A comparison of final year undergraduate nursing students’ readiness for registration

The International Council of Nurses (2009) acknowledges that the perception : New Graduates are not prepared for the realities of practice nor do they have the competencies needed by current health care services...

Community Pharmacies and the Needs of Mobile EU Citizens - A study on Finns living in Spain

Migration within the European Union (EU) has increased since the Union was established. Community pharmacies provide open access to health care services and can be the first, most frequently used or even the only contact with a nation s health care system among mobile community residents. In some of the mass-migration areas in Southern Europe, most of the customers may represent mobile citizens of foreign background. This has not always been taken into consideration in the development of community pharmacy services. Mobile patients have been on the EU's health policy agenda, but they have seldom been mentioned in the context of community pharmacies. In most of the EU member states, governments control the specific legislation concerning community pharmacies and there is no harmonised pharmaceutical policy or consistent minimal standards for community pharmacy services in the EU. The aim of this study was to understand medication use, the role of community pharmacies and the symptom mitigation process of mobile community residents. Finns living in Spain were used as an example to examine how community pharmacies in a EU member state meet the needs of mobile community residents. The data were collected by a survey in 2002 (response rate 53%, n= 533) and by five focus group discussions in 2006 (n=30). A large number (70%) of the respondents had moved to Spain for health reasons and suffered from chronic morbidity. Community pharmacies had an important role in the healthcare of mobile community residents and the respondents were mostly satisfied with these services. However, several medication safety risks related to community pharmacy practices were identified: 1) Availability of prescription medicines without prescription (e.g., antibiotics, sleeping pills, Viagra®, asthma medications, cardiovascular medicines, psoriasis medicines and analgesics); 2) Irrational use of medicines (e.g., 41% of antibiotic users had bought their antibiotics without a prescription, and the most common reasons for antibiotic self-medication were symptomatic common colds and sore throats); 3) Language barriers between patients and pharmacy professionals; 4) Lack of medication counselling; 5) Unqualified pharmacy personnel providing pharmacotherapy. A fifth of the respondents reported experiencing problems during pharmacy visits in Spain, and the lack of a common language was the source of most of these problems. The findings of this study indicate that regulations and their enforcement can play a crucial role in actually assuring the rational and safe use of medicines. These results can be used in the development of pharmaceutical and healthcare policies in the EU. It is important to define consistent minimum standards for community pharmacy services in the EU. Then, the increasing number of mobile community residents could access safe and high quality health care services, including community pharmacy services, in every member state within the EU.

Transparency and ‘uncomfortable knowledge’ in child protection

Australia's child protection systems and the provision of out-of-home care, in particular, have been subject to sustained criticism for decades from dozens of official inquiries and reviews. It is now well established that many children in state care are treated significantly less well than required by relevant legal frameworks and community standards. Much attention and significant resources have been directed toward trying to ameliorate this ‘wicked problem’ and yet it continues. This article focuses on one reason the problems persists, namely the secrecy and closed cultures that characterize relevant organizations which reinforce strategies of denial that avoid acknowledging or dealing with ‘uncomfortable knowledge’. It is a situation many people in child protection systems confront. It is, for example, when we know abuse is taking place, or when they see or are ourselves party to corrupt or negligent practices. It is knowing that important ethical principles are being abrogated. We draw on recent official reports and inquiries noting the repeated calls for greater transparency and independent oversight. An argument is made for a default position of total transparency subject to caveats that protect privacy and any investigation underway. An account of what this can look like is offered.

