Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review

OBJECTIVE

To review the impact of clinical supervision of post-registration/qualification healthcare professionals on healthcare organisational outcomes.

BACKGROUND

Clinical supervision is a professional support mechanism that benefits patients, healthcare professionals and healthcare organisations. Whilst evidence is growing on the impact of clinical supervision on patient and healthcare professional outcomes, the evidence base for the impact of clinical supervision on organisational outcomes remains weak.

METHODS

This review used a convergent segregated approach to synthesise and integrate quantitative and qualitative research findings, as per the Joanna Briggs Institute's recommendations for mixed methods systematic reviews. Databases searched included CINAHL, Embase, PubMed, PschINFO, and Scopus. Whilst a narrative synthesis was performed to present the findings of the quantitative and qualitative studies, the evidence from both quantitative and qualitative studies was subsequently integrated for a combined presentation. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Thirty-two studies including 27 quantitative, two qualitative and three mixed methods studies, were included in the review. The results of the quantitative analysis showed that effective clinical supervision was associated with lower burnout and greater staff retention, and effective supervisor was associated with lower burnout and greater job satisfaction. Qualitative findings showed that healthcare professionals believed that adequate clinical supervision could mitigate the risk of burnout, facilitate staff retention, and improve the work environment, while inadequate clinical supervision can lead to stress and burnout. The evidence from quantitative and qualitative studies were complementary of each other.

CONCLUSION

Clinical supervision can have a variable effect on healthcare organisational outcomes. The direction of this effect appears to be influenced by the effectiveness of both the clinical supervision provided and that of the clinical supervisor. This highlights the need for organisations to invest in high quality supervision practices if maximal gains from clinical supervision are to be attained.

Financial constraints, government subsidies, and corporate innovation

To investigate the relationships between financial constraints, government subsidies, and corporate innovation, a semi-logarithmic fixed-effect panel model and mediation effect test were applied, based on the data of Chinese listed companies from 2007 to 2017. We find that (1) financial constraints suppress corporate innovation. (2) Government subsidies are targeted at bailing out firms facing financial constraints. (3) Government subsidies promote corporate innovation (4) Government subsidies partially offset the suppression of financial constraints on innovation. We contribute to the fields of public finance, corporate finance, and corporate innovation by: (1) justifying the government subsidies target strategy as a bailout of corporate financial constraints, (2) verifying the corporate-innovation promotion of government subsidies, thus justifying the efficiency of government subsidies, and (3) showing that different types of innovation benefit differently from subsidies, thus justifying subsidies as a structural innovation engine.

The process of developing dynamic capabilities: The conceptualization attempt and the results of empirical studies

While most researchers interested in the concept of dynamic capabilities focus their attention on analyzing how companies transform their resources to compete in their environment, the process of developing dynamic capabilities is treated as a marginal issue. Although the literature suggests various approaches to developing dynamic capabilities, they are formulated in general terms, and doubts can be raised about the links between actions. There is also a lack of empirical research indicating the links between activities in the process of developing dynamic capabilities and their influence on the effectiveness of an organization. The aim of the study is to formulate a proposal for a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of a company and to determine the links between the activities in the model. The theoretical contribution of the paper consists in presenting a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of the company. The results presented in the paper refer to an empirical examination of the model of developing dynamic capabilities, covering five activities: searching for opportunities; knowledge management and learning; coordination; configuration and reconfiguration; and organizational adaptation. The study also includes an examination of the possible impact the components of the dynamic capabilities building process have on a company’s performance. The study uses the survey method and data was obtained from top managers. The conclusion, based on data from 471 Polish companies, was made using structural equation modelling. The results of the empirical research suggest that the individual activities in the process of developing dynamic capabilities are interconnected, and through mutual interactions and couplings, they positively affect the economic effectiveness of an enterprise. The results indicate that searching for opportunities is the precursor, and the main factor influencing the other activities in the process, which suggests that managers should focus on improving activities in this area.

Data-informed recommendations for services providers working with vulnerable children and families during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic and associated response measures have led to unprecedented challenges for service providers working with vulnerable children and families around the world.

OBJECTIVE

The goal of the present study was to better understand the impact of the pandemic and associated response measures on vulnerable children and families and provide data-informed recommendations for public and private service providers working with this population.

PARTICIPANTS AND SETTING

Representatives from 87 non-government organizations (NGOs) providing a variety of direct services (i.e. residential care, family preservation, foster care, etc.) to 454,637 vulnerable children and families in 43 countries completed a brief online survey.

METHODS

Using a mixed methods design, results examined 1) ways in which children and families have been directly impacted by COVID-19, 2) the impact of the pandemic on services provided by NGOs, 3) government responses and gaps in services for this population during the pandemic, and 4) strategies that have been effective in filling these gaps.

RESULTS

Data revealed that the pandemic and restrictive measures were associated with increased risk factors for vulnerable children and families, including not having access to vital services. The NGOs experienced government restrictions, decreased financial support, and inability to adequately provide services. Increased communication and supportive activities had a positive impact on both NGO staff and the families they serve.

CONCLUSIONS

Based on the findings, ten recommendations were made for service providers working with vulnerable children and families during the COVID-19 pandemic.

