Detecting and measuring deprivation in primary care: development, validity and reliability of a self-reported questionnaire - the DiPCare-Q

Background: General practitioners play a central role in taking deprivation into consideration when caring for patients in primary care. Validated questions to identify deprivation in primary-care practices are still lacking. For both clinical and research purposes, this study therefore aims to develop and validate a standardized instrument measuring both material and social deprivation at an individual level. Methods: The Deprivation in Primary Care Questionnaire (DiPCare-Q) was developed using qualitative and quantitative approaches between 2008 and 2011. A systematic review identified 199 questions related to deprivation. Using judgmental item quality, these were reduced to 38 questions. Two focus groups (primary-care physicians, and primary-care researchers), structured interviews (10 laymen), and think aloud interviews (eight cleaning staff) assured face validity. Item response theory analysis was then used to derive the DiPCare-Q index using data obtained from a random sample of 200 patients who were to complete the questionnaire a second time over the phone. For construct and criterion validity, the final 16 questions were administered to a random sample of 1,898 patients attending one of 47 different private primary-care practices in western Switzerland (validation set) along with questions on subjective social status (subjective SES ladder), education, source of income, welfare status, and subjective poverty. Results: Deprivation was defined in three distinct dimensions (table); material deprivation (eight items), social deprivation (five items) and health deprivation (three items). Item consistency was high in both the derivation (KR20 = 0.827) and the validation set (KR20 = 0.778). The DiPCare-Q index was reliable (ICC = 0.847). For construct validity, we showed the DiPCare-Q index to be correlated to patients' estimation of their position on the subjective SES ladder (rs = 0.539). This position was correlated to both material and social deprivation independently suggesting two separate mechanisms enhancing the feeling of deprivation. Conclusion: The DiPCare-Q is a rapid, reliable and validated instrument useful for measuring both material and social deprivation in primary care. Questions from the DiPCare-Q are easy to use when investigating patients' social history and could improve clinicians' ability to detect underlying social distress related to deprivation.

Staff officers manual, 1958

This manual is a compilation of principles, procedures and information to be used as a guide by Iowa Civil Defense Directors, Commanders, Chairmen and their staffs.

08019-011 Staff Beaver Creek Final Report

Staff and Beaver Creeks are two tributaries of the Upper Iowa River (UIR). Additional acres that drain directly into the UIR bring the size of the project area to 41,328 acres. The goal of the project is to reduce sediment loading and excess nutrients from reaching the streams which ultimately reach the UIR. Staff/Beaver Water Quality Project initially received funding as part of the FY 2005 WSPF/319 grant application cycle. Tremendous progress has been accomplished towards the original goals of the project. Due to the large number of Best Management Practices (BMPs) installed and the continued high interest for those practices, more work remains to be done. The heavy rains received in 2008 caused severe erosion and has dramatically increased interest in conservation practices. A thorough watershed assessment was completed in the fall of 2008. Data from this assessment indicates additional work is needed. The initial grant funding will be exhausted within fiscal year 2009. Therefore, the Howard Soil and Water Conservation District is seeking 3 years of funding. The District believes interest in the water quality project is at an all time high and that with an additional three years of funding, even more progress can be achieved in reducing sediment delivery and excess nutrients to these priority streams.

Soins aux mineurs non accompagnés (MNA): l'expérience lausannoise [Caring for unaccompanied minors: an experience from Lausanne].

La prise en charge médicale du mineur non accompagné est complexe et nécessite la mise en place d'un réseau biopsychosocial. A Lausanne, l'Unité multidisciplinaire de santé des adolescents (UMSA) joue un rôle préventif et curatif pour cette population extrêmement vulnérable. Une prise en charge psychologique rapide est souvent nécessaire en raison des événements de vie dramatiques auxquels la plupart de ces adolescents ont été confrontés. L'absence de projet d'avenir pour la majorité de ces adolescents reste une entrave majeure à leur développement et à leur santé mentale et physique. Medical treatment of an unaccompanied minor is made more complicated firstly by its connections with the politics of immigration and secondly by the difficulty in gaining recognition of the priority of the minor's interests. Enabling healthcare teams to travel and meet these particularly vulnerable youths makes medical care more accessible to them and facilitates an optimal bio-psycho-social treatment. For most of these adolescents it is their lack of plans for the future which remains the major obstacle to their development and mental and physical health.

