Validation of the dietetic confidence scale

Dietitians have reported a lack of confidence in counselling clients with mental health issues. Standardised tools are needed to evaluate programs aiming to improve confidence. The Dietetic Confidence Scale (DCS) was developed to assess dietitians’perception of their capability about working with clients experiencing depression. Exploratory research revealed a 13-item, two-factor model. Dietetic confidence was associated with: 1) Confidence using the Nutrition Care Process; and 2) Confidence in Advocacy for Self-care and Client-care. This study aimed to validate the DCS using this two-factor model.The DCS was administered to 458 dietitians. Confirmatory factor analysis (CFA) assessed the scale’s psychometric validity. Reliability was measured using Cronbach’s alpha (α) co-efficient. CFA results supported the hypothesised two-factor, 13-item model. The Good Fit Index (GFI = 0.95) indicated a strong fit. Item-factor correlations ranged from r = 0.50 to 0.89. The overall scale and subscales showed good reliability (α = 0.93 to 0.76). This is the first study to validate an instrument that measures dietetic confidence about working with clients experiencing depression. The DCS can be used to measure changes in perceived confidence and identify where further training, mentoring or experience is needed. The findings also suggest that initiatives aimed at building dietitians' confidence about working with clients experiencing depression, should focus on improving client-focused nutrition care, foster advocacy, reflective practice, mentoring and encourage professional support networks. Avenues for future research include further validity and reliability testing to expand the generalisability of results; and modifying the scale for other disease or client populations.

Addressing alcohol related harms within maxillofacial trauma practice

Background A brief intervention, conducted in the acute setting care setting after an alcohol-related injury, has been reported to be highly beneficial in reducing the risk of re-injury and in reducing subsequent level of alcohol consumption. This project aimed to understand Australasian Oral and Maxillofacial Surgeons' attitudes, knowledge and skills in terms of alcohol screening and brief intervention within acute settings for patients admitted with facial trauma. Materials and Methods A web-based survey was made available to all members (n=200-250) of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS), promoted through a number of email bulletins sent by the Association to all members. Implied consent is assumed for participants who complete the online survey. The survey explored their current level of involvement in treating patients with alcohol-relatd facial trauma, as well as their knowledge of and attitudes towards alcohol screening and brief intervention. The survey also explored their willingness for further training and involvement in implementing a SBI program. Parts of the survey were based on a hypothetical case with facial injury and drinking history which was presented to the participants and the participants were asked to give their response to this scenario. Results A total of 58 surgeons completed the on-line survey. 91% of surgeons surveyed were males and 88% were consultant surgeons. 71% would take alcohol history; 29% would deliver a brief alcohol intervention and 14% would refer the patients to an alcohol treatment service or clinician. 40% agreed to have adequate training in managing patients with alcohol-related injuries, while 17% and 19% felt they had adequate time and resources. 76% of surgeons reported the need for more information on where to refer patients for appropriate alcohol treatment. Conclusion The study findings confirm the challenges and barriers to implementing brief alcohol intervention in current practice. There are service gaps that exist, as well as opportunities for training.

Teaching in Higher Education : From Content-focused to Learning-focused Approaches to Teaching

