Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process

AIMS

A 10-month project funded by the NewMind network sought to develop the specification of a visualisation toolbox that could be applied on digital platforms (web- or app-based) to support adults with lived experience of mental health difficulties to present and track their personal wellbeing in a multi-media format.

METHODS

A participant co-design methodology, Double Diamond from the Design Council (Great Britain), was used consisting of four phases: Discover - a set of literature and app searches of wellbeing and health visualisation material; Define - an initial workshop with participants with lived experience of mental health problems to discuss wellbeing and visualisation techniques and to share personal visualisations; Develop - a second workshop to add detail to personal visualisations, for example, forms of media to be employed, degree of control over sharing; and Deliver - to disseminate the learning from the exercise.

RESULTS

Two design workshops were held in December 2017 and April 2018 with 13 and 12 experts-by-experience involved, respectively, including two peer researchers (co-authors) and two individual-carer dyads in each workshop, with over 50% of those being present in both workshops. A total of 20 detailed visualisations were produced, the majority focusing on highly personal and detailed presentations of wellbeing.

DISCUSSION

While participants concurred on a range of typical dimensions of wellbeing, the individual visualisations generated were in contrast to the techniques currently employed by existing digital wellbeing apps and there was a great diversity in preference for different visualisation types. Participants considered personal visualisations to be useful as self-administered interventions or as a step towards seeking help, as well as being tools for self-appraisal.

CONCLUSION

The results suggest that an authoring approach using existing apps may provide the high degree of flexibility required. Training on such tools, delivered via a module on a recovery college course, could be offered.

A prospective study of injuries to elite Australian rugby union players

OBJECTIVES

To assess injury patterns and incidence in the Australian Wallabies rugby union players from 1994 to 2000. To compare these patterns and rates with those seen at other levels of play, and to see how they have changed since the beginning of the professional era.

METHODS

Prospective data were recorded from 1994 to 2000. All injuries to Australian Wallabies rugby union players were recorded by the team doctor. An injury was defined as one that forced a player to either leave the field or miss a subsequent game.

RESULTS

A total of 143 injuries were recorded from 91 matches. The overall injury rate was 69/1000 player hours of game play. The injury rates in the periods before (1994-1995) and after (1996-2000) the start of the professional era were 47/1000 player hours and 74/1000 player hours respectively. The lock was the most injured forward, and the number 10 the most injured back. Most injuries were soft tissue, closed injuries (55%), with the head being the most commonly injured region (25.1%). The phase of play responsible for most injuries was the tackle (58.7%). Injuries were more likely to occur in the second half of the game, specifically the third quarter (40%). The vast majority of injuries were acute (90%), with the remainder being either chronic or recurrent.

CONCLUSIONS

Injury rate increases at higher levels of play in rugby union. Injury rates have increased in the professional era. Most injuries are now seen in the third quarter of the game, a finding that may reflect new substitution laws. There is a need for standardised collection of injury data in rugby union.

Male sex workers in three Australian cities: socio-demographic and sex work characteristics

This article describes the socio-demographic and sex work characteristics of sex workers in Sydney, Melbourne, and Brisbane. A total of 185 male sex workers completed the questionnaire component of the study. The results of this study serve to debunk many of the myths surrounding the popular view of the male sex worker (MSW). The respondents in this study were on average 27 years old, and the majority had completed secondary education, with 30% having gained some form of tertiary qualification. Interestingly, those MSWs who had not completed secondary education were mostly street workers and were generally aged under 25 years. The majority of sex workers lived in rented accommodation, with only 6% reporting to be homeless. Half of all respondents identified as being "gay," 31% as "bisexual" and 5.5% as "straight." More than half of the respondents were in a permanent relationship. Only 7.3% of this group reported using heroin daily, although the majority consumed alcohol, tobacco, marijuana, and ecstasy. The majority of sex workers had been in the profession for less than six months, although some had been working in the industry for more than ten years. Most of the sex workers reported having taken an HIV test and a preference to offer safer sex. The article highlights ways in which the work context of MSW can be better understood and supported by education and public policy programs.

A profile of the clients of male sex workers in three Australian cities

OBJECTIVE

This paper describes the profile of clients as reported by 186 male sex workers in three Australian cities.

METHOD

The data were collected using a diary which was completed after each commercial sexual encounter with a male client over a two-week period. The data reported in this study are based on reports from 2,088 sex encounters and a profile of 1,776 clients.

