Barriers to Accessing Primary Dental Care in Adults with Alcohol Dependence: A Qualitative Study

Background:People with alcohol dependence (AD) frequently experience oral health problems, but their dental attendance is poor, with limited evidence to the reasons why from their perspective.Objective:To explore perceived barriers, motivators, and facilitators to accessing primary dental care in people with AD.Methods:Qualitative study consisting of remote one-to-one and group semistructured interviews with a convenience sample of adults with lived experience of AD in northern England. Data were audio-recorded, transcribed, and coded. A reflexive thematic analysis method was used; use of COM-B model informed data interpretation.Results:Twenty adults with lived experience of AD participated in 18 one-to-one interviews and 1 group interview (of 3 participants). Barriers to access were fear and physical, social, and environmental factors (physical effects of AD, financial barriers, nonprioritization of oral health). Motivators to access were pain and prioritization of oral health. Facilitators to access were patterns of alcohol use (i.e., sobriety) and dental service provision within recovery services.Conclusions:Fear of “the dentist” is a major barrier to accessing dental care, and pain is the primary motivator, among people with AD, although neither are unique to this population. Fear and physical, social, and environmental barriers to access contribute to problem-oriented attendance, which negatively affect oral health outcomes. Opportunity to facilitate attendance increases when a person is in remission from AD through their physical capabilities improving. Increasing capability and opportunity can influence attendance beyond the automatic motivation of pain. Provision of dental care within recovery services could facilitate access to care. Understanding the “web of causation” is key to developing any intervention to improve dental access in people with AD. Further research is needed from the perspective of other adult populations with lived experience of AD, as well as of dental professionals, to gain deeper insight into barriers, facilitators, and possible solutions

Barriers to employment of Australian cancer survivors living with geographic or socio-economic disadvantage: a qualitative study

First published: 07 April 2021Background: Opportunities for cancer survivors' employment can both reflect and perpetuate health inequities, as employment is an important social determinant of health. Socio-economic and geographic disadvantage is associated with greater difficulty finding work, but little is known about work needs of Australian cancer survivors living with disadvantage. Objective: This study examined survivor and health-care professional (HCP) perspectives on barriers experienced by Australian cancer survivors experiencing disadvantage when attempting to remain at or return to work. Method: Focus groups and individual interviews were held with cancer survivors (N = 15) and oncology and primary HCPs (N = 41), focusing on communities at risk of disadvantage. Participants were asked about employment barriers and facilitators in general and in the context of disadvantage. Themes were identified using framework analysis. Results: Geographic and socio-economic disadvantage resulted in specific individual- and system-level barriers. These related to distance from treatment and support services and limited availability and suitability of work for survivors living with geographic disadvantage, and limited availability, security, and flexibility of work and previous unemployment for survivors living with socio-economic disadvantage. Identified needs included system-level changes such as public and workplace-level education, legislative and policy changes, and better access to resources. Conclusions: Cancer survivors living with disadvantage experience limited access to flexible employment opportunities and resources, further perpetuating their disadvantage. Promotion of health equity for cancer survivors living with disadvantage requires systemic changes to support attempts to remain at/return to work. Patient or public contribution: This study included cancer survivors and HCPs as investigators, authors and participants.Emma Kemp, Vikki Knott, Paul Ward, Suzana Freegard, Ian Olver, Julia Fallon-Ferguson ... et al

Bringing the heart and soul back in: collaborative inquiry and the DBA

Waddock and Lozano (2013) propose that there is an urgent need to bring the 'heart and soul' back into management education. Indeed, its absence has also been implicated in the plethora of recent scandals and the global financial crisis. We suggest that, in part, such issues are attributable to a continued over reliance on a scientific and detached form of knowing which displaces particular 'human characteristics' and in so doing, downplays our inherent connections to others. In contrast, we identify the importance of embracing a supplementary form of knowing- collaborative inquiry which potentially restores our connections to others in ways which provide opportunities for a more heartfelt and soulful management practice. Specifically, we extend Van de Ven and Johnson’s (2006) notion of collaborative inquiry to consider how it is mobilized in the context of a UK DBA program and in turn examine the impact this move accomplishes. Drawing upon a detailed analysis of twenty students’ reflective journals, we illustrate the ways in which they develop a form of empathy. Crucially, we found that this was one important means for (re)-connecting to others and in ways which begin to bring in a sense of heart and soul back into management education

