Treatment and provider choice in worker injury rehabilitation: A systematic literature review

BACKGROUND: In the face of significant costs for injured worker rehabilitation and its impact on society, ongoing examination of how rehabilitation is carried out is warranted. OBJECTIVE: To review recent studies that explored the impact of the worker’s choice in terms of provider and treatment on the outcome for the worker in injury rehabilitation. METHOD: A systematic literature review was conducted using searches through electronic databases, with studies retrieved then subjected to a quality appraisal. RESULTS: Nineteen studies were eligible for inclusion. Studies reviewed found that choice of provider or treatment generated more positive outcomes for workers, and workers preferred a treatment provider familiar with their care. The worker’s ability to exercise choice was affected by conflict with other stakeholders and misalignment of expectations. The relationship between choice and costs was unclear, sometimes conflicting. CONCLUSIONS: The impact of treatment and provider choice on outcomes for workers remains unclear. The worker’s ability to choose may be hampered by systemic constraints, access to preferred providers, misalignment of stakeholder expectations, and the worker’s ability to engage in decision making. Greater worker engagement in their rehabilitation could potentially reduce costs as well as improve psychosocial outcomes.

Water, Sanitation, and Women's Empowerment: A systematic review and qualitative metasynthesis

Background Water and sanitation programs historically have focused on women's instrumental value in improving effectiveness and impact of programs, though focus is shifting to consider how programming and conditions may contribute to women's empowerment an gender equality. To date no systematic review has comprehensively assessed and synthesized evidence on water and sanitation and women's and girls' empowerment. The primary aims of this review were to: a) identify empirical water and sanitation research that engaged empowerment and/or empowerment-related domains from a pre-specified conceptual model; b) tabulate and report how empowerment-related terminology was used, where and when research was conducted, what methods were leveraged, and if water and/or sanitation was the primary focus; c) synthesize findings by empowerment domain and water and/or sanitation focus. Methods and Findings The conceptual model of women's and girls' empowerment developed by van Eerdewijk et.al (2017) informed our search strategy and analysis. The model presents three interrelated domains (agency, resources, institutional structures) and 13 sub-domains of empowerment. We searched MEDLINE, EMBASE, CABI Global Health, PsycINFO, CINAHL and AGRICOLA for any peer-reviewed sources presenting research related to water and/or sanitation and either empowerment and/or related terms from the conceptual model (4 May 2020). Systematic and ancestry and decendency searching identified 12,616 publications, of which 257 were included following screening, representing 1,600,348 participants. We assessed all studies using the Mixed-Method Appraisal Tool (MMAT). We followed the 'best-fit framework synthesis' approach for analysis, using the domains and sub-domains of the conceptual model as codes to assess all included sources. During coding, we inductively identified two additional sub-domains relevant to water and sanitation: privacy and freedom of movement. Thematic analysis guided synthesis of coded text by domain and sub-domain. The majority of research took place in Asia (46%; 117) or Africa (40%; 102), engaged adults (69%; 177), and were published since 2010; (82%; 211). A greater proportion of studies focused on water (45%; 115) than sanitation (22%; 57) or both (33%; 85). Over half of articles use the term empowerment yet only 7% (17) provided a clear definition or conceptualization. Agency was the least commonly engaged domain (47%; 122) while the Resources domain was dominant (94%; 241). Measures for assessing empowerment and related domains is limited. This review was limited by only including sources in English and only includes menstruation-focused research in the context of water and sanitation. Conclusions Water and sanitation research specifically engaging women's and girls' empowerment in a well-defined or conceptualized manner is limited. A substantial body of research examining domains and sub-domains of empowerment exists, as does research that illuminates myriad negative impacts of water and sanitation conditions and circumstances women's and girl's well-being. Available research should be used to develop and evaluate programs focused on improving the life outcomes of women and girls, which has only been minimally conducted to date. A more comprehensive 'transformative WASH' that includes gender-transformative approaches to challenge and reduce systemic constraints on women's and girls' resources and agency is not only warranted but long overdue.

Discourses for deep transformation: perceptions of economic growth in two rural communities in Lower Saxony, Germany

Ecological degradation stemming from the paradigmatic pursuit of economic growth is well known. Transforming the current dominant economic discourse will be a great challenge of our time and one that can foster a transformation to a more sustainable state. Little research exists concerning perceptions of growth by individuals in rural areas. In this empirical study, we analysed 33 interviews from two rural communities in Northwest Germany through qualitative content analysis. Our results highlight four archetypical perceptions of economic growth: (1) growth as inherently positive, (2) growth as being self-evident and without alternatives, (3) growth as a systemic constraint, and (4) growth as critical and with negative consequences. Differing perceptions about five key themes within broader societal discourses shape the four archetypical perceptions. All four archetypes are characterized by a common perception of systemic constraints, a lack of concrete alternatives to the current economic system and a lack of individual and societal agency, showing a system that is locked into its current trajectory. The understanding of the consequences of growth, stemming from the knowledge of rural inhabitants, can lay the groundwork for future research on discourses of growth. We envision a strengthening of tangible alternatives to the dominant economic growth paradigm within and with the local communities as necessary for a sustainability transformation.

