Psychometric evaluation of the French version of the questionnaire attitudes towards morphine use; a cross-sectional study in Valais, Switzerland.

BACKGROUND: In Switzerland, nurses are allowed to prescribe and administer morphine in emergency situations without a doctor. Still, nurses and other health professionals are often reluctant to prescribe and administer morphine for pain management in patients. No valid French-speaking instrument is available in Switzerland to assess the attitudes of nurses and other health professionals towards the prescription and administration of morphine. In this study, we evaluated the psychometric properties of the French version of the questionnaire "Attitudes towards morphine use". METHODS: The instrument was derived from an Italian version. Forward and back translations of the questionnaire were performed. Item analysis and construct validity were assessed between April and December 2010 in a cross sectional study including five Swiss hospitals in a sample of 588 health professionals (533 nurses, mean age 38.3 ± 10.2 years). Thirty subjects participated in test-retest reliability. RESULTS: The time to complete the instrument ranged between 12 and 15 minutes and neither floor nor ceiling effect were found. The initial 24-item instrument showed an intraclass correlation (ICC) of 0.69 (95% CI: 0.64 to 0.73, P < 0.001), and a Cronbach's α of 0.700. Factor analysis led to a six-component solution explaining 52.4% of the total variance. After excluding five items, the shortened version showed an ICC of 0.74 (95% CI, 0.70 to 0.77, P < 0.001) and a Cronbach's α of 0.741. Factor analysis led to a five-component solution explaining 54.3% of the total variance. The five components were named "risk of addiction/dependence"; "operational reasons for not using morphine"; "risk of escalation"; "other (non-dependence) risks" and "external (non-operational) reasons". In test-retest, the shortened instrument showed an ICC of 0.797 (95% CI, 0.630 to 0.911, P < 0.001) and a Cronbach's α of 0.797. CONCLUSIONS: The 19-item shortened instrument assessing attitudes towards the prescription and administration of morphine showed adequate content and construct validity

Cystathionine beta synthase deficiency and brain edema associated with methionine excess under betaine supplementation: Four new cases and a review of the evidence.

CBS deficient individuals undergoing betaine supplementation without sufficient dietary methionine restriction can develop severe hypermethioninemia and brain edema. Brain edema has also been observed in individuals with severe hypermethioninemia without concomitant betaine supplementation. We systematically evaluated reports from 11 published and 4 unpublished patients with CBS deficiency and from additional four cases of encephalopathy in association with elevated methionine. We conclude that, while betaine supplementation does greatly exacerbate methionine accumulation, the primary agent causing brain edema is methionine rather than betaine. Clinical signs of increased intracranial pressure have not been seen in patients with plasma methionine levels below 559 μmol/L but occurred in one patient whose levels did not knowingly exceed 972 μmol/L at the time of manifestation. While levels below 500 μmol/L can be deemed safe it appears that brain edema can develop with plasma methionine levels close to 1000 μmol/L. Patients with CBS deficiency on betaine supplementation need to be regularly monitored for concordance with their dietary plan and for plasma methionine concentrations. Recurrent methionine levels above 500 μmol/L should alert clinicians to check for clinical signs and symptoms of brain edema and review dietary methionine intake. Levels approaching 1000 μmol/L do increase the risk of complications and levels exceeding 1000 μmol/L, despite best dietetic efforts, should be acutely addressed by reducing the prescribed betaine dose

Presence and mobility of arsenic in estuarine wetland soils of the Scheldt estuary (Belgium)

We aimed to assess the presence and availability of arsenic (As) in intertidal marshes of the Scheldt estuary. Arsenic content was determined in soils sampled at 4 sampling depths in 11 marshes, together with other physicochemical characteristics. Subsequently, a greenhouse experiment was set up in which pore water arsenic (As) concentrations were measured 4 times in a 298-day period in 4 marsh soils at different sampling depths (10, 30, 60 and 90 cm) upon adjusting the water table level to 0, 40 and 80 cm below the surface of these soils. The As content in the soil varied significantly with sampling depth and location. Clay and organic matter seem to promote As accumulation in the upper soil layer (0–20 cm below the surface), whereas sulfide precipitation plays a significant role at higher sampling depths (20– 100 cm below the surface). The As concentrations in the pore water of the greenhouse experiment often significantly exceeded the Flemish soil sanitation thresholds for groundwater. There were indications that As release is not only affected by the reductive dissolution of Fe/Mn oxides, but also by e.g. a direct reduction of As(V) to As(III). Below the water table, sulfide precipitation seems to lower As mobility when reducing conditions have been sufficiently established. Above the water table, sulfates and bicarbonates induce As release from the solid soil phase to the pore water

