Notes

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Research and policymaking on positive mental health and well-being have increased within the last decade, partly fueled by decreasing levels of well-being in the general population and among at-risk groups. However, measurement of well-being often takes place in the absence of reflection on the underlying theoretical conceptualization of well-being. This disguises the fact that different rating scales of well-being often measure very different phenomena because rating scales are based on different philosophical assumptions, which represent radically different foundational views about the nature of well-being. The aim of this paper is to examine the philosophical foundation of the Satisfaction with Life Scale (SWLS) in order to clarify the underlying normative commitments and the psychometric compromises involved in the translation of theory into practice. SWLS is widely used by psychologists, public health professionals, economists, and is popular in national and international surveys of well-being. This paper introduces the philosophical theory of life satisfaction and explores how three central discussions within life satisfaction theory are reflected in the construction of the SWLS; (1) Whether we should be equally satisfied with our past, present and future, (2) Whether we should be satisfied with all the various domains of our lives, and (3) How to avoid the trap of "false consciousness", i.e. that people fail to recognize the injustice or misfortune of their lives. In the end, life satisfaction theory is contrasted with affective foundational theories of well-being, to explore the magnitude and limits of SWLS as a rating scale based on life satisfaction theory.Ethical review and analysis of health policy may help to ensure policies address the needs of society and align with relevant values and principles. Indeed, researchers and bioethicists have recognized the need for ethical frameworks specifically for public health applications. The objective of this research was to compile structured tools for ethical review of (drafted or existing) health policy and to analyze these tools for their scope and philosophical underpinnings. A systematic search and review of academic and grey literature was conducted to compile existing tools designed for health policy ethics review. The search yielded 13 health policy ethical review tools. Qualitative content analysis revealed that all of the tools were influenced by multiple ethical values and that a majority were influenced by more than one ethical theory. The most common values were non-maleficence and beneficence (92.3%). The most common influencing ethical theory was the Principles Approach (92.3%). The structure of the tools demonstrates a heterogeneity of methodology designs to approach policy ethics review. This research offers a unique contribution to the bioethics field that provides a useful resource and understanding of the current ethical review tools for health policy.Studies evaluating robotic guidance in lumbar fusion are limited primarily to evaluation of screw accuracy and perioperative complications. This is the first study to evaluate granular differences in short and long-term complication and revision rate profiles between robotic (RG) fluoroscopic (FG) guidance for minimally invasive short-segment lumbar fusions. A retrospective analysis of a prospective, multi-center database was performed. Complications were subdivided into surgical (further subcategorized into adjacent segment disease, new-onset back pain, radiculopathy, motor-deficit, hardware failure, pseudoarthrosis), wound, and medical complications. Complication and revision rates were compared between RG and FG groups cumulatively at 30, 90 days, and 1 year. 374 RG and 111 FG procedures were performed. RG was associated with an 86.25, 83.20, and 69.42% cumulative reduction in complication rate at 30, 90 days, and 1 year, respectively, compared to FG (p  less then  0.001). At all follow-up points, new-onset radiculopathy and medical complications were most prevalent in both groups. The greatest reductions in complication rates were seen for new-onset back pain (88.13%; p = 0.001) and wound complications (95.05%; p  less then  0.001) at 30 days, new-onset motor deficits (90.11%; p = 0.004) and wound complications (85.16%; p  less then  0.001) at 90 days, and new-onset motor deficits (85.16%; p = 0.002), wound (85.16%; p  less then  0.001), and medical complications (75.72%; p  less then  0.001) at 1 year. RG was associated with a 92.58% (p = 0.002) reduction in revision rate at 90 days and a 66.08% (p = 0.026) reduction at 1 year. RG was associated with significant reductions in postoperative complication rates at all follow-up time points and significant reductions in revision rates at 90 days and 1 year.The purpose of this study was to examine the relationship between dimensions of religiosity (organizational, non-organizational, subjective) and depressive symptoms in the Black church. Surveys were administered to attendees of four churches in the northeastern U.S. The Multidimensional Measure of Religious Involvement for African Americans examined religiosity and the Patient Health Questionnaire-8 items assessed depressive symptoms. Logistic regression analysis was employed to examine the relationship between religiosity and depressive symptoms adjusting for potentially influential covariates. Participants reporting high organizational religiosity were significantly more likely to report non-significant depressive symptoms (adjusted odds ratio (AOR) = 1.80, 95% confidence interval (CI) = 1.05, 3.08) in comparison with those reporting low organizational religiosity, when controlling for potentially influential covariates. Our findings suggest that organizational religiosity may be protective against depression. These findings inform the development of initiatives seeking to reduce the burden of depression in the Black church.Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6 year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals. TL12-186 Pre- and post-placement bed days were compared using the paired-sample t test in a naturalistic one-group pretest-posttest analytic design. Psychiatric hospital and residential treatment bed days were significantly reduced post-placement (-77.5% and -99.8%, respectively). Most patients (89.0%) had fewer psychiatric hospital bed days post-placement, and all patients with pre-placement residential treatment program bed days had fewer of those days post-placement. Longer CRC placements were associated with greater reductions in bed utilization.We examined the effectiveness and safety of a walking program offered as part of cognitive behavioral therapy for chronic pain (CBT-CP). Participants were randomized to 10 weeks of CBT-CP, delivered either in person or by interactive voice response. Participants reported pedometer-measured step counts daily throughout treatment and received a weekly goal to increase their steps by 10% over the prior week's average. Walking-related adverse events (AEs) were assessed weekly. Participants (n = 125) were primarily male (72%), and white (80%) with longstanding pain (median 11 years). There was no significant difference between treatment groups in rate of change in daily steps, but there was a significant increase in steps from baseline to treatment termination in the combined study sample (1648 steps (95% CI 1063-2225)). Participants classified as active doubled. AEs were mostly minor and temporary. Treatment was effective and safe whether the program was delivered in-person or remotely.Trial registration number clinicaltrials.gov identifier NCT01025752.The average length of inpatient stay (LOS) for psychiatric care has declined substantially across Canada and the United States during the past two decades. Although LOS is based presumably on patient, hospital, and community factors, there is little understanding of how such factors are linked with LOS. The purpose of this study was to explore potential individual and systemic factors associated with LOS in a large-scale, longitudinal dataset. Study participants consisted of individuals 11 years of age and older admitted for psychiatric conditions to a New Brunswick hospital between April 1, 2003 and March 31, 2014 (N = 51,865). The study used a retrospective cohort design examining data from the New Brunswick Discharge Abstract Database, administrative data comprised of all inpatient admissions across provincial hospitals. Hierarchical regression analysis was used to estimate the association of individual, facility, and system-level factors with psychiatric LOS. Results indicated that hospital-level factors and individual-level characteristics (i.e., discharge disposition, aftercare referral, socioeconomic status (SES)) account for significant variability in LOS. Consistent with extant literature, our results found that hospital, clinical, and individual factors together are associated with LOS. Furthermore, our results highlight demographic factors surrounding living situation and available financial supports, as well as the match or mismatch between preferred language and language in which services are offered.The difficulty of implementing mental healthcare reforms owes much to the influence of stakeholders. So far, the endorsement of mental health policy reforms by stakeholder coalitions has received little attention. This study describes stakeholder coalitions formed around common mental health policy goals and highlights their central goals and oppositions. Data were collected on the policy priorities of 469 stakeholders (policymakers, service managers, clinicians, and user representatives) involved in the Belgian mental healthcare reform. Four coalitions of stakeholders endorsing different mental health policy goals were identified using a hierarchical cluster analysis on stakeholders' policy priorities. A belief network analysis was performed to identify the central and peripheral policy goals within coalitions. Coalitions brought together stakeholders with similar professional functions. Disagreements were observed between service managers and policymakers around policy goals. The two coalitions composed of policymakers supported a comprehensive approach that combines the different goals and also supported the shortening of hospital stays, whereas the two coalitions composed of service managers emphasised the personal recovery of users and continuity of care. Regardless of the coalitions' differing policy priorities, strengthening community care was a central goal while patient-centred goals were peripheral. The competing policy positions of the coalitions identified may explain the slow and inconsistent pace of the Belgian mental healthcare reform. Strengthening community care may be an essential part of reaching consensus across coalitions. Finally, special care must be taken to ensure that patient-centred policy goals, such as social integration, are not set aside in favour of other goals.
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