Health promotion co-existing in a high-security prison context : a documentary analysis

Purpose: There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced understanding of context is required in order to understand health promotion in prison and examines the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments. Design/methodology/approach: Independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis. Findings: Analysis revealed elements of prison life which were disempowering and antithetical to health promotion. While security imperatives were paramount, there were examples where this was disproportionate and disempowered individuals. The data shows examples where, even in these high-security contexts, empowerment can be fostered. These were exemplified in relation to peer approaches designed to improve health and where prisoners felt part of democratic processes where they could influence change. Practical implications: Both in the UK and internationally, there is a growing rhetoric for delivering effective health promotion interventions in prison, but limited understanding about how to operationalise this. This paper gives insight into how this could be done in a high-security prison environment. Originality/value: This is the first paper which looks at the potential for health promotion to be embedded in high-security prisons. It demonstrates features of prison life which act to disempower and also support individuals to take greater control over their health

Swimming with captive dolphins: current debates and post-experience dissonance

Dolphins have widespread contemporary appeal and anthropomorphic social representations of dolphins have fuelled a growing desire in tourist populations to seek interaction with them. This paper is concerned with the staged performance of swim-with-dolphin interaction programmes in aquaria. Qualitative interviews with tourists who have swum with captive dolphins identified their immediate recollections and stressed the grace, size and power of dolphins, but also a belief that the experience was too staged, too short and too expensive. Post-purchase dissonance focused on concerns with the size of enclosures and about captivity, too many tricks, limited interpretation and unfulfilled expectations of a quality interaction

Enabling an Equitable Energy Transition Through Inclusive Research

Comprehensive and meaningful inclusion of marginalized communities within the research enterprise will be critical to ensuring an equitable, technology-informed, clean energy transition. We provide five key action items for government agencies and philanthropic institutions to operationalize the commitment to an equitable energy transition

Barriers and opportunities for evidence-based health service planning: the example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK

Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models

Increasing Trend in the Number of Severe Hypoglycemia Patients in Korea

BackgroundTo investigate whether the number of subjects with severe hypoglycemia who are brought to a hospital emergency department is increasing and to identify whether there have been changes in the demographic and clinical characteristics of those subjects.MethodsWe analyzed data from the Emergency Departments of two general hospitals in Seoul, Korea. We included data from all adult subjects with type 2 diabetes who presented to an emergency department with severe hypoglycemia between January 1, 2004 and December 30, 2009.ResultsA total of 740 cases of severe hypoglycemia were identified. The mean subject age was 69±12 years, mean duration of diabetes was 13.8±9.3 years, and 53.2% of subjects were receiving insulin therapy. We observed a sharp rise in the number of cases between 2006 and 2007. Stages 3-5 chronic kidney disease was diagnosed in 31.5% of subjects, and low C-peptide levels (<0.6 ng/mL) were found in 25.5%. The mean subject age, duration of diabetes, HbA1c level, and renal and insulin secretory function values did not change significantly during the study period. The proportion of glimepiride use increased, while use of gliclazide decreased among sulfonylurea users. Use of insulin analogues increased, while use of NPH/RI decreased among insulin users.ConclusionWe identified a sharp increase in the number of subjects with severe hypoglycemia presenting to an emergency room since 2006. The clinical characteristics of these subjects did not change markedly during the study period. Nationwide studies are warranted to further clarify this epidemic of severe hypoglycemia

Barriers to kidney transplants in Indonesia : a literature review

Background: People living with chronic kidney disease will require renal dialysis or a kidney transplant to maintain life. Although Indonesia has a developing healthcare industry, Indonesia\u27s kidney transplant rates are lower than comparable nations.Purpose: To explore the healthcare literature to identify barriers to kidney transplants in particular in relation to Indonesia.Methods: Healthcare databases were searched (CINAHL, Medline, EBSCOhostEJS, Blackwell Synergy, Web of Science, PubMed, Google Scholar and Proquest 5000) using the search terms: transplant, kidney disease, renal, dialysis, haemodialysis, Indonesia and nursing. The search was limited to English and Indonesian language data sources from 1997 to 2007. Reference lists of salient academic articles were hand searched.Results: The results of our search identified six articles that met our criteria. Costs are the major barrier to kidney transplant in Indonesia, followed by cultural beliefs, perception of the law, lack of information and lack of infrastructure. In addition, kidney disease prevention strategies are required.Conclusions: There are many complex socio-economic, geographical, legal, cultural and religious factors that contribute to low kidney transplant rates in Indonesia. Although an increase in transplantation rates will require strategies from various agencies, healthcare professionals, including nurses, can play a role in overcoming some barriers. Community education programmes, improving their own education levels and by increasing empowerment in nursing we may contribute to improved kidney transplant rates in Indonesia.<br /