The aim of this dissertation was to explore teaching in higher education from the teachers’ perspective. Two of the four studies analysed the effect of pedagogical training on approaches to teaching and on self-efficacy beliefs of teachers on teaching. Of these two studies, Study I analysed the effect of pedagogical training by applying a cross-sectional setting. The results showed that short training made teachers less student-centred and decreased their self-efficacy beliefs, as reported by the teachers themselves. However, more constant training enhanced the adoption of a student-centred approach to teaching and increased the self-efficacy beliefs of teachers as well. The teacher-focused approach to teaching was more resistant to change. Study II, on the other hand, applied a longitudinal setting. The results implied that among teachers who had not acquired more pedagogical training after Study II there were no changes in the student-focused approach scale between the measurements. However, teachers who had participated in further pedagogical training scored significantly higher on the scale measuring the student-focused approach to teaching. There were positive changes in the self-efficacy beliefs of teachers among teachers who had not participated in further training as well as among those who had. However, the analysis revealed that those teachers had the least teaching experience. Again, the teacher-focused approach was more resistant to change. Study III analysed approaches to teaching qualitatively by using a large and multidisciplinary sample in order to capture the variation in descriptions of teaching. Two broad categories of description were found: the learning-focused and the content-focused approach to teaching. The results implied that the purpose of teaching separates the two categories. In addition, the study aimed to identify different aspects of teaching in the higher-education context. Ten aspects of teaching were identified. While Study III explored teaching on a general level, Study IV analysed teaching on an individual level. The aim was to explore consonance and dissonance in the kinds of combinations of approaches to teaching university teachers adopt. The results showed that some teachers were clearly and systematically either learning- or content-focused. On the other hand, profiles of some teachers consisted of combinations of learning- and content-focused approaches or conceptions making their profiles dissonant. Three types of dissonance were identified. The four studies indicated that pedagogical training organised for university teachers is needed in order to enhance the development of their teaching. The results implied that the shift from content-focused or dissonant profiles towards consonant learning-focused profiles is a slow process and that teachers’ conceptions of teaching have to be addressed first in order to promote learning-focused teaching.

Tactual Display of Consonant Voicing to Supplement Lipreading

This research is concerned with the development of tactual displays to supplement the information available through lipreading. Because voicing carries a high informational load in speech and is not well transmitted through lipreading, the efforts are focused on providing tactual displays of voicing to supplement the information available on the lips of the talker. This research includes exploration of 1) signal-processing schemes to extract information about voicing from the acoustic speech signal, 2) methods of displaying this information through a multi-finger tactual display, and 3) perceptual evaluations of voicing reception through the tactual display alone (T), lipreading alone (L), and the combined condition (L+T). Signal processing for the extraction of voicing information used amplitude-envelope signals derived from filtered bands of speech (i.e., envelopes derived from a lowpass-filtered band at 350 Hz and from a highpass-filtered band at 3000 Hz). Acoustic measurements made on the envelope signals of a set of 16 initial consonants represented through multiple tokens of C1VC2 syllables indicate that the onset-timing difference between the low- and high-frequency envelopes (EOA: envelope-onset asynchrony) provides a reliable and robust cue for distinguishing voiced from voiceless consonants. This acoustic cue was presented through a two-finger tactual display such that the envelope of the high-frequency band was used to modulate a 250-Hz carrier signal delivered to the index finger (250-I) and the envelope of the low-frequency band was used to modulate a 50-Hz carrier delivered to the thumb (50T). The temporal-onset order threshold for these two signals, measured with roving signal amplitude and duration, averaged 34 msec, sufficiently small for use of the EOA cue. Perceptual evaluations of the tactual display of EOA with speech signal indicated: 1) that the cue was highly effective for discrimination of pairs of voicing contrasts; 2) that the identification of 16 consonants was improved by roughly 15 percentage points with the addition of the tactual cue over L alone; and 3) that no improvements in L+T over L were observed for reception of words in sentences, indicating the need for further training on this task

Exploring knowledge and skills on HIV in student nurses and midwives

A cross-sectional survey design using a self-administered questionnaire was sent to a sample of 62 final-year student nurses and midwives to describe their knowledge of, skills related to, and attitudes towards, human immunodeficiency virus/acquired immune deficiency syndrome. Out of the 47 respondents who return the questionnaire, only 53% stated that they had received class instruction on the topic and 63.8% claimed to have increased their knowledge mainly from reading professional journals. Although only 32% said that they had cared for a patient or knew of a family member or another person with the disease, 91% indicated that they were willing to care for such patients. Overall, the respondents demonstrated positive attitudes towards this group of patients and a good level of knowledge about the subject, although some gaps were evident. However, a large majority stated that their skills to cater for the physical and psychological needs of this group of patients were deficient and would like further training.

