Methodological challenges in conducting a systematic review of community wide interventions to increase physical activity

Introduction: Evaluating the effectiveness of interventions designed to increase the physical activity in communities is often a difficult and complex task, requiring considerable expertise and investment, and often constrained by methodological limitations. These limitations, in turn, create additional challenges when these studies are used in systematic reviews as they hinder the confidence, precision and interpretation of results. The objective of this paper is to summarise the methodological challenges posed in conducting a systematic review of community-wide physical activity interventions to help inform those conducting future primary research and systematic reviews. Methods: We conducted a Cochrane systematic review of community-wide interventions to increase physical activity. We assessed the methodological quality of the included studies. We will investigate these in greater detail, particularly in relation to the potential impact on measures of effect, confidence in results, generalizability of results and general interpretation. Results: The systematic review was conducted and has been published in the Cochrane Library. A logic model was helpful in defining and interpreting the studies. Many studies of unsuitable study design were excluded; however several important methodological limitations of the primary studies evaluating community-wide physical activity interventions emerged. These included: - the failure to use validated tools to measure physical activity; - issues associated with pre and post test designs; - inadequate sampling of populations; - poor control groups; and - intervention and measurement protocols of inadequate duration. Although it is challenging to undertake rigorous evaluations of complex interventions, these issues result in significant uncertainty over the effectiveness of these interventions, and the possible factors required for a community-wide intervention to be successful. In particular, the combination of several of these limitations (e.g. un-validated tools, inadequate sampling, and short duration) is that studies may lack the sensitivity to detect any meaningful change. Multiple publications of findings for the same study also made interpretation difficult; however, interventions with parallel qualitative publications were helpful. Discussion: Evaluating community wide interventions to increase physical activity in a rigorous way is incredibly challenging. These findings reflect these challenges but have important ramifications for researchers conducting primary studies to determine the efficacy of such interventions, as well as for researchers conducting systematic reviews. This new review shows that the inadequacies of design and evaluation are continuing. It is hoped that the adoption of such suggestions may aid in the development of systematic reviews, but more importantly, in enabling translation of such findings into policy and practice.

Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : a literature review

BACKGROUND: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. AIM: The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. METHODS: A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse-patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. RESULTS: Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. CONCLUSION: While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.

Effects of average speed enforcement on speed compliance and crashes : a review of the literature

Average speed enforcement is a relatively new approach gaining popularity throughout Europe and Australia. This paper reviews the evidence regarding the impact of this approach on vehicle speeds, crashes rates and a number of additional road safety and public health outcomes. The economic and practical viability of the approach as a road safety countermeasure is also explored. A literature review, with an international scope, of both published and grey literature was conducted. There is a growing body of evidence to suggest a number of road safety benefits associated with average speed enforcement, including high rates of compliance with speed limits, reductions in average and 85th percentile speeds and reduced speed variability between vehicles. Moreover, the approach has been demonstrated to be particularly effective in reducing excessive speeding behaviour. Reductions in crash rates have also been reported in association with average speed enforcement, particularly in relation to fatal and serious injury crashes. In addition, the approach has been shown to improve traffic flow, reduce vehicle emissions and has also been associated with high levels of public acceptance. Average speed enforcement offers a greater network-wide approach to managing speeds that reduces the impact of time and distance halo effects associated with other automated speed enforcement approaches. Although comparatively expensive it represents a highly reliable approach to speed enforcement that produces considerable returns on investment through reduced social and economic costs associated with crashes.