Interrogating violence against women and state violence policy: Gendered intersectionalities and the quality of policy in The Netherlands, Sweden and the Uk

This article builds on feminist scholarship on intersectionality to address violence against women, and state policy thereon. It takes up the challenge of analysing the complex, situated and spatial relationship between theorizing on violence against women and state policy on such violence. Drawing on extensive comparative European data, it explores the relations of gender and intersectionality, conceptualized as gendered intersectionalities, by examining how multiple inequalities are made visible and invisible in state policy and debates in the Netherlands, Sweden and the UK. Attention is paid to different forms of gendered intersectionalities in policy, for example, tendencies to degender violence against women. A key aim of the article is to investigate how comparative analysis can be a starting point for assessing if, how and to what extent the inclusion of multiple inequalities could increase the quality of policy, for both reducing and stopping violence, and assisting those subject to violence

Gender-based violence against women in contemporary France: domestic violence and forced marriage policy since the Istanbul Convention

ABSTRACT: In 2014, France ratified the Council of Europe’s Convention on Preventing and Combating Violence against Women and Domestic Violence (the Istanbul Convention) and passed the Law for Equality between Women and Men to bring French law into line with it. The Law for Equality between Women and Men situates the fight against violence against women within a broader context of the need to address inequalities between women and men. This is not new at the international level, but it is new to France. When the structural, transformative understandings of violence against women found in international texts are translated into national laws, policy documents and implementation on the ground, they might challenge widespread ideas about gender relations, or they might be diluted in order to achieve consensus. To what extent has French violence against women policy moved into line with UN and Council of Europe initiatives which present violence against women as both a cause and a consequence of gendered power relations? Have internationally accepted concepts of gender and gender-based violence been incorporated into French policy debates and, if so, how? What implications, if any, does all this have for the continued struggle in France and elsewhere to eliminate violence a gainst women? RÉSUMÉ: En 2014, la France a ratifié la Convention du Conseil de l’Europe sur la prévention et la lutte contre la violence à l’égard des femmes et la violence domestique (dite Convention d’Istanbul) et a adopté dans la foulée la loi pour l’égalité réelle entre les femmes et les hommes afin de mettre en conformité la législation française. Cette loi place la lutte contre la violence à l’égard des femmes dans un contexte de lutte contre les inégalités de genre. Si cela est loin d’être une nouveauté à l’échelle internationale, cela l’est en France. Lorsque les conceptions structurelles et transformatrices de la violence à l’égard des femmes présentes dans les textes internationaux sont traduites à l’échelle nationale en lois, documents d’orientation et mesures de mise en œuvre sur le terrain, elles peuvent alors remettre en question des idées largement répandues sur les rapports de genre, ou au contraire être édulcorées afin d’aboutir à un consensus. Dans quelle mesure la politique de la France relative à la violence à l’égard des femmes s’est-elle alignée sur les initiatives de l’ONU et du Conseil de l’Europe qui présentent ce type de violence comme étant à la fois une cause et une conséquence des rapports de force liés au genre? Le genre et la violence fondée sur le genre, qui sont des concepts internationalement reconnus, ont-ils été intégrés dans les débats politiques français, et si oui, de quelle manière? Quelles en sont les implications le cas échéant sur la poursuite, en France et ailleurs, de la lutte pour éliminer la violence à l’égard des femmes

Dutch women are liberated, migrant women are a problem: the evolution of policy frames on gender and migration

Contains fulltext : 45690.pdf (publisher's version ) (Closed access)18 p

Barriers to nurses performing physical assessments in rehabilitation care units: An observational study.

