Spirituality and religious practices among outpatients with schizophrenia and their clinicians

OBJECTIVES: Religious issues may be neglected by clinicians who are treating psychotic patients, even when religion constitutes an important means of coping. This study examined the spirituality and religious practices of outpatients with schizophrenia compared with their clinicians. Clinicians' knowledge of patients' religious involvement and spirituality was investigated. METHODS: The study sample included 100 patients of public psychiatric outpatient facilities in Geneva, Switzerland, with a diagnosis of nonaffective psychosis. Audiotaped interviews were conducted with use of a semistructured interview about spirituality and religious coping. The patients' clinicians (N=34) were asked about their own beliefs and religious activities as well as their patients' religious and clinical characteristics. RESULTS: Sixteen patients (16 percent) had positive psychotic symptoms reflecting aspects of their religious beliefs. A majority of the patients reported that religion was an important aspect of their lives, but only 36 percent of them had raised this issue with their clinicians. Fewer clinicians were religiously involved, and, in half the cases, their perceptions of patients' religious involvement were inaccurate. A few patients considered religious practice to be incompatible with treatment, and clinicians were seldom aware of such a conflict. CONCLUSIONS: Religion is an important issue for patients with schizophrenia, and it is often not related to the content of their delusions. Clinicians were commonly not aware of their patients' religious involvement, even if they reported feeling comfortable with such an issue.

Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

Más allá de una distinción dicotómica del apoyo a la democracia: diversos perfiles de no demócratas

El apoyo ciudadano a la democracia constituye un requisito fundamental de los modernos regímenes democráticos, tanto respecto de su estabilidad y consolidación como de la calidad de su funcionamiento. En este marco, la legitimidad democrática pertenece a la dimensión de creencias ciudadanas respecto de que la democracia y sus instituciones son las más apropiadas (de hecho, las únicas aceptables) como régimen de gobierno. Sin perjuicio de lo anterior, no todos los ciudadanos expresan este conjunto de actitudes positivas hacia el régimen democrático. En gran parte de las nuevas democracias un número considerable de personas o bien no entregan un apoyo abierto a la democracia o, expresan actitudes contradictorias hacia los regímenes democráticos. Este grupo de individuos ha sido normalmente tratado por la literatura como un solo grupo homogéneo, que responde sin más consideraciones a la etiqueta de “no demócratas”. Sin embargo, tal como esta investigación pretende demostrar, existen razones teóricas y empíricas para esperar que no haya un único perfil de ciudadanos que no apoya la democracia. Por el contrario, sería posible encontrar y analizar diversos perfiles de “no demócratas”, que explican sus diferencias de acuerdo a distintas objeciones hacia la democracia. Esto es, las razones que se tienen para no entregar un apoyo difuso a la democracia no serían las mismas en todos los casos. De esta forma se derivan las siguientes preguntas de investigación: ¿Cuáles son los argumentos teóricos y empíricos que permiten distinguir diversos tipos de “no demócratas”? ¿Cuáles son las distintas objeciones hacia la democracia (razones) que configuran estos perfiles diversos? Sin embargo, no basta con responder sólo a estas preguntas. Es necesario avanzar en esta línea argumental, preguntándose respecto de la relevancia de distinguir distintos perfiles de “no demócratas”. Así, surge una tercera pregunta: ¿Bajo qué circunstancias tiene relevancia efectuar una distinción entre quienes no apoyan la democracia?

Cos i espiritualitat : in-corporant rituals i creences en les noves formes de religiositat

El fenomen de les noves religions posa de relleu la importància del cos i les emocions com a elements constitutius de la subjectivitat. En aquest treball s'estudia el procés de construcció de la identitat espiritual, a través de la in-corporació de nous valors i creences, i de la corporeïtzació dels rituals. Es parteix d'una aproximació etnogràfica, a través d'un treball de camp al sí d'un grup d'orientació oriental. A partir de l'observació participant i la celebració d'entrevistes, es proposa analitzar com es forja l'espiritualitat. En tant que experiència corporal, es posa de manifest la rellevància de les emocions en els processos d'interacció i socialització de la persona en un grup donat.

