Family and cultural factors in the development of eating disorders : a study of feminine identity in twenty-four bulimic women.

In this study twenty-four bulimic women participated in a questionnaire and semi-structured interview designed to examine their perceptions of themselves, their eating problems, and their families. In accord with the literature in the field, the questionnaire and interview were structured and data analyzed to facilitate a comparison of bulimia and anorexia nervosa. The analysis suggests that eating patterns and family experiences of bulimics and anorexics differ in significant ways. There was no one significant or common eating pattern for all subjects. However, all the women engaged in secretive eating binges which did not appear to be motivated by hunger. Unlike anorexics, all women were acutely aware of their eating problem and shared an obsessive concern with food and body size. None were hyperactive. Most striking was the significance of the late adolescent transition of leaving home. Unlike anorexics for whom entering adolescence is a central conflict, bulimics experience mildly troubled adolescence and more severe difficulty entering adult womenhood. However, for bulimics the problems of adolescence centered on their emerging sexuality and peer relations. These problems highlighted certain characteristics of their relationships with parents. Subjects reported relationships with mothers to be overinvolved and conflict avoidant. Identification with mothers was problematic and conflictual for all women. Subjects described their fathers as emotionally unavailable. Alcohol abuse was present in a significant minority of fathers. During the transition from family of origin to living autonomously dysfunctional eating patterns intensified. It was suggested that conflicts between family culture and the larger culture played a significant role in the development of bulimia. It was concluded that the entire field of eating disorders is in need of further conceptual clarification. Current classification schemes fail to discriminate amongst phenomena that may be discrete in origins and dynamics. A comparison of the early dynamics of individuals suffering from a variety of eating disorders could provide some of the clarification needed

Perceptions of the learning environment in higher specialist training of doctors: implications for recruitment and retention.

INTRODUCTION: Career choice, sense of professional identity and career behaviour are influenced, subject to change and capable of development through interaction with the learning environment. In this paper workplace learning discourses are used to frame ongoing concerns associated with higher specialist training. Data from the first stage of a multimethods investigation into recruitment into and retention in specialties in the West Midlands is used to consider some possible effects of the specialist learning environment on recruitment and retention. METHODS: The aim of the study was to identify issues, through interviews with 6 consultants and questionnaires completed by specialist registrars from specialties representing a range of recruitment levels. These would inform subsequent study of attributes and dispositions relevant to specialist practice and recruitment. The data were analysed using NVivo software for qualitative data management. RESULTS: Participants' perceptions are presented as bipolar dimensions, associated with: curriculum structure, learning relationships, assessment of learning, and learning climate. They demonstrate ongoing struggle between different models of workplace learning. CONCLUSION: Changes in the postgraduate education of doctors seem set to continue well into the future. How these are reflected in the balance between workplace learning models, and how they influence doctors' sense of identity as specialists suggests a useful basis for examination of career satisfaction and recruitment to specialties

A methodology for assessing the professional development needs of nurses and midwives in Indonesia: paper 1 of 3

BACKGROUND: Despite recent developments, health care provision in Indonesia remains suboptimal. Difficult terrain, economic crises, endemic diseases and high population numbers, coupled with limited availability of qualified health care professionals, all contribute to poor health status. In a country with a population of 220 million, there are currently an estimated 50 nurses and 26 midwives per 100 000 people. In line with government initiatives, this series of studies was undertaken to establish the training and development needs of nurses and midwives working within a variety of contexts in Indonesia, with the ultimate aim of enhancing care provision within these domains. METHODS: An established, psychometrically valid and reliable training needs instrument was modified for use within the Indonesian context. While this technique has had widespread international use in the developed world, its application for developing countries has not yet been established. The standard form consists of a biographical cover sheet and a core set of 30 items (all health-related tasks), which have to be rated along two seven-point scales. The first of these scales asks respondents to assess how important the task is to their job and the second scale is a self-assessment of respondents' current performance level of the task. By comparing the importance rating with the performance rating, an index of training need can be obtained (high importance and low performance indicating a significant training need). The modifications incorporated for use in this series of studies were a further 10 items, which were constructed following expert group and focus group discussions and a review of the relevant literature. Pilot trials with 109 respondents confirmed its feasibility and acceptability. The instrument was then administered to 524 nurses and 332 midwives across Indonesia. RESULTS: The data were subjected to a retrospective factor analysis, using a Varimax rotation and Cronbach's α to check the instrument's validity and reliability following modification. The results yielded six factors, which accounted for >53% of the variance, each of which had a Cronbach's α score of between 0.8644 and 0.7068. CONCLUSION: The results suggest that the modified instrument remained valid and reliable for use in the Indonesian nursing and midwifery context

