• Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting.

      Evans, A.L.; Scally, Andy J.; Wellard, S.J.; Wilson, J.D. (2007)
      Objectives: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. Methods: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. Results: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p¿=¿0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, ¿¿=¿0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p¿=¿0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. Conclusions: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.
    • The prevalence of nonprescription cannabinoid-based medicines in British children's hospices: results of a national survey

      Tatterton, Michael J.; Walker, C. (2019-10)
      Background: Almost 50,000 children and young people are affected by life-limiting conditions in the United Kingdom, around a third of which use children's hospices. Anecdotal evidence suggests that cannabinoid-based medicines (CBMs), specifically cannabis oil (CO), are being used by families with increasing frequency to manage distressing symptoms. The use of most nonprescription CBMs in the United Kingdom remains illegal. Objective: The objective of the study was to identify the prevalence of CO use by families who use children's hospices in the United Kingdom, and the approaches taken by those services to manage it. Design: An electronic survey was sent to each of the 54 children's hospices in the United Kingdom between May and July 2018, comprising 10 questions. Results: Forty children's hospices from across the four countries of the United Kingdom responded to the survey, representing 74% of British children's hospices. About 87.5% of hospices knew of children who use CO therapeutically. Sixty-nine percent of those hospices have received requests to administer CO during an episode of care. Approaches by organizations around CO management varied across the sectors, including arrangements for storage, administration, and recording of its use. Hospices highlighted how the lack of available guidance made decision making more challenging. Only a third of responding organizations routinely questioned families about the use of cannabis when prescribing medicines. Conclusion: CO is used extensively by children who use children's hospices. Despite recognizing the use of CO, many hospices are unable to support it. There is a need for clear guidelines on how hospices should approach the care needs of children, allowing hospices to meet the needs of children who use CO, and families in a safe, consistent, and relevant way, safeguarding all children, families, and professionals within the organization.
    • A preventative lifestyle intervention for older adults (Lifestyle Matters): a randomised controlled trial

      Mountain, Gail; Windle, G.; Hind, D.; Walters, S.; Keertharuth, A.; Chatters, R.; Sprange, K.; Craig, C.; Cook, S.; Lee, E.; et al. (2017-07)
      Objectives To test whether an occupation based lifestyle intervention can sustain and improve the mental wellbeing of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial. Participants 288 independently living adults aged 65 years or over, with normal cognition were recruited from two UK sites between December 2011 and November 2015. Interventions Lifestyle Matters is a NICE recommended multi-component preventive intervention designed to improve the mental wellbeing of community living older people at risk of decline. It involves weekly group sessions over four months and one to one sessions. Main outcome measures The primary outcome was mental wellbeing at 6 months (mental health dimension of the SF-36).Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness(de Jong Gierveld Loneliness Scale),assessed at 6 and 24 months. Results Data on 262 (intervention =136; usual care =126) participants were analysed using intention to treat analysis. Mean SF-36 mental health scores at six months differed by 2·3 points (95 CI -1·3 to 5·9; P=0·209) after adjustments. Conclusions Analysis shows little evidence of clinical or cost effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline. The results pose questions regarding how preventive interventions to promote wellbeing in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline.
    • Princípios e práticas de formação de policiais para o atendimento às mulheres em situação de violência

      Macaulay, Fiona; Martins, J. (Brazilian Forum on Public Safety, 2020-10)
      This training manual on gender-based violence is intended for use by all those who train the police and other actors in the local protection networks. It outlines the principles of effective training based on the integrated competencies of knowledge, attitudes and skills, and emphasises the use of appreciative inquiry, group learning and dynamic techniques such as dramatisation and case-based learning
    • Problem Based Learning in a Women-centred Midwifery Curriculum

      Haith-Cooper, Melanie; MacVane Phipps, Fiona E.; Pansini-Murrell, J.; Ball, D. (1999)
    • Problem solving, confidence and frustration when carrying out familiar tasks on non-familiar mobile devices