Use and views on social networking sites of pharmacy students in the United Kingdom

Objective. To investigate students' use and views on social networking sites and assess differences in attitudes between genders and years in the program.

Methods. All pharmacy undergraduate students were invited via e-mail to complete an electronic questionnaire consisting of 21 questions relating to social networking.

Results. Most (91.8%) of the 377 respondents reported using social networking Web sites, with 98.6% using Facebook and 33.7% using Twitter. Female students were more likely than male students to agree that they had been made sufficiently aware of the professional behavior expected of them when using social networking sites (76.6% vs 58.1% p=0.002) and to agree that students should have the same professional standards whether on placement or using social networking sites (76.3% vs 61.6%; p<0.001).

Conclusions. A high level of social networking use and potentially inappropriate attitudes towards professionalism were found among pharmacy students. Further training may be useful to ensure pharmacy students are aware of how to apply codes of conduct when using social networking sites.

A formação como actividade de aprendizagem docente

A partir dos pressupostos da teoria histórico-cultural, e em particular da Teoria da Actividade, desenvolvida por Leontiev, esta pesquisa estudou a aprendizagem docente num projecto de formação e investigação que privilegiou a atividade orientadora de ensino como metodologia de formação. Este desenvolveu-se em São João da Madeira e em Aveiro, com educadoras pertencentes a jardins de infância que mantinham um protocolo de colaboração com a disciplina de prática pedagógica da Licenciatura em Educação de Infância da Universidade de Aveiro. Para a dinâmica de formação, numa metodologia de pesquisa colaborativa, consideraram-se os encontros de formação como um espaço de discussão e reflexão dos pressupostos teóricos e da atividade orientadora de ensino, como desencadeadores de um movimento na aprendizagem docente. Dada a complexidade do objecto de estudo, investigar a aprendizagem docente, procurando compreender os sujeitos no seu próprio movimento de aprendizagem, assumimos o conceito de isolado (Caraça, 1998) como método de análise do fenómeno estudado. Identificamos três isolados que nos pareceram reunir factores determinantes, isto é, aqueles cuja acção de interdependência influiu sensivelmente no fenómeno estudado. O isolado contextual procurou analisar a aprendizagem num contexto próprio do desenvolvimento, considerando que as particularidades de cada contexto interferem no movimento de aprendizagem, definindo as acções e as operações de organização colectiva. A actividade reflexiva e crítica sobre a organização do ensino, sobre a prática e sobre o desenvolvimento docentes, constituiu o isolado reflexivo. Em estreita interdependência com os isolados anteriores, consideramos o isolado conceptual que mostra o movimento de apropriação, pelas educadoras, dos conceitos desenvolvidos ao longo do trabalho de investigação. A análise dos dados apresentou indicadores de mudança de qualidade na aprendizagem das educadoras, desencadeadas e sustentadas pela dinâmica de elaboração, de desenvolvimento e de reflexão de actividades de ensino, desenvolvidas colectivamente. Concluiu-se que a formação possibilitou a mudança nas concepções das educadoras sobre a aprendizagem, sobre a organização do ensino e sobre o seu próprio processo de aprendizagem. As contribuições teóricas da perspectiva histórico-cultural que fundamentam esse trabalho possibilitaram repensar a formação do professor, principalmente no que se refere aos processos de aprendizagem docente.

Perinatal choline supplementation reveals a dissociation between two types of spatial strategies.

