Educating the future workforce: building the evidence about interprofessional learning

This paper addresses the theme of interprofessional education for health and social care professionals as it effects on the development of the work force. The drivers for change in the UK, typified by the Bristol Royal Infirmary and Victoria Climbié inquiries and the response to this in the form of Department of Health policy, are discussed. The need for rapid development of the evidence base around this subject is evident form literature reviews of the impact of interprofessional education. Directions for future research and investment in this area are proposed including the need for a stronger theoretical base and for longitudinal studies over extended periods of time in order to examine short, medium and long term outcomes in relation to health care practice

Demographic, socioeconomic, and health correlates of unmet need for mental health treatment in the United States, 2002–16: evidence from the national surveys on drug use and health

Abstract: Background: Unmet need for mental health services remains high in the United States and is disproportionately concentrated in some groups. The scale and nature of these disparities have not been fully elucidated and bear further scrutiny. As such, in this study, we examine the demographic, socioeconomic, and health correlates of unmet need for mental health treatment as well as the reasons for unmet need. Methods: We draw upon the National Survey for Drug Use and Health (NSDUH) from 2002 to 16 for adults aged 18 and over in the United States (n = 579,017). Using multivariable logistic regression, we simultaneously model the demographic, socioeconomic, and health correlates of unmet need for mental health treatment from 2002 to 16. We also analyse the reasons for unmet need expressed by these populations, reasons which include cost, perceived stigma, minimisation of symptoms, low perceived effectiveness of treatment, and structural barriers. Results: Major characteristics associated with increased odds of unmet need include past year substance abuse or dependence (other than hallucinogens and sedatives), fair, poor, or very poor health, being female, and an educational attainment of college or higher. With respect to reasons for unmet need, cost was most often cited, followed by perceived stigma, structural barriers, and minimisation. Characteristics associated with increased odds of indicating cost as a reason for unmet need include: being uninsured or aged 26–35. Minimisation and low perceived effectiveness are mentioned by high-income persons as reasons for unmet need. College-educated persons and women had higher odds of citing structural barriers as a reason for unmet need. Conclusions: The correlates and causes of unmet need highlight the intersectionality of individual health needs with implications on addressing inequities in mental health policy and practice

Access to healthy foods: Part I. Barriers to accessing healthy foods: Differentials by gender, social class, income and mode of transport

This paper examines the issues of access to food and the influences people face when shopping for a healthy food basket. It uses data from the Health Edu cation Authority's 1993 Health and Lifestyles Survey to examine the barriers people face in accessing a healthy diet. The main findings are that access to food is primarily determined by income, and this is in turn closely related to physical resources available to access healthy food. There is an associated class bias over access to sources of healthy food. The poor have less access to a car, find it harder to get to out-of-town shopping centres and thus are less able to carry and transport food in bulk. The majority of people shop in supermarkets as they report that local shops do not provide the services people demand and that food choice and quality are limited. In tackling food poverty and pro moting healthy eating, health promotion practice needs to address these struc tural issues as opposed to relying on psycho-social models of education based on the provision of information and choice

Social inclusion and valued roles : a supportive framework

The aim of this paper is to examine the concepts of social exclusion, social inclusion and their relevance to health, well-being and valued social roles. The article presents a framework, based on Social Role Valorization (SRV), which was developed initially to support and sustain socially valued roles for those who are, or are at risk of, being devalued within our society. The framework incorporates these principles and can be used by health professionals across a range of practice, as a legitimate starting point from which to support the acquisition of socially valued roles which are integral to inclusio

Dynamic Behavior of Precast Concrete Beam-Column Sub-Assemblages with High Performance Connections Subjected to Sudden Column Removal Scenario

Unbonded posttensioned precast concrete (UPPC) structure has shown its excellent aseismic performance in laboratory tests and earthquake investigation. However, the progressive collapse behavior of UPPC subjected to column removal scenario is still unclear. To fill this knowledge gap, two 1/2 scaled UPPC beam-column sub-assemblages were tested under a penultimate column removal scenario. The dynamic test results indicated that UPPC sub-assemblages have desirable load redistribution capacity to mitigate progressive collapse. The failure modes of the sub-assemblages observed in dynamic test were quite similar to that in static counterparts

Older parents of people who have a learning disability : perceptions of future accomodation needs

