Determinants of unplanned admissions in children: investigating the relationship between primary care quality and health service use with unplanned admissions in children

Introduction: High quality primary care is considered central to preventing avoidable health system waste such as unplanned short stay admissions (SSA) for minor conditions and alleviating health inequality. Recent policy changes in primary care (2004) may have impacted on provision, access and supply of GPs. This provides an ideal opportunity to study its role on keeping children healthy in the community. I aimed to quantify the impact of policy change; GP timeliness and access; and GP utilisation on potentially preventable admissions and health disparities in children. Methods: My studies included a segmented population based trends study design and a retrospective cohort design. I used national hospital and primary care administrative datasets, focusing on children aged ≤14 years between April 2000 and March 2013, in England. My primary outcome measures were SSA rates (<2 days stay) for chronic conditions and infectious illness; my secondary outcome emergency department (ED) visits. I investigated: the impact of 1) primary care policy change in 2004; 2) patients’ reported access to their GP; and 3) primary care utilization on unplanned health service use and reducing deprivation gradients. Results: There was a significant increase in the number of children being admitted with chronic conditions for a short stay after primary care policy changes (11% rate increase in year of change), but not for infectious illness. Children were less likely to visit EDs or be admitted for a chronic condition if their GP offered better access. Better preventive care reduced children’s risk of an unplanned admission and deprivation gradients were narrowed in children who regularly consulted their GP. Conclusion: Primary care plays a significant role in limiting use of urgent and unplanned health service use, particularly for deprived children and those with chronic conditions. Investment in primary care is vital in a time of epidemiological transition in children.Open Acces

A New Approach to the \u3cem\u3eDevīmāhātmya\u3c/em\u3e: The Greatness of the Goddess in its Purāṇic Context

Although the text of the Devīmāhātmya is itself a section of the Mārkaṇḍeya Purāṇa, recent scholarship has taken a primarily extrinsic approach to the text and its use by emphasizing the life of the Devīmāhātmya (henceforth DM) well apart from the textual tradition of the purāṇas. A reading of the DM in the context of the MārkP is instructive, because it reveals some interesting thematic connections that are indicative of larger thematic trends within the purāṇa, which prior extrinsic studies have not explored. Broadly speaking, these themes glorify women and Goddesses as positive manifestations of some fundamental female energy and efficacy. These themes occur in the DM and also occur in other narratives within the MārkP that praise female actors who restore order in times of crisis. An evaluation of these thematic connections will show that the DM is best understood not only as an important text in its own right, but as an important piece of the MārkP as a whole. Conversely, the subject matter of the MārkP should not be viewed as unrelated to that of the DM. Therefore, my thesis is a preliminary effort to situate a text glorifying the Goddess in its purāṇic context through an analysis of narrative and thematic content

Mismatch and Burnout: An Exploration of Burnout and Work Passion Amongst Academic Affairs Professionals Through an Organizational Lens

Though the concept of burnout is well developed, there is less research on burnout in higher education, especially on specific staff populations, and loss of work passion. The current study aimed to understand burnout and work passion for academic affairs professionals who work with undergraduate students on academic probation and students conditionally admitted to the institution, including impacts, how these experiences have been navigated, and organizational supports that help alleviate these outcomes. Utilizing a sequential mixed methods research design, the study collected survey responses from identified professionals working with these student populations at a specific institution type. Demographic and t-test statistics were conducted. Then, interviews were conducted with professionals in an academic support department at a case study institution. Results suggest differences in general passion, emotional exhaustion, cynicism, value, and control between entry level and supervisory positions. Qualitative findings suggest high workload and lack of institutional support are among major influences on staff burnout and identify the cyclical nature of burnout for academic support staff during a semester. Variations in support, feeling valued, reward, and community were identified between departmental, institutional, and student contexts. Findings also shed light on how COVID-19 influenced the work experience and burnout of academic support staff. The study includes scholarly and practical implications for departments and institutions, including strategies for employee and institutional support, as well as a more developed understanding of burnout and work passion for this population of academic support staff

An assessment on the use of chest imaging in children admitted with viral induced wheeze

Viral induced wheeze in preschool children (children less than 5 years of age) is a common condition encountered by general practitioners and paediatricians worldwide. Martinez et al, in 2005 showed that approximately 25-30% of infants and young children would have at least two episodes of wheezing in early childhood. Approximately 40% will have had an episode of wheeze by the age of 3 years and almost half of them will have had at least one episode of wheezing by the age of six.1 Bisgaard et al in 2006 showed in a cohort study that nearly 33% of children between the ages of 1 and 5 years suffer from wheezing associated with upper respiratory tract infections. Fortunately, the majority tend to have only transient symptoms which resolve by five to six years of age. The small anatomy of the bronchi in infants results in higher peripheral airway resistance. Subsequently, respiratory illness will have proportionately greater impact on total airway resistance. In addition, infants have less elastic tissue recoil and fewer collateral airways, making them susceptible to obstruction and atelectasis. The rib cage, trachea, and bronchi are also more compliant in infants and young children. These factors make infants and young children particularly susceptible to wheezing and respiratory distress.peer-reviewe

Mapping the Pāśupata Landscape

In Mapping the Pāśupata Landscape Elizabeth A. Cecil presents a spatial and material history of the Pāśupata tradition and examines the formation of a Śaiva religious landscape in Early Medieval India. Readership: All interested in the history of Hinduism, and particularly the worship of the god Śiva, in premodern India; scholars of early medieval history and society in South Asia, and those interested in the study of text and material culture

The use of behaviour change techniques within breastfeeding maintenance interventions : a systematic review