      Attard, C.; Mountain, Gail; Romano, D.M. (2016-08)
      Smart mobile devices, which are hand-held electronic devices with an advanced operating system (such as the Android platform) connected via a wireless protocol, have become an integral and essential part of our everyday life, and support both social and workplace activities. However, adopting mobile technology within the workplace setting can give rise to challenges that impact user behaviour and performance. A study was carried out amongst 90 participants located in two countries, using internet connectivity as a case study. Confidence and frustration have previously been connected with technology competence, but this was not applied to a workplace scenario during problem-solving, when users are assigned an unfamiliar smart mobile device. This research focuses on identifying the link between workplace users' levels of confidence and frustration when seeking to independently solve problems whilst completing familiar tasks on new smart mobile devices. A detailed video analysis of users' attitudes and behaviour during problem-solving was conducted, emphasising a correlation between attitudes and behaviour towards completing a task.
    • Problem-Based Learning within Health Professional Education, What is the Role of the Lecturer? A review of the literature

      Haith-Cooper, Melanie (2000)
      The profile of an effective facilitator has been likened to that of a saint, unfazed by ambiguity, undaunted by student irritation or personal frustration (Katz 1995, p 52). With the increasing popularity of using problem-based learning (PBL) within health professional curricula, it could be argued that the health lecturer’s role in education is changing. As a lecturer, I have only recently become involved in using PBL. With increasing exposure to the process and through reviewing the literature, I have come to realise that the role of the lecturer is fraught with difficulty. The literature is often conflicting with PBL meaning different things to different people (Barrows 1986). It provides no consistent guidelines as to how the lecturer should adapt to undertake this new role. This article explores the issues around the role of the lecturer within PBL and through reviewing the literature, investigates the level of intervention the lecturer should provide when students are undertaking the PBL process. Suggestions will be made to ‘facilitate’ the lecturer into facilitating an effective teaching strategy.
    • Problem-based learning: not the emperor’s new clothes

      Haith-Cooper, Melanie; MacVane Phipps, Fiona E. (2003)
      In October 2002 the ex-RCIVI director of education and research Rosaline Steele wrote an editorial in the RCM Midwives Journal on problem-based learning (PBL), entitled 'the emperor's new clothes or a new way of seeing?' This is a response to that article.
    • Promoting and maintaining physical activity in the transition to retirement: a systematic review of interventions for adults around retirement age

      Baxter, S.; Johnson, M.; Payne, N.; Buckley-Woods, H.; Blank, L.; Hock, E.; Daley, A.; Taylor, A.; Pavey, T.; Mountain, Gail; et al. (2016-02-01)
      It has been argued that transition points in life, such as the approach towards, and early years of retirement present key opportunities for interventions to improve the health of the population. Research has also highlighted inequalities in health status in the retired population and in response to interventions which should be addressed. We aimed to conduct a systematic review to synthesise international evidence on the types and effectiveness of interventions to increase physical activity among people around the time of retirement. A systematic review of literature was carried out between February 2014 and April 2015. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for identification of relevant studies included electronic database searching, reference list checking, and citation searching. Systematic search of the literature identified 104 papers which described study populations as being older adults. However, we found only one paper which specifically referred to their participants as being around the time of retirement. The intervention approaches for older adults encompassed: training of health care professionals; counselling and advice giving; group sessions; individual training sessions; in-home exercise programmes; in-home computer-delivered programmes; in-home telephone support; in-home diet and exercise programmes; and community-wide initiatives. The majority of papers reported some intervention effect, with evidence of positive outcomes for all types of programmes. A wide range of different measures were used to evaluate effectiveness, many were self-reported and few studies included evaluation of sedentary time. While the retirement transition is considered a significant point of life change, little research has been conducted to assess whether physical activity interventions at this time may be effective in promoting or maintaining activity, or reducing health inequalities. We were unable to find any evidence that the transition to retirement period was, or was not a significant point for intervention. Studies in older adults more generally indicated that a range of interventions might be effective for people around retirement age.
    • Promoting Mental Health in the Workplace

      Kelsey, Catherine (2017-10)
      The survey considered this was a greater burden compared to cancer (16%) and heart disease (16%), suggesting reducing mental ill health should be a priority for public health (Davies 2014). [...]the impact of stigma associated with poor mental health prevents individuals from accessing services that have the capacity to improve lives (Corrigan et al, 2014). To support organisations to reduce sickness absence, NICE published its "Workplace health: management practices" guidelines in 2016 (NICE, 2016), and the more recent "Healthy workplaces: improving employee mental and physical health and wellbeing" (NICE, 2017) shows workplace health now features high on the Government's agenda. [...]transformational programmes have sought to create a sea change in the way mental healthcare is delivered, from a mainly medical model approach, considered denigrating, paternalistic, inhumane and reductionist (Shah and Mountain, 2007), to that of a biopsychosocial model (Engel, 1977)With its emphasis on a more broad and integrated approach to human behaviour, this model requires the use of effectivecommunication skills in service delivery, to extend care beyond that of the individual to include family members and to emphasise the importance of illness prevention as well as treatment provsion (Dogar, 2007). The case for mental health promotion at work Considerable emphasis is now being placed on the importance of positive mental health and wellbeing as mental health is now considered a priority for the Government, with recent policies aiming to create a parity with physical health.
    • Proposed reforms to UK policy on honour based violence: the big societal divide?