To describe the perceived barriers to nurses performing physical assessments of patients in rehabilitation wards. Secondarily, to investigate how sociodemographic and professional characteristics influence the use and frequency of physical assessments by nurses and their perceptions of barriers to their practice. A multicentre, cross-sectional, observational study. Data were collected from September to November 2020 among nurses working with inpatients in eight rehabilitation care institutions in French-speaking Switzerland. Instruments included the Barriers to Nurses' use of Physical Assessment Scale. Almost half of the 112 nurses who responded reported performing physical assessments regularly. The predominant perceived barriers to performing physical assessments were 'specialty area', 'lack of nursing role models' and 'lack of time and interruptions'. Greater clinical nursing experience in rehabilitation wards and more senior nurse specialist positions were associated with significantly lower use of physical assessment procedures by nurses. The present study revealed heterogeneity in the use of physical assessment by nurses practicing in rehabilitation units and highlighted their perceived barriers to this. Most nurses working in rehabilitation care units did not routinely perform physical assessments as part of their daily clinical practice. These results should raise stakeholders' awareness of this fact. Effective interventions to increase the use of physical assessments in nursing practice are to be recommended, including continuing education or hiring enough highly qualified nurses as role models in wards. This will promote quality of care and patient safety in rehabilitation care units. There was no patient or public involvement in the present study

Prescribing pattern insights from a longitudinal study of older adult inpatients with polypharmacy and chronic non-cancer pain.

BACKGROUND The present study sought to determine the prevalence of chronic non-cancer pain (CNCP) among older adult inpatients with polypharmacy. It also aimed to analyse prescription patterns and assess the therapy adequacy and patient complexity for those with and without CNCP. METHODS This 4-year longitudinal study examined data from an exhaustive acute care hospital register on home-dwelling older adult patients (≥65) with polypharmacy. Commonly known combinations of potentially inappropriate medications were used to estimate therapy adequacy. Patient complexity was evaluated by comparing number of comorbidities and investigating physical and cognitive deficits. RESULTS We determined a prevalence of CNCP of 9.7% among all older adult inpatients with polypharmacy, rising to 11.3% for those aged ≥85. Overall, CNCP patients were prescribed more drugs and had more comorbidities and physical and cognitive deficits than patients without CNCP. Older adult patients with CNCP received more analgesics, greater quantities of opioids, paracetamol and co-analgesics and elevated opioid dosages. Older adult patients with CNCP aged ≥85 received fewer analgesics, opioids, non-steroidal anti-inflammatory drugs and co-analgesics but more paracetamol. Older adult patients with CNCP were prescribed more potentially inappropriate medications involving opioids. In particular, 24.5% received an opioid and a hypnotic (benzodiazepine or Z-drug), and 8.6% received an opioid and a gabapentinoid. CONCLUSION Observed differences in medication use between older adult inpatients with or without CNCP may be relevant for clinical practice. Potentially inadequate co-prescribing (such as hypnotics and opioids) affects a higher proportion of patients with CNCP and may have serious unintended consequences. SIGNIFICANCE STATEMENT This study describes differences in prescription patterns between people with and without chronic non-cancer pain in a large dataset of 20,422 discharges. The differences found may be relevant to clinical practice. In particular, high co-prescribing of opioids and hypnotics may have serious unintended consequences. Greater physical and cognitive deficits may indicate greater patient complexity, and appropriate interventions need to be developed to improve the management of this vulnerable patient group

From evidence to action: applying gender mainstreaming to pay gaps in the Welsh public sector

Progress on reducing gender disparities remains painfully slow, despite efforts to identify the determinants of gender pay gaps and specify size and shape. Recent studies highlight the need for a more nuanced account of the way that public policy shapes organizational responses and insights into the types of organizational practices that diminish pay disparities. In response, this research reports on an action research intervention in three large Welsh public organizations, subject to a unique statutory equality duty. Data demonstrate how an evidence‐based gender mainstreaming approach facilitated the development of a ‘no blame’ strategy, which legitimized organizational proactivity through collaborative and empowering change management processes. The research contributes to the study of gender pay gaps by demonstrating that gender mainstreaming, with facilitative local conditions and supportive public policy, shapes action on gender segregation, with particular success in women's low‐paