scholarly journals Defining and measuring bedtime routines in families with young children—A DELPHI process for reaching wider consensus

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247490
Author(s):  
George Kitsaras ◽  
Michaela Goodwin ◽  
Julia Allan ◽  
Iain A. Pretty
Keyword(s):  
Young Children ◽  
Initial Step ◽  
Delphi Process ◽  
Family Activities ◽  
Health And Social Care ◽  
Important Health ◽  
Definition Of ◽  
Bedtime Routine ◽  
Night Period ◽  
Difference Plot

Introduction Bedtime routines are one of the most common family activities. They affect children’ wellbeing, development and health. Despite their importance, there is limited evidence and agreement on what constitutes an optimal bedtime routine. This study aims to reach expert consensus on a definition of optimal bedtime routines and to propose a measurement for bedtime routines. Method Four-step DELPHI process completed between February and March 2020 with 59 experts from different scientific, health and social care backgrounds. The DELPHI process started with an expert discussion group and then continued with 3 formal DELPHI rounds during which different elements of the definition and measurement of bedtime routines were iteratively refined. The proposed measurement of bedtime routines was then validated against existing data following the end of the DELPHI process. Results At the end of the four round DELPHI process and with a consistent 70% agreement level, a holistic definition of bedtime routines for families with young children between the ages of 2 and 8 years was achieved. Additionally, two approaches for measuring bedtime routines, one static (one-off) and one dynamic (over a 7-night period) are proposed following the end of the DELPHI process. A Bland-Altman difference plot was also calculated and visually examined showing agreement between the measurements that could allow them to be used interchangeably. Discussion Both the definition and the proposed measurements of bedtime routines are an important, initial step towards capturing a behavioural determinant of important health and developmental outcomes in children.

scholarly journals Perceived Barriers and Facilitators for Bedtime Routines in Families with Young Children

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 50
Author(s):  
George Kitsaras ◽  
Michaela Goodwin ◽  
Michael Kelly ◽  
Iain Pretty ◽  
Julia Allan
Keyword(s):  
Young Children ◽  
Social Role ◽  
Theoretical Domains Framework ◽  
Structured Interview ◽  
Perceived Barriers ◽  
Sources Of Information ◽  
Important Health ◽  
Motivation For Change ◽  
Past Experiences ◽  
Bedtime Routine

Objectives: Bedtime routines are a highly recurrent family activity with important health, social and behavioural implications. This study examined perceived barriers to, and facilitators of, formulating, establishing, and maintaining optimal bedtime routines in families with young children. Design: Participants completed a semi-structured interview based on the Theoretical Domains Framework (TDF). Analysis followed a deductive approach. Participants: A total of 32 parents participated in the study. Most participants (N = 30) were females, were white (N = 25) and stay at home parents (N = 12). Results: Key barriers included lack of appropriate knowledge and sources of information, problematic skills development, social influences, cognitive overload, and lack of motivation for change. Facilitators included social role, access to resources, positive intentions, beliefs about consequences and reinforcement. In particular, optimal bedtime routines were less likely to be enacted when parents were tired/fatigued and there was a strong effect of habit, with suboptimal routines maintained over time due to past experiences and a lack of awareness about the importance of a good bedtime routine. Conclusions: Several theory-based, and potentially modifiable, determinants of optimal bedtime routines were identified in this study, providing important information for future interventions. Several of the key determinants identified were transient (tiredness) and/or non-conscious (habit), suggesting that future interventions may need to be deployed in real time, and should extend beyond conventional techniques.

scholarly journals A Scoping Review and Thematic Classification of Patient Complexity: Offering a Unifying Framework

2012 ◽  
Vol 2 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Alexis K. Schaink ◽  
Kerry Kuluski ◽  
Renée F. Lyons ◽  
Martin Fortin ◽  
Alejandro R. Jadad ◽  
...  
Keyword(s):  
Scoping Review ◽  
Chronic Conditions ◽  
Modern Medicine ◽  
Complex Chronic Conditions ◽  
Health And Social Care ◽  
Payment Schemes ◽  
Important Health ◽  
The Face ◽  
Patient Complexity ◽  
Important Health Issue

