Women and presbyterianism in Scotland c1830 to c1930

This thesis is a consideration of the changing relationship between women and presbyterianism in Scotland during the period c1830 - c1930, focusing particularly upon its effect on the developments which increased the involvement of women in public, social, ecclesiastical and political realms. It claims that women were historical agents who acted critically and creatively in response to their circumstances, and so were active participants in the processes of change.The values and beliefs expressed by Scottish women were not biologically essential or uniform, but shaped by their historical location. They were differentiated by a range of factors -including class, race, gender, character and geographical location - which belied the prevalent archetypal understanding of 'True Womanhood'. The period witnessed significant developments in the options available, especially to certain groups of women in church and society. Many women welcomed the potent concept of mission to justify and define their moral agency in religious work, philanthropy, education, and campaigns for social and political progress.The topic is introduced in chapter one with a brief consideration of its treatment (and neglect) in Scottish historiography, highlighting the significance of a presbyterian ethos in shaping the social and cultural landscape. I discuss sources, methodology, and limitations of the study. I contextualise the narrative by outlining the evolution of patriarchy as an organising principle in post-Reformation society, and of the 'separate spheres' doctrine which dominated discourse about women throughout the period.Chapter two looks at the development of women's work within the presbyterian denominations, and how that was related to the general industrial and professional employment of female labour in Scotland. Chapter three explores the involvement of women in the foreign missions of the church. Chapter four examines the official position of women within the presbyterian polity of the main denominations, and the options available to those who sought to challenge and change female exclusion from status and responsibility. Chapter five discusses the participation of women in four major campaigns to transform aspects of their society: anti-slavery] temperance; the struggle for access to higher education; the women's suffrage campaign. It focuses particularly on the ways in which people, policies and practices were influenced by presbyterianism, and vice versa and analyses, in the Scottish context, the claim that Protestantism was an almost essential precondition for the development of feminism in the western world. Chapter six is an attempt, based on the research, and on insights from contemporary feminist theology, to assess whether presbyterianism in Scotland during the period could be characterised as a source of liberation or oppression for women. Appendix I is a comparative case study of two local branches of the Church of Scotland Woman's Guild

Interventions to improve healthcare workers’ hand hygiene compliance: a systematic review of systematic reviews

Objective: To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). Methods: PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. Results: Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. Conclusions: This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes

‘Too Far Gone’: Dyslexia, Homelessness and Pathways into Drug Use and Drug Dependency

The aim of this paper is to investigate the relationship between dyslexia, homelessness, drug use and drug dependency. We analyzed data from the “Multiple Exclusion Homelessness Across the United Kingdom Survey,” a national survey that collected data from 443 respondents who have experienced some form of homelessness in the U.K. Our particular interest lied in the different experiences of drug use and drug dependency, comparing homeless people with dyslexia and homeless people without dyslexia. The study reveals that people with dyslexia are overrepresented within the survey’s homeless population. Furthermore, the findings indicate that there is an increase in dependency problems as well as significant mental health problems for respondents with dyslexia compared to the non-dyslexic homeless control group. The results show that dyslexic respondents were more likely to use methadone, more susceptible to self-harm, and reported an increase in suicide attempts compared with the non-dyslexic control group

Allied Health Student Clinical Placements in Residential Aged Care Facilities: Staff Opinions, Attitudes, and Support Needs

Purpose: As the population ages, the incidence and prevalence of chronic health issues requiring allied health management is increasing. Currently, there is an undersupply of appropriately skilled allied health professionals working in aged care. This has also been identified as a setting in which many beginning health practitioners are reluctant to seek employment. In order to address this workforce shortage, it is imperative that students are prepared for a possible future career within aged care facilities. Early clinical experience within this setting may increase student confidence, raise awareness of the need for services, and encourage students to consider working in aged care. At present, student clinical placements within aged care facilities are limited, potentially contributing to difficulties addressing workforce needs. The reasons for the lack of clinical placements and the relative contribution of the opinions, attitudes, training, and support needs of staff are unknown. The purpose of this study was to investigate the opinions, attitudes, support, and training needs of physiotherapists, dieticians, and managers working in residential aged care regarding allied health professional student clinical placements. Method: A written survey of allied health professionals (dieticians and physiotherapists, n=26) and managers (n=40) working in residential aged care was conducted. Responses were analysed using qualitative and quantitative methods. Results: Participants had generally positive attitudes towards student placements in residential aged care. Managers were significantly more positive regarding the scope for student clinical placements within their facilities than allied health professionals (p\u3c 0.05). The biggest barrier to student placements identified by both managers and allied health professionals was the nature of employment of allied health professionals in the sector. Participating allied health professionals also indicated that they required specific training in student supervision and the provision of clinical education. Conclusion: The attitudes and opinions of allied health professionals and managers did not appear to contribute to a lack of allied health professional student placements in aged care facilities. The main barriers to placement were the nature of allied health professional employment and a lack of staff experience in supervising students on clinical placement. Specific training and mentoring of allied health professionals may facilitate increased student placement capacity in the aged care setting

