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1.
J Environ Radioact ; 248: 106883, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35468420

RESUMO

Leaching and transport of contaminants is a complex interacting system affected by a suite of environmental factors. This study demonstrates the potential significance of weather events and moisture movement when interpreting plutonium (Pu) migration and advective transport in the soil matrix. Using a column transport experiment, two soil types, a sandy soil and clay-rich soil, were spiked with 238Pu as a tracer to observe the effect of simulated tropical and arid rainfall events on Pu mobility. Partition coefficients (Kd) were determined over a period of weeks and under varying rainfall rates to establish the impact of changing weather events on Pu mobility. The variability of these temporal Kds covers six orders of magnitude over a relatively brief time period. This demonstrates the necessity for non-static Kds to accurately describe Pu transport in these systems. The Pu Kds determined by these column transport experiments fall within the bounds of anticipated values (approximately 80-300,000 mL g-1) from immobile (magnitude 106 mL g-1) to moderately mobile (magnitude 101 mL g-1). The overall transport rate, shown by a decrease in calculated Kd, increases in environments where rainfall is more episodic, such as in arid regions as opposed to the consistently abundant rainfall in tropical regions. In contrast to the 238Pu spike, 239+240Pu resulting from contamination from nuclear tests in the sandy soil (aged for >30 years) showed higher mobility; we hypothesise that the ageing of the contamination, in particular Pu-bearing particles, accounts for this significant increase in Pu mobility. Low intensity, high frequency events in tropical sandy soil systems containing Pu particle contamination have the potential to mobilise Pu (>105 decrease in calculated Kd) over shorter periods of weeks, and not years as previously assumed. This increased mobility, when applied to radioecological models using Kd as a site-specific parameter, shows that there is likely to be a continued impact (risk quotient >1) on non-human biota in tropical sandy soil ecosystems.


Assuntos
Plutônio , Monitoramento de Radiação , Poluentes Radioativos do Solo , Ecossistema , Plutônio/análise , Monitoramento de Radiação/métodos , Solo , Poluentes Radioativos do Solo/análise
2.
Sociol Health Illn ; 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35488431

RESUMO

How parents manage potential tensions between normative discourses of 'competent parenting' and their desires to consume alcohol has received little attention. In this article, we explore the elements that encourage or constrain parents' drinking and investigate how parents consider and manage their alcohol use in the context of multiple social roles with sometimes conflicting demands and expectations around 'competent parenting'. Our analysis draws on 30 semi-structured interviews with Australian parents, conducted as part of a broader project which aimed to explore how home drinking is integrated into everyday life. While parents' accounts of drinking alcohol highlighted effects such as embodied experiences of relaxation and facilitating shared adult moments, many participants described drinking less than they otherwise would if their children were not present. Participants discussed various social roles and routines which constrained consumption, with drinking bounded by responsibility. As such, drinking emerged as something needing to be actively negotiated, particularly in light of discourses that frame expectations of what constitutes 'competent parenting'. When considering parents' alcohol consumption in the future, we argue that it is important to destigmatise their consumption by acknowledging the importance of adults' pleasure and wellbeing, alongside children's needs for safety and modelling of safer alcohol consumption.

3.
West J Emerg Med ; 23(2): 108-114, 2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35302440

RESUMO

INTRODUCTION: Our aim was to measure hepatitis C virus (HCV) screening and linkage-to-care rates in an urban emergency department (ED) before and after implementing an HCV viral RNA (vRNA) reflex testing protocol within a HCV screening program for at-risk patients. Our hypothesis was that using a reflex testing protocol would increase HCV testing rates of at-risk patients in the ED, which would increase the linkage-to-care rate. METHODS: In August 2018, our institution implemented an automated, electronic health record-based HCV screening protocol in the ED for at-risk patients. In January 2019, we implemented an HCV vRNA reflex testing protocol (reflex testing) for all positive HCV antibody (Ab) tests that were initiated through the screening protocol. We compared completion rates of HCV vRNA testing and the rate of linkage to care for patients with positive HCV Ab test results before and after implementation of reflex testing (five months per study period). RESULTS: Prior to reflex testing implementation, 233/425 (55%) patients with a positive HCV Ab test had an HCV vRNA test performed, whereas 270/323 (84%) patients with a positive HCV Ab test result had vRNA testing after reflex testing implementation (odds ratio [OR], 4.2; 95% confidence interval (CI): 3.0-6.0; P < 0.001). Of the eligible patients with positive HCV Ab test results who could be linked to care, 45 (10.6%) were linked to care before HCV reflex implementation and 46 (14.2%) were linked to care with reflex testing (OR, 1.4; 95% CI: 0.9-2.2; P = 0.13). CONCLUSION: Implementing a reflex testing initiative into an HCV screening program in the ED can result in an increase of the percentage of patients who receive an HCV vRNA test after having had a positive HCV Ab. Hepatitis C virus vRNA reflex testing was not associated with a statistically significant increase in linkage-to-care rates for HCV Ab-positive patients; however, further studies are required.


