Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic ( or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction ( AMI) ( n = 3427), or stroke ( n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals ( long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups ( same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided. Conclusions: Diagnosis-outcome indicators based on administrative data require validation as markers of significant risk adjusted SV. Validated indicators allow quantification of realisable outcome benefits if all hospitals achieved best performer levels. The overall level of quality of care within single institutions cannot be inferred from the results of one or a few indicators.

The directions taken by young people on leaving compulsory education:a study in two Birmingham schools

The thesis addresses the relative importance of factors affecting working-class school-leavers' post-compulsory education transitions into post-sixteen education, training, employment and unemployment. It focuses on school-leavers choosing to enter the labour market, whether successfully or not and the influences affecting this choice. Methodologically, the longitudinal approach followed young people from before they left school to a period of months after. Discrepancies between young people's intended and actual destinations emphasised the diverse influences on post-sixteen transitions. These influences were investigated through a dynamic multi-method approach, drawing from quantitative and qualitative methodologies providing depth and insight while locating the research within a structural framework, allowing a comparison with local and national trends. Two crucial factors of school and gender affected young people's intended and actual post-sixteen directions. School policy, including treatment of disaffected pupils and recruitment to a large, on-site sixth form, influenced the number of pupils opting to continue their education. Girls were more likely to continue education after the end of compulsory schooling and gave different reasons to boys for doing so. Family and peer groups were influential, helping young people develop a 'horizon for action' incorporating habitus and subjective preferences that specified acceptable post-sixteen directions. These influences operated within the context of the local labour market. Perception of the latter rather than actual conditions informed post-sixteen decisions; however, labour market reality influenced the success of the school-leavers' endeavours. The research found that the economics-based rational choice model of decision-making did not apply to many working class school-leavers. The cohort made pragmatically rational decisions dependent on their 'horizon for action'. based on partial, occasionally inaccurate information. Policy recommendations consider the careers service and structure or school sixth forms as aiding successful transitions from compulsory education into education, employment or training. The maintenance allowance may be ineffectual in tackling its objective of social inclusion.

An alternative measure of the ICT-Opportunity Index

We developed an alternative approach for measuring information and communication technology (ICT), applying Data Envelopment Analysis (DEA) using data from the International Telecommunications Union as a sample of 183 economies. We compared the ICT-Opportunity Index (ICT-OI) with our DEA-Opportunity Index (DEA-OI) and found a high correlation between the two. Our findings suggest that both indices are consistent in their measurement of digital opportunity, though differences still exist in different regions. Our new DEA-OI offers much more than the ICT-OI. Using our model, the target and peer groups for each country can be identified.

Psychic Punishment Costs and Deterrence

In this paper we analyze criminal deterrence in the presence of specific psychic costs of punishments. We consider a dynamic model with three players, analyzing the choices of a representative lawmaker, potential criminal and judge. In our setting the lawmaker decides whether to introduce a fixed punishment enhancement above a chosen threshold of crime level, depending on its popularity among the voters. In reaction, the judge, who is influenced by her own preferences as well as the opinion of her peer group, might change the probability of punishment, through affecting the standard of reasonable doubt. Our results suggest that large discontinuous and mandatory increases in punishment can have unintended effects that are contrary to the stated goal of such punishment enhancements. In equilibrium, when either the judge or her peer group is "anti-punishment" enough, the level of criminal activity might increase in response to the punishment enhancement. This perverse effect is less likely to occur if there is a higher number of peer groups within the "elite", so that a greater extent of self-selection by judges can occur. Our results have relevance for a number of areas outside the traditional criminal justice system as well, such as special courts (such as ecclesiastical or military courts), or the strictness and enforcement of regulations.

Applied Research “Specializers”Versus “Samplers” in Youth Sport: Comparing Experiences and Outcomes

The purpose of the current study was to examine two different trajectories of sport participation and explore any similarities or differences that may result regarding per­sonal development and sport outcomes. Seventy-four youth athletes (40 “specializ­ers” and 34 “samplers”) were recruited for the current study and four measures were employed to assess sport experiences and outcomes. Discriminant function analyses revealed no differences between groups in asset possession or sources of enjoyment however, differences were reported in sport experiences and burnout. The “samplers” reported more experiences regarding the integration of sport and family as well as linkages to the community. Although the “specializers” reported higher levels of physical/emotional exhaustion than did the “samplers,” they also reported more expe­riences related to diverse peer groups. The differences highlight the importance of examining specific pathways of development in sport to gain a deeper understanding of youths’ experiences in sport.