What are the ‘active ingredients’ of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

Objectives. Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action. Methods. The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions. Results. Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly ‘Knowledge’ and ‘Environmental context and resources’. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly ‘Information about health consequences’, ‘Credible source’, and ‘Instruction on how to perform the behaviour’. Conclusions. We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content

Non-market Valuation Biases Due to Aboriginal Cultural Characteristics in Northern Saskatchewan: The Values Structures Component

Current non-market valuation techniques have been developed based on assumptions about values held within the Eurocentred culture. Contentions between cultures over natural resources are hypothesized to occur because of differences in held values resulting in different values being assigned to the resources in question. This study measured the held values of an Aboriginal band in Northern Saskatchewan as the first dimension of a non-market valuation study of natural resources. These held value structures are presented noting differences by age and gender and in comparison with the local Non-Aboriginal community and another Aboriginal group in northern Alberta.Resource /Energy Economics and Policy,

Enhancing the quality and safety of care through training generalist doctors: a longitudinal, mixed-methods study of a UK broad-based training programme

Objective Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-based training programme prepares doctors for a changing health service. Setting and participants We adopted a longitudinal, mixed-methods approach, collecting questionnaire data from trainees on the broad-based training (BBT) programme in England (baseline n=62) and comparator trainees in the same regions (baseline n=90). We held 15 focus groups with BBT trainees and one-to-one telephone interviews with trainees post-BBT (n=21) and their Educational Supervisors (n=9). Results From questionnaire data, compared with comparator groups, BBT trainees were significantly more confident that their training would result in: wider perspectives, understanding specialty complementarity, ability to apply learning across specialties, manage complex patients and provide patient-focused care. Data from interviews and focus groups provided evidence of positive consequences for patient care from BBT trainees’ ability to apply knowledge from other specialties. Specifically, insights from BBT enabled trainees to tailor referrals and consider patients’ psychological as well as physical needs, thus adopting a more holistic approach to care. Unintended consequences were revealed in focus groups where BBT trainees expressed feelings of isolation. However, when we explored this sentiment on questionnaire surveys, we found that at least as many in the comparator groups sometimes felt isolated. Conclusions Practitioners with an understanding of care across specialty boundaries can enhance patient care and reduce risks from poor inter-specialty communication. Internationally, there is growing recognition of the place of generalism in medical practice and the need to take a more person-centred approach. Broad-based approaches to training support the development of generalist doctors, which is well-suited to a changing health service

'Black sheep in the herd'? The role, status and identity of generalist doctors in secondary care

Changing patient demographics raise important challenges for healthcare providers around the world. Medical generalists can help to bridge gaps in existing healthcare provision. Various approaches to medical generalism can be identified, for example hospitalists in the US and the restructuring of care away from medical disciplines in the Netherlands, which have different implications for training and service provision. Drawing on international debates around the definition and role of generalism, this paper explores one manifestation of generalism in the UK in order to understand how abstract ideas work in practice and some of the benefits and challenges. Broad-based training (BBT) is a two-year postgraduate training programme for doctors recently piloted in England. The programme provided 6-month placements in four specialties (General Practice, Core Medicine, Psychiatry and Paediatrics) and aimed to develop broad-based practitioners adept at managing complex and specialty integration. Our longitudinal, mixed-methods evaluation of the programme demonstrates that although trainees value becoming more holistic in their medical practice, they also raise concerns about being perceived differently by co-workers, and report feeling isolated. Using identity theory to explore the interplay between generalism and existing boundaries of professionalism in healthcare provision, we argue that professional identity, based on disciplinary structure and maintained by boundary work, troubles identity formation for generalist trainees who transcend normative disciplinary boundaries. We conclude that it is important to address these challenges if generalism in secondary care settings is to realise its potential contribution to meeting increasing health service demands