A Study of a Staff Alcohol Policy in a Large Public Health Organisation, Looking at the Policy Content, the Policy Development and the Implementation Process, and the Policy Impact

There are different approaches to dealing with alcohol related problems in the workplace. A literature review indicates that two of the models that underpin programmes to deal with alcohol related problems in the workplace are the disease model and the health promotion model. The disease model considers alcoholism as an illness and uses curative techniques to restore the individual to sobriety. The health promotion model looks at the determinants of health and promotes changes in the environment and structures, which would support healthy behaviour in relation to alcohol. Employee Assistance Programmes (EAPs) may have elements of both theses models. Dealing with alcohol problems at work involves a captive audience and the workplace as a setting can be used to influence healthier lifestyles. A workplace alcohol policy is a mechanism through which alcohol related issues might be dealt with, and the necessary resources and commitment of managers and staff channelled to this end. The policy aims should be clear and unambiguous, and specific plans put in place for implementing all aspects of the policy. In the case of the alcohol policy in the organisation under study, the policy was underpinned by a health promotion ethos and the policy document reflects broad aims and objectives to support this. The steering group that oversaw the development of the policy had particular needs of their own which they brought to the development process. The common theme in their needs was how to identify and support employees with alcohol related problems within an equitable staff welfare system. The role of the supervisor was recognised as crucial and training was provided to introduce the skills needed for an early intervention and constructive confrontation with employees who had alcohol related problems. Opportunities provided by this policy initiative to deal with broader issues around alcohol and to consider the determinants of health in relation to alcohol were not fully utilised. The policy formalised the procedures for dealing with people who have alcohol related problems in an equitable and supportive manner. The wider aspect of the health promotion approach does not appear to have been a priority in the development and implementation of the policy.This resource was contributed by The National Documentation Centre on Drug Use.

Report of an audit of child protection research in Ireland 1990-2009.

A total of 190 research documents were identified in line with the criteria agreed between the researchers and the CAAB, and are included in the audit. The key findings from the analysis of the audit are as follows:    - Research identified in the audit has tended to focus on child protection and the child protection system generally, as well as sexual abuse. This research has primarily been undertaken by clinicians and academics, and spans across sectors.   - Over half, (110 or 58%) of the research falls under the heading of policy/practice reviews/analysis. This is further reflected in the fact that the research most commonly focused on operating procedures, followed by practice issues and the policy framework, both in studies with a single focus and those with multiple foci.   - The most common type of publication was peer reviewed article (74 or 39%), with commissioned research accounting for just 7% (13). This is in line with the findings that 68% (128) of commissioning/publishing bodies and 74% (139) of research bodies were in the academic sector.   - The research published and/or commissioned by the statutory sector follows the pattern found in the audit generally, with the most common type of study being policy/practice review/analysis (27 or 48%) and the most common focus being operating procedures (22 or 39%).   - Information sources rarely incorporated primary research with children, with only 14 studies (8%) citing direct contact with children and young people. Information on children was more commonly gathered from case files, professionals and family members.   - The topics covered in the identified research were very wide-ranging but closely related to the primary subject area (type of abuse) and the sector in which the research was located.   One conclusion stated that: There is a shortage of child protection-focused research on the factors that cause and perpetuate child abuse, such as homelessness, addiction, parental mental illness and domestic violence. The need for material on these areas is demonstrated by the nature and scale of reports to the child protection system and the removal of some children from their families into out of home care as a result of the above mentioned adversities.This resource was contributed by The National Documentation Centre on Drug Use.

Pluralized life courses? An exploration of the life trajectories of individuals with psychiatric disorders.

BACKGROUND: : Most of the existing research relating to the life courses of people with psychiatric symptoms focuses on the occurrence and the impact of non-normative events on the onsets of crises; it usually disregards the more regular dimensions of life, such as work, family and intimate partnerships that may be related to the timing and seriousness of psychiatric problems. An additional reason for empirically addressing life trajectories of individuals with psychiatric problems relates to recent changes of family and occupational trajectories in relation to societal trends such as individualization and pluralization of life courses.¦AIM: : This paper explores the life trajectories of 86 individuals under clinical supervision and proposes a typology of their occupational, co-residence and intimacy trajectories. The results are discussed in light of the life-course paradigm.¦METHOD: : A multidimensional optimal matching analysis was performed on a sample of 86 individuals under clinical supervision to create a typology of trajectories. The influence of these trajectories on psychiatric disorders, evaluated using a SCL-90-R questionnaire, was then assessed using linear regression modelling.¦RESULTS: : The typologies of trajectories showed that the patients developed a diversity of life trajectories. Individuals who have developed a standard life course with few institutionalization periods reported more symptoms and distress than individuals with an institutionalized life trajectory.¦CONCLUSION: : The results of this study stress that psychiatric patients are social actors who are influenced by society at large and its ongoing process of change. Therefore, it is essential to take into account the diversity of occupational and family trajectories when dealing with individuals in therapeutic settings.