Assuntos
Hepacivirus , Hepatite C , Serviço Hospitalar de Emergência , Hepacivirus/genética , Hepatite C/diagnóstico , Anticorpos Anti-Hepatite C , Humanos , Reflexo
4.
Psychol Addict Behav ; 2022 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-35129993

RESUMO

OBJECTIVES: To date, there have been no previous studies examining sex differences in the development of alcohol-related perceptions over time, a potential avenue for targeted prevention and early intervention efforts. This article examines any potential sex differences in young children's development of situational drinking norms over time. METHOD: Two hundred ninety-eight children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task-which involves attributing alcoholic beverages to adults in varying situational contexts-annually over 3 years (2015, 2016, 2017). Three-level regression models were estimated examining whether perceptions of situational drinking norms varied as a function of the sex of the participant and whether there were any changes over time. RESULTS: Over time children did not attribute more alcoholic beverages to adults in various situations, instead both boys and girls became more accurate at correctly identifying situations in which drinking is more common. Over time, both boys and girls attributed more alcoholic beverages in common situations and less in uncommon situations, with no significant sex differences in attributions of alcohol found. CONCLUSIONS: We identified no significant sex differences in the development of situational drinking norms over time, suggesting that education and prevention campaigns can be unified/nontargeted by sex. However, given our findings differ from previous studies that identify significant sex differences between children on the development of other alcohol-related cognitions beyond situational drinking norms, there is a need for more international research in this space to understand the importance and nature of the development of alcohol-related perceptions over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

5.
Soc Sci Med ; 296: 114712, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35093796

RESUMO

Home drinking contributes substantially to health harms associated with alcohol consumption. Drawing on practice theory and new materialism, we argue that drinking is a social practice that allows particular sets of effects, or affordances, when it takes place in a person's home. Qualitative interviews were conducted by telephone with 40 Australian adult home drinkers, of whom 20 drank at a level designated as low risk and 20 at a level which exposed them to a higher likelihood of harm. Our analyses identified four substantive affordances of home drinking practice. The first two concern transformations of home life. Home drinking allowed both celebration and smoothing of dissatisfaction with domestic relationships. Through producing subtly different affective states at home compared to in other locations, drinking practice rendered domestic settings home-like: as places of comfort and respite. The second two affordances of home drinking concern how home as a place acts in the co-constitution of drinking patterns. This entailed routinising alcohol consumption alongside other home-based practices and loosening constraints on intoxication. Importantly for our argument, each of these operated with greater intensity for participants who drank at a heavier level than for those who drank more moderately. For example, heavy drinkers expressed a greater imperative to alter relationships and affective states at home and emphasised how being at home produced opportunities for, and removed obstacles to, heavy drinking. We show that home drinking is patterned with other activities and entwined in domestic wellbeing and the emergence of home as a space of privacy, autonomy and relaxation for Australians in our study sample. Understanding home drinking as deeply embedded in the constitution of contemporary western domestic life helps to explain heavy alcohol consumption in these settings. It also supports the need for targeted public health responses such as restrictions on home delivery of alcohol.