Treball sobre persones vinculades a la fe catòlica, evangèlica i musulmana residents a la ciutat de Vic : la seva actitud davant la mort. Creences i valors

El comportament de les persones en relació a la vida i la mort és variat. Què influeix en aquest comportament?. Les seves creences, els seus valors, la religió, la societat..? són tota una colla de preguntes que originen l'interès central d'aquest treball: l'esforç d'aproximar-se al procés de mort, de dol des del punt de vista de la religió, i, més concretament, de les creences, valors i guies de comportament que aquesta proporciona als creients. Aquestes i altres preguntes pretenen ser resoltes en aquest treball, a partir de l'estudi d'una mostra concretament centrada en els habitants de la ciutat de Vic.

Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial.

BACKGROUND: Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. METHODS: Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups. RESULTS: Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes. CONCLUSIONS: This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly. TRIAL REGISTRATION: Trial registration number: NCT01496144.

Estudi interdisciplinari de l'epigrafia malloquina

El tema central ha consistit a estudiar, a partir de les fonts epigràfiques, la vida privada i pública de Mallorca en època romana, tot analitzant-ne el sistema econòmic i polític, la societat, les formes d'expressió cultural, la religió i les creences, la geografia i la topografia, els principals esdeveniments històrics, els jaciments arqueològics, les dades d'interès antropològic, la situació lingüística, etc. Per tot això, l'estudi està directament relacionat amb disciplines com ara la història, la geografia, la política, l'epigrafia, l'arqueologia, l'economia, la filosofia, l'antropologia, la sociologia, la demografia, etc.

Estudi Interdisciplinari de l'Epigrafia Mallorquina

A partir de les fonts epigràfiques, es fa un estudi interdisciplinari de la vida privada i pública de Mallorca en època romana, tot analitzant-ne el sistema econòmic i polític, la societat, les formes d'expressió cultural, la religió i les creences, la geografia i la topografia, els principals esdeveniments històrics, els jaciments arqueològics, les dades d'interès antropològic i la situació lingüística. El punt de partida és la pregunta següent: quines dades sobre la Mallorca romana es poden obtenir a partir de les fonts epigràfiques? I també: com s'organitzava la societat mallorquina en època romana, quines divinitats eren objecte de culte, amb quines comunitats o pobles tenia relacions comercials, quins rituals funeraris seguia, quina estructura econòmica la gestionava, quina llengua parlava i d'acord amb quin sistema polític es governava.

A Brief Cognitive Behavioural Therapy Alcohol Intervention Programme is an Effective Secondary Prevention Approach for New Employees entering an Irish Workforce: A Pilot

The prevalence of unhealthy drinking at all levels in Irish society poses serious issues in terms of the consequence to individuals concerned, as well as to society as a whole. The workplace offers a useful setting for early identification and intervention with new employees who may have pre-existing alcohol use disorder issues. This pilot study aimed to evaluate the effectiveness within the workplace of a brief Cognitive Behavioural Therapy (CBT) intervention in reducing participants binge and risky drinking behaviours. Twenty-six Irish Naval recruits volunteered to participate in this randomised controlled trial. The intervention was conducted over four consecutive one and a half hour weekly sessions. Participants completed four principle outcome measures at intake, termination of the intervention and at the two-month follow-up assessment. The Alcohol Use Disorders Identification Test (Babor, Higginis-Biddle, Saunders & Monterio, 2001) was used to measures participants’ consumption levels and frequency of binge or risky drinking. A Readiness Ruler (Miller, Zweben, Diclemente, & Rychtarik, 1992) was used to measure participants’ readiness to change drinking, while the Drinking Expectancy Questionnaire (Young & Oei, 1996) was used to measure participants’ beliefs pertaining to alcohol, and their ability to refuse alcohol in high-risk social surroundings. There were preliminary data in support of the intervention. There were interaction effects that approached statistical significance for both a reduction in participants’ binge drinking (p =. 064) and an increase in participants’ ability to refuse alcohol in high-risk social settings (p = .059). There was also a significant interaction effect (pThis resource was contributed by The National Documentation Centre on Drug Use.