¿Por qué los estudiantes participan poco en la gestión de la universidad? La opinión del profesorado = Why do students participate so little in the management of the university? The opinion of the teaching staff

El artículo invita a reflexionar sobre la participación de los estudiantes en la gestión y el gobierno de la universidad a partir de una investigación. Se centra en la opinión y percepción que el profesorado implicado directamente en la gestión de la docencia tiene sobre esta participación. Se aportan datos relevantes que ayudan a disponer de una visión más completa de un fenóneno complejo y multidimensional como es la participación estudiantil. Sus interpretaciones nos ofrecen información significativa que contribuye a comprender algunas de las causas de la baja participación y nos orienta hacia las posibles estrategias a emprender para intentar invertir esta tendencia

Introducing online teaching in Humanities: A case study about the acceptance of online activities by the academic staff of classical languages

The purpose of this paper is to show the perceptions of the academic staff of classical languages (ancient Greek and Latin) concerning use of online activities during their courses. The study was carried out in three countries: Greece (three major Universities), Spain (University of Barcelona) and the United States (University of California, Berkeley) with the participation of thirty-three academic instructors. Depending on the level of use and acceptance of the ICT and following G. Moore¿s classification, we separated the participating academics in three groups: the conservatives, the mainstream and the early adopters. The fact that the smallest group is the third clearly shows the necessity for teachers¿ preparation and training before introducing innovative projects in the classroom. Since the starting point for the application of innovation in the classroom is the teacher, policy makers should focus on helping them become conscious of changes in teaching methods and include their opinion during the design of innovative projects.

Introducing online teaching in Humanities: A case study about the acceptance of online activities by the academic staff of classical languages

The purpose of this paper is to show the perceptions of the academic staff of classical languages (ancient Greek and Latin) concerning use of online activities during their courses. The study was carried out in three countries: Greece (three major Universities), Spain (University of Barcelona) and the United States (University of California, Berkeley) with the participation of thirty-three academic instructors. Depending on the level of use and acceptance of the ICT and following G. Moore¿s classification, we separated the participating academics in three groups: the conservatives, the mainstream and the early adopters. The fact that the smallest group is the third clearly shows the necessity for teachers¿ preparation and training before introducing innovative projects in the classroom. Since the starting point for the application of innovation in the classroom is the teacher, policy makers should focus on helping them become conscious of changes in teaching methods and include their opinion during the design of innovative projects.

Att förstå det stora i det lilla : byskolan som pedagogik, kultur och struktur

I det lilla sammanhanget synliggörs de stora frågorna om både pedagogik, kultur och struktur och om samverkan mellan dem. Studiet av de minsta enheterna i den finländska utbildningen ger kunskap om det viktiga i pedagogiska relationer och i skolgemenskaper, men synliggör också samhällsskeendets inbyggda konflikter om mål och värderingar. Det övergripande syftet med studien är att fördjupa kunskapen om de små skolornas pedagogiska, kulturella och strukturella innebörd och betingelser. Genom djupintervjuer med 12 finlandssvenska lärare i byskolor med färre än 30 elever, analys av skolindragningsdebatt och utbildningspolitiska styrdokument, samt genom teoretiskt förankrade reflektioner skapas en förståelse av såväl lärares arbete och pedagogiska tänkande som skolans funktion i samhället. Avhandlingen byggs upp enligt ett hermeneutiskt och narrativt tänkande. I studien framkommer att byskollärares pedagogiska tänkande syftar till det enskilda barnets optimala och balanserade helhetsutveckling i en gemenskap, där det är centralt att finna den pedagogiska balansen och möjligheten inom kontinuum mellan bl.a. elevbemyndigande och beledsagande. De pedagogiska intentionerna bär syftet att ge rötter och vingar, samhörighet och frihet. I lärarnas beskrivningar uttrycks en sammanvävning mellan deras pedagogiska intentioner och de kontextuella möjligheterna att realisera dessa. Byskollärarna är bärare av en pedagogisk professionalitet som utvecklas i relation till arbetets betingelser. Det praktiska yrkeskunnandet innefattar en balansgång mellan å ena sidan systematik och organisering och å andra sidan flexibilitet och frihet. Att samma lärare handhar eleverna en lång tid är en pedagogisk möjlighet och utmaning. I lärarnas berättelser aktualiseras vad balansgången i en god pedagogisk relation innebär. Både lärare och elever fostras in i en särskild skolkultur och undervisningskultur, i en växelverkan. Yrkeskulturen präglas av olika former av samverkan, både med skolans hela personal som ett teamarbete och med lokalsamhället. Lärarna uttrycker god arbetstrivsel, men friheten och ansvaret i arbetet kan vara både stimulerande och betungande. I en metaanalys skapas teoretiska modeller för vad arbete i närhetens och litenhetens spänningsfält kan innebära och hur det kan påverka lärares professionella utveckling och ork. Den lilla byskolan relaterad till en större samhällskontext öppnar för frågor om vad kvalitet innebär och vilka värderingar som är riktgivande inom utbildningsplanering. Kampen för kontinuiteten i byskolans berättelse tolkas som en kamp för det lokala rummet, för gemenskap, existens, framtid, likvärdighet och trygghet. Kampen för byskolan är ett försvar av både lokal livskvalitet och pedagogisk kvalitet för den enskilde eleven. I det övergripande kulturella sammanhanget synliggörs motsättningar. Det verkar finnas en inbyggd konflikt i utbildningsplaneringens föresatser att samtidigt uppnå jämlikhet, kostnadseffektivitet och kvalitet. En teoretisk modell synliggör hur pedagogik, kultur och struktur samverkar inom utbildning/byskola och påverkar lärares och elevers handlingsutrymme.

