A healthy settings framework: an evaluation and comparison of midwives' responses to addressing domestic violence

Objectives: to compare and contrast how midwives working in either hospital- or community-based settings address domestic violence by evaluating their views on: prevalence of domestic violence; their role in addressing domestic violence; the acceptability of routine enquiry; and barriers encountered in asking clients questions about violence and abuse in pregnancy. Design: a postal survey questionnaire. Setting: Northern Ireland. Study population: 983 hospital and community midwives. Findings: overall, 488 midwives returned a completed questionnaire; a 57% response rate. Comparisons were made using descriptive, inferential statistics and cross-tabulation. Although there were significant differences between hospital- and community-based midwives in relation to domestic violence, both groups of midwives tended to underestimate its prevalence. Key conclusions: the findings suggest that midwives per se identify and respond to a fraction of the cases of domestic abuse in pregnancy, due to lack of confidence, education and training. This reinforces the need for both hospital and community midwives to gain further confidence and an understanding of the many psychosocial factors that surround domestic violence. Implications for practice: healthy settings theory can be used effectively to identify good practice with women who experience domestic violence. Effective investment for health care requires the gaps between hospital- and community-based practice to be bridged, and for work to be integrated.

Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol

Background-Asthma, post-nasal drip syndrome (PNDS), and gastrooesophageal reflux (GOR) account for many cases of chronic non-productive cough (CNPC). Each may simultaneously contribute to cough even when clinically silent, and failure to recognise their contribution may lead to unsuccessful treatment.

Methods—Patients (all lifetime non-smokers with normal chest radiographs and spirometric measurements) referred with CNPC persisting for more than three weeks as their sole respiratory symptom underwent histamine challenge, home peak flow measurements, ear, nose and throat (ENT) examination, sinus CT scanning, and 24 hour oesophageal pH monitoring. Treatment was prescribed on the basis of diagnoses informed by investigation results.

RESULTS—Forty three patients (29 women) of mean age 47.5 years (range 18-77) and mean cough duration 67 months (range 2-240) were evaluated. On the basis of a successful response to treatment, a cause for the cough was identified in 35 patients (82%) as follows: cough variant asthma (CVA) (10 cases), PNDS (9 cases), GOR (8cases), and dual aetiologies (8 cases). Histamine challenge correctly predicted CVA in 15 of 17 (88%) positive tests. ENT examination and sinus CT scans each had low positive predictive values for PNDS (10 of 16 (63%) and 12 of 18 (67%) positive cases, respectively), suggesting that upper airways disease frequently co-exists but does not always contribute to cough. When negative, histamine challenge and 24 hour oesophageal pH monitoring effectively ruled out CVA and GOR, respectively, as a cause for cough.

CONCLUSION—This comprehensive approach aids the accurate direction of treatment and, while CVA, PNDS and GOR remain the most important causes of CNPC to consider, a group with no identifiable aetiology remains.

Investigating the Interhemisphere 14C Offset in the 1st Millennium AD and Assessment of Laboratory Bias and Calibration Errors

Past measurements of the radiocarbon interhemispheric offset have been restricted to relatively young samples because of a lack of older dendrochronologically secure Southern Hemisphere tree-ring chronologies. The Southern Hemisphere calibration data set SHCal04 earlier than AD 950 utilizes a variable interhemispheric offset derived from measured 2nd millennium AD Southern Hemisphere/Northern Hemisphere sample pairs with the assumption of stable Holocene ocean/ atmosphere interactions. This study extends the range of measured interhemispheric offset values with 20 decadal New Zealand kauri and Irish oak sample pairs from 3 selected time intervals in the 1st millennium AD and is part of a larger program to obtain high-precision Southern Hemisphere 14C data continuously back to 200 BC. We found an average interhemispheric offset of 35 ± 6 yr, which although consistent with previously published 2nd millennium AD measurements, is lower than the offset of 55–58 yr utilized in SHCal04. We concur with McCormac et al. (2008) that the IntCal04 measurement for AD 775 may indeed be slightly too old but also suggest the McCormac results appear excessively young for the interval AD 755–785. In addition, we raise the issue of laboratory bias and calibration errors, and encourage all laboratories to check their consistency with appropriate calibration curves and invest more effort into improving the accuracy of those curves.