Roles, barriers and behavioral determinants related to community pharmacists' involvement in optimizing opioid therapy for chronic pain: a qualitative study

Background Opioid are currently widely used to manage chronic non-malignant pain (CNMP), but there is a growing concern about harm resulting from opioid misuse and the need for medicine optimization, in which pharmacists could potentially play a key role. Objective This study explored pharmacists' roles, barriers and determinants related to their involvement in optimizing prescribed opioids for patients with chronic pain. Setting Community pharmacies in the United Kingdom. Method Semi-structured interviews based on the Theoretical Domains Framework were conducted between January and May 2020 with 20 community pharmacists recruited through professional networks. Data were analysed thematically. Main outcome measure: Pharmacists’ perceived roles, barriers and behavioural determinants in relation to opioid therapy optimization. Result Pharmacists demonstrated desire to contribute to opioid therapy optimization. However, they described that they were often challenged by the lack of relevant knowledge, skills and training, inadequate time and resources, systemic constraints (such as lack of access to medical records and information about diagnosis), and other barriers including relationships with doctors and patients. Conclusion The contribution of community pharmacists to optimize opioid therapy in CNMP is unclear and impeded by lack of appropriate training and systemic constraints. There is a need to develop innovative practice models by addressing the barriers identified in this study to enhance the contribution of community pharmacists in optimization of opioid therapy for chronic pain.

Grand Strategy Under Nonpolarity

The random and indeterminate nature of the current nonpolar world suggests a condition of increasing entropy. Relative capability advantages in today’s system do not translate as easily as they once did into power and influence over others. Unlike past multipolar and bipolar systems, the current system exerts only weak, if any, systemic constraints on actors. Thus, polarity has become a largely meaningless concept. Instead, we see an increase in the number and kinds of actors that can affect the system’s outcomes. In addition, complex process variables at the systemic and micro levels—especially those related to globalization and the digital revolution—are fundamentally reshaping the current and future dynamics of world politics. The key to grand strategy in this “hybrid world” of many types of actors wielding various kinds of power will be, first, for states to recognize the limits of traditional power bases and, second, to identify and cooperate with private actors that possess issue-specific resources, expertise, and influence with respect to the task at hand. That said, it is a complex and unpredictable world, not well-suited to the linear thinking associated with grand strategy.

Economic Security within the Limits of Economic Complexity

Introduction. The issues of ensuring economic security of regions (especially of those with a specific situation) taking into account the influence of economic complexity are a novel research problem. The development of regions, primarily the border ones, is determined by two divergent processes: growing economic complexity, determined by external constraints or opportunities, and economic security, associated with the internal potential and resources of the region. Based on the study conducted, the article reveals the features of the interconnection between economic security and economic complexity, the latter determining the innovative and technological limitations to the growth and development of territories. Materials and Methods. The author has conducted semantic analysis and thematic clustering of economic security using data from bibliographic and reference databases of publications in English (Web of Science) and in Russian (eLIBRARY.RU). The assessment of economic complexity was based on the conducted analysis of the UN Comtrade foreign trade statistics, that of economic security – on the official data published by Rosstat. Results. The author has identified the terminological connection between economic security and economic complexity, and has provided a theoretical representation of the relations and interdependence of these categories. The paper presents the methodological provisions for studying the economic security of border regions, taking into consideration the possibilities for increasing their economic complexity. Discussion and Conclusion. In the context of systemic constraints in the development of the region, economic security is largely determined by both the available internal potential and resources, and the possibilities of their use. However, the region gains new capabilities with the increase in its economic complexity, the latter also limiting its economic security. In fact, the choice of key areas for the structural transformation of the region’s economy depends on whether priority is given to maintaining the level of economic security or increasing economic complexity. The mechanism and criteria discussed in this paper, as well as the methodological provisions of such a choice, contribute to further development of the theory of economic security and economic complexity at the regional level and are of practical importance for regional governance.

Mobilizing affect, shaping market subjects: Tracing the connections of neuroliberalism and social finance in youth homelessness projects

In this article, I take the framework of neuroliberalism as an analytical lens to explore the functioning and implementation of a social impact bond-funded welfare service for young homeless people in the UK. After reflecting on the lines of connections and divergences between social impact bonds and neuroliberal logics, I draw attention to the limitations that exist in welfare interventions inspired by neuroliberal thought. On the one hand, the studied intervention functioned mainly through designing trustful, ideal-type relationships as a means to ‘fix’ people, thereby focusing on behavioural and biographical deficiencies and spreading good life ideals of a marketized world. On the other hand, I demonstrate how this focus on adjusting micro-contexts and tinkering with the affective, relational infrastructure fails to understand systemic constraints. Those were particularly evident with regard to the precarious labour market environment and colliding welfare agendas individuals were confronted with.

Community Pharmacists' Roles in Optimising Opioids Therapy for Chronic Non-malignant Pain Patients: a Qualitative Study.

Background: Opioids are currently widely used to manage chronic non-malignant pain, but there is a growing concern about harm resulting from opioid misuse, and the need for medicine optimisation, in which pharmacists could potentially play a key role.Objective: This study seeks to identify challenges to community pharmacists’ role in optimizing prescribed opioids for Chronic Non-Malignant Pain (CNMP).Setting: Community pharmacies in the UK.Method: Semi-structured interviews based on the Theoretical Domains Framework were conducted with 20 community pharmacists recruited through professional networks and analysed thematically.Result: Pharmacists perceive themselves as guardians of patients’ welfare and aspire to contribute to prescribed opioid optimisation. However, they are challenged by the lack of relevant training, inadequate time and resources, infrastructural and systemic constraints (such as repeat prescribing and prescription delivery services, lack of access to medical records and information about diagnosis), personal factors, including communication with doctors, and relationship with patients.Conclusion: The role of community pharmacists in optimising chronic opioid therapy is neither well-defined nor implemented in the UK. Utilisation of their potential skills and knowledge in this area requires an appropriate training curriculum, tackling the infrastructural and systemic constraints, support and resources to facilitate pharmacists’ engagement in patient monitoring and education. The findings in this study can contribute to inform policy makers with potentials to enhance pharmacists’ role in opioids therapy optimisation and, hence, ensure patients' safety when using prescribed opioids.