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Objective: The patient perspective workshops at the Outcome Measures in Rheumatology Clinical Trials have included daily measures of health status (patient diary) and use of electronic tools for data collection in the research agenda. The objective of this study was to compare daily and weekly registrations of self-reported health status measures between personal digital assistant (PDA) and paper-pencil (PP) format regarding scores, variation, and feasibility., Methods: Thirty-eight patients with stable rheumatoid arthritis recorded their health status during 84 days in a repeated crossover design, using PDA or PP format during four 21-day periods. Visual analog scales (VAS) for pain, fatigue, and global disease and the Rheumatoid Arthritis Disease Activity Index were scored daily; the Short Form 36 and Modified Health Assessment Questionnaire were scored weekly., Results: The average scores and measures of variation of the 4 daily health status measures over 21 days did not differ significantly between PDA and PP formats in either of the 2 crossover periods. The values for the average range between the maximum and minimum values for daily measures were similar between the 2 formats, but showed considerable variation (e.g., range for pain VAS was 19-28 mm over each 21-day period). The time to complete the instruments was similar between the 2 formats. Missing daily data entries were generally low for both periods and somewhat higher for PDA. The majority of patients (82.9%) preferred using PDA., Conclusion: Daily assessments with PDA may be efficiently used for frequent data collection because this format performs similarly to the traditional PP format.

As obesity and physical inactivity rates continue to rise in the United States, Kentucky ranks third in childhood obesity rates (10‐17 year olds) and 50th in physical inactivity. The public school environment is a logical place to examine practices and closely discern how time is spent. Federal legislation over the past 50 years has largely dictated the emphasis and priority of our public education system and how schools are funded and assessed. Recently, new federal legislation, the Every Student Succeeds Act (ESSA) of 2015, moved more power, flexibility, and accountability to the states allowing for additional funding opportunities surrounding not just reading and mathematics standardized test scores. Kentucky made promising steps toward including a well‐rounded education in their accountability plan, however; ultimately removed those measures in their revised submission to the US Education Department. We must reexamine our current priorities and policies based on evidence‐based best practices regarding health, physical activity, and academic achievement. This report outlines history, issues, and policy solutions which will move Kentucky's youth toward better opportunities for quality physical activity in our public schools within our current resources. [ABSTRACT FROM AUTHOR]

The article announces the papers that won the "Stress and Health" Top Papers Award 2021, including "Work From Home Today for a Better Tomorrow! How Working From Home Influences Work-Family Conflict and Employees' Start of the Next Workday," "Midlife Family Financial Strain, Sense of Control and Pain in Later Years: An Investigation of Rural Husbands and Wives," and "Effectiveness of a Low-dose Mindfulness-based Intervention for Alleviating Distress in Young Unemployed Adults."

Background: A person‐centred approach in the context of health services delivery implies a biopsychosocial model focusing on all factors that influence the person's health and functioning. Those wishing to monitor change should consider this perspective when they develop and use guidelines to stimulate active consideration of the person's needs, preferences and participation in goal setting, intervention selection and the use of appropriate outcome measures. Objective: To develop a position paper that promotes a person‐centred approach in guideline development and implementation. Design, setting and participants: We used three narrative discussion formats to collect data for achieving consensus: a nominal group technique for the Allied Health Steering Group, an Internet discussion board and a workshop at the annual G‐I‐N conference. We analysed the data for relevant themes to draft recommendations. Results: We built the position paper on the values of the biopsychosocial model. Four key themes for enhancing a person‐centred approach in clinical guidelines emerged: (i) use a joint definition of health‐related quality of life as an essential component of intervention goals, (ii) incorporate the International Classification of Functioning, Disability and Health (ICF) as a framework for considering all domains related to health, (iii) adopt a shared decision‐making method, and (iv) incorporate patient‐reported health outcome measures. The position statement includes 14 recommendations for guideline developers, implementers and users. Conclusion: This position paper describes essential elements for incorporating a person‐centred approach in clinical guidelines. The consensus process provided information about barriers and facilitators that might help us develop strategies for implementing person‐centred care. [ABSTRACT FROM AUTHOR]

The article discusses information about the 27th Sociology of Health and Illness Monograph. Topics covered include the emergence of the construct of overdiagnosis, the impact of diagnostic, prognostic, and treatment uncertainty on the lay-professional interface, and organisational and health system level responses to uncertainty.

Background: People with intellectual disabilities are more likely to experience sleep problems, which can affect quality of life, physical health, mental health and well‐being. Methods: An integrative literature review was conducted to investigate what is known about behavioural sleep disturbances in people with an intellectual disability. The search used the following databases: Scopus, PsycInfo and Cinahl, to find papers published since 2015. Results: Within intellectual disability research, sleep appears as a common issue due to its high prevalence, negative relationships with an individual's physical and mental health, their quality of life, and impact of sleep problems on family or carers. The growing evidence base appears to support the use of behavioural, lifestyle and pharmacological interventions to improve sleep in people with an intellectual disability. Conclusion: A wide array of literature provides evidence that people with intellectual disabilities are affected by and need support with their sleep. [ABSTRACT FROM AUTHOR]

Introduction: Associations between structural inequalities and health are well established. However, there is limited work examining this link in relation to mental health, or that centres public perspectives. This study explores people's experience and sense‐making of inequality in their daily lives, with particular consideration of impacts on mental health. Methods: We conducted a peer research study. Participants had to live in one of two London Boroughs and have an interest in inequalities and mental health. Using social media, newsletters, local organisations and our peer researchers' contacts, we recruited 30 participants who took photos representing their experience of inequality and discussed them during semi‐structured interviews. Data were analysed using reflexive thematic analysis. Results: Three themes were identified in this study: (1) inequalities are unjust, multilayered and intertwined with mental health. Accounts demonstrated a deep understanding of inequalities and their link to mental health outcomes, describing inequalities as 'suffering' and 'not good for anyone'. Financial, housing, immigration and healthcare problems exacerbated poor mental health, with racism, gender‐based violence and job loss also contributing factors for both poor mental health and experiences of inequality; (2) inequalities exclude and have far‐reaching mental health consequences, impacting personal sense of belonging and perceived societal value and (3) moving forwards—addressing long‐standing inequality and poor public mental health necessitated coping and resilience strategies that are often unacknowledged and undervalued by support systems. Conclusion: Lived experience expertise was central in this study, creating an innovative methodological approach. To improve public mental health, we must address the everyday, painful structural inequalities experienced by many as commonplace and unfair. New policies and strategies must be found that involve communities, redistributing resources and power, building on a collective knowledge base, to coproduce actions combatting inequalities and improving population mental health. Patient or Public Contribution: This study was peer‐led, designed and carried out by researchers who had experiences of poor mental health. Six authors of the paper worked as peer researchers on this study. [ABSTRACT FROM AUTHOR]

