An international review of the patterns and determinants of health service utilisation by adult cancer survivors

Background: There is a need to review factors related to health service utilisation by the increasing number of cancer survivors in order to inform care planning and the organisation and delivery of services.

Methods: Studies were identified via systematic searches of Medline, PsycINFO, CINAHL, Social Science Citation Index and the SEER-MEDICARE library. Methodological quality was assessed using STROBE; and the Andersen Behavioural Model was used as a framework to structure, organise and analyse the results of the review.

Results: Younger, white cancer survivors were most likely to receive follow-up screening, preventive care, visit their physician, utilise professional mental health services and least likely to be hospitalised. Utilisation rates of other health professionals such as physiotherapists were low. Only studies of health service use conducted in the USA investigated the role of type of health insurance and ethnicity. There appeared to be disparate service use among US samples in terms of ethnicity and socio-demographic status, regardless of type of health insurance provisions- this may be explained by underlying differences in health-seeking behaviours. Overall, use of follow-up care appeared to be lower than expected and barriers existed for particular groups of cancer survivors.

Conclusions: Studies focussed on the use of a specific type of service rather than adopting a whole-system approach and future health services research should address this shortcoming. Overall, there is a need to improve access to care for all cancer survivors. Studies were predominantly US-based focussing mainly on breast or colorectal cancer. Thus, the generalisability of findings to other health-care systems and cancer sites is unclear. The Andersen Behavioural Model provided an appropriate framework for studying and understanding health service use among cancer survivors. The active involvement of physicians and use of personalised care plans are required in order to ensure that post-treatment needs and recommendations for care are met.

Incorporation of the United Nations Convention on the Rights of the Child in Law: A Comparative Review

Incorporation in law is recognised as key to the implementation of the UNCRC. This article considers the ways in which a variety of countries have chosen to incorporate the CRC, drawing on a study conducted by the authors for UNICEF-UK. It categorises the different approaches adopted into examples of direct incorporation (where the CRC forms part of domestic law) and indirect incorporation (where there are legal obligations which encourage its incorporation); and full incorporation (where the CRC has been wholly incorporated in law) and partial incorporation (where elements of the CRC have been incorporated). Drawing on evidence and interviews conducted during field visits in six of the countries studied, it concludes that children’s rights are better protected – at least in law if not also in practice – in countries that have given legal status to the CRC in a systematic way and have followed this up by establishing the necessary systems to support, monitor and enforce the implementation of CRC rights.

Minority Rights and Minority Protection in Europe

In order to gain access to the EU, nations must be seen to implement formal instruments that protect the rights of minorities. This book examines the ways in which these tools have worked in a number of post-communist states, and explores the interaction of domestic and international structures that determine the application of these policies.

Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: protocol for a controlled before and after study

Background: Clinical Commissioning Groups (CCGs) are mandated to use research evidence effectively to ensure optimum use of resources by the National Health Service (NHS), both in accelerating innovation and in stopping the use of less effective practices and models of service delivery. We intend to evaluate whether access to a demand-led evidence service improves uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. 

Methods/design: This is a controlled before and after study involving CCGs in the North of England. Participating CCGs will receive one of three interventions to support the use of research evidence in their decision-making:1) consulting plus responsive push of tailored evidence; 2) consulting plus an unsolicited push of non-tailored evidence; or 3) standard service unsolicited push of non-tailored evidence. Our primary outcome will be changed at 12 months from baseline of a CCGs ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes will measure individual clinical leads and managers’ intentions to use research evidence in decision making. Documentary evidence of the use of the outputs of the service will be sought. A process evaluation will evaluate the nature and success of the interactions both within the sites and between commissioners and researchers delivering the service. 

Discussion: The proposed research will generate new knowledge of direct relevance and value to the NHS. The findings will help to clarify which elements of the service are of value in promoting the use of research evidence.Those involved in NHS commissioning will be able to use the results to inform how best to build the infrastructure they need to acquire, assess, adapt and apply research evidence to support decision-making and to fulfil their statutory duties under the Health and Social Care Act.

Comparing Social Work Students' Perceptions of Risk Using Online Discussion Fora: Lessons Learned from a European Pilot Project

Comparisons of international child welfare systems have identified two basic orientations to practice; a ‘child protection’ orientation and a ‘child welfare’ orientation, which are founded upon fundamentally different values and assumptions regarding the family, the origins of child care problems, and the proper role of the state in relation to the family. This paper describes a project which sought to compare how undergraduate social work students from three European Universities perceive risk in referrals about the welfare of children and to explore the impact of different cultural, ideological and educational contexts on the way in which risk is constructed by students. Students from Northern Ireland, Germany and Poland examined three vignettes via ten online discussion fora each of which provided a narrative summary of their discussion. The paper presents some findings from the analysis of the qualitative data emerging from the student discussions and draws out the lessons learned in terms of how the project was designed and implemented using online discussion fora.

Public perceptions of personalised nutrition through the lens of Social Cognitive Theory

Social Cognitive Theory has been used to explain findings derived from focus group discussions (N = 4) held in the United Kingdom with the aim of informing best practice in personalised nutrition. Positive expectancies included weight loss and negative expectancies surrounded on-line security. Monitoring and feedback were crucial to goal setting and progress. Coaching by the service provider, family and friends was deemed important for self-efficacy. Paying for personalised nutrition symbolised commitment to behaviour change. The social context of eating, however, was perceived a problem and should be considered when designing personalised diets. Social Cognitive Theory could provide an effective framework through which to deliver personalised nutrition.

The U.N. convention on the rights of the child: Relevance and application to pediatric clinical bioethics

This article provides an overview of the relevance and import of the U.N. Convention on the Rights of the Child (CRC) to child health practice and pediatric bioethics. We discuss the four general principles of the CRC that apply to the implementation of all rights contained in the document, the right to health articulated in Article 24, and the important position ascribed to parents in fulfilling the rights of their children. We then examine how the CRC is implemented and monitored in law and practice. The CRC and associated principles of child rights provide strategies for rights-based approaches to clinical practice and health systems, as well as to policy design, professional training, and health services research. In light of the relevance of the CRC and principles of child rights to children’s health and child health practice, it follows that there is an intersection between child rights and pediatric bioethics. Pediatric bioethicists and child rights advocates should work together to define this intersection in all domains of pediatric practice.