This review will be conducted as part of a Qualification in Health Psychology (Stage 2) being undertaken by Calum McHale, whose post is funded by NHS Lothian and NHS Education for Scotland (NES).Literature ReviewPublisher PD

Direct observation of weight-related communication in primary care : a systematic review

Funding: Review was carried out as part of a PhD funded by the University of St Andrews 600th Anniversary Scholarship.Background. Primary care is ideally placed to play an effective role in patient weight management however patient weight is seldom discussed in this context. A synthesis of studies that directly observe weight discussion in primary care is required to more comprehensively understand and improve primary care weight-related communication. Objective. To systematically identify and examine primary care observational research that investigates weight-related communication and its relationship to patient weight outcomes. Methods. A systematic review of literature published up to August 2015, using seven electronic databases (including MEDLINE, Scopus, and PsycINFO), was conducted using search terms such as overweight, obese, doctor patient communication. Results. Twenty papers were included in the final review. Communication analysis focused predominantly on practitioner use of specific patient-centred communication. Practitioner use of motivational interviewing was associated with improved patient weight-related outcomes, including patient weight loss and increased patient readiness to lose weight; however few studies measured patient weight-related outcomes. Conclusion. Studies directly observing weight-related communication in primary care are scarce and limited by a lack of focus on patient communication and patient weight-related outcomes. Future research should measure practitioner and patient communications during weight discussion, and their impact on patient weight-related outcomes. This knowledge may inform the development of a communication intervention to assist practitioners to more effectively discuss weight with their overweight and/or obese patients.PostprintPeer reviewe

Citizen Comprehension of Difficult Issues: Lessons from Civil Jury Trials

Lay participation in debates concerning public policies is a touchstone of a democracy. The Constitution enshrines this value not only by providing for a system of elected representatives, but also by recognizing the right to trial by jury. When a democratic society seeks to impose the rigors of the law on an individual, it must justify those standards to a panel of citizens and allow the austere expression of the law to become infused with the values of the community. Through this process, the vision of justice shared by members of the community informs the dialogue of adjudication. The increasing complexity of issues presented for adjudication causes some commentators to question the ability of civil juries to fulfill this traditional role. To reach a reasoned and principled judgment, lay representatives must comprehend technical information and apply the proper legal standard. In the past, concerns about the ability of laypersons to participate effectively arose in antitrust trials where civil juries encountered massive amounts of evidence and sophisticated economic arguments. Recently, similar concerns have arisen when civil juries consider technical evidence in toxic tort and product liability cases., Such concerns are likely to become more acute with the expansion of the right to trial by jury into statutory causes of action where juries consider complex questions of damages. Questions about the competence and bias of laypersons are also raised in nonjury contexts, such as in proposals to permit laypersons to participate more fully in regulatory proceedings that require an assessment of the risks and benefits to a community. We seek to address these concerns by reviewing the literature on jury competence with three purposes in mind. First, we hope to establish that, although the civil jury has some areas of vulnerability, its ability to render a reasoned and principled decision is far greater than typically acknowledged. Second, we wish to identify those areas in which laypersons encounter particular difficulties and suggest remedies to improve lay comprehension in these complex matters. Finally, we hope to draw upon research on the civil jury in assessing the potential for lay participation in regulatory proceedings. Thus, this Article aims to provide information about the civil jury\u27s functioning which may be used to evaluate the claims of proponents and opponents of lay participation in a wide range of complex legal proceedings

'You just eyeball it’: parent and nursery staff perceptions and influences on child portion size : a reflexive thematic analysis

Funding: This project was supported by the MSc Health Psychology programme at the University of St Andrews.Background Childhood obesity is one of the most serious public health epidemics of the 21st century. Observational studies report that increases in portion size (PS) have occurred in parallel with levels of obesity. Increased PSs of high-energy-dense foods can promote overeating, and without compensatory behaviours, can contribute to childhood obesity. Caregivers make decisions about PSs for children in the home and nursery environment, thus are gatekeepers to child food intake. Understanding caregiver PS decisions can aid in the best practice of PS provision to young children. The aim of this study was to explore parent and nursery staff influences on child PS selection and their suggestions for useful tools/strategies in PS decisions. Methods A qualitative design was employed using focus group discussions (FGDs) with parents and nursery staff of children aged 3–5 years. FGDs were employed given their ability to generate rich data, as well as permit the exploration of collective perceptions, attitudes, behaviours and experiences. Data were analysed using an inductive, semantic approach to reflexive thematic analysis. Results Four FGDs were conducted: two with parents (n = 13), two with nursery staff (n = 17). Four overarching themes were derived: (i) awareness of PS guidelines; (ii) control over PS; (iii) social influences on children's eating behaviours; (iv) child-specific, social and external factors influencing parent and nursery staff PS decisions. Additionally, participants discussed tools/strategies they believe would be useful in PS decisions. Conclusion Data from the themes suggest that caregiver control, social, child-specific and external factors are more influential than PS guidelines in both parent and nursery staff PS decisions for young children aged 3–5 years. These findings can inform future childhood obesity prevention initiatives focussed on improving parent and nursery staff provision/use of age-appropriate PSs.Peer reviewe

Predictors of weight discussion in primary care consultations : a multilevel modelling approach

This research was funded by a University of St Andrews 600th Anniversary Doctoral Scholarship.Objective To understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. Methods Two multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. Results Weight-related discussions were more likely to occur when a greater proportion of PCP’s total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. Conclusion This work demonstrates that multilevel modelling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. Practice Implications Through the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.PostprintPeer reviewe