Same Involvement, Different Reasons: How Personality Factors and Organizations Contribute to Heavy Work Investment

The academic literature has drawn a clear distinction between a positive form (i.e., work engagement) and a negative form (i.e., workaholism) of heavy work investment (HWI). Nevertheless, the different weight of individual and situational factors contributing to their development was not thoroughly explored. This study aims to investigate the role of individual variables (i.e., obsessive-compulsive traits, achievement orientation, perfectionism, and conscientiousness) and situational factors (i.e., job demands and overwork climate) regarding engagement and workaholism simultaneously. Hypotheses were tested using a sample of 523 Italian employees. Results of structural equation modeling revealed that overwork climate and job demands were conversely related to engagement and workaholism, with job demand reporting the strongest association with workaholism. Furthermore, fear of failure was the only individual factor showing a significant and opposite relationship with workaholism and engagement. In contrast, perfectionism was positively associated with both forms of HWI. These results shed light on the potential effectiveness of intervention strategies focused on the employees and organizations in preventing workaholism and promoting engagement.

Using interpersonal communication strategies to encourage science conversations on social media

Today, many science communicators are using social media to share scientific information with citizens, but, as research has shown, fostering conversational exchanges remains a challenge. This largely qualitative study investigated the communication strategies applied by individual scientists and environmental non-governmental organizations on Twitter and Instagram to determine whether particular social media practices encourage two-way conversations between science communicators and citizens. Data from Twitter and Instagram posts, interviews with the communicators, and a survey of audience members were triangulated to identify emergent communication strategies and the resulting engagement; provide insight into why particular practices are employed by communicators; and explain why audiences choose to participate in social media conversations with communicators. The results demonstrate that the application of interpersonal communication strategies encourage conversational engagement, in terms of the number of comments and unique individuals involved in conversations. In particular, using selfies (images and videos), non-scientific content, first person pronoun-rich captions, and responding to comments result in the formation of communicator-audience relationships, encouraging two-way conversations on social media. Furthermore, the results indicate that Instagram more readily supports the implementation of interpersonal communication strategies than Twitter, making Instagram the preferred platform for promoting conversational exchanges. These findings can be applicable to diverse communicators, subjects, audiences, and environments (online and offline) in initiatives to promote awareness and understanding of science.

NGO online disclosures index in the presence of auxiliary information

This study highlights the need for analysis of online disclosure practices followed by non-governmental organizations; furthermore, it justifies the crucial role of potential correlates of online disclosure practices followed by non-governmental organizations. We propose a novel index for analyzing the extent of online disclosure of non-governmental organizations (NGO). Using the information stored in an auxiliary variable, we propose a new estimator for gauging the average value of the proposed index. Our approach relies on the use of two factors: imperfect ranked-set sampling procedure to link the auxiliary variable with the study variable, and an NGO disclosure index under simple random sampling that uses information only about the study variable. Relative efficiency of the proposed index is compared with the conventional estimator for the population average under the imperfect ranked-set sampling scheme. Mathematical conditions required for retaining the efficiency of the proposed index, in comparison to the imperfect ranked set sampling estimator, are derived. Numerical scrutiny of the relative efficiency, in response to the input variables, indicates; if the variance of the NGO disclosure index is less than the variance of the estimator under imperfect ranked set sampling, then the proposed index is universally efficient compared to the estimator under imperfect ranked set sampling. If the condition on variances is unmet, even then the proposed estimator remains efficient if majority of the NGO share online data on the auxiliary variable. This work can facilitate nonprofit regulation in the countries where most of the non-governmental organizations maintain their websites.

What sets the conditions for success in community-partnered evaluation work? Multiple perspectives on a small-scale research-practice partnership evaluation

The goals of this study are: (a) to share reflections from multiple stakeholders involved in a foundation-funded community-partnered evaluation project, (b) to share information that might be useful to researchers, practitioners, and funders considering the merits of researcher/practitioner evaluation projects, and (c) to make specific suggestions for funders and researcher/practitioner teams starting an evaluation project. Three stakeholders in a small-scale research-practice partnership (RPP) reflected on the evaluation project by responding to three prompts. A researcher, community organization leader, and funder at a small foundation share specific tips for those considering a small-scale RPP. Engaging in a small-scale RPPs can be a very meaningful experience for individual researchers and smaller organizations and funders. The benefits and challenges align and differ in many ways with those encountered in larger projects.

The fractal structure of communities of practice: Implications for business organization

Communities of practice (COP) are informal (sometimes formal) groupings of professionals with shared interests that form to facilitate the exchange of expertise and shared learning or to function as professional support networks. We analyse a dataset on the size of COPs and show that their distribution has a fractal structure similar to that found in huntergatherer social organisation and the structure of human personal social networks. Small communities up to about 40 in size can be managed democratically, but all larger communities require a leadership team structure. We show that frequency of interaction declines as size increases, as is the case in personal social networks. This suggests that professional work-oriented organisations may be subject to the same kinds of constraint imposed on human social organisation by the social brain. We discuss the implications for business management structure.

A congruence perspective on how human and social capital affect learning capability and innovation

Human capital and social capital are vital for sustainable development of organization, but existing studies are inadequate to explore the synergistic effect of them on organizational behaviors or organizational outcomes. The research employed multiple-source questionnaire to collect data of more than 400 R&D firms from leaders and corresponding employees in Chinese context. Bootstrapping method and response surface were used to analyze the associations between all the parameters. The results showed that: (1) in the case of the in-congruence between human capital and social capital, learning capability of R&D firms is at highest level when human capital is at low level and social capital is at high level; (2) learning capability partially mediates the impact of human capital and social capital on innovation performance; (3) environmental dynamism and environmental competitiveness have a joint moderating effect on the relationship between learning capability and innovation performance.