      Eshareturi, Cyril; Morgan, A.; Lyle, C. (2015-04)
      Honour Based Violence results in several deaths each year in the UK and has many health and social implications. In recent years, practitioners have stated that the scale is increasing and that government policies are not making adequate provision to address it as a major problem. The House of Commons Home Affairs Committee report remains the most comprehensive government document on the issue of honour based violence in England and Wales to date. We used the Rist policy cycle framework to critically analyse the Report, dismantling the policy process into three key stages for subsequent independent assessment. Current policy defines and categorises honour based violence differently from domestic violence yet has chosen to tackle it under the rubric of domestic violence. Responses have been constrained by limited capital to adequately finance specialist interventions, lack of expertise, inability to reach individuals who are most susceptible therefore highly vulnerable, and contraction of specialist non-governmental organisations who have always been at the fore in tackling issues on honour based violence. Consequently, the government’s response has been unconvincing and improperly conceptualised by accepting it into the broader context of violence against women and hence domestic violence. Stronger coordinated response at local level is needed but this is where issues of community, integration, tolerance, and the Big Society agenda are made complex and serve to confound new legislation and policy. Overcoming highly sensitive cultural barriers is a key challenge to all. Consequently, we recommend that for honour based violence to be tackled effectively, the government needs to re-access and take a broader view on the issue by constructing honour based violence within the discourse of human rights in order to declare a position that sits easily in the context of cultural differences and the Big Society.
    • The prospective role of defeat and entrapment in depression and anxiety: A 12-month longitudinal study

      Griffiths, Alys W.; Wood, A.M.; Maltby, J.; Taylor, P.J.; Tai, S. (2014-04)
      The concepts of “defeat” (representing failed social struggle) and “entrapment” (representing an inability to escape from a situation) have emerged from the animal literature, providing insight into the health consequences of low social rank. Evolutionary models suggest that these constructs co-occur and can lead to the development of mental disorders, although there is limited empirical evidence supporting these predictions. Participants (N=172) were recruited from economically deprived areas in North England. Over half of participants (58%) met clinical cut-offs for depression and anxiety, therefore we conducted analyses to establish whether participant outcomes were dependent on baseline defeat and entrapment levels. Participants completed measures of defeat, entrapment, depression and anxiety at two time-points twelve months apart. Factor analysis demonstrated that defeat and entrapment were best defined as one factor, suggesting that the experiences co-occurred. Regression analyses demonstrated that changes in depression and anxiety between T1 and T2 were predicted from baseline levels of defeat and entrapment; however, changes in defeat and entrapment were also predicted from baseline depression and anxiety. There are implications for targeting perceptions of defeat and entrapment within psychological interventions for people experiencing anxiety and depression and screening individuals to identify those at risk of developing psychopathology.
    • A prospective study of consecutive emergency medical admissions to compare a novel automated computer-aided mortality risk score and clinical judgement of patient mortality risk

