Women's experiences when caring for relatives with mental illness in Northern Ireland: A qualitative study.

Care in the Community policies has led to people with mental illness receiving treatment and care at home; however, few studies have examined the impact on carers of providing care to a person with mental illness. This was a qualitative study of the experiences of 11 women who are informal carers of people with a long-term mental illness. The study aimed to gain an understanding of the characteristics of this particular caregiving context that contributes to the stress of the role, and to identify the ways in which services could support women in these roles to promote their wellbeing and support the recovery of those they care for. Two groups of themes emerged: the first was the sources of stress, which included how they became a carer, family obligations and relationships and engaging with services. The second was the impact on health and wellbeing, including emotional and mental health, the need for, and absence of support, and coping with stress. The study highlighted a number of unique features of mental illness that lead to additional stress for the carer and render the usual support structures and delivery mechanisms inappropriate. The results pose challenges for those tasked with supporting carers in this context and developing interventions to promote recovery in the community.

Use of prescribed contraception in Northern Ireland 2010-2016.

Objective: The aim of this study was to describe the use of prescribed contraceptives in Northern Ireland (NI) and how this varies with a woman's age, the deprivation in the area in which she lives and characteristics of her general practice (GP).Method: A population-based cohort study was conducted including 560,074 females, aged 12-49 registered with a GP (2010-2016) contributing 3,255,500 woman-years of follow-up. Dispensed contraceptive prescriptions were linked to demographic details.Results: A contraceptive prescription was dispensed in 26.2% of woman-years with women aged 20-24 most likely to have a contraceptive dispensed (45.7% of woman-years). After adjusting for patient and other practice characteristics, practices in the least deprived quintile prescribed 6% more contraception than those in the most deprived quintile. The combined oral contraceptives (16.6% of woman-years) and progesterone only pill (8.0% of woman-years) were the most commonly dispensed methods. Patient and practice level characteristics were found to be related to the specific contraceptive methods dispensed which also changed during the time frame of the study.Conclusions: This is the first population-based assessment of contraceptive prescription in NI. It is useful for health service planning and to inform broader reproductive policy debates. The impact of practice area-based deprivation, above that of the woman's residence, on contraceptive dispensing is a new finding that deserves more exploration.

Stakeholders Perspectives on the Success Drivers in Ghana's National Health Insurance Scheme - Identifying Policy Translation Issues.

BACKGROUND: Ghana's National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap. METHODS: Based on an empirical qualitative case study of stakeholders' views on challenges and success factors in four mutual schemes (district offices) located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs. RESULTS: In the study, interviewees referred to both 'hard and soft' elements as driving the "success" of the Ghana scheme. The main 'hard elements' include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The 'soft' elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity); and ownership and participation. CONCLUSION: Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period of years, amounting to a process best conceived as germination as opposed to emulation. The Ghana experience illustrates that in adopting health financing systems that function well, countries need to customise systems (policy customisation) to suit their socio-economic, political and administrative settings. Home-grown health financing systems that resonate with social values will also need to be found in the process of translation.

Compliance with surgical antibiotic prophylaxis at an Australian teaching hospital.

BACKGROUND: Surgical antibiotic prophylaxis (SAP) is one practice proven to prevent surgical site infections. METHODS: Compliance of SAP choice, timing, and duration with guidelines was assessed utilizing prospectively collected surgical site infection (SSI) surveillance data from January 2008 through September 2010. RESULTS: Antibiotic choice was adequate or optimal in 97% of cardiac and orthopedic joint replacement procedures and 89% of colorectal procedures. In 6% to 8% of surgical procedures, SAP was not administered within 1 hour of the incision. SAP was continued beyond 24 hours in 20% of cardiac operations and 13% of colorectal procedures. Numerous combinations of antibiotics were used for prophylaxis, including ticarcillin/clavulanic acid in 67% of colorectal procedures. Many choices were not in keeping with both local and international recommendations. Deep SSI rates for cardiac procedures were above the state aggregate rate in 2010 only, whereas SSI rates for colorectal surgery were in excess of the state aggregate rate for all quarters. Antimicrobial-resistance data indicate a gradual increase in extended-spectrum ß-lactamase-producing bacteria. CONCLUSION: In cardiac and colorectal surgery, the optimal choice of SAP is seldom administered, and duration of SAP is excessively long. More education and communication are required to improve these practices.

Local recurrence after partial mastectomy: relation to initial surgical margins.