Characteristics of Health Care Organizations Associated With Clinician Trust: Results From the Healthy Work Place Study

Importance

There is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention.

Objective

To examine organizational characteristics associated with trust.

Design, Setting, and Participants

This prospective cohort study uses data collected from 2012 to 2014 from 34 primary care practices employing physicians (family medicine and general internal medicine) and advanced practice clinicians (nurse practitioners and physician assistants) in the upper Midwest and East Coast of the United States as part of the Healthy Work Place randomized clinical trial. Analyses were performed from 2015 to 2016.

Main Outcomes and Measures

Clinician trust was measured using a 5-item scale, including belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need (range, 1-4, with 1 indicating low and 4 indicating high; Cronbach α = 0.77). Other metrics included work control, work atmosphere (calm to chaotic), organizational culture (cohesiveness, emphases on quality and communication, and values alignment; range, 1-4, with 1 indicating low and 4 indicating high), and clinician stress (range, 1-5, with 1 indicating low and 5 indicating high), satisfaction (range, 1-5, with 1 indicating low and 4 indicating high), burnout (range, 1-5, with 1 indicating no burnout and 5 indicating very high feeling of burnout), and intention to leave (range, 1-5, with 1 indicating no intention to leave and 5 indicating definite intention to leave). Analyses included 2-level hierarchical modeling controlling for age, sex, specialty, and clinician type. Cohen d effect sizes (ESs) were considered small at 0.20, moderate at 0.50, and large at 0.80 or more.

Results

The study included 165 clinicians (mean [SD] age, 47.3 [9.2] years; 86 [52.1%] women). Of these, 143 (87.7%) were physicians and 22 (13.3%) were advanced practice clinicians; 105 clinicians (63.6%) worked in family medicine, and 60 clinicians (36.4%) worked in internal medicine. Compared with clinicians with low levels of trust, clinicians who reported high levels of trust had higher mean (SD) scores for work control (2.49 [0.52] vs 2.18 [0.45]; P < .001), cohesiveness (3.11 [0.46] vs 2.51 [0.51]; P < .001), emphasis on quality vs productivity (3.12 [0.48] vs 2.58 [0.41]; P < .001), emphasis on communication (3.39 [0.41] vs 3.01 [0.44]; P < .001), and values alignment (2.61 [0.59] vs 2.12 [0.52]; P < .001). Men were more likely than women to express loyalty (ES, 0.35; 95% CI, 0.05-0.66; P = .02) and high trust (ES, 0.31; 95% CI, 0.01-0.62; P = .04). Compared with clinicians with low trust at baseline, clinicians with high trust at baseline had a higher mean (SD) satisfaction score (3.99 [0.08] vs 3.51 [0.07]; P < .001; ES, 0.70; 95% CI, 0.39-1.02). Compared with clinicians in whom trust declined or remained low, clinicians with improved or stable high trust reported higher mean (SD) satisfaction (4.01 [0.07] vs 3.43 [0.06]; P < .001; ES, 0.98; 95% CI, 0.66-1.31) and lower stress (3.21 [0.09] vs 3.53 [0.09]; P = .02; ES, -0.39; 95% CI, -0.70 to -0.08) scores and had approximately half the odds of intending to leave (odds ratio, 0.481; 95% CI, 0.241-0.957; P = .04).

Conclusions and Relevance

Addressing low levels of trust by improving work control and emphasizing quality, cohesion, communication, and values may improve clinician satisfaction, stress, and retention.

The Relationship between Green Organization Identity and Corporate Environmental Performance: The Mediating Role of Sustainability Exploration and Exploitation Innovation

The link between green organizational identity (GOI) and corporate environmental performance (CEP) has been investigated, but existing studies have no consistent conclusion. A significant research gap remains regarding the mediating role of sustainability exploration innovation (SER), sustainability exploitation innovation (SEI), and the moderating role of government environmental regulation (GER). This study explored the relationship between GOI and CEP in a moderated meditation model which includes SER, SEI, and GER. Using structural equation modelling and bootstrap method based on data sets from of 380 Chinese companies, the results show that: (1) GOI promotes SER, thereby enhancing CEP; (2) GOI promotes SEI, thereby enhancing CEP; (3) GER can positively moderate the indirect effect of GOI on CEP via SER; (4) GER negatively moderate the indirect effect of GOI on CEP via SEI. These findings suggest that firms choose different innovative ways between SER and SEI to improve CEP which depends on different levels of GER in China.

Financial interests of patient organisations contributing to technology assessment at England's National Institute for Health and Care Excellence: policy review

OBJECTIVE

To investigate the prevalence of financial interests among patient organisations contributing to health technology assessment at the National Institute for Health and Care Excellence (NICE) in England and the extent to which NICE's disclosure policy ensures that decision making committees are aware of these interests.

DESIGN

Policy review using accounts, annual reports, and websites of patient organisations; payments declared by pharmaceutical manufacturers on their websites and a centralised database (Disclosure UK); declarations of interests by nominated representatives of patient organisations; and responses from patient organisations.

SETTING

Appraisals of medicines and treatments (technologies) for use in the English and Welsh National Health Service.

PARTICIPANTS

53 patient organisations contributing to 41 NICE technology appraisals published in 2015 and 2016, with 117 separate occasions that a patient organisation contributed to the appraisal of a technology.