CARDI Research Brief: Medication use in patients with dementia at the end of life

��Palliative care and medication use are important issues in dealing with end-of-life stage dementia. As research into palliative care for patients with advanced dementia has been limited to date, CARDI funded a project, led by Dr. Carole Parsons of Queen’s University Belfast, as part of its grants programme. This project aimed to evaluate the extent to which patient-related factors influenced clinical decision-making with regard to medication use in patients with endstagedementia. This research brief presents a summary of the findings from the full report, Assessment of factors which influence physician decisionmaking regarding medication use in patients with dementia at the end of life (Parsons, et al., 2012).Read the research brief here: Medication use in patients with dementia at the end of lifeRead the press release here

Analysis of antenal sensilla patterns of Rhodnius prolixus from Colombia and Venezuela

Antennal sensilla patterns were used to analyze population variation of domestic Rhodnius prolixus from six departments and states representing three biogeographical regions of Colombia and Venezuela. Discriminant analysis of the patterns of mechanoreceptors and of three types of chemoreceptors on the pedicel and flagellar segments showed clear differentiation between R. prolixus populations east and west of the Andean Cordillera. The distribution of thick and thin-walled trichoids on the second flagellar segment also showed correlation with latitude, but this was not seen in the patterns of other sensilla. The results of the sensilla patterns appear to be reflecting biogeographic features or population isolation rather than characters associated with different habitats and lend support to the idea that domestic R. prolixus originated in the eastern region of the Andes.

Cope with Confidence - survey of heart failure patient experience

Your views matter - if you have heart failure, or are close to someone who does, please complete our survey by 31st�March 2012 (link below).Heart failure is a common condition affecting at least 20,000 people in Northern Ireland. The aim of this survey is to find out how to increase the confidence of people living with heart failure so they have a better quality of life, and can work in partnership with health care professionals and support services in managing their condition. The findings of this survey will be used to help improve services.Your views are important and we would encourage you to complete the survey. It should only take around 20 minutes. Participation is confidential which means that your identity will not be revealed. You are asked for your age, the first part of you post code and which GP practice you are registered with. This is so the results for different age groups and for different large geographical areas (i.e. Health & Social Care Trust areas) can be compared.� Results will not be examined by individual GP practice.Participation is voluntary i.e. taking part in the study is your decision. Whether you participate or not will have no effect on the medical care you receive from your GP practice or elsewhere. None of the health care professionals involved in your care will know if you participate or not: neither will they see your individual response.Whether you are an adult or a young person living with heart failure, or a partner, care giver, son, daughter, relative or friend, we would like you to share your experiences. This will help us to develop existing services in Northern Ireland to better meet your needs.You can share your experience by completing the survey online, clicking this�link:�http://sg.sensemaker-suite.com/CopewithconfidenceThe survey should be completed by 31st�March 2012.�If you have any queries about the survey, or you would like to request a paper copy to complete, please contact the Public Health Agency (028) 9032 1313 and ask for extension 2487 or email us at copewithconfidence@hscni.netPlease note that the survey team can only assist in survey related questions and will not able to answer questions about heart failure, its treatment or services provided.The Northern Ireland Chest Heart & Stroke Association and The British Heart Foundation can provide information about support available to people with heart failure. Their contact details are:.�Northern Ireland Chest Heart and Stroke Association:� www.nichsa.com, telephone (028) 9032 0184.�British Heart Foundation:� www.bhf.org.uk, telephone 0300 330 3311

Steps to deal with stress - A simple guide to stressing less and enjoying life more

The Steps to deal with stress booklet provides tips and practical advice on coping with stress in your life and covers recognizing stress, getting ready, coping better, learning from bad experiences and taking action now. Simple steps such as relaxation exercises and talking to someone can help you feel better and put you in a better frame of mind for dealing with your problems.

