Parents as carers on a neonatal unit: Qualitative study of parental and staff perceptions in a low-income setting.

Aim To determine parents' experiences on a neonatal unit in a low-income country, how they and staff perceive the role of parents and if parents' role as primary carers could be extended. BACKGROUND: A busy, rural district hospital in Rwanda. Rwandan neonatal mortality is falling, but achieving Sustainable Development Goal target is hampered by trained staff shortage. METHODS: Qualitative thematic content analysis of semi-structured interviews with 12 parents and 16 staff. RESULTS: Parental concerns were around their baby's survival, stress and discharge. They were satisfied with their baby's care but feared their baby may die. Mothers described stress from remaining in hospital throughout baby's stay, providing all non-technical care including tube or breast feeds day and night, followed by kangaroo mother care until discharge. They expressed loneliness from lack of visitors, difficulty finding food and somewhere to sleep, financial worries, concern about family at home, and were desperate to be discharged. Staff focused on shortage of nurses limiting technical care, ability to educate parents and provide follow-up. Neither groups thought parents' role could be extended. CONCLUSION: Staff, including senior management, were mainly focused on increasing nursing numbers. Parents' concerns were psychosocial and about coping emotionally with their baby's care and practical concerns about inpatient facilities, particularly lack of food and accommodation and absence from home. Staff preoccupation with nurse numbers made them concentrate on medical care, but parental issues identified are more likely to be provided by experienced mothers, allied health professionals, mothers' groups or community health workers.

Reliability of the spine adverse events severity system (SAVES) for individuals with traumatic spinal cord injury.

STUDY DESIGN: Test-retest analysis. OBJECTIVES: To determine the intra- and inter-rater reliability of the Spine Adverse Events Severity System for Spinal Cord Injury (SAVES-SCI) in patients with traumatic SCI. SETTING: Quaternary care spine program in Vancouver, Canada. METHODS: Ten hypothetical patient cases were developed. The cases were completed by 10 raters (seven physicians, one nurse, one physiotherapist and one researcher) who were asked to identify and grade the severity of adverse events using SAVES-SCI twice with 1-week interval. Intra- and inter-rater reliability were calculated using kappa statistics and intraclass correlation coefficients (ICC). RESULTS: Intra-rater reliability for both identifying and grading AEs were high with all AEs (kappa greater than 0.6) except for bone implant, diathermy burn, massive blood loss, myocardial infarction, neurological deterioration, pressure ulcer, return to operating room and tracheostomy requirement. The inter-rater reliability measured with ICC were all above 0.6 for identifying and grading intraoperative, pre and postoperative AEs and consequences of SCI. CONCLUSIONS: The SAVES-SCI demonstrated acceptable intra-and inter-rater reliability for a majority of the AEs. Further clarification and definition of some of the AEs as well as provision of sample training cases for clinicians would assist in reducing measurement errors. The SAVES-SCI is a useful tool to assess and capture AEs in patients with acute traumatic SCI.

Global differences between women and men in the prevalence of obesity: is there an association with gender inequality?

BACKGROUND/OBJECTIVES: In most populations the prevalence of obesity is greater in women than in men; however, the magnitude of the difference between the sexes varies significantly by country. We considered the role of gender inequality in explaining these disparities. SUBJECTS/METHODS: We undertook an ecological analysis of internationally comparable obesity prevalence data to examine the association between indicators of gender inequality and the differences between men and women in obesity prevalence. Gender inequality was assessed using three measures: the Gender Inequality Index, the Global Gender Gap Index and the Social Institutions and Gender Index. We fitted multiple regression models to examine the association. RESULTS: We found that the prevalence of obesity across countries shows gendered patterning with greater prevalence and greater heterogeneity in women than in men (P<0.001). We also found that two of three measures of gender inequality were significantly associated with the sex differences in obesity prevalence across countries. CONCLUSIONS: The patterning of obesity across countries is gendered. However, the association between global measures of gender inequality and the sex gap in obesity is dependent on the measure used. Further research is needed to investigate the mechanisms that underpin the gendered nature of obesity prevalence.

Knowledge translation and implementation in spinal cord injury: a systematic review.

OBJECTIVE: To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. METHODS: MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. RESULTS: A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. CONCLUSION: The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

Use of the Spine Adverse Events Severity System (SAVES) in patients with traumatic spinal cord injury. A comparison with institutional ICD-10 coding for the identification of acute care adverse events.

