Student nurses' gender-based accounts of men in nursing

Stereotypes of nursing as a female profession and of male nurses as gay can limit male recruitment. This UK-based focus-group study examines whether student nurses reproduce or challenge such views. Using discourse analysis, discussion transcript segments dealing with male nurses’ gender or sexuality were examined for turn design, sequential organization, and procedural relevance. Results showed participants characterized such stereotypical constructions of male nurses as held only by other people. They themselves, however, used gender-based distinctions to problematic male nursing. These findings indicate nursing students would benefit from training which emphasizes the positioning of men and women within society

Mental Health and Unemployment in Scotland: Understanding the impactof welfare reforms in Scotland for individuals with mental health conditions

During 2016, 30 individuals with a mental health condition (who claimed ESA, have had their ESA withdrawn and moved on to JSA, or have been directed into the WRAG group based on the decision of the WCA) were interviewed. The 30 participants were recruited throughout Scotland. In addition, we interviewed seven individuals who had involvement with various intermediaries, such as advocacy organisations, collective advocacy groups, Citizens Advice Bureau and (an ex employee of) Ingeus. Participants were recruited through advocacy organisations, voluntary groups and the local media. Overall, we established that the Work Capability Assessment (WCA) does not inspire confidence in participants in its adequacy for assessing mental health problems. There is concern that the assessors do not appear to have appropriate expertise in mental health. The WCA experience for many, caused a deterioration in people’s mental health which individuals did not recover from. In the worst cases, the WCA experience led to thoughts of suicide. People felt that that there was an inconsistency in terms of GP recommendations and the WCA recommendations. Many people were subject to further upset and distress due to communication from the DWP being lost in the post. Having a mental health condition (MHC) in parallel with being unemployed and on benefits leads individuals to be confronted with multiple and competing stigmas, which they find hard to manage and these become self-reinforcing and self-perpetuating. The WCA and other mandatory structures, work against individuals developing or retaining employability skills as voluntary work is seen as demonstrating fitness for work; education is also not possible whilst receiving ESA. The system fails to recognise that for many, volunteering is good for wellbeing and may be ‘as good as it gets’. Whilst the Scottish Government does not have control over the ESA component of Universal Credit, it needs to carefully consider how any benefits that is does have control over (e.g. DLA) are assessed and managed for people with a MHC. Moreover, as control over the Work Programme and Work Choice is to be devolved to Scotland, the Scottish Government should develop replacement programmes which are appropriate to people with mental health problems which can also work in parallel with the benefits system

Mental Health and Unemployment in Scotland: Understanding the impactof welfare reforms in Scotland for individuals with mental health conditions

During 2016, 30 individuals with a mental health condition (who claimed ESA, have had their ESA withdrawn and moved on to JSA, or have been directed into the WRAG group based on the decision of the WCA) were interviewed. The 30 participants were recruited throughout Scotland. In addition, we interviewed seven individuals who had involvement with various intermediaries, such as advocacy organisations, collective advocacy groups, Citizens Advice Bureau and (an ex employee of) Ingeus. Participants were recruited through advocacy organisations, voluntary groups and the local media. Overall, we established that the Work Capability Assessment (WCA) does not inspire confidence in participants in its adequacy for assessing mental health problems. There is concern that the assessors do not appear to have appropriate expertise in mental health. The WCA experience for many, caused a deterioration in people’s mental health which individuals did not recover from. In the worst cases, the WCA experience led to thoughts of suicide. People felt that that there was an inconsistency in terms of GP recommendations and the WCA recommendations. Many people were subject to further upset and distress due to communication from the DWP being lost in the post. Having a mental health condition (MHC) in parallel with being unemployed and on benefits leads individuals to be confronted with multiple and competing stigmas, which they find hard to manage and these become self-reinforcing and self-perpetuating. The WCA and other mandatory structures, work against individuals developing or retaining employability skills as voluntary work is seen as demonstrating fitness for work; education is also not possible whilst receiving ESA. The system fails to recognise that for many, volunteering is good for wellbeing and may be ‘as good as it gets’. Whilst the Scottish Government does not have control over the ESA component of Universal Credit, it needs to carefully consider how any benefits that is does have control over (e.g. DLA) are assessed and managed for people with a MHC. Moreover, as control over the Work Programme and Work Choice is to be devolved to Scotland, the Scottish Government should develop replacement programmes which are appropriate to people with mental health problems which can also work in parallel with the benefits system

Genotype and environment affect the grain quality and yield of winter oats (Avena sativa L.)

The extent to which the quality and yield of plant varieties are influenced by the environment is important for their successful uptake by end users particularly as climatic fluctuations are resulting in environments that are highly variable from one growing season to another. The genotype-by-environment interaction (GEI) of milling quality and yield was studied using four winter oat varieties in multi-locational trials over 4 years in the U.K. Significant differences across the 22 environments were found between physical grain quality and composition as well as grain yield, with the environment having a significant effect on all of the traits measured. Grain yield was closely related to grain number m−2 whereas milling quality traits were related to grain size attributes. Considerable genotype by environment interaction was obtained for all grain quality traits and stability analysis revealed that the variety Mascani was the least sensitive to the environment for all milling quality traits measured whereas the variety Balado was the most sensitive. Examination of environmental conditions at specific within-year stages of crop development indicated that both temperature and rainfall during grain development were correlated with grain yield and β-glucan content and with the ease of removing the hull (hullability)

Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial.

Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters' Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention's implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe's changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains

Effect of non-monetary incentives on uptake of couples’ counselling and testing among clients attending mobile HIV services in rural Zimbabwe: a cluster-randomised trial

Background Couples' HIV testing and counselling (CHTC) is associated with greater engagement with HIV prevention and care than individual testing and is cost-effective, but uptake remains suboptimal. Initiating discussion of CHTC might result in distrust between partners. Offering incentives for CHTC could change the focus of the pre-test discussion. We aimed to determine the impact of incentives for CHTC on uptake of couples testing and HIV case diagnosis in rural Zimbabwe. Methods In this cluster-randomised trial, 68 rural communities (the clusters) in four districts receiving mobile HIV testing services were randomly assigned (1:1) to incentives for CHTC or not. Allocation was not masked to participants and researchers. Randomisation was stratified by district and proximity to a health facility. Within each stratum random permutation was done to allocate clusters to the study groups. In intervention communities, residents were informed that couples who tested together could select one of three grocery items worth US$1·50. Standard mobilisation for testing was done in comparison communities. The primary outcome was the proportion of individuals testing with a partner. Analysis was by intention to treat. 3 months after CHTC, couple-testers from four communities per group individually completed a telephone survey to evaluate any social harms resulting from incentives or CHTC. The effect of incentives on CHTC was estimated using logistic regression with random effects adjusting for clustering. The trial was registered with the Pan African Clinical Trial Registry, number PACTR201606001630356. Findings From May 26, 2015, to Jan 29, 2016, of 24 679 participants counselled with data recorded, 14 099 (57·1%) were in the intervention group and 10 580 (42·9%) in the comparison group. 7852 (55·7%) testers in the intervention group versus 1062 (10·0%) in the comparison group tested with a partner (adjusted odds ratio 13·5 [95% CI 10·5–17·4]). Among 427 (83·7%) of 510 eligible participants who completed the telephone survey, 11 (2·6%) reported that they were pressured or themselves pressured their partner to test together; none regretted couples' testing. Relationship unrest was reported by eight individuals (1·9%), although none attributed this to incentives. Interpretation Small non-monetary incentives, which are potentially scalable, were associated with significantly increased CHTC and HIV case diagnosis. Incentives did not increase social harms beyond the few typically encountered with CHTC without incentives. The intervention could help achieve UNAIDS 90-90-90 targets

HIV self-testing services for female sex workers, Malawi and Zimbabwe

OBJECTIVE: To present findings from implementation and scale-up of human immunodeficiency virus (HIV) self-testing programmes for female sex workers in Malawi and Zimbabwe, 2013-2018. METHODS: In Zimbabwe, we carried out formative research to assess the acceptability and accuracy of HIV self-testing. During implementation we evaluated sex workers' preferences for, and feasibility of, distribution of test kits before the programme was scaled-up. In Malawi, we conducted a rapid ethnographic assessment to explore the context and needs of female sex workers and resources available, leading to a workshop to define the distribution approach for test kits. Once distribution was implemented, we conducted a process evaluation and established a system for monitoring social harm. FINDINGS: In Zimbabwe, female sex workers were able to accurately self-test. The preference study helped to refine systems for national scale-up through existing services for female sex workers. The qualitative data helped to identify additional distribution strategies and mediate potential social harm to women. In Malawi, peer distribution of test kits was the preferred strategy. We identified some incidents of social harm among peer distributors and female sex workers, as well as supply-side barriers to implementation which hindered uptake of testing. CONCLUSION: Involving female sex workers in planning and ongoing implementation of HIV self-testing is essential, along with strategies to mitigate potential harm. Optimal strategies for distribution and post-test support are context-specific and need to consider existing support for female sex workers and levels of trust and cohesion within their communities

Implementation and Operational Research: Cohort Analysis of Program Data to Estimate HIV Incidence and Uptake of HIV-Related Services Among Female Sex Workers in Zimbabwe, 2009-2014.

BACKGROUND: HIV epidemiology and intervention uptake among female sex workers (FSW) in sub-Saharan Africa remain poorly understood. Data from outreach programs are a neglected resource. METHODS: Analysis of data from FSW consultations with Zimbabwe's National Sex Work program, 2009-2014. At each visit, data were collected on sociodemographic characteristics, HIV testing history, HIV tests conducted by the program and antiretroviral (ARV) history. Characteristics at first visit and longitudinal data on program engagement, repeat HIV testing, and HIV seroconversion were analyzed using a cohort approach. RESULTS: Data were available for 13,360 women, 31,389 visits, 14,579 reported HIV tests, 2750 tests undertaken by the program, and 2387 reported ARV treatment initiations. At first visit, 72% of FSW had tested for HIV; 50% of these reported being HIV positive. Among HIV-positive women, 41% reported being on ARV. 56% of FSW attended the program only once. FSW who had not previously had an HIV-positive test had been tested within the last 6 months 27% of the time during follow-up. After testing HIV positive, women started on ARV at a rate of 23/100 person years of follow-up. Among those with 2 or more HIV tests, the HIV seroconversion rate was 9.8/100 person years of follow-up (95% confidence interval: 7.1 to 15.9). CONCLUSIONS: Individual-level outreach program data can be used to estimate HIV incidence and intervention uptake among FSW in Zimbabwe. Current data suggest very high HIV prevalence and incidence among this group and help identify areas for program improvement. Further methodological validation is required