Measurement and outcomes of co-production in health and social care: a systematic review of empirical studies

Background: Co-production is promoted as an effective way of improving the quality of health and social care but the diversity of measures used in individual studies makes their outcomes difficult to interpret. Objective: The objective is to explore how empirical studies in health and social care have described the outcomes of co-production projects and how those outcomes were measured. Design and methods: A scoping review forms the basis for this systematic review. Search terms for the concepts (co-produc* OR coproduc* OR co-design* OR codesign*) and contexts (health OR 'public service* OR "public sector") were used in: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled trials (Wiley), MEDLINE (EBSCOHost), PsycINFO (ProQuest), PubMed (legacy) and Scopus (Elsevier). There was no date limit. Papers describing the process, original data and outcomes of co-production were included. Protocols, reviews and theoretical, conceptual and psychometric papers were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The Mixed Methods Appraisal Tool underpinned the quality of included papers. Results: 43 empirical studies were included. They were conducted in 12 countries, with the UK representing &gt;50% of all papers. No paper was excluded due to the Mixed Methods Quality Appraisal screening and 60% of included papers were mixed methods studies. The extensive use of self-developed study-specific measures hampered comparisons and cumulative knowledge-building. Overall, the studies reported positive outcomes. Co-production was reported to be positively experienced and provided important learning. Conclusions: The lack of common approaches to measuring co-production is more problematic than the plurality of measurements itself. Co-production should be measured from three perspectives: outputs of co-production processes, the experiences of participating in co-production processes and outcomes of co-production. Both self-developed study-specific measures and established measures should be used. The maturity of this research field would benefit from the development and use of reporting guidelines.CC BY</p

Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Objectives: This study aimed to explore how the concepts of co‐production and co‐ design have been defined and applied in the context of health and social care and to identify the temporal adoption of the terms. Methods: A systematic scoping review of CINAHL with Full Text, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, PubMed and Scopus was conducted to identify studies exploring co‐production or co‐design in health and social care. Data regarding date and conceptual definitions were extracted. From the 2933 studies retrieved, 979 articles were included in this review. Results: A network map of the sixty most common definitions and—through exploration of citations—eight definition clusters and a visual representation of how they interconnect and have informed each other over time are presented. Additional findings were as follows: (i) an increase in research exploring co‐production and co‐design in health and social care contexts; (ii) an increase in the number of new definitions during the last decade, despite just over a third of included articles providing no definition or explanation for their chosen concept; and (iii) an increase in the number of publications using the terms co‐production or co‐design while not involving citizens/patients/service users. Conclusions: Co‐production and co‐design are conceptualized in a wide range of ways. Rather than seeking universal definitions of these terms, future applied research should focus on articulating the underlying principles and values that need to be translated and explored in practice. Patient and Public Contribution: The search strategy and pilot results were presented at a workshop in May 2019 with patient and public contributors and researchers. Discussion here informed our next steps. During the analysis phase of the review, informal discussions were held once a month with a patient who has experience in patient and public involvement. As this involvement was conducted towards the end of the review, we agreed together that inclusion as an author would risk being tokenistic. Instead, acknowledgements were preferred. The next phase involves working as equal contributors to explore the values and principles of co‐production reported within the most common definitionspublishedVersio

The Role of Lower Leg Muscle Activity in Blood Pressure Maintenance of Older Adults

Purpose. Age-associated muscle weakness, postural instability, and orthostatic hypotension have been identified as contributing factors to falls , but the relationships among them are not clear. Therefore, the purpose of this study, a two-way factorial design, was to investigate the differences in lower extremity (LE) muscle activity, blood pressure (BP), and heart rate (HR) between young and older individuals in an upright position. Methods. Ten young males (20-24 yrs.) and 10 older males (65-82 yrs.) stood for 15 minutes while BP, HR, and LE electromyography (EMG) were recorded at one minute intervals . A two-way ANOVA was used for data analysis , p=.05. Results. Mean arterial pressure of both groups significantly increased from supine values within one minute of standing (young = 86.5±1.68 to 96.9±3.16 mmHg, old = 100.3±4.42 to 114.0±5.40 mmHg). BP variables remained elevated during the 15 minutes of standing despite a significantly attenuated HR response in the older group (young = 85±4.51 bpm, old = 73±3.98 bpm). Standing EMG activity of the older group was significantly greater than the young group. Conclusion. This study suggests that increased LE muscle activity may play a role in the ability of older individuals to maintain BP in the standing position

