Do acute elevations of serum creatinine in primary care engender an increased mortality risk?

Background: The significant impact Acute Kidney Injury (AKI) has on patient morbidity and mortality emphasizes the need for early recognition and effective treatment. AKI presenting to or occurring during hospitalisation has been widely studied but little is known about the incidence and outcomes of patients experiencing acute elevations in serum creatinine in the primary care setting where people are not subsequently admitted to hospital. The aim of this study was to define this incidence and explore its impact on mortality. Methods: The study cohort was identified by using hospital data bases over a six month period. Inclusion criteria: People with a serum creatinine request during the study period, 18 or over and not on renal replacement therapy. The patients were stratified by a rise in serum creatinine corresponding to the Acute Kidney Injury Network (AKIN) criteria for comparison purposes. Descriptive and survival data were then analysed. Ethical approval was granted from National Research Ethics Service (NRES) Committee South East Coast and from the National Information Governance Board. Results: The total study population was 61,432. 57,300 subjects with ‘no AKI’, mean age 64.The number (mean age) of acute serum creatinine rises overall were, ‘AKI 1’ 3,798 (72), ‘AKI 2’ 232 (73), and ‘AKI 3’ 102 (68) which equates to an overall incidence of 14,192 pmp/year (adult). Unadjusted 30 day survival was 99.9% in subjects with ‘no AKI’, compared to 98.6%, 90.1% and 82.3% in those with ‘AKI 1’, ‘AKI 2’ and ‘AKI 3’ respectively. After multivariable analysis adjusting for age, gender, baseline kidney function and co-morbidity the odds ratio of 30 day mortality was 5.3 (95% CI 3.6, 7.7), 36.8 (95% CI 21.6, 62.7) and 123 (95% CI 64.8, 235) respectively, compared to those without acute serum creatinine rises as defined. Conclusions: People who develop acute elevations of serum creatinine in primary care without being admitted to hospital have significantly worse outcomes than those with stable kidney function

Social factors associated with the decision to relinquish a baby for adoption

Little is known about the characteristics, social circumstances and mental health of women who give a child up for adoption. This paper reports data from a longitudinal study of 8556 women interviewed initially at their first obstetrical visit. In total, 7668 proceeded to give birth to a live singleton baby, of which 64 then relinquished the baby for adoption. Relinquishing mothers were predominantly 18 years of age or younger, in the lowest family income group, single, having an unplanned and/or unwanted baby and reported that they were not living with a partner. These women were somewhat more likely to manifest symptoms of anxiety and depression both prior, and subsequent to, the adoption, but the majority of relinquishing mothers were of 'normal' mental health. The decision to relinquish a baby appears to be a consequence of an unwanted pregnancy experienced by an economically deprived single mother rather than the result of emotional or psychological/psychiatric considerations. These findings document a particular dimension of the impact of poverty on health

What should we assess in practice?

Aim: This article reports on a PhD study and follow up work undertaken to review and develop a tool for assessment of practice. Background: The assessment of practice in nursing and midwifery education and, other health professions has been the source of concern, criticism and research for a number of years with the conclusion that it might not be possible to develop an assessment tool that could encompass all aspects of professional practice. Methods: A qualitative evaluation study was undertaken using the naturalistic method of inquiry. A combination of tools was used in order to collect the data and enable progressive focusing and cross checking of the findings. These included documentary analysis, a questionnaire and focus group and individual interviews. The data was collected from documents analysis, focus group interviews, individual interviews and questionnaires. Results: The results showed that the assessment tool in use at the time did not encompass all criteria assessors used and six areas were identified as those to include in any future tool. Conclusion: The six areas identified by subjects as those to include in any assessment tool were further developed with specific statements so that they could be used within a tool. Implications for nursing management and education: Within the changing nature of health care there is a need to review whether the tool used for assessing pre-registration education of nursing and midwifery students practice is ‘fit for purpose’

The association between school performance at 14 years and young adults' use of cannabis: An Australian birth cohort study

This study examines, firstly, the association between school performance at 14 years and frequency of use of cannabis in early adulthood and, secondly, whether this association is explained by family and individual characteristics, including child cognitive capacity in childhood and adolescence. Data are from a cohort of 3,478 Australian young adults who were followed up from birth to age 21 years. Data on child school performance and use of cannabis were collected at the 14- and 21-year follow-ups, respectively. Child school performance was assessed at 14 years via self- and maternal-report. Potential confounding factors were measured between the child's birth and age 14 years. School performance at 14 years predicts young adults' use of cannabis. Children who had lower school performance had increased risk of frequent use of cannabis in young adulthood. Exploration of the pathway linking school performance and cannabis use in young people may help identify opportunities for preventive interventions

