Quality of care: testing some measures in homes for elderly people

In this national study of 17 residential homes, 309 residents were interviewed, 264 members of staff completed an anonymous survey, and 228 relatives responded to a postal questionnaire. The data were collected between January andSeptember 1995. The aim of the study was to suggest promising measures of quality of care, looking particularly at depression as a possible indicator. It also served as a follow-up study of the Caring in Homes Initiative, although its timing ruled out evaluation of the impact of this development programme, because changes occurred in the homes before this study began. No strict definition of quality was adopted a priori, but a pragmatic approach was taken, addressing the perspectives of residents, health and social care professionals, home staff, managers, and relatives

Preparing Rural Youth for the Future of Work through Remote Work Education

With population migration out of Utah\u27s rural communities threatening the future workforce in small towns, Utah State University Extension recognized an opportunity to provide remote work education to rural youth to empower them to remain in their communities and seek remote employment. Teaming up with Utah\u27s Rural Online Initiative program, Utah State University Extension created the virtual 4-H Remote Skills Camp: For College and Career Readiness

Girl Power's Last Chance?:Tavi Gevinson, Feminism, and Popular Media Culture

This paper focuses on Tavi Gevinson, the teenage fashion blogger-turned-editor in chief of the online magazine Rookie, as a case study with which to interrogate the production and circulation of feminist politics within a ‘post-girl power’ era. Drawing on theories of performativity, I employ a discursive and ideological textual analysis of Gevinson’s self-produced media and media coverage to map how she uses the opportunities afforded by digital media to rearticulate narratives of ‘girl power’ and perform a feminist girlhood subjectivity that makes feminism accessible to her many readers. While I argue that Gevinson’s ability to do so is positive and demonstrates the porous nature of postfeminist media culture, I also suggest that we must be critical of the ways in which her feminism functions as part of her self brand that reproduces feminism as white, middle-class, and ‘hip’. Thus, I conclude by questioning a larger cultural trend towards the branding of feminism and advocating the need for an intersectional approach to understanding the resurgence of feminism within contemporary popular media culture

Blinding and Sham Control Methods in Trials of Physical, Psychological, and Self-Management Interventions for Pain (Article I): a Systematic Review and Description of Methods

Blinding is challenging in randomised controlled trials (RCTs) of physical, psychological, and self-management therapies (PPS) for pain, mainly due to their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently employed sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham controlled RCTs of PPS treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment, to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (e.g., duration and frequency of treatments) than others (e.g., physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations

Best Practices for Queer Metadata

This document is the result of two years of work by a group of nearly one hundred knowledge organisers, cataloguers, librarians, archivists, scholars, and information professionals with a concerted interest in improving the metadata treatment of queer people, communities, and items in GLAMS (Galleries, Libraries, Archives, Museums, and Special Collections) and other informational institutions. Their work has been supported by over 800 peer reviewers; combined, these groups make up the Queer Metadata Collective (QMDC). The QMDC builds upon earlier work done by the Trans Metadata Collective (TMDC), a similarly-organised group of metadata workers and information professionals with a concerted interest in improving the metadata representation of trans and gender-diverse people. The work of the TMDC culminated in Metadata Best Practices for Trans and Gender Diverse Resources, focusing on the description, cataloguing, and classification of information resources as well as the creation of metadata about trans and gender-diverse people, including authors, communities, and other creators. Following the publication of the Best Practices, several TMDC members founded and developed the QMDC over the summer of 2022. This document focuses on metadata by and about queer people, communities, and resources. While there is significant overlap between queer metadata and trans and gender diverse metadata, QMDC’s recommendations should not be seen as excluding or superseding TMDC’s, as trans and gender diverse people, communities, and resources have specific needs. For best practices and recommendations about trans and gender-diverse resources, please consult the TMDC document. If the TMDC and QMDC recommendations conflict (we are not aware of any instances in which they do), prefer the TMDC document for trans and gender diverse resources and the QMDC for other types of queer resources.UT Librarie

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

<p>Abstract</p> <p>Background</p> <p>Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows.</p> <p>Methods</p> <p>Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex.</p> <p>Results</p> <p>Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1^st(7.4 μg/m³) to the 25^th(17.2 μg/m³), 50^th(33.8 μg/m³), 75^th(108.3 μg/m³), and 90^th(180.8 μg/m³) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage.</p> <p>Conclusions</p> <p>The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.</p

Residential care for elderly people: policy implications from an exploratory study