The Benefits of Sampling Sports During Childhood

Sampling may promote prolonged engagement in sport by limiting physical injuries (Fraser-Thomas et al., 2005). Overtraining injuries are a concern for young athletes who specialize in one sport and engage in high volumes of deliberate practice (Hollander, Meyers, & Leunes, 1995; Law, Côté, & Ericsson, 2007). For instance, young gymnasts who practice for over 16 hours a week have been shown to have higher incidences of back injuries (Goldstein, Berger, Windier, & Jackson, 1991). A sampling approach in child-controlled play (e.g. deliberate play) rather than highly adult-controlled practice (e.g. deliberate practice) has been proposed as a strategy to limit overuse and other sport-related injuries (Micheli, Glassman, & Klein, 2000). In summary, sampling may protect against sport attrition by limiting sport related injuries and allowing children to have early experiences in sport that are enjoyable. Psychosocial Benefits of Sampling Only a small percentage of children who participate in school sports ever become elite athletes. Therefore, the psychosocial outcomes of sport participation are particularly important to consider. Recent studies with youth between the ages of 11 to 17 have found that those who are involved in a variety of extracurricular activities (e.g. sports, volunteer, arts) score more favourably on outcome measures such as Grade Point Average (GPA; Fredricks & Eccles, 2006a) and positive peer relationships (Fredricks & Eccles, 2006b) than youth who participate in fewer activities. These patterns are thought to exist due to each extracurricular activity bringing its own distinct pattern of socialization experiences that reinforce certain behaviours and/or teach various skills (Fredricks & Eccles, 2006b; Rose-Krasnor, Bussen, Willoughby, & Chambers, 2006). This contention is corroborated by studies of children and youths' experiences in extracurricular activities indicating that youth have unique experiences in each activity that contribute to their development (Hansen, Larson, & Dworkin, 2003; Larson, Hansen, & Moneta, 2006). This has led Wilkes and Côté (2007) to propose that children who sample different activities (through their own choice or by virtue of parental direction), have a greater chance of developing the following five developmental outcomes compared to children who specialize in one activity: 1) life skills, 2) prosocial behaviour, 3) healthy identity, 4) diverse peer groups and 5) social capital.

Relação entre exposição a comportamentos desviantes e delinquência juvenil

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Criminologia

Friendship dynamics and popularity hierarchies among inclusive men

Previous research has demonstrated that aggression and marginalization are key components of maintaining popularity within male peer groups. However, more recent ethnographic studies have documented a significant shift in young men’s attitudes and behaviours, with more inclusive masculinities flourishing. My previous research has examined friendship dynamics and popularity hierarchies among boys, showing that contemporary popularity is stratified by a boy’s charisma, authenticity, emotional support, and social fluidity. In this article, I draw upon ethnographic research to provide an intersectional analysis of how adolescent masculinities are influenced by class, age and sexuality

Qualidade de vida relacionada com a saúde em crianças e adolescentes – estudo bicêntrico e comparação com dados europeus