BACKGROUND: Local recurrence (LR) after partial mastectomy (PM) has been associated with inadequate surgical margins. We assessed LR association with initial margins after PM in patients receiving postoperative radiation therapy (RT). METHODS: Initial margins, re-excision status, and ipsilateral LR were identified for all patients having initial PM from 2003 to 2008. RESULTS: Seven hundred twelve patients underwent PM as their final procedure, and 598 (84.0%) had adjuvant RT. Initial margins were positive or <1-mm margins in 166 patients (27.8%). Re-excision was performed for all positive and 20.2% of patients with margins <1 mm. We observed 10 LRs (1.7%) at the 3.4-year mean follow-up. For patients with initial margins <1 mm, the LR rate was 4.2% (7/167) and just .7% for margins ≥1 mm (P = .006). CONCLUSIONS: We report lower LR rates than traditionally reported. The surgical practice of re-excision to achieve margins of 1 to 5 mm needs closer scrutiny because it may have no impact on LR.

Oncology care in rural northern new England.

PURPOSE: A team from Maine, New Hampshire, and Vermont evaluated quality of care for breast and colon cancers in these predominantly rural states. METHODS: Central cancer registry records from diagnosis years 2003 to 2004 in Maine, New Hampshire, and Vermont were aggregated. Patient residence was classified into three tiers (small rural, large rural, and urban) using Rural-Urban Commuting Area classification. RESULTS: Among 6,134 women diagnosed with breast cancer, there were significant differences between rural and urban residents in age (P < .001), stage (P < .001), and tumor size (P = .006). Use of breast-conserving surgery was similar, but sentinel lymph node (SLN) dissection was more common in urban (44.1%) than in large rural (39.9%) and small rural (37.6%) areas. Patients who underwent SLN dissection were more likely to receive radiation therapy after lumpectomy than patients who underwent regional lymph node dissection without SLN (85.9% v 75.5%). However, there was no statistically significant association between the rates of postlumpectomy radiation therapy by residence. Among 2,848 patients with colon cancer, patient characteristics in rural and urban areas were similar, but there were differences in their subsequent surgical treatment (P < .001) and lymph node sampling (P = .079). Adjuvant chemotherapy for patients with stage III colon cancer was less frequent in rural (57.3%) than in urban areas (64.7%; P < .001). CONCLUSION: Central cancer registry data, aggregated among three states, identified differences between rural and urban areas in care for patients with breast and colon cancers. To our knowledge, this is the first time residential category, cancer stage, and treatment data have been analyzed for multiple states using population-based data.

Use of card sort methodology in the testing of a clinical leadership competencies model.

The purpose of this paper is to examine the utility of a qualitative 'card sort' research tool - when it is merged with traditional quantitative data gathering methods - to add to our understanding about the nature of competency-based approaches to leadership studies. The study demonstrates how a qualitative technique (card sort) was used for the task of testing a clinical leadership competencies model. All the steps in the card sort methodology are described through its application to the research problem. The paper concludes that card sort has considerable use in adding to the validity of research into the competency approach to leadership. The study reports only one single case. Therefore, the technique must be repeated to secure its validation as a testing technique. The card sort method is proven to be a viable tool to ascertain the individual subjects perceptions regarding competencies. The methodology is described in sufficient detail so as to enable its replication and application by professionals and academic researchers alike. Both groups will find this methodology useful and interesting. The paper seeks to improve upon existing methods for studying leadership competencies. By addressing the limitations of different methods, and also by merging different independent approaches, this project provides an innovative integrated knowledge that can be of significant value.

Do employee health management programs work?

Current peer review literature clearly documents the economic return and Return-on-Investment (ROI) for employee health management (EHM) programs. These EHM programs are defined as: health promotion, self-care, disease management, and case management programs. The evaluation literature for the sub-set of health promotion and disease management programs is examined in this article for specific evidence of the level of economic return in medical benefit cost reduction or avoidance. The article identifies the methodological challenges associated with determination of economic return for EHM programs and summarizes the findings from 23 articles that included 120 peer review study results. The article identifies the average ROI and percent health plan cost impact to be expected for both types of EHM programs, the expected time period for its occurrence, and caveats related to its measurement.

Leadership competencies in the context of health services.

