Effectiveness of interventions to improve employment for people released from prison: systematic review and meta-analysis

BACKGROUND: People released from prison experience complex health challenges in addition to challenges resettling into the community. Consequently, employment rates are low. Participating in good quality employment can support good health and is protective against future reoffending. Multiple interventions are provided to support people into employment on release. The effectiveness of interventions for improving employment outcomes has not previously been evaluated in a meta-analysis. AIM: Our objective was to examine the effectiveness of interventions to improve employment following release from prison. METHOD: We searched seven databases and three trial registries for peer reviewed randomised controlled trials (RCTs), published since 2010, that included adults and measured an employment outcome(s). We conducted meta-analysis using random effects models with sub-group and sensitivity analyses. We appraised bias risk per outcome, and incorporated this into an assessment of the certainty estimates for each outcome. A group of people with experience of imprisonment met with us throughout the project to inform our search strategy and interpretation of results. RESULTS: We included 12 RCTs (2,875 participants) which were all conducted in the USA. Few outcomes were of low risk of bias. Intervention participants were 2.5 times more likely to work at least one day (95% CI:1.82-3.43) and worked more days over 12 months (MD = 59.07, 95% CI:15.83-102.32) compared to controls. There was no effect on average employment status or employment at study end. There is moderate certainty in these estimates. CONCLUSION: Interventions can improve some employment outcomes for people released from prison. More evidence is required to establish effective interventions for sustaining quality employment, particularly outside the USA, and which consider outcomes for different groups of people released, such as women or those with health or substance use needs

The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey

Background: Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. Methods: We enquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. Results: The same three information sources – professional meetings & conferences, peerreviewed journals and medical colleagues – were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. Conclusion: No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs

Parental use of routines, setting limits, and child screen use during COVID-19: findings from a large Canadian cohort study

BackgroundAn increase in child screen time has been observed throughout the COVID-19 pandemic. Home environment and parenting practices have been associated with child screen time. The purpose of this study was to examine associations between parental use of routines, limit setting, and child screen time during the (COVID-19) pandemic to inform harm-reducing strategies to limit the potential harms ensued by excessive screen use.MethodsA cohort study was conducted in 700 healthy children (3,628 observations) aged 0–11 years though the TARGet Kids! COVID-19 Study of Children and Families in Toronto, Canada from May 2020-May 2021. The independent variables assessed were parent-reported use of routines and setting limits. Outcomes were parent-reported child daily screen time in minutes and whether the Canadian 24-Hour screen time guideline was met, defined as 0 for <1 years, 60 or less for 1–5 years, and 120 or less for >5 years. Linear and logistic mixed-effects models were fitted using repeated measures of independent variables and outcomes with a priori stratification by developmental stages (<3, 3–4.99, ≥5 years).ResultsA total of 700 children with 3,628 observations were included in this study [mean age = 5.5 (SD = 2.7, max = 11.9) years, female = 47.6%]. Mean change in child screen time before vs. during the pandemic was +51.1 min/day and level of parental use of routines and setting limits remained stable. Lower use of routines was associated with higher child screen time (β = 4.0 min; 95% CI: 0.9, 7.1; p = 0.01) in ages ≥5 years and lower odds of meeting the screen time guideline in ages <3 years and ≥5 years (OR = 0.59; 95% CI: 0.38, 0.88; p = 0.01; OR = 0.76; 95% CI: 0.67, 0.87; p < 0.01). Lower use of limit setting was associated with higher child screen time and lower odds of meeting the screen time guideline in ages ≥5 years (β = 3.8 min; 95% CI: 0.69, 6.48; p < 0.01; OR = 0.86; 95% CI: 0.78, 0.94; p < 0.01).ConclusionsLower parental use of routines and limits during the COVID-19 pandemic were associated with higher screen time and lower odds of meeting the screen time guideline among school-age children. Results may help inform strategies to promote healthy screen use in this age group

Improving the Effectiveness of Health Care Innovation Implementation: Middle Managers as Change Agents

The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers’ commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers’ commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers’ influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected

A qualitative analysis of Medicaid beneficiaries perceptions of prenatal and immediate postpartum contraception counseling

