Mental health needs of children and youth with learning disabilities:Overview of a community needs assessment

The purpose of the present report is to describe a community needs assessment that puts the process and choice of a suitable approach into a context. The study examined the mental health needs of children and youth with learning disabilities and their families and how they fit within the continuum of services in Metropolitan Toronto. A series of recommendations was developed for the Ministry of Community and Social Services. The recommendations emphasize: prevention, training and consultation, and research. The study illustrates the importance of involving relevant constituencies in both the planning of a needs assessment and the formulation and implementation of recommendations based on the investigation.

Risks to patient confidentiality when communicating health information to blind and partially sighted patients.

The research reports on a survey of 228 blind and partially sighted persons in 15 health authorities across Scotland. The survey reports data on patient experience of receiving health information in accessible reading formats. Data indicated that about 90% of blind and partially sighted persons did not receive communications from various NHS health departments in a format that they could read by themselves. The implications for patient privacy, confidentiality and wider impact on life and health care are highlighted. The implications for professional ethical medical practice and for public policy are also discussed. Recommendations for improved practice are made.

Cancer survivors with self-reported late effects: their health status, care needs and service utilisation

OBJECTIVE: Cancer survivors (CSs) are at risk of developing late effects (LEs) associated with the disease and its treatment. This paper compares the health status, care needs and use of health services by CSs with LEs and CSs without LEs.

METHODS: Cancer survivors (n = 613) were identified via the Northern Ireland Cancer Registry and invited to participate in a postal survey that was administered by their general practitioner. The survey assessed self-reported LEs, health status, health service use and unmet care needs. A total of 289 (47%) CSs responded to the survey, and 93% of respondents completed a LEs scale.

RESULTS: Forty-one per cent (111/269) of CSs reported LEs. Survivors without LEs and survivors with LEs were comparable in terms of age and gender. The LEs group reported a significantly greater number of co-morbidities, lower physical health and mental health scores, greater overall health service use and more unmet needs. Unadjusted logistic regression analysis found that cancer site, time since diagnosis and treatment were significantly associated with reporting of LEs. CSs who received combination therapies compared with CSs who received single treatments were over two and a half times more likely to report LEs (OR = 2.63, 95% CI = 1.32-5.25) after controlling for all other variables.

CONCLUSIONS: The CS population with LEs comprises a particularly vulnerable group of survivors who have multiple health care problems and needs and who require tailored care plans that take account of LEs and their impact on health-related quality of life.

Are the differences in adulthood ill-health across the North-South divide and between Scotland and England also evident in early childhood health indicators?

Regional differences in adult morbidity and mortality within England (i.e., north-south divide or gradient) and between England and Scotland (i.e., Scottish effect) are only partly explained by adult levels of socioeconomic status or risk factors. This suggests variation in early life, and is supported by the fetal origins and life-course literature which posits that birth outcomes and subsequent, cumulative exposures influence adult health. However, no studies have examined the north-south gradient or Scottish effect in health in the earliest years of life. The aims of the study were: i) to examine health indicators in English and Scottish children at birth and age three to establish whether regional differences exist; and ii) to establish whether observed changes in child health at age three were attributable to birth and/or early life environmental exposures. Respondents included 10,639 biological Caucasian mothers of singleton children recruited to the Millennium Cohort Study (MCS) in the year 2000. Outcome variables were: gestational age and birth weight, and height, body mass index (BMI), and externalising behavioural problems at age three. Region/country was categorised as: South (reference), Midlands, North (England), and Scotland. Respondents provided information on child, maternal, household, and socioeconomic characteristics. Results indicated no significant regional variations for gestational age or birth weight. At age three there was a north-south gradient for externalising behaviour and a north-south divide in BMI which attenuated on adjustment. However, a north-south divide in height was not fully explained by adjustment. There was also evidence of a ‘Midlands effect’, with increased likelihood of shorter stature and behaviour problems. Results showed a Scottish effect for height and BMI in the unadjusted models, and height in the adjusted model, but a decreased likelihood of behaviour problems. Findings indicated no regional differences in health at birth, but some regional variation at age three supports the cumulative life-course model.