The training and development needs of midwives in Indonesia: paper 2 of 3

BACKGROUND: There is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives. METHODS: A psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents. RESULTS: The occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwives CONCLUSION: The results from this survey suggest important regional differences in how the midwife's role is discharged and underline the importance of this sort of research, in order to ensure the suitability of basic and postbasic educational provision. The study also highlights the need for further development and training of midwives in a wide range of tasks. These results provide a systematic and reliable overview of current midwifery roles and development needs and could serve to inform future training

The training and development needs of nurses in Indonesia: paper 3 of 3

BACKGROUND: Indonesia's recent economic and political history has left a legacy of widespread poverty and serious health problems, and has contributed to marked inequalities in health care. One means of responding to these challenges has been through a reconsideration of the professional roles of nurses, to enable them to deal with the range and complexity of health problems. However, there are currently a number of obstacles to achieving these aims: there is a serious shortfall in trained nurses; the majority of nurses have only limited education and preparation for the role; and there is no central registration of nurses, which means that it is impossible to regulate either the profession or the standards of care. This study aimed to establish the occupational profiles of each grade of nurse, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings. METHODS: An established and psychometrically valid questionnaire was administered to 524 nurses, covering three grades and coming from five provinces. RESULTS: Significant differences in job profile were found in nurses from different provinces, suggesting that the nature of the role is determined to some degree by the geographical location of practice. The roles of hospital and community nurses, and the different grades of nurse, were fairly similar. All nurses reported significant training needs for all 40 tasks, although these did not vary greatly between grade of nurse. The training needs of nurses from each of the provinces were quite distinct, while those of hospital nurses were greater than those of community nurses. CONCLUSION: The results suggest that the role of the nurse is not as diverse as might be expected, given the different levels of preparation and training and the diversity of their work environments. This may reflect the lack of a central registration system and quality framework, which would normally regulate clinical activities according to qualifications. The differences in training needs between subsections of the sample highlight the importance of identifying skills deficits and using this information to develop customized post-registration education programmes. Together, these results provide a rigorous and reliable approach to defining the occupational roles and continuing education needs of Indonesian nurses

Translating and validating a Training Needs Assessment tool into Greek

<p>Abstract</p> <p>Background</p> <p>The translation and cultural adaptation of widely accepted, psychometrically tested tools is regarded as an essential component of effective human resource management in the primary care arena. The Training Needs Assessment (TNA) is a widely used, valid instrument, designed to measure professional development needs of health care professionals, especially in primary health care. This study aims to describe the translation, adaptation and validation of the TNA questionnaire into Greek language and discuss possibilities of its use in primary care settings.</p> <p>Methods</p> <p>A modified version of the English self-administered questionnaire consisting of 30 items was used. Internationally recommended methodology, mandating forward translation, backward translation, reconciliation and pretesting steps, was followed. Tool validation included assessing item internal consistency, using the alpha coefficient of Cronbach. Reproducibility (test – retest reliability) was measured by the kappa correlation coefficient. Criterion validity was calculated for selected parts of the questionnaire by correlating respondents' research experience with relevant research item scores. An exploratory factor analysis highlighted how the items group together, using a Varimax (oblique) rotation and subsequent Cronbach's alpha assessment.</p> <p>Results</p> <p>The psychometric properties of the Greek version of the TNA questionnaire for nursing staff employed in primary care were good. Internal consistency of the instrument was very good, Cronbach's alpha was found to be 0.985 (p < 0.001) and Kappa coefficient for reproducibility was found to be 0.928 (p < 0.0001). Significant positive correlations were found between respondents' current performance levels on each of the research items and amount of research involvement, indicating good criterion validity in the areas tested. Factor analysis revealed seven factors with eigenvalues of > 1.0, KMO (Kaiser-Meyer-Olkin) measure of sampling adequacy = 0.680 and Bartlett's test of sphericity, p < 0.001.</p> <p>Conclusion</p> <p>The translated and adapted Greek version is comparable with the original English instrument in terms of validity and reliability and it is suitable to assess professional development needs of nursing staff in Greek primary care settings.</p

Sedimentary carbon on the continental shelf : emerging capabilities and research priorities for Blue Carbon.

