Stroke presentation and hospital management: comparison of neighbouring healthcare systems with differing health policies.

Background: Acute stroke care is shaped by healthcare policies. Differing policies in similar populations allow for assessment of policy impact on health and healthcare outcomes. Aims: To compare stroke presentation and hospital care in two adjacent healthcare systems with differing healthcare policies. Methods: Interviews and chart review of consecutive acute stroke admissions in Northern Ireland (n=103) and the Republic of Ireland (n=100). Results: Marked regional contrasts were evident for key aspects of hospital care. Northern Ireland performed significantly better on 15 of 16 quality of care (Sentinel Audit) items. Delivery on standards was significantly better in Northern Ireland for early assessment (Northern Ireland 72%; Republic of Ireland 54%, p

Attitudes of qualified versus student mental health nurses towards an individual diagnosed with schizophrenia

Aims: This paper is the report of a study which sought to compare the attitudes held by student and qualified mental health nurses towards individuals with schizophrenia in the Republic of Ireland. Background: Media portrayals of individuals with schizophrenia often include images of aggression and violence. With global initiatives aimed at reducing the stigma and exclusion associated with mental illness, the attitudes of those who care for people with schizophrenia are of particular interest. Methods: A survey was administered to 66 student mental health nurses, and 121 qualified mental health nurses. Participants completed the community attitudes to mental illness scale (CAMI) and the social interaction scale (SIS) in 2009. Multivariate analysis of variance was used to test for the effects of qualification, work setting, years of experience and education on the measures. Results: A statistically significant difference was found between community mental health nurses and those employed in an inpatient setting on the social restrictiveness and community mental health ideology subscales of the CAMI and on the SIS. Findings also showed a statistically significant difference between nurses in the 10-14 years of experience group and the 5-9 years of experience group on the SIS. Conclusions: Mental health nurses employed in an inpatient setting are often confronted with patients who have challenging behavioural presentations which may explain their socially restrictive attitudes. However, nurses must be alerted to the fact that such negative attitudes may adversely affect the therapeutic relationship and ultimately lead to stigmatisation and its negative consequences.

Coronary heart disease: health knowledge and behaviour

Objective To determine the current level of knowledge and understanding of CHD in the general public in Northern Ireland and to identify factors that are associated with higher knowledge levels. Setting Six provincial centres in Northern Ireland. Methods The data in the present study were collected using an interview administered questionnaire. 1,000 members of the general public were interviewed face-to-face. CHD knowledge was computed as a continuous variable, i.e. higher score represents better CHD knowledge. Main outcome measure CHD knowledge in the general public in Northern Ireland. Results Study respondents displayed limited knowledge and understanding of CHD. Study respondents who achieved higher CHD knowledge scores were more likely to report: exercising for 30 min three times or more per week, paying attention to their diet, being overweight, having a family history of CHD, living in a higher socioeconomic area (according to postcode) and having attended tertiary education. Respondents in the present study while recognising the role that community pharmacists had to play in helping patients manage their prescribed medicines, did not recognise the community pharmacists' role in other aspects of CHD detection or management. Conclusion The deficit in CHD knowledge could translate into inadequate preventative behaviour patterns and suboptimal clinical outcomes. If community pharmacists wish to become increasingly involved in public health delivery relating to CHD they need to develop effective and accessible services and promote these to the public who at present do not recognise this role of the community pharmacist.

Longitudinal Pathways Between Political Violence and Child Adjustment: The Role of Emotional Security about the Community in Northern Ireland

Links between political violence and children's adjustment problems are well-documented. However, the mechanisms by which political tension and sectarian violence relate to children's well-being and development are little understood. This study longitudinally examined children's emotional security about community violence as a possible regulatory process in relations between community discord and children's adjustment problems. Families were selected from 18 working class neighborhoods in Belfast, Northern Ireland. Participants (695 mothers and children, M=12.17, SD=1.82) were interviewed in their homes over three consecutive years. Findings supported the notion that politically-motivated community violence has distinctive effects on children's externalizing and internalizing problems through the mechanism of increasing children's emotional insecurity about community. Implications are considered for understanding relations between political violence and child adjustment from a social ecological perspective.

