THE INFLUENCE OF FAMILY STRUCTURE AND TRANSITIONS ON PARENTING, INCOME, RESIDENTIAL MOBILITY, AND SUBSTANCE INITIATION IN EARLY ADOLESCENCE: A COMPARISON OF CAUCASIAN AND AFRICAN AMERICAN YOUTH

The effect of family structure on youth adjustment has received increasing attention as historical trends in single parenting, divorce, remarriage, and cohabitation with partners and extended family members have produced a diverse constellation of structures. African American youth are less likely than Caucasian youth to live in an “intact” family. Links between family structure and a variety of indices of youth adjustment have been established, although a relatively understudied outcome is that of substance initiation, despite its association with dependence and other negative sequelae. The dynamic effect of transitions has additionally been less studied than the static effect of structure. Differences in family structure and transitions may influence outcomes via parental socialization (monitoring and attachment) as well as strain (residential mobility and changes in income). These mechanisms may operate differently for Caucasian and African American youth, and may partially explain differences in adjustment. Relations between youth adjustment and transitions may be reciprocal in nature, a less often studied premise. This project made use of a nationally representative sample of more than 2,000 adolescents aged 12 to 13 in 1997 assessed across 3 waves. Regression analyses were employed to examine the associations among family structure and transitions, parenting, income, residential mobility, and substance initiation over time. This study found that living in non- two-parent family structures was consistently associated with higher concurrent levels of substance initiation, lower parental monitoring and relationship quality, lower income, and higher residential mobility. The effects of transitions on substance initiation and parenting were less robust than hypothesized, but reinforced the notion that consistently living outside a two-parent family, or consistently living in a single-parent family, is negatively associated with parenting, income, and residential stability over time. Evidence for mediated effects via changes in parenting, residential mobility, and income were significant but small in magnitude, and varied by race, such that they were significant for Caucasian but not African American youth . Partial evidence for reciprocal causality was found. Alcohol initiation at the first wave predicted separations, but marijuana initiation did not. These findings have important implications for parents, clinicians, and policy makers

The Influence of Parental Monitoring and Peer Deviance on Substance Use Among Middle School Students

Substance use is a significant problem among middle school students in the United States. Research indicates that the early use of substances increases the likelihood of negative outcomes including long-term use and abuse. Both parenting and peer variables exert strong influences on children\u27s decisions to use or abstain from substances. As children age, peers begin to exert a stronger influence, but parenting practices can significantly reduce peers\u27 harmful influences. In this study, three waves of data (collected at the end of 6th grade, and the beginning and end of 7th grade) from a large multi-site study were used to examine the role of peer deviance as a mediator of the influence of parental monitoring on substance use among an ethnically diverse sample of over 2,500 middle school students. Structural equation modeling was used to examine the longitudinal interrelations among parental monitoring, peer deviance, and substance use among middle school students, and to investigate potential group differences by gender and family structure. The hypotheses that peer deviance and substance use would influence one another over time were upheld. The two variables were interrelated such that peer deviance produced increases in substance use over time, but so too did substance use produce peer deviance over time. The prospective relation between substance use and peer deviance was stronger than the converse relation, suggesting that substance using peers seek one another out. Parental monitoring was associated with decreases in substance use over time, but its influence was small. Parental monitoring was more strongly associated with decreases in peer deviance. However, parental monitoring\u27s effect on substance use was not mediated by peer deviance over these 3 waves in that parental monitoring at Wave 1 did not predict substance use 1 year later. Contrary to hypothesis, substance use was not associated with changes in parental monitoring over time, although peer deviance was associated with less monitoring. In general, parental monitoring was more closely linked to peer deviance than it was to substance use. This study found no convincing evidence to suggest group differences in the overall pattern of findings according to gender or family structure

Male Veterans Coping with the Pendulum Swing of Rheumatoid Arthritis Pain: A Qualitative Study

