Core principles to reduce current variations that exist in grading of midwifery practice in the United Kingdom.

Aim To reduce variations in grading of midwifery practice and enhance reliability of assessment. Background The first phase of a national project showed there to be widely ranging interpretation and application of professional educational standards in relation to grading of practice in midwifery. This raised concerns about reliability and equity of professional assessment. The second phase therefore sought to achieve consensus on a set of core principles. Methods A participatory action research process in two stages, using a Mini-Delphi approach. Educational leads from all 55 institutions delivering midwifery programmes nationally were invited to participate. Stage one: Questionnaire comprising 12 statements drawn from the findings of the initial phase of the project. Stage two: Face-to-face discussion. Findings Statements were categorised based on questionnaire responses: 1) Consensus, 2) Staged consensus, 2) Minor modifications, 4) Controversial. Consensus was achieved on 11 core principles through group discussion; only one was omitted from the final set. Recommendations All midwifery programmes nationally to incorporate the agreed core principles. Findings should be disseminated to the regulatory body to help inform changes to midwifery and nursing educational standards. The core principles may also contribute to curriculum development in midwifery and other professions internationally

Individual earnings mobility and the persistence of earnings inequalities in Australia

This paper assesses earnings mobility among workers in Australia between 2001/2 and 2008/9 using HILDA household panel data. We examine the pattern of individuals' earnings growth and explore the importance of mobility as an equaliser of longer-term earnings. We find that progressive earnings growth decreased overall inequality even after considering the re-ranking that occurred in the distribution. This was partly driven by growth of earnings with age and partly by step changes associated with job-to-job moves, promotions and taking on more responsibility. Shocks also acted against this equalising process, most notably job loss, which had substantial negative effects on earnings and disproportionately fell on lower-waged workers

The Human–Nature Relationship and Its Impact on Health: A Critical Review

Within the past four decades, research has been increasingly drawn toward understanding whether there is a link between the changing human–nature relationship and its impact on people’s health. However, to examine whether there is a link requires research of its breadth and underlying mechanisms from an interdisciplinary approach. This article begins by reviewing the debates concerning the human–nature relationship, which are then critiqued and redefined from an interdisciplinary perspective. The concept and chronological history of “health” is then explored, based on the World Health Organization’s definition. Combining these concepts, the human–nature relationship and its impact on human’s health are then explored through a developing conceptual model. It is argued that using an interdisciplinary perspective can facilitate a deeper understanding of the complexities involved for attaining optimal health at the human–environmental interface

Exposure Assessment Approaches for Engineered Nanomaterials

Products based on nanotechnology are rapidly emerging in the marketplace, sometimes with little notice to consumers of their nanotechnology pedigree. This wide variety of nanotechnology products will result (in some cases) in unintentional human exposure to purposely engineered nanoscale materials via the dermal, inhalation, ingestion, and ocular pathways. Occupational, consumer, and environmental exposure to the nanomaterials should be characterized during the entire product lifecycle—manufacture, use, and disposal. Monitoring the fate and transport of engineered nanomaterials is complicated by the lack of detection techniques and the lack of a defined set of standardized metrics to be consistently measured. New exposure metrics may be required for engineered nanomaterials, but progress is possible by building on existing tools. An exposure metric matrix could organize existing data by relating likely exposure pathways (dermal, inhalation, ocular, ingestion) with existing measurements of important characteristics of nanoscale materials (particle number, mass, size distribution, charge). Nanomaterial characteristics not commonly measured, but shown to initiate a biological response during toxicity testing, signal a need for further research, such as the pressing need to develop monitoring devices capable of measuring those aspects of engineered nanomaterials that result in biological responses in humans. Modeling the behavior of nanoparticles may require new types of exposure models that individually track particles through the environment while keeping track of the particle shape, surface area, and other surface characteristics as the nanoparticles are transformed or become reactive. Lifecycle analysis could also be used to develop conceptual models of exposure from engineered nanomaterials.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79200/1/j.1539-6924.2010.01446.x.pd

Framing the agricultural use of antibiotics and antimicrobial resistance in UK national newspapers and the farming press