MAIN OUTCOME MEASURES

Prevalence of specific interests (that is, funding from manufacturer(s) of a technology under appraisal or competitor products); proportion of specific interests of which NICE's decision making committees were aware; proportion of unknown specific interests for which disclosure was not required by NICE's policy RESULTS: 38/53 (72%) patient organisations had accepted funding from the manufacturer(s) of a technology or a competitor product in the same year that they had contributed to the appraisal of that technology or the previous year. Specific interests were present on 92/117 (79%) occasions that patient organisations contributed to appraisals in 2015 and 2016. NICE's decision making committees were aware of less than a quarter of specific interests (30/144; 21%). For nearly two thirds of the specific interests not known to committees (71/114; 62%), disclosure by patient organisations was not required by NICE's policy.

CONCLUSIONS

Financial interests are highly prevalent among patient organisations contributing to health technology assessment. NICE should review its disclosure policy to ensure that decision making committees are aware of all relevant interests.

Structural and procedural barriers to health assessment for asylum seekers and other migrants - an explorative survey in Sweden

BACKGROUND

Health assessments (HAs) for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how they are organized, and whether it is mandatory or not to attend varies between countries. Swedish national statistics have shown that only about 45% of asylum seekers attend the optional HA offered upon their arrival in Sweden. There are significant variations among Sweden's 21 counties, ranging from 20 to 90%. The reasons for the low attendance have not yet been fully explored, though there are indications of structural weaknesses within the healthcare system. This study aimed to identify variations in policies and implementation of HAs targeting asylum seekers and other migrants. The study analyzes the structure and processes in different Swedish counties and discusses how this might influence the coverage.

METHODS

This research project had an exploratory quantitative descriptive design applying a cross-sectional survey based on two structured questionnaires. Descriptive statistics were performed to summarize the data.

RESULTS

The number of healthcare centers in each county that carried out HAs on asylum seekers varied independently of the size of the county. Variations in regard to structure, organization, processes, and performance monitoring of the HA process also appeared diverse, and these were in some cases also reported differently by administrators and healthcare professionals in the same county. Most commonly, the HAs were carried out in ordinary health centers, though some counties presented alternative solutions on how to organize the HAs.

CONCLUSIONS

There seems to be no coherent national system for carrying out HAs on asylum seekers in Sweden. The structure, organization, processes, and outcomes vary between the counties, and the reasons for the low coverage of HAs appear to be multifaceted.

ParticipACTION after 5 years of relaunch: a quantitative survey of Canadian organizational awareness and capacity regarding physical activity initiatives

INTRODUCTION

ParticipACTION is a Canadian physical activity communications and social marketing organization relaunched in 2007. This study assesses the capacity of Canadian organizations to adopt, implement, and promote physical activity initiatives. The four objectives were to compare findings from baseline (2008) and follow-up (2013) with respect to: (1) awareness of ParticipACTION; (2) organizational capacity to adopt, implement and promote physical activity initiatives; (3) potential differences in capacity based on organizational size, sector, and mandate; and (4) assess perceptions of ParticipACTION five years after relaunch.

METHODS

In this cross-sectional study, representatives from local, provincial/territorial, and national organizations completed an online survey assessing capacity to adopt, implement, and promote physical activity. Descriptive statistics and one-way analyses of variance were conducted to examine the objectives.

RESULTS

Response rate for opening an email survey invitation and consenting to participate was 40.6% (685/1688) and 540 surveys were completed. Awareness of ParticipACTION increased from 54.6% at baseline to 93.9% at follow-up (Objective 1). Findings at both baseline and follow-up reflected good organizational capacity to adopt, implement and promote physical activity (Objective 2) although some varied by organizational sector and mandate (Objective 3). Most respondents reported that ParticipACTION provided positive leadership (65.3%), but there was less agreement regarding ParticipACTION's facilitation of infrastructure (44.0%) or organizational will/motivation (47.1%)(Objective 4).

CONCLUSION

Canadian organizations continue to report having good capacity to adopt, implement, and promote physical activity. There was no discernible change in capacity indicators five years after ParticipACTION's relaunch although its broader contribution to the physical activity sector was endorsed.

Organisational capacity and its relationship to research use in six Australian health policy agencies

There are calls for policymakers to make greater use of research when formulating policies. Therefore, it is important that policy organisations have a range of tools and systems to support their staff in using research in their work. The aim of the present study was to measure the extent to which a range of tools and systems to support research use were available within six Australian agencies with a role in health policy, and examine whether this was related to the extent of engagement with, and use of research in policymaking by their staff. The presence of relevant systems and tools was assessed via a structured interview called ORACLe which is conducted with a senior executive from the agency. To measure research use, four policymakers from each agency undertook a structured interview called SAGE, which assesses and scores the extent to which policymakers engaged with (i.e., searched for, appraised, and generated) research, and used research in the development of a specific policy document. The results showed that all agencies had at least a moderate range of tools and systems in place, in particular policy development processes; resources to access and use research (such as journals, databases, libraries, and access to research experts); processes to generate new research; and mechanisms to establish relationships with researchers. Agencies were less likely, however, to provide research training for staff and leaders, or to have evidence-based processes for evaluating existing policies. For the majority of agencies, the availability of tools and systems was related to the extent to which policymakers engaged with, and used research when developing policy documents. However, some agencies did not display this relationship, suggesting that other factors, namely the organisation's culture towards research use, must also be considered.