The Association of Directors of Social Services, in response to the Burgner review, has called for joint health and local-authority inspection of residential homes (Community Care, 8.1.97, p. 1). Yet there is little agreement about what constitutes good residential care (Gibbs and Sinclair, 1992). Without such information, we cannot make valid comparisons between homes or set meaningful standards. The study described below tested a wide range of possible measures of quality of care. It adopted an eclectic approach, including the perspectives of residents, health and social care professionals, home staff, managers, and relatives. Full details of the instruments used are given in the final report, which is available from the Personal Social Services Research Unit, University of Kent at Canterbury, CT2 7NF, as Discussion Paper 1245

Utilisation of health services and geography: deconstructing regional differences in barriers to facility-based delivery in Nepal

While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder–Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers’ education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers’ birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas

Context-specific, evidence-based planning for scale-up of family planning services to increase progress to MDG 5: health systems research

Background: Unmet need for family planning is responsible for 7.4 million disability-adjusted life years and 30% of the maternity-related disease burden. An estimated 35% of births are unintended and some 200 million couples state a desire to delay pregnancy or cease fertility but are not using contraception. Unmet need is higher among the poorest, lesser educated, rural residents and women under 19 years. The barriers to, and successful strategies for, satisfying all demand for modern contraceptives are heavily influenced by context. Successfully overcoming this to increase the uptake of family planning is estimated to reduce the risk of maternal death by up to 58% as well as contribute to poverty reduction, women's empowerment and educational, social and economic participation, national development and environmental protection. Methods: To strengthen health systems for delivery of context-specific, equity-focused reproductive, maternal, newborn and child health services (RMNCH), the Investment Case study was applied in the Asia-Pacific region. Staff of local and central government and non-government organisations analysed data indicative of health service delivery through a supply-demand oriented framework to identify constraints to RMNCH scale-up. Planners developed contextualised strategies and the projected coverage increases were modelled for estimates of marginal impact on maternal mortality and costs over a five year period. Results: In Indonesia, Philippines and Nepal the constraints behind incomplete coverage of family planning services included: weaknesses in commodities logistic management; geographical inaccessibility; limitations in health worker skills and numbers; legislation; and religious and cultural ideologies. Planned activities included: streamlining supply systems; establishment of Community Health Teams for integrated RMNCH services; local recruitment of staff and refresher training; task-shifting; and follow-up cards. Modelling showed varying marginal impact and costs for each setting with potential for significant reductions in the maternal mortality rate; up to 28% (25.1-30.7) over five years, costing up to a marginal USD 1.34 (1.32-1.35) per capita in the first year. Conclusion: Local health planners are in a prime position to devise feasible context-specific activities to overcome constraints and increase met need for family planning to accelerate progress towards MDG 5

Factors influencing place of delivery for pastoralist women in Kenya: a qualitative study

BACKGROUND: Kenya's high maternal mortality ratio can be partly explained by the low proportion of women delivering in health facilities attended by skilled birth attendants (SBAs). Many women continue to give birth at home attended by family members or traditional birth attendants (TBAs). This is particularly true for pastoralist women in Laikipia and Samburu counties, Kenya. This paper investigates the socio-demographic factors and cultural beliefs and practices that influence place of delivery for these pastoralist women. METHODS: Qualitative data were collected in five group ranches in Laikipia County and three group ranches in Samburu County. Fifteen in-depth interviews were conducted: seven with SBAs and eight with key informants. Nineteen focus group discussions (FGDs) were conducted: four with TBAs; three with community health workers (CHWs); ten with women who had delivered in the past two years; and two with husbands of women who had delivered in the past two years. Topics discussed included reasons for homebirths, access and referrals to health facilities, and strengths and challenges of TBAs and SBAs. The data were translated, transcribed and inductively and deductively thematically analysed both manually and using NVivo. RESULTS: Socio-demographic characteristics and cultural practices and beliefs influence pastoralist women's place of delivery in Laikipia and Samburu counties, Kenya. Pastoralist women continue to deliver at home due to a range of factors including: distance, poor roads, and the difficulty of obtaining and paying for transport; the perception that the treatment and care offered at health facilities is disrespectful and unfriendly; lack of education and awareness regarding the risks of delivering at home; and local cultural values related to women and birthing. CONCLUSIONS: Understanding factors influencing the location of delivery helps to explain why many pastoralist women continue to deliver at home despite health services becoming more accessible. This information can be used to inform policy and program development aimed at increasing the proportion of facility-based deliveries in challenging settings