Vårdande och icke-vårdande tröst

The aim of the thesis is, from a caring science perspective including a caring theology perspective, to illustrate the meaning of the phenomenon consolation and howconsolation relates to suffering and care. Two studies were completed where staff and elderly care receivers were interviewed and a third study focused on an analysis of consolation as it is presented in the Book of Job in the Old Testament. These studies deal with carers' experiences of consolation and consoling, elderly care receivers' experiences of consolation, and Job's experience of consolation. Phenomenology and hermeneutics form the basis for the methodological approach. A phenomenological- hermeneutic method, inspired by Paul Ricoeur, has been used for the text analyses. The thesis also covers significant aspects of poetical and religious texts. The metaphors that occur in the interview studies with the carers and the elderly are analysed in order to take care of the excess of meaning that, according to Ricoeur, can be expressed in metaphors. The result showfive overall meanings: The contradictory consolation, The bonding consolation, The mute and rigid consolation, The uncontrolled consolation and The restful consolation. A caring consolation is contradictory in the sense that it entails that the sufferer on the one hand passes on his or her suffering to someone else and on the other hand that the suffering can be returned to be suffered. Consolation can thus entail suffering. The bonding consolation is present, i.e. is with the sufferer and is based on that person's suffering. This consolation is characterised by a close fellowship, a feeling of being understood at a deeper level. The results also reveal a consolation that is mute and rigid. This consolation does not respond to the sufferer's experience of his or her suffering, is shapeless and therefore unable to follow the suffering. An example of a mute, rigid and non-caring consolation is the consolation of the friends in the Book of Job. This consolation is not capable of consoling because it does not correspond to where Job is, i.e. in his experience of his suffering. A caring consolation is also uncontrolled because it is on the one hand spontaneous and on the other hand helps the sufferer to lose control over the suffering. To lose control entails, amongst other things, the sufferer giving up trying to understand suffering and instead lets that which is incomprehensible be incomprehensible. A consoling and health-bringing rest in or from the struggle with suffering presents itself by giving up what in various ways is tied to the suffering. The result as a whole is interpreted from a caring science perspective with the following important concepts: caring relationship, faith, health and sacrifice. Consolation as health is considered on the basis of a theoretical model inspired by Katie Eriksson's ontological health model. The research is also illustrated from a philosophical-ethical perspective, mainly based on the work of Emmanuel Levinas. The findings are discussed in relation to previous research and also to caring science, society and care.