Assuntos
Consumo de Bebidas Alcoólicas , Intoxicação Alcoólica , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Intoxicação Alcoólica/epidemiologia , Austrália/epidemiologia , Humanos
6.
Int J Drug Policy ; 99: 103461, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34537479

RESUMO

BACKGROUND: The news media can reflect and influence public opinion, as well as affect individual practice. In the context of significant changes in alcohol consumption among young people over the past twenty years, we examined Australian newspaper reporting of young people (under 18 years) and alcohol to assess whether there have been changes over time in the content and slant of articles that reflect or elucidate these trends. METHODS: Factiva was used to search newspaper articles from major Australian newspapers over a twenty year period (2000-2019). After screening, two researchers coded 2415 newspaper articles across four key domains: article type, article theme, sources cited and topic slant (e.g. approving, disapproving tone). Change over time across the study period was assessed using joinpoint Poisson regression analyses. RESULTS: There was a significant increase in articles on young people and alcohol between 2000 and 2008, before a corresponding decrease to 2019. Policy or prevention strategies were the most common theme of articles (35.8%), followed by articles reporting on risks or harms associated with alcohol use for young people (18.1%). Researchers were the most common source reported (25.1%), followed by politicians (19.0%). Three quarters of articles (75.9%) had a socially disapproving topic slant, which increased significantly up until 2011, with a corresponding decrease thereafter. CONCLUSION: Attention to, and problematisation of, young people and alcohol increased in the first decade of this millennium which may have acted to sustain or accelerate declining drinking trends. However, this dissipated back to baseline levels in the second decade, which may indicate a lag time in recognition of young people's drinking becoming less of a public health 'problem'.


Assuntos
Meios de Comunicação de Massa , Opinião Pública , Adolescente , Austrália/epidemiologia , Humanos , Saúde Pública
7.
Drug Alcohol Rev ; 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34752657

RESUMO

INTRODUCTION: As a result of COVID-19 and associated lockdown restrictions, children may have been exposed to more home-based alcohol consumption and parents' drinking practices. This paper explores Australian parents' perceptions of their children's awareness of drinking and their reflections on the impact of COVID-19 on children's exposure and acquisition of alcohol-related knowledge. METHODS: In-depth interviews were undertaken with 30 parents and carers of children aged four to 12 years from across Australia. Participants described their family lives, the role of alcohol, any changes in alcohol and family dynamics experienced because of COVID-19 and their children's exposure and knowledge of alcohol before and during their experience of COVID-19. Using social learning theory as a guiding framework, transcripts were analysed to identify relevant themes. RESULTS: Pre-COVID-19 children were commonly thought to be aware of behavioural changes owing to alcohol consumption, made associations between people, beverages and activities and recognised boundaries around consumption. COVID-19 was suggested to have impacted the environments in which children were exposed and the types of modelling and practices they were exposed to. It was more common for participants to describe COVID-19 affecting other children's learning and knowledge of alcohol, rather than their own. DISCUSSION AND CONCLUSIONS: Participants were mindful of children's knowledge and the role they played in modelling consumption practices prior to and during the COVID-19 lockdowns. There may be scope to use the insights provided here to support parents in modelling approaches and engaging with children about alcohol in ways that challenge or disrupt its prominence or acceptability.

8.
Artigo em Inglês | MEDLINE | ID: mdl-34735204

RESUMO

Alcohol expectancies are well-established determinants of alcohol consumption. Traditionally, expectancies were assessed using self-report questionnaires. However, researchers have increasingly begun to explore the use of pictographic assessments, for example, the revised Alcohol Expectancy Task [rAET]. The current research aimed to examine the factor structure of the task in relation to the hypothesised expectancy dimensions, participants' endorsement of these dimensions, and whether rAET scores are associated with drinking patterns. The rAET presents participants with several illustrated scenarios in which people are displaying emotions, following the Circumplex Model of Affect. For each scenario, participants select which type of drink the person presented in the illustration was most likely to have drunk. The rAET was administered online to a convenience sample (n = 1,192, female: 50.7%, Mage = 36.8, SD = 13.7). The confirmatory factor analysis demonstrated adequate fit of the hypothesised four-factor model. Mean comparisons demonstrated that positive expectancies were more pronounced than negative expectancies, and a distinction between arousal and sedation expectancies was found. Results of a structural equation model found that positive sedation and positive arousal were related to high drinking frequency. There were no links between usual quantity of alcohol use or binge drinking. It appears that the rAET can be successfully used to assess alcohol expectancies in terms of the emotions that are expected to occur from alcohol consumption. Future research is needed to establish the tool's assessment properties in different settings, and its utility in predicting alcohol consumption in different age groups, particularly children and young adolescents. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

