OR 0.62, 95% CI 0.46-0.84; respectively). Exclusive public funding of the study was important for 67.02% (4257/6352) of the participants. Men (OR 1.37, 95% CI 1.17-1.61) and persons >55 years (OR 1.97, 95% CI 1.57-2.47) were more likely to consider the exclusive public funding as very important.

Conclusions

The use of the Internet, the willingness to help advance public health research, and the study being publicly funded were key motives for participating in the Web-based NutriNet-Santé cohort. These motives differed by sociodemographic profile and obesity, yet were not associated with lifestyle or health status. These findings can help improve the retention strategies in Web-based cohorts, particularly during decisive study periods when principal exposure information is collected.     

Patient preferences and performance bias in a weight loss trial with a usual care arm

Objectives

This qualitative study examines performance bias, i.e. unintended differences between groups, in the context of a weight loss trial in which a novel patient counseling program was compared to usual care in general practice.

Methods

14/381 consecutive interviewees (6 intervention group, 8 control group) within the CAMWEL (Camden Weight Loss) effectiveness trial process study were asked about their engagement with various features of the research study and a thematic content analysis undertaken.

Results

Decisions to participate were interwoven with decisions to change behavior, to the extent that for many participants the two were synonymous. The intervention group were satisfied with their allocation. The control group spoke of their disappointment at having been offered usual care when they had taken part in the trial to access new forms of help. Reactions to disappointment involved both movements toward and away from behavior change.

Conclusion

There is a prima facie case that reactions to disappointment may introduce bias, as they lead the randomized groups to differ in ways other than the intended experimental contrast.

Practice implications

In-depth qualitative studies nested within trials are needed to understand better the processes through which bias may be introduced.     

Treatment possibilities for individuals at clinical high risk of psychosis

Aim: The purpose of this study was to undertake a first step in trying to understand the types of treatments young people at clinical high risk of psychosis are interested in pursuing. Methods: The sample consisted of 30 young people who were current participants in the ongoing North American Prodrome Longitudinal Study (NAPLS 2) and who met criteria for being at clinical high risk for psychosis. Participants were administered a questionnaire that asked them to identify the types of mental health problems they were currently getting help with or would like to get help with and the types of treatments they thought would be helpful and may be interested in receiving. Results: Results showed that when individuals first began participation in NAPLS, almost half had no expectations for treatment. They wanted help but they did not really know what kind of help to be asking for. Participants had a wide range of concerns for which they wanted help. Although a majority endorsed attenuated positive symptoms as a concern, many other issues such a family and social problems were often identified. For those who were already receiving help, the general opinion was that it was beneficial. Conclusions: The findings suggest that this population sees many different interventions as being potentially helpful. Furthermore, they are open to participating in a variety of treatments, including psychotherapeutic and psychiatric interventions as well as more general treatments addressing a range of possible deficits or difficulties.     

Measurement properties of a modified measure of participation for persons with spinal cord injury

Objective: The primary aim of this study was to examine and refine a modified measure of participation for adults with spinal cord injury (SCI) based on a conceptual model of participation.

Method: This study involved secondary analysis of data from a larger study designed to identify a standard measure of participation for use in SCI research. The larger study recruited 634 community-dwelling adults with SCI from seven collaborating SCI Model Systems Centers, of whom 520 subjects (average age 45.1 ± 13.6 years, 76% were male) completed the survey that is the focus of the present analysis. Content review, confirmatory factor analysis (CFA), Rasch analysis, and precision analysis were employed to select the items for the modified participation measure.

Results: Three participation domains were supported: Productivity, Social, and Community, that displayed good model-fit (CFI=0.984, TLI=0.982, RMSEA=0.043) in CFA and good item-fit (infit= 0.6 to 1.4) in Rasch analysis. Differential Item Functioning (DIF) was found in one item, however its magnitude was small. The precision of each scale was better for participants in the middle range of participation and was lower for participants with extremely low or high participation.

Conclusion: The study results support the proposed three-dimensional construct of participation by demonstrating good model-fit and item-fit. Ongoing efforts are needed to expand the domain coverage and increase the precision of the instrument.     

Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life

Objective: This exploratory study describes the problematic secondary health conditions among adults with a spinal cord injury (SCI) and the impact these health concerns have on social participation and daily life.

Design: Cross-sectional survey design.

Setting: A community-based rehabilitation program within the United States.

Participants: Fifty-six adults (33 males and 23 females; age 18 to 73 [M?=?39.4, SD?=?12.7]) with SCI participating in the community-based rehabilitation program.

Methods: Subjects identified the top five problematic secondary health conditions related to his/her SCI, belief about the impact these conditions have on social participation and daily life, and if they believed the secondary health condition(s) were avoidable.

Results: The top problematic areas identified were bladder control, pain, bowel control, and pressure ulcers, and 73% felt these problems were unavoidable. In addition, more than 66% had each of these problems continuously during the last 12 months. When examining the impact of the problematic secondary health conditions, 75% identified that the primary problem had a significant impact on social participation and 64% identified it significantly impacted daily life.

Conclusion: Although the majority of the participants were actively participating in a community-based rehabilitation wellness program, it appears that they thought engagement in social participation and daily life were negatively impacted by the secondary health conditions and unavoidable. The results suggested unfulfilled goals despite the emphasized efforts of medical providers to help manage the secondary conditions. Future research should examine why individuals with SCI still have a difficult time managing secondary health conditions.     

糖尿病教育中态度与认知、技能、习惯改变的关系研究

目的:研究糖尿病教育中态度与认知、技能、习惯改变的关系。方法:采用自愿的原则在本院选择符合标准的2型糖尿病患者66例,按随机数字表法分为家属参与组和非家属参与组,对所有糖尿病患者和参与的家属进行相同的糖尿病教育、饮食行为试验及团体治疗,并对两组糖尿病患者管理前后参与态度、认知能力、技能、饮食习惯及血糖、血压、血脂等指标进行对比分析;对两组管理后,按态度得分重新分成态度高、低分两组,研究参与态度对认知能力、技能、习惯、客观指标等的影响。结果:态度高分组在技能改变、监测血糖习惯、良好饮食习惯、其他健康生活习惯等方面均优于态度低分组,差异均有统计学意义(P0.05);管理后态度高低分两组的客观指标比较差异无统计学意义(P0.05);家属参与组高态度得分率均优于非家属参与组,差异均有统计学意义(P0.05)。结论:糖尿病教育中态度与技能、习惯改变呈正相关;态度与临床血糖各种控制指标可能存在正相关;家属参与的糖尿病患者态度改变更积极。     

TPM在制药企业设备维修管理中的应用介绍

设备维修管理是现代制药企业生产和经营管理的重要基础,传统的设备维修管理模式存在诸多不适应企业发展需求的问题,企业需要改进原有的设备管理模式以适应日益激烈的市场竞争。TPM作为一种先进的设备维修管理模式,在中国现代制药企业设备管理中必将发挥重要的作用。分析了TPM的内涵与潜质,介绍了企业实施TPM的方法和实现目标,探讨了TPM在制药企业中的具体应用并对如何实施TPM提出相应的解决方案。