RESULTS

The findings reveal, for example, that the most common source used for recruiting clients was advertisements, followed by escort agencies, although there were differences between the three cities; the majority of the clients were in their 40s but clients of street workers were younger; clients were most often classified as 'middle class', with differences by source of client recruitment; less than half the clients were identified as being gay and a significant number were identified as bisexual or straight; alcohol and drug use took place in a small percentage of the encounters; most workers had some information about their clients, such as occupation and home number; violence was infrequent; and unsafe sex was requested in a minority of the encounters.

CONCLUSION

Overall, the results reveal that clients of male sex workers are a highly heterogeneous group.

IMPLICATIONS

The paper highlights a number of issues which can further promote safety and public accountability in male sex work.

The attitudes of community based rehabilitation workers towards people with disabilities in south India

This study explored the attitudes of south Indian Community Based Rehabilitation (CBR) workers towards people with disabilities. The research presents a demographic profile of the CBR worker, provides a measure of their attitudes towards people with disabilities, and investigates the factors that influence the formation of these attitudes, in particular the role of CBR education programmes. A questionnaire and an attitude measurement instrument, specifically developed for the Indian context, provided descriptive data. Interviews provided background information on south Indian culture and CBR educational programmes. Analysis of the data revealed that CBR workers in south India tend to be young, female and lacking in work experience. They have positive attitudes towards people with disabilities, which are influenced by their amount of education. CBR educational programmes appeared to have little effect on workers' attitudes, perhaps reflecting a lack of educational strategies directed specifically at attitude development.

Randomized trial of aromatherapy. Successful treatment for alopecia areata

OBJECTIVE

To investigate the efficacy of aromatherapy in the treatment of patients with alopecia areata.

DESIGN

A randomized, double-blind, controlled trial of 7 months' duration, with follow-up at 3 and 7 months.

SETTING

Dermatology outpatient department.

PARTICIPANTS

Eighty-six patients diagnosed as having alopecia areata.

INTERVENTION

Eighty-six patients were randomized into 2 groups. The active group massaged essential oils (thyme, rosemary, lavender, and cedarwood) in a mixture of carrier oils (jojoba and grapeseed) into their scalp daily. The control group used only carrier oils for their massage, also daily.

MAIN OUTCOME MEASURES

Treatment success was evaluated on sequential photographs by 2 dermatologists (I.C.H. and A.D.O.) independently. Similarly, the degree of improvement was measured by 2 methods: a 6-point scale and computerized analysis of traced areas of alopecia.

RESULTS

Nineteen (44%) of 43 patients in the active group showed improvement compared with 6 (15%) of 41 patients in the control group (P = .008). An alopecia scale was applied by blinded observers on sequential photographs and was shown to be reproducible with good interobserver agreement (kappa = 0.84). The degree of improvement on photographic assessment was significant (P = .05). Demographic analysis showed that the 2 groups were well matched for prognostic factors.

CONCLUSIONS

The results show aromatherapy to be a safe and effective treatment for alopecia areata. Treatment with these essential oils was significantly more effective than treatment with the carrier oil alone (P = .008 for the primary outcome measure). We also successfully applied an evidence-based method to an alternative therapy.

Developing outcomes for community nursing: the Nominal Group Technique

The focus of healthcare has shifted from examining the process (what is done) to measuring what is achieved (outcomes). While various tools have been developed to measure inpatient outcomes, there is no specific measure of outcomes for community-based care. A collaborative research project involving the University of Wollongong and the Illawarra Area Health Service has been established to address the gap in patient reporting and evaluation. This paper describes the initial phase of a research project using the Nominal Group Technique (NGT) to develop outcome measures appropriate to community health. The NGT is a technique that uses groups of stake holders to obtain information. Nominal groups are unlike focus groups in that NGT seek responses to predetermined and structured questions. Other aspects of outcome measurement, such as casenote audits and addressing the client's perspective are being considered later in the project. This paper focuses largely upon the process of using the NGT to develop outcomes and to encourage the participation in the research project by community nurses. It was vital from the outset to generate a sense of ownership of both the process and the findings and the NGT was seen as a process that would enable both the development of outcome statements and active participation.

Outcomes of transposition of the great arteries in the ear of atrial inflow correction

OBJECTIVE

To examine long term morbidity and mortality following atrial inflow corrective procedures for transposition of the great arteries (TGA) and to investigate factors that influence morbidity and mortality.

DESIGN

Retrospective cohort study from a single centre.

SETTING

Cardiology and cardiothoracic surgical unit in a large tertiary referral centre.

