Health promotion challenges for young adults living with intellectual disability and type 1 diabetes.

BACKGROUND: Self-management of type 1 diabetes mellitus (T1DM) can be challenging for people with intellectual disability. Often, parents provide health support due to lack of appropriate services outside the home. The study aim was to identify barriers and facilitators to T1DM self-management for young adults with intellectual disability and the implications for health promotion. METHODS: Five male participants with intellectual disability, aged 17-26 years, and seven parents were interviewed between October 2017 and February 2019. Interview data were descriptively analysed. FINDINGS: Two categories for barriers and facilitators were identified: 1) Diabetes self-management is complex (carbohydrate counting, blood glucose level monitoring, insulin therapy); 2) support for diabetes care (reliance on parents and carers, the National Disability Insurance Scheme, mainstream diabetes service support). CONCLUSIONS: Parents are critical for the support of people with intellectual disability and T1DM in the absence of disability staff with appropriate health skills.

Prices for Medical Services Vary Within Hospitals, but Vary More Across Them.

Using commercial claims for 2012-2013 from the Colorado All Payer Claims Database, we examine how medical service prices vary for five hospital-based procedures and the complexity-adjusted inpatient price. We find that prices vary substantially in multiple dimensions. Our analysis indicates that there is significant price variation across payers for the same service in the same hospital. If prices converged to the lowest rate each hospital receives, commercial expenditures would fall by 10% to 20%. Differences across hospitals account for an even more substantial amount of the overall variation. For five out of six prices, we find that differences associated just with hospitals' metropolitan areas account for over 35% of the total variation. We observe substantial residual variation (18%-32%) after accounting for factors specific to a given payer or provider.

Developing community mobility and driving with youth on the autism spectrum: A psychosocial perspective.

BACKGROUND: Youth on the autism spectrum face particular challenges with community mobility and driving, contributing to reduced community participation. Skill development may be uniquely shaped by complex interactions between autistic traits, psychosocial influences and community environments. Research to guide occupational therapy practice is sparse. OBJECTIVE: This short report explores the complex interplay between psychosocial and environmental influences on community mobility development, to stimulate further occupational therapy research and provide considerations for practice. METHOD: Because of the lack of autism specific research, we firstly discuss psychosocial and environmental influences impacting non-autistic youth, then draw on current research to identify challenges for youth on the spectrum. Finally, we propose considerations for practice and research. CONCLUSION: Psychosocial considerations for developing community mobility and driving include social communication, safety, navigating unpredictable community environments, emotional regulation and motivation for community participation. Future research should explore how to develop foundational community mobility skills; communication and social skills; and autistic needs for inclusive design. Supporting normative community mobility skills during adolescence may underpin transition to independence in adulthood. SIGNIFICANCE: Broadening the focus of community mobility and driving research to understand environmental and psychosocial contexts of community environments, is necessary to provide guidance for occupational therapists supporting youth on the spectrum with independent community participation.

More than depression: a multi-dimensional assessment of postpartum distress symptoms before and after a residential early parenting program.

INTRODUCTION: Parents are vulnerable to psychological distress symptoms in the postpartum period. It is routine to screen for depressive symptoms, but anxiety, stress, fatigue, irritability and insomnia symptoms are less often assessed despite their prevalence. This study aimed to assess multiple dimensions of psychological distress, and their reliable change and clinically significant change among women admitted to a residential program for assistance with unsettled infant behaviors (UIB). METHOD: Women admitted to a five-night residential early parenting program completed self-report measures: the Depression Anxiety Stress Scale, Irritability Depression Anxiety Scale, Fatigue Severity Scale, and Insomnia Severity Index. A sub-group completed a computerized emotional Go-NoGo (EGNG) task as a measure of emotional impulsivity. RESULTS: Seventy-eight women were recruited (Mage = 34.46, SDage = 4.16). On admission, 48% of women reported clinically elevated depressive symptoms and 97.5% of women not reporting elevated depressive symptoms reported clinical elevations in at least one other form of distress. Upon discharge, all self-report distress symptoms were significantly reduced (all p-values <.001), but reliable and clinically significant change only occurred in a subgroup of women. There were no significant changes in indicators of impulsivity based on the EGNG. CONCLUSIONS: In addition to, and often in the absence of, depressive symptoms, women attending an early parenting program experienced a wide range of psychological distress, including fatigue, insomnia, anxiety and stress. Different forms of distress improved in different magnitudes to the treatment provided. These findings highlight the need for a multi-dimensional approach in the assessment and treatment of postpartum distress.