Political Violence and Child Adjustment in Northern Ireland: Testing Pathways in a Social-Ecological Model Including Single- and Two-Parent Families

Moving beyond simply documenting that political violence negatively impacts children, we tested a social ecological hypothesis for relations between political violence and child outcomes. Participants were 700 mother child (M = 12.1 years, SD = 1.8) dyads from 18 working-class, socially deprived areas in Belfast, Northern Ireland, including single- and two-parent families. Sectarian community violence was associated with elevated family conflict and children's reduced security about multiple aspects of their social environment (i.e., family, parent child relations, and community), with links to child adjustment problems and reductions in prosocial behavior. By comparison, and consistent with expectations, links with negative family processes, child regulatory problems, and child outcomes were less consistent for nonsectarian community violence. Support was found for a social ecological model for relations between political violence and child outcomes among both single- and two-parent families, with evidence that emotional security and adjustment problems were more negatively affected in single-parent families. The implications for understanding social ecologies of political violence and children's functioning are discussed.

Testing a social ecological model for relations between political violence and child adjustment in Northern Ireland

Relations between political violence and child adjustment are matters of international concern. Past research demonstrates the significance of community, family, and child psychological processes in child adjustment, supporting study of interrelations between multiple social ecological factors and child adjustment in contexts of political violence. Testing a social ecological model, 300 mothers and their children (M = 12.28 years, SD = 1.77) from Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures or community discord, family relations, and children's regulatory processes (i.e., emotional security) and outcomes. Historical political violence in neighborhoods based on objective records (i.e., politically motivated deaths) were related to family members' reports of current sectarian antisocial behavior and nonsectarian antisocial behavior. Interparental conflict and parental monitoring and children's emotional security about both the community and family contributed to explanatory pathways for relations between sectarian antisocial behavior in communities and children's adjustment problems. The discussion evaluates support for social ecological models for relations between political violence and child adjustment and its implications for understanding relations in other parts of the world.

The Impact of Shame on the Therapeutic Alliance and Intimate Relationships

Objectives


This study examined the role of shame coping styles and state shame in predicting the therapeutic alliance and intimate relationship functioning in individuals with mental health problems.


Method


A sample of 50 treatment-receiving adults aged 21 to 67 years with a mix of common mental health difficulties was recruited from a clinical psychology service. Participants were given questionnaire measures of shame states, shame coping styles, intimate relationship functioning, and the therapeutic alliance.


Results


Regression analyses indicated that the shame coping strategy of physical and psychological withdrawal was the primary risk factor for development of a less effective therapeutic alliance. Both withdrawal and attack self coping styles were significant predictors of impaired intimate relationship functioning.


Conclusions


These findings have implications for the theoretical role of shame in mental health presentations as well as the potential for internalizing shame coping styles (i.e., withdrawal, attack self) to act as a barrier to successful therapy and interpersonal relationships. The inclusion of shame-focused assessments and interventions in the initial stages of treatment with clients exhibiting these strategies could improve prognosis.

Negative Aspects of Close Relationships as a Predictor of Increased Body Mass Index and Waist Circumference: The Whitehall II Study

Objectives. We investigated whether exposure to negative aspects of close relationships was associated with subsequent increase in body mass index (BMI) and waist circumference.
Methods. Data came from a prospective cohort study (Whitehall II) of 9425 civil servants aged 35 to 55 years at baseline (phase 1: 1985-1988). We assessed negative aspects of close relationships with the Close Persons Questionnaire (range 0-12) at phases 1 and 2 (1989-1990). We measured BMI and waist circumference at phases 3 (1991-1994) and 5 (1997-1999). Covariates at phase 1 included gender, age, marital status, ethnicity, BMI, employment grade, smoking, physical activity, fruit and vegetable consumption, and common mental disorder.
Results. After adjustment for sociodemographic characteristics and health behaviors, participants with higher exposure to negative aspects of close relationships had a higher likelihood of a 10% or greater increase in BMI and waist circumference (odds ratios per 1-unit increase 1.08 [95% confidence interval (CI)=1.02, 1.14; P=.007] and 1.09 [CI=1.04, 1.14; P <= .001], respectively) as well as a transition from the overweight (25 <= BMI <30) to the obese (BMI >= 30) category.
Conclusions. Adverse social relationships may contribute to weight gain.