Applying Health Locus of Control and Latent Class Modelling to food and physical activity choices affecting CVD risk

Health Locus of Control (HLC) classifies our beliefs about the connection between our actions and health outcomes (Skinner, 1996) into three categories: “internal control”, corresponding to health being the result of an individual's effort and habits; “control by powerful others”, whereby health depends on others, such as doctors; and “chance control”, according to which health depends on fate and chance. Using Choice Experiments we investigate the relationship between HLC and willingness to change lifestyle, in terms of eating habits, physical activity and associated cardiovascular disease risk, in a 384 person sample representative of the 40–65 aged population of Northern Ireland administered between February and July 2011. Using latent class analysis we identify three discrete classes of people based on their HLC: the first class is sceptical about their capacity to control their health and certain unhealthy habits. Despite being unsatisfied with their situation, they are reluctant to accept behaviour changes. The second is a group of individuals unhappy with their current situation but willing to change through exercise and diet. Finally, a group of healthy optimists is identified, who are satisfied with their current situation but happy to take more physical activity and improve their diet. Our findings show that any policy designed to modify people's health related behaviour should consider the needs of this sceptical class which represents a considerable proportion of the population in the region.

Risking peace in the ‘War against the Poor’? Social exclusion and the legacies of the Northern Ireland conflict

Discourses around poverty, dependency and austerity take a particular form when it comes to Northern Ireland which is seen as ripe for economic ‘rebalancing’ and public sector reduction. The Welfare Reform Act 2012 is pivotal in that it provides the muscle for disciplining claimants for a low-waged, flexible labour market. But the Northern Ireland Assembly has not passed the Act or agreed a budget and the return of Direct Rule beckons as a result. The article sheds light on the stand-off over the Welfare Reform Act using data from the 2012 PSE Survey. It demonstrates that the impact of violent conflict is imprinted on the population in terms of high rates of deprivation, poor physical and mental health, and significant differences between those experiencing little or no conflict, and those with ‘high’ experience. In ignoring these legacies of the conflict, the Westminster government is risking peace in its ‘war against the poor’.

Nuclear disasters and health: lessons learned, challenges, and proposals

Past nuclear disasters, such as the atomic bombings in 1945 and major accidents at nuclear power plants, have highlighted similarities in potential public health effects of radiation in both circumstances, including health issues unrelated to radiation exposure. Although the rarity of nuclear disasters limits opportunities to undertake rigorous research of evidence-based interventions and strategies, identification of lessons learned and development of an effective plan to protect the public, minimise negative effects, and protect emergency workers from exposure to high-dose radiation is important. Additionally, research is needed to help decision makers to avoid premature deaths among patients already in hospitals and other vulnerable groups during evacuation. Since nuclear disasters can affect hundreds of thousands of people, a substantial number of people are at risk of physical and mental harm in each disaster. During the recovery period after a nuclear disaster, physicians might need to screen for psychological burdens and provide general physical and mental health care for many affected residents who might experience long-term displacement. Reliable communication of personalised risks has emerged as a challenge for health-care professionals beyond the need to explain radiation protection. To overcome difficulties of risk communication and provide decision aids to protect workers, vulnerable people, and residents after a nuclear disaster, physicians should receive training in nuclear disaster response. This training should include evidence-based interventions, support decisions to balance potential harms and benefits, and take account of scientific uncertainty in provision of community health care. An open and joint learning process is essential to prepare for, and minimise the effects of, future nuclear disasters.