The Relationship Between Low Family Income and Psychological Disturbance in Young Children: An Australian Longitudinal Study

Objective This study examines the relationship between low family income (LFI) experienced at different points in time, chronic low income status and its impact on child behaviour measured at 5 years of age. Method Longitudinal data from the Mater University Study of Pregnancy were used to measure LFI in families at three points in time (the antenatal period, 6 months post birth and at 5 years of age). Outcome variables were three independent groups of behaviour problems labelled as externalising, social, attentional and thought (SAT) problems, and internalising problems. These groups were developed from the Child Behaviour Checklist. An analysis based on logistic regression modelling was carried out examining the relationship between LFI and a range of intermediate variables known to be associated with child behaviour problems. Results The more often families experienced low income, the higher the rate of child behaviour problems at age 5. Low family income was still independently associated with SAT behaviour problems after controlling for smoking in the first trimester, parenting styles, maternal depression and marital disharmony at age 5. The association between LFI and internalising and externalising behaviour problems was largely mediated by maternal depression. Conclusion Low family income is a significant factor in the aetiology of a variety of child behaviour problems. The mechanisms involved in the link between LFI and childhood internalising and externalising behaviours involve the exposure of the children to maternal depression. However, the relationship between LFI and SAT behaviour problems remains to be elucidated

Examining the social construction of surveillance: a critical issue for health visitors and public health nurses working with mothers and children

Aims and objectives In this paper we will critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. Background The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. Design We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. Methods Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance Results Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power Conclusions Health care providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. Relevance to clinical practice Health care providers should be aware of how their positions of expert and privilege within health care systems affect relationships with mothers. A more comprehensive understanding of personal social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families

SF Box - A tool for evaluating the effects on soil functions in remediation projects

Although remediation is usually aimed at reducing the risks posed by contaminants to human health and the environment, it is also desirable that the remediated soil within future green spaces is capable of providing relevant ecological functions, e.g. basis for primary production. While addressing a contamination problem by reducing contaminant concentration/amounts in the soil, the remedial action itself can lead to soil structure disturbances, decline in organic matter and nutrient deficiencies, and in turn affect a soil's capacity to carry out its ecological soil functions. This paper presents the SF Box (Soil Function Box) tool that is aimed to facilitate integration of information from suggested soil quality indicators (SQIs) into a management process in remediation using a scoring method. The scored SQIs are integrated into a soil quality index corresponding to one of five classes. SF Box is applied on two cases from Sweden (Kvillebäcken and Hexion), explicitly taking into consideration uncertainties in the results by means of Monte Carlo simulations. At both sites the generated soil quality indices corresponded to a medium soil performance (soil class 3) with a high certainty. The main soil constraints at both Kvillebäcken and Hexion were associated with biological activity in the soil, as soil organisms were unable to supply plant-available nitrogen. At the Kvillebäcken site the top layer had a content of coarse fragment (ø > 2mm) higher than 35%, indicating plant rooting limitations. At the Hexion site, the soil had limited amount of organic matter, thus poor aggregate stability and nutrient cycling potential. In contrast, the soil at Kvillebäcken was rich in organic matter. The soils at both sites were capable to store a sufficient amount of water for soil organisms between precipitations

'The Girl Effect': Exploring Narratives of Gendered Impacts and Opportunities in Neoliberal Development

This paper explores representations of girls in current discourses of neoliberal development through an analysis of a range of texts that promote the global Girl Effect movement. These representations are situated in the context of theoretical debates about gender mainstreaming and policy developments that construct girls and women's 'empowerment' as 'smart economics'. The paper draws on postcolonial and transnational feminist analyses that critique market-led approaches to development and their complicities in the dynamics of neo-colonialism and uneven development, to contextualise the Girl Effect movement. It is argued that the Girl Effect movement draws on colonial stereotypes of girls as sexually and culturally constrained, but reworks these through the discourses of neoliberal development to construct girls as good investment potential. In doing so, it reproduces a dominant narrative that highlights the cultural causes of poverty but obscures structural relations of exploitation and privilege