The path to improving healthcare quality for individuals with complex health conditions is complicated by a lack of common understanding of complexity. Modern medicine, together with social and environmental factors, has extended life, leading to a growing population of patients with chronic conditions. In many cases, there are social and psychological factors that impact treatment, health outcomes, and quality of life. This is the face of complexity. Care challenges, burden, and cost have positioned complexity as an important health issue. Complex chronic conditions are now being discussed by clinicians, researchers, and policy-makers around such issues as quantification, payment schemes, transitions, management models, clinical practice, and improved patient experience. We conducted a scoping review of the literature for definitions and descriptions of complexity. We provide an overview of complex chronic conditions, and what is known about complexity, and describe variations in how it is understood. We developed a Complexity Framework from these findings to guide our approach to understanding patient complexity. It is critical to use common vernacular and conceptualization of complexity to improve service and outcomes for patients with complex chronic conditions. Many questions still persist about how to develop this work with a health and social care lens; our framework offers a foundation to structure thinking about complex patients. Further insight into patient complexity can inform treatment models and goals of care, and identify required services and barriers to the management of complexity.

What initiatives do healthcare leaders agree are needed for healthcare system improvement? Results of a modified-Delphi study

2018 ◽  
Vol 32 (8) ◽  
pp. 1002-1012
Author(s):  
Stuart Barson ◽  
Robin Gauld ◽  
Jonathon Gray ◽  
Goran Henriks ◽  
Christina Krause ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Healthcare System ◽  
Professional Training ◽  
Delphi Process ◽  
Content Type ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Health And Social Care ◽  
System Leaders ◽  
Practical Implications

Purpose The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. Design/methodology/approach A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments. Findings The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people. Research limitations/implications Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input. Practical implications The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems. Originality/value This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.

scholarly journals Proposal of a composite indicator for measuring social media presence in the wine market

2020 ◽  
Author(s):  
Andrea Conchado Peiró ◽  
José Miguel Carot Sierra ◽  
Elena Vázquez Barrachina ◽  
Enrique Orduña Malea
Keyword(s):  
Social Media ◽  
Market Research ◽  
Initial Step ◽  
Composite Indicators ◽  
New Approach ◽  
Misleading Information ◽  
Social Media Networks ◽  
Wine Market ◽  
Definition Of ◽  
Research Analysis

Cybermetrics field is attracting considerable interest due to its utility as a data-oriented technique for research, though it may provide misleading information when used in complex systems. This paper outlines a new approach to market research analysis through the definition of composite indicators for cybermetrics, applied to the Spanish wine market. Our findings show that the majority of cellars were present in only one or two social media networks: Facebook, Twitter or both. Besides, the presence on the Web can be summarized into three principal components: website quality, presence on Facebook, and presence on Twitter. Three groups of cellars were identified according to their position in these components: cellars with a high number of errors in their website with complete absence of information in social media, cellars with strong presence in social media, and cellars in an intermediate position. Our results constitute an excellent initial step towards the definition of a methodology for building composite indicators in cybermetrics. From a practical approach, these indicators may encourage cellar managers to make better decisions towards their transition to the digital market.

scholarly journals The definitions of health care and social welfare informatics competencies

2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Minna Tiainen ◽  
Outi Ahonen ◽  
Leena Hinkkanen ◽  
Elina Rajalahti ◽  
Alpo Värri
Keyword(s):  
Health Care ◽  
Social Welfare ◽  
Social Care ◽  
Well Being ◽  
Health And Social Care ◽  
Digital Environments ◽  
Version 2.0 ◽  
Digital Competencies ◽  
Definition Of ◽  
Health And Well Being

Digital transformation is changing the ecosystem and at the same time professionals’ competencies worldwide. Minimising health care and social welfare costs while increasing citizens’ health and well-being is challenging. Technology and digital tools play an important role in reaching this goal. However, there are inequalities concerning technology, and this has many impacts. Digitalisation brings challenges not only to health care and social welfare professionals but to citizens, too. Working with or using services in digital environments demands new skills. This has social and ethical impacts, e.g. how is equal access to services ensured. Health and social care professionals should have different competencies to respond to this, such as societal competencies. The purpose of this article is to describe how the definition of competencies in health care and social welfare version 1.0 (developed in the national SotePeda 24/7 project) was finalised as the final version 2.0 for Finnish healthcare and social welfare education by experts’ evaluation. Data was collected through an electronic questionnaire administered to selected experts (N=140) during January 2020. The number of experts who responded to the study was 52. These experts (social and health, business and IT) work or have worked in tasks related to the digitalisation of social and health care. The questionnaire was based on version 1.0 of the definition of digital competencies of health care and social welfare informatics. The questionnaire was mainly quantitative, but it also included open-ended qualitative questions. The experts agreed to a large extent on the version 1.0 definition, but some adjustments were made to the definition based on our study. The resulting definition is intended for use in the planning, implementation and evaluation of health care and social welfare education, but it can also be used for polytechnic education. The aim is to develop the digital skills of educators, degree students and in-service trainees in a multidisciplinary way (social and health, business and IT) to meet the needs of working life.