Social comparison and body image in non or infrequent exercisers and exercisers

Body image refers to an individual's internal representation ofhis/her outer self (Cash, 1994; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). It is a multidimensional construct which includes an individual's attitudes towards hislher own physical characteristics (Bane & McAuley, 1998; Cash, 1994; Cash, 2004; Davison & McCabe, 2005; Muth & Cash, 1997; Sabiston, Crocker, & Munroe-Chandler, 2005). Social comparison is the process of thinking about the self in relation to others in order to determine if one's opinions and abilities are adequate and to assess one's social status (Festinger, 1954; Wood, 1996). Research investigating the role of social comparisons on body image has provided some information on the types and nature of the comparisons that are made. The act of making social comparisons may have a negative impact on body image (van den Berg et ai., 2007). Although exercise may improve body image, the impact of social comparisons in exercise settings may be less positive, and there may be differences in the social comparison tendencies between non or infrequent exercisers and exercisers. The present study examined the nature of social comparisons that female collegeaged non or infrequent exercisers and exercisers made with respect to their bodies, and the relationship of these social comparisons to body image attitudes. Specifically, the frequency and direction of comparisons on specific tal-gets and body dimensions were examined in both non or infrequent exercisers and exercisers. Finally, the relationship between body-image attitudes and the frequency and direction with which body-related social comparisons were made for non or infrequent exercisers and exercisers were examined. One hundred and fifty-two participants completed the study (n = 70 non or ill infrequent exercisers; n = 82 exercisers). Participants completed measures of social physique anxiety (SPA), body dissatisfaction, body esteem, body image cognitions, leisure time physical activity, and social comparisons. Results suggested that both groups (non or infrequent exercisers and exercisers) generally made social comparisons and most frequently made comparisons with same-sex friends, and least frequently with same-sex parents. Also, both groups made more appearance-related comparisons than non-appearance-related comparisons. Further, both groups made more negative comparisons with almost all targets. However, non or infrequent exercisers generally made more negative comparisons on all body dimensions, while exercisers made negative comparisons only on weight and body shape dimensions. MANOV As were conducted to examine if any differences on social comparisons between the two groups existed. Results of the MANOVAs indicated that frequency of comparisons with targets, the frequency of comparisons on body dimensions, and direction of comparisons with targets did not differ based on exercise status. However, the direction of comparison of specific body dimensions revealed a significant (F (7, 144) = 3.26,p < .05; 1]2 = .132) difference based on exercise status. Follow-up ANOVAs showed significant differences on five variables: physical attractiveness (F (1, 150) = 6.33,p < .05; 1]2 = .041); fitness (F(l, 150) = 11.89,p < .05; 1]2 = .073); co-ordination (F(I, 150) = 5.61,p < .05; 1]2 = .036); strength (F(I, dO) = 12.83,p < .05; 1]2 = .079); muscle mass or tone (F(l, 150) = 17.34,p < .05; 1]2 = 1.04), with exercisers making more positive comparisons than non or infrequent exercisers. The results from the regression analyses for non or infrequent exercisers showed appearance orientation was a significant predictor of the frequency of social comparisons N (B = .429, SEB = .154, /3 = .312,p < .01). Also, trait body image measures accounted for significant variance in the direction of social comparisons (F(9, 57) = 13.43,p < .001, R2adj = .68). Specifically, SPA (B = -.583, SEB = .186, /3 = -.446,p < .01) and body esteem-weight concerns (B = .522, SEB = .207, /3 = .432,p < .01) were significant predictors of the direction of comparisons. For exercisers, regressions revealed that specific trait measures of body image significantly predicted the frequency of comparisons (F(9, 71) = 8.67,p < .001, R2adj = .463). Specifically, SPA (B = .508, SEB = .147, /3 = .497,p < .01) and appearance orientation (B = .457, SEB = .134, /3 = .335,p < .01) were significant predictors of the frequency of social comparisons. Lastly, for exercisers, the results for the regression of body image measures on the direction of social comparisons were also significant (F(9, 70) = 14.65,p < .001, R2adj = .609) with body dissatisfaction (B = .368, SEB = .143, /3 = .362,p < .05), appearan.ce orientation (B = .256, SEB = .123, /3 = .175,p < .05), and fitness orientation (B = .423, SEB = .194, /3 = .266,p < .05) significant predictors of the direction of social comparison. The results indicated that young women made frequent social comparisons regardless of exercise status. However, exercisers m,a de more positive comparisons on all the body dimensions than non or infrequent exercisers. Also, certain trait body image measures may be good predictors of one's body comp~son tendencies. However, the measures which predict comparison tendencies may be different for non or infrequent exercisers and exercisers. Future research should examine the effects of social comparisons in different populations (i.e., males, the obese, older adults, etc.). Implications for practice and research were discussed.