A Study of Sexual Health Issues, Attitudes and Behaviours: The Views of Early School Leavers

This research aimed to explore the sexual attitudes, beliefs and behaviours of early school leavers and how a group of young people, without the advantage of completing post-primary education, deal with the complicated issues of constructing, defining and experiencing sexual practice.This resource was contributed by The National Documentation Centre on Drug Use.

A Study to Examine the Attitudes of General Practitioners Towards Drug Users in the North East Region of Ireland

The research examines general practitioners attitudes and how these effect the management of drug misusers within their practice. The methodology is quantitative in approach. The instrument used is a structured postal questionnaire. Participants include all general practitioners within the North East region of Ireland. Anonymity and confidentiality of all respondents are guaranteed. Data was collected over a six week period, under the following headings - attitudes and beliefs, factors influencing treatment, treatment options, training and demographics. Attitudes and beliefs towards drug users were measured using a five point Likert scale ranging from strongly agrees to strongly disagree. The data was analysed with the aid of a computer package, SPSS allowing descriptive statistics to be presented. Results indicate that the majority of respondents are male. There appears to be sympathy towards drug users and that treatment approaches should be holistic. However, there appears to be a major lack of confidence in treating and managing drug misusers. Patient, social and practice factors all influence the decision to the drug misuser. Treatment options are varied, ranging from methadone maintenance to referral for residential treatment. However, a number of respondents offer no treatment for drug misusers. General practitioners do not feel adequately trained in treating and/or managing this client group. Results indicate that improved communication, ongoing education and more research is needed in this area.This resource was contributed by The National Documentation Centre on Drug Use.

Psychosis with coexisting substance misuse: assessment and management in adults and young people.

This guideline offers best practice advice on the assessment and management of people with psychosis and coexisting substance misuse. Psychosis is a condition that affects a person’s mental state, including their thoughts, mood and behaviour. The symptoms of psychosis are:• hallucinations – hearing voices and sometimes seeing things that are not really there• delusions – having fixed beliefs that are false but which the person believes in completely. Substance misuse is a broad term encompassing, in this guideline, the harmful use of any psychotropic substance, including alcohol and either legal or illicit drugs. Use of such substances is harmful when it has a negative effect on a person’s life, including their physical and mental health, relationships, work, education and finances or leads to offending behaviour.This resource was contributed by The National Documentation Centre on Drug Use.