Background: This study examines the perceptions of the Australian public canvassed in 2021 during the COVID‐19 pandemic about their health system compared to four previous surveys (2008, 2010, 2012 and 2018). Methods: In 2021, a nationwide online survey was conducted with a representative sample of Australians (N = 5100) recruited via market research panels. The results were compared to previous nationwide Australian survey samples from 2018 (N = 1024), 2012 (N = 1200), 2010 (N = 1201) and 2008 (N = 1146). The survey included questions consistent with previous polls regarding self‐reported health status and overall opinions of, and confidence in, the Australian health system. Results: There was an increase in the proportion of respondents reporting positive perceptions at each survey between 2008 and 2021, with a significantly higher proportion of respondents expressing a more positive view of the Australian healthcare system in 2021 compared to previous years (χ2(8, N = 9645) = 487.63, p < 0.001). In 2021, over two‐thirds of respondents (n = 3949/5100, 77.4%) reported that following the COVID‐19 pandemic, their confidence in the Australian healthcare system had either remained the same (n = 2433/5100, 47.7%) or increased (n = 1516/5100, 29.7%). Overall, respondents living in regional or remote regions, younger Australians (< 45 years) and women held less positive views in relation to the system. In 2021, the most frequently identified area for urgent improvement was the need for more healthcare workers (n = 1350/3576, 37.8%), an area of concern particularly for Australians residing in regional or remote areas (n = 590/1385, 42.6%). Conclusions: Irrespective of disruptions to the Australian healthcare system caused by the COVID‐19 pandemic, Australians' perceptions of their healthcare system were positive in 2021. However, concerns were raised about inadequate workforce capacity and the cost of healthcare, with differences identified by age groups and geographical location. Patient or Public Contribution: Health consumer representatives from the Consumers Health Forum of Australia contributed to the co‐design, deployment, analysis and interpretation of the results of this survey. J.A. and L.W. from the Consumers Health Forum of Australia contributed to the development of the paper. [ABSTRACT FROM AUTHOR]

Objective: Although Ireland has one of the highest levels of well‐being in Europe, having a health condition has been found to have a direct negative impact. The aim of this study is to evaluate the current situation and the experiences of patients with epidermolysis bullosa (EB), a rare genetic skin disease, and their relatives living in Ireland, with a focus on burdens and helpful practices. Methods and Measures: In a mixed‐methods design, a series of standardised questionnaires were combined with open‐ended questions. Via an online survey, data from n = 59 EB patients and relatives of EB patients living in Ireland were collected. Results: EB affects both the patients and their relatives. Burdens were found in relation to the visibility of EB, the degree of severity, the current health status, reduced mobility, the financial impact of EB, the psychosocial impact and personal and social resources. The paper also analyses existing resources and highlights opportunities for support and needs of improvement. Conclusion: Quality of life with EB is influenced by somatic symptoms and the psychosocial burden. Individual helpful practices in dealing with this rare disease can be considered as mediators, but they need to be supported by structural and healthcare improvements. Patient or Public Contribution: The perspective of EB patients, their relatives and EB experts were taken into account in the development of the study design via two feedback loops with the EB patient organisations DEBRA Ireland and DEBRA Austria. The design was adapted accordingly. Additionally, by including open‐ended questions, patients and relatives could contribute their individual perspectives and add insights into their lives with EB that might not have been captured with the structured online survey alone. [ABSTRACT FROM AUTHOR]

Introduction: Parent carers of children with special educational needs or disabilities are at risk of poorer health and wellbeing outcomes because of the distinct and challenging circumstances they face. Evaluations of interventions promoting the health of parent carers should focus on measuring the aspects of health and wellbeing which are most relevant to this group. As part of a programme of research on parent carer‐focused interventions, this study aimed to understand which aspects of health and wellbeing are perceived by parent carers as most meaningful and important. Methods: A qualitative study using semistructured online interviews was conducted. A purposive sample of parent carers was interviewed about relevant health and wellbeing outcomes. Transcripts were analysed thematically. Results: Thirty parent carers were interviewed, 19 of whom had experienced a health‐promoting intervention, either as participants (n = 14) or facilitators (n = 5). Three main themes were identified: 'self, identity and beliefs'; 'social connections and support' and 'health‐promoting practices and outcomes.' Each theme encompassed the challenges participants faced, and the changes that helped them overcome these challenges. 'Self‐identity' challenges focused on the overwhelming nature of the parental care role and the emotional impact of this. Changes were brought about by developing a positive mindset, increasing confidence, and reconnecting with aspects of their identity which were important to them before they became parent carers. Challenges related to 'social connections' reflected parent carers' isolation. Change was brought about through increased peer support and peer interactions. Parent carers experienced challenges in terms of 'health‐promoting activities' because they lacked free time and experienced poor physical health. Changes were brought about by engagement in health‐promoting activities of various kinds. Conclusion: Parent carers view health and wellbeing in terms of overcoming the common challenges they face as a group. These challenges reflect the ways in which their physiological and psychological needs are often unmet. Researchers interested in measuring parent carer health and wellbeing should consider the specific challenges this group face, as well as theoretical frameworks which can make sense of these challenges, such as self‐determination theory. Patient or Public Contribution: Our team carries out patient and public involvement (PPI) through a Family Faculty group facilitated by a Family Involvement Co‐ordinator (A. McD.) who is herself a parent carer. A study‐specific PPI working group was established which included members of the Family Faculty. The PPI group advised on various aspects of the research as reported in the paper. The manuscript was co‐authored by the team's Family Involvement Co‐ordinator (A. McD.). [ABSTRACT FROM AUTHOR]

Objectives: To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca. Design: A scoping review was applied. Papers published in English between 2012 and 2023 were included but non‐human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence. Results: The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non‐communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively. Conclusion: Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non‐ and communicable‐diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca. [ABSTRACT FROM AUTHOR]

This paper critically comments on the state of affairs in the UK relating to the pandemic and explores how a focus on inequities experienced by marginalized and vulnerable groups is necessary for exposing the material realties of everyday life, but also how such a focus has been hijacked by center right politics to distract us from collective responsibilities and building alliances for systemic change. The paper critically reviews the impact of the COVID‐19 pandemic on the most marginalized and vulnerable in UK society and highlights the interconnected risk factors of COVID‐19 and its secondary impacts to demonstrate how these are linked to political ideology, policy, and practice. We conclude with recommendations informed through a looking back at the key tenants and purposes of universal healthcare to apprise what is needed in this moment of crisis and beyond. [ABSTRACT FROM AUTHOR]