Association of the presence of residual anti-Toxoplasma gondii IgM in pregnant women and their respective family groups in Miracema, Northwest Rio de Janeiro, Brazil

The seroprevalence of toxoplasmosis in 832 pregnant women in Miracema, Rio de Janeiro, was determined and 75.1% (625) and 2.0% (17) were anti-Toxoplasma gondii IgG and IgM positive, respectively. Out of the 17 IgM positive pregnant women, only one had low avidity IgG corresponding to the acute phase of the infection. All the other women presented with high avidity IgG and also presented with residual IgM anti-T. gondii. Of this sample, 106 received home visits (this includes 11 family nuclei of pregnant women with residual IgM anti-T. gondii, 68 nuclei of only IgG positive pregnant women and 27 nuclei of pregnant women with no antibodies to anti-T. gondii), resulting in 267 individuals visited. Out of these 267 individuals, 21 were positive for IgG and IgM anti-T. gondii and were candidates for the IgG avidity test. All of them presented with high avidity IgG and residual IgM. Five of these IgM+ individuals were (5/238; 2.1%) relatives of IgM negative pregnant women. The other 16 (16/29; 55.2%) were relatives of IgM+ pregnant women who were positive for residual IgM anti-T. gondii. This association was statistically significant (p = 0.0000). The analysis presented herein raises questions regarding the presence of residual IgM anti-T. gondii such as genetic determinants or even constant antigenic stimuli for the same family cluster.

The association of education with body mass index and waist circumference in the EPIC-PANACEA study

Background To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC). Method This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models. Results Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m2 lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m2). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm. Conclusion In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.

Validation of the Spanish version of the Index of Spouse Abuse

Background: Partner violence against women is a major public health problem. Although there are currently a number of validated screening and diagnostic tools that can be used to evaluate this type of violence, such tools are not available in Spain. The aim of this study is to analyze the validity and reliability of the Spanish version of the Index of Spouse Abuse (ISA). Methods: A cross-sectional study was carried out in 2005 in two health centers in Granada, Spain, in 390 women between 18 and 70 years old. Analyses of the factorial structure, internal consistency, test-retest reliability, and construct validity were conducted. Cutoff points for each subscale were also defined. For the construct validity analysis, the SF-36 perceived general health dimension, the Rosenberg Self-Esteem Scale and the Goldberg 12-item General Health Questionnaire were included. Results: The psychometric analysis shows that the instrument has good internal consistency, reproducibility, and construct validity. Conclusions: The scale is useful for the analysis of partner violence against women in both a research setting and a healthcare setting

Enquête préliminaire et évaluation de la satisfaction globale des soins dans une structure ambulatoire psychiatrique pour enfants et adolescents

The complexity and difficulty of assessing psychiatric care for children and adolescents is a widely accepted reality. However, this should not discourage necessary efforts to stress the richness and efficiency of clinical practices, regardless of their theoretical models. We present the results of a quality-like survey addressing patient satisfaction and therapeutic alliance conducted in 2007 in an outpatient ward of the department of psychiatry for children and adolescents of the University of Lausanne (Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent - SUPEA, Lausanne). We developed a questionnaire on the basis of a "traditional" patient satisfaction survey, consisting of questions dealing with a range of different types of ambulatory settings and evaluating: access to care, quality of reception, patient's perception of the type of care and support offered, the therapeutic alliance and global satisfaction. Questions regarding the therapeutic alliance were based on the Revised Help Alliance Questionnaire (HAQ-II, Lester Luborski). Questionnaires were anonymous and self-administered by children from 10 years old up and parents separately. High levels of global satisfaction were reported (80% satisfied or very satisfied). Certain specific aspects seem to influence the global satisfaction level and therapeutic alliance. Patients with self-reported anxiety problems were less satisfied than those with selfreported conduct problems. The mode of reference of the patient, self or by parents versus by school or social workers, affected the perceived alliance. A higher frequency of sessions was also related to a better perceived alliance and satisfaction.

Effects of social support on the clinical course of Crohn's disease.