Choline supplementation improving memory functions in rodents is assumed to increase the synthesis and release of acetylcholine in the brain. We have found that a combined pre- and postnatal supplementation results in long-lasting facilitation of spatial memory in juvenile rats when training was conducted in presence of a local salient cue. The present work was aimed at analysing the effects of peri- and postnatal choline supplementation on spatial abilities of naive adult rats. Rats given a perinatal choline supplementation were trained in various cued procedures of the Morris navigation task when aged 5 months. The treatment had a specific effect of reducing the escape latency of the rats when the platform was at a fixed position in space and surrounded by a suspended cue. This effect was associated with an increased spatial bias when the cue and platform were removed. In this condition, the control rats showed impaired spatial discrimination following the removal of the target cue, most likely due to an overshadowing of the distant environmental cues. This impairment was not observed in the treated rats. Further training with the suspended cue at unpredictable places in the pool revealed longer escape latencies in the control than in the treated rats suggesting that this procedure induced a selective perturbation of the normal but not of the treated rats. A special probe trial with the cue at an irrelevant position and no escape platform revealed a significant bias of the control rats toward the cue and of the treated rats toward the uncued spatial escape position. This behavioural dissociation suggests that a salient cue associated with the target induces an alternative "non spatial" guidance strategy in normal rats, with the risk of overshadowing of the more distant spatial cues. In this condition, the choline supplementation facilities a spatial reliance on the cue, that is an overall facilitation of learning a set of spatial relations between several visual cues. As a consequence, the improved escape in presence of the cue is associated with a stronger memory of the spatial position following disappearance of the cue. This and previous observations suggest that a specific spatial attention process relies on the buffering of highly salient visual cues.to facilitate integration of their relative position in the environment.

Advance directives and the impact of timing. A qualitative study with Swiss general practitioners.

PRINCIPLES: Advance directives are seen as an important tool for documenting the wishes of patients who are no longer competent to make decisions in regards to their medical care. Due to their nature, approaching the subject of advance directives with a patient can be difficult for both the medical care provider and the patient. This paper focuses on general practitioners' perspectives regarding the timing at which this discussion should take place, as well as the advantages and disadvantages of the different moments. METHODS: In 2013, 23 semi-structured face-to-face interviews were performed with Swiss general practitioners. Interviews were analysed using qualitative content analysis. RESULTS: In our sample, 23 general practitioners provided different options that they felt were appropriate moments: either (a) when the patient is still healthy, (b) when illness becomes predominant, or (c) when a patient has been transferred to a long-term care facility. Furthermore, general practitioners reported uncertainty and discomfort regarding initiating the discussion. CONCLUSION: The distinct approaches, perspectives and rationales show that there is no well-defined or "right" moment. However, participants often associated advance directives with death. This link caused discomfort and uncertainty, which led to hesitation and delay on the part of general practitioners. Therefore we recommend further training on how to professionally initiate a conversation about advance directives. Furthermore, based on our results and experience, we recommend an early approach with healthy patients paired with later regular updates as it seems to be the most effective way to inform patients about their end-of-life care options.

A transversalidade do tema meio ambiente na prática pedagógica

A educação é notadamente uma das ações mais importantes de mobilização socioambiental e cada vez mais se reconhece o papel transformador da escola frente às problemáticas ambientais. No ano de 1997 o Brasil publicou os PCNs (Parâmetros Curriculares Nacionais) que traziam os Temas Transversais, dentre eles o Meio Ambiente, para serem inseridos no cotidiano escolar. Esse contexto serviu de base para nossa investigação que teve por objetivo verificar como se dá a abordagem do tema Meio Ambiente, no que se refere à sua transversalidade, na prática pedagógica entre professores e alunos do ensino fundamental. Para tanto foi utilizada uma abordagem quanti-qualitativa, utilizando-se de técnicas como questionário e entrevistas, envolvendo 12 professores e 357 alunos de escolas públicas estaduais e municipais de dois municípios vizinhos, localizados no estado de Pernambuco, Brasil. A investigação esteve apoiada no pensamento de diversos autores, dentre os quais destacamos Carvalho, I. (2004, 2006, 2007); Gadotti, M. (2005, 2008, 2010); Gavidia, V. (2002); Guimarães, M. (2003, 2004, 2009); Leff, E. (2007, 2008, 2009, 2010); Loureiro, C. (2004, 2005, 2006); Reigotta, M. (2007, 2008, 2009) e Yus, R. (1998, 2002). Com a análise dos dados obtidos concluímos que o trabalho docente envolvendo o tema Meio Ambiente ainda não atingiu o patamar transversal, embora utilizando abordagens significativas, como projetos pedagógicos, a prática interdisciplinar que a transversalidade requer ainda não foi consolidada, indicando a necessidade de aperfeiçoamento profissional - teórico e prático - sobre a aplicabilidade do tema.