Introduction: There are over 3.81 billion worldwide active social media (SoMe) users. SoMe are ubiquitous in medical education, with roles across undergraduate programmes, including professionalism, blended learning, well being and mentoring. Previous systematic reviews took place before recent explosions in SoMe popularity and revealed a paucity of high‐quality empirical studies assessing its effectiveness in medical education. This review aimed to synthesise evidence regarding SoMe interventions in undergraduate medical education, to identify features associated with positive and negative outcomes. Methods: Authors searched 31 key terms through seven databases, in addition to references, citation and hand searching, between 16 June and 16 July 2020. Studies describing SoMe interventions and research on exposure to existing SoMe were included. Title, abstract and full paper screening were undertaken independently by two reviewers. Included papers were assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) and/or the Standards for Reporting Qualitative Research (SRQR) instrument. Extracted data were synthesised using narrative synthesis. Results: 112 studies from 26 countries met inclusion criteria. Methodological quality of included studies had not significantly improved since 2013. Engagement and satisfaction with SoMe platforms in medical education are described. Students felt SoMe flattened hierarchies and improved communication with educators. SoMe use was associated with improvement in objective knowledge assessment scores and self‐reported clinical and professional performance, however evidence for long term knowledge retention was limited. SoMe use was occasionally linked to adverse impacts upon mental and physical health. Professionalism was heavily investigated and considered important, though generally negative correlations between SoMe use and medical professionalism may exist. Conclusions: Social media is enjoyable for students who may improve short term knowledge retention and can aid communication between learners and educators. However, higher‐quality study is required to identify longer‐term impact upon knowledge and skills, provide clarification on professionalism standards and protect against harms. Two sides of the coin: With this systematic review, the authors synthesize evidence demonstrating how #SoMe can improve outcomes despite ongoing questions about professionalism [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to analyse the status, hotspots and trends of research on oral care for the elderly in mainland China in the past 20 years through bibliometrics, which aims to provide new ideas and targets for future clinical work and research. Design: Bibliometric analysis. Methods: Relevant literature was retrieved from China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, Web of Science and PubMed. NoteExpress, Co‐Occurrence and CiteSpace were used to analyse bibliometric features in terms of year of publication, journal of publication, authors, institution and keywords. Results: A total of 716 related articles were obtained. The number of publications shows an increasing trend over time, only 2017–2021; 309 papers were published, accounting for 43.2% of the total number of publications. A total of 238 articles were published in Science Citation Index journals or Chinese core journals, accounting for 33.2% of the total number of articles. The study of oral health‐related quality of life in the elderly is a hot research topic. There is a lack of research on the elderly living in elderly care facilities. [ABSTRACT FROM AUTHOR]

Introduction: Those with severe and enduring mental ill health are at greater risk of long‐term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research. Methods: The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted. Results: This priority setting exercise guided by people's needs and lived experience has produced a set of well‐defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities. Conclusions: Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health. Patient or Public Contribution: This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops. [ABSTRACT FROM AUTHOR]

This paper addresses normative issues that arise in relation to indicators and measures of health impact. With inspiration from Nicole Hassoun's recent proposal, the paper argues and illustrates that those interested in measuring global health impact face questions about how to prioritize among those with ill‐health, how to weigh benefits to those who cannot lead minimally good lives against benefits to the better off, and how to think about whether someone is badly off. [ABSTRACT FROM AUTHOR]

Introduction: Stakeholder engagement remains scarce in basic brain research. However, it can greatly improve the relevance of investigations and accelerate the translation of study findings to policy. The Lifebrain consortium investigated risk and protective factors influencing brain health using cognition, lifestyle and imaging data from European cohorts. Stakeholder activities of Lifebrain—organized in a separate work package—included organizing stakeholder events, investigating public perceptions of brain health and dissemination. Here, we describe the experiences of researchers and stakeholders regarding stakeholder engagement in the Lifebrain project. Methods: Stakeholder engagement in Lifebrain was evaluated through surveys among researchers and stakeholders and stakeholders' feedback at stakeholder events through evaluation forms. Survey data were analysed using a simple content analysis approach, and results from evaluation forms were summarized after reviewing the frequency of responses. Results: Consortium researchers and stakeholders experienced the engagement activities as meaningful and relevant. Researchers highlighted that it made the research and research processes more visible and contributed to new networks, optimized data collection on brain health perceptions and the production of papers and provided insights into stakeholder views. Stakeholders found research activities conducted in the stakeholder engagement work package to be within their field of interest and research results relevant to their work. Researchers identified barriers to stakeholder engagement, including lack of time, difficulties in identifying relevant stakeholders, and challenges in communicating complex scientific issues in lay language and maintaining relationships with stakeholders over time. Stakeholders identified barriers such as lack of budget, limited resources in their organization, time constraints and insufficient communication between researchers and stakeholders. Conclusion: Stakeholder engagement in basic brain research can greatly benefit researchers and stakeholders alike. Its success is conditional on dedicated human and financial resources, clear communication, transparent mutual expectations and clear roles and responsibilities. Public Contribution: Patient organizations, research networks, policymakers and members of the general public were involved in engagement and research activities throughout the project duration. [ABSTRACT FROM AUTHOR]

Background: Lifestyle has become a major and well‐recognized aspect of modern healthcare, but there is little awareness of the origins of lifestyle medicine. Results: This paper shows that a major contribution to lifestyle medicine was made by Greco‐Roman physicians. Ancient Greek and Roman doctors placed considerable emphasis on the role lifestyle played in determining the state of their patients' health. [ABSTRACT FROM AUTHOR]

Background: Dysphagia impacts negatively on quality of life, however there is little in‐depth qualitative research on these impacts from the perspective of people with dysphagia. Aims: To examine the lived experiences and views of people with lifelong or ongoing dysphagia on the impacts of dysphagia and its interventions on quality of life, and barriers and facilitators to improved quality of life related to mealtimes. Methods & Procedures: Nine adults with lifelong or acquired chronic dysphagia engaged in in‐depth interviews and a mealtime observation. The observations were recorded and scored using the Dysphagia Disorders Survey (DDS). Interviews were recorded, transcribed and de‐identified before content thematic and narrative analysis, and verification of researcher interpretations. Outcomes & Results: Participants presented with mild to severe dysphagia as assessed by the DDS. They viewed that dysphagia and its interventions reduced their quality of life and that they had 'paid a high price' in terms of having reduced physical safety, reduced choice and control, poor mealtime experiences, and poor social engagement. As part of their management of dysphagia, participants identified several barriers to and facilitators for improved quality of life including: being involved in the design of their meals, being adaptable, having ownership of swallowing difficulties, managing the perceptions of others and resisting changes to oral intake. Conclusions & Implications: This research improves understanding of the primary concerns of people with dysphagia about their mealtime experiences and factors impacting on their quality of life. Clinicians working with people with dysphagia need to consider how self‐determination, autonomy and freedom of choice could be improved through involvement in food design of texture‐modified foods. It is important that future research considers the views of health professionals on how these findings could impact on policy and practice particularly in ways to address the barriers and enhance facilitators to improved quality of life for people with dysphagia. What this paper adds: What is already known on the subject: Dysphagia impacts on quality of life, particularly as the severity of the dysphagia increases. Research to date has focused on people with dysphagia associated with an acquired health condition and has used quantitative assessment methods to measure quality of life. What this paper adds to existing knowledge: This study provides a qualitative examination of the impacts of dysphagia on quality of life from the perspective of people with lifelong or ongoing acquired dysphagia and their supporters. This study also provides qualitative insights into the barriers and facilitators of mealtime‐related quality of life. What are the potential or actual clinical implications of this work?: Health professionals should engage in open communication with their clients with dysphagia regarding the impacts of dysphagia on their lifestyle and quality of life. By considering these impacts, health professionals may be able to recommend interventions that are more acceptable to the person with the dysphagia which may have a positive impact on their mealtime experience. [ABSTRACT FROM AUTHOR]

