Farmers, farm workers and work-related stress

This research explores the ways in which stress affects farming communities, how this has changed in recent years, and the degree to which work-related aspects of stress may be assuaged by support interventions. A qualitative case study research approach was employed to address these issues, involving 60 interviews in five locations across England and Wales.In examining farming stress, a distinction is made between its intrinsic, extrinsic and workrelated dimensions. Whileinterviewees tended to associate day-to-day worries and acute stress with farming’s intrinsic demands (such as disease and adverse weather conditions), external causes of tension (such as competition and regulation), together with worries about finances and family, were associated with more sustained anxieties. By contrast, work-related aspects of farming stress, such as workload issues and farming practices, involved a combination of physical and mental health effects.Notably, work-related and extrinsic dimensions of stress have increased in recent years in relation to organisational and policy shifts, price fluctuations, mounting paperwork demands, workload intensification, and changes in agricultural regulation. These have prompted an escalation in the aspects of their work that farming communities feel powerless to control, and represent a major area for policy intervention. Principal farmers displayed the most visible manifestations of stress, linked at once to the intrinsic, extrinsic and workrelated dimensions of their work. By contrast, family farm workers and labourers often lacked autonomy over the way they worked, and work-related aspects of stress concerning workload and organisation made up a greater part of their experience. Increased paperwork demands emerged as a major cause of stress among interviewees, particularly forfarmers and their wives, who struggled to balance these with traditional farming priorities. Differences between farmswere also influential in explaining stress. Livestock farming embodied intrinsic pressures relating to stock crises and the unpredictability of animals, but more recently has come under intense economic pressure, prompting a rationalisation of working practices. Arable farmers found the organisation of activities, such as harvesting and planting, in a context of reduced and increasingly contractual workforces particularly challenging. Mixed farmers faced the dual stresses of balancing work activities with conflicting timetables, and the paperwork demands of a complex portfolio of farming. Smaller farms were struggled with intensified workloads, while larger enterprises had to comply with the demands of more inspection regimes.Support agencies need to overcome the stigma attached to asking for help among farming communities and offer a rangeof responsive and proactive services. Locally based support was more likely to be used and trusted, although concernsabout client confidentiality might deter those most in need from seeking help. Where existing local networks wereestablished, there was a strong argument for providers to plug into these and work towards publicising their efforts to ensure that support is provided most effectively. Critically, support must be multidimensional, reflecting the wide range of stressors and their impacts among farming communities

Show Me How to Do Like You: Co-mentoring as Feminist Pedagogy

Three professors reflect on the experience of creating a learning community of 22 students by linking courses in Literature and Ethics. The project demonstrates practical strategies for incorporating feminist scholarship and pedagogy into the core curriculum and for integrating core courses from diverse disciplines

Implementing Online Dispute Resolution in MO HealthNet Appeals: Increasing Access to Remedies While Decreasing State Spending

The distress associated with filing a civil lawsuit can leave an individual with a range of emotions, including despondency, humiliation, frustration, loss of self-confidence, and anxiety. Generally, an individual will only file suit if they suffer a serious harm. Subsequently, the individual must relive the injury at each step of the litigation. Repeatedly revisiting the injury disrupts the individual’s life and often leaves them feeling isolated and helpless. Now, picture an individual having to go through the entire process without the guidance of a lawyer, which is called pro se representation. This only adds to the individual’s stress levels. Representing one’s self in a traditional court system is similar to playing chess without ever learning the rules. Both games are governed by precise, complex procedures that make it very difficult for any novice to win against an expert. Consequently, pro se individuals often fail to obtain the relief they seek, rendering all of their stress and physical suffering moot

Involving young men in preventing violence against women : a case study of Instituto Promundo's Program H : a research report presented in partial fulfilment of the requirements for the degree of Master of International Development at Massey University, Manawatū, New Zealand

Intimate partner violence among youth is recognised as a public health concern, an obstacle to economic development, and a gross violation of human rights. This research found that intimate partner violence against women is closely linked to inequitable gender attitudes. In order to combat violence related to these gender attitudes, prevention interventions have particularly targeted young men in recent years. However, in aiming to solve this issue, violence prevention has often heavily focused on reducing the risk of negative behaviour, rather than positively empowering youth participation and growth. Approaches that instead view youth as resources to be developed, rather than simply as risks to society, are recommended. This research is focusing specifically on Instituto Promundo as an example of an organisation that seeks to fulfil youth rights in practice and improve youth behaviour and attitudes relating to gender within the Brazilian context. Promundo’s ‘Program H’ works to empower young men to rewrite harmful traditional masculinities and ultimately prevent violence through engagement in both individual and community activities. This report utilised a Positive Youth Development framework to investigate Program H, and found that the initiative has the potential to simultaneously prevent the risk of violence while also promoting positive youth behaviour. Program H significantly contributes to changing inequitable gender norms amongst young men, with potential positive and empowering flow-on effects to the young people of Brazil and the wider Latin American region

Pressure injury management: An exploration of current practice within New South Wales and Victorian Health Services