This work was supported by Cefas internal Seedcorn self-investment funding under the project DP440: Blue carbon within climate mitigation and ecosystem service approaches to natural asset assessments, and by Cefas’ Ecosystem Theme science theme.Continental shelf sediments store large amounts of organic carbon. Protecting this carbon from release back into the marine system and managing the marine environment to maximize its rate of accumulation could both play a role in mitigating against climate change. For these reasons, in the context of an expanding ‘Blue Carbon’ concept, research interest in the quantity and vulnerability of carbon stored in continental shelf, slope, and deep ocean sediments is increasing. In these systems, carbon storage is physically distant from carbon sources, altered between source and sink, and disturbed by anthropogenic activities. The methodological approaches needed to obtain the evidence to assess shelf sea sediment carbon manageability and vulnerability within an evolving blue carbon framework cannot be transferred directly from those applied in coastal vegetated ‘traditional’ blue carbon habitats. We present a ‘toolbox’ of methods which can be applied in marine sediments to provide the evidence needed to establish where and when marine carbon in offshore sediments can contribute to climate mitigation, focusing on continental shelf sediments. These methods are discussed in the context of the marine carbon cycle and how they provide evidence on: (i) stock: how much carbon is there and how is it distributed? (ii) accumulation: how rapidly is carbon being added or removed? and (iii) anthropogenic pressures: is carbon stock and/or accumulation vulnerable to manageable human activities? Our toolbox provides a starting point to inform choice of techniques for future studies alongside consideration of their specific research questions and available resources. Where possible a stepwise approach to analyses should be applied in which initial parameters are analysed to inform which samples, if any, will provide information of interest from more resource-intensive analyses. As studies increasingly address the knowledge gaps around continental shelf carbon stocks and accumulation – through both sampling and modelling – the management of this carbon with respect to human pressures will become the key question for understanding where it fits within the blue carbon framework and within the climate mitigation discourse.Publisher PDFPeer reviewe

Reluctant empiricists: community mental health nurses and the art of evidence-based praxis

The definitive version of this article is available at www.blackwell-synergy.comThe National Service Framework for Mental Health (1999) emphasizes the need for a culture of evidence-based practice (EBP) in mental health care. However, there is relatively little research addressing EBP from the perspective of community mental health nurses and we are still unsure of why the uptake of this style of working has been slow. This paper suggests that rather than thinking in terms of ‘barriers’ to the uptake of EBP, the issue may best be conceptualized as a form of praxis on the part of nurses, as they seek to manage the diversity of ideologies and practices in their working lives. From an interview and focus group study, we identify how practitioners’ narrow definition of EBP itself, their formulation of how EBP was at odds with the nurse’s professional activity and the organizational constraints within which they work were perceived to inhibit access to information and offer little time and managerial support for information seeking. Those who attempt to further the involvement of community mental health staff in EBP will have to reconceptualize the reasons why staff have yet to incorporate it fully, and acknowledge that this does not occur because staff are simply ‘ignorant Luddites’, but that this resistance enables them to retain a sense of control over their working lives and retain a focus on work with clients. Future EBP initiatives will have to address these ideological and organizational factors in order for uptake to be accelerated. This may involve changing organizational cultures and work roles and even encouraging activism on the part of the practitioners so as to enable them to learn from each other and educate and change their work environments

Broad Down, Devon: archaeological and other stories

publication-status: PublishedThis is a post-print, author-produced version of an article accepted for publication Journal of Material Culture, 2010, Vol. 15, Issue 3, pp. 345 - 367. Copyright © 2010 SAGE Publications. The definitive publisher-authenticated version is available online at http://mcu.sagepub.com/content/15/3/345.shortThis article explores the knowledge construction process of an archaeological site in East Devon, UK. Bouncing off an oral historical account of the site that seems to run against scientific truth claims, the author investigates the story of how knowledge of the site has developed over the last two centuries. Building on previous work that explores the history and practice of archaeology, the article opens up questions of what counts as evidence. Then, taking a cue from more recent work that suggests a more dynamic and open-ended engagement with the landscape, the article turns to examine how the meaning of a site can be made and remade. As part of this endeavour, questions of what as well as who can ‘speak’ are examined and some space is opened up for the agency of ‘minor figures’, both human and non-human