This paper by Le et al. (2020) is a valuable addition to the literature because it provides evidence regarding the trajectories of health‐related quality of life (HRQoL) in children with language disorders from the ages of 4–13 years. The authors found that higher language scores were associated with better HRQoL particularly in the school and social domains. Of the children in the low language group, 40% were in the stable‐high HRQoL trajectory, while the others were in the reduced‐slow‐decline (26%) and low‐rapid‐decline (34%) HRQoL groups. Despite the prevalence of language disorder and its impact on many aspects of children's everyday lives, many professionals and members of the public are still unaware of this condition and its potential consequences. The publication of the Le et al. (2020) paper is timely because it coincides with a call to action to support these children by McGregor (2020). McGregor (2020) argued that we fail children with developmental language disorders both in terms of research and service provision. In her recent discussion paper, she provided evidence that these children face significant risks with regard to academic achievement: they are 6 times more likely to have reading disabilities, 6 times more likely to have spelling difficulties, 4 times more likely to have difficulties with mathematics and 12 times more likely to present with all three difficulties. [ABSTRACT FROM AUTHOR]

Background: The Successful Aging after Elective Surgery (SAGES) II Study was designed to examine the relationship between delirium and Alzheimer's disease and related dementias (AD/ADRD), by capturing novel fluid biomarkers, neuroimaging markers, and neurophysiological measurements. The goal of this paper is to provide the first complete description of the enrolled cohort, which details the baseline characteristics and data completion. We also describe the study modifications necessitated by the COVID‐19 pandemic, and lay the foundation for future work using this cohort. Methods: SAGES II is a prospective observational cohort study of community‐dwelling adults age 65 and older undergoing major non‐cardiac surgery. Participants were assessed preoperatively, throughout hospitalization, and at 1, 2, 6, 12, and 18 months following discharge to assess cognitive and physical functioning. Since participants were enrolled throughout the COVID‐19 pandemic, procedural modifications were designed to reduce missing data and allow for high data quality. Results: About 420 participants were enrolled with a mean (standard deviation) age of 73.4 (5.6) years, including 14% minority participants. Eighty‐eight percent of participants had either total knee or hip replacements; the most common surgery was total knee replacement with 210 participants (50%). Despite the challenges posed by the COVID‐19 pandemic, which required the use of novel procedures such as video assessments, there were minimal missing interviews during hospitalization and up to 1‐month follow‐up; nearly 90% of enrolled participants completed interviews through 6‐month follow‐up. Conclusion: While there are many longitudinal studies of older adults, this study is unique in measuring health outcomes following surgery, along with risk factors for delirium through the application of novel biomarkers—including fluid (plasma and cerebrospinal fluid), imaging, and electrophysiological markers. This paper is the first to describe the characteristics of this unique cohort and the data collected, enabling future work using this novel and important resource. [ABSTRACT FROM AUTHOR]

Introduction: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities may have inequalities in hospital admissions compared with the general population. The present authors aimed to investigate admissions for physical health conditions in this population. Methods: The present authors conducted a systematic review, searching six databases using terms on intellectual disabilities and hospital admission. Papers were selected based on pre‐defined inclusion/exclusion criteria, data extracted, tabulated and synthesized and quality assessed. PROSPERO registration number: CRD42015020575. Results: Seven of 29,613 papers were included. There were more admissions, and a different pattern of admissions (more medical and dental), for people with intellectual disabilities, but most studies did not take account of higher disease prevalence. Three papers considered admissions for ambulatory care‐sensitive conditions, two of which accounted for disease prevalence (asthma, diabetes) and found higher admission rates for people with intellectual disabilities. Conclusion: Admissions are common. Asthma and diabetes admission data suggest suboptimal primary health care for people with intellectual disabilities compared with the general population, but evidence is limited. [ABSTRACT FROM AUTHOR]

We chose to respond to this paper because bad things are happening in health care for people with intellectual disabilities. We met with Chris Hatton, one of the authors of the article. There were things we liked about the article, things we liked about the study that were not in the article and things we asked Chris about. We enjoyed talking to Chris about the study and writing our response. [ABSTRACT FROM AUTHOR]

Background: In an Australian randomized controlled trial (RCT), two techniques for intrapartum fetal surveillance were compared: ST analysis (STan) as an adjunct to cardiotocography (CTG), compared with CTG alone. The aim was to determine whether CTG + STan could reduce emergency cesarean birth rates while maintaining or improving neonatal outcomes. Secondary aims were to compare clinical, economic, and psychosocial outcomes. The purpose of this paper was to present psychosocial outcomes from one cohort enrolled in the trial. Methods: The study was conducted at one tertiary referral hospital. Participants who had taken part in the trial from the outset were invited to complete a questionnaire between March 2018 and January 2020, approximately 8 weeks after giving birth. Outcomes included depression, psychological distress, health‐related quality of life, and infant feeding practices. Analysis was by intention to treat. Results: N = 207/527 participants completed the questionnaire (n = 113, STan; n = 94, CTG alone). Overall, no statistically significant or clinically meaningful differences were found in the two groups for symptoms of depression, psychological distress, quality of life, or infant feeding. A statistically significant difference was observed for the subscale of pain‐discomfort, where scores were higher on average in the CTG alone arm relative to that in the CTG + STan arm. Conclusions: Although STan as an adjunct to CTG constitutes a different clinical technology from CTG alone, both monitoring types appeared to produce similar results in terms of postnatal psychosocial outcomes for women. Findings from this study provide service users and staff with a comprehensive assessment of STan that can be used to make evidence‐informed decisions about monitoring options should STan become more widely available. [ABSTRACT FROM AUTHOR]

In competitive and elite sports, mental health and athletic performance cannot be considered separately. Mental disorders in sports are bidirectionally associated with reduced athletic performance. A decline in performance, both within and outside of sport, can be a sign of mental disorder. Additionally, poor athletic performance is a potential risk factor for mental disorders in athletes. The central role sports psychiatrists play in the mental health of athletes is well‐established. However, their role in athletic performance is less well‐described and more controversial, perhaps due to a perception that performance is purely a secondary outcome of good mental health. This paper discusses the role that sports psychiatrists can play in athletic performance within competitive and elite sports. Performance can be distinguished into three key focus areas for sports psychiatrists: (i) performance restoration, (ii) performance maintenance, and (iii) performance enhancement. These should be considered throughout the continuum of mental health care, from prevention, treatment, to ongoing care for mental disorders. When reduced performance is due to a mental disorder, psychiatric treatment should purposefully aim to restore functioning and performance as part of management. Maintenance of performance is, similarly, an important element of the prevention, psychiatric treatment, and ongoing care of mental disorders. Holistic sports psychiatrists may also choose to aim for athletic performance enhancement beyond the context of mental health symptoms and disorders, to help athletes flourish and achieve their goals. [ABSTRACT FROM AUTHOR]