An Enantiodivergent Synthesis of C\u3csup\u3eα\u3c/sup\u3e-Methyl Nipecotic Acid Analogues From δ-Lactam Derivatives Obtained Through a Highly Stereoselective Cyclization Strategy

A stereoselective and enantiodivergent strategy for the construction of δ-lactams is described. The strategy utilizes chiral malonic esters prepared from enantiomerically enriched mono esters of disubstituted malonic acid. A cyclization occurs with the selective displacement of a substituted benzyl alcohol as the leaving group. The resulting δ-lactams are then converted into nipecotic acid analogues using straightforward transformations. The resulting nipecotic acid analogues proved capable organocatalysts in Mannich reactions

The dynamics of refugee return: Syrian refugees and their migration intentions

We study the drivers of refugees' decision making about returning home using observational and experimental data from a survey of 3,003 Syrian refugees in Lebanon. We find that the conditions in refugee-hosting countries play a minor role. In contrast, conditions in a refugee's home country are the main drivers of return intentions. Even in the face of hostility and poor living conditions in host countries, refugees are unlikely to return unless the situation at home improves significantly. These results challenge traditional models of decision making about migration, where refugees weigh living conditions in the host and home countries (“push” and “pull” factors). We offer an alternative theoretical framework: a model of threshold-based decision making whereby only once a basic threshold of safety at home is met do refugees compare other factors in the host and home country. We explore some empirical implications of this new perspective using qualitative interviews and quantitative survey data

Nebulized mesenchymal stem cell derived conditioned medium ameliorates Escherichia coli induced pneumonia in a rat model

BackgroundMesenchymal stem cells (MSC) have shown immense therapeutic promise in a range of inflammatory diseases, including acute respiratory distress syndrome (ARDS), and are rapidly advancing through clinical trials. Among their multimodal mechanisms of action, MSCs exert strong immunomodulatory effects via their secretome, which contains cytokines, small molecules, extracellular vesicles, and a range of other factors. Recent studies have shown that the MSC secretome can recapitulate many of the beneficial effects of the MSC itself. We aimed to determine the therapeutic capacity of the MSC secretome in a rat bacterial pneumonia model, especially when delivered directly to the lung by nebulization which is a technique more appropriate for the ventilated patient.MethodsConditioned medium (CM) was generated from human bone marrow derived MSCs in the absence of antibiotics and serum supplements. Post-nebulization lung penetration was estimated through nebulization of CM to a cascade impactor and simulated lung and quantification of collected total protein and IL-8 cytokine. Control and nebulized CM was added to a variety of lung cell culture models and injury resolution assessed. In a rat E. coli pneumonia model, CM was instilled or administered by nebulization and lung injury and inflammation assessed at 48 h.ResultsMSC-CM was predicted to have good distal lung penetration and delivery when administered by nebulizer. Both control and nebulized CM reduced NF-κB activation and inflammatory cytokine production in lung cell culture, while promoting cell viability and would closure in oxidative stress and scratch wound models. In a rat bacterial pneumonia model, both instilled and nebulizer delivered CM improved lung function, increasing blood oxygenation and reducing carbon dioxide levels compared to unconditioned medium controls. A reduction in bacterial load was also observed in both treatment groups. Inflammatory cytokines were reduced significantly by both liquid and aerosol CM administration, with less IL-1β, IL-6, and CINC1 in these groups compared to controls.ConclusionMSC-CM is a potential therapeutic for pneumonia ARDS, and administration is compatible with vibrating mesh nebulization

Neighbourhood green space, social environment and mental health: an examination in four European cities