STUDY DESIGN: Observational cohort comparison. OBJECTIVES: To compare the previously validated Spine Adverse Events Severity system (SAVES) with International Classification of Diseases, Tenth Revision codes (ICD-10) codes for identifying adverse events (AEs) in patients with traumatic spinal cord injury (TSCI). SETTING: Quaternary Care Spine Program. METHODS: Patients discharged between 2006 and 2010 were identified from our prospective registry. Two consecutive cohorts were created based on the system used to record acute care AEs; one used ICD-10 coding by hospital coders and the other used SAVES data prospectively collected by a multidisciplinary clinical team. The ICD-10 codes were appropriately mapped to the SAVES. There were 212 patients in the ICD-10 cohort and 173 patients in the SAVES cohort. Analyses were adjusted to account for the different sample sizes, and the two cohorts were comparable based on age, gender and motor score. RESULTS: The SAVES system identified twice as many AEs per person as ICD-10 coding. Fifteen unique AEs were more reliably identified using SAVES, including neuropathic pain (32 × more; P<0.001), urinary tract infections (1.4 × ; P<0.05), pressure sores (2.9 × ; P<0.001) and intra-operative AEs (2.3 × ; P<0.05). Eight of these 15 AEs more frequently identified by SAVES significantly impacted length of stay (P<0.05). Risk factors such as patient age and severity of paralysis were more reliably correlated to AEs collected through SAVES than ICD-10. CONCLUSION: Implementation of the SAVES system for patients with TSCI captured more individuals experiencing AEs and more AEs per person compared with ICD-10 codes. This study demonstrates the utility of prospectively collecting AE data using validated tools.

The risk of antimalarials in patients with renal failure.

We present here a patient with end stage renal failure who received two weeks antimalarial prophylaxis at full dose leading to life threatening toxicity with severe acute megaloblastic anaemia, symptomatic pancytopenia and exfoliative dermatitis. Prompt recognition and treatment can rapidly reverse these fatal effects but more importantly, education of patients before travel is imperative in preventing such events.

Admission as a dental student to the former UMDS and its relationship to socio-demographic characteristics.

OBJECTIVES: To describe the socio-demographic characteristics of successful and unsuccessful applicants to one UK dental school over a period of five years. To compare the characteristics of successful and unsuccessful candidates. DESIGN: Retrospective analysis of admissions data for the former United Medical and Dental Schools of Guy's and St Thomas' (UMDS) dental school provided by Universities and Colleges Admissions Service (UCAS) for a five year period (1994-1998). PARTICIPANTS: Applicants to the former UMDS dental school between 1994 and 1998. MAIN OUTCOME MEASURES: Success of candidates at four stages of the application process: initial application; offer made by the dental school; offer accepted or declined by the candidate; candidate accepted by the school (post A level results). Comparisons were made of the success rates among candidates grouped according to socio-demographic characteristics at each transition between these stages. A level performance was not included in the analysis, which must limit the findings, and may explain some of the variation found in the study. RESULTS: The effect of socio-demographic characteristics on the admissions process was small though significant. Approximately 9% of initial applicants reached the final stage and were accepted into the dental school. The most marked effect was a bias towards female entrants (11.5% of women applicants were accepted, compared with 7% of men). Only 5% of applicants from all the Black minority groups were successful. In comparison 17% of applicants of Chinese origin were successful. The proportion of accepted applicants from London and the South East (12%) was greater than from other areas (9%). CONCLUSIONS: Any conclusions must be tempered by the limitations of the study: the retrospective nature of the study together with the lack of information on A level results. Given these caveats, this study has demonstrated that the success of applicants to one former dental school was related to their socio-demographic characteristics. A prospective study including a number of dental schools in the UK which records both predicted and achieved A level grades would provide more definitive information on the impact of socio-demographic factors on admission to dental school.

Barriers to the use of dental services by individuals from minority ethnic communities living in the United Kingdom: findings from focus groups.

OBJECTIVE: To describe the barriers identified by individuals from minority ethnic communities resident in the United Kingdom to their use of dental services. METHOD: Focus group discussions were held with individuals from minority ethnic groups. Data were analysed using the technique of content analysis on the basis of categories defined by the researchers. FINDINGS: Barriers to regular attendance identified by participants included: language, a mistrust of dentists, cost, anxiety, cultural misunderstandings, concern about standards of hygiene. The type of barrier identified differed between ethnic groups, though mistrust of dentists was common to all groups. CONCLUSIONS: The findings confirm previous research identifying barriers to the use of dental services. However, for the first time in the United Kingdom, it has been suggested that the nature of the perceived barriers varies across ethnic groups. These findings have implications for attempts to increase use of dental services among individuals from minority ethnic communities.

Dental caries and treatment experience of adults from minority ethnic communities living in the South Thames Region, UK.