Essays in equilibrium asset pricing

This thesis consists of four essays in equilibrium asset pricing. The main topic is investors' heterogeneity: I investigates the equilibrium implications for the financial markets when investors have different attitudes toward risk. The first chapter studies why expected risk and remuneration on the aggregate market are negatively related, even if intuition and standard theory suggest a positive relation. I show that the negative trade-off can obtain in equilibrium if investors' beliefs about economic fundamentals are procyclically biased and the market Sharpe ratio is countercyclical. I verify that such conditions hold in the real markets and I find empirical support for the risk-return dynamics predicted by the model. The second chapter consists of two essays. The first essay studies how het¬erogeneity in risk preferences interacts with other sources of heterogeneity and how this affects asset prices in equilibrium. Using perceived macroeconomic un¬certainty as source of heterogeneity, the model helps to explain some patterns of financial returns, even if heterogeneity is small as suggested by survey data. The second essay determines conditions such that equilibrium prices have analytical solutions when investors have heterogeneous risk attitudes and macroeconomic fundamentals feature latent uncertainty. This approach provides additional in-sights to the previous literature where models require numerical solutions. The third chapter studies why equity claims (i.e. assets paying a single future dividend) feature premia and risk decreasing with the horizon, even if standard models imply the opposite shape. I show that labor relations helps to explain the puzzle. When workers have bargaining power to exploit partial income insurance within the firm, wages are smoother and dividends are riskier than in a standard economy. Distributional risk among workers and shareholders provides a rationale to the equity short-term risk, which leads to downward sloping term structures of premia and risk for equity claim. Résumé Cette thèse se compose de quatre essais dans l'évaluation des actifs d'équilibre. Le sujet principal est l'hétérogénéité des investisseurs: J'étudie les implications d'équilibre pour les marchés financiers où les investisseurs ont des attitudes différentes face au risque. Le première chapitre étudie pourquoi attendus risque et la rémunération sur le marché global sont liées négativement, même si l'intuition et la théorie standard suggèrent une relation positive. Je montre que le compromis négatif peut obtenir en équilibre si les croyances des investisseurs sur les fondamentaux économiques sont procyclique biaisées et le ratio de Sharpe du marché est anticyclique. Je vérifier que ces conditions sont réalisées dans les marchés réels et je trouve un appui empirique à la dynamique risque-rendement prédites par le modèle. Le deuxième chapitre se compose de deux essais. Le première essai étudie com¬ment hétérogénéité dans les préférences de risque inter agit avec d'autres sources d'hétérogénéité et comment cela affecte les prix des actifs en équilibre. Utili¬sation de l'incertitude macroéconomique perù comme source d'hétérogénéité, le modèle permet d'expliquer certaines tendances de rendements financiers, même si l'hétérogénéité est faible comme suggéré par les données d'enquête. Le deuxième essai détermine des conditions telles que les prix d'équilibre disposer de solutions analytiques lorsque les investisseurs ont des attitudes des risques hétérogènes et les fondamentaux macroéconomiques disposent d'incertitude latente. Cette approche fournit un éclairage supplémentaire à la littérature antérieure où les modèles nécessitent des solutions numériques. Le troisième chapitre étudie pourquoi les equity-claims (actifs que paient un seul dividende futur) ont les primes et le risque décroissante avec l'horizon, mme si les modèles standards impliquent la forme opposée. Je montre que les relations de travail contribue à expliquer l'énigme. Lorsque les travailleurs ont le pouvoir de négociation d'exploiter assurance revenu partiel dans l'entreprise, les salaires sont plus lisses et les dividendes sont plus risqués que dans une économie standard. Risque de répartition entre les travailleurs et les actionnaires fournit une justification à le risque à court terme, ce qui conduit à des term-structures en pente descendante des primes et des risques pour les equity-claims.

The last taboo: A guide to dementia, sexuality, intimacy and sexual behaviour in care homes ILC-UK

The International Longevity Centre - UK��launched a new paper (Wednesday, 6th July 2011). The last taboo: A guide to dementia, sexuality, intimacy and sexual behaviour in care homes, provides care home workers and managers with information and practical advice on this complex, controversial and sensitive issue.The need for affection, intimacy and relationships for people with dementia in care homes has too often been ignored and side-lined in policy and practice. The onset of old age or a cognitive impairment does not erase the need for affection, intimacy and/or relationships. While the issues involved can be complex, controversial and sensitive and may challenge our own beliefs and value system, it is essential that we understand more about them to foster a more person-centred approach to dementia care. Care home residents with dementia often have complex care needs and trying to understand and respond to the more intimate and sexual aspects of a resident’s personality can be challenging.Aimed at care home workers and managers, the guide not only provides essential information on this aspect of dementia care but offers practical advice to support current work-based practices. Set out in an accessible and easy-to-read format, this guide includes case studies, questions, suggestions and a self assessment quiz to promote easy learning. It also provides a possible pathway for care home managers to develop a guiding policy on sexual expression in dementia.The guide for care staff is summarised in 10 key points:1. Some residents with dementia will have sexual or sensual needs.2. Affection and intimacy contribute to overall health and wellbeing for residents.3. Some residents with dementia will have the capacity to make decisions about their needs.4. If an individual in care is not competent to decide, the home has a duty of care towards the individual to ensure they are protected from harm.5. There are no hard and fast rules. Assess each situation on an individual basis6. Remember not everyone with dementia is heterosexual.7. Inappropriate sexual behaviour is not particularly common in dementia.8. Confront your own attitudes and behaviour towards older people and sex generally.9. Communicate – look at how you can improve communication with your colleagues, managers, residents and carers on this subject10. Look after yourself and remember your own needs as a care professional��The full paper is available: The Last Taboo

Health Status of Gypsies and Travellers in England

Qualitative study into the effect of the attitudes, beliefs and lifestyles of Travellers and Gypsies on health inequality issues.