Teaching assistants and pupils' academic and social engagement in mainstream schools: insights from systematic literature reviews

The last 20 years have seen a huge expansion in the additional adults working in classrooms in the UK, USA, and other countries. This paper presents the findings of a series of systematic literature reviews about teaching assistants. The first two reviews focused on stakeholder perceptions of teaching assistant contributions to academic and social engagement. Stakeholders were pupils, teachers, TAs, headteachers and parents. Perceptions focused on four principal contributions that teaching assistants contribute to: pupils’ academic and socio-academic engagement; inclusion; maintenance of stakeholder relations; and support for the teacher. The third review explored training. Against a background of patchy training provision both in the UK and the USA, strong claims are made for the benefits to TAs of training provided, particularly in building confidence and skills. The conclusions include implications for further training and the need for further research to gain an in-depth understanding as to precisely the manner in which TAs engage with children.

Investigating early years teachers’ understanding and response to children’s preconceptions

This paper focuses on young children’s scientific preconceptions and discusses teachers’ identification of these preconceptions when teaching science in the early years, on which research is still limited. This paper is based on the theoretical framework of constructivism and it defines preconceptions as children’s erroneous concepts prior to formal education. A two phase case study approach was employed, facilitating in-depth investigation though the use of questionnaires, interviews and observations. The results indicate that the teachers did not dedicate time to identify children’s preconceptions when planning and teaching science, even when acknowledging preconceptions’ possible existence. This indicates a possible lack of appreciation of the importance of children’s preconceptions of the consequences when ignoring them. The results also indicate the need for further training and professional development in relation to the teaching of early-years science, especially since only a very small percentage of early years teachers tend to study science during their years compulsory education. A number of suggestions are also provided for practice and policy that can be useful for other subjects as well.

"An on-going individual adjustment" : a qualitative study of midwives' experiences counselling pregnant women on physical activity in Sweden

Background: In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide. Methods: Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. Results: The main theme- "An on-going individual adjustment" was built on three categories: "Counselling as a challenge"; "Counselling as walking the thin ice" and "Counselling as an opportunity" reflecting the midwives on-going need to adjust their counselling depending on each woman's specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective. Conclusions: Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman's individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women's motivation for performance of physical activity.

Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Using simulated patients to develop doctors' skills in facilitating bahaviour change : addressing childhood obesity

Objectives : This study aimed to describe the application, feasibility and outcomes of using simulated patients (SPs) to increase the skills of general practitioners (GPs) delivering a behavioural intervention to reduce childhood overweight and mild obesity.

Methods : Five female actors were trained as SPs. A total of 67 GPs from 46 general practices in Melbourne, Victoria, Australia, conducted two simulated consultation visits regarding healthy lifestyle family behaviour change, during which they practised their skills and received formative feedback. The GPs and SPs rated GP performance immediately after each consultation. Subsequently, 139 parents of overweight or obese 5–9-year-old children rated GP performance during real-life consultations. Other measures included child body mass index (BMI) Z-scores (at baseline and at a 9-month follow-up) and GP-reported levels of comfort and competence and the perceived value of SP visits.

Results : Simulated patient ratings, but not GP self-ratings, of GP performance predicted both parent ratings of real-life consultations (Spearman's rho 0.39 for correlation with SP rating at Visit 1) and subsequent reductions in BMI Z-scores between baseline and follow-up (Visit 1, rho − 0.45; Visit 2, rho − 0.46). GP levels of comfort and competence were maintained during and after the SP visits. A total of 95% of GPs rated simulated consultations as useful, although only 18% said they would pay for them.

Conclusions : Simulated patient assessment may predict real patient feedback and clinical outcomes, helping to identify doctors who require further training in behaviour change techniques. Randomised controlled trials may establish whether SPs actually raise skills or improve outcomes.