This paper takes a critical look at the role of chronobiology in society today, with particular reference to its entanglements with health and medicine and whether or not this amounts to the (bio)medicalisation of our bodily rhythms. What we have here, we show, is a complex unfolding storyline, within and beyond medicine. On the one hand, the promises and problems of these circadian, infradian and ultradian rhythms for our health and well‐being are now increasingly emphasised. On the other hand, a variety of new rhythmic interventions and forms of governance are now emerging within and beyond medicine, from chronotherapies and chronopharmacology to biocompatible school and work schedules, and from chronodiets to the optimisation of all we do according to our 'chronotypes'. Conceptualising these developments, we suggest challenges us to think within and beyond medicalisation to wider processes of biomedicalisation and the biopolitics of our body clocks: a vital new strand of chronopolitics today indeed which implicates us all in sickness and in health as the very embodiment of these rhythms of life itself. The paper concludes with a call for further research on these complex unfolding relations between chronobiology, health and society in these desynchronised times of ours. [ABSTRACT FROM AUTHOR]

Objective To conduct a systematic appraisal of the published literature reviews related to the impact of cancer on everyday life. This theme was identified as the top priority area for research by participants in the Macmillan Listening Study, which was the first UK-wide public consultation exercise to identify patients' priorities for cancer research. Search strategy The top priority area was divided into ten sub-themes, and a modified systematic review was undertaken for each sub-theme using electronic searches. Inclusion criteria Literature review papers were included if they were written in English, involved patients diagnosed ≥18 years, any cancer types and published between 2000 and 2006. Data extraction and synthesis Two thousand and two hundred and fifty-two potentially eligible papers were identified. Abstracts were read by the first author and selected for inclusion in the review. Twenty percentages of the papers were also read independently by other authors. Sixty-two review papers were finally selected. Main results The systematic appraisal revealed that some sub-themes of the patient-identified priority area (e.g., how to support family members of cancer patients) were under-researched, while other sub-themes (e.g., anxiety and depression experienced by cancer patients) had been explored to some extent. Certain areas of research interest to patients were found to have been explored; however, their significance was limited by the quality of the research. Conclusion The systematic appraisal highlights important areas for future research and the need for more effective dissemination of study findings to wider audiences, including service users. This study also indicates the need for further research to enhance the generalizability and/or significance of findings. [ABSTRACT FROM AUTHOR]

This paper presents the concerns of a client diagnosed with autism spectrum disorder about completing outcome measures. He was asked to complete CORE‐10 each time he attended a therapy session with the first author. This paper takes an epistemological position of co‐production, and written in response to the client's concerns, but this is limited by the client's wish and capacity to be involved in the writing up of this article. Implications of his experiences are drawn out for both clients with this diagnosis and more generally for all clients. Recommendations are made to recognise the limitations of measures and how to use outcome measures with more validity. [ABSTRACT FROM AUTHOR]

This paper proposes that resources from philosophy as a way of life (PWL), in particular the prescription of targeted 'spiritual exercises' (Hadot) can be used in palliative counselling, addressing Alexandrova's critique that philosophy as 'big picture' theories alone are insufficient. Part I shows how the disciplines of philosophy and medicine for a long time intersected, in particular in competing prescriptive notions of 'regimen' or 'way of life' (diaitês) in the ancient world, in which philosophy was considered widely as PWL. Part II applies PWL work on the ancient philosophical spiritual exercises to contemporary clinical settings. We show how six ancient spiritual exercises respond to patients' needs as persons, whose quality of life is importantly shaped by their beliefs and sense‐making, as they face profound existential or spiritual challenges, as well as forms of physical disability and diminished capabilities which they may never have previously countenanced. [ABSTRACT FROM AUTHOR]

Objectives: For many people with dementia and unpaid carers, using technology for care and support has become essential. Rapid proliferation of technology highlights the need to understand digital access to health and social care services for dementia. This mixed‐methods systematic review aims to explore digital access to health and social care services for dementia, from the perspective of people with dementia and unpaid carers. Methods: Nine electronic databases were searched in May 2023 for qualitative, quantitative, or mixed‐method studies, published in English or German, focused on experiences of using technology‐delivered health and social care services for people with dementia and unpaid carers. After removal of duplicates and screening, 44 empirical papers were included. Results: From the 44 studies, findings were grouped into five categories, highlighting experiences for people with dementia and unpaid carers: (1) Adapting to technology, (2) Inequalities and variations in outcomes, (3) Impact on caring, (4) Impact on health, and (5) Impact on relationships. Proliferation of technology in care access emphasised the need for quick adaptation to technology and examination of its impact. The impact of such service delivery has evidenced mixed findings. There were improvements in the health and wellbeing of people with dementia and unpaid carers, and benefits for their dyadic relationship. However, using technology for health and social care access is not always possible and is often reliant on unpaid carers for support. Lower tech‐literacy, lack of equipment or money to buy equipment and poor internet connection can impact the potential for positive outcomes. Conclusions: Technology can bring great benefits: social inclusion, improved service access and care. However, using technology in service delivery in dementia needs careful thought. Professionals and service providers need to be cognizant of the complex nature of dementia, and the benefits and challenges of hybrid service delivery. Key points: Evidence emphasises benefits and challenges to the availability, implementation, use, of technology in health and social care access in dementia.Though there are issues, technology can help improve quality of life for people with dementia, can support carers to care, and facilitate positive relationships between unpaid carers and people with dementia.Proliferation of technology for care access was expedited during COVID‐19, but has not been equally rolled out, making remote and disadvantaged groups less well‐served.A hybrid delivery of services in which people are given choice of delivery method, and are supported in accessing and using technology, will better serve people with dementia and unpaid carers. [ABSTRACT FROM AUTHOR]

Bearings are foundational supporting components in diverse mechanical systems, essential for the reliable operation of these systems through real‐time monitoring and precise health state assessment. However, vibration signals from bearings in practical equipment often contain excessive noise and redundant information, complicating health state assessment. To address this challenge, this paper proposes a neural network‐based method named parallel encoder‐decoder (PED). This method features a parallel architecture that combines the long short‐term memory network and the temporal convolutional network for the encoder, along with a self‐attention module for the decoder. PED is adept at learning the temporal representations hidden in original signals and filtering vibration signals to remove noise and redundant information. Additionally, a multi‐objective loss function is developed to enhance the prediction results. A normalized Mahalanobis distance‐based metric is then employed to compare residual signals during bearing operation with those under normal conditions. The case study evaluates the PED observer's proficiency in accurately predicting vibration signals and assessing the performance of health indicator curves, demonstrating the proposed PED observer's superiority over conventional networks. [ABSTRACT FROM AUTHOR]