This study describes the physical, psychological and social context of rheumatoid arthritis (RA) pain from the male veterans. A qualitative, descriptive design was employed using a purposive sampling to ensure representation of male veterans. Interviews were conducted with 12 male veterans of the VA Greater Los Angeles Healthcare System. Socio-demographic characteristics, clinical profiles and descriptors of rheumatoid pain experienced by male veterans’ since their diagnoses were gathered. Interviews were audio recorded and transcribed verbatim. Grounded Theory analysis techniques were used to identify concepts related to living with RA Pain. Six concepts related to RA pain adaptation emerged. Three concepts were associated with movement (keep moving, consequences of not moving, staying physically active) and three were related to emotion (thinking positive thoughts, doing jobs, focusing on male identity). The “keep moving” concept explained coping with chronic RA pain through three activity types: physical, cognitive and socio-economic activities. These activities fluctuated in intensity depending upon the disease stage and RA symptoms. The forward and backward pendulum swing described the unpredictable course and pain coping strategy of the veterans. Further studies are recommended to determine the transferability of our findings to other populations and to confirm the impact of continuous motion as an effective pain management strategy for RA

Dehydration and Performance on Clinical Concussion Measures in Collegiate Wrestlers

The effects of dehydration induced by wrestling-related weight-cutting tactics on clinical concussion outcomes, such as neurocognitive function, balance performance, and symptoms, have not been adequately studied

Indicators of sustainable capacity building for health research: analysis of four African case studies

<p>Abstract</p> <p>Background</p> <p>Despite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce. By analysing projects in Africa that had successfully built sustainable capacity, we aimed to identify evidence that could indicate that capacity building was likely to be sustainable.</p> <p>Methods</p> <p>Four projects were selected as case studies using pre-determined criteria, including the achievement of sustainable capacity. By mapping the capacity building activities in each case study onto a framework previously used for evaluating health research capacity in Ghana, we were able to identify activities that were common to all projects. We used these activities to derive indicators which could be used in other projects to monitor progress towards building sustainable research capacity.</p> <p>Results</p> <p>Indicators of sustainable capacity building increased in complexity as projects matured and included</p> <p>- early engagement of stakeholders; explicit plans for scale up; strategies for influencing policies; quality assessments (<it>awareness and experiential stages)</it></p> <p>- improved resources; institutionalisation of activities; innovation <it>(expansion stage)</it></p> <p>- funding for core activities secured; management and decision-making led by southern partners <it>(consolidation stage)</it>.</p> <p>Projects became sustainable after a median of 66 months. The main challenges to achieving sustainability were high turnover of staff and stakeholders, and difficulties in embedding new activities into existing systems, securing funding and influencing policy development.</p> <p>Conclusions</p> <p>Our indicators of sustainable capacity building need to be tested prospectively in a variety of projects to assess their usefulness. For each project the evidence required to show that indicators have been achieved should evolve with the project and they should be determined prospectively in collaboration with stakeholders.</p

‘The Phone is My Boss and My Helper’ – A Gender Analysis of an mHealth Intervention with Health Extension Workers in Southern Ethiopia

Mobile health (mHealth) provides health services and information via mobile technologies, including mobile phones. There is considerable optimism in mHealth’s potential to overcome health systems’ deficiencies to ensure access to safe, effective and affordable health services. This has led to an ‘explosion of mHealth activities’ and ‘large-scale adoption and deployment of mobile phones’ by Community Health Worker (CHW) programmes. MHealth innovation in relation to CHWs, on which low- and middle-income countries (LMICs) disproportionately depend, has been reported to be ‘particularly promising’. CHWs’ use of mHealth has the potential to improve their motivation; decision-making; training; adherence to guidelines; data entry and quality; planning and efficiency; and communication and health promotion; while also enhancing coverage and timeliness of services and reducing costs. MHealth also allows the monitoring and tracking of health indicators in real time, providing crucial insights to policy makers and enabling CHWs to better serve communities

Public health research outputs from efficacy to dissemination: a bibliometric analysis