Why do people donate to conservation? Insights from a 'real world' campaign

Non-governmental organisations (NGOs) play a key role in biodiversity conservation. The majority of these organisations rely on public donations to fund their activities, and therefore fundraising success is a determinant of conservation outcomes. In spite of this integral relationship, the key principals for fundraising success in conservation are still guided by expert opinion and anecdotal evidence, with very few quantitative studies in the literature. Here we assessed the behaviour of monetary donors across twenty-five different species-focused conservation campaigns organised by an NGO conservation and environmental society. The Australian Geographic Society (AGS) carried out fundraising campaigns over a five and half year period using an identical methodology in thirty-four of its country-wide network of outlet shops. AGS owns and operates these shops that sell toys and games related to science and nature. We tested how the following factors influenced monetary donations from members of the public:1) campaign duration, 2) appeal and familiarity of species, 3) species geographic distribution relative to the fundraising location, 4) level of income and education of potential donors, 5) age and gender profile of potential donors. Contrary to past research, we found most of these factors did not significantly influence the amount of donations made to each campaign by members of the public. Larger animals did elicit a significantly higher amount donated per transaction than smaller animals, as did shops located in poorer neighbourhoods. Our study findings contrast with past research that has focused largely on hypothetical donations data collected via surveys, and demonstrates the complexity and case-specific nature of relationships between donor characteristics and spending patterns. The study highlights the value of assessing real-world fundraising campaigns, and illustrates how collaboration between academia and NGOs could be used to better tailor fundraising campaigns to maximise donations from individual citizens.

Toward a more comprehensive analysis of the role of organizational culture in child sexual abuse in institutional contexts

This article draws on a report prepared for the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (Palmer et al., 2016) to develop a more comprehensive analysis of the role that organizational culture plays in child sexual abuse in institutional contexts, where institutional contexts are taken to be formal organizations that include children among their members (referred to here as "youth-serving organizations"). We begin by integrating five strains of theory and research on organizational culture from organizational sociology and management theory into a unified framework for analysis. We then elaborate the main paths through which organizational culture can influence child sexual abuse in youth-serving organizations. We then use our unified analytic framework and our understanding of the main paths through which organizational culture can influence child sexual abuse in youth-serving organizations to analyze the role that organizational culture plays in the perpetration, detection, and response to child sexual abuse in youth-serving organizations. We selectively illustrate our analysis with case materials compiled by the Royal Commission into Institutional Responses to Child Sexual Abuse and reports of child sexual abuse published in a variety of other sources. We conclude with a brief discussion of the policy implications of our analysis.

Organisational and extraorganisational determinants of volume of service delivery by English community pharmacies: a cross-sectional survey and secondary data analysis

OBJECTIVES

This study aimed to identify the organisational and extraorganisational factors associated with existing variation in the volume of services delivered by community pharmacies.

DESIGN AND SETTING

Linear and ordered logistic regression of linked national data from secondary sources-community pharmacy activity, socioeconomic and health need datasets-and primary data from a questionnaire survey of community pharmacies in nine diverse geographical areas in England.

OUTCOME MEASURES

Annual dispensing volume; annual volume of medicines use reviews (MURs).

RESULTS

National dataset (n=10 454 pharmacies): greater dispensing volume was significantly associated with pharmacy ownership type (large chains>independents>supermarkets), greater deprivation, higher local prevalence of cardiovascular disease and depression, older people (aged >75 years) and infants (aged 0-4 years) but lower prevalence of mental health conditions. Greater volume of MURs was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, and lower disease prevalence.Survey dataset (n=285 pharmacies; response=34.6%): greater dispensing volume was significantly associated with staffing, skill-mix, organisational culture, years open and greater deprivation. Greater MUR volume was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, weekly opening hours and lower asthma prevalence.

CONCLUSIONS

Organisational and extraorganisational factors were found to impact differently on dispensing volume and MUR activity, the latter being driven more by corporate ownership than population need. While levels of staffing and skill-mix were associated with dispensing volume, they did not influence MUR activity. Despite recent changes to the contractual framework, the existing fee-for-service reimbursement may therefore not be the most appropriate for the delivery of cognitive (rather than supply) services, still appearing to incentivise quantity over the quality (in terms of appropriate targeting) of services delivered. Future research should focus on the development of quality measures that could be incorporated into community pharmacy reimbursement mechanisms.

[Experience and present situation of Western China Gastric Cancer Collaboration]

The Western China Gastric Cancer Collaboration (WCGCC) was founded in Chongqing, China in 2011. At the early stage of the collaboration, there were only about 20 centers. While now, there are 36 centers from western area of China, including Sichuan, Chongqing, Yunnan, Shanxi, Guizhou, Gansu, Qinghai, Xinjiang, Ningxia and Tibet. During the past few years, the WCGCC organized routinely gastric cancer standardized treatment tours, training courses of mini-invasive surgical treatment of gastric cancer and the clinical research methodology for members of the collaboration. Meanwhile, the WCGCC built a multicenter database of gastric cancer since 2011 and the entering and management refer to national gastric cancer registration entering system of Japan Gastric Cancer Association. During the entering and collection of data, 190 items of data have unified definition and entering standard from Japan Gastric Cancer Guidelines. Nowadays, this database included about 11 872 gastric cancer cases, and in this paper we will introduce the initial results of these cases. Next, the collaboration will conduct some retrospective studies based on this database to analyze the clinicopathological characteristics of patients in the western area of China. Besides, the WCGCC performed a prospective study, also. The first randomized clinical trial of the collaboration aims to compare the postoperative quality of life between different reconstruction methods for total gastrectomy(WCGCC-1202, ClinicalTrials.gov Identifier: NCT02110628), which began in 2015, and now this study is in the recruitment period. In the next steps, we will improve the quality of the database, optimize the management processes. Meanwhile, we will engage in more exchanges and cooperation with the Chinese Cochrane Center, reinforce the foundation of the clinical trials research methodology. In aspect of standardized surgical treatment of gastric cancer, we will further strengthen communication with other international centers in order to improve both the treatment and research levels of gastric cancer in Western China.