OBJECTIVES: In a rapidly changing health-care environment, clinicians are increasingly called upon to assume complex leadership responsibilities. The research was undertaken to develop an understanding of the limits to the conceptual and methodological basis of leadership competency modelling in health services context. METHODS: Data were collected from all of the clinicians in a Psychiatric Hospital, Bahrain using a researcher-developed questionnaire. Data were gathered to critically assess the validity of the competency-based approach to leadership on the basis of subjects' capacity to discriminate in terms of importance and accomplishment between the items featured in a research tool containing a comprehensive list of 124 leadership competencies. RESULTS: The results of the analyses indicate a weak identification with the competencies in the sense of revealing low levels of discriminatory sophistication on the part of subjects. CONCLUSION: The study design was limited to participants working in single hospital; therefore, the conclusions made cannot yet be regarded categorically as generalizable. Leadership selection, development and education activities may not achieve their ultimate outcomes due to the subject identification problem associated with the competence approach. It might be necessary to reconsider the efficiency of human resource activities that rely solely on the competency approach. The conceptual basis of leadership competence in health services has been previously neglected. This research casts doubt on competency approaches to leadership if based on subject identification with pre-defined items.

Female street sex workers in Hong Kong: moving beyond sexual health.

BACKGROUND: For many years, the sex industry in Hong Kong has appeared to be an integral and ever-expanding component of the city's sociocultural and economic structure. Accordingly, the physical and psychological health of sex workers is becoming an increasing concern for the workers themselves, the public, and government policy. METHODS: A cross-sectional survey on the quality of life (World Health Organization Quality of Life [WHOQOL]) of female sex workers (FSWs) in Hong Kong was used to investigate the physical and psychological well-being of street FSWs, and the results were compared with those of non-sex-working Hong Kong women after adjusting for age, educational level, marital status, and health status. RESULTS: The 89 FSWs surveyed scored significantly lower on QOL--WHOQOL-BREF (HK)--measures compared with the non-sex-working women. One common aspect among these sex workers was their negative view of themselves and of life. Many sex workers were at risk of being abused while at work, and many women worked without legal protection. Most of the women surveyed engaged in sex work to support their families. Because their income was often insufficient, some of their needs, especially those concerning health, were often neglected. CONCLUSIONS: The low WHOQOL-BREF (HK) scores in FSWs indicate feelings of helplessness and entrapment, which may well result in detrimental effects on sex workers' health, self-esteem, and confidence when asserting their basic rights, such as access to healthcare and safety. The conclusion highlights the vulnerability of this population to apparent weaknesses in Hong Kong's current healthcare system.

Investigation of the glidant properties of compacted colloidal silicon dioxide by angle of repose and X-ray photoelectron spectroscopy.

The optimal flow-enhancing effect of a new compacted, hydrophilic colloidal silicon dioxide (AEROSIL 200 VV Pharma) on microcrystalline cellulose (Avicel PH 101) and pregelatinized starch (Starch 1500) was found to be 0.25% under gentle and 0.125% under strong mixing conditions, as measured by the angle of repose. The effect could be explained by X-ray photoelectron spectroscopy (XPS) investigations. The Si 2p signals of the silicon dioxide indicated that the coverage of the excipient surface with AEROSIL was greater for all mixtures produced under strong mixing conditions and corresponded to a higher degree of de-agglomeration of the AEROSIL aggregates. The more extensive surface coverage of Avicel PH 101 as compared to Starch 1500 could be explained by the particle morphology on the one hand and by the XPS C 1s signals on the other. Due to the different conformation of the two excipients, Avicel PH 101 offers a higher density of hydroxyl groups on its surface which are available for hydrogen bonding with the surface hydroxyl groups of hydrophilic colloidal silicon dioxide.

Health and social care futures in Ireland: the need for cross-boundary work.

Fundamental changes are taking place in health and social care. The drivers for these changes include new discoveries, new treatments and globalization and the need to examine and consider cross-boundary work. This paper will outline some of the issues generated from a research project that aimed to provide an all-Ireland perspective on health and social care futures and to examine the implications of these trends both for nursing specifically and health and social care generally. Cross-boundary working is important in relation to health and social care futures. This incorporates cross-boundary working to include interprofessional, intraprofessional and interagency but also cross-border working with the Republic of Ireland. There is a great potential for cross-boundary work in nursing as we look towards the future. Nonetheless, it needs to be acknowledged that working across sectors, departments and even borders is not easy and barriers do exist. Some of the implications for nursing include the need to re-examine nursing roles and span the boundaries of our profession with the increasing development of nurse-led services. In addition nurses need to develop ways of "working together" strategically with others to achieve the public health agenda.