Carers' preferences for the delivery of therapy services for people with disability in rural Australia: evidence from a discrete choice experiment.

BACKGROUND: The implementation of the Australian National Disability Insurance Scheme is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However, little attention has been paid to examine how users of the National Disability Insurance Scheme will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics. METHODS: A stated preference discrete choice experiment was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit and private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time. RESULTS: A total of 133 carers completed the discrete choice experiment. The majority of respondents cared for a child with a disability (84%); the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out-of-pocket cost and travelling up to 4 h to receive a therapy session (P < 0.05). Sector providing the service was not statistically significant. CONCLUSION: Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability.

Op Patwin Part 2: HMS illustrious' medical response to typhoon Haiyan.

Operation PATWIN was the United Kingdom's (UK) response to the disaster caused by Typhoon Haiyan. The UK deployed a force including HMS DARING and HMS ILLUSTRIOUS and this article describes the medical response including the deployment of a Role 2 medical team and the hosting of a UK civilian medical team UK Med. The deployment followed humanitarian guidelines in UK doctrine and contained in the Oslo guidelines, but demonstrated a unique example of a civilian team supported by the military.

What is talked about? Community living staff experiences of talking with older people with intellectual disability about dying and death.

BACKGROUND: The aim of this study was to explore what community living staff talked about and did with people with intellectual disability (ID) to assist them to understand dying and death. METHOD: Guided by grounded theory methodology, focus groups and one-to-one interviews were conducted with 22 staff who had talked about any topic relating to dying and death with their clients. RESULTS: There was little evidence that staff talked with, or did things with clients to assist understanding of the end of life, both prior to and after a death. Prior to death staff assisted clients in a limited way to understand about determining wishes in preparation for death, and what dying looks like by observance of its passage. Following a death staff offered limited assistance to clients to understand the immutability of death, and how the dead can be honoured with ritual, and remembered. CONCLUSIONS: The findings have implications for why people with ID have only partial understanding of the end of life, the staff skills required to support clients' understanding, and when conversations about the end of life should occur.

'If and when?': the beliefs and experiences of community living staff in supporting older people with intellectual disability to know about dying.

BACKGROUND: The aim of this study was to explore the way in which community living staff engaged with people with intellectual disability (ID) about dying and death. METHOD: Guided by grounded theory methodology, focus groups and individual interviews were conducted with staff who had either no experience with client death, experience of a client sudden death, or a client death experience which was pre-dated by a period of end-of-life care. RESULTS: While in principle, staff unanimously supported the belief that people with ID should know about dying, there was limited in-practice engagement with clients about the topic. Engagement varied according to staff experience, client capacity to understand and the nature of the 'opportunity' to engage. Four 'opportunities' were identified: 'when family die', 'incidental opportunities', 'when clients live with someone who is dying' and 'when a client is dying'. Despite limited engagement by staff, people with ID are regularly exposed to dying and death. CONCLUSIONS: People with ID have a fundamental right to know about dying and death. Sophisticated staff skills are required to ensure that people with ID can meaningfully engage with end-of-life issues as opportunities arise.

Experiencing rights within positive, person-centred support networks of people with intellectual disability in Australia.

BACKGROUND: This research describes issues related to human rights as they arose within the everyday lives of people in nine personal support networks that included adult Australians with an intellectual disability (ID). METHOD: The research was part of a wider 3-year ethnographic study of nine personal support networks. A major criterion for recruitment was that people in these networks were committed to actively developing the positive, meaningful future of an adult family member with an ID. Data were collected from November 2007 to March 2011 via interviews, participant observations and analysed within the framework of situational analysis. Findings were checked with network members. RESULTS: The issue of rights was challenging to network members. Subtle rights violations could have a major impact on an individual with a disability. Network members worked to protect the rights of people with ID by building and maintaining an empathic and respectful support network, developing the person's self-confidence and autonomy and ensuring that the person with an ID was an active member of the personal support network. CONCLUSION: The maintenance of rights within a supportive environment remains a difficult task. It can be facilitated by a deep knowledge and respect for the person being supported, the promotion of his or her active participation in the planning and provision of support, and an experimental and reflective approach.

Job stressors in naval personnel serving on ships and in personnel serving ashore over a twelve month period.

Sixty one percent of respondents to a questionnaire survey of occupational stress (Phase I) returned follow-up questionnaires twelve months later (Phase II). The Phase I questionnaire measured psychological strain resulting from exposure to occupational stressors, and measured the presence of stress buffers and demographic, psychological and lifestyle-related confounding factors, including age, rank and gender, mood state and the occurrence of stressful life events outside of work. The prevalence of strain was 31% at Phase I and 33% at Phase II. Fifty percent of personnel had no strain on either occasion, 15% had strain on both occasions and the remainder had strain on one occasion. The main stressor associated with strain at Phase I was an inability to disengage from work and this stressor accounted for a greater proportion of the variance in strain in personnel serving on ships than those serving ashore. The twelve-month follow-up questionnaire (Phase II) re-assessed psychological strain. A multiple linear regression analysis was conducted to identify factors measured at Phase I that predicted strain at Phase II in previously strain-free individuals. A lack of autonomy and control and dissatisfaction with living conditions predicted strain twelve months later in those serving on ships. Of the living conditions assessed, lack of privacy was the most strongly associated with strain twelve months later in those serving on ships. These stressors were not associated with strain twelve months later in those serving ashore. The findings suggest that improvements to the design of the environment on ships may have benefits for the psychological health of personnel.

Work demands and need for recovery from work in ageing seafarers.

This study was conducted on a population of seafarers serving in the Royal Fleet Auxiliary (RFA), the organisation providing support at sea to the Royal Navy. An investigation into work-related fatigue in RFA personnel onboard ships was carried out following changes to the regulations concerning maximum retirement age, to determine whether age was associated with recovery from work demands. A total of 322 personnel aged from 19 to 61 years were interviewed onboard seven RFA ships. The Need for Recovery scale was used to measure fatigue and work demands exposure was measured using the Baecke questionnaire and the NASA Task Load Index. It was found that older personnel did not have higher work-related fatigue than younger personnel. A measure of frustration at work was found to be most strongly related to work-related fatigue, even in seafarers who carried out physically demanding jobs. Work-related fatigue was found to accumulate over time in personnel who continued to be exposed to work demands onboard a ship. Finally, a relatively high level of work-related fatigue was found in the RFA sample as a whole, which may hold implications for management interventions. It was concluded that older personnel in the RFA can cope with the day-to-day demands of working life as well as younger personnel, possibly due to a 'survivor effect', whereby those personnel who do not cope as well with work demands leave and find a different job, leaving only those who successfully deal with the demands of working life at sea. STATEMENT OF RELEVANCE: In order to manage work demands in seafarers, it is important to identify the most fatiguing demands. Age is of interest because of the demographic ageing of the workforce. Age was not associated with a higher need for recovery. Psychological work demands had a greater effect on need for recovery than physical work demands.

Chronic and acute psychological strain in naval personnel.

BACKGROUND: Previous surveys have shown that there is a greater prevalence of psychological strain in Naval personnel than in the general population and have described the main psychosocial stressors associated with strain. AIMS: To determine the prevalence of acute strain and of repeated episodes of strain over 6- and 12-month periods. METHODS: Six and twelve months after completing a Phase I Work and Well-Being questionnaire, 2596 personnel were reassessed using a follow-up General Health Questionnaire-12. RESULTS: The response rates at 6 and 12 months ranged from 51 to 60%. There was no evidence of response bias at follow-up. The prevalence of acute strain was 31% at Phase I. After 6 months, approximately half of strain cases had recovered. Only 10% had strain over the entire period. Change in strain was linked to change in work role. CONCLUSIONS: Accumulation of strain and recovery occur within 6 months depending on change in work role. Management of strain might best be achieved by management of work demands and deployment length. Further studies will investigate the rate of accumulation of strain over the course of demanding deployments. Exposure to psychosocial stressors such as effort reward imbalance accounted for much of the difference between chronic strain sufferers and those with no strain.

Occupational stress and strain in the Royal Navy 2007.

BACKGROUND: Previous surveys of psychological strain in the Naval Service (NS) have shown higher than expected levels of strain when compared to the general population. AIM: To repeat the survey last carried out in 2004 and to obtain further information on the nature of the occupational stressors associated with strain. METHODS: General Health Questionnaire-12 strain rates and job/life stressors were measured using a Work and Well-Being Questionnaire. Models of strain were developed for male and female personnel in the Royal Navy (RN) and males in the Royal Marines (RM). RESULTS: The response rate was 57%. The psychological strain rate was 31.5% overall. Personnel suffering from strain tended to be 'overcommitted' to work, had low levels of commitment to the NS and had suffered stressful life events (SLEs) in the previous 12 months. Strain rates declined with age and rank in males, but not in females. Strain was significantly positively correlated with levels of overcommitment, effort-reward imbalance (ERI), role conflict, work-family conflict, organizational commitment and exposure to SLEs. Models of strain in the males and females in the RN and in the RM accounted for between 37 and 44% of the variance in strain. CONCLUSIONS: The survey provides evidence for both the demand control and ERI models-components of these models contribute independently to strain. High levels of commitment to the organization were associated with lower strain and exposure to SLEs to higher strain.