BACKGROUND: Social support has been found to be protective from adverse health effects of psychological stress. We hypothesized that higher social support would predict a more favorable course of Crohn's disease (CD) directly (main effect hypothesis) and via moderating other prognostic factors (buffer hypothesis). METHODS: Within a multicenter cohort study we observed 597 adults with CD for 18 months. We assessed social support using the ENRICHD Social Support Inventory. Flares, nonresponse to therapy, complications, and extraintestinal manifestations were recorded as a combined endpoint indicating disease deterioration. We controlled for several demographic, psychosocial, and clinical variables of potential prognostic importance. We used multivariate binary logistic regression to estimate the overall effect of social support on the odds of disease deterioration and to explore main and moderator effects of social support by probing interactions with other predictors. RESULTS: The odds of disease deterioration decreased by 1.5 times (95% confidence interval [CI]: 1.2-1.9) for an increase of one standard deviation (SD) of social support. In case of low body mass index (BMI) (i.e., 1 SD below the mean or <19 kg/m(2)), the odds decreased by 1.8 times for an increase of 1 SD of social support. In case of low social support, the odds increased by 2.1 times for a decrease of 1 SD of BMI. Low BMI was not predictive under high social support. CONCLUSIONS: The findings suggest that elevated social support may favorably affect the clinical course of CD, particularly in patients with low BMI. (Inflamm Bowel Dis 2010;).

Quantitative ultrasound of bone in institutionalized elderly women: a cross-sectional and longitudinal study.

Quantitative ultrasound of bone is a promising method for bone assessment: radiation-free, portable and predictive of hip fracture. Its portability allowed us to study the relationships between ultrasonic parameters of bone with age and with non-vertebral fractures in elderly women living in 19 nursing homes. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the calcaneus were measured (and the stiffness index calculated) in a sample of 270 institutionalized women, aged 85 +/- 7 years, using an Achilles bone densitometer (Lunar). The effects of age, history of non-vertebral and non-traumatic fractures, body mass index, triceps skinfold and arm circumference were assessed on BUA, SOS and stiffness index. Furthermore, to evaluate longitudinally the influence of aging on the ultrasound parameters of bone, 60 subjects from the same group had a second ultrasound measurement after 1 year. The cross-sectional analysis of the data on all 270 women showed a significant decrease (p < 0.001) with age in BUA, SOS and stiffness index (-0.47%, -0.06%, and -1.01% respectively per year). In the 94 women, (35%) with a history of previous non-vertebral fractures, ultrasound parameters were significantly lower (p < 0.0001) than in the 176 women with no history of fracture (-8.3% for BUA, -1.3% for SOS, -18.9% for stiffness index). In contrast, there was no significant difference in anthropometric measurements between the groups with and without previous non-vertebral fractures, although the measurements decreased significantly with age. In the longitudinal study, repeated quantitative ultrasound after 11.4 +/- 0.8 months showed no significant decrease in BUA (-1%) but a significant decrease in SOS (-0.3%, p < 0.0001) and in stiffness index (-3.6%, p < 0.0002). In conclusion, quantitative ultrasound of the calcaneus measures properties of bone which continue to decline in institutionalized elderly women, and is able to discriminate women with previous non-vertebral fractures.

New clinical practice guideline on enteral feeding in very low birth wieght infants; second part

INTRODUCTION: The nutrition of very low birth weight (VLBW) infants is aimed at promoting a similar growth to that occurring in the uterus. However, in practice this is difficult to achieve and extrauterine growth restriction is frequent. The current tendency is to avoid this restriction by means of early parenteral and enteral nutrition. Nonetheless, uncertainty about many of the practices related with nutrition has resulted in a great variation in the way it is undertaken. In 2009 and 2011 in our hospital there was an unexpected increase in necrotizing enterocolitis. To check to see wether our nutrition policy was involved, we underlook a systematic review and drewup clinical practice guidelines (CPG) about enteral feeding in VLBW infants. New considerations about the duration of the fortification and the use of probiotics have led to an update of these CPG. METHODS: A total of 21 clinical questions were designed dealing with the type of milk, starting age, mode of administration, rate and volume of the increments, fortification, use of probiotics and protocol. Afete conducting a systematic search of the available evidence, the information was contrasted and summarized in order to draw up the recommendations. The quality of the evidence and the strength of the recommendations were determined from the SIGN scale. COMMENT: These CPG aim to help physicians in their decision making. The protocolized application of wellproven measurements reduces the variation in clinical practice and improves results.

16 días de activismo contra la violencia de género: pintando de naranja nuestro mundo

Boletín semanal para profesionales sanitarios de la Secretaría General de Calidad, Innovación y Salud Pública de la Consejería de Igualdad, Salud y Políticas Sociales