9.
Appl Radiat Isot ; 176: 109878, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34343748

RESUMO

Atmospheric nuclear testing has occurred worldwide resulting in trace amounts of plutonium (Pu) isotopes in soils and sediments across the globe. Soils and sediments can vary greatly in both physical and chemical properties within close geographic regions presenting a major challenge for sample preparation in the analysis of fallout radionuclides. It is vital to have a rapid, agile method for the complete digestion of samples containing refractory Pu particles to address this challenge. A radioanalytical procedure for the analysis of Pu isotopes in soils/sediments has been developed improving sample preparation using fusion. This is done by eliminating the need for pre-dissolution combustion to remove organic material and providing greater application to a diverse range of samples including those of metal-bearing mineralogy. The integration of borate and peroxide flux materials creates a sample dissolution procedure that is greater than the sum of its parts. This method is applicable to the analysis of 239/240Pu in soil/sediment samples with a sample mass of 3 g, ranging from 0.05 to 5000 mBq/g achieving 242Pu tracer recoveries between 50 and 94%, with a trace-level detection limit of 0.04 mBq/g and measurement uncertainties down to 19%; adjustable to measurement priorities with variation in count time, background counts, chemical recovery and total activity of the sample. This sample preparation technique can be utilized with complementary analysis of alpha spectrometry or ICP-MS. Achieving these parameters provides a highly adaptable standard method for 239/240Pu in soil/sediment analysis applicable to samples from radioecological research at trace environmental levels to emergency response scenarios with 48-h turn-around producing highly repeatable, succinct and high-quality analysis.

10.
Sci Rep ; 11(1): 10698, 2021 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-34021195

RESUMO

The high-energy release of plutonium (Pu) and uranium (U) during the Maralinga nuclear trials (1955-1963) in Australia, designed to simulate high temperature, non-critical nuclear accidents, resulted in wide dispersion µm-sized, radioactive, Pu-U-bearing 'hot' particles that persist in soils. By combining non-destructive, multi-technique synchrotron-based micro-characterization with the first nano-scale imagining of the composition and textures of six Maralinga particles, we find that all particles display intricate physical and chemical make-ups consistent with formation via condensation and cooling of polymetallic melts (immiscible Fe-Al-Pu-U; and Pb ± Pu-U) within the detonation plumes. Plutonium and U are present predominantly in micro- to nano-particulate forms, and most hot particles contain low valence Pu-U-C compounds; these chemically reactive phases are protected by their inclusion in metallic alloys. Plutonium reworking was observed within an oxidised rim in a Pb-rich particle; however overall Pu remained immobile in the studied particles, while small-scale oxidation and mobility of U is widespread. It is notoriously difficult to predict the long-term environmental behaviour of hot particles. Nano-scale characterization of the hot particles suggests that long-term, slow release of Pu from the hot particles may take place via a range of chemical and physical processes, likely contributing to on-going Pu uptake by wildlife at Maralinga.

11.
J Radiol Prot ; 41(2)2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33761475

RESUMO

Large areas of the former British nuclear test site at Maralinga were contaminated by the explosive dispersal of plutonium. The Australian Government, in consultation with stakeholders, determined that the site should be cleaned-up so that it is fit for unrestricted habitation by the Aboriginal traditional owners (Maralinga Tjarutja). Engagement with the stakeholders, particularly the Maralinga Tjarutja, determined that the specific criterion for rehabilitation was 5 mSv y-1and that some restrictions on permanent occupancy should remain. Remediation of the site began in 1995, took 5 years and cost AU$106 million. The site was returned to its traditional owners in 2009 and is now the site of a flourishing tourism operation.


Assuntos
Guerra Nuclear , Plutônio , Poluentes Radioativos do Solo , Austrália , Plutônio/análise , Poluentes Radioativos do Solo/análise
12.
Drug Alcohol Rev ; 40(5): 800-807, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33034123

RESUMO

INTRODUCTION AND AIMS: By the time young adolescents initiate alcohol consumption they have firmly established attitudes, expectations and beliefs about alcohol and its effects. To further unravel the origins of this knowledge in childhood, we aim to address Dutch children's knowledge of the types of alcoholic beverages adults typically consume in certain situational contexts (i.e. their knowledge of beverage-specific situational norms). DESIGN AND METHODS: A total of 329 children (4-8 years old) completed the Dutch electronic Appropriate Beverage Task at three-time points (2015, 2016, 2017). Three-level regression models were estimated examining whether children's beverage-specific situational norms depend on the gender of the person displayed in the task, sex of the participant and whether there were any beverage-specific changes over time. RESULTS: Beverage-specific findings seem to be robust across the appropriateness of the situation. Beer was the most frequently attributed alcoholic beverage overall and across the common drinking situations. White wine was attributed significantly more to females in the task. Beer, red wine and champagne were attributed significantly more to males. Attributions of individual alcoholic beverages did not change significantly over time. There were no significant differences between the participating boys and girls. DISCUSSION AND CONCLUSIONS: Results suggest that 4-8-year olds are yet to form knowledge of beverage-specific situational norms. Independent of the situation, time and participants' sex, the gender of the person displayed in the task seemed to be more salient to children than situational or environmental indicators in determining consumption.