Sustainable infrastructure operations : a review of assessment schemes and decision support

Infrastructure forms a vital component in supporting today’s way of life and has a significant role or impact on economic, environmental and social outcomes of the region around it. The design, construction and operation of such assets are a multi-billion dollar industry in Australia alone. Another issue that will play a major role in our way life is that of climate change and the greater concept of sustainability. With limited resources and a changing natural world it is necessary for infrastructure to be developed and maintained in a manner that is sustainable. In order to achieve infrastructure sustainability in operations it is necessary for there to be: a sustainability assessment scheme that provides a scientifically sound and realistic approach to measuring an assets level of sustainability; and, systems and tools to support the making of decisions that result in sustainable outcomes by providing feedback in a timely manner. Having these in place will then help drive the consideration of sustainability during the decision making process for infrastructure operations and maintenance. In this paper we provide two main contributions; a comparison and review of sustainability assessment schemes for infrastructure and their suitability for use in the operations phase; and, a review of decision support systems/tools in the area of infrastructure sustainability in operations. For this paper, sustainability covers not just the environment, but also finance/economic and societal/community aspects as well. This is often referred to as the Triple Bottom Line and forms one of the three dimensions of corporate sustainability [Stapledon, 2004].

Nutritional support and functional capacity in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Currently there is confusion about the value of using nutritional support to treat malnutrition and improve functional outcomes in chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to clarify the effectiveness of nutritional support in improving functional outcomes in COPD. A systematic review identified 12 RCTs (n = 448) in stable COPD patients investigating the effects of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 10 RCTs), enteral tube feeding (1 RCT)] versus control on functional outcomes. Meta-analysis of the changes induced by intervention found that whilst respiratory function (FEV(1,) lung capacity, blood gases) was unresponsive to nutritional support, both inspiratory and expiratory muscle strength (PI max +3.86 SE 1.89 cm H(2) O, P = 0.041; PE max +11.85 SE 5.54 cm H(2) O, P = 0.032) and handgrip strength (+1.35 SE 0.69 kg, P = 0.05) were significantly improved, and associated with weight gains of ≥ 2 kg. Nutritional support produced significant improvements in quality of life in some trials, although meta-analysis was not possible. It also led to improved exercise performance and enhancement of exercise rehabilitation programmes. This systematic review and meta-analysis demonstrates that nutritional support in COPD results in significant improvements in a number of clinically relevant functional outcomes, complementing a previous review showing improvements in nutritional intake and weight.

We need to talk about cultural studies [Review]

A review of Graeme Turner, What’s Become of Cultural Studies (Sage, London, 2012) and Lawrence Grossberg, Cultural Studies in the Future Tense (Duke University Press, Durham, 2010).

Soft power in China : public diplomacy through communication [Review]

Review of Soft Power in China: Public diplomacy through communication, edited by J IAN WANG, New York, Palgrave Macmillan, 2011, US$89 (hard), 220 pp

A review of "The Peace In Between : Post-war violence and peacebuilding", edited by Astri Suhrke and Mats Berdal, Routledge, 2012

The term post-war violence has been with us for much of the twentieth century but the issue itself has existed for centuries. The study of violence in post-war societies has been explored by philosophers (Erasmus), statesmen (Sir Thomas More) and sociologists (Emile Durkheim). In many cases the cessation of war and the signing of peace accords do not always mean an end to the violence. This book examines in considerable detail the causes and purposes of post-conflict violence and argues that features which constrain or encourage violence accumulate in such a manner as to create distinct and different types of post-war environments...

Corporate commitment to sustainability : is it all hot air? An Australian review of the linkage between executive pay and sustainable performance

Across time, companies have increasingly made public commitments to sustainable development and to reducing their impacts on climate change. Management remuneration plans (MRPs) are a key mechanism to motivate managers to achieve corporate goals. We review the MRPs negotiated with key management personnel in a sample of large Australian carbon-intensive companies. Our results show that, as in past decades, the companies in our sample have MRPs in place that continue to fixate on financial performance. We argue that this provides evidence of a disconnection, or ‘decoupling’, between the sustainability-related rhetoric of the sample companies, and their ‘real’ organisational practices and priorities.