Political Violence and Child Adjustment: Longitudinal Tests of Sectarian Antisocial Behavior, Family Conflict, and Insecurity as Explanatory Pathways

Understanding the impact of political violence on child maladjustment is a matter of international concern. Recent research has advanced a social ecological explanation for relations between political violence and child adjustment. However, conclusions are qualified by the lack of longitudinal tests. Toward examining pathways longitudinally, mothers and their adolescents (M = 12.33, SD = 1.78, at Time 1) from 2-parent families in Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures assessing multiple levels of a social ecological model. Utilizing autoregressive controls, a 3-wave longitudinal model test (T1, n = 299; T2, n = 248; T3, n = 197) supported a specific pathway linking sectarian community violence, family conflict, childrens insecurity about family relationships, and adjustment problems.

Risk and resilience: The moderating role of social coping for maternal mental health in a setting of political conflict:The moderating role of social coping for maternal mental health in a setting of political conflict

Violence can threaten individual wellbeing and tear at the social fabric of communities. At the same time, suffering can mobilize social coping and mutual support. Thus, the backdrop of political violence increases risk factors and stimulates resilience. The current study examined the moderating role of social coping as reflective of risk and resiliency in Northern Ireland, a setting of protracted conflict. Specifically, structural equation modeling was used to investigate whether social coping protects from or exacerbates the negative impact of sectarian crime and nonsectarian crime on maternal mental health (N?=?631). Nonsectarian crime predicted greater psychological distress for mothers in Belfast. Mixed support was found for the buffering and depletion moderation hypotheses; social coping functioned differently for nonsectarian crime and sectarian crime. Greater social coping buffered mothers' psychological distress from the negative effects of nonsectarian crime, but exacerbated maternal mental health problems when facing sectarian crime. Results suggest that social coping is a complex phenomenon, particularly in settings of protracted political violence. Implications for interventions aimed at alleviating psychological distress by enhancing mothers' social coping in contexts of intergroup conflict are discussed. We would like to thank the many families in Northern Ireland who have participated in the project. We would also like to express our appreciation for the project staff, graduate students, and undergraduate students at the University of Notre Dame and the University of Ulster. A special thanks to Cindy Bergeman and Dan Lapsley for feedback on earlier drafts of this manuscript. This research was supported by NICHD grant 046933-05 to the E. Mark Cummings.

The justice-workplace health relationship:The mediating role of emotions

Purpose - The purpose of this paper is to examine the mediational effects of positive and negative emotions in the relationship between organisational justice and health. Design/methodology/approach - This cross-sectional research obtained data from 206 workers employed within the financial/banking, manufacturing, and retail industries in Barbados. Findings - Structural equation modelling analyses revealed that positive and negative emotions completely mediated the effects of relational justice (but not procedural justice) on overall health. Research limitations/implications - Research was cross-sectional, and relied on self-report measures. The findings suggest that employers must properly evaluate their health and safety policies and practices in the organisation to ensure that aspects of the psychosocial work environment are being properly implemented, managed, and monitored, to ensure that individuals' health and well-being are not at risk. Originality/value - The paper represents a first attempt to investigate the roles of positive and negative emotions in the justice-health relationship in a different cultural context such as the Caribbean. Justice has been rarely researched as a psychosocial work stressor. The study described in the paper focused on multiple health outcomes. Copyright © 2012 Emerald Group Publishing Limited. All rights reserved.

Capitalism, the state and health care in the age of austerity:A Marxist analysis

The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever-increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population are also addressed. Marx’s writings on the state and its relation to the capitalist class were fragmentary, and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class-balance theory of the state, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations include Poulantzas’s structuralist abdication theory and Miliband’s instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie’s ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie.

Nationalism, Territory, and Organized Violence: Introduction to the Special Issue

Recent decades have seen significant advances in research on the relationship between nationalist ideology and organized violence. New scholarship has paid much closer attention to the microdynamics of violence, the strikingly uneven distribution of violence, the relationship between master cleavages and intimate local and personal struggles, and to process, history, and contingency. Nationalist ideology is understood to be bound up intimately with institutions and with everyday relationships at the local level. We introduce the contributions to this special issue, outlining the way in which they highlight the power of ideas, narratives, and microlevel solidarity in mobilization for violence and how they address the crucial importance of territoriality in linking ideas and action.