Stalking and violence victimization among Finnish university students

This study examined the nature and lifetime prevalence of two types of victimization among Finnish university students: stalking and violence victimization (i.e. general violence). This study was a cross-sectional study using two different datasets of Finnish university students. The stalking data was collected via an electronic questionnaire and the violence victimization data was collected via a postal questionnaire. There were 615 participants in the stalking study (I-III) and 905 participants in the violence victimization study. The thesis consists of four studies. The aims regarding the stalking substudies (Studies I-III) were to examine the lifetime prevalence of stalking among university students and to analyze how stalking is related to victim and stalker characteristics and certain central variables of stalking (victim-stalker relationship, stalking episodes, stalking duration). Specifically, the aim was to identify factors that are associated with stalking violence and to factors contributing to the stalking duration. Furthermore, the aim was also to investigate how university students cope with stalking and whether coping is related to victim and stalker background characteristics and to certain other core variables (victim-stalker relationship, stalking episodes, stalking duration, prior victimization, and stalking violence). The aims for the violence victimization substudy (Study IV) were to examine the prevalence of violence victimization, i.e. general violence (minor and serious physical violence and threats) and how violence victimization is associated with victim/abuser characteristics, symptomology, and the use of student health care services. The present study shows that both stalking and violence victimization (i.e. general violence) are markedly prevalent among Finnish university students. The lifetime prevalence rate for stalking was 48.5% and 46.5% for violence victimization. When the lifetime prevalence rate was restricted to violent stalking and physical violence only, the prevalence decreased to 22% and 42% respectively. The students reported exposure to multiple forms of stalking and violence victimization, demonstrating the diversity of victimization among university students. Stalking victimization was found to be more prevalent among female students, while violence victimization was found to be more prevalent among male students. Most of the victims of stalking knew their stalkers, while the offender in general violence was typically a stranger. Stalking victimization often included violence and continued for a lengthy period. The victim-stalking relationship and stalking behaviors were found to be associated with stalking violence and stalking duration. Based on three identified stalking dimensions (violence, surveillance, contact seeking), the present study found five distinct victim subgroups (classes). Along with the victim-stalker relationship, the victim subgroups emerged as important factors contributing to the stalking duration. Victims of violent stalking did not differ greatly from victims of non-violent stalking in their use of behavioral coping tactics, while exposure to violent stalking had an effect on the use of coping strategies. The victim-offender relationship was also associated to a set of symptoms regarding violence victimization. Furthermore, violence victimization had a significant main effect on specific symptoms (mental health symptoms, alcohol consumption, symptom index), while gender had a significant main effect on most symptoms, yet no interaction effect was found. The present results also show that victims of violence are overrepresented among frequent health care users. The present findings add to the literature on the prevalence and nature of stalking and violence victimization among Finnish university students. Moreover, the present findings stress the importance of violence prevention and intervention in student health care, and may be used as a guideline for policy makers, as well as health care and law enforcement professionals dealing with youth violence prevention.

Kumppanuus on tiiviimpää kuin yhteistyö : Maahanmuuttajataustaisten vanhempien näkemyksiä kasvatuskumppanuudesta

The main idea of this study was to find out how immigrants understand and define successful co-operation and professional partnership in early childhood education. Another target of this research was to think over how the parents see professional partnership from their viewpoint, and how willing / ready the they are in engaging in the professional partnership with the day care personnel. The theoretical part of this research is based on theories of immigration and theories of it s different forms, theories of cultural varieties and theory of modernizing co-operation through using professional partnership. Also guidelines and policies for day care and early childhood education play a part in the theory section. Theory part is written to support research problems. The research method used in this study is peer interview. The interviewed are both immigrants and customers of day care services. The data collected is comprised of materials from peer interviews and personal background information. The interviewed were of Somalia and Russian ethnic groups. Interview were carried out in each group in the participants own mother tongue. These peer interviews showed that parents were interested and willing to discuss professional partnership. From this research one can conclude that the term professional partnership is seen as a complex term, and as a term difficult to understand. From the results it is seen that quite often the principles of professional partnership are not carried out in practise. According to the material gathered, the parents feel that lack of common language and prejudice against immigrants effectively prevents the professional partnership from being formed. The cultural differences can become challenging in a professional partnership. Based on this research, one can conclude that when different cultures meet, there has to be mutual will to understand and to be understood in order to make sure that the children s development, both educational and physical, is supported in a best possible way.