The DBA in British universities Assessment and standards

SIGLEAvailable from British Library Document Supply Centre-DSC:m01/11346 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Longitudinal Bedside Assessments of Brain Networks in Disorders of Consciousness: Case Reports From the Field.

Clinicians are regularly faced with the difficult challenge of diagnosing consciousness after severe brain injury. As such, as many as 40% of minimally conscious patients who demonstrate fluctuations in arousal and awareness are known to be misdiagnosed as unresponsive/vegetative based on clinical consensus. Further, a significant minority of patients show evidence of hidden awareness not evident in their behavior. Despite this, clinical assessments of behavior are commonly used as bedside indicators of consciousness. Recent advances in functional high-density electroencephalography (hdEEG) have indicated that specific patterns of resting brain connectivity measured at the bedside are strongly correlated with the re-emergence of consciousness after brain injury. We report case studies of four patients with traumatic brain injury who underwent regular assessments of hdEEG connectivity and Coma Recovery Scale-Revised (CRS-R) at the bedside, as part of an ongoing longitudinal study. The first, a patient in an unresponsive wakefulness state (UWS), progressed to a minimally-conscious state several years after injury. HdEEG measures of alpha network centrality in this patient tracked this behavioral improvement. The second patient, contrasted with patient 1, presented with a persistent UWS diagnosis that paralleled with stability on the same alpha network centrality measure. Patient 3, diagnosed as minimally conscious minus (MCS-), demonstrated a significant late increase in behavioral awareness to minimally conscious plus (MCS+). This patient's hdEEG connectivity across the previous 18 months showed a trajectory consistent with this increase alongside a decrease in delta power. Patient 4 contrasted with patient 3, with a persistent MCS- diagnosis that was similarly tracked by consistently high delta power over time. Across these contrasting cases, hdEEG connectivity captures both stability and recovery of behavioral trajectories both within and between patients. Our preliminary findings highlight the feasibility of bedside hdEEG assessments in the rehabilitation context and suggest that they can complement clinical evaluation with portable, accurate and timely generation of brain-based patient profiles. Further, such hdEEG assessments could be used to estimate the potential utility of complementary neuroimaging assessments, and to evaluate the efficacy of interventions

The relative contributions of different sulphur point sources to acidification on SSSIs in Britain

Acidification of the natural environment by anthropogenic sources of sulphur and nitrogen in many parts of Europe is well documented (Last & Watling 1991). In Britain at present point sources account for approximately 70% of the total load (RGAR 1990). Acidification leads to a number of adverse impacts on the nature conservation resources of Britain (Woodin & Farmer 1993, Farmer 1995) and it is important that emissions are reduced to a level which is sustainable (DoE 1994). There has, however, been little attempt to quantify the relative contribution of different sources of sulphur to impacts on nature conservation. Such information would be particularly important in formulating national pollution reduction strategies and inform individual regulatory decisions. This report presents results from one approach to this problem. The nature conservation impact is assessed by reference to Sites of Special Scientific Interest (SSSIs). However, it is important to note that whilst these statutorily designation sites do contain the most important habitats and species of nature conservation importance in Britain, important conservation resources also occur in other areas. The analysis is based on assessments using the critical loads approach. The impact is quantified by an examination of sulphur deposition which is greater than the critical load for soils on each SSSI. The critical loads approach (Bull 1991, CLAG 1994) has been used extensively to define thresholds for effects and is a central component of the UK government’s policy development for controlling acid emissions (DoE 1991, DoE 1994). In this study exceedence of a critical load leading to soil acidification on an SSSI is considered to constitute an adverse impact on that site