Assuntos
Consumo de Bebidas Alcoólicas , Vinho , Adolescente , Adulto , Bebidas Alcoólicas , Cerveja , Bebidas , Criança , Pré-Escolar , Eletrônica , Feminino , Humanos , Masculino
13.
Pharmacol Res Perspect ; 8(5): e00637, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32881317

RESUMO

We used electronic medical record (EMR) data in the National Patient-Centered Clinical Research Network (PCORnet) to characterize "real-world" prescription patterns of Type 2 diabetes (T2D) medications. We identified a retrospective cohort of 613,203 adult patients with T2D from 33 datamarts (median patient number: 12,711) from 2012 through 2017 using a validated computable phenotype. We characterized outpatient T2D prescriptions for each patient in the 90 days before and after cohort entry, as well as demographics, comorbidities, non-T2D prescriptions, and clinical and laboratory variables in the 730 days prior to cohort entry. Approximately half of the individuals in the cohort were females and 20% Black. Hypertension (60.3%) and hyperlipidemia (50.5%) were highly prevalent. Most patients were prescribed either a single T2D drug class (42.2%) or had no evidence of a T2D prescription in the EMR (42.4%). A smaller percentage was prescribed multiple T2D drug types (15.4%). Among patients prescribed a single T2D drug type, metformin was the most common (42.6%), followed by insulin (18.2%) and sulfonylureas (13.9%). Newer classes represented approximately 13% of single T2D drug type prescriptions (dipeptidyl peptidase-4 inhibitors [6.6%], glucagon-like peptide-1 receptor agonists [2.5%], thiazolidinediones [2.0%], and sodium-glucose cotransporter-2 inhibitors [1.6%]). Among patients prescribed multiple T2D drug types, the most common combination was metformin and sulfonylureas (63.5%). Metformin-based regimens were highly prevalent in PCORnet's T2D population, whereas newer agents were prescribed less frequently. PCORnet is a novel source for the potential conduct of observational studies among patients with T2D.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Hipoglicemiantes/classificação , Hipoglicemiantes/uso terapêutico , Adulto , Idoso , Comorbidade , Diabetes Mellitus Tipo 2/etnologia , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Quimioterapia Combinada , Registros Eletrônicos de Saúde , Feminino , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Insulina/uso terapêutico , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Estudos Retrospectivos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Tiazolidinedionas/uso terapêutico , Estados Unidos/epidemiologia
14.
J Environ Radioact ; 223-224: 106398, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32932188

RESUMO

Plutonium (Pu) interactions in the environment are highly complex. Site-specific variables play an integral role in determining the chemical and physical form of Pu, and its migration, bioavailability, and immobility. This paper aims to identify the key variables that can be used to highlight regions of radioecological sensitivity and guide remediation strategies in Australia. Plutonium is present in the Australian environment as a result of global fallout and the British nuclear testing program of 1952-1958 in central and west Australia (Maralinga and Montebello islands). We report the first systematic measurements of 239+240Pu and 238Pu activity concentrations in distal (≥1000 km from test sites) catchment outlet sediments from Queensland, Australia. The average 239+240Pu activity concentration was 0.29 mBq.g -1 (n = 73 samples) with a maximum of 4.88 mBq.g -1.238Pu/239+240Pu isotope ratios identified a large range (0.02-0.29 (RSD: 74%)) which is congruent with the heterogeneous nuclear material used for the British nuclear testing programme at Maralinga and Montebello Islands. The use of a modified PCA relying on non-linear distance correlation (dCorr) provided broader insight into the impact of environmental variables on the transport and migration of Pu in this soil system. Primary key environmental indicators of Pu presence were determined to be actinide/lanthanide/heavier transition metals, elevation, electrical conductivity (EC), CaO, SiO2, SO3, landform, geomorphology, land use, and climate explaining 81.7% of the variance of the system. Overall this highlighted that trace level Pu accumulations are associated with the coarse, refractive components of Australian soils, and are more likely regulated by the climate of the region and overall soil type.


