Disability in young adults following major trauma: 5 year follow up of survivors

BACKGROUND: Injuries are a major cause of mortality and morbidity in young people. Despite this, the long-term consequences for young survivors of severe injury are relatively unexplored. METHODS: Population based cohort study involving 5 year post injury structured interview of all cases of major trauma (Injury Severity Score > 15) identified retrospectively for 12 month period (1988 to 1989) within former Yorkshire Health Authority area of the United Kingdom. RESULTS: 125 individuals aged 11–24 years at time of injury were identified. Of these, 109 (87%) were interviewed. Only 20% (95% CI 14–29%) of those interviewed reported no disability. Mean Office of Population Census and Surveys (OPCS) disability score of the remainder was 7.5 (median 5.8, range 0.5 to 19.4). The most commonly encountered areas of disability were behaviour (54%, 95% CI 45–63%), intellectual functioning (39%, 95% CI 31–49%) and locomotion (29%, 95% CI 22–39%). Many respondents reported that their daily lives were adversely affected by their health problems for example, causing problems with work, 54% (95% CI 45–63%), or looking after the home, 28% (95% CI 21–38%). Higher OPCS scores were usually but not always associated with greater impact on daily activities. The burden of caring responsibilities fell largely on informal carers. 51% (95% CI 42–61%) of those interviewed would have liked additional help to cope with their injury and disability. CONCLUSION: The study has revealed significant disability amongst a cohort of young people 5 years post severe injury. Whilst many of these young people were coping well with the consequences of their injuries, others reported continuing problems with the activities of daily life. The factors underpinning the young people's differing experiences and social outcome should be explored

Too few staff, too many patients: A qualitative study of the impact on obstetric care providers and on quality of care in Malawi

Background: Shortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Despite the government of Malawi's efforts to increase the number of human resources for health, maternal mortality rates remain persistently high. Health workers' perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition, while the resulting sub-standard care and poor attitudes towards women dissuade women from facility-based delivery. Understanding the situation from the health worker perspective can inform policy options that may contribute to a better working environment for staff and improved quality of care for Malawi's women. Methods: A qualitative research design, using critical incident interviews, was used to generate a deep and textured understanding of participants' experiences. Eligible participants had performed at least one of the emergency obstetric care signal functions a in the previous three months and had experienced a demotivating critical incident within the same timeframe. Data were analysed using NVivo software. Results: Eighty-four interviews were conducted. Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The main themes emerging were: too few staff, too many patients; lack of clinical officers/doctors; inadequate obstetric skills; undermining performance and professionalism; and physical and psychological consequences for staff. Underlying factors were inflexible scheduling and staff allocations that made it impossible to deliver quality care. Conclusion: This study revealed the difficult circumstances under which maternity staff are operating and the professional and emotional toll this exacts. Systems failures and inadequate human resource management are key contributors to the gaps in provision of obstetric care and need to be addressed. Thoughtful strategies that match supply to demand, coupled with targeted efforts to support health workers, are necessary to mitigate the effects of working in this context and to improve the quality of obstetric care for women in Malawi

Does gender affect business ‘performance’? A study of microbusinesses in business services in the UK

There is a dearth of studies that have examined the issue of the impact of gender on business performance. Three problems are evident in this earlier work:(1) the need to expose theoretical assumptions; (2) the adequacy of methodologies adopted; and (3) apparent equivocal results. A theme running through much of this work is whether the concept of ‘performance’ is itself gendered. This paper confines itself to addressing three research questions in respect of the impact of gender of business owner on business performance. The field data comprise a sample of 104 microbusinesses in business services in two locations-Newcastle upon Tyne and Milton Keynes, in the UK. The results show (1) no significant difference between the performance of the businesses of sole male and sole female owners, (2) clear evidence of the underperformance of spouse-owned businesses, (3) no support for the hypothesis that women have an ‘integrated approach’ to their business and personal lives (in contrast to men), and (4) evidence that cultural presuppositions about gender roles were most clearly demonstrated in the spouse-owned businesses

Networking, entrepreneurship and microbusiness behaviour

It has been argued that networking by owner-managers of small businesses will enhance business performance. Yet to define and demonstrate the presence of networking activity is suffused with methodological difficulties. In this paper the authors attempt to disentangle some of these difficulties. The paper draws on quantifiable data from 104 owner-managers and qualitative data from 34 critical incident interviews from a study of microbusinesses to assess the nature and extent of networking activity. The paper shows: a high proportion of owner-managers use their trading contacts as sources of useful additional information; they use ‘weak ties’ for purposes such as recruitment; a sparse use of institutional networks; an association between networking activity and business performance, although it seems that this must be qualified by sectoral differences; an association between type of owner-manager on a scale of entrepreneurship and networking activity. The policy implications of this paper suggest that economic development agencies continue to have problems reaching out to the microbusiness. This paper recommends that such agencies might use a tool to differentiate more finely amongst the microbusiness population

An entrepreneurial network evolving:patterns of change

It is now recognized that to broaden our understanding about networks more qualitative and longitudinal work is required that examines transformation and the change processes of networks; how they emerge and develop over time. The case study reported here deals with these issues. It considers the development of a network for new entrepreneurs first established by a local enterprise support agency in North East Scotland.This forum provided a near ‘natural experiment’ to chart network emergence, change and evolution. Employing participant observation, interviews and surveys, data were collected over a six-year period. This allowed the network to be mapped, and provided information about structural characteristics and in-depth detail about network dynamics and change processes over time. Findings show how network structure shifts from calculative to affective ties and demonstrate the importance of social ties for the operation of a network

Reinventing traditional solutions: job creation, gender and the micro-business household

There has been overwhelming interest in the numbers of jobs attributable to the formation and growth of new small firms but comparative silence about their working practices. We offer two novel, inter-linked approaches to thinking about work and employment in small firms. Firstly, we use a methodological approach which takes a household level analysis as a starting point, making gender a foundation stone. Secondly, we use an institutional perspective which focuses on power and power relations. From quantitative and qualitative empirical work with micro-businesses in business services we show that family work can be a vital resource. Yet there can also be severe costs, particularly for the many women who participate in business alongside their husbands as co-owners, employees and unpaid helpers. Gender divisions of labour are, typically, reproduced in traditional fashion. Even when business owners bring in employees from outside the family, relations within the micro-business are not fully market relations. Conflicts arise as business/owners and their employees struggle to manage these partially decommodified relations. The micro-business service sector actually represents a return to traditional ways of organising business by integrating business and household so that the traditional embedding of business and family of in-between pre-modern institutions is reinvented