Early Childhood teachers’ work in a time of change

This article investigates teacher decision-making in a time of rapid educational reforms. Institutional ethnography is used to discover how teachers’ work is co-ordinated by the texts of a new national curriculum, and a system for the assessment and ratings of kindergarten, preschool and long day-care services in individual settings and across sites. The research draws on video recorded interview data gathered from five teachers working with three to five year old children in kindergarten classrooms throughout South East Queensland. Analysis shows the reported effects of policy regimes designed to improve the quality of learning young children experience, on classroom teachers’ work. Findings suggest that increasing levels of governance enacted through policy texts are creating an audit culture where teachers’ educational work with children is changing. The article argues that the reported workload associated with the production of evidence, and the focus on providing ‘proof’ of quality, is taking teachers away from time spent building educative relationships with children. Note: In Queensland, kindergarten caters for children aged three and a half to five years. This year is known as Preschool in some Australian states.

Improved wound management at lower costs: A sensible goal for Australia

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Depression, Anxiety, Psychiatric Comorbidity and Dimensions of Temperament and Personality

This study is part of the Mood Disorders Project conducted by the Department of Mental Health and Alcohol Research, National Public Health Institute, and consists of a general population survey sample and a major depressive disorder (MDD) patient cohort from Vantaa Depression Study (VDS). The general population survey study was conducted in 2003 in the cities of Espoo and Vantaa. The VDS is a collaborative depression research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute and the Department of Psychiatry of the Peijas Medical Care District (PMCD) beginning in 1997. It is a prospective, naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) MDD. In the general population survey study, a total of 900 participants (300 from Espoo, 600 from Vantaa) aged 20 70 years were randomly drawn from the Population Register Centre in Finland. A self-report booklet, including the Eysenck Personality Inventory (EPI), the Temperament and Character Inventory Revised (TCI-R), the Beck Depression Inventory and the Beck Anxiety Inventory was mailed to all subjects. Altogether 441 participants responded (94 returned only the shortened version without TCI-R) and gave their informed consent. VDS involved screening all patients aged 20-60 years (n=806) in the PMCD for a possible new episode of DSM-IV MDD. 542 consenting patients were interviewed with a semi-structured interview (the WHO Schedules for Clinical Assessment in Neuropsychiatry, version 2.0). 269 patients with a current DSM-IV MDD were included in the study and further interviewed with semi-structured interviews to assess all other axis I and II psychiatric diagnoses. Exclusion criteria were DSM-IV bipolar I and II, schizoaffective disorder, schizophrenia or another psychosis, organic and substance-induced mood disorders. In the present study are included those 193 (139 females, 54 males) individuals who could be followed up at both 6 and 18 months, and their depression had remained unipolar. Personality was investigated with the EPI. Personality dimensions associated not only to the symptoms of depression, but also to the symptoms of anxiety among general population and in depressive patients, as well as to comorbid disorders in MDD patients, supporting the dimensional view of depression and anxiety. Among the general population High Harm Avoidance and low Self-Directedness associated moderately, whereas low extraversion and high neuroticism strongly with the depressive and anxiety symptoms. The personality dimensions, especially high Harm Avoidance, low Self-Directedness and high neuroticism were also somewhat predictive of self-reported use of health care services for psychiatric reasons, and lifetime mental disorder. Moreover, high Harm Avoidance associated with a family history of mental disorder. In depressive patients, neuroticism scores were found to decline markedly and extraversion scores to increase somewhat with recovery. The predictive value of the changes in symptoms of depression and anxiety in explaining follow-up neuroticism was about 1/3 of that of baseline neuroticism. In contrast to neuroticism, the scores of extraversion showed no dependence on the symptoms of anxiety, and the change in the symptoms of depression explained only 1/20 of the follow-up extraversion compared with baseline extraversion. No evidence was found of the scar effect during a one-year follow-up period. Finally, even after controlling for symptoms of both depression and anxiety, depressive patients had a somewhat higher level of neuroticism (odds ratio 1.11, p=0.001) and a slightly lower level of extraversion (odds ratio 0.92, p=0.003) than subjects in the general population. Among MDD patients, a positive dose-exposure relationship appeared to exist between neuroticism and prevalence and number of comorbid axis I and II disorders. A negative relationship existed between level of extraversion and prevalence of comorbid social phobia and cluster C personality disorders. Personality dimensions are associated with the symptoms of depression and anxiety. Futhermore these findings support the hypothesis that high neuroticism and somewhat low extraversion might be vulnerability factors for MDD, and that high neuroticism and low extraversion predispose to comorbid axis I and II disorders among patients with MDD.