Assuntos
Monitoramento de Radiação , Indicadores Ambientais , Sedimentos Geológicos , Ilhas , Plutônio/análise , Queensland , Dióxido de Silício , Poluentes Radioativos do Solo/análise
15.
Alcohol Alcohol ; 55(6): 690-697, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-32676647

RESUMO

AIMS: This paper analyses the content of news media messages on drinking during pregnancy in Australia over an 18-year period to understand whether and how the nature of messages communicated to women has changed over time. METHODS: Factiva was used to search Australian newspapers from 2000 to 2017, resulting in a sample of 1394 articles from the 18 major national and state-based newspapers. Content analysis of articles was undertaken, and Poisson regression analysis was used to assess changes over time. RESULTS: The largest number of articles on drinking during pregnancy was published in 2007. Themes that significantly increased over time included Harms to the Child (from 0.97% in 2008 to 29.69% in 2015) and Prevention Initiatives (from 0% in 2005 to 12.50% in 2017). Articles endorsing women not consuming alcohol during pregnancy significantly increased over time (from 20.69% in 2001 to 53.78% in 2013), matched by a decreasing trend in the proportion of articles presenting mixed advice (from 15.93% in 2009 to 0% in 2017). The largest number of articles adopted no position in relation to women's consumption. CONCLUSIONS: A stronger abstinence message during pregnancy has been communicated through Australian newspaper media over time. The mixed messaging and large number of articles not endorsing a position on consumption may reflect the inconclusiveness of the evidence on harms from low to moderate levels of alcohol consumption during pregnancy. Opportunities remain for researchers to work with public health advocates to disseminate balanced messages based on evidence-based research.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/tendências , Análise de Dados , Jornais como Assunto/tendências , Consumo de Bebidas Alcoólicas/prevenção & controle , Austrália/epidemiologia , Feminino , Humanos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Estudos Retrospectivos
16.
BMC Med Educ ; 20(1): 168, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32450851

RESUMO

BACKGROUND: A common feature of performance assessments is the use of human assessors to render judgements on student performance. From a measurement perspective, variability among assessors when assessing students may be viewed as a concern because it negatively impacts score reliability and validity. However, from a contextual perspective, variability among assessors is considered both meaningful and expected. A qualitative examination of assessor cognition when assessing student performance can assist in exploring what components are amenable to improvement through enhanced rater training, and the extent of variability when viewing assessors as contributing their individual expertise. Therefore, the purpose of this study was to explore assessor cognition as a source of score variability in a performance assessment of practice-based competencies. METHOD: A mixed-method sequential explanatory study design was used where findings from the qualitative strand assisted in the interpretation of results from the quantitative strand. Scores from one objective structured clinical examination (OSCE) were obtained for 95 occupational therapy students. Two Generalizability studies were conducted to examine the relative contribution of assessors as a source of score variability and to estimate the reliability of domain and holistic scores. Think-aloud interviews were conducted with eight participants assessing a subset of student performances from the OSCE in which they participated. Findings from the analysis of think-aloud data and consideration of assessors' background characteristics were used to assist in the interpretation of variance component estimates involving assessors, and score reliability. RESULTS: Results from two generalizability analyses indicated the highest-order interaction-error term involving assessors accounted for the second-highest proportion of variance, after student variation. Score reliability was higher in the holistic vs. analytic scoring framework. Verbal analysis of assessors' think-aloud interviews provided evidential support for the quantitative results. CONCLUSIONS: This study provides insight into the nature and extent of assessor variability during a performance assessment of practice-based competencies. Study findings are interpretable from the measurement and contextual perspectives on assessor cognition. An integrated understanding is important to elucidate the meaning underlying the numerical score because the defensibility of inferences made about students' proficiencies rely on score quality, which in turn relies on expert judgements.


