Physicians' perspectives on the treatment of patients with eating disorders in the acute setting

Abstract Background Hospitalisation for an eating disorder is rare, however treatment in the acute medical setting can be a life-saving admission. While the multidisciplinary team delivers overall patient care, medical decisions are the responsibility of the treating physicians. Treatment decisions directly impact on patient care and outcomes. This study aimed to explore the considerations that influence the medical decisions of physicians when treating patients with eating disorders in the acute setting. Method Semi-structured interviews were conducted with ten medical physicians who had previously treated eating disorders on a general medical unit in two Australian tertiary hospitals. An interview schedule, based on the literature and four relevant domains from the Consolidated Framework for Implementation Research, was developed. Interviews were audio recorded, transcribed verbatim and analyzed thematically. Coding and interim themes and sub-themes were developed by two dietitian researchers; these were further refined through researcher discussion and triangulation with two additional dietitian researchers. Results Ten doctors were interviewed (3 consultants (1 adult general medical and 2 paediatricians: 13–16 years medical experience), 2 registrars (4–7 years experience), 1 resident (1 year experience), and 4 interns (< 1 year experience). Doctors described memorable patient cases, related to hospital stays over several weeks. Interviews ranged in length from 58 min to 91 min. Four themes (with five sub-themes) were developed: 1) navigating uncertainty (focusing on processes and goals and seeking information), 2) being “the good doctor” (doing the right thing), 3) seeing the big picture (depending on key players and considering short and long-term), and 4) involving family and patient. Conclusions Non-specialist physicians described challenges in the treatment of eating disorders in the inpatient setting. They take a holistic approach that considers both short and longer-term goals, relying on specialist colleagues, the wider multidisciplinary team and sometimes family members to guide treatment decisions during admissions on general medical wards. Additional support, education and training centered on the key themes may increase physicians’ confidence and ability to make effective treatment decisions for this patient group. The results are relevant to all health professionals working in this field to better understand the priorities of medical physicians and to support them to achieve positive outcomes in the inpatient treatment of patients with eating disorders

Capturing the geography of children’s active and sedentary behaviours at home: the HomeSPACE measurement tool

Children spend much of their time at home, indoors and sedentary. This study reports on the development, exploratory factor analysis, validity and reliability of the HomeSPACE Instrument. The instrument assesses features of the home physical environment that influence children’s sedentary behaviour and physical activity, and the family influences that create this environment. The space and equipment audit achieved good to excellent criterion validity and test-retest reliability for equipment, outdoor features and home design measures (Study 1, n = 36 parents). Family influence scales showed acceptable internal consistency and test-retest reliability (Study 2, n = 96 parents). Factor analysis highlighted fifteen scales to assess the importance, preferences and supportiveness of the home environment for activity. The HomeSPACE Instrument extends previous tools to provide a valid and reliable assessment of home influences on children’s sedentary behaviour and physical activity, that is adaptable for varying home physical environments

COVID-19 and Informal Work in 11 Cities: Recovery Pathways Amidst Continued Crisis

The majority of the global workforce – 61% – is informal and has been disproportionately impacted by measures to prevent the spread of COVID-19 and by the accompanying economic downturn. The focus on aggregate job and livelihood losses masks the multiple drivers behind these losses that are leaving labour markets in general, but particularly in developing countries, without a viable path to recovery. The global informal workforce is diverse, and understanding experiences of workers in different contexts and sectors is required to design effective recovery policies. This Working Paper reflects the findings from the longitudinal study of nearly 2,000 informal workers in 11 cities around the world. Surveys and in-depth interviews were conducted with domestic workers, home-based workers, street vendors and market traders, and waste pickers in mid-2020 and then again in mid-2021. The findings reveal the differentiated pathways of impact and thus recovery for different groups of informal workers approximately a year and a half into the pandemic. The study shows that the economic fallout of the COVID-19 crisis remains deep and persistent for workers at the base of the economy