The aim of this qualitative study was to provide an insight into the perceptions of older parents of learning disabled people on the future accommodation needs of their adult children. Semi-structured interviews were used to seek parental awareness of residential options available, concerns in relation to future accommodation and the preferred accommodation options for their offspring. Four couples who shared the family home with an adult who has a learning disability took part in the study and data was analysed using a step by step form of content analysis as described by Burnard (1991). Emergent themes from transcripts were then organised into main categories The results of this study suggest that older parents are dissatisfied with both statutory and private services, that they have concerns for their non-disabled children and their own ageing. Being a parent to a person who has a learning disability is seen to be a difficult task and yet parents may want to provide support at home for as long a possible. Of the parents who participated in this study, three couples wanted to maintain their adult child at home for as long as possible and the parents who were actively seeking accommodation outside the family home expected to be involved in all aspects of their daughter�s care for the long term future

Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods

Cost-effectiveness analysis is now an integral part of health technology assessment and addresses the question of whether a new treatment or other health care program offers good value for money. In this paper we introduce the basic framework for decision making with cost-effectiveness data and then review recent developments in statistical methods for analysis of uncertainty when cost-effectiveness estimates are based on observed data from a clinical trial. Although much research has focused on methods for calculating confidence intervals for cost-effectiveness ratios using bootstrapping or Fieller’s method, these calculations can be problematic with a ratio-based statistic where numerator and=or denominator can be zero. We advocate plotting the joint density of cost and effect differences, together with cumulative density plots known as cost-effectiveness acceptability curves (CEACs) to summarize the overall value-for-money of interventions. We also outline the net-benefit formulation of the cost-effectiveness problem and show that it has particular advantages over the standard incremental cost-effectiveness ratio formulation

ON THE PERFORMANCE OF NONPARAMETRIC SPECIFICATION TESTS IN REGRESSION MODELS

Some recently developed nonparametric specification tests for regression models are described in a unified way. The common characteristic of these tests is that they are consistent against any alternative hypothesis. The performance of the test statistics is compared by means of Monte Carlo simulations, analysing how heteroskedasticity, number of regressors and bandwidth selection influence the results. The statistics which do not use a bandwidth perform slightly better if the regression model has only one regressor; otherwise, some of the statistics which use a bandwidth behave better if the bandwidth is chosen adequately. These statistics are applied to test the specification of three commonly used Mincer-type wage equations with Uruguayan and Spanish data; all of them are rejected.

Ethnic Minorities and their Health Needs: Crisis of Perception and Behaviours

There is considerable evidence to suggest that racial and ethnic disparities exist in the provision of emergency and wider healthcare. The importance of collecting patient ethnic data has received attention in literature across the world and eliminating ethnic and racial health equalities is one of the primary aims of healthcare providers internationally. The poor health status of certain racial and ethnic groups has been well documented. The improvement of racial and ethnic disparities in healthcare is at the forefront of many public health agendas. This article addresses important policy, practice, and cultural issues confronted by the pre-hospital emergency care setup. This aspect of care plays a unique role in the healthcare safety net in providing a service to a very diverse population, including members of ethnic and racial minorities. Competent decision making by the emergency care practitioners requires patient-specific information and the health provider's prior medical knowledge and clinical training. The article reviews the current ethnicity trends in the UK along with international evidence linking ethnicity and health inequalities. The study argues that serious difficulties will arise between the health provider and the patient if they come from different backgrounds and therefore experience difficulties in cross-cultural communication. This adversely impacts on the quality of diagnostic and clinical decision making for minority patients. The article offers few strategies to address health inequalities in emergency care and concludes by arguing that much more needs to be done to ensure that we are hearing the voices of more diverse groups, groups who are often excluded from engagement through barriers such as language or mobility difficulties

Doing research with children and young people who do not use speech for communication

Despite emphasis in policy on participation of disabled children, we still know relatively little about how to obtain the views of disabled children with significant communication impairment and their views are often overlooked in planning and service provision. This article describes how the views of children who do not use speech were accessed in research aiming to identify disabled children and young people's priorities regarding outcomes of social care and support services. The main challenge was to develop a method that was reliable, non-threatening, enjoyable and relevant to individual children, as well as enabling children to think beyond their everyday life and express what they aspire to