scholarly journals The Management of Iron Chelation Therapy: Preliminary Data from a National Registry of Thalassaemic Patients

Anemia ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Adriana Ceci ◽  
Laura Mangiarini ◽  
Mariagrazia Felisi ◽  
Franco Bartoloni ◽  
Angela Ciancio ◽  
...  
Keyword(s):  
Preliminary Data ◽  
Age Groups ◽  
Iron Chelation ◽  
Cost Effective ◽  
National Registry ◽  
Therapeutic Interventions ◽  
Current Status ◽  
Mediterranean Countries ◽  
Important Health ◽  
Definition Of

Thalassaemia and other haemoglobinopathies constitute an important health problem in Mediterranean countries, placing a tremendous emotional, psychological, and economic burden on their National Health systems. The development of new chelators in the most recent years had a major impact on the treatment of thalassaemia and on the quality of life of thalassaemic patients. A new initiative was promoted by the Italian Ministry of Health, establishing a Registry for thalassaemic patients to serve as a tool for the development of cost-effective diagnostic and therapeutic approaches and for the definition of guidelines supporting the most appropriate management of the iron-chelating therapy and a correct use of the available iron-chelating agents. This study represents the analysis of the preliminary data collected for the evaluation of current status of the iron chelation practice in the Italian thalassaemic population and describes how therapeutic interventions can widely differ in the different patients' age groups.

scholarly journals Perceptions of Health Status in Multiple Sclerosis Patients and Their Doctors

2013 ◽  
Vol 40 (2) ◽  
pp. 210-218 ◽  
Author(s):  
Marcelo Kremenchutzky ◽  
Len Walt
Keyword(s):  
Multiple Sclerosis ◽  
Health Status ◽  
Bodily Pain ◽  
Kappa Statistic ◽  
Patient Perceptions ◽  
Mean Values ◽  
Health Domains ◽  
Important Health ◽  
Definition Of ◽  
Multiple Sclerosis Patients

Objective:To compare neurologist and patient perceptions of multiple sclerosis (MS)-related health status.Methods:MS patients (n=99) were recruited from six sites in Canada. Following a consultation with their neurologist, patients estimated their relapse frequency, rated their general health and quality of life (QoL), reviewed descriptions of eight health domains and selected the three most important, and completed a utility assessment using the standard gamble (SG). Concurrently, neurologists independently used the same instruments to rate their patients' health status. Assessments were compared on the basis of paired mean values of both groups and the degree of exact agreement quantified by intraclass coefficient (ICC) and kappa analyses, which yield values of 1.0 with 100% agreement.Results:There were significant differences (p<0.001) between patient and neurologist ratings for relapses in the last year (0.86 vs. 0.4, respectively), QoL (61.2 vs. 69.7 (maximum score = 100) and utility (0.864 vs. 0.971); ICC analysis revealed moderate to poor levels of agreement (0.56 for QoL to 0.03 for SG). There was little concordance in identification of important health domain and the only significant associations were in bodily pain and social functioning (kappa statistic = 0.24, p = 0.026 for both). Neurologists identified physical functioning domains as important, while patients placed more emphasis on mental health domains.Conclusions:Discrepancies between neurologist and patient perceptions of MS were observed. The study identifies a need to educate neurologists on the recognition of MS health domains that are important in the definition of patient QoL.

scholarly journals A Proposed Revision to the Definition of “Derecho”

2016 ◽  
Vol 97 (6) ◽  
pp. 935-949 ◽  
Author(s):  
Stephen F. Corfidi ◽  
Michael C. Coniglio ◽  
Ariel E. Cohen ◽  
Corey M. Mead
Keyword(s):  
Initial Step ◽  
The United States ◽  
Early Years ◽  
Mississippi Valley ◽  
Physical Processes ◽  
Convective Systems ◽  
Convective Structures ◽  
Physically Based ◽  
Wind Events ◽  
Definition Of