Organizational Twitter Use: Content Analysis of Tweets during Breast Cancer Awareness Month

On an average, at least one out of eight women are at risk of falling prey to breast cancer during their lifespan. Amongst varied initiatives to spread awareness about breast cancer, the most well-known campaign is Breast Cancer Awareness Month. This article explored, through content analysis, how four different health-related organizations-Susan G. Komen, U.S. News Health, Woman's Hospital, and Breast Cancer Social Media-used their Twitter accounts to talk about varied aspects of breast cancer during the month of October, which is observed as Breast Cancer Awareness Month. All the tweets by these organizations were analyzed for the presence or absence of the theoretical parameters of the Health Belief Model (HBM). A content analysis of 2916 tweets based on the HBM revealed that the content posted by these organizations reflected the use of varied theoretical constructs of the framework. Overall, the study demonstrated that while different organizations shared valuable breast cancer-related content on Twitter, each used the social media platform in a different fashion, evident through focus on different types of HBM constructs while publishing breast cancer-related tweets.

Participation in global value chain and green technology progress: evidence from big data of Chinese enterprises

This study examined the stimulative effects of Chinese enterprises' participation in the global value chain (GVC) on the progress of their green technologies. Using difference-in-difference panel models with big data of Chinese enterprises, we measured influencing factors such as enterprise participation degree, enterprise scale, corporate ownership, and research and development (R&D) investment. The results revealed that participation in the GVC can considerably improve the green technology levels in all enterprises, except state-owned ones. However, the older an enterprise, the higher the sluggishness is likely to be in its R&D activities; this is particularly true for state-owned enterprises. The findings provide insights into the strategy of actively addressing Chinese enterprises' predicament of being restricted to the lower end of the GVC.

The relevance and implications of organizational involvement for serious mental illness populations

Consumer involvement has gained greater prominence in serious mental illness (SMI) because of the harmonious forces of new research findings, psychiatric rehabilitation, and the recovery movement. Previously conceived subdomains of consumer involvement include physical involvement, social involvement, and psychological involvement. We posit a fourth subdomain, organizational involvement. We have operationally defined organizational involvement as the involvement of mental health consumers in activities and organizations that are relevant to the mental health aspect of their identities from an individual to a systemic level across arenas relevant to mental health. This study surveyed adults with SMI regarding their current level of organizational involvement along with their preferences and beliefs about organizational involvement. Additionally, a path model was conducted to understand the relationships between domains of consumer involvement. Although participants reported wanting to be involved in identified organizational involvement activities and believing it was important to be involved in these kinds of activities, organizational involvement was low overall. The path model indicated that psychological involvement among other factors influence organizational involvement, which informed our suggestions to improve organizational involvement among people with SMI. Successful implementation must be a thoroughly consumer-centered approach creating meaningful and accessible involvement opportunities. Our study and prior studies indicate that organizational involvement and other subdomains of consumer involvement are key to the health and wellbeing of consumers, and therefore greater priority should be given to interventions aimed at increasing these essential domains.

Analyzing health organizations' use of Twitter for promoting health literacy

This study explored health-related organizations' use of Twitter in delivering health literacy messages. A content analysis of 571 tweets from health-related organizations revealed that the organizations' tweets were often quoted or retweeted by other Twitter users. Nonprofit organizations and community groups had more tweets about health literacy than did other types of health-related organizations examined, including health business corporations, educational institutions, and government agencies. Tweets on health literacy topics focused predominantly on using simple language rather than complicated language. The results suggest that health organizations need a more strategic approach to managing positive organizational self-presentations in order to create an optimal level of exposure on social networking sites.

Faith-based aid, globalisation and the humanitarian frontline: an analysis of Western-based Muslim aid organisations

This paper focuses on the emergence and modus operandi of Muslim faith-based aid organisations from the West, particularly those from the United Kingdom. Through case studies of Islamic Relief Worldwide and Muslim Hands, it examines the actual and potential added value generated by these humanitarian players in Muslim-majority contexts at times when aid actors from or associated with the West are being perceived by some as instrumental to the political agendas of Western powers, or are being confronted with the consequences thereof. The study analyses Muslim faith-based aid organisations' transnational networks, their implementing partnerships with local faith-based non-governmental organisations (NGOs), and their security position within and their access to insecure contexts, drawing on field examples and opinion from Central Asia, Iraq and Pakistan. It thereby argues that there is ground for an expansion of the role of Muslim aid actors, because of the existence of social and political realities in the field that cannot be always effectively tackled by the dominant international development approaches.

