Objective To examine the access to the renal transplant waiting list and renal transplantation in Scotland. Design Cohort study. Setting Renal and transplant units in Scotland. Participants 4523 ...adults starting renal replacement therapy in Scotland between 1 January 1989 and 31 December 1999. Main outcome measures Impact of age, sex, social deprivation, primary renal disease, renal or transplant unit, and geography on access to the waiting list and renal transplantation. Results 1736 of 4523 (38.4%) patients were placed on the waiting list for renal transplantation and 1095 (24.2%) underwent transplantation up to 31 December 2000, the end of the study period. Patients were less likely to be placed on the list if they were female, older, had diabetes, were in a high deprivation category, and were treated in a renal unit in a hospital with no transplant unit. Patients living furthest away from the transplant centre were listed more quickly. The only factors governing access to transplantation once on the list were age, primary renal disease, and year of listing. A significant centre effect was found in access to the waiting list and renal transplantation. Conclusions A major disparity exists in access to the renal transplant waiting list and renal transplantation in Scotland. Comorbidity may be an important factor.
Providing rehabilitation services to address the health needs of rural residents requires overcoming the challenges of geography, limited referral options and a shortage of occupational therapists ...(OTs) and physical therapists (PTs). However, little is known about how rehabilitation professionals in rural areas enact their practice to meet and overcome these challenges. To address this gap and contribute to enhancing health for rural residents, this study was designed to explore rural rehabilitation practice from the perspectives of OTs and PTs in rural British Columbia (BC).
A purposive sample of OTs and PTs in rural communities (population <15 000) in northern BC was recruited for this qualitative study. Potential participants received an invitation mailed to workplaces and were selected to ensure a variety of work experiences, roles and practice settings. In semi-structured interviews, participants were asked to describe the skills and knowledge they perceived as unique to rural practice and strategies they used to overcome challenges. Guided by interpretive description, transcripts were analysed inductively using broad-level coding, and findings were collapsed into interpretive categories. Interpretations and implications for education, practice and policy were reviewed with participants to ensure relevance to rural practice.
From interviews with 6 OTs and 13 PTs, serving a total of 15 rural communities, rehabilitation practice and participants' definition of health were understood to be substantially shaped by rurality or the contextual features of geography, determinants of health and access to services. Participants considered general practice 'a specialty' requiring advanced skills in assessment. They described 'stretching their role' and 'participating in, and partnerships with, community' as ways to overcome resource shortages. Reflective practice, networking and collaboration were deemed essential to maintaining competence. Rural clinical placements, mentoring and improving access to continuing professional development were regarded as central to the recruitment and retention required to sustain optimal levels of service to residents.
The research findings illustrate the unique influence that the rural context has on the practice of OTs and PTs in BC. They underscore the importance of facilitating learning about rural health within professional training programs and of providing accessible professional development resources to address health human resource shortages and meet the rehabilitation needs of rural residents.
The UK National Health Service is subject to variation in demand for medical
services, particularly during the winter. The article describes System Watch, a
real-time system developed to assist with ...hospital bed management in NHS
Scotland by monitoring and predicting activity within hospitals and the primary
care sector. System Watch gathers daily hospital numbers of emergency admissions
and beds occupied by emergencies. It uses this and other information to model
long- and short-term demand for emergency bed admissions and present predictions
in a graphical form through a web-based user interface. The article evaluates
the accuracy of predictions and the initial experience of the use of System
Watch by bed managers. The results indicate that System Watch’s
accuracy is sufficient for planning purposes at both health board area and
hospital level. Finally, additional possible uses of System Watch are described
and future developments outlined.
SUMMARY Prior research has largely characterized audit negotiations as a dyadic relationship between auditors and managers. However, the Sarbanes-Oxley Act (SOX) substantially enhances the audit ...committee's oversight responsibilities for the financial reporting and auditing processes. Thus, negotiations post-SOX may be viewed as a triadic relationship that now involves the audit committee with the authority to scrutinize audit negotiations. Consistent with auditors considering their relative bargaining power and expectations of counterpart behavior, Brown-Liburd and Wright (2011) find that auditors are most contending when the audit committee is strong and the past relationship is contentious. We extend Brown-Liburd and Wright (2011) by examining the joint effects of these factors on managers' pre-negotiation judgments. We posit that rather than mirror auditor behavior, managers make different judgments because they have a different perspective and set of incentives than do auditors. Prior research suggests that managers are more flexible, more accurately determine their counterpart's goals and limits, and are more likely to use certain negotiation tactics than auditors. Further, managers have incentives to maximize the current outcome while maintaining their firm's reporting reputation. As such, managers will be less aggressive in responding to a contentious past auditor relationship, particularly in the presence of a strong audit committee that may ask difficult questions and potentially intervene against their favor. However, managers will act more aggressively to capitalize on a cooperative past auditor relationship, particularly in the presence of a weak audit committee that is passive or persuadable. To examine these two boundary conditions, we conduct an experiment with 137 experienced CFO/controllers. We find strong evidence supporting our expectations that managers act as if both the audit committee and the auditor jointly play important roles in ensuring high financial reporting quality. JEL Classifications: M41; M42.
