19,425 research outputs found

    Identifying and responding to people with mild learning disabilities in the probation service

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    It has long been recognised that, like many other individuals, people with learningdisabilities find their way into the criminal justice system. This fact is not disputed. Whathas been disputed, however, is the extent to which those with learning disabilities arerepresented within the various agencies of the criminal justice system and the ways inwhich the criminal justice system (and society) should address this. Recently, social andlegislative confusion over the best way to deal with offenders with learning disabilities andmental health problems has meant that the waters have become even more muddied.Despite current government uncertainty concerning the best way to support offenders withlearning disabilities, the probation service is likely to continue to play a key role in thesupervision of such offenders. The three studies contained herein aim to clarify the extentto which those with learning disabilities are represented in the probation service, toexamine the effectiveness of probation for them and to explore some of the ways in whichprobation could be adapted to fit their needs.Study 1 and study 2 showed that around 10% of offenders on probation in Kent appearedto have an IQ below 75, putting them in the bottom 5% of the general population. Study 3was designed to assess some of the support needs of those with learning disabilities in theprobation service, finding that many of the materials used by the probation service arelikely to be too complex for those with learning disabilities to use effectively. To addressthis, a model for service provision is tentatively suggested. This is based on the findings ofthe three studies and a pragmatic assessment of what the probation service is likely to becapable of achieving in the near future

    Modifying Group Interpersonal Psychotherapy for Peripartum Adolescents in Sub-Saharan African Context: Reviewing Differential Contextual and Implementation Considerations

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    Background: This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content. Methods: A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and cultural barriers experienced by adolescents were carried out modeled on the Consolidated Framework for Implementation Research. Focus group discussions with depressed adolescents on their experiences, feedback from caregivers, partners, health workers inform focused modifications. An IPT expert committee of three practitioners, along with UNICEF adolescent officer, and mental health policy expert from Ministry of Health and representative community advisory body reviewed the adaptations and modifications made to the WHO IPT-G manual. Discussion: Integration of mental health needs of peripartum adolescents as demonstrated in the stakeholder engagement process, adaptation of key terms into locally relevant language, determination of number of sessions, and user-centric design modifications to digitize a brief version of group interpersonal psychotherapy are presented

    Implementing Health Impact Assessment as a Required Component of Government Policymaking: A Multi-Level Exploration of the Determinants of Healthy Public Policy

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    It is widely understood that the public policies of ‘non-health’ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level. The three integrated articles of this dissertation provide insights into specific aspects of the policy process as they relate to HIA. Chapter one details a case study of purposive information-seeking among public servants within Ontario’s Ministry of Education (MOE). Situated within Ontario’s Ministry of Health (MOH), chapter two presents a case study of policy collaboration between health and ‘non-health’ ministries. Finally, chapter three details a framework analysis of the political factors supporting health impact tool use in two sub-national jurisdictions – namely, Québec and South Australia. MOE respondents (N=9) identified four components of policymaking ‘due diligence’, including evidence retrieval, consultation and collaboration, referencing, and risk analysis. As prospective HIA users, they also confirmed that information is not routinely sought to mitigate the potential negative health impacts of education-based policies. MOH respondents (N=8) identified the bureaucratic hierarchy as the brokering mechanism for inter-ministerial policy development. As prospective HIA stewards, they also confirmed that the ministry does not proactively flag the potential negative health impacts of non-health sector policies. Finally, ‘lessons learned’ from case articles specific to Québec (n=12) and South Australia (n=17) identified the political factors supporting tool use at different stages of the policy cycle, including agenda setting (‘policy elites’ and ‘political culture’), implementation (‘jurisdiction’), and sustained implementation (‘institutional power’). This work provides important insights into ‘real life’ policymaking. By highlighting existing facilitators of and barriers to HIA use, the findings offer a useful starting point from which proponents may tailor context-specific strategies to sustainably implement HIA at the sub-national government level

    Lift EVERY Voice and Sing: An Intersectional Qualitative Study Examining the Experiences of Lesbian, Gay, Bisexual, and Queer Faculty and Administrators at Historically Black Colleges and Universities