PATIENTS

All 130 patients who had TGA diagnosed between August 1972 and May 1988 and were considered suitable for atrial inflow correction; 109 of these underwent surgery (operative cohort: 84 Mustard operations and 25 Senning operations); 95 survived to hospital discharge (hospital surviving cohort).

MAIN OUTCOME MEASURES

Death and cardiac events.

RESULTS

There were relatively good long term results from atrial inflow correction for TGA with 5, 10, and 15 year survivals of 77.3%, 75.9%, and 71.3%. However, there was an appreciable incidence of late cardiac death and events, with 5, 10, and 15 year cardiac event-free survivals of 74.5%, 67.1%, and 39.6%. Supraventricular tachycardia was the only significant risk factor for late cardiac death (relative risk 8.72, 95% confidence interval, 2.86 to 26.64). Senning patients had better event-free survival (p = 0.04).

CONCLUSIONS

Atrial inflow correction for TGA has a reasonably good 15 year survival (71.3%), but there is an appreciable incidence of late cardiac deaths and events (15 year event-free survival 39.6%). The Senning procedure is preferable to the Mustard procedure for cases unsuitable for arterial switching.

Determining the effectiveness of thresholds, an intervention to enhance the career development of young people with physical disabilities

People with disabilities have lower work force participation rates than the general public. One factor that has been attributed to this is a lack of vocational programs for adolescents with disabilities. Thresholds is a vocational program designed to enhance the career development strategies of adolescents with physical disabilities. In a three-part series, participants reflect on who they are, clarify their career future and explore the world of work, and test out strategies for investigating career opportunities and addressing obstacles to career success. Following pilot testing, Thresholds was field tested with two groups of adolescents in two urban centres in Canada. Findings suggested that this program could enhance the vocational decision-making abilities and self-appraisal skills of participants. Entry level characteristics of participants were critical in determining the extent of change. Feedback encouraged modifications to make the program more useful and effective.

Operational calibration of Geostationary Operational Environmental Satellite-8 and-9 imagers and sounders

We describe the operational in-orbit calibration of the Geostationary Operational Environmental Satellite (GOES)-8 and-9 imagers and sounders. In the infrared channels the calibration is based on observations of space and an onboard blackbody. The calibration equation expresses radiance as a quadratic in instrument output. To suppress noise in the blackbody sequences, we filter the calibration slopes. The calibration equation also accounts for an unwanted variation of the reflectances of the instruments' scan mirrors with east-west scan position, which was not discovered until the instruments were in orbit. The visible channels are not calibrated, but the observations are provided relative to the level of space and are normalized to minimize east-west striping in the images. Users receive scaled radiances in a GOES variable format (GVAR) data stream. We describe the procedure users can apply to transform GVAR counts into radiances, temperatures, and mode-A counts.

The risks of thrombolysis in patients without acute myocardial infarction

The risk of administering thrombolysis to patients with suspected myocardial infarction who subsequently do not sustain an infarct, but develop complications associated with thrombolysis is of concern to all physicians. The objective of this study was to ascertain the effect of altering the criteria for the administration of thrombolysis on the number of patients who received thrombolysis in the absence of infarction. During 1990 and 1992 details of all admissions with chest pain were recorded. During 1991 the policy for the administration of thrombolysis was altered so that only patients with ST elevation were eligible. A total of 1473 patients were admitted with chest pain in 1990 and 1967 in 1992. Of the patients admitted in 1990, 663 (45%) had confirmed infarction of whom 378 (57.0%) received thrombolysis. In 1992, 855 (43%) were admitted with infarction and of these 450 (52.6%) had thrombolytic therapy. 118 patients had no evidence of myocardial infarction, but received thrombolysis. 91 (77.1%) were admitted in 1990 and 27 (22.9%) in 1992 (P < 0.01). Of these only 24 (20%) subjects had ST elevation or bundle branch block on the admission electrocardiograph and 41 (35%) had normal tracings. Four (3%) subjects had serious complications of whom one (0.8%) died. The implementation of ECG criteria resulted in a significant reduction in the number of patients without infarction who received thrombolysis, but did not significantly alter the rate of thrombolysis in those with definite myocardial infarction.

Women and myocardial infarction: agism rather than sexism?

OBJECTIVE

To determine whether women with myocardial infarction are treated differently from men of the same age and to assess the effect of changes in the coronary care unit admission policy.

DESIGN

Clinical audit.

SETTING

The coronary care unit and general medical wards of a teaching hospital. In 1990 the age limit for admission to coronary care was 65 years. This age limit was removed in 1991.