Objectives This study examines the relationship between neighbourhood green space, the neighbourhood social environment (social cohesion, neighbourhood attachment, social contacts), and mental health in four European cities. Methods The PHENOTYPE study was carried out in 2013 in Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands), and Kaunas (Lithuania). 3771 adults living in 124 neighbourhoods answered questions on mental health, neighbourhood social environment, and amount and quality of green space. Additionally, audit data on neighbourhood green space were collected. Multilevel regression analyses examined the relation between neighbourhood green space and individual mental health and the influence of neighbourhood social environment. Results Mental health was only related to green (audit) in Barcelona. The amount and quality of neighbourhood green space (audit and perceived) were related to social cohesion in Doetinchem and Stoke-on-Trent and to neighbourhood attachment in Doetinchem. In all four cities, mental health was associated with social contacts. Conclusions Neighbourhood green was related to mental health only in Barcelona. Though neighbourhood green was related to social cohesion and attachment, the neighbourhood social environment seems not the underlying mechanism for this relationship

The relationship between natural outdoor environments and cognitive functioning and its mediators

Background Urban residents may experience cognitive fatigue and little opportunity for mental restoration due to a lack of access to nature. Natural outdoor environments (NOE) are thought to be beneficial for cognitive functioning, but underlying mechanisms are not clear. Objectives To investigate the long-term association between NOE and cognitive function, and its potential mediators. Methods This cross-sectional study was based on adult participants of the Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project. Data were collected in Barcelona, Spain; Doetinchem, the Netherlands; and Stoke-on-Trent, United Kingdom. We assessed residential distance to NOE, residential surrounding greenness, perceived amount of neighborhood NOE, and engagement with NOE. Cognitive function was assessed with the Color Trails Test (CTT). Mediation analysis was undertaken following Baron and Kenny. Results Each 100 m increase in residential distance to NOE was associated with a longer CTT completion time of 1.50% (95% CI 0.13, 2.89). No associations were found for other NOE indicators and cognitive function. Neighborhood social cohesion was (marginally) significantly associated with both residential distance to NOE and CTT completion time, but no evidence for mediation was found. Nor were there indications for mediation by physical activity, social interaction with neighbors, loneliness, mental health, air pollution worries, or noise annoyance. Conclusions Our findings provide some indication that proximity to nature may benefit cognitive function. We could not establish which mechanisms may explain this relationship

Development of the natural environment scoring tool (NEST)

Natural environments (green and blue space) are associated with a range of health benefits, but their use is likely to be influenced by the presence of features, facilities and amenities and the condition/maintenance, or the natural environment quality. Most 'quality' assessment tools have focused on green spaces and their support for physical activity. This limits their utility for assessment of other natural environment typologies and uses (e.g., social, relaxation). We aimed to develop a tool for feasible, in situ assessment of diverse natural environments that might support a variety of uses, and to explore associations between natural environment quality and objectively measured amount of natural environment and neighbourhood-level socio-economic status (SES). This work was conducted as part of the PHENOTYPE project. Data were collected in 124 neighbourhoods in four European cities (Barcelona, Doetinchem, Kaunas, Stoke-on-Trent). The Natural Environment Scoring Tool (NEST) was developed using existing tools, expert input and field-testing. The final tool comprised 47-items across eight domains: Accessibility, Recreation facilities, Amenities, Aesthetics- natural, Aesthetics- non-natural, Significant natural features, Incivilities and Usability; typology-specific Overall Scores were derived. In total, 174 natural environments, covering a range of typologies, were audited. Mean time to complete NEST was 16±28 min. There was good inter-rater agreement. Mean domain scores showed some expected patterns by typology (e.g., higher Recreation Facilities scores in urban parks and formal recreation areas; lower Amenities scores in natural/semi-natural areas). Highest mean Overall Scores were observed for areas of blue space and woodland, the types of area that often lack the recreational facilities or amenities that can be dominant in physical activity-focused audit tools. There was a trend towards lower natural environment quality in neighbourhoods of lower SES, with some inter-city variation. Correlations between NEST scores and amount of natural environment indicated higher natural environment in areas with worse access. We recommend further testing of NEST in other locations in relation to use and health outcomes