Introdução: O interesse pela Qualidade de Vida Relacionada com a Saúde (QVRS) é relativamente recente e na literatura são ainda poucos os estudos em idade pediátrica. Objetivos: Avaliar a QVRS em crianças e adolescentes de duas unidades dos cuidados de saúde primários portugueses. Material e métodos: Estudo transversal, descritivo e analítico. Foi aplicado o questionário KIDSCREEN-27® a uma amostra de conveniência de utentes, com idades compreendidas entre os 8 e os 18 anos, que recorreram entre 1 de fevereiro e 31 de julho de 2013, ao Centro de Saúde (CS) Sete Rios e à Unidade de Saúde Familiar (USF) Infesta. Resultados: Responderam ao questionário 163 indivíduos (85 do CS Sete Rios e 78 da USF Infesta). A média de idades foi 11,59±2,54 anos, com um predomínio do sexo feminino (102/62,6%). Os scores QVRS calculados revelaram valores elevados e estatisticamente superiores aos dados europeus disponíveis (p<0,001). As raparigas obtiveram scores QVRS mais baixos, mas apenas significativo na avaliação do bem-estar físico (p<0,001). O Suporte Social e Grupos de Pares foi a área pior avaliada pelos pais (p=0,006). O Ambiente Escolar foi o as- peto onde os adolescentes manifestaram um score significativamente inferior às crianças (p=0,041). Apesar dos utentes da USF Infesta apresentarem scores ligeiramente mais baixos, esta diferença não foi estatisticamente significativa. Conclusões: Os dados demonstram uma boa QVRS nas duas populações pediátricas avaliadas. Os resultados da análise comparativa evidenciaram algumas diferenças que deverão ser alvo de análise mais aprofundada em estudos posteriores, no sentido de planear medidas para a melhoria da QVRS.

Vendor manual

This manual explains the WIC Program vendor responsibilities. Topics covered are: competitive pricing and peer groups, definitions for WIC vendors, DHEC regional map, vendor price surveys, how to become a South Carolina WIC vendor, transacting WIC checks, depositing WIC checks, vendor monitoring and administrative review procedures.

Gleichermaßen auf das Leben vorbereitet? Ergebnisse der Jugendstudie AIDA

In [diesem] Beitrag stellen die Autoren ausgewählte Ergebnisse der Berliner Längsschnittstudie AIDA (Adaptation in der Adoleszenz) vor und knüpfen dabei an die Frage "Equally prepared for life?" an, die die OECD (2009) im Rahmen einer Re-Analyse von PISA-Daten stellte und mit Blick auf die Leistungsunterschiede in Mathematik und Naturwissenschaften mit einem "Nein" beantwortet wurde. Denn: Weibliche Jugendliche berichten über mehr Angst im Fach Mathematik, haben weniger Selbstvertrauen, spezifische mathematische Probleme lösen zu können, und neigen dazu, ihre Leistungsfähigkeit zu unterschätzen. Der internationale Vergleich verdeutlicht, dass diese Geschlechterunterschiede in Deutschland größer sind als in den meisten OECD-Ländern. Die AIDA-Studie erlaubt es, auch in weiteren nichtkognitiven Persönlichkeitsmerkmalen nach bedeutsamen Unterschieden zu fragen. (DIPF/Orig.)

School participation of students with autism spectrum disorders

This paper addresses the participation of students with autism spectrum disorders (ASD) in main- stream schools. There are different benefits for ASD students to be educated in an inclusive environment (Gena, 2006; Whitaker, 2004). They challenge the school community by presenting difficulties in essential domains for school activi- ties (Chamberlain, Kasari and Rotheram-Fuller, 2006; Eman and Farrell, 2009; Humphrey and Symes, 2010). Thus, these are students with increased difficulties participating in inclusive environments, reinforcing the need of an ade- quate inclusion process (Gena, 2006; Hall and McGregor, 2000; Hestenes and Carroll, 2000). We characterised this students ’ participation with a questionnaire to the students from mainstream classes in which ASD students were included, a questionnaire applied to each class teacher/head teacher and an interview to four of the school educational assistants. The location of the ASD student in mainstream classroom was also ana- lysed, trying to understand if it influences the quality of ASD students ’ participation, hypothesis- ing that there is an influence. Results showed a good perception of the students with ASD and their behaviour, low frequency of behaviours involving interaction with these students, good feelings about their presence at the school/class and an overall acceptance of them in the peer groups of typical development students. Results are mostly consistent across the different infor- mation sources. We found a significant effect of the location on the quality of participation. Results are mainly consistent with the literature reviewed and enlighten the need to keep making progress on inclusion practices related to ASD students in mainstream schools.

