Ex-military personnel's experiences of loneliness and social isolation from discharge, through transition, to the present day.

OBJECTIVES: This study aimed to examine the unique factors of loneliness and social isolation within the ex-military population from discharge, through transition, to the present day. DESIGN: A qualitative, Phenomenological approach was adopted. METHODS: In-depth semi-structured interviews were carried out with 11 participants who had all served in the British Armed Forces and represented all three military services (Royal Navy; Army; Royal Air Force). Reflexive Thematic Analysis was used to analyse the data. RESULTS: Three themes were generated-a sense of loss; difficulty in connecting in civilian life; and seeking out familiarity. The findings of this study were examined through the lenses of the Social Needs Approach and the Cognitive Discrepancy Model. CONCLUSIONS: Individuals developed close bonds in the military through meaningful and prolonged contact, reducing feelings of loneliness and social isolation during their time in service. The sense of belonging was key to social connection, but transition out of the military severed existing relationships, and a lack of belonging hindered the development of relationships within the civilian community. This study has implications for service provision relating to ex-military personnel and future service leavers.

Why do parents choose not to immunise their children?

AIMS: To ascertain the reasons why some parents choose not to immunise their children and where these parents obtained their immunisation information. METHODS: Seventy general practitioners (GPs) in Christchurch who kept a record of children whose parents declined immunisation were asked to recruit these parents. Half of the GPs were able to invite the 76 parents of children declining immunisation to take part in this study. Twenty one (28%) of these parents agreed to completing a structured questionnaire. RESULTS: Parents in this sample were highly educated and had used information from a variety of sources in making their decision not to immunise. Almost half of the parents had not discussed immunisation with their lead maternity carer. They viewed information from the Ministry of Health as biased. They were concerned about vaccine safety and efficacy and the effects of immunisation on their child's immune system. CONCLUSIONS: Parents who choose not to immunise their children are distrustful of information provided by the Ministry of Health. General practitioners are the main source of immunisation information for these parents and they must be able to provide accurate, unbiased information regarding the risks and benefits of immunisation.

Hospital restructuring: identifying the impact on patients and nurses.

Health systems throughout the democratic world have been subject to 'reform' in recent years as countries have attempted to contain the rapidly rising costs of health care. Because hospital care accounts for a large proportion of health sector spending, hospital restructuring has been an important part of those changes. In an attempt to make hospitals more efficient and cost-effective, New Zealand, like other countries, has introduced extensive changes to the way in which treatment and care are delivered to patients, and to the way nurses' work is organised and managed. International research has identified links between the way in which nursing is organised in a hospital, and that hospital's patient outcomes. The current authors are part of a team of researchers undertaking research which uses the methodology of the International Hospital Outcomes Study to examine nurse staffing and patient outcomes in New Zealand's secondary and tertiary hospitals across the period 1988-2001. The research involves a large survey of all nurses working in the study hospitals, an examination of the way in which the hospitals have been restructured, and an analysis of patient outcomes.

The earlier, the better: the effect of early community contact on the attitudes of medical students to older people.

BACKGROUND: Early clinical contact for medical students is an important curricular innovation. We wished to determine if early contact with older people in the second year of a more vertically integrated medical undergraduate programme influenced attitudes to older people and if any effect was synergistic with the effect of an existing fourth year course. SUBJECTS: Second and fourth-year medical students. METHODS: We used a modified version of the Rosencranz-McNevin semantic differential on ageing to assess attitudes of medical students before and after a one-week early community contact week. Some second-year students were followed into fourth year and the effect on their attitudes of a health care of the elderly course was measured. We compared these data with attitude scores from an earlier cohort of students who had undertaken the fourth-year but not the second-year component. RESULTS: Contact with older people during second-year had a significantly favourable effect on attitudes to older people, especially for students who saw older people in the community rather than in rest homes. The attitudes towards older people of students who had undertaken a fourth-year clinical health care of the elderly attachment were significantly better on two of three subscales than those of fourth-year students who had not seen older people during their second year. CONCLUSION: Contact with older people early in a medical student's training, and within a more vertically integrated programme, has a positive effect on attitudes to older people. This effect may be synergistic with contact later in training.