Abstract The word “derecho” was first used by Gustavus Hinrichs in 1888 to distinguish the widespread damaging windstorms that occurred on occasion over the mid–Mississippi Valley region of the United States from damaging winds associated with tornadoes. The term soon fell into disuse, however, and did not appear in the literature until Robert Johns and William Hirt resurrected it in the mid-1980s. While the present definition of derecho served well during the early years of the term’s reintroduction to the meteorological community, it has several shortcomings. These have become more apparent in recent years as various studies shed light on the physical processes responsible for the production of widespread damaging winds. In particular, the current definition’s emphasis on the coverage of storm reports at the expense of identifying the convective structures and physical processes deemed responsible for the reports has led to the term being applied to wind events beyond those for which it originally was intended. The revised definition of a derecho proposed herein is intended to focus more specifically on those types of windstorms that are the most damaging and potentially life threatening because of their intensity, sustenance, and degree of organization. The proposal is not intended to be final or all encompassing, but rather an initial step toward ultimately realizing a more complete physically based taxonomy that also addresses other forms of damaging-wind-producing convective systems.

Treatment of Advanced Colorectal Cancer (CRC) in Daily Practice: Results of a Survey in two Italian Regions, Piemonte and Valle D'aosta

1998 ◽  
Vol 84 (5) ◽  
pp. 562-566 ◽  
Author(s):  
Alessandro Comandone ◽  
Roberto Berardo ◽  
Roberto Faggiuolo ◽  
Antonella Boglione ◽  
Paola Bergnolo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Performance Status ◽  
Daily Practice ◽  
New Drugs ◽  
Therapeutic Choice ◽  
Italian Regions ◽  
Important Health ◽  
Definition Of ◽  
No Gold Standard

Aims and background Colorectal cancer (CRC) is one of the most important health problems in Western countries: it is the fourth cancer in terms of incidence and the second cause of cancer death. Surgery is the main therapeutic choice and there is broad consensus on the role of adjuvant chemotherapy (CT) after resection. Unfortunately, 50% of the patients will relapse and die of the disease. Palliative CT based on 5-fluorouracil (5FU) may induce a 9-48% response rate with a median survival of 11.5 months. At present there is no gold standard for CT in advanced CRC and the situation has become more complicated since the advent of new drugs (Raltitrexed, Irinotecan, Oxaliplatin). The aim of this study was the identification of the different approaches to treatment of advanced CRC among the clinicians (oncologists, radiologists, internal medicine specialists, surgeons) who practice CT. Methods and study design Forty-six clinicians from two Italian Regions (Piemonte and Valle d'Aosta) were interviewed by telephone. Results 5FU modulated with Lederfolin according to the classic Machover scheme is the main option in daily practice. More sophisticated therapies are reserved to patients with a good performance status (PS) and are prescribed only in the larger centers. The planned therapies usually consist of six courses. Restaging may be performed after three or six courses. A marked difference has been recorded in the evaluation of a situation of no change (NC): 25.5% of the clinicians evaluate stable disease as a positive result. In the event of disease progression or relapse, 35% of the clinicians do not prescribe second-line CT. In case of further treatment, the options are totally subjective. Conclusions A national survey on this issue is necessary under the auspices of AIOM (Associazione Italiana Oncologia Medica) and involving oncologists, epidemiologists and statisticians, in order to define the reasons for variations in therapy in advanced CRC and determine the differences between clinicians of different age, specialization and location. This survey could lead to a definition of guidelines for the treatment of advanced CRC.

The Relationship Between Marital Status and Health

2003 ◽  
Vol 24 (1) ◽  
pp. 124-148 ◽  
Author(s):  
Pauline M. Prior ◽  
Bernadette C. Hayes
Keyword(s):  
Physical Health ◽  
Positive Association ◽  
Bed Occupancy ◽  
Never Married ◽  
Health Differences ◽  
Health And Social Care ◽  
Care Facilities ◽  
Important Health ◽  
Working Age ◽  
The Relationship

Based on census materials collected in Britain from 1921 to 1991 and using bed occupancy as a proxy for health, this study focuses on the relationship between marriage and physical health. The results confirm the positive association between marriage and physical health within this society. Married people consistently make less use of residential health and social care facilities than do nonmarried people, and this relationship holds across all census years. This is not to deny, however, some important health differences within the nonmarried population, such as the increasing vulnerability of widowed females aged 65 years and older and of never-married males of working age.

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