A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial

Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications.

HIV outbreak among injecting drug users in Finland

An HIV outbreak among Finnish injecting drug users (IDUs) occurred in 1998. By the end of 2005, 282 IDUs were in-fected, most of them by recombinant virus CRF01_AE of HIV. After a rapid spread, the outbreak subsided, and the prevalence of HIV among IDUs remained low (<2%). The purpose of the study was to describe the outbreak in order to recognise factors that have influenced the spread and restriction of the outbreak, and thus to find tools for HIV preven-tion. Data on Finnish IDUs newly diagnosed HIV-positive between 1998 and 2005 was collected through interviews and patient documents. Study I compared markers of disease progression between 93 Finnish IDUs and 63 Dutch IDUs. In study II, geographical spread of the HIV outbreak was examined and compared with the spatial distribution of employed males. In study III, risk behaviour data from interviews of 89 HIV-positive and 207 HIV-negative IDUs was linked, and prevalence and risk factors for unprotected sex were evaluated. In study IV, data on 238 newly diagnosed IDUs was combined with data on 675 sexually transmitted HIV cases, and risk factors for late HIV diagnosis (CD4 cell count <200/µL, or AIDS at HIV diagnosis) were analysed. Finnish IDUs infected with CRF01_AE exhibited higher viral loads than did Amsterdam IDUs infected with subtype B, but there was no difference in CD4 development. The Finnish IDU outbreak spread and was restricted socially in a marginalised IDU population and geographically in areas characterised by low proportions of employed males. Up to 40% of the cases in the two clusters outside the city centre had no contact with the centre, where needle exchange services were available since 1997. Up to 63% of HIV-positive and 80% of HIV-negative sexually active IDUs reported inconsistent condom use, which was associated with steady relationships and recent inpatient addiction care. Com-pared to other transmission groups, HIV-positive IDUs were diagnosed earlier in their infection. The proportion of late diagnosed HIV cases in all transmission groups was 23%, but was only 6% among IDUs diagnosed during the first four years of the epidemic. The high viral load in early HIV infection may have contributed to the rapid spread of recombinant virus in the Finnish outbreak. The outbreak was restricted to a marginalised IDU population, and limited spatially to local pockets of pov-erty. To prevent HIV among IDUs, these pockets should be recognised and reached early through outreach work and the distribution of needle exchange and other prevention activities. To prevent the sexual transmission of HIV among IDUs, prevention programmes should be combined with addiction care services and targeted at every IDU. The early detection of the outbreak and early implementation of needle exchange programmes likely played a crucial role in re-versing the IDU outbreak.

Hospital social work in Australia: Emerging trends or more of the same?

Social work in health care has been established for more than 100 years and is one of the largest areas of practice for social workers. Over time, demographic changes and growth in the aging population, increased longevity rates, an explosion in rates of chronic illness together with rapidly increasing cost of health care have created serious challenges for acute hospitals and health social workers. This article reviews the Australian health care system and policies with particular emphasis on the public hospital system. It then examines current hospital social work roles, including the continued role in discharge planning and expanding responsibility for emerging client problems, such as patient complexity, legal, and carer issues. The article concludes with a discussion of evolving issues and challenges facing health social work to ensure that social work remain relevant within this practice context.

Information Technology Development Needs in Community Pharmacies : A Strategic Approach