Analysis of the psychometric properties of the Spanish version of the Beck Depression Inventory in Argentina.

Increased international collaboration in clinical trials has created a need for cross-culturally valid instruments to assess quality of life and behavioral disorders. Cross-cultural studies of depressive symptomatology, in particular, must be preceded by an exhaustive study of the psychometric properties of the instruments, to ensure the validity of the comparison. In this article, we examine the validity, reliability and factor structure of the Spanish version of the Beck Depression Inventory (BDI) in a random stratified sample of 608 community residents in Argentina. Our findings indicate that this version of the BDI is psychometrically strong and appropriate for use in Argentina, and we suggest that it is suitable for assessing depressive symptomatology in Spanish speakers.

Deoxygenation-induced cation fluxes in sickle cells: relationship between net potassium efflux and net sodium influx.

Deoxygenation-induced cation fluxes in sickle cells were studied by measuring net cation movements in ouabain-treated cells. These deoxy cation fluxes were highly dependent on pH, showing inhibition at pH less than 7 and greater than 8 and a maximum at 7.4-7.5. Activation occurred at oxygen tensions around 40-50 torr and fluxes rose sharply as PO2 fell lower. Deoxy K efflux paralleled deoxy Na influx at pH values between 7 and 8, and at all oxygen tensions. Sickle cells were separated by density on Percol-Stractan gradients. Dense cells had lower deoxy cation fluxes of both Na and K than did lighter cell fractions, but in none of the fractionated populations did deoxy K efflux exceed deoxy Na influx. These data demonstrate that deoxy cation fluxes are activated at physiological pH and oxygen tensions and that there are no conditions of pH and PO2 and no cell populations in which cation fluxes induced by deoxygenation contribute directly to net cation loss in sickle cells. Chloride replacement (with nitrate) did not alter deoxy cation fluxes, and deoxy K efflux did not require the presence of external Na (tetramethylammonium replacement). Thus, deoxy cation fluxes do not have the characteristics of a cation-chloride cotransport or cation countertransport system.

Influence of prostaglandin D2 on hemodynamic effects of group B streptococcus in neonatal lambs.

Infusions of group B streptococci cause pulmonary hypertension in several neonatal animal models. A continuous infusion of prostaglandin D2 reduced the magnitude of this pulmonary hypertensive response; indomethacin completely blocked the response. Prostaglandin D2 or cyclooxygenase inhibitors may be important therapeutic agents for infants with group B streptococcal sepsis who manifest pulmonary hypertension.

Haematology of subclinical fatty liver in dairy cows.

The relationship between liver fat content and haematology was investigated in 369 cows from eight herds sampled in the second week after calving. High levels of fat in the liver were associated with a depression in total white cell count and in neutrophils, eosinophils and lymphocytes. There was no correlation between liver fat content and the percentage of E rosetting lymphocytes, packed cell volume or haemoglobin concentration. The changes in peripheral white cell counts may be related to the increased incidence of post parturient disease in cows with fatty liver.

Application of an automated enzymatic technique for the determination of non-esterified fatty acids in bovine blood.

An enzymatic method for the measurement of non-esterified fatty acid (NEFA) concentrations in blood was applied to samples from dairy cows. The method was carried out on a discrete analyser and showed considerable savings over other methods, particularly in time. The precision of the method was very high and the accuracy was good within normal concentration ranges when compared with an extraction reference method. Using this enzymatic method, it is possible to measure NEFA concentrations in bovine serum or plasma on a routine basis. The results will be of particular value in assessing the metabolic and nutritional status of cows in the post parturient period.

Blood composition and liver fat in post parturient dairy cows.

Cows from three different herds were used to investigate the relationship between plasma D(-)-3-hydroxybutyrate, serum free fatty acid and blood glucose concentrations and the amount of fat present in the liver in the week after calving. The study was particularly concerned with the diagnostic value of D(-)-3-hydroxybutyrate estimations. These estimations did not make a significant contribution to diagnosis of fatty liver nor did they reflect accurately the nutritional status of the cows.