This article seeks to demonstrate that chronic illness is increasingly being viewed as culpability in the face of known risks, an instance of moral failure that requires the intervention of a range of political technologies. I argue that, in many western nations, it is becoming less acceptable to enter and remain in a physically incapacitated state: it clashes too uncomfortably with the image of the ‘good citizen’ as someone who actively participates in social and economic life, makes rational choices and is independent, self-reliant and responsible. By engaging in a genealogical analysis of chronic illness and individual responsibility, exploring how they are placed within the framework of contemporary ‘risk-society’, employing the insights derived from recent governmentality studies and developing a case study based on the current Australian experience with health promotion and welfare reform, I investigate the ways in which the concepts of health and illness are currently being deployed as tools of ‘government’.

Objective Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT) is a short (<2 minutes) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection. Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥65 years); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model. Results Seventeen studies (3,702 observations) were included. Settings were acute medicine, surgery, a care home and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8–32.1%; range 10.5–61.9%). The pooled sensitivity was 0.88 (95% CI 0.80–0.93) and the pooled specificity was 0.88 (95% CI 0.82–0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77–0.92) and the pooled specificity was 0.89 (95% CI 0.83–0.93). The methodological quality of studies varied but was moderate to good overall. Conclusions The 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection. PROSPERO Registration number CRD42019133702.

Background.There are increasing imperatives for patients and members of the public to engage as partners in identifying health research priorities. The use of participatory methods to engage stakeholders in health care in research prioritization is not commonly reported.Objective.This article analyses the use of World Cafés as a participatory method for research prioritization with marginalized communities in Ireland and the USA.Methods.The principles of purposeful and snowball sampling were followed in both settings and a diverse range of community and health care stakeholders participated (n = 63 Ireland and n = 55 USA). The principles for a classic World Café were employed but there were novel features in each setting as well. Stewart et al.’s (Patients’ and clinicians’ research priorities. Health Expect 2011; 14: 439–48, conceptual framework for patient engagement was adapted and used to comparatively analyse the strengths and weaknesses of the World Cafés, focusing on agenda setting, engagement with research processes, interactional features and outputs.Results.Design principles for World Cafés were found to align with high-quality patient engagement for research prioritization in both settings. They served to facilitate meaningful collaboration among stakeholder groups in research prioritization (research agenda setting) and explored research priorities (engagement with research). The café ambience, emphasis on hospitality and self-facilitation created an environment for dialogues within and across participating groups (interactional features). There was a commitment to follow-up actions with reference to possible subsequent research (outputs).Conclusions.The World Café is a valuable, participatory, flexible method that can be used with community and health care stakeholders for research prioritization with marginalized communities.

the findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit.

the ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged.

This paper outlines a recent study which, in an attempt to illuminate the processes surrounding the formation of what is increasingly being referred to as 'the disabled identity', set out to explore the effects of the onset and ongoing experience of impairment in relation to disabled people's self-perceptions. A grounded theory approach was adopted and the data derived from the stories of 92 people from four countries, through telephone dialogues and autobiographical material which sought to answer, or, in the case of unsolicited material, could be said to have answered, the question: How has [the illness or disabling condition] affected the ways in which you see yourself and how others treat you? The major areas of identity which were found to be affected by disability were those which related to independence, work and appearance/sexuality, all of which were heavily influenced by the negative attitudes of others and each of which were related to qualities which could be argued to represent the pivotal characteristics separating the 'affiliated and the marginalised' in contemporary Western society (Rose 1996: 340).

Introduction: Qualitative meta-synthesis draws together data from multiple studies and can enrich understandings of client experiences and inform health policy. Meta-ethnography is the most commonly utilised qualitative synthesis approach in healthcare; however, there is variation in the conduct and quality of many published meta-ethnographies. This paper aims to guide occupational therapists on the process of completing a meta-ethnography. Method: A systematic search of articles published from 1986-2016 was conducted. Studies which described an evaluation or critique of meta-ethnography as a research method, and consequently provided reflections or guidance on the method, were included. Two authors independently screened papers and nine relevant papers and one key text were identified. Two authors independently extracted data from identified sources. Results: The seven stages of meta-ethnography described by Noblit and Hare (1988) are presented and integrated with key advancements from subsequent publications. Stages include starting the meta-synthesis, consideration of relevant studies, reading the studies and deciding on how they should be put together, translating the studies into one another, synthesising translations and expressing the synthesis. Conclusion: Given the proliferation of qualitative methods in occupational therapy research, rigorous use of meta-ethnography has great potential to contribute to the research evidence base.

BackgroundMultimorbidity is recognized internationally as having a serious impact on health outcomes. It is associated with reduced quality of life, increased health care utilization, and future functional decline. Physical activity is associated with good health and psychological well-being. The aim of this study was to identify the impact of physical activity and physical function on the development and worsening of multimorbidity over time.MethodsUsing The Irish Longitudinal Study on Ageing (TILDA), we analyzed 4,823 participants ≥50 years with and without multimorbidity. Multimorbidity was defined as the presence of ≥2 chronic conditions. Development of multimorbidity was measured as the accrual of additional conditions over a 2-year period. Physical activity and physical function were measured using the International Physical Activity Questionnaire (IPAQ), gait speed (m/sec), and grip strength (kg).ResultsSixteen groups of chronic conditions were included in analyses. 53.7% of included participants had multimorbidity at baseline and 71.7% at follow-up. Six hundred and thirty-eight of 2,092 (30.4%) participants without multimorbidity and 1,005 of 2,415 (41.6%) with existing multimorbidity developed new condition/s. Gait speed (relative risk [RR] = 0.67, confidence interval [CI]: 0.49–0.90), grip strength (RR = 0.98, CI: 0.97–0.99), and age (compared to 50–59 years, 60–69: RR = 1.30, CI: 1.11–1.52; ≥70: RR = 1.35, CI: 1.03–1.77) were significantly associated with the development of multimorbidity and accrual of additional conditions.ConclusionThese results show that physical function is associated with the development and worsening of multimorbidity over time. They support the recent National Institute for Health & Care Excellence (NICE) Guidance on multimorbidity that suggests that patients with multimorbidity and reduced gait speed should be identified and targeted for interventions to improve health outcomes.