\u27How can your marriage effect your child?\u27

A child\u27s development involves their physical and mental ability to grow. A child needs to have the right environment for them to grow. Some children grow up with both married parents, one parent, stepparents, or neither of their parents. In this research project I want to learn more about how family/divorced parents can affect a child\u27s development. I think a child with divorced parents is most likely to not develop all the way or at the same pace as a child with both married parents because having two parents allows the child to get more and different attention than just having one parent in the house or no parent involved at all. I plan on researching articles, reading reviews, and collecting data to support my research for this topic. I am grateful to have grown up with both married parents and I am interested in interviewing a friend of mine who has experienced living with divorced and how it has affected her in a good and/or bad way. Family is a key component of the socialization of children and I am excited to learn more about how my future students and future coworkers grew up and how it affected and shaped them into the person they are today

Out of the storm: Extreme weather resilience for community homelessness

This paper reports on the outcomes of a collaborative, strengths-based program developed to improve the preparedness of people experiencing homelessness during extreme weather in South Australia. The program, Out of the Storm, provided resources for dealing with heat, cold and storms that were co-designed by people experiencing homelessness, emergency services and health provider representatives and volunteer graphic designers. The program employed peer outreach workers who delivered 278 emergency kits and maps and who conducted 466 conversations about extreme weather with other people in experiencing homelessness in South Australia. This paper outlines the Out of the Storm program, including how principles of Trauma-Informed Extreme Weather Resilience Education were incorporated. This evaluation demonstrated that the Out of the Storm activities gave people access to relevant information and weatherprotection items and built confidence, opportunities and social connections within the community and with emergency services organisations and health providers. © 2020 Australian Institute for Disaster Resilience

The Dynamic Family Home: a qualitative exploration of physical environmental influences on children&apos;s sedentary behaviour and physical activity within the home space

Abstract Background: Recent changes in home physical environments, such as decreasing outdoor space and increasing electronic media, may negatively affect health by facilitating sedentariness and reducing physical activity. As children spend much of their time at home they are particularly vulnerable. This study qualitatively explored family perceptions of physical environmental influences on sedentary behaviour and physical activity within the home space. Methods: Home based interviews were conducted with 28 families with children aged 9-13 years (total n = 74 individuals), living in Perth, Australia. Families were stratified by socioeconomic status and selected to provide variation in housing. Qualitative methods included a family interview, observation and home tour where families guided the researcher through their home, enabling discussion while in the physical home space. Audio recordings were transcribed verbatim and thematically analysed

Exploring service users’ experience of community meetings in a high secure service

Purpose The purpose of this paper is to explore service users’ experience of community meetings (CMs) within a high secure setting. Design/methodology/approach A qualitative design was employed in which focus groups were used to capture service users’ experience of CMs. In all, 12 focus groups comprising a total of 27 participants were carried out using a semi-structured interview schedule. Data were analysed using thematic and saliency analysis, identifying themes which were pertinent to the research aims. Findings Positive experiences reported by service users included a safe space to explore ward issues and develop skills, with some viewing the meeting as a therapeutic forum in which to facilitate personal growth. Research limitations/implications There were a wide range of patient presentations and views. Furthermore, only 20 per cent of the patient population were included within this study. Practical implications A number of recommendations have been identified that can have positive implications for patients (quality of life and recovery), staff (resolving conflicts and problem-solving) and the overall therapeutic milieu of the ward. Originality/value There are no reviews looking at CMs within the last decade. This paper brings the understanding up to date to allow the development of this potentially positive tool

Capturing the geography of children’s active and sedentary behaviours at home: the HomeSPACE measurement tool

<p>Children spend much of their time at home, indoors and sedentary. This study reports on the development, exploratory factor analysis, validity and reliability of the HomeSPACE Instrument. The instrument assesses features of the home physical environment that influence children’s sedentary behaviour and physical activity, and the family influences that create this environment. The space and equipment audit achieved good to excellent criterion validity and test-retest reliability for equipment, outdoor features and home design measures (Study 1, <i>n</i> = 36 parents). Family influence scales showed acceptable internal consistency and test-retest reliability (Study 2, <i>n</i> = 96 parents). Factor analysis highlighted fifteen scales to assess the importance, preferences and supportiveness of the home environment for activity. The HomeSPACE Instrument extends previous tools to provide a valid and reliable assessment of home influences on children’s sedentary behaviour and physical activity, that is adaptable for varying home physical environments.</p