An exploration of the practice, policy and legislative issues of the specialist area of nursing people with intellectual disability: A scoping review.

The specialist field of intellectual disability nursing has been subjected to a number of changes since the move towards deinstitutionalisation from the 1970s. Government policies sought to change the nature of the disability workforce from what was labelled as a medicalised approach, towards a more socially oriented model of support. Decades on however, many nurses who specialise in the care of people with intellectual disability are still employed. In Australia, the advent of the National Disability Insurance Scheme offers an apt moment to reflect upon these decades of specialised nursing care as the context of this nursing care will continue to evolve. A review of the published literature was conducted to explore what has shaped the field in the past and how this might inform the future of this speciality area under new policy and service contexts. People with intellectual disability have specific health and support needs that require a specialised workforce. Specialist nurses continue to be needed for people with intellectual disability.

Physician Market Structure, Patient Outcomes, and Spending: An Examination of Medicare Beneficiaries.

OBJECTIVE: To understand the impact of changes in physician market structure on clinical outcomes and health care utilization. DATA SOURCES: 2005-2012 Medicare fee-for-service claims and enrollment data. STUDY DESIGN: We consider the effect of cardiology market structure on utilization and health outcomes for four patient populations. We estimate the risk-adjusted impact of competition using multivariate regression models. PRINCIPAL FINDINGS: The study finds that an increase in consolidation leads to statistically and economically significant increases in negative health outcomes. For example, we find that moving from a zip code at the 25th percentile of cardiology market concentration to one at the 75th percentile would be associated with 5 to 7 percent increases in risk-adjusted mortality for three of the sample populations. We also found higher expenditures in more concentrated markets. For example, moving from a zip code at the 25th percentile of cardiology market concentration to one at the 75th would be associated with 7 to 11 percent increases in expenditures, depending on sample population. CONCLUSIONS: Our estimates indicate that increases in cardiology market concentration are associated with worse health outcomes and higher health care expenditures. Some effects may be attributed to vertical as well as horizontal changes.

How vertical integration affects the quantity and cost of care for Medicare beneficiaries.

Health systems are employing physicians in growing numbers. The implications of this trend are poorly understood and controversial. We use rich data from the Centers for Medicare and Medicaid Services to examine the effects of a set of physician acquisitions by hospital systems on outpatient utilization and spending. We find that financial integration systematically produces economically large changes in the acquired physicians' behavior, but has less consistent effects at the acquiring system level.

For-profit status and industry evolution in health care markets: evidence from the dialysis industry.

This paper examines why for-profit dialysis providers have displaced non-profit providers over the last 25 years. Using detailed data on individual markets' evolutions, I find that for-profit facilities were quicker to enter growing markets and slower to exit declining ones than non-profit facilities. Moreover, for-profit providers' presence in a market had a larger impact on the exit and entry behavior of competitors. These results suggest that for-profit dialysis providers have an advantage in static competition relative to non-profit providers, and that this-rather than lower entry costs-explains their increasing prominence. Additional empirical analyses indicate that for-profits' advantage cannot solely be attributed to efficiencies related to membership in a large, multi-facility chain. This further suggests that managerial incentives have had an economically significant impact on long-run market structure in this industry.

The appropriateness and feasibility of an online e-Portfolio for assessment of undergraduate allied health students.