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    While there is minimal literature that address the experiences of lesbian, gay, bisexual, and trans* identified students at Historically Black Colleges and Universities (HBCUs), the experiences of Black, queer faculty and administrators at HBCUs has not been studied. This intersectional qualitative research study focused on the experiences of lesbian, gay, bisexual, and queer identified faculty and administrators who work at HBCUs. By investigating the intersections of religion, race, gender, and sexuality within a predominantly Black institution, this study aims to enhance diversity, equity, and inclusion efforts at HBCUs by sharing the experiences of the LGBQ faculty and administrators that previously or currently work at an HBCU as a full-time employee. The research questions that guided this study were 1) How have LGBQ faculty and staff negotiated/navigated their careers at HBCUs? and 2) How do LGBQ faculty and staff at HBCUs influence cultural (relating to LGBQ inclusion) change at the organizational level? The main theoretical framework used was intersectionality and it shaped the chosen methodology and methods. The Politics of Respectability was the second theoretical framework used to describe the intra-racial tensions within the Black/African American community. The study included 60-120 minute interviews with 12 participants. Using intersectionality as a guide, the data were coded and utilized for thematic analysis. Then, an ethnodramatic performance engages readers. The goals of this study were to encourage policy changes, promote inclusivity for LGBQ employees at HBCUs, and provide an expansion to the body of literature in the field pertaining to the experiences of LGBQ faculty and administrators in higher education

    Educació postural: avaluació dels coneixements de la salut de l'esquena en activitats de la vida diària en estudiants d'Educació Secundària

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    Objectiu: Dissenyar i validar un qüestionari sobre coneixements de la salut i la cura de l’esquena en activitats de la vida diària en joves També analizar diferents models de puntuació de les respostes. Metodologia: Es va seguir un mètode general de prospectiva (Delphi), amb el consens d’un grup de sis experts. Estudi de consistencia interna i fiabilitat en una mostra de 89 xics i 80 xiques. Amb les dades obteses aplicació de cinc models de puntuació basats en donar un pes diferent a les respostes. Consistència interna del qüestionari calculada amb l'Alfa de Cronbach amb cadascú dels models. Estudi de la fiabilitat amb l'anàlisi de mesures repetides test-retest i l’estudi de l’error de mesura amb la representació gràfica dels valors descrita per Bland i Altman. Es calcularen les desviacions estàndard de les diferències, la prova t per a una mostra amb les diferències, els coeficients de correlació intraclasse i els seus intervals de confiança del 95%, l’error estàndard de mesura, el canvi mínim detectable i el coeficient de reproductibilitat. Efecte sòl/sostre calculat amb els percentatges de resposta més alts i més baixos en les puntuacions del primer passe. Per a l'anàlisi de la capacitat discriminatòria de les puntuacions obtingudes es van utilitzar les mitjanes totals del primer passe, es va reagrupar la variable en quatre grups per quartils i es va aplicar una ANOVA d'un factor entres el quartil 1 y el quartil 4. Resultats: Anàlisi de la validesa tots els valors obtesos sobre la consistència interna són iguals o majors a .6 Als diferents models, l'Alfa de Cronbach va oscil·lar entre .6 i .7. En la representació de les puntuacions mitjanes de totes dues passades i el càlcul del pendent de la seua funció lineal hi ha una relació positiva entre les mesures. El valor del pendent, en tots els models al voltant de .7 excepte en el model C que va ser de .56. L’índex de determinació va mostrar un nivell de coherència de les mesures reals amb les teòriques moderat Coeficient de correlació entre les puntuacions i el coeficient de correlació intraclasse igual o major a .75. Error de mesura i límits d'acord de les puntuacions calculats a partir de la desviació típica de la diferència de les mitjanes van indicar una probabilitat molt baixa de ser diferents entre ells. L'efecte sòl/sostre va indicar que aquest efecte no es va produir L'anàlisi de regressió de les mitjanes i diferències de les puntuacions totals de tots els models va indicar un augment significatiu de les diferències en les puntuacions a mesura que el valor mitjà d'aquestes va augmentar. Les diferències entre tots els models van ser significatives. Conclusions: Es presenta un qüestionari per a mesurar els coneixements sobre la postura corporal i la cura de l'esquena en activitats de la vida diària en adolescents validat. Es determina que les mateixes dades, es poden analitzar utilitzant diferents models, proporcionant cadascun d#aquests informació diferent

    The Professional Identity of Doctors who Provide Abortions: A Sociological Investigation

