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BackgroundObesity is a global epidemic affecting all age groups, populations, and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial, and environmental factors and government policy. Consequently, a Whole System Approach (WSA)-which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live-is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs.MethodSystematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts.ResultsA total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight, and obesity to inform their planning or delivery, and to understand/map the associated systems. Common mathematical approaches include agent based or System Dynamic Modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight, and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake, and increasing physical activity. Public and user involvement in WSA was not widely reported.ConclusionThe application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required.

This study aimed to explore, from peer workers' perspectives, the supports and strategies they use to optimise their wellbeing and effectiveness in their roles. A qualitative descriptive study was conducted using semi-structured interviews with nine peer workers from a community managed organisation in New South Wales, Australia in 2022. Data were analysed using qualitative content analysis. Peer workers described four types of personal strategies: looking after myself; increasing my peer-related skills; recognising and using my skills; and advocating for and promoting peer work. They described five types of organisational support that helped them to use these strategies and influenced their wellbeing and performance: professional development opportunities; a mental health friendly environment; place of peer work in the organisation; team dynamics and support; and logistical support. This research can help stakeholders recognise the strategies and supports that are beneficial to peer workers and facilitate understanding and support between mental health staff. While a small, contextualised study, it could provide strategies for peer workers new to the industry and for organisations seeking to ensure the sustainability of their peer workforce and the quality of services supplied to consumers. [ABSTRACT FROM AUTHOR]

Unfortunately, it remains a common theme that when students reach the end of secondary school, they have focused most of their efforts on academic achievement but not on preparations for future employment (Hewett, Douglas, & Keil, 2014; McDonnall, 2010). Important employability skills for students with visual impairments are detailed within the career education area of the expanded core curriculum (Wolffe, 2014); however, these are apparently not prioritized until transition looms. This commentary suggests different time constructs are important when preparing for transition. "Starting early" (timing) with a student with visual impairment is essential to increase available time.

Introduction: Throughout the transition to motherhood, changes are experienced across a woman's physical, mental, social, and occupational self. Maternal chronic illness adds the complexity of increased healthcare needs and navigating a high‐risk, medicalised pregnancy, birth, and post‐natal period. Literature concerning motherhood transitions in chronic illness generally focusses on the mother's medical health and pregnancy outcomes; little is known about the impacts on women's occupations, balance, and quality of life. Understanding these issues may help support women in a more tailored and holistic way. Objective: This scoping review aims to gather, analyse, and synthesise existing empirical research on occupational engagement and occupational balance as they impact on wellbeing and quality of life in women with a lifetime chronic illness before and during pregnancy and in early motherhood. Method: The review follows the nine‐stage framework described in the Joanna Briggs Institute Manual for Evidence Synthesis (2020). Five databases were searched: Embase, Medline, PsycINFO, CINAHL, Scopus, and OT Seeker. Data were extracted and examined via content analysis, described in narrative synthesis, summarised into a conceptual framework, and tabulated. Findings: A total of 8,655 papers were discovered on initial search. Following title and abstract screening, 220 full‐text studies were assessed for eligibility, and 46 papers were finally included. Analysis generated four major themes: The Disrupted Transition Journey; Adaptation, Compromise and Choice; Outcomes; and Drawing on What's Available. The themes were conceptualised into a framework to explain how women sought to balance motherhood and illness‐related occupations. Adequate access to information, social support, expert care, and financial resources improved both quality of life and healthcare compliance. Conclusion: Findings of this scoping review deepen the understanding of occupational balance during the transition to motherhood in the context of lifetime chronic illness. Healthcare providers and supportive family and friends can use this knowledge to adapt their approach to assisting women with chronic illness on the motherhood journey. These findings may also inform further inquiry into the scope of occupational therapy practice with this population. [ABSTRACT FROM AUTHOR]

In this article, the authors trace the emergence of an institutional discourse of ethical research and interrogate its effects in constituting what ethical research is taken to be and how ethical researchers are configured. They illuminate the dissonance between this regime of truth and research practice and the implications for the injunction to respect others, illustrating their case with instances from their interview study with anorexic teenage girls. The authors propose that conceptualising the regulation of research ethics as an institutional discourse opens up the possibility for asserting counterdiscourses that place relational ethics at the center of moral decision making in research. (Contains 4 notes.)

In this paper we posit a radical retheorization of anorexia as a form of deviance. We examine how the disciplinary practices and moral technologies typical of contemporary secondary schooling signify and enter into the articulation of three "virtue discourses" (discipline, achievement and healthism), and tease out how these "virtue discourses" play into the formation of the "anorexic" subject. Informed by Foucauldian theory, our analysis draws on our life history interview study with teenage girls diagnosed with anorexia nervosa and their parents. We argue that anorexia can be understood not as a form of deviance but as a "paradox of virtue" involving zealous compliance with and taking up of socially and culturally sanctioned "virtue discourses" that are immanent in schooling and wider society. (Contains 2 notes.)

This study evaluated a home-based intervention for parents with intellectual disability to promote child health and home safety in the preschool years. The intervention improved parents' ability to recognize home dangers and to handle emergencies, increased their knowledge about illness and medicines, and increased the number of safety precautions parents implemented. All gains were maintained at 3 months' post-intervention. (Contains references.) (Author/DB)

The developmental status of 37 Australian preschool children (ages 5-78 months) born to mothers with intellectual disability was assessed. In all developmental domains, a substantial proportion of the children (between 35 and 57%) showed a delay of at least 3 months. Delays in physical and communication development were most prevalent. (Contains references.) (CR)

International research indicates that delayed discharges from inpatient mental health units are common and most occur because patients lack suitable housing. However, little is known about this issue in an Australian setting. This mixed‐methods study aimed to investigate the extent, cost and contributors to housing‐related delayed discharge (HRDD) from inpatient mental health units in one Local Health District in New South Wales, Australia. A medical records review was conducted to quantify housing‐related delay and housing difficulties noted. Perceptions of discharge staff about the factors contributing to the delays were gathered through in‐depth interviews and analysed using constant comparative analysis. Findings indicated that HRDD for working aged adults accounted for 11.6% of total mental health bed days in 2018, costing the health system $4,054,149. When extrapolated nationally HRDD could cost Australia $269.5 million per year. While individual characteristics and contexts were thought to make some patients more vulnerable, data indicated that the major contributors were lack of housing options, lack of services, difficulty with funding and lack of clear pathways to achieve housing. The findings highlight the urgent need for additional housing for people with mental health issues and a whole of government approach to addressing the substantial issue of housing‐related delayed discharge. [ABSTRACT FROM AUTHOR]

The emergence of an institutional discourse of ethical research is traced and questions are raised about its effects in constituting what ethical research is taken to be and how ethical researchers are configured. It is proposed that conceptualizing such a regulation of research ethics opens up the possibility for asserting counterdiscourses that make relational ethics important for moral decision making in research.