BACKGROUND/AIM: Online technologies are widely used in tertiary institutions for both learning and assessment. There is a paucity of research into the use of e-Portfolios for assessment in the field of occupational therapy and other allied health disciplines. This study aimed to determine if a new assessment platform, using a flexible online learning platform, PebblePad(™) , is appropriate and feasible for use with allied health university staff and students in their first and second year of study. METHODS: A mixed methods approach was employed in two phases, before the development of a new assessment (Phase 1) and after completion of the new assessment (Phase 2), aimed to generate a comprehensive analysis of the appropriateness and feasibility of the new assessment platform. Inductive thematic analysis was used to investigate participants' focus group responses in both phases. To assess learning outcomes survey responses were analysed using t-tests, and descriptive ratings of the assessment and current use of online platforms were extracted. RESULTS: Triangulated results indicate that the assessment did not meet all five domains of appropriateness. Negative experiences and a lack of social and ecological validity were attributed to the PebblePad(™) . The PebblePad(™) was not feasible, requiring extensive support in implementation. CONCLUSIONS: While PebblePad(™) did not meet all domains of appropriateness and was not feasible, students reported learning gains after completing the assessment, suggesting that content may be more important than the assessment platform. More rigorous research is needed to determine the best online platform for assessment in the allied health disciplines.

Formal intergenerational mentoring at Australian Men's Sheds: a targeted survey about mentees, mentors, programmes and quality.

Intergenerational mentoring enables a purposeful exchange of skills and knowledge to enhance individual and social outcomes for sub-groups at risk of health and social disparities. Male intergenerational mentoring may be an approach to help address these disparities in young men. Over 1000 Men's Sheds operate in Australia with 39% providing some form of mentoring mainly to youth. Yet, little is known about the variables intrinsic to creating and running quality programmes. This study aimed to identify the characteristics of formal intergenerational mentoring programmes, review their quality against the Australian Youth Mentoring Network (AYMN) quality benchmarks, and identify the factors that predict quality in these programmes. All known Australian Men's Sheds were invited to participate in an online cross-sectional survey. Forty sheds with formal mentor programmes completed the survey for a total of 387 mentees (mean = 9.7 mentees/programme), the majority being male. The majority of mentor programme facilitators were unpaid male volunteers aged 61 years and older, and programmes were unfunded. Promoting social and emotional well-being of the mentees was the primary focus in more than half of the programmes, and working on a shared construction project was the most common activity. Respondents rated the three most important factors that influenced programme effectiveness as being: (i) meaningful activities; (ii) mentors' approach; and (iii) a safe environment. Univariate analyses revealed that mentoring programmes that had a system in place for screening mentors, trained mentors and evaluated the programme were most likely to rate highly against the AYMN quality benchmarks.

Men with disabilities - A cross sectional survey of health promotion, social inclusion and participation at community Men's Sheds.

BACKGROUND: The intersections between chronicity, disability and social inequality are well understood. Novel ways to counter the social determinants of health and disability are needed. Men's Sheds are a community space where men can participate in a range of shared activities and potentially experience a health and social benefits. OBJECTIVE: This cross-sectional survey was conducted to inform future research by determining who attended Men's Sheds and the range of health, social, community, and educational activities undertaken there. This paper explores the membership of people with disabilities (PWD) at Men's Sheds and the factors that predict their membership. METHODS: An online survey link was sent to all known Men's Sheds internationally in 2012. Data were analyzed using descriptive and inferential (univariate and multivariate) statistics. RESULTS: 32.2% of international sheds and 29% of Australian sheds specifically targeted the inclusion of PWD. 80% of these sheds have significantly more members with disabilities than sheds who do no target PWD. Factors associated with greater membership of PWD included the provision of transport, social outings and promoting occupational skills. CONCLUSIONS: PWD are being encouraged to join and are joining Men's Sheds. This is significant as the value of participation and inclusion toward better health and wellbeing is well known. Men's Sheds offer a community space where the social determinants of chronicity and disability can potentially be countered.

Community-based Men's Sheds: promoting male health, wellbeing and social inclusion in an international context.

