Black/White Differences in Cancer: A Framework for Intervention Linking Social Structure and Survival

Black/White differences in cancer survival persist. Factors shown to be differentiallyrelated to survival, and to differ by race, include the extent of disease present at diagnosis,disease classification or tumor histology, and host vulnerability. It is suggestedthat efforts to reduce this survival differential generally have been unsuccessful due toa failure to accurately identify the sources of this differential. Differences in the extentof disease present at diagnosis, for example, may not be a function of failure to seekphysicians or dollars spent on health care, but may be due to differences in the natureof health care provided. Similarly, differences in socioeconomic status, lifestyle characteristics,and occupational exposures between blacks and whites may be correlatedwith histologic differences and the level of host vulnerability. Differences in relativesurvival rates are viewed as resulting largely from structural sources. Some mech

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes.

BACKGROUND: Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay. AIM: To establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations. DESIGN AND SETTING: Systematic review assessing the effectiveness of GP DA testing in adults. METHOD: MEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively. RESULTS: The authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high. CONCLUSION: GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction

Correlates of disability among the non-institutionalized impaired

The present study was exploratory in nature. Utilizing a multifaceted concept of disability, an attempt was made to systematically identify factors relating to the disabling impact of severe physical impairment among non-institutionalized adults. Data were drawn from the 1979 telephone survey of handicapped persons conducted for the City of Houston. The study sample consisted of 811 severely impaired, noninstitutionalized adults between the ages of eighteen and ninety-six. Major findings of the study suggest that the level of disability exhibited is the additive effect of a number of potentially exacerbating or ameliorating factors. The extent to which the individual is disabled, however, appears to be primarily a function of the additive effects of age, occupation and attendant related factors, impairment characteristics, and the age when onset occurred, and secondarily, of the utilization of rehabilitation services and household characteristics. Suggestions for future research in this area are offered.Sociology, Department o

Advancing Complexity Theory as a Qualitative Research Methodology

Although complexity theory is increasingly used to explain and understand complex health-system behavior, little is known about utilizing complexity theory to augment qualitative research methods. We advance this field by describing our use of complexity theory as a qualitative research methodology to explore sustainable health-care responses to intimate partner violence. We outline how complexity theory shaped our theoretical perspective, conceptualization of the research problem, and selection of methodology and methods. We show how a research methodology informed by complexity theory can capture new insights into complex problems, advancing the application of complexity theory and qualitative research design

Exploring the complex pathway of the primary health care response to intimate partner violence in New Zealand

Abstract Background Integrating sustainable responses to intimate partner violence in health care is a persistent and complex problem internationally. New Zealand holds a leading role, having established national health system infrastructure for responding to intimate partner violence within hospital and selected community settings. However, resources for, and engagement with, the primary health care sector has been limited. The present study focuses on what affects a sustainable response to intimate partner violence within New Zealand primary health care settings. Methods Utilising complexity theory, we reconceptualised a sustainable primary health care response to intimate partner violence as a complex adaptive system. To explore interactions between agents, we analysed the function(s) of key policy, strategy, guideline and evaluation documents informing intimate partner violence responsiveness in health care. We chronologically threaded these documents together by their function(s) to show how discourse influencing intimate partner violence responsiveness emerges from agent interactions. Results This paper presents a complexity informed implementation narrative of the New Zealand health system response to intimate partner violence across the last two decades, focused on the participation of the primary health care sector. We demonstrate how competing discourses have contributed to system gaps and unintended consequences over time. Our findings consider implications for a sustainable response to intimate partner violence in primary health care and call attention to system interactions that challenge a whole health system approach in New Zealand. Conclusions Use of complexity theory facilitates an innovative perspective of a persistent and complex problem. Given the complexity of the problem and New Zealand’s leadership, sharing the lessons learnt is critical for the international community involved in developing health care system approaches to intimate partner violence

Exploring sustainable primary care responses to intimate partner violence in New Zealand: Qualitative use of complexity theory

© © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To explore what affects sustainable responses to intimate partner violence within New Zealand primary care settings using complexity theory. Design Primary care professional interviews on intimate partner violence as a health issue are analysed using a complexity theory-led qualitative research methodology grounded in poststructuralism. Setting Four general practices in one region of the North Island of New Zealand, two serving a general patient population and two adopting an indigenous approach. Participants Seventeen primary care professionals and management from the four recruited general practices. Results The complex adaptive system approach the ' Triple R Pathway', calls attention to system interactions influencing intimate partner violence responsiveness across health system levels. Four exemplars demonstrate the use of the Triple R Pathway. Two key system areas challenge the emergence of primary care responsiveness: (1) Non-recognition of intimate partner violence as a key determinant of ill-health. (2) Uncertainty and doubt. Conclusions The relationship between intimate partner violence and ill-health is not well recognised, or understood in New Zealand, at both policy and practice levels. Inadequate recognition of socioecological determinants of intimate partner violence leads to a simple health system response which constrains primary care professional responsiveness. Constant intervention in system interactions is needed to promote the emergence of sustainable responses to intimate partner violence

Non-Invasive and Diagnostic Cardiology MR Imaging of Arrhythmogenic Right Ventricular Cardiomyopathy: Morphologic Findings and Interobserver Reliability

Abstract Background: Magnetic resonance (MR) imaging is frequently used to diagnose arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, the reliability of various MR imaging features for diagnosing ARVC/D is unknown. The purpose of this study was to determine which morphologic MR imaging features have the greatest interobserver reliability for diagnosing ARVC/D. Methods: Forty-five sets of films of cardiac MR images were sent to 8 radiologists and 5 cardiologists with experience in this field. There were 7 cases of definite ARVC/D as defined by th