Objectives: In the United States, about four out of every ten births are financed by Medicaid, making it a program that is key in addressing racial disparities in maternal health. Many women covered by Medicaid have access to prenatal and immediate postpartum contraception counseling that can aid them in their postpartum contraception decision-making. However, existing inequities within Medicaid and a history of reproductive harms targeting Black women and women with low incomes may contribute to women with Medicaid having different experiences of contraception counseling. This qualitative study explores how Black women and White women insured by Medicaid perceive prenatal and immediate postpartum contraception counseling and identifies additional factors that shape their contraception decision-making. Methods: We conducted semi-structured interviews with 15 Medicaid beneficiaries who delivered at a public teaching hospital in North Carolina. Interviews focused on women?s beliefs about planning for pregnancy, experiences with prenatal and immediate postpartum contraception counseling, and perceived need for postpartum contraception. We used a priori and emergent codes to analyze interviews. Results: Seven Black women and eight White women completed interviews 14-60 days postpartum. All women reported receiving prenatal and immediate postpartum counseling. Several women described receiving prenatal counseling, reflective of patient-centered contraception counseling, that helped in their postpartum contraception decision-making; one woman described receiving immediate postpartum counseling that helped in her decision-making. Some Black women reported receiving unsupportive/coercive contraception counseling. In addition to contraception counseling, past reproductive health experiences and future pregnancy intentions were salient to women's contraception decision-making.Conclusions:Prenatal and immediate postpartum contraception counseling can help some Medicaid beneficiaries with their postpartum contraception decision, but past reproductive health experiences and future pregnancy intentions are also relevant. Counseling that does not consider these experiences may be harmful, particularly to Black women, further contributing to racial disparities in maternal postpartum health outcomes

From strategy to action: How top managers’ support increases middle managers’ commitment to innovation implementation in health care organizations

Evidence suggests that top managers’ support influences middle managers’ commitment to innovation implementation. What remains unclear is how top managers’ support influences middle managers’ commitment. Results may be used to improve dismal rates of innovation implementation

Toward a More Comprehensive Understanding of organizational influences On Implementation: the organization theory For Implementation Science Framework

INTRODUCTION: Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. to advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework. METHODS: The process of distilling organization theory constructs into domains involved concept mapping and iterative consensus-building. First, we recruited organization and implementation scientists to participate in an online concept mapping exercise in which they sorted organization theory constructs into domains representing similar theoretical concepts. Multidimensional scaling and hierarchical cluster analyses were used to produce visual representations (clusters) of the relationships among constructs in concept maps. Second, to interpret concept maps, we engaged members of the Cancer Prevention and Control Research Network (CPCRN) OTIS workgroup in consensus-building discussions. RESULTS: Twenty-four experts participated in concept mapping. Based on resulting construct groupings\u27 coherence, OTIS workgroup members selected the 10-cluster solution (from options of 7-13 clusters) and then reorganized clusters in consensus-building discussions to increase coherence. This process yielded six final OTIS domains: organizational characteristics (e.g., size; age); governance and operations (e.g., organizational and social subsystems); tasks and processes (e.g., technology cycles; excess capacity); knowledge and learning (e.g., tacit knowledge; sense making); characteristics of a population of organizations (e.g., isomorphism; selection pressure); and interorganizational relationships (e.g., dominance; interdependence). DISCUSSION: Organizational influences on implementation are poorly understood, in part due to the limitations of extant frameworks. to improve understanding of organizational influences on implementation, we distilled 70 constructs from nine organization theories into six domains. Applications of the OTIS framework will enhance understanding of organizational influences on implementation, promote theory-driven strategies for organizational change, improve understanding of mechanisms underlying relationships between OTIS constructs and implementation, and allow for framework refinement. Next steps include testing the OTIS framework in implementation research and adapting it for use among policymakers and practitioners