OBJECTIVE: To describe the dental caries and treatment experience of groups of adults from minority ethnic communities living in the South Thames Region of England. DESIGN: Cross-sectional clinical study. SETTINGS: Community, religious and educational centres for adults from minority ethnic communities. PARTICIPANTS: Snowball sample of 928 adults from 44 ethnic groups including: Black Caribbean (141), Black African (134); Pakistani (123); Indian (190); Bangladeshi (78); Chinese/Vietnamese (143) and 119 from other groups. RESULTS: More participants were dentate or had 18 or more sound and untreated teeth than adults living in the same area (Todd and Lader, 1991). Duration of residence in the United Kingdom predicted caries or treatment experience in the sample as a whole and in Chinese/Vietnamese people. Increased DMFT was predicted by age and by history of visiting a UK dentist in the sample as a whole and in the Black African group. CONCLUSIONS: Effect of duration of UK residence on presence and extent of caries suggests that oral health may be better among adults from these ethnic minority groups than among the general population. However, the differences can also be attributed to sampling bias and old comparison data. Better sampling strategies are required for research of this type.

The work patterns of male and female dental practitioners in the United Kingdom.

AIM: The aim of the study was to determine differences between male and female dental practitioners in the type of dentistry they practice, and their working practice, and to compare these data to previously published studies of the working practices of female dentists in the United Kingdom. DESIGN: A postal questionnaire survey. PARTICIPANTS: A 1 in 10 sample of individuals taken from the UK Dentists Register. RESULTS: The data revealed that women dentists are more likely than male dentists to work in the Community Dental Service. Within general dental practice women are more likely to work part-time, to carry out National Health Service treatment and to specialize in orthodontics or paediatric dentistry. More women than men take career breaks, and the reasons for taking career breaks differ between male and females. Women take longer career breaks on average. However, differences between male and female practitioners in the total duration of their career breaks are largely accounted for by child rearing. Finally, male dental practitioners are more likely than female dental practitioners to report reading professional journals. The findings are analysed in the light of previous surveys of the working practices of female dental practitioners both within the United Kingdom and internationally. CONCLUSION: The main finding reported here is that there are no differences between men and women in the number and length of career breaks taken, if childcare is excluded.

A study of the career development of male and female dental practitioners.

AIM: The aim of the study was to determine differences between male and female dental practitioners in the positions they occupy within their employment, and to analyse the correlates of such differences. METHOD: Postal questionnaire survey of a 1 in 10 sample of individuals taken from the General Dental Council register. RESULTS: Female dental practitioners occupy lower positions in the employment hierarchies of the Community Dental Service and the Hospital Dental Service. Women general dental practitioners are significantly less likely to be sole proprietor of, or a partner in, a general practice. Ownership of a general practice is related to: sex, age, number of years qualified, number of children, and hours worked. Consultants in the Hospital Dental Service are more likely to be male, older, to have been qualified longer and (obviously) to hold more additional qualifications than their non-consultant colleagues. Senior Dental Officers and Directors of the Community Dental Service are more likely to be male, work longer hours and (again obviously) to hold more additional qualifications than Community Dental Officers. CONCLUSIONS: Differences exist between male and female dental practitioners in the positions they occupy within employment hierarchies. Age, length of time since qualification and the acquisition of additional qualifications are consistently found to differentiate dental practitioners' status.

Questioning science: how knowledge is socially constructed.

This paper argues that 'science' does not tell us 'the truth' but is simply one explanatory framework (of potentially many explanations) for understanding the world. Scientific fact is not a given, located somewhere 'out there' waiting to be discovered. Rather as a set of ideas, which offer to explain the world, scientific knowledge is produced by people and does not exist separately from them. 'Science' cannot pre-exist the social world in which it is produced. It follows that 'scientific research' is equally a product of social forces and cannot be epistemologically separate and 'objective' either. However, the concept of 'scientific research' as 'objective' is so taken for granted in the discipline of dentistry (and elsewhere) that those involved barely see it as a process at all. This paper seeks to make apparent these processes and the values implicit in them.

'London dentist in HIV scare': HIV and dentistry in popular discourse.

This is a qualitative analysis of the non-structured responses to a survey (see 'Notes') which elicited people's attitudes towards being treated by HIV-positive dentists. These findings are discussed in terms of a sociology of knowledge, that is, an understanding of how individuals come to believe what they do. It uses the concept of 'public' and 'private' accounts to explore some of the themes which emerged.

Public perceptions of the funding of NHS dental services.

A survey was carried out of 102 members of the general public, asking for their views of the recent changes in the government funding of NHS dentistry. Approximately 80% of those surveyed had heard about the changes. The majority thought that the implications of the change would be a rise in costs to patients and a fall in the number of NHS dentists.