In this paper, the problem of fault prognosis is investigated for linear stochastic systems with intermittent faults (IFs) and strong noise. Different from permanent faults, the degradation state of IFs are related to the fault duration time, leading to difficulties in the first step of fault prognosis, that is, the health indicator (HI) extraction. Generally, HI extraction of IFs is achieved by fault detection techniques. Therefore, the proposed fault prognosis approach mainly covers the following steps. First, the HI and degradation model are introduced for linear stochastic systems with IFs. Then, considering dynamic characteristic of systems and influence of strong noise, an IF detection algorithm under strong noise is proposed using weighted moving average methods to extract the HI. Moreover, an alternative HI extraction approach is given by an HI estimation way, which avoids using fault detection techniques. Subsequently, the degradation model is fitted by virtue of HIs and the least square method, and the remaining useful life is predicted with the aid of the obtained model. Finally, an experiment concerning the rotary steerable drilling tool system is provided to verify the effectiveness of the derived results. [ABSTRACT FROM AUTHOR]

Epidemiological data suggest that the prevalence of autoimmune diseases is increasing. Although evidence implies that people with chronic illnesses experience higher levels of burnout, there are few available insights for developing preventative interventions. This paper builds on the conservation of resources (COR) and the job demands–resources (JD‐R) framework to investigate the association between impaired health, burnout, and work engagement. In two studies, we research the role of health status as a resource, respectively, autoimmune illness symptom severity as a diminished resource, and investigate its variance explanation in burnout and work engagement above and beyond the effects of job demands and resources. Study 1 investigated the hypotheses among 87 employees with inflammatory bowel diseases. Controlling for job demands and resources, symptom severity was positively associated with (exhaustion) burnout and negatively associated with work engagement. In Study 2, we applied mixed model analyses using a sample of 129 employees with multiple sclerosis. We found significant associations of symptom severity on burnout and vigor work engagement above and beyond the effects of job demands and social support. Our studies provide important insights for employees with chronic illnesses and the organizations in which they work and give indications for theory development, future research, and the development of interventions. [ABSTRACT FROM AUTHOR]

Health represents the dynamic balance of physical, mental, social, and existential well‐being in adapting to conditions of life and the environment. Health is essential for the quality of life (QoL) of all individuals, including those with intellectual disability (ID). People with ID experience health inequities and barriers to quality health care that must be addressed to foster the QoL of this population. This paper illustrates how poor health negatively impacts each of the eight domains of the QoL model proposed by Shalock and Verdugo (2002) (e.g., health conditions limit work performance, decreasing opportunities for personal development and self‐determination). Suggestions for healthcare practices and behaviors that would improve the quality of healthcare provided to people with ID, and thus their health and QoL, are offered (e.g., engaging people with ID in the medical conversation, talking to them in plain language and without jargon enhances the personal development, self‐determination, interpersonal relationships, and social inclusion domains of QoL). Finally, we suggest actions that people with ID and their families might implement to maximize their health and wellness (e.g., maintaining a healthy lifestyle, and using the health promotion resources provided by disability organizations). [ABSTRACT FROM AUTHOR]

A goal of living as well as possible is central to practice and research with young adults living with home mechanical ventilation (HMV). Significant effort has been put into conceptualizing and measuring the quality of life (QOL) as a proxy for living well. Yet, dominant understandings of QOL have been influenced by normative, ableist, and biomedical discourses about what constitutes a good life that, when applied in practice and systems with those living with HMV, can contribute to exclusion and constrain opportunities to live well. Inquiry into what certain understandings of living well can do is critical to opening up possibilities to reimagine living well with HMV. This paper draws on findings from a critical narrative inquiry that explored the experiences of five young adults (ages 18–40 years) living with HMV. Data were co‐constructed virtually through an initial interview and photo‐elicitation using participant‐generated photographs. A critical narrative analysis of participants' stories made visible the ideological effects of ableist, biomedical, and individualist discourses and how the young adults reproduced and resisted these dominant discourses. Their stories further opened up possibilities for nurses and other healthcare providers to see living well and QOL differently. [ABSTRACT FROM AUTHOR]

This paper draws attention to the health‐related work that disabled people do when engaging with rehabilitation services. Medical sociology has a rich history of looking at the 'illness work' that patients do, while disability studies scholars have explored the cultural value placed upon paid work and the effects on social status of being unable to work. Yet, a longstanding froideur between these two disciplines, which have fundamentally opposed ontologies of illness and disability, means that neither discipline has attended closely to the rehabilitation‐related work that disabled people do. The concept of 'adjusting' to illness highlights seemingly irreconcilable disciplinary differences. Yet this article argues that the notion of 'adjustment work' can elucidate the socio‐political character of the work disabled people do in their rehabilitation, which could create a more substantial and sustainable dialogue on this subject between disability studies and medical sociology. To make this case, we discuss interview data from the Rights‐based Rehabilitation project, which sought to explore disabled people's lived experiences of rehabilitation. [ABSTRACT FROM AUTHOR]

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Background: Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority. Objectives: To summarise the best available evidence relating to the components of case‐management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact. Search Methods: We searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies. Selection Criteria: We included all randomised and non‐randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation. Data Collection and Analysis: We assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta‐analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most 'rich' and 'thick' data. Main Results: We included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings. Case Management and Housing Outcomes: Case management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = −0.51 [95% confidence interval [CI]: −0.71, −0.30]; p < 0.01). For studies included in the meta‐analyses, Housing First had the largest observed impact, followed by Assertive Community Treatment, Critical Time Intervention and Intensive Case Management. The only statistically significant difference was between Housing First and Intensive Case Management (SMD = −0.6 [–1.1, −0.1]; p = 0.03) at ≥12 months. There was not enough evidence to compare the above approaches with standard case management within the meta‐analyses. A narrative comparison across all studies was inconclusive, though suggestive of a trend in favour of more intensive approaches. Case Management and Mental Health Outcomes: The overall evidence suggested that case management of any description was not more or less effective compared to usual care for an individual's mental health (SMD = 0.02 [−0.15, 0.18]; p = 0.817). Case Management and Other Outcomes: Based on meta‐analyses, case management was superior to usual care for capability and wellbeing outcomes up to 1 year (an improvement of around one‐third of an SMD; p < 0.01) but was not statistically significantly different for substance use outcomes, physical health, and employment. Case Management Components: For homelessness outcomes, there was a non‐significant trend for benefits to be greater in the medium term (≤3 years) compared to long term (>3 years) (SMD = −0.64 [−1.04, −0.24] vs. −0.27 [−0.53, 0]; p = 0.16) and for in‐person meetings in comparison to mixed (in‐person and remote) approaches (SMD = −0.73 [−1.25,−0.21]) versus −0.26 [−0.5,−0.02]; p = 0.13). There was no evidence from meta‐analyses to suggest that an individual case manager led to better outcomes then a team, and interventions with no dedicated case manager may have better outcomes than those with a named case manager (SMD = −0.36 [−0.55, −0.18] vs. −1.00 [−2.00, 0.00]; p = 0.02). There was not enough evidence from meta‐analysis to assess whether the case manager should have a professional qualification, or if frequency of contact, case manager availability or conditionality (barriers due to conditions attached to service provision) influenced outcomes. However, the main theme from implementation studies concerned barriers where conditions were attached to services. Characteristics of Persons Experiencing Homelessness: No conclusions could be drawn from meta‐analysis other than a trend for greater reductions in homelessness for persons with high complexity of need (two or more support needs in addition to homelessness) as compared to those with medium complexity of need (one additional support need); effect sizes were SMD = −0.61 [−0.91, −0.31] versus −0.36 [−0.68, −0.05]; p = 0.3. The Broader Context of Delivery of Case Management Programmes: Other major themes from the implementation studies included the importance of interagency partnership; provision for non‐housing support and training needs of PEH (such as independent living skills), intensive community support following the move to new housing; emotional support and training needs of case managers; and an emphasis on housing safety, security and choice. Cost Effectiveness: The 12 studies with cost data provided contrasting results and no clear conclusions. Some case management costs may be largely off‐set by reductions in the use of other services. Cost estimates from three North American studies were $45–52 for each additional day housed. Authors' Conclusions: Case management interventions improve housing outcomes for PEH with one or more additional support needs, with more intense interventions leading to greater benefits. Those with greater support needs may gain greater benefit. There is also evidence for improvements to capabilities and wellbeing. Current approaches do not appear to lead to mental health benefits. In terms of case management components, there is evidence in support of a team approach and in‐person meetings and, from the implementation evidence, that conditions associated with service provision should be minimised. The approach within Housing First could explain the finding that overall benefits may be greater than for other types of case management. Four of its principles were identified as key themes within the implementation studies: No conditionality, offer choice, provide an individualised approach and support community building. Recommendations for further research include an expansion of the research base outside North America and further exploration of case management components and intervention cost‐effectiveness. [ABSTRACT FROM AUTHOR]