PATIENTS

539 female and 977 male patients admitted with myocardial infarction between 1990 and 1992.

MAIN OUTCOMES

Admission to the coronary care unit, administration of thrombolysis, and in-hospital mortality.

RESULTS

409 men and 254 women were admitted with myocardial infarction in 1990 and 568 men and 285 women in 1992. Removal of the age limit for admission to the coronary care unit resulted in an increase in the numbers of both sexes admitted with myocardial infarction. In both years, however, proportionately more men with infarction were admitted to coronary care: 226 men (55%) and 96 women (38%) (P < 0.01) (95% CI 7 to 28) in 1990 and 459 men (81%) and 200 women (70%) (P < 0.01) (%CI 2 to 19) in 1992. Some 246 men (60%) and 133 women (52%) with infarction (P < 0.01) received thrombolytic treatment in 1990 compared with 319 men (56%) and 130 women (46%) (P < 0.01) in 1992. The mean age of women sustaining a myocardial infarction was significantly greater in both years studied. In 1992 a total of 78 men (7%) and 34 women (4%) (P < 0.05) admitted with chest pain underwent cardiac catheterisation before discharge from hospital.

CONCLUSIONS

Differences in admission rates to the coronary care unit and the rate of thrombolysis between the sexes can be explained by the older age of women sustaining infarction. The application of age limits for admission to coronary care or administration of thrombolysis places elderly patients at a disadvantage. As women sustain myocardial infarctions at an older age they are placed at a greater disadvantage.

A critical review of cognitive and memory assessment tools:

A small percentage of cardiac clients experience cognitive and memory disorders after surgery. Since these disorders could limit a client's ability to function independently in daily activities, it would seem imperative that occupational therapists be able to examine the cognitive and memory dysfunctions of their cardiac clients. This paper presented information on the reliability and validity of a number of tools that have been administered by researchers and rehabilitation professionals to assess cognition. A critique of the information on assessment instruments and screening tools suggested that several tools could provide therapists with valuable diagnostic material on cognition. Promising screening tools and assessments appeared to require further research with a cardiac population.

Nicardipine sustained release in hypertension

1. A novel formulation of nicardipine (25% standard, 75% sustained release--SR) was evaluated in mild hypertension in a double-blind, randomized, placebo-controlled comparison with standard nicardipine (STD), using clinic measurements (Hawksley) augmented by home recorded blood pressures (Copal UA 251). 2. At 2 h after dosing (peak effect) both STD nicardipine (30 mg three times daily) and SR nicardipine (60 mg twice daily) for 28 days produced a highly significant reduction in sitting and standing blood pressure. The mean sitting blood pressure was reduced by 20/16 mm Hg (STD) and by 25/18 mm Hg (SR) compared with placebo. 3. Predose (8-11 h after last dose of STD, 12-15 h after last dose of SR) the reductions in sitting blood pressure relative to placebo were 11/6 mm Hg (STD) and 14/7 mm Hg (SR). 4. Home recordings confirmed the hypotensive effect of both formulations. Both exhibited a distinct 'peak dose' effect between 1-3 h after dosing. The effect of the SR formulation was sustained throughout the 12 h dosing interval. 5. Of the 60 patients entering the study, one died of unexplained staphylococcal septicaema, two were withdrawn for non drug-related reasons and 14 (32%) were withdrawn because of adverse effects on active therapy (headaches, facial flushing, leg oedema, chest pain, dizziness). 6. In the 43 patients who completed the study adverse symptoms were reported more frequently while they were on the two active formulations of nicardipine compared with placebo. Most of these reactions were again of vasodilator origin.(ABSTRACT TRUNCATED AT 250 WORDS)

The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems

With the increasing manufacture of expensive systems for the measurement of ambulatory blood pressure there is a need for potential purchasers to be able to satisfy themselves that the systems have been evaluated according to agreed criteria. The British Hypertension Society has, therefore, drawn up a protocol of requirements for the evaluation of these devices. This protocol incorporates many features of the American National Standard for Non-Automated Sphygmomanometers but includes many additional features, such as strict criteria for observer training, interdevice variability testing before and after a month of ambulatory use, and a new system of analysis which permits the test system to be graded. It is recommended that manufacturers of ambulatory blood pressure measuring devices should obtain an unbiased evaluation according to a recognized standard before a device is marketed.