<p>Abstract</p> <p>Background</p> <p>More intervention research is needed, particularly 'real world' intervention replication and dissemination studies, to optimize improvements in health. This study assessed the proportion and type of published public health intervention research papers over time in physical activity and falls prevention, both important contributors to preventable morbidity and mortality.</p> <p>Methods</p> <p>A keyword search was conducted, using Medline and PsycINFO to locate publications in 1988-1989, 1998-1999, and 2008-2009 for the two topic areas. In stage 1, a random sample of 1200 publications per time period for both topics were categorized as: non-public health, non-data-based public health, or data-based public health. In stage 2 data-based public health articles were further classified as measurement, descriptive, etiological or intervention research. Finally, intervention papers were categorized as: efficacy, intervention replication or dissemination studies. Inter-rater reliability of paper classification was 88%.</p> <p>Results</p> <p>Descriptive studies were the most common data-based papers across all time periods (1988-89; 1998-1999;2008-2009) for both issues (physical activity: 47%; 54%; 65% and falls 75%; 64%; 63%), increasing significantly over time for physical activity. The proportion of intervention publications did not increase over time for physical activity comprising 23% across all time periods and fluctuated for falls across the time periods (10%; 21%; 17%). The proportion of intervention articles that were replication studies increased over the three time periods for physical activity (0%; 2%; 11%) and for falls (0%; 22%; 35%). Dissemination studies first appeared in the literature in 2008-2009, making up only 3% of physical activity and 7% of falls intervention studies.</p> <p>Conclusions</p> <p>Intervention research studies remain only a modest proportion of all published studies in physical activity and falls prevention; the majority of the intervention studies, are efficacy studies although there is growing evidence of a move towards replication and dissemination studies, which may have greater potential for improving population health.</p

Engaging new migrants in infectious disease screening: a qualitative semi-structured interview study of UK migrant community health-care leads.

Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants) and face multiple barriers to healthcare. There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C). Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status. Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical. One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community-focused screening models - drawing on models of best practice from other countries receiving high numbers of migrants

Towards building equitable health systems in Sub-Saharan Africa: lessons from case studies on operational research

<p>Abstract</p> <p>Background</p> <p>Published practical examples of how to bridge gaps between research, policy and practice in health systems research in Sub Saharan Africa are scarce. The aim of our study was to use a case study approach to analyse how and why different operational health research projects in Africa have contributed to health systems strengthening and promoted equity in health service provision.</p> <p>Methods</p> <p>Using case studies we have collated and analysed practical examples of operational research projects on health in Sub-Saharan Africa which demonstrate how the links between research, policy and action can be strengthened to build effective and pro-poor health systems. To ensure rigour, we selected the case studies using pre-defined criteria, mapped their characteristics systematically using a case study development framework, and analysed the research impact process of each case study using the RAPID framework for research-policy links. This process enabled analysis of common themes, successes and weaknesses.</p> <p>Results</p> <p>3 operational research projects met our case study criteria: HIV counselling and testing services in Kenya; provision of TB services in grocery stores in Malawi; and community diagnostics for anaemia, TB and malaria in Nigeria. <b>Political context and external influences: </b>in each case study context there was a need for new knowledge and approaches to meet policy requirements for equitable service delivery. Collaboration between researchers and key policy players began at the inception of operational research cycles. <b>Links</b>: critical in these operational research projects was the development of partnerships for capacity building to support new services or new players in service delivery. <b>Evidence: </b>evidence was used to promote policy dialogue around equity in different ways throughout the research cycle, such as in determining the topic area and in development of indicators.</p> <p>Conclusion</p> <p>Building equitable health systems means considering equity at different stages of the research cycle. Partnerships for capacity building promotes demand, delivery and uptake of research. Links with those who use and benefit from research, such as communities, service providers and policy makers, contribute to the timeliness and relevance of the research agenda and a receptive research-policy-practice interface. Our study highlights the need to advocate for a global research culture that values and funds these multiple levels of engagement.</p

A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]

BACKGROUND: Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. METHODS/DESIGN: To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. DISCUSSION: The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.Jeffrey Braithwaite, Johanna Westbrook, Marjorie Pawsey, David Greenfield, Justine Naylor, Rick Iedema, Bill Runciman, Sally Redman, Christine Jorm, Maureen Robinson, Sally Nathan and Robert Gibber