The Institute for Healthcare Improvement Framework for Improving Joy at Work includes self-care as a strategy to support happy, healthy, and productive people; however, this relationship has not ...previously been empirically demonstrated. The purpose of this study was to describe self-care practices and levels of meaning and joy in work (MJW) in a sample of registered nurses and to explore the relationship between self-care and MJW. Registered nurses (n = 122) from a regional health system completed a survey during a nursing recognition event. Measures included a Demographic Questionnaire, the Meaning and Joy in Work Questionnaire (MJWQ), and the Brief Mindful Self-Care Scale (Brief MSCS). The mean MJWQ score was 4.29 on a scale of 1 to 5, and the mean Brief MSCS score was 3.05. There was a significant relationship between MJWQ and Brief MSCS scores ( r = 0.43, P < .001). These results indicate that supporting self-care in nurses may improve MJW.The Institute for Healthcare Improvement Framework for Improving Joy at Work includes self-care as a strategy to support happy, healthy, and productive people; however, this relationship has not previously been empirically demonstrated. The purpose of this study was to describe self-care practices and levels of meaning and joy in work (MJW) in a sample of registered nurses and to explore the relationship between self-care and MJW. Registered nurses (n = 122) from a regional health system completed a survey during a nursing recognition event. Measures included a Demographic Questionnaire, the Meaning and Joy in Work Questionnaire (MJWQ), and the Brief Mindful Self-Care Scale (Brief MSCS). The mean MJWQ score was 4.29 on a scale of 1 to 5, and the mean Brief MSCS score was 3.05. There was a significant relationship between MJWQ and Brief MSCS scores ( r = 0.43, P < .001). These results indicate that supporting self-care in nurses may improve MJW.
Abstract Physical activity recommendations for children in several countries advise that all young people should accumulate at least 60 min of moderate to vigorous physical activity every day. ...Perceiving physical activity intensity, however, can be a difficult task for children and it is not clear whether children can identify their levels of moderate to vigorous physical activity in accordance with the recommended guidelines. This study aimed to (1) explore whether children can identify time spent in moderate to vigorous physical activity; and (2) investigate whether heart rate biofeedback would improve children's ability to estimate time spent in moderate to vigorous physical activity. Thirty seven children (15 boys and 22 girls, mean age 12.6 years) wore data recording Polar E600 heart rate monitors during eight physical education lessons. At the end of each lesson children's estimated time in zone was compared to their actual time in zone. During a six lesson Intervention phase, one class was assigned to a biofeedback group whilst the other class acted as the control group and received no heart rate biofeedback. Post-Intervention, students in the biofeedback group were no better than the control group at estimating time spent in zone (mean relative error of estimation biofeedback group: Pre-Intervention 41 ± 32% to Post-Intervention 28 ± 26%; control group: Pre-Intervention 40 ± 39% to Post-Intervention 31 ± 37%). Thus it seems that identifying time spent in moderate to vigorous physical activity remains a complex task for children aged 11-13 even with the help of heart rate biofeedback.
Is there anything more important than the health, well-being and education of a nation’s children? This paper takes the position that school is the most important place to educate children about ...health and to develop lifelong health promoting skills. We believe that health promotion programs and activities are integral to the school’s educational program, not as extracurricular, but as central to school’s educational mission. In this chapter, we highlight the importance of physical education and physical activity as key components of a well-designed coordinated school health program. We also outline the skills that PE teachers must learn to take a leadership role in the school health movement.
Introduction
Though in-hospital supplementation of the newborn is associated with decreased breastfeeding success, excessive neonatal weight loss is a medical indication for supplementation. Studies ...have theorized that maternal fluid intake during labor may impact neonatal weight loss, resulting in unnecessary supplementation. The purpose of this review was to synthesize evidence regarding the relationship between maternal fluid intake during labor and neonatal weight loss.
Methods
Literature searches were conducted in relevant databases using controlled vocabulary. The main findings and outcomes were compared across studies and calculations conducted to report the proportion of studies reporting significant findings.
Results
11 studies were included in the review. Overall, 7 studies (64%) identified a significant relationship between maternal fluid intake during labor and neonatal weight loss.
Conclusions
Given the risk to the newborn associated with excessive weight loss, it is not prudent to incorporate maternal fluid intake into supplementation guidelines based on existing evidence. Further research is needed before practice recommendations can be made.
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