In the context of health care, information technology (IT) has an important role in the operational infrastructure, ranging from business management to patient care. An essential part of the system is medication management in inpatient and outpatient care. Community pharmacists strategy has been to extend practice responsibilities beyond dispensing towards patient care services. Few studies have evaluated the strategic development of IT systems to support this vision. The objectives of this study were to assess and compare independent Finnish community pharmacy owners and staff pharmacists priorities concerning the content and structure of the next generation of community pharmacy IT systems, to explore international experts visions and strategic views on IT development needs in relation to services provided in community pharmacies, to identify IT innovations facilitating patient care services and to evaluate their development and implementation processes, and to assess community pharmacists readiness to adopt innovations. This study applied both qualitative and quantitative methods. A qualitative personal interview of 14 experts in community pharmacy services and related IT from eight countries and a national survey of Finnish community pharmacy owners (mail survey, response rate 53%, n=308), and of a representative sample of staff pharmacists (online survey, response rate 22%, n=373) were conducted. Finnish independent community pharmacy owners gave priority to logistical functions but also to those related to medication information and patient care. The managers and staff pharmacists have different views of the importance of IT features, reflecting their different professional duties in the community pharmacy. This indicates the need for involving different occupation groups in planning the new IT systems for community pharmacies. A majority of the international experts shared the vision of community pharmacy adopting a patient care orientation; supported by IT-based documentation, new technological solutions, access to information, and shared patient data. Community pharmacy IT innovations were rare, which is paradoxical because owners and staff pharmacists perception of their innovativeness was seen as being high. Community pharmacy IT systems development processes usually had not undergone systematic needs assessment research beforehand or evaluation after the implementation and were most often coordinated by national governments without subsequent commercialization. Specifically, community pharmacy IT developments lack research, organization, leadership and user involvement in the process. Those responsible for IT development in the community pharmacy sector should create long-term IT development strategies that are in line with community pharmacy service development strategies. This could provide systematic guidance for future projects to ensure that potential innovations are based on a sufficient understanding of pharmacy practice problems that they are intended to solve, and to encourage strong leadership in research, development of innovations so that community pharmacists potential innovativeness is used, and that professional needs and strategic priorities will be considered even if the development process is led by those outside the profession.

La souffrance émotionnelle des personnels d’intervention : résultats préliminaires de l’étude sur la santé et la qualité de vie au travail dans les métiers du secteur de l’aide et du soin à domicile

Resumen: La prolongación de la edad y el aumento de la expectativa de vida han hecho surgir nuevas necesidades de atención para las personas ancianas y ello ha inducido a la ampliación de las prestaciones de servicios a domicilio. En este sentido, el trabajo de estos profesionales de intervención a domicilio, así como sus misiones, están en plena mutación. Es un sector con dificultades, debido a la dificultad de reclutar un personal especializado y al absentismo inquietante. Después de un análisis sobre el estado de este sector de la profesión en el que se establece la diferencia entre el enfoque físico y el psicológico sobre la salud, nuestra reflexión se centra en los riesgos psicosociales de esta población de profesionales. Se presentan los resultados preliminares de la investigación realizada con una muestra de 38 personas que ejercían laboralmente en este sector. Emerge la expresión de un sufrimiento emocional, en la que el aislamiento de los participantes es uno de los factores que caracterizan los oficios identificados con una fuerte dimensión relacional con personas vulnerables. La dimensión asistencial del trabajo se presenta como fuente de satisfacción del oficio pero, a su vez, puede conducir a una dificultad de gestionar acontecimientos no previstos

Skill premium effects on fertility and female labor force supply

Published as an article in: Journal of Population Economics, 2004, vol. 17, issue 1, pages 1-16.

Revisión sistemática sobre las preferencias del lugar de muerte de los pacientes en fase final de la vida

Objetivo general:Recopilar y sintetizar la información sobre estado actual de las preferencias del lugar de la muerte de los pacientes en fase final de la vida. Metodología:Dos estrategias fueron utilizadas para la selección de la información congruente para el trabajo. En primer lugar, desde el mes de octubre hasta finales del mes de diciembre del año 2013 se realizaron búsquedas en las siguientes bases de datos: Web of Science, Medline, Pubmed, Scopus, La Biblioteca Cochrane plus y Cuiden y posteriormente se realizó una búsqueda en el catálogo de la biblioteca “Encore” de la Universidad del País Vasco. La evaluación de calidad de los estudios se realizó utilizando programas CASPe y Fichas de Lectura Critica 2.O. Conclusión:Gran parte de la gente prefiere morir en sus casas, pero hay otros que cambian sus preferencias a lo largo del curso de la enfermedad o simplemente su preferencia es diferente. Conocer las voluntades y las preferencias de los pacientes en fase Terminal de la vida es una tarea primordial en la atención en dicha fase.