The politics of risk in the Philippines: comparing state and NGO perceptions of disaster management

It is now generally appreciated that what constitutes vulnerability to one person is not necessarily perceived as such by the next. Different actors 'see' disasters as different types of events and as a result they prepare for, manage and record them in very different ways. This paper explores what different perceptions of vulnerability mean in terms of the understanding and practices of two significant sets of actors and stakeholders involved in disaster preparedness and management in the Philippines: the state and NGOs. Approaches to disaster are not just a function of people's perceptions of disaster risk but also of their understanding of the prevailing social order and social relations. Despite a shared vocabulary-which increasingly presents disasters as processes rather than events, takes a proactive rather than a reactive approach, and favours the inclusion of stakeholders rather than solely relying on technocratic management-different realities continue to make for different responses.

Suicide assisted by two Swiss right-to-die organisations

BACKGROUND

In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.

OBJECTIVES

First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.

METHODS

This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and investigated by the University of Zurich's Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990-2000 (n = 149) were compared with the data of the present study.

RESULTS

More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).

CONCLUSIONS

Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study.

Determinants of malnutrition in Senegal: individual, household, community variables, and their interaction

The relationship between poverty and nutrition is a two-sided one: on the one hand, economic growth (which is generally associated with an eradication of poverty) leads to reduced malnutrition. On the other hand, nutrition is one of the key ingredients for human capital formation, which in turn represents one of the fundamental factors of growth. There are numerous studies that show the correlates of malnutrition using both household- and community-level variables. However, few of these studies allow for the potential endogeneity of community infrastructure or indicate their interplay with characteristics of the mother. The current study considers the socio-economic determinants of child malnutrition and investigates how programs compensate for the increased risks facing young mothers and their children or substitute for a low social status of the mother in the household. The empirical results show that children of mothers giving birth at a young age are disadvantaged in terms of their anthropometric status. Interaction effects of the presence of a non-governmental organization (NGO) or a health post in the village with characteristics of the mother stress the important role played by these institutions in helping disadvantaged mothers overcome their difficulties. These findings have implications for efficient program design and represent a further step towards gaining an improved understanding of the complex determinants of child (mal)nutrition.

Variations In The Quality Of Care Accessible To Rural Communities In Tanzania

The government of Tanzania has made access to health care a priority. In particular, it has made great efforts to increase the number of facilities available to the rural population. By examining one such rural area, we find that although facilities exist and are staffed with competent clinicians, the quality of care received by patients visiting government facilities is subpar, especially that received by the poor in rural areas compared with urban areas. Importantly, nongovernmental organization (NGO) facilities provide better and more consistent care across the rural-urban divide. Access to high-quality care is inequitable, and this inequality is not inevitable.

YMCA Hiking Patterns at Rocky Mountain National Park: Implications for Public Health

Background:

There is little data on hiking patterns in national parks to support hiking behavior as a vehicle to meet the joint YMCA, CDC, and National Park Service initiatives to encourage physical activity through public land use.

Methods:

The YMCA of the Rockies hiking program provided data from Hike Report forms completed after 343 supervised hikes for one summer season in Rocky Mountain National Park (ROMO) to assess visitor hiking patterns.

Results:

Of the total hikes, 64.4% were categorized as easy, 27.1% moderate, and 8.5% difficult. There were 1937 individual hikers which represented 13.3% of the estimated potential hiker sample. The majority of hikers (69%) only took easy hikes with 72.7% participating in only one hike and 27.3% doing two or more hikes. Energy cost estimates for hike categories indicated mean MET levels between 4.0 to 5.7.

Conclusion:

Hiking patterns at ROMO may be reflective of general population inactivity suggesting the need to design strategies to promote visitor hiking.

Validating Neonatal Mortality and Use of NGO Reproductive Health Outreach Services in Rural Bangladesh

Although the neonatal mortality rate (NMR) in Bangladesh remained steady between 1995-99 and 1999-2003 (41-42 deaths per 1,000 live births), evidence from the management information system (MIS) of a large nongovernmental organization (NGO) program indicates that the NMR declined by about 50 percent between 1996 and 2002 in the area served. This study aims to validate the recording of neonatal deaths among the cohort of children registered as born in 2003 and to assess the evidence of a decline in the NMR. It also measures the coverage of reproductive health outreach services, focusing on 12 of the 27 NGOs that have provided services in the same areas since 1996. Field-workers' registers, verbal autopsy reports, and immunization records were checked to confirm infants' survival. Interviews were conducted with 142 mothers of children who died within 28 days postpartum and with a random sample of 109 women with registered stillbirths. Out of 11,253 registered live births in 2003, 210 neonatal deaths were found, compared with 194 deaths that were reported in the MIS for 2003. The corrected NMR was 19 deaths per 1,000 live births, and it was in the range of 15-29 deaths per 1,000 live births in 11 of the NGO areas. Because underreporting of neonatal deaths was probably higher in 1996 when the MIS-reported NMR was 39 deaths per 1,000 live births, the decline in the NMR is likely to have been genuine.

The Dutch heart health community intervention ‘Hartslag Limburg’: results of an effect study at organizational level

BACKGROUND

'Hartslag Limburg', a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high-risk strategy to reduce CVD risk behaviours. This article presents the results of the effect evaluation study of the community intervention at the organizational level. Organizational changes were an intermediate goal of the Hartslag Limburg community intervention, as these are assumed to be a prerequisite for changes at the individual level.

METHODS

A baseline-post-test control group design was used. The baseline measurement was conducted in 1998 and the post-test measurement in 2001. At baseline, 700 organizations were selected in the Maastricht region, and 577 in a control region. All organizations that were potentially significant agents in health-promoting activities were included. Data on organizational involvement in health-promoting activities were gathered by means of structured questionnaires, and sent to organization representatives by mail.