      Faisal, Muhammad; Khatoon, Binish; Scally, Andy J.; Richardson, D.; Irwin, S.; Davidson, R.; Heseltine, D.; Corlett, A.; Ali, J.; Hampson, R.; et al. (2019-06)
      Objectives: To compare the performance of a validated automatic computer-aided risk of mortality (CARM) score versus medical judgement in predicting the risk of in-hospital mortality for patients following emergency medical admission. Design: A prospective study. Setting: Consecutive emergency medical admissions in York hospital. Participants: Elderly medical admissions in one ward were assigned a risk of death at the first post-take ward round by consultant staff over a 2-week period. The consultant medical staff used the same variables to assign a risk of death to the patient as the CARM (age, sex, National Early Warning Score and blood test results) but also had access to the clinical history, examination findings and any immediately available investigations such as ECGs. The performance of the CARM versus consultant medical judgement was compared using the c-statistic and the positive predictive value (PPV). Results: The in-hospital mortality was 31.8% (130/409). For patients with complete blood test results, the c-statistic for CARM was 0.75 (95% CI: 0.69 to 0.81) versus 0.72 (95% CI: 0.66 to 0.78) for medical judgements (p=0.28). For patients with at least one missing blood test result, the c-statistics were similar (medical judgements 0.70 (95% CI: 0.60 to 0.81) vs CARM 0.70 (95% CI: 0.59 to 0.80)). At a 10% mortality risk, the PPV for CARM was higher than medical judgements in patients with complete blood test results, 62.0% (95% CI: 51.2 to 71.9) versus 49.2% (95% CI: 39.8 to 58.5) but not when blood test results were missing, 50.0% (95% CI: 24.7 to 75.3) versus 53.3% (95% CI: 34.3 to 71.7). Conclusions: CARM is comparable with medical judgements in discriminating in-hospital mortality following emergency admission to an elderly care ward. CARM may have a promising role in supporting medical judgements in determining the patient's risk of death in hospital. Further evaluation of CARM in routine practice is required.
    • Protecting the self: a descriptive qualitative exploration of how Registered Nurses cope with working in surgical areas.

      Mackintosh, Carolyn (Elsevier, 2007)
      Aims This paper aims to explore and describe how qualified nurses working with in, in-patient surgical areas cope with the daily experiences they are exposed to. Background It has long been recognised that many aspects of nursing work can result in high levels of stress, with negative consequences for the individual nurse and patient care. Difficulties in coping with nursing work can also result in burnout, as well as raising concerns about cognitive dissonance, emotional labour and the use of emotional barriers. Why some nurses are more prone to experience these phenomena than others, is unclear. Method A descriptive qualitative approach is taken using a purposive, theoretically congruent sample of 16 qualified registered nurses all of whom participated in a semi-structured interview during 2002. All interviews were tape recorded and transcribed verbatim and then analysed using the four stages outlined by Morse and Field [Morse, J.M., Field, P.A., 1996. Nursing Research: The Application of Qualitative Approaches. Chapman & Hall, London]. Findings Three key themes emerged from analysis; relationships with patients, being a person and the effect of experience. All three interlink to describe a process whereby the individual switches off from the environment around them by adopting a working persona which is different but related to their own personal persona and is beneficially enhanced as a consequence of experience. Conclusion Working as a nurse results in exposure to potentially distressing and stressful events from which it is important to protect the self. Participants in this study achieve protection by the development of a working persona which facilitates switching off and is beneficially enhanced by experience.
    • Protocol for the IDEAL-2 longitudinal study: following the experiences of people with dementia and their primary carers to understand what contributes to living well with dementia and enhances active life

      Silarova, B.; Nelis, S.M.; Ashworth, R.M.; Ballard, C.; Bienkiewicz, M.; Henderson, C.; Hillman, A.; Hindle, J.V.; Hughes, J.C.; Lamont, R.A.; et al. (2018-10)
      There is a major need for longitudinal research examining the experiences of people with dementia and their primary carers, as relatively little is known about how the factors associated with capability to ‘live well’ vary over time. The main aim of the IDEAL-2 study is to investigate how and why, over time, people with dementia and their primary carers might vary in their capability to live well with dementia, whilst exploring both their use of health and care services and their unmet needs. IDEAL-2 will build on the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort of 1547 people (who, at recruitment between July 2014 and July 2016, had mild-to-moderate dementia), and their 1283 primary carers in Great Britain. The existing cohort will be enriched with additional participants with mild-to-moderate dementia (and their primary carers where available and willing) from the following groups: people with rarer forms of dementia, and/or those who are ≥90 years or < 65 years of age at time of recruitment. We will assess the primary outcome, capability to live well with dementia, and the factors influencing it using questionnaires at yearly intervals for 3 years. Additionally, we will seek to link the cohort data with administrative data to obtain information about health service use. Some participants will be invited for in-depth face-to-face interviews. The cohort study will be supplemented by linked research focusing on: the co-production of new measures of living well; including the perspectives of people with advanced dementia living in residential care settings; including people with dementia from black, Asian, and minority ethnic groups; and understanding the experience of people living with undiagnosed dementia. IDEAL-2 will provide evidence about the key indicators of, and factors associated with, living well over the course of dementia and how these differ for particular subgroups. It will tell us which combinations of services and support are most beneficial and cost-effective. Moreover, the IDEAL-2 study will gather evidence from underresearched groups of people with dementia, who are likely to have their own distinct perceptions of living well.
    • Providing enhanced care in communities [editorial].

