Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis.

Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD therefore often has a significant impact on the quality of life of both patients and their families. In this review we discuss recent findings on the putative links between AD, its association with itch, sleep disturbance and neuropsychiatric morbidity, including the role of inflammation in these conditions. Itch was thought to predominantly drive sleep disruption in AD. We now understand changes in sleep influence immune cell distribution and the associated inflammatory cytokines, which suggests a bidirectional relationship between AD and sleep. We also increasingly recognize inflammation as a key driver in psychological symptoms and disorders. The link between cutaneous, systemic and possible brain inflammation could at least in part be driven by the sleep deprivation and itch-driven neuronal proliferation seen in AD.

Prevalence, incidence and carrier frequency of 5q-linked spinal muscular atrophy - a literature review.

Spinal muscular atrophy linked to chromosome 5q (SMA) is a recessive, progressive, neuromuscular disorder caused by bi-allelic mutations in the SMN1 gene, resulting in motor neuron degeneration and variable presentation in relation to onset and severity. A prevalence of approximately 1-2 per 100,000 persons and incidence around 1 in 10,000 live births have been estimated with SMA type I accounting for around 60% of all cases. Since SMA is a relatively rare condition, studies of its prevalence and incidence are challenging. Most published studies are outdated and therefore rely on clinical rather than genetic diagnosis. Furthermore they are performed in small cohorts in small geographical regions and only study European populations. In addition, the heterogeneity of the condition can lead to delays and difficulties in diagnosing the condition, especially outside of specialist clinics, and contributes to the challenges in understanding the epidemiology of the disease. The frequency of unaffected, heterozygous carriers of the SMN1 mutations appears to be higher among Caucasian and Asian populations compared to the Black (Sub-Saharan African ancestry) population. However, carrier frequencies cannot directly be translated into incidence and prevalence, as very severe (death in utero) and very mild (symptom free in adults) phenotypes carrying bi-allelic SMN1 mutations exist, and their frequency is unknown. More robust epidemiological data on SMA covering larger populations based on accurate genetic diagnosis or newborn screening would be helpful to support planning of clinical studies, provision of care and therapies and evaluation of outcomes.

A qualitative study of hospital patients' understanding of health promotion.

AIMS AND OBJECTIVES: To examine hospital patients' understanding of health promotion in Jordan. BACKGROUND: Increasingly, hospital nurses are urged to promote patients' health and meet their needs. Yet, internationally, little is known about how patients themselves understand health promotion, and no Jordanian study has been undertaken in this area. DESIGN: A qualitative design was used. METHODS: Focus group discussions (n = 4) were undertaken with hospital patients. All discussions were digitally recorded, transcribed verbatim and analysed using qualitative thematic analysis. RESULTS: Three images of health promotion emerged. These include health promotion as having adequate health knowledge, economic independency and good environment. It was also found that gender and spirituality affected patients' conceptualisations. CONCLUSIONS: Hospital patients' understanding and expectations of health promotion are complex and go beyond the disease management approach. Therefore, if health promotion is to meet patients' needs and operate at empowerment and socio-economic levels, the images identified in this article should be considered. The study limitations and recommendations for practice and future research are also outlined. RELEVANCE TO CLINICAL PRACTICE: There is a need for a framework of health promotion that integrates patients' beliefs in general and particularly those related to religion and gender roles within the daily philosophy of care. Having achieved this, hospital nurses will be able to deliver culturally competent and wide-reaching health promotion.

Debating the use of work-based learning and interprofessional education in promoting collaborative practice in primary care: a discussion paper.

BACKGROUND: The context of primary care in the UK is changing rapidly, underpinned by continuing policy drivers to ensure person-centred safe and effective practice. Undergraduate and postgraduate programmes for healthcare practitioners are increasingly using interprofessional education (IPE) as one route to engender greater understanding of others' roles and contributions to health care, with the suggestion that IPE leads to better integration and teamwork, and thus stronger collaborative practice. Access to education and professional development for those working in primary care is difficult, and individuals need the focus of learning to be clearly relevant to their practice. AIMS: To review and debate the evidence on the role of work-based learning and IPE in enhancing collaborative practice in primary care. METHOD: Literature search and critique of key papers relevant to primary care practice. RESULTS: The three themes emerged of IPE, workbased learning (WBL) and collaborative practice. There is a growing body of literature to support the positive outcomes of IPE and the utilisation of WBL in developing practice. A range of practitioners in a variety of work settings have used WBL approaches in the implementation of innovations and the development of communities of practice. However, little evidence exists to support these approaches in primary care. CONCLUSION: The application of WBL across primary care teams can support a positive and collaborative learning culture, resulting in changes to professional practice.

Exploring leadership in community nursing teams.

AIMS: This article is a report on a study investigating how leadership is perceived in community nursing teams and how these perceptions are translated into working practices of team leaders. BACKGROUND: The consensus in community nursing literature is that leadership is important, and especially so in a time of change. However, little empirical evidence exists on how leadership works in practice. METHOD: The study adopted an exploratory descriptive design, utilising individual semi-structured interviews and focus groups in four case-studies, with a total of 54 participants. Two case-studies focussed on district nursing teams and two involved public health nursing teams, located in two geographical areas. Participants debated their understanding of the concept of leadership, its associated practices and behaviours in teams, if they saw themselves as leaders, and what preparation was required. The study was undertaken in 2009. Framework analysis techniques were employed to analyse the data. FINDINGS: A 'quasi-family' model of leadership emerged, with significant emphasis on the importance of personal relationships and support. Nursing grade had a greater impact on perceptions of leadership than geographical context or professional and clinical focus. CONCLUSION: No clear fit with any existing theoretical framework was identified. However, nurses in the highest grade banding, in particular, demonstrated practices associated with transformational leadership. Nurses expressed the very clear need to be acknowledged, respected and valued, and that those who provided this support were regarded as good leaders.

Arabic-speaking students' primary care experiences in Scotland.

Internationalisation of the higher education sector has resulted in greater ethnic and cultural diversity within the student population throughout the UK and European Union. There is limited knowledge about the burden of poor health and health care utilisation among minority ethnic groups in higher education. Scottish health policy is directed toward proactive care delivered within primary care settings. The community of one university in Scotland was chosen to explore the perceptions of accessibility and acceptability of primary care among one minority group, namely Arabic speakers. The research methodology was of an exploratory descriptive design, with a convenience sample of Arabic speakers studying at one university. Quantitative and qualitative data were provided by 20 respondents. A questionnaire elicited demographic data and information about any primary care services used, while semi-structured interviews gathered more in-depth data. Participants were generally satisfied with primary health services. The majority were satisfied with the availability of a healthcare professional of their preferred gender, and their communication with and attitudes of healthcare professionals, as well as the health information provided. Recommendations include greater availability of written information in Arabic, and further research concerning cultural competence for healthcare professionals.