Association between adolescent leisure, peer social capital and academic performance among Canadian youth

Previous research shows discrepant findings between youth leisure programming (before and after school programs, structured summer program, day camp, overnight camp), academic performance and other youth developmental outcomes. Studies underscores the importance of family, community and school social capital in educational success of youth, investigation of peer social capital in the leisure context and academic performance outcomes is limited. This study uses a sample of 10 and 11 year olds (N=1764) from the Canadian National Longitudinal Survey of Children and Youth (NLSCY) Cycle 6, to study the association between youth leisure programming, peer social capital and academic performance. Ordinal logistic regression models consistently showed a positive association between overnight camp and academic performance even after controlling for determinants of health, and measures of family, school and community social capital. Similarly, the measure of peer social capital was positively associated with academic performance. Most importantly, the interaction between overnight camp participation and peer social capital was significantly associated with academic performance. Study findings, highlight overnight camp opportunities and peer social

Health-Enhancing Physical Activity and Well-Being: Is it How Often, How Long, or How Much Effort that Matters? A Test of Basic Psychological Needs Theory

The primary objectives of the present study were 1) to examine the relationship between health-enhancing physical activity (HEPA) and well-being across the previous day and 2) to examine the role of basic psychological need satisfaction as a potential mediator of the HEPA – well-being relationship. Participants (N = 203) were a convenience sample of undergraduate students with data collected cross sectionally. HEPA was generally associated with well-being (r‟s ranged from .18 to .62). Multiple mediation analyses supported psychological need satisfaction as mechanisms underpinning the HEPA – well- being relationship. Subsequent analyses demonstrated that effort put forth in HEPA activities, as opposed to frequency or duration, uniquely predicted well-being. The role of effort was further highlighted in the multiple mediation analyses. As such future research may wish to investigate the utility of a HEPA program that facilitates effortful engagement and fulfillment of basic psychological needs.

The Legal Framing of Computerized Processing of Health Data : A European and Canadian Perspective

The use of information and communication technologies in the health and social service sectors, and the development of multi-centred and international research networks present many benefits for society: for example, better follow-up on an individual’s states of health, better quality of care, better control of expenses, and better communication between healthcare professionals. However, this approach raises issues relative to the protection of privacy: more specifically, to the processing of individual health information.

Efectividad en redes Inter-Organizacionales : una aproximación al concepto y su medición

El concepto de efectividad en Redes Inter-organizacionales se ha investigado poco a pesar de la gran importancia en el desarrollo y sostenibilidad de la red. Es muy importante entender este concepto ya que cuando hablamos de Red, nos referimos a un grupo de más de tres organizaciones que trabajan juntas para alcanzar un objetivo colectivo que beneficia a cada miembro de la red. Esto nos demuestra la importancia de evaluar y analizar este fenómeno “Red Inter-organizacional” de forma más detallada para poder analizar que estructura, formas de gobierno, relaciones entre los miembros y entre otros factores, influyen en la efectividad y perdurabilidad de la Red Inter-organizacional. Esta investigación se desarrolla con el fin de plantear una aproximación al concepto de medición de la efectividad en Redes Inter-organizacionales. El trabajo se centrara en la recopilación de información y en la investigación documental, la cual se realizará por fases para brindarle al lector una mayor claridad y entendimiento sobre qué es Red, Red Inter-Organizacional, Efectividad. Y para finalizar se estudiara Efectividad en una Red Inter-organizacional.

Health care network formation and policyholders' welfare

We develop a model in which two insurers and two health care providers compete for a fixed mass of policyholders. Insurers compete in premium and offer coverage against financial consequences of health risk. They have the possibility to sign agreements with providers to establish a health care network. Providers, partially altruistic, are horizontally differentiated with respect to their physical address. They choose the health care quality and compete in price. First, we show that policyholders are better off under a competition between conventional insurance rather than under a competition between integrated insurers (Managed Care Organizations). Second, we reveal that the competition between a conventional insurer and a Managed Care Organization (MCO) leads to a similar equilibrium than the competition between two MCOs characterized by a different objective i.e. private versus mutual. Third, we point out that the ex ante providers’ horizontal differentiation leads to an exclusionary equilibrium in which both insurers select one distinct provider. This result is in sharp contrast with frameworks that introduce the concept of option value to model the (ex post) horizontal differentiation between providers.