Teaching medical students about epilepsy

A small study was designed to evaluate three seminars on epilepsy for junior medical students. A self-completion questionnaire on knowledge and attitudes was constructed and administered to case and control students and, as part of a parallel study, to senior medical students, general practitioners, and a sample of patients attending general practice. Students undertaking seminars on epilepsy showed significant improvement in overall knowledge, but not in attitudes. Many students had observed an epileptic seizure before entering medical school, but neither this, nor close acquaintance with persons with epilepsy, appeared to affect their responses. Age appeared to influence knowledge in the sample of general practice attenders, with those aged 30-59 scoring a significantly higher mean score than older and younger subgroups.

The Block Nurse Program

In the Block Nurse Program, existing resources and agencies are used to help keep elderly persons in their own homes with case-management by public health nurses living in the community. In an external evaluation of the program it was documented that a neighborhood long-term care delivery model not only works, but keeps elderly persons in their homes at low cost and with high care standards.

Stillbirths and fetal movements

The unexplained stillbirth is an event distressing to patients, families and medical attendants alike. Many of these deaths can be prevented by the use of fetal movement record cards. In a retrospective study of stillbirths occurring over two consecutive twenty-month periods, the first twenty-month period being prior to, the second subsequent to the introduction of fetal movement record cards on a non-prescriptive basis a significant decrease in perinatal mortality and stillbirth rates was observed. The percentage of patients using fetal movement record cards in the second time period cannot be estimated, but in only one of twenty-seven unexplained stillbirths was the mother using a fetal movement record card. Examination of antenatal records for hospital clinic patients suffering unexplained stillbirths shows that systematic enquiry about fetal activity was absent in the first time period and rare in the second time period.

A comparison of single doses of bucindolol and oxprenolol in hypertensive patients

Single doses of bucindolol 50, 100 and 200 mg were compared to placebo and single doses of oxprenolol 40, 80 and 160 mg in seven patients with mild hypertension, in a double-blind randomized study. Both bucindolol and oxprenolol inhibited exercise induced tachycardia. The mean maximum inhibition of exercise heart rate was similar after each dose of both drugs (20%, P less than 0.001). Bucindolol produced a significantly greater reduction in blood pressure than either oxprenolol or placebo. This was most apparent in standing systolic and diastolic and post-exercise systolic blood pressures between 1 and 2 h after dosing and was dose-related. All seven patients experienced adverse effects related to hypotension within the first 2 h after ingestion of bucindolol 200 mg. Plasma concentrations of oxprenolol, bucindolol or 5-hydroxy-bucindolol, sampled 2 h after dosing, could not be related to either the changes in blood pressure or to the occurrence of symptoms. The results emphasise the need for careful dose-finding of new drugs prior to their more widespread evaluation in phase 3 studies.

Ro 31-1118, a new cardioselective beta-adrenoceptor antagonist. Pharmacokinetics and effects on heart rate and blood pressure in mild hypertensives

Five patients with mild hypertension were given single oral doses of Ro 31-1118 (10,20,40, and 80 mg) and placebo in a randomized, double-blind, within-patient study. Plasma concentrations of Ro 31-1118 and supine, standing, exercise, and post-exercise heart rates and blood pressures were measured before and at regular intervals after drug administration. The pharmacokinetic data were consistent with a one-compartment model with first-order absorption and a variable time lag. Peak plasma concentrations and area under curve were linearly related to dose, whereas time to peak concentration, half-time, clearance and apparent volume of distribution were dose-independent. There was a reduction in exercise and post-exercise heart rate of approximately 10% after 10 mg and 20 mg Ro 31-1118, and of approximately 15% after 40 mg and 80 mg. At all doses standing systolic blood pressure was reduced by approximately 5%. A similar fall was seen in exercise and post-exercise systolic blood pressures. There was no substantial effect of Ro 31-1118 on supine or standing heart rates nor on diastolic blood pressure. No adverse effects were reported. It is concluded that Ro 31-1118 has linear pharmacokinetics over the dose range 10-80 mg, and has a weak antihypertensive effect when administered in single doses to patients with mild hypertension.

Haematological differences in three population groups

The increased absolute lymphocyte counts of Indians and Blacks in comparison with Whites, observed in a former study, were shown, in a study on blood donors, to occur in women rather than men of these two groups. Neutrophil counts showed no sex differences, but were significantly highest in Whites and lowest in Blacks. Indians of both sexes had significantly higher mean red cell counts, together with smaller red cells, than subjects in the other two groups. In no group was a significant correlation observed between body mass and haemoglobin level.