Regulating for corporate human rights abuses : the emergence of corporate reporting on the ILO’s human rights standards within the global garment manufacturing and retail industry

Despite the ubiquitous nature of the discourse on human rights there is currently little research on the emergence of disclosure by multinational corporations on their human rights obligations or the regulatory dynamic that may lie behind this trend. In an attempt to begin to explore the extent to which, if any, the language of human rights has entered the discourse of corporate accountability, this paper investigates the adoption of the International Labour Organisation's (ILO) human rights standards by major multinational garment retail companies that source products from developing countries, as disclosed through their reporting media. The paper has three objectives. Firstly, to empirically explore the extent to which a group of multinational garment retailers invoke the language of human rights when disclosing their corporate responsibilities. The paper reviews corporate reporting media including social responsibility codes of conduct, annual reports and stand-alone social responsibility reports released by 18 major global clothing and retail companies during a period from 1990 to 2007. We find that the number of companies adopting and disclosing on the ILO's workplace human rights standards has significantly increased since 1998 – the year in which the ILO's standards were endorsed and accepted by the global community (ILO, 1998). Secondly, drawing on a combination of Responsive Regulation theory and neo-institutional theory, we tentatively seek to understand the regulatory space that may have influenced these large corporations to adopt the language of human rights obligations. In particular, we study the role that International Governmental Organisation's (IGO) such as ILO may have played in these disclosures. Finally, we provide some critical reflections on the power and potential within the corporate adoption of the language of human rights.

Design approaches for promoting beneficial indoor environments in healthcare facilities : a review

As a result of growing evidence regarding the effects of environmental characteristics on the health and wellbeing of people in healthcare facilities (HCFs), more emphasis is being placed on, and more attention being paid to, the consequences of design choices in HCFs. Therefore, we have critically reviewed the implications of key indoor physical design parameters, in relation to their potential impact on human health and wellbeing. In addition, we discussed these findings within the context of the relevant guidelines and standards for the design of HCFs. A total of 810 abstracts, which met the inclusion criteria, were identified through a Pubmed search, and these covered journal articles, guidelines, books, reports and monographs in the studied area. Of these, 231 full publications were selected for this review. According to the literature, the most beneficial design elements were: single-bed patient rooms, safe and easily cleaned surface materials, sound-absorbing ceiling tiles, adequate and sufficient ventilation, thermal comfort, natural daylight, control over temperature and lighting, views, exposure and access to nature, and appropriate equipment, tools and furniture. The effects of some design elements, such as lighting (e.g. artificial lighting levels) and layout (e.g. decentralized versus centralized nurses’ stations), on staff and patients vary, and “the best design practice” for each HCF should always be formulated in co-operation with different user groups and a multi-professional design team. The relevant guidelines and standards should also be considered in future design, construction and renovations, in order to produce more favourable physical indoor environments in HCFs.

Physical characteristics of the indoor environment that affect health and wellbeing in healthcare facilities : a review

Understanding the physical characteristics of the indoor environment that affect human health and wellbeing is the key requirement underpinning the beneficial design of a healthcare facility (HCF). We reviewed and summarised physical factors of the indoor environment reported to affect human health and wellbeing in HCFs. Research materials included articles identified in a Pubmed search, guidelines, books, reports and monographs, as well as the bibliographies of review articles in the area studied. Of these, 209 publications were selected for this review. According to the literature, there is evidence that the following physical factors of the indoor environment affect the health and wellbeing of human beings in an HCF: safety, ventilation and HVAC systems, thermal environment, acoustic environment, interior layout and room type, windows (including daylight and views), nature and gardens, lighting, colour, floor covering, furniture and its placement, ergonomics, wayfinding, artworks and music. Some of these, in themselves, directly promote or hinder health and wellbeing, but the physical factors may also have numerous indirect impacts by influencing the behaviour, actions, and interactions of patients, their families and the staff members. The findings of this research enable a good understanding of the different physical factors of the indoor environment on health and wellbeing and provide a practical resource for those responsible for the design and operate the facilities as well as researchers investigating these factors. However, more studies are needed in order to inform the design of optimally beneficial indoor environments in HCFs for all user groups.