Despite links to animal disease governance, food and biosecurity, rural studies has neglected consideration of how actors make sense of the use of antibiotics in animal agriculture and the implications for animal and human health. As antimicrobial resistance (AMR) has become a high-profile problem, the contribution of animal antibiotics is frequently mentioned in scientific and policy documents but how different agricultural actors interpret its significance is less clear. This paper offers the first social scientific investigation of contestation and consensus surrounding the use of antibiotics in agriculture and their implications for AMR as mediated through mainstream news-media and farming print media in the UK. Frame analysis of four national newspapers and one farming paper reveals three distinct frames. A ‘system failure’ frame is the most frequently occurring and positions intensive livestock production systems as a key contributor to AMR-related crises in human health. A ‘maintaining the status quo’ frame argues that there is no evidence linking antibiotics in farming to AMR in humans and stresses the necessity of (some) antibiotic use for animal health. A third frame – which is only present in the farming media – highlights a need for voluntary, industry-led action on animal antibiotic use in terms of farmer self-interest. Common to all frames is that the relationship between agricultural use of antibiotics and problems posed by AMR is mostly discussed in terms of the implications for human health as opposed to both human and animal health

Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice

Background There is an emerging interest in the inadvertent harm caused to patients by the provision of primary health-care services. To date (up to 2015), there has been limited research interest and few policy directives focused on patient safety in primary care. In 2003, a major investment was made in the National Reporting and Learning System to better understand patient safety incidents occurring in England and Wales. This is now the largest repository of patient safety incidents in the world. Over 40,000 safety incident reports have arisen from general practice. These have never been systematically analysed, and a key challenge to exploiting these data has been the largely unstructured, free-text data. Aims To characterise the nature and range of incidents reported from general practice in England and Wales (2005–13) in order to identify the most frequent and most harmful patient safety incidents, and relevant contributory issues, to inform recommendations for improving the safety of primary care provision in key strategic areas. Methods We undertook a cross-sectional mixed-methods evaluation of general practice patient safety incident reports. We developed our own classification (coding) system using an iterative approach to describe the incident, contributory factors and incident outcomes. Exploratory data analysis methods with subsequent thematic analysis was undertaken to identify the most harmful and most frequent incident types, and the underlying contributory themes. The study team discussed quantitative and qualitative analyses, and vignette examples, to propose recommendations for practice. Main findings We have identified considerable variation in reporting culture across England and Wales between organisations. Two-thirds of all reports did not describe explicit reasons about why an incident occurred. Diagnosis- and assessment-related incidents described the highest proportion of harm to patients; over three-quarters of these reports (79%) described a harmful outcome, and half of the total reports described serious harm or death (n = 366, 50%). Nine hundred and ninety-six reports described serious harm or death of a patient. Four main contributory themes underpinned serious harm- and death-related incidents: (1) communication errors in the referral and discharge of patients; (2) physician decision-making; (3) unfamiliar symptom presentation and inadequate administration delaying cancer diagnoses; and (4) delayed management or mismanagement following failures to recognise signs of clinical (medical, surgical and mental health) deterioration. Conclusions Although there are recognised limitations of safety-reporting system data, this study has generated hypotheses, through an inductive process, that now require development and testing through future research and improvement efforts in clinical practice. Cross-cutting priority recommendations include maximising opportunities to learn from patient safety incidents; building information technology infrastructure to enable details of all health-care encounters to be recorded in one system; developing and testing methods to identify and manage vulnerable patients at risk of deterioration, unscheduled hospital admission or readmission following discharge from hospital; and identifying ways patients, parents and carers can help prevent safety incidents. Further work must now involve a wider characterisation of reports contributed by the rest of the primary care disciplines (pharmacy, midwifery, health visiting, nursing and dentistry), include scoping reviews to identify interventions and improvement initiatives that address priority recommendations, and continue to advance the methods used to generate learning from safety reports

Design of a randomized controlled trial for multiple cancer risk behaviors among Spanish-speaking Mexican-origin smokers

Background: Smoking, poor diet, and physical inactivity account for as much as 60% of cancer risk. Latinos experience profound disparities in health behaviors, as well as the cancers associated with them. Currently, there is a dearth of controlled trials addressing these health behaviors among Latinos. Further, to the best of our knowledge, no studies address all three behaviors simultaneously, are culturally sensitive, and are guided by formative work with the target population. Latinos represent 14% of the U. S. population and are the fastest growing minority group in the country. Efforts to intervene on these important lifestyle factors among Latinos may accelerate the elimination of cancer-related health disparities