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    Abortion is a medicalised problem in England and Wales, where the law places doctors at the centre of legal provision and puts doctors in control of who has an abortion. However, the sex-selection abortion scandal of 2012 presented a very real threat to 'abortion doctors', when the medical profession's values and practices were questioned in the media, society and by Members of Parliament. Doctors found themselves at the centre of a series of claims that stated doctors were acting both illegally and unethically, driven by profit rather than patient needs. Yet, the perspectives of those doctors who provide abortions has been under-researched; this thesis aims to fill that gap by examining the beliefs and values of this group of doctors. Early chapters highlight the ambiguous position of the abortion provider in Britain, where doctors are seen as a collective group of professionals motivated by medical dominance and medical autonomy. They outline how this position is then questioned and contested, with doctors being presented as unethical. By studying abortion at the macro-, meso- and micro-levels, this thesis seeks to better understand the values of the 'abortion doctor', and how these levels shape the work and experiences of abortion providers in England and Wales. This thesis thus addresses the question: 'What do abortion doctors' accounts of their professional work suggest about the contemporary dynamics of the medicalisation of abortion in Britain?'. It investigates the research question using a qualitative methodological approach: face-to-face and telephone interviews were conducted with 47 doctors who provide abortions in England and Wales. The findings from this empirical study show how doctors' values are linked to how they view the 'normalisation of abortion'. At the macro-level doctors, openly resisted the medicalisation of abortion through the position ascribed to them by the legal framework, yet at the meso-level doctors construct an identity where normalising abortion is based on further medicalising services. Finally, at the micro-level, the ambiguous position of the abortion provider is further identified in terms of being both a proud provider and a stigmatised individual. This thesis shows that while the existing medicalisation literature has some utility, it has limited explanatory power when investigating the problem of abortion. The thesis thus provides some innovative insights into the relevance and value of medicalisation through a comprehensive study on doctors' values, beliefs and practices

    Impact of progressive familial intrahepatic cholestasis on caregivers: caregiver-reported outcomes from the multinational PICTURE study

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    From Springer Nature via Jisc Publications RouterHistory: received 2021-11-02, accepted 2022-01-16, registration 2022-01-18, pub-electronic 2022-02-02, online 2022-02-02, collection 2022-12Publication status: PublishedFunder: Albireo Pharma, Inc.Abstract: Background: Progressive familial intrahepatic cholestasis (PFIC) is a spectrum of rare genetic diseases characterized by inadequate bile secretion that requires substantial ongoing care, though little research is published in this area. We report health-related quality of life (HRQoL) and work productivity outcomes from the retrospective, cross-sectional PICTURE study investigating the burden of PFIC on caregivers. Information from caregivers of patients with PFIC 1 or 2 in Germany, the United Kingdom and the United States from September 2020 to March 2021 was included. Results: The PICTURE study sample comprised HRQoL responses from 22 PFIC caregivers. Patients were on average 8.2 years old; most caregivers were 30–49 years old (68%) and mothers (77%). Median CarerQoL-7D score was 67.7/100; mean CarerQoL-VAS score for general happiness was 5.7/10 (SD 2.1). Most caregivers reported fulfilment in their caregiving responsibilities, but problems with mental and physical health, finances, and relationships. When stratified by patient’s PFIC type, mean CarerQoL-7D and CarerQoL-VAS scores suggested worse HRQoL outcomes with PFIC2 versus PFIC1 (59.4 vs. 71.2, and 5.3 vs. 6.5, respectively). Additionally, more caregivers reported impact on sleep in the PFIC2 versus PFIC1 subgroup (93% vs. 75%). When stratified by history of PFIC-related surgeries, mean CarerQoL-7D and VAS scores were higher among those whose children had no specified surgeries (67.7 vs. 59.0/100 and 6.2 vs. 5.2/10, respectively). Nearly all caregivers reported an impact of caregiving responsibilities on sleeping (86%) and on personal relationships (82%). No caregivers reported having formal care support. Most caregivers were employed (73%); a third reported mean productivity loss of 12.9 days (SD 19.3) over the last 3 months, and a mean of 2.8 (SD 9.5) missed years of employment during their career. A higher number of workdays were missed by PFIC 2 caregivers compared to PFIC1 over last 3 months (16 days vs. 3 days). Conclusions: The PICTURE study has demonstrated the prevalent, comprehensive, and meaningful burden that caring for an individual with PFIC has on caregivers. Despite fulfilment from caregiving, the breadth and depth of these responsibilities reduced caregiver reported HRQoL including mental and physical health, productivity, career prospects, sleep, relationships and finances
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