Males experience greater mortality and morbidity than females in most Western countries. The Australian and Irish National Male Health Policies aim to develop a framework to address this gendered health disparity. Men's Sheds have a distinct community development philosophy and are thus identified in both policies as an ideal location to address social isolation and positively impact the health and wellbeing of males who attend. The aim of this international cross-sectional survey was to gather information about Men's Sheds, the people who attend Men's Sheds, the activities at Men's Sheds, and the social and health dimensions of Men's Sheds. Results demonstrate that Men's Sheds are contributing a dual health and social role for a range of male subgroups. In particular, Men's Sheds have an outward social focus, supporting the social and mental health needs of men; health promotion and health literacy are key features of Men's Sheds. Men's Sheds have an important role to play in addressing the gendered health disparity that males face. They serve as an exemplar to health promotion professionals of a community development context where the aims of male health policy can be actualized as one part of a wider suite of global initiatives to reduce the gendered health disparity.

A narrative review of Men's Sheds literature: reducing social isolation and promoting men's health and well-being.

Men's Sheds are community-based organisations that typically provide a space for older men to participate in meaningful occupation such as woodwork. Men's Sheds are considered an exemplar for the promotion of men's health and well-being by health and social policy-makers. The objective of this literature review was to determine the state of the science about the potential for Men's Sheds to promote male health and well-being. Between October 2011 and February 2012, we conducted searches of databases, the grey literature and manual searches of websites and reference lists. In total, we found 5 reports and 19 articles about Men's Sheds. The majority of the literature has emanated from Australian academics and is about older men's learning in community contexts. There is a limited body of research literature about Men's Sheds; the literature consists of either descriptive surveys or small qualitative studies. The range of variables that might contribute towards best practice in Men's Sheds has not yet been adequately conceptualised, measured, tested or understood. Future research should be focussed on the health and well-being benefits of Men's Sheds; it needs to incorporate social determinants of health and well-being within the study designs to enable comparison against other health promotion research. Without this research focus, there is a danger that the potential health and well-being benefits of Men's Sheds as supportive and socially inclusive environments for health will not be incorporated into future male health policy and practice.

Chaos in Western Medicine: how issues of social-professional status are undermining our health.

From the period immediately following the second world war, western (orthodox) medicine - both as a philosophy of medicine and as a professional guild of medical professionals actively practicing medicine - has made progress in leaps and bounds, especially considering the advances in technology and associated enterprises. Over the last thirty years, however, the practice of orthodox medicine has taken a turn for the worst despite progressive philosophies and tenets of basic practice as offered by the professional bodies that regulate how medicine is operated and implemented. Current healthcare environments are in a chaotic state of affairs, most notably due to issues involving affordability of medical professionals. It is argued that the social-professional status of medical doctors allow exorbitant and unreachable demands on governments for increased salaries. The title-based supremacy of doctors within the occupations domain is not supported by what they are offering society at large, and it compromises the ability of medical institutions and governments to provide better and more affordable healthcare. From a sociological point of view, this paper examines the social-religious history of such social class-based occupational power and dominance, and paves the way toward an overhaul of current medical education frameworks that proactively will ensure greater occupational equity in healthcare settings, across all healthcare disciplines tasked with patient care and improvement of healthcare services. In essence, doctoral titles should only be awarded after successful completion of postgraduate doctoral studies, and a new breed of medical professionals must emerge, able to contribute more meaningfully to the advancement of medicine as a profession, as well as toward increased standards of healthcare and improved health services delivery.

Gendered service delivery: a masculine and feminine perspective on staff gender.

Despite acknowledgement that paid caregivers have a significant impact on the lives of people with intellectual disability, the subjective experience of staff gender is rarely considered in research. Qualitative data from a study on the sexual health needs of men and boys with intellectual disability is presented. We designed this study to determine what impact staff gender has on the sexual health needs of men and boys with intellectual disability. Findings suggest that although staff traverse the same geographies of care, they do it in uniquely gendered ways. Staff gender is an important consideration when dealing with sexual health matters and can enhance the type and quality of relationships between people with intellectual disability.