South Asia has made significant progress in reducing child undernutrition. The prevalence of stunting declined by one third between 2000 and 2019; as a result, in 2019, there were 34 million fewer stunted children than in 2000, indicating that progress for child nutrition is possible and is happening at scale. However, no country in South Asia is on track for all nutrition targets of Sustainable Development Goal 2, and the region has the highest prevalence of stunting (33.2%) and wasting (14.8%) in the world. Nepal, the best performing country in the region, narrowly missed the Millennium Development Goal (MDG) target to half the prevalence of child underweight between 1990 and 2015 and achieved the fastest recorded reduction in stunting prevalence in the world between 2001 and 2011. In 2019, UNICEF Nepal completed a series of papers to examine Nepal's progress on maternal and child nutrition during the MDG era. The series explores the trends, distribution and disparities in stunting, micronutrient deficiencies and feeding practices in children under 5 years and anaemia in adolescents and women. Besides, it reviews national micronutrient programmes (vitamin A supplementation, iron and folic acid supplementation and universal salt iodization) and Nepal's first Multi‐Sector Nutrition Plan, to illuminate the success factors and enduring challenges in the policy and programme landscape for nutrition. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy and programme actions to improve maternal and child nutrition in Nepal and other similar contexts. [ABSTRACT FROM AUTHOR]

This paper provides an outline of a new research project, funded through UKRI's 'Transforming UK food systems' programme. The H3 project (Healthy soil, Healthy food, Healthy people) aims to transform the UK food system 'from the ground up', through an integrated programme of research at lab, farm, landscape, local, regional and national scales. This article introduces the H3 project with a particular emphasis on those parts of our work that have most direct relevance in terms of improving human diet and nutrition. Specifically, we seek to make early interventions in the food system through biofortification and other measures that reduce the need for costly interventions at later stages. Focusing on low‐income populations and using a 'health by stealth' approach, we also seek to increase fibre consumption among the UK population by reformulating foods that are already an established part of people's diet. The paper concludes by assessing the likely impact of these interventions and the significance we attach to working with stakeholders in business, government and civil society. [ABSTRACT FROM AUTHOR]

China's 2009 health care reform agenda has been referred to as one of the most ambitious health policy programmes in modern history. Significant investment has combined with new structures, incentives, and regulations that have aimed to improve access, as well as gain greater control over a health care market much criticised for putting profit before patients. A range of health services research has been undertaken to analyse these efforts. Sociological perspectives have also been documented yet up to now a review and synthesis combining these various contributions has not been undertaken. By drawing on the lens of McDonaldization, the paper presents a narrative review that analyses the extent to which China's 2009 reform agenda has increased efficiency, calculability, predictability, and control over service provision. The review identifies elements of McDonaldization within China's 2009 reform agenda, however, notable gaps remain. In response to the limits of McDonaldization as a lens for understanding China's health care reform, the paper calls for alternative perspectives that are better able to understand the sociocultural dynamics shaping service provision, as well as an interdisciplinary research agenda that is able to generate new insights and understanding regarding health care in China. [ABSTRACT FROM AUTHOR]

Introduction: This article describes the planning and development of a novel self‐management support protocol, self‐management engaging together (SET) for Health, purposefully designed and embedded within traditional case management services to be accessible to people living with schizophrenia and comorbidities. Drawing on established self‐management principles, SET for Health was codesigned by researchers, healthcare providers and clients, to create a practical and meaningful intervention to support the target group to manage their own health and wellness. Decision making is described behind tailoring the self‐management innovation to meet the needs of an at risk, disadvantaged group served by tertiary, public health care in Canada. Method: This integrated knowledge translation (IKT) study used a descriptive approach to document the process of planning and operationalizing the SET for Health intervention as a part of routine care in two community‐based teams providing predominantly schizophrenia services. Diffusion of innovations literature informed planning. The setting was strategically prepared for organizational change. A situational assessment and theoretical frameworks identified contextual elements to be addressed. Existing established self‐management approaches for mental illness were appraised. Results: When a review of established approaches revealed incongruence with the aims and context of service delivery, common essential elements were distilled. To facilitate collaborative client–provider self‐management conversations and self‐management learning opportunities, core components were operationalized by the use of tailored interactive tools. The materials coproduced by clients and providers offered joint reference tools, foundational for capacity‐building and recognition of progress. Conclusion: Planning and developing a model of self‐management support for integration into traditional schizophrenia case management services required attention to the complex social ecological nature of the treatment approach and the workplace context. Demonstration of proof of concept is described in a separate paper. [ABSTRACT FROM AUTHOR]