The international generalisability of evidence for health policy: a cross country comparison of medication adherence following policy change

Copayments for prescriptions may increase morbidity and mortality via reductions in adherence to medications. Relevant data can inform policy to minimise such unintended effects. We explored the generalisability of evidence for copayments by comparing two international copayment polices, one in Massachusetts and one in Ireland, to assess whether effects on medication adherence were comparable. We used national prescription data for public health insurance programmes in Ireland and Medicaid data in the U.S. New users of oral anti-hypertensive, anti-hyperlipidaemic and diabetic drugs were included (total n = 14,259 in U.S. and n = 43,843 in Ireland). We examined changes in adherence in intervention and comparator groups in each setting using segmented linear regression with generalised estimating equations. In Massachusetts, a gradual decrease in adherence to anti-hypertensive medications of −1% per month following the policy occurred. In contrast, the response in Ireland was confined to a −2.9% decrease in adherence immediately following the policy, with no further decrease over the 8 month follow-up. Reductions in adherence to oral diabetes drugs were larger in the U.S. group in comparison to the Irish group. No difference in adherence changes between the two settings for anti-hyperlipidaemic drugs occurred. Evidence on cost-sharing for prescription medicines is not ‘one size fits all’. Time since policy implementation and structural differences between health systems may influence the differential impact of copayment policies in international settings

Zero-Hour Contracts and Stress in UK Domiciliary Care Workers

UK domiciliary care workers play a vital role in maintaining and improving the lives of service users who have a variety of needs. Around 60% of these employees work under zero-hours contracts but, while it is known that conditions such as temporary and shift working can influence employee health and performance, zero-hours have not been widely investigated. This project sought to firstly investigate the stress associated with working as a domiciliary care worker, as well as comparing the experiences of employees contracted to zero hours with those contracted to at least 16 hours per week. Twenty-nine semi-structured interviews (15 zero-hour, 14 contracted hours) were conducted in the West Midlands of the UK and analysed using thematic analysis. Across all participants, four predominant stressors were found. Firstly, level of pay for what is a job with high levels of responsibility were poor. Secondly, participants described struggling to maintain an adequate work-life balance due to the varied timings of visits, as well as rude and aggressive behaviour from both service users and their families. Lastly, a lack of peer support and poor care from peers was discussed. However, every respondent described the positive relationships that they develop with service users being a distinct stress-reliever. Zero-hours respondents discussed two further stressors. Power refers to the relationship between employee and management, with respondents describing the balance of power being with management. Uncertainty reflected respondents not having set hours of work or pay, and thus not being able to plan in their personal lives and sometimes not being able to pay bills. Findings suggest that domiciliary care workers are exposed to a range of stressors, with zero-hours adding to these. Further research should look into methods to improve both the job role for workers, and redress the power relationships for those with zero-hours contracts

Sustainable Food Systems At Urban Public Universities: A Survey Of U‐21 Universities

Urban communities are challenged by the conventional food system in diverse ways. To mitigate these challenges, a growing sustainable food system (SFS) movement mobilizes existing resources—including public institutions—to resolve disparities in access to healthy food, increase economic opportunities, conserve natural resources, and build a stronger, more local food system. Many public universities located in inner cities have adopted missions committing themselves to the improvement of their cities and regions. They also perform anchoring roles to revitalize their immediate neighborhoods, and, in a contemporary extension of their civic purposes, embrace sustainability as an institutional goal. Urban public universities therefore can play many SFS leadership roles, including through links to innovative scholarship, campus dining halls, other food retail such as farmers markets, and civic engagement activities such as community gardens. Through a study of 21 urban public universities, this paper investigates the presence and characteristics of SFS leadership, underlying rationales, and factors that support and oppose leadership.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112274/1/juaf12149.pd