      Horne, Maria (2015-05)
      The NHS has always been a bargaining chip for politicians. Cuts to budgets; an ageing population; and more complex, comorbid long-term conditions have placed greater demands on health and care services. There continues to be pressure on GPs, community services, and the voluntary and social care sectors. Now that the political parties have presented their manifestos for the NHS, we need to consider what is right for patients and local communities.
    • Providing welfare advice in general practice: Referrals, issues and outcomes

      Greasley, Peter; Small, Neil A. (2009-12-14)
      General practices in the UK are increasingly hosting welfare advice services on their premises to address patients' social and economic needs. In this paper, the authors present the outcomes of a service providing welfare advice across 30 general practices in inner-city Bradford. A retrospective study of all patients referred for advice during the initial 24 months of the project was conducted. The following information was collected: patient demographics, source of referrals, advice issues raised and income generated through benefit claims. The advice workers saw 2484 patients dealing with over 4000 welfare advice issues. Demand for the service varied widely across practices, reflecting practice list size and engagement with the service by practice staff. The main source of referrals was general practitioners (28%), and disability-related welfare benefits constituted the largest category of advice issues. Sixty-nine per cent of patients seen for advice were of south Asian ethnic origin. The advice workers raised £2 389 255 in welfare benefit claims for patients, primarily through disability-related benefits. Approximately one in four patients referred for advice benefited financially. It is concluded that the service is an excellent strategy by which primary care organisations address the social, economic and environmental influences on the health of their population.
    • Psychological and social factors associated with coexisting frailty and cognitive impairment: A systematic review

      Ellwood, Alison; Mountain, Gail; Quinn, Catherine (2022-05-01)
      Those living with coexistent frailty and cognitive impairment are at risk of poorer health outcomes. Research often focuses on identifying biological factors. This review sought to identify the association psychological and social factors have with coexisting physical and cognitive decline. Six databases were systematically searched in July 2020. Studies included individuals aged 60 years or older identified as being both frail and cognitively impaired. A narrative synthesis examined patterns within the data. Nine studies were included, most employed a cross-sectional design. Depression was investigated by all nine studies, those with coexistent frailty and cognitive impairment had higher levels of depressive symptoms than peers. Findings were mixed on social factors, although broadly indicate lower education, living alone and lower material wealth were more frequent in those living with coexistent decline. Further research is needed to explore potentially modifiable psychological and social factors which could lead to the development of supportive interventions.
    • The psychological consequences of power on self-perception: implications for leadership

      Voyer, B.G.; McIntosh, Bryan (2013)
      Purpose – The purpose of this paper is to explore theoretical connections between the cognitive consequences of power on self-perception and the behaviours of leaders. Design/methodology/approach – A systematic literature review was carried out to investigate the psychological consequences of power in terms of self-perception, perspective taking abilities, emotions and behaviours. The literature reviewed is further integrated in a theoretical model, and a series of propositions suggesting a relation between power, perspective taking, self-construal and leadership are introduced. Findings – This paper argues that power creates both temporary and enduring cognitive changes that transform the way individuals assimilate and differentiate their self from others. This transforms the way individuals in power behave as leaders, as well as followers. Individuals’ self-construal and perspective taking seem to play a mediating role in determining the behaviours of powerful and powerless individuals. This relation is moderated by organizational culture and structure, as well as personality traits. Research limitations/implications – Further research is needed to test these propositions, including the existence of cross-cultural differences in the power – self-construal relation, and the consequences of holding different types of power on an individual's self-construal. For employees and consultants working in organizational development and organizational change, understanding the potential consequences of power in terms of self-perception will improve the understanding of promoting individuals to higher positions. The present research also bears implications for scholars interested in understanding cross-cultural and gender differences in leadership. Originality/value – This conceptualization of self-construal as an interface between power and leadership reconcile the individual dynamics of trait theories of leadership and the environmental positions of situational theories of leadership. The paper discusses elements considered critical for design of leadership programs in the workplace, professional development and programs to shape the design of leadership.