Medical competence, anatomy and the polity in seventeenth-century Rome

At the centre of this article are two physicians active in Rome between 1600 and 1630 who combined medical practice with broader involvement in the dynamic cultural, economic and political scene of the centre of the Catholic world. The city's distinctive and very influential social landscape magnified issues of career-building and allows us to recapture physicians’ different strategies of self-fashioning at a time of major social and religious reorganization. At one level, reconstructing Johannes Faber and Giulio Mancini's medical education, arrival in Rome and overlapping but different career trajectories contributes to research on physicians’ identity in early modern Italian states. Most remarkable are their access to different segments of Roman society, including a dynamic art market, and their diplomatic and political role, claimed as well as real. But following these physicians from hospitals to courts, including that of the Pope, and from tribunals to the university and analysing the wide range of their writing – from medico-legal consilia to political essays and reports of anatomical investigations – also enriches our view of medical practice, which included, but went beyond, the bedside. Furthermore, their activities demand that we reassess the complex place of anatomical investigations in a courtly society, and start recovering the fundamental role played by hospitals – those quintessential Catholic institutions – as sites of routine dissections for both medical teaching and research. (pp. 551–567

Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization

ObjectiveCoronary artery bypass grafting with cardiopulmonary bypass carries a risk for neurologic complications because of cerebral hypoperfusion and microembolization. The basic goals of a novel closed minimized extracorporeal circulation are to prevent excessive hemodilution and to avoid blood-air interface. The aim of this prospective randomized study was to determine the effect of using the minimized extracorporeal circulation system compared with open conventional extracorporeal circulation on cerebral tissue oxygenation and microembolization.MethodsForty patients undergoing coronary artery bypass grafting (20 in each group) were continuously monitored for changes in cerebral oxygenated hemoglobin and tissue oxygenation index by using near-infrared spectroscopy. Total microembolic count and gaseous embolic count in both median cerebral arteries were monitored with multifrequency transcranial Doppler instrumentation.ResultsIn the conventional extracorporeal circulation group there was a highly significant reduction in both cerebral oxygenated hemoglobin and tissue oxygenation index from the start to the end of cardiopulmonary bypass (P < .01). The rate of decrease in cerebral oxygenated hemoglobin after aortic cannulation was faster in the conventional extracorporeal circulation group (F test = 9.03, P < .001). No significant changes with respect to cerebral oxygenated hemoglobin or tissue oxygenation index occurred in the minimized extracorporeal circulation group, except at the beginning of rewarming (P < .01). Total embolic count, as well as gaseous embolic count, in the left and right median cerebral arteries was significantly lower in the minimized extracorporeal circulation group (all P < .05). Postoperative bleeding was greater (P < .05) and the transfusion rate was higher (P < .05) in the conventional extracorporeal circulation group.ConclusionsUse of closed minimized cardiopulmonary bypass compared with conventional open cardiopulmonary bypass preserves cerebral tissue oxygenation and reduces cerebral microembolization

A mathematical model for breath gas analysis of volatile organic compounds with special emphasis on acetone

Recommended standardized procedures for determining exhaled lower respiratory nitric oxide and nasal nitric oxide have been developed by task forces of the European Respiratory Society and the American Thoracic Society. These recommendations have paved the way for the measurement of nitric oxide to become a diagnostic tool for specific clinical applications. It would be desirable to develop similar guidelines for the sampling of other trace gases in exhaled breath, especially volatile organic compounds (VOCs) which reflect ongoing metabolism. The concentrations of water-soluble, blood-borne substances in exhaled breath are influenced by: (i) breathing patterns affecting gas exchange in the conducting airways; (ii) the concentrations in the tracheo-bronchial lining fluid; (iii) the alveolar and systemic concentrations of the compound. The classical Farhi equation takes only the alveolar concentrations into account. Real-time measurements of acetone in end-tidal breath under an ergometer challenge show characteristics which cannot be explained within the Farhi setting. Here we develop a compartment model that reliably captures these profiles and is capable of relating breath to the systemic concentrations of acetone. By comparison with experimental data it is inferred that the major part of variability in breath acetone concentrations (e.g., in response to moderate exercise or altered breathing patterns) can be attributed to airway gas exchange, with minimal changes of the underlying blood and tissue concentrations. Moreover, it is deduced that measured end-tidal breath concentrations of acetone determined during resting conditions and free breathing will be rather poor indicators for endogenous levels. Particularly, the current formulation includes the classical Farhi and the Scheid series inhomogeneity model as special limiting cases.Comment: 38 page