Assuntos
Competência Clínica , Cognição , Avaliação Educacional/normas , Docentes/normas , Terapeutas Ocupacionais/educação , Exame Físico/normas , Humanos , Julgamento , Variações Dependentes do Observador
18.
Addict Behav ; 106: 106375, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32163804

RESUMO

The aim of this paper is to explore whether in the eyes of young adolescents the consumption of different alcoholic beverages is associated with different alcohol expectancies, namely beliefs on what emotional outcomes take place when alcohol is consumed. 283 nine to 12-year olds from Switzerland completed the Alcohol Expectancy Task (AET). Participants were asked to assign one of 12 beverages (four alcoholic, eight non-alcoholic) to 16 adults depicting four emotional states (happy, angry, relaxed, sad). General linear modelling was used to examine beverage attributions across the four different emotional states. Beer was the most commonly attributed beverage across all 16 adults depicted. Happy and angry persons were most commonly attributed beer. Gender variations were found for relaxed persons, with females predominantly attributed champagne and males predominantly attributed beer. Young adolescents predominantly gave white wine to sad persons. Findings reveal a level of nuanced knowledge existing among young adolescents with minimal drinking experience, in that they hold very different expectancies for different beverages, prompting for future investigations to examine beverage-specific expectancies. Furthermore, findings showing beverage-specific expectancies among young adolescents may have implications for researchers' considerations of how alcohol-related knowledge and expectancies develop throughout childhood.


Assuntos
Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas , Adolescente , Adulto , Cerveja , Bebidas , Criança , Emoções , Feminino , Humanos , Masculino , Suíça
19.
Pharmacoepidemiol Drug Saf ; 28(5): 632-639, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30680840

RESUMO

PURPOSE: PCORnet, the National Patient-Centered Clinical Research Network, represents an innovative system for the conduct of observational and pragmatic studies. We describe the identification and validation of a retrospective cohort of patients with type 2 diabetes (T2DM) from four PCORnet sites. METHODS: We adapted existing computable phenotypes (CP) for the identification of patients with T2DM and evaluated their performance across four PCORnet sites (2012-2016). Patients entered the cohort on the earliest date they met one of three CP categories: (CP1) coded T2DM diagnosis (ICD-9/ICD-10) and an antidiabetic prescription, (CP2) diagnosis and glycosylated hemoglobin (HbA1c) ≥6.5%, or (CP3) an antidiabetic prescription and HbA1c ≥6.5%. We required evidence of health care utilization in each of the 2 prior years for each patient, as we also developed an incident T2DM CP to identify the subset of patients without documentation of T2DM in the 365 days before t0 . Among a systematic sample of patients, we calculated the positive predictive value (PPV) for the T2DM CP and incident-T2DM CP using electronic health record (EHR) review as reference. RESULTS: The CP identified 50 657 patients with T2DM. The PPV of patients randomly selected for validation was 96.2% (n = 1572; CI:95.1-97.0) and was consistently high across sites. The PPV for the incident-T2DM CP was 5.8% (CI:4.5-7.5). CONCLUSIONS: The T2DM CP accurately and efficiently identified patients with T2DM across multiple sites that participate in PCORnet, although the incident T2DM CP requires further study. PCORnet is a valuable data source for future epidemiological and comparative effectiveness research among patients with T2DM.


Assuntos
Pesquisa Comparativa da Efetividade/métodos , Redes de Comunicação de Computadores , Diabetes Mellitus Tipo 2/epidemiologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Assistência Centrada no Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Incidência , Armazenamento e Recuperação da Informação , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
20.
J Nurs Care Qual ; 34(1): 80-85, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30198944

RESUMO

BACKGROUND: Providing appropriate and timely mealtime assistance to hospitalized patients should be part of a multifaceted and multidisciplinary approach to optimizing a patient's nutritional care plan. PROBLEM: There was anecdotal evidence at the study hospital that patients did not receive adequate and/or timely assistance at mealtimes. APPROACH: A best practice implementation project, using a proven strategy of audit, feedback, and reaudit, was used to effect practice change on an acute general medical ward. OUTCOMES: The combined interventions of staff engagement, redesigning the model of care to reprioritize activities at mealtimes, clarifying nutritional care roles and responsibilities, introducing a protected mealtime and a novel 2-tiered colored tray system, and implementing an awareness and education program have resulted in significant improvements in mealtime assistance. CONCLUSIONS: Success of the project is considered to be replicable and sustainable hospitalwide and more broadly.


Assuntos
Comportamento Cooperativo , Refeições/psicologia , Guias de Prática Clínica como Assunto , Hospitais , Humanos , Papel do Profissional de Enfermagem , Inovação Organizacional
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