INTRODUCTION Pressure injuries (PIs) are a multifactorial issue affecting those with complex chronic care needs. PI is also an important quality and safety issue, which presents challenges across all health service settings (Australian Commission on Safety and Quality in Health Care (ACSQHC), 2012a, 2012b). When PI occur they result in poor client and health system outcomes. Research in the area of PI has traditionally focused on acute and long-term aged care settings. The aim of the research project, which will be described in the present thesis, was to explore current practice in PI management, with a particular emphasis on PI management within community service settings. An enhanced understanding of current practice, captured across the main health service settings that comprise the Australian Health Care System (AHCS), informed new mechanisms to support the workforce in this challenging area of practice. METHODS A health services research approach was used to inform the current project. The aim of health services research is to improve health care through enhanced clinical and organisational practices and health care policy (Shi, 2008). All decisions regarding the research process were informed by a desire to influence outcomes of care through the application of the research findings in everyday practice. This applied approach was achieved through mixed qualitative methods, which were selected for there ability to address the research questions (Patton, 2002). Phase One involved two community based case explorations during which data related to the provision of PI services, experience of PI services and perceptions of real need for PI management were gathered. Phase Two involved five interdisciplinary group discussions with clinicians (n=38) from community based, hospital based and long-term aged care settings. These discussions were used to gather a range of perspectives and experiences regarding current practice. Phase Three involved peer validation processes including the provision of overall feedback to health services, two in-depth interviews and a series of presentations to clinicians and researchers at key conferences. All data were analysed using a thematic analysis approach (Braun & Clark, 2006). FINDINGS AND DISCUSSION Data collected over the course of this project were aggregated, synthesised and presented at the key levels of operation within health care: the system, client and clinician levels. This approach enabled consideration of the key issues influencing PI management, the capacity for change and the potential impact of innovations at each level of the AHCS. Participants discussed health systems as well as clinician and client behaviour at length. There were a number of issues occurring at the system, clinician and client levels that influenced PI management. The data suggested that participants were not convinced that the general approaches to PI were meeting the needs of all clients and services. Key issues relating to workforce development included skill-mix and organisation of services, along with education and training. Consideration of the key issues at the system, client and service levels of the AHCS, suggested that longer-term PI needs may be best met by supporting team-based approaches within primary health care. Most participants believed that increasing client and support care involvement in PI management was essential to meet increasing demands for these services. Additionally, the role of clients and their informal support care was found to be necessary in the early recognition of the signs and symptoms of PI, due to its natural history. Clients and their support care would thus benefit from clinicians, learning how to effectively educate clients as partners in their own care. SUGGESTIONS FOR PRACTICE AND RESEACH A new model of care is proposed and its necessary supports are described. This new model of care enhances client access to PI management by ensuring the best use of skills and local resources, toward team based approaches within community based care. By creating a ‘hub’ for PI needs within primary health care, this will better support the transition of PI management between hospital based and community based services, as well as facilitate improved continuity of care and co-ordination of care for those with longer-term PI needs. A necessary support for the model, amongst others, is a new role that works to address ‘gaps’ and the cross organisational boundaries that influence daily practice. This new role will also provide important support for clinicians in partnering with clients in their own care, by acting as an educative resource within community service settings. CONCLUSION As clients and their support care have the greatest opportunity to identify the early signs and symptoms of PI, the up-skilling of clinicians to effectively impartinformation to lay-persons isnecessary. The proposed new model of care and its accompany of supports may assist health services to enhance continuity ofcareandaccess to PI services, through the optimum organisationof skills at the local service level. Facilitating greater client and support care participation in PI management may assist health services to enhance preventative efforts, and assist in the earlier identification and expedited management of PI. KEYWORDS Pressure injury, Pressure ulcer, community, workforce, allied health, health services research

Late diagnosis of HIV in the United Kingdom: an evidence review.

•Late diagnosis of HIV remains an important public health issue in the UK, with 40% of newly diagnosed individuals in 2014 diagnosed late •Reducing the number of people presenting to care at a late stage of HIV infection is a key public health priority in the United Kingdom. It is one of only three sexual health indicators included on the Public Health Outcomes Framework for England and a key ambition of the Framework for Sexual Health Improvement in England •Late diagnosis of HIV is defined as having a CD4 count of less than 350 cells per mm3 within 3 months of diagnosis and is associated with significantly heightened levels of HIV related morbidity and mortality, increased risk of onward HIV transmission (Halve it, 2011) and higher healthcare costs •Evidence suggests that certain groups are disproportionally affected by late diagnosis, namely older adults, heterosexuals and non-national populations, in particular black Africans •Evidence suggest that the majority of individuals have lowered perceptions of their risk of acquiring HIV and for those who have recent high risk behaviour, fear of disease is an important barrier to testing. Amongst black African populations, there are additional barriers to testing including a heightened fear of disclosure due to stigma •Amongst healthcare professionals, missed diagnostic opportunities are well documented and are linked to clinician’s own perceptions of risk and a lack of knowledge of HIV and testing procedures •Interventions to expand testing beyond routine settings have been shown as both acceptable and feasible to patients and staff and, cost effective. Pilots to expand testing in hospital and primary care settings have found varying levels of testing activity among clinicians suggesting that support and training for healthcare staff is necessary and effective in increasing testing •Community outreach testing has been found particularly effective among MSM and black African populations. Research suggests that effective interventions must be: grounded in community mobilisation and outreach settings; normalise both testing and treatment for HIV and, address HIV related stigma. Emerging evidence also suggests that new home sampling and home testing methods will be particularly effective in accessing harder to reach groups particularly among MS

Addressing Obstacles to Success: Improving student completion, retention and achievement in science modules in applied health programmes, with particular reference to Maori

The overall aim of our research project is to remove “the problem” of achievement in science for students in the nursing and midwifery programmes. Past students have reported science as difficult and time-consuming, and their achievement results reflected this. Science was seen as a barrier to overall course success (Gibson et al, 2005). Other research (Zepke, et al, 2006; Otrel-Cass et al, 2006) has focused on problems of retention and completion in the tertiary sector, thus locating the student or the tertiary context as the problem. Our research rests on a different proposition, arguing that the curriculum is at the root of “the problem”. We are adjusting the science curriculum in an attempt to make the links between science and practice more explicit, so that students might see greater relevance for their learning, make richer links to prior experience and more explicitly link the science to their chosen careers