Estilos de vida dos adolescentes e seus comportamentos desviantes e/ou delinquentes

A delinquência juvenil representa um problema social em crescimento e é influenciada por um conjunto de fatores de risco muitas vezes presentes no estilo de vida dos jovens. Desta forma, a pertinência deste estudo foca-se na compreensão dos estilos de vida dos jovens e os comportamentos desviantes ou delinquentes para melhor compreender e intervir no combate à delinquência. A amostra foi constituída por 80 participantes de ambos os sexos pertencentes à localidade de Ponte de Lima. Para tal recorreu-se à administração de um questionário, construído para o efeito, e o qual contempla itens para a caracterização sociodemográfica dos participantes, o seu funcionamento escolar/ocupacional e familiar, o estilo de vida e a ocupação de tempos livres e, por último, procura-se caracterizar a frequência da prática de certos comportamentos e desvios por parte dos adolescentes, nos últimos 12 meses. Os resultados deste estudo demonstraram que apesar da maior parte dos jovens se revelarem satisfeitos com o seu ambiente familiar, uma percentagem não negligenciável caraterizou esse ambiente como razoável, apelando à necessidade de haver mais tempo para a família e mais diálogo. Os relatos dos participantes apontam para a ausência de supervisão parental nas saídas à noite, falta de imposição de regras e tarefas diárias. A maior parte dos participantes classificou o ambiente escolar como razoável, admitindo a existência de alguns conflitos com colegas, professores e funcionários, falta de hábitos de estudo e atividades extracurriculares; a maior parte dos jovens admitiu realizar essencialmente atividades em grupos de pares, desde as saídas à noite como atividades de lazer; os comportamentos desviantes e delinquentes que mais se destacaram nos últimos 12 meses foram o envolvimento em agressões com colegas, professores e funcionários, o dano intencional de objetos de outra pessoa, e o download de filmes, músicas e documentos e o envolvimento em grupos de pares desviantes; os comportamentos delinquentes descritos foram a invasão em propriedades privadas, os furtos, e o tráfico de droga. O sexo masculino destacou-se na prática de crimes. Os dados deste estudo apontam, assim para a necessidade de se apostar mais na prevenção precoce de comportamentos de risco, de forma a diminuir comportamentos desviantes ou delinquentes futuros.

Social competence at the playground: Preschoolers during recess

Social interactions at the playground have been represented as a rich learning opportunity to hone and master social skills at pre- school years. Specifically, all forms of social play (fantasy, role, ex- ercise or rough-and-tumble) have been related to children’s social competence. The main goal of this study was to examine whether it is a certain kind of social play which facilitates the development of social competence, or if it is just the opportunity for interacting during recess that provides children with an optimal environment for social learning. A total of 73 preschoolers (4–6 years old) were videotaped at the school’s playground. Teachers provided assess- ments of children’s social competence. Children’s interactions at the playground were assessed through an innovative measuring method, based on radio-frequency identification devices. The results showed a positive association between exercise play and children’s social competence. In contrast with the literature, both forms of pretend play, fantasy and role play were unrelated to children’s social competence. Smaller peer groups and longer interactions also demonstrated a positive association with these preschoolers’ social competence. The study shows the importance of outdoor physical play for preschoolers’ social success. More- over, the study suggests that the environment in which children play has an important effect on the adaptive nature of their play.

Social competence at the playground: Preschoolers during recess

Social interactions at the playground have been represented as a rich learning opportunity to hone and master social skills at preschool years. Specifically, all forms of social play (fantasy, role, exercise or rough-and-tumble) have been related to children’s social competence. The main goal of this study was to examine whether it is a certain kind of social play which facilitates the development of social competence, or if it is just the opportunity for interacting during recess that provides children with an optimal environment for social learning. A total of 73 preschoolers (4–6 years old) were videotaped at the school’s playground. Teachers provided assessments of children’s social competence. Children’s interactions at the playground were assessed through an innovative measuring method, based on radio-frequency identification devices. The results showed a positive association between exercise play and children’s social competence. In contrast with the literature, both forms of pretend play, fantasy and role play were unrelated to children’s social competence. Smaller peer groups and longer interactions also demonstrated a positive association with these preschoolers’ social competence. The study shows the importance of outdoor physical play for preschoolers’ social success. Moreover, the study suggests that the environment in which children play has an important effect on the adaptive nature of their play.