Objective: To review and synthesise research related to the ageing farming workforce influence on the health and sustainability of agricultural communities. Design: Using the PRISMA framework as a guide, the CINHAL and Medline databases were searched. Search 1 used the key search terms of ageing OR aging, farm*, workforce. Search 2 used health, sustainability and 'agricultural OR farm communit*. Search 3 combined Searches 1 and 2. Search 4 followed journal citations to identify other relevant articles. A process of narrative synthesis was applied to the results through the prism of rural social capital that described the current state of knowledge and understanding under four themes. Result: Database searches and searching of citations identified 16 contemporary articles. Seven of the papers were from Australia, and the balance from five other high‐income countries. The four that themes emerged are: vulnerabilities of ageing farmers; economic and climatic drivers; social capital and sustainability; and integrative strategies, that might offer a way forward. Conclusion: Integrating these forces of nature, economics and sociology to address the ageing farming workforce and the associated health and sustainability of agricultural communities remains a major challenge for researchers, governments, the agricultural sector and rural communities. [ABSTRACT FROM AUTHOR]

There is a growing body of literature which suggests that decisions about healthcare priority setting should take into account the extent to which patients are worse off. However, such decisions are often based on how badly off patients are with respect to the condition targeted by the treatment whose priority is under consideration (condition‐specific severity). In this paper I argue that giving priority to the worse off in terms of condition‐specific severity does not reflect the morally relevant sense of being worse off. I conclude that an account of giving priority to the worse off relevant for healthcare priority setting should take into account how badly off patients are when all of their conditions are considered (holistic severity). [ABSTRACT FROM AUTHOR]

A child's early relationships and experiences influence their long‐term development and learning. In Australia, some children can face complex levels of deprivation when compared to their peers. This study sheds light on how educators are responding. Data analysed consist of individual interviews with early childhood educators working in diverse communities. The findings highlight educators' accounts of responsiveness as narrowly framed with attention focused on children's cultural heritage which overshadows other equity groups. The paper argues that by becoming sensitive to the contexts of children's lives, there is potential to build the early childhood workforce's capacity for addressing inequalities in childhood. [ABSTRACT FROM AUTHOR]

Ecological studies are observational studies commonly used in public health research. The main characteristic of this study design is that the statistical analysis is based on pooled (i.e., aggregated) rather than on individual data. Thus, patient‐level information such as age, gender, income and disease condition are not considered as individual characteristics but as mean values or frequencies, calculated at country or community level. Ecological studies can be used to compare the aggregated prevalence and incidence data of a given condition across different geographical areas, to assess time‐related trends of the frequency of a pre‐defined disease/condition, to identify factors explaining changes in health indicators over time in specific populations, to discriminate genetic from environmental causes of geographical variation in disease, or to investigate the relationship between a population‐level exposure and a specific disease or condition. The major pitfall in ecological studies is the ecological fallacy, a bias which occurs when conclusions about individuals are erroneously deduced from results about the group to which those individuals belong. In this paper, by using a series of examples, we provide a general explanation of the ecological studies and provide some useful elements to recognize or suspect ecological fallacy in this type of studies. SUMMARY AT A GLANCE: This article describes the application of ecological studies to provide an answer to specific epidemiological questions. This paper focuses on the problem of ecological fallacy, a bias which occurs when conclusions about a given relationship in individuals are deduced from inferences about the group to which those individuals belong. [ABSTRACT FROM AUTHOR]

Do wage‐setting institutions, such as collective bargaining, improve health and, if so, is this because they reduce income inequality? Wage‐setting institutions are often assumed to improve health because they increase earnings and reduce inequality and yet, while individual‐level studies suggest higher earnings improve well being, the direct effects of these institutions on mortality remains unclear. This paper explores both the relationship between wage‐setting institutions and mortality rates whether income inequality mediates this relationship. Using 50 years of data from 22 high‐income countries (n ~ 825), I find mortality rates are lower in countries with collective bargaining compared to places with little or no wage protection. While wage‐setting institutions may reduce economic inequality, these institutions do not appear to improve health because they reduce inequality. Instead, collective bargaining improves health, in part, because they increase average wage growth. The political and economic drivers of inequality may not, then, be correlated with health outcomes, and, as a result, health scholars need to develop more nuanced theories of the political economy of health that are separate from but in dialogue with the political economy of inequality. [ABSTRACT FROM AUTHOR]

Background: The Test of Masticating and Swallowing Solids (TOMASS) is an international standardized swallowing assessment tool. However, its psychometric characteristics have not been analysed in patients with dysphagia. Aims: To analyse TOMASS's (1) inter‐ and intra‐rater reliability in a clinical population of patients with dysphagia, (2) known‐group validity, (3) concurrent validity and (4) correlation with meal duration. Methods & Procedures: Two age‐ and gender‐matched groups of 39 participants each were recruited: A group of patients with dysphagia and a control group with no history of dysphagia. The TOMASS was carried out in both populations, video‐recorded and scored offline by two speech and language therapists (SLT 1 and SLT 2) (inter‐rater reliability) and twice by the same SLT (intra‐rater reliability). In the clinical group, the TOMASS was carried out three times: (1) to verify understanding of the required tasks, (2) performed concurrently during fibreoptic endoscopic evaluation of swallowing (FEES) to assess validity and (3) during clinical assessment to assess reliability. TOMASS under endoscopic control was recorded and the number of white‐out events was counted to compare with the number of observed swallows per cracker during standard TOMASS as a measure of concurrent validity. As additional measures of TOMASS validity, oral dental status, classified as 'functional' or 'partially functional', and duration of a standard meal were assessed by an SLT (SLT 1 or SLT 2), and then correlated with TOMASS. Outcome & Results: TOMASS's inter‐ and intra‐rater reliability were high (intraclass correlation coefficient (ICC) > 0.95) in both the clinical and the control groups. The number of masticatory cycles (p = 0.020), swallows (p = 0.013) and total time (p = 0.003) of TOMASS were significantly lower in the control group than in the clinical group. Patients with 'partially functional' oral dental status showed a significantly higher number of masticatory cycles per cracker and a longer duration of ingestion than patients with a 'functional' one. Concurrent validity suggested a substantial agreement between TOMASS and FEES in defining the number of swallows per cracker. The mean difference of the two measures was –0.02 (95% confidence interval (CI) = –1.7 to 1.2). Meal duration significantly correlated with the 'number of swallows per cracker' (r = 0.49; p = 0.002) and 'total time' (r = 0.41; p = 0.011). Conclusions & Implications: Preliminary psychometric analysis of TOMASS in a clinical sample of outpatients with dysphagia suggests that it is a reliable and valid (specifically related to the number of swallows per cracker) tool. TOMASS's application in clinical practice to quantitatively measure solid bolus ingestion is recommended. What this paper addsWhat is already known on the subjectThe Test of Masticating and Swallowing Solids (TOMASS) is an international standardized swallowing assessment tool to evaluate oral preparation and oral phase of solids. The TOMASS' reliability and validity were tested on healthy subjects and normative data were gained.What this paper adds to existing knowledgeThe study provides the first data on the validity and reliability of the TOMASS in a clinical population. The TOMASS was proved to be a reliable and valid tool also in patients with dysphagia and to distinguish between patients with dysphagia and healthy subjects.What are the potential or actual clinical implications of this work?The use of the TOMASS in clinical practice is recommended as a valid and reliable tool to quantitatively measure the ingestion of solid in patients with dysphagia. [ABSTRACT FROM AUTHOR]