RESULTS

The overall post-test percentage of organizations involved in at least one activity relating to physical activity was higher in the Maastricht region than in the control region. Furthermore, the number of activities per organization involved in activities relating to healthy eating, smoking behaviour or physical activity was higher in the Maastricht region than in the control region at post-test.

CONCLUSIONS

This study provided valuable information about organizational involvement in health-promoting activities, as well as important information to consider in future research in this area. Due to the limitations of the study, the importance of measuring change at different social levels in community-based programmes, and the scarcity of effect studies of community interventions at the organizational level, further research on this subject is warranted.

Registro español sobre organización, recursos y actividades en Cardiología Pediátrica

INTRODUCTION

We present the findings of the registry of activities and resources of the Spanish Society of Pediatric Cardiology in 2002, with the objective of providing a national reference for professionals and entities involved in the study and treatment of congenital heart defects.

METHODS

Data were retrospectively collected through questionnaires sent from the Spanish Society of Pediatric Cardiology to the heads of pediatric cardiology units with medical and surgical activities, as well as to all the members of the Society and those of the Pediatric Cardiology Section of the Spanish Society of Cardiology.

RESULTS

Thirty-eight centers, including 17 national centers with medical and surgical activities, completed the questionnaire. Human resources consisted of 110 cardiologists, 43 surgeons and 12 residents in training. All the centers had the elementary tools for diagnosis and all except one had Echo-2D-Doppler. There were eight catheterization laboratories exclusively used for pediatric activities and nine further laboratories that combined adult and pediatric activities. A total of 83,061 patients were attended in outpatient clinics and there were 6,938 hospital admissions in 22 centres. A total of 279 ablation procedures were performed in 12 electrophysiology laboratories. The seventeen centres with surgical activities performed 2,498 cardiac catheterisms (968 interventional) and 2,292 cardiac surgical interventions.

CONCLUSIONS

Given the large number of participating centers, the present report provides exhaustive information on the organization, resources and activities of pediatric cardiology in Spain. Pediatric cardiology should be granted official recognition of its work so that teaching hospitals, organization, resources and activities can be regulated.

The right-to-die movement: extrapolating from the National Hemlock Society U.S.A. membership survey

A national membership survey of Hemlock Society USA was conducted by Fox and Kamakahi (1995). Respondents (N=6398) were asked a variety of questions, but in this paper we perform a longitudinal analysis of the characteristics of Hemlock Society USA members. Hemlock Society USA members are divided into three 5-year cohorts: Early Joiners (11 or more years of membership), Middle Joiners (6 to 10 years membership), and Late Joiners (5 or fewer years of membership). Differences between cohorts are examined and extrapolations made regarding Hemlock Society USA and the Right-to-Die Movement. A series of one-way ANOVAs were used with Scheme post-hoc comparisons as heuristic tools for assessing between-cohort differences. Late Joiners are different from earlier members, but are more like other Hemlock Society USA members than the adult U.S. population at large. Hemlock Society USA members are essentially societal "elites" (based on socio-demographic variables) who work in social environments that are decidedly split on the issue of voluntary suicide and euthanasia.

Conflicts among human values and trust in institutions

Institutions contribute to maintaining social order and stability in society. At the same time, they restrain the freedom of individuals. Based on the theory of value structure and content (Schwartz, 1992), we hypothesized about the relations of people's trust in institutions to their value priorities. More precisely, we predicted and found that the level of trust in various institutions correlated positively with values that stress stability, protection, and preservation of traditional practices, and negatively with values that emphasize independent thought and action and favour change. In addition, we demonstrated that groups defined on the basis of religious affiliation or political orientation exhibited contrasting value priorities on the same bipolar dimension. Moreover, differences in value priorities accounted for the fact that religious individuals and right-wing supporters expressed more trust in institutions than non-religious individuals and left-wing supporters.

Organizational impact in the dermatologic literature

We revisit our citation data derived from 58,201 articles published between 1981 and 1994 in the 17 top-ranked peer-reviewed international dermatology journals to identify the institutions that house the people who have made the greatest impact on the dermatologic literature during this period. Using these citation data, we estimate an institution's impact in 2 ways. First, institutions are ranked by the gross number of citations to articles from 1981 to 1994 accurred during this same period. To recognize institutions whose articles, on average, have received higher numbers of citations, we also rank institutions by the average number of citations received by each article published by a particular institution (blended impact factor).

State tobacco lobbyists and organizations in the United States: crossed lines

OBJECTIVES

This research took a quantitative look at state-level tobacco lobbying in the United States.

METHODS

Publicly available lobbying data were collected from all states during 1994. Data were compiled on tobacco industry lobbyists, their tobacco employers, health lobbyists, and factors associated with such lobbying.

RESULTS

In 1994, 450 tobacco industry lobbyists lobbied at a state level. Most lobbying was on behalf of four organizations: Philip Morris (34%), the Tobacco Institute (21%), RJ Reynolds (17%), and the Smokeless Tobacco Council (15%). Approximately one half of all tobacco lobbyists also lobbied for a health-related organization (e.g., state medical association, hospital, physician association).

CONCLUSIONS

All US states have tobacco lobbyists. Many health organizations knowingly or unknowingly employ lobbyists who also lobby for the tobacco industry.

Buying groups seek compliance

Purchasing groups are trying harder than ever to entice hospitals into buying a greater percentage of products through group contracts, and to tackle the old obstacle of contract compliance, according to Modern Healthcare's 1994 purchasing survey.