Generic and professional caring in a Chinese setting: an ethnopraphic study

The objective of the present study is to describe the cultural care practices, meanings, values and beliefs which form the basis of caring in a Chinese context. The research has its starting point in a caring science perspective and a qualitative research approach with interpretative ethnography as methodological guideline. The theoretical perspective is formed by elements of the theory of caritative caring, developed by Eriksson, and the theory of Culture Care Diversity and Universality, developed by Leininger. Previous research of suffering, culture and caring is described and also a presentation of actual transcultural nursing research as well as a presentation of the social structure dimensions of Chinese culture is included in the theoretical background. The empirical part includes patients and relatives, nurses and Hu Gongs as informants. The data collected are analysed based on Geertz’s idea of forming “thick descriptions” through examining the “what, how and why” of people’s actions. The findings show that the family has a prominent position in Chinese caring practices. The patient plays an unobtrusive role and a mutual dependence between the patient and the family members is evident. The professional nursing care is an extended act which includes the family in the caring relationship. The care practices of the Chinese nurse are characterized by great professional nursing skills. Suffering is described by the informants as being caused by disease, pain and social circumstances. “Social suffering” is described as worse than physical or mental suffering. Culturally competent and congruent care is a prerequisite for avoiding cultural pain, imposition and blindness when caring for the suffering human being. The findings of the present study necessitate a broadening in caring theory to include the family in the caring relationship. A further conclusion is that a broadening in our perception and understanding of culture would promote the delivery of culturally competent and congruent care. Suffering need to be seen as enclosed in cultural patterns of how it is expressed, interpreted, understood and relieved. Care and caring need to be seen as embedded in culture and the care practices values and beliefs have to be congruent with the cultural patterns where the care is provided.

An Infant with Food Allergy and Eczema in the Family – The Mental and Economic Burden of Caring

Allergic diseases including food allergy and eczema in an infant in combination with the everyday activities of caring for a family will pose challenges to parents. Only fragments of these challenges are revealed to health care professionals. Families have varying mental, social and economic resources to help them care for an allergic infant, and all such resources are important in determining how families succeed in meeting these challenges and the quality of the infant’s care. This study evaluated the whole burden to the family caused by an infant's allergic disease during the first 24 months of life. As the primary caregiver during this period is usually the mother, her perspective was considered important. Ecocultural theory, which considers families as capable of modifying the positive and negative forces facing them, was taken as the frame of reference. Data were collected as part of an ongoing prospective mother-infant study, and the methods included severity scoring of atopic dermatitis, dietary records, health-related quality of life measurements and assessments of the use of health care services and medications for treating the infant’s eczema, food allergy and asthma. Interviews with mothers were analysed by deductive content analysis on the basis of ecocultural theory and the family empowerment model. The theme “Living an ordinary family life” guided the organization of family activities essential for treating the infant's food allergy and eczema. These activities were sources of both strain and support for the mothers, the allergy-related supporting factors being the mother’s own knowledge of the allergy, hopes for an improvement in the infant’s condition, social support and work. An infant’s food allergy at the age of one year caused considerable strain for the mother in cases where the introduction of new foods into the child’s diet was delayed. This delay was still causing the mother additional strain when the child was 24 months of age. The infants waking at night at the ages of 12 and 24 months because of itching related to eczema caused strain for the mothers. The infants’ health-related quality of life was impaired at ages of 6 and 12 months compared with healthy infants. The principal reasons for impairments were itching, scratching and sleep disturbances at 6 and 12 months and treatment difficulties at 6 months. Problems with getting to sleep were reported at all stages irrespective of eczema and were also present in healthy infants. The economic impact of the treatment of allergic diseases on families during the first 24 months was 131 EUR (2006 value) in cases of eczema and 525 EUR in cases of food allergy. From the societal perspective, the costs of food allergy were a median of 3183 EUR (range 628–11 560 EUR) and of eczema a median of 275 EUR (range 94–1306 EUR). These large variations in costs in food allergy and eczema indicate that disease varies greatly . In conclusion, food allergy and eczema cause extra activities and costs to families which arrange these disease-related activities in such a way that they support the leading family theme “Living an ordinary family life”. Health care professionals should consider this thematic character of family life and disease-related activities in order to ensure that new treatments are sustainable, meaningful and tailored to daily activities. In addition, those mothers who are experiencing difficulties with food allergic infants or infants with eczema should be recognized early and provided with individual encouragement and support from health clinics. In the light of the present results, early detection of symptoms and effective parental guidance can contribute to the well-being and health-related quality of life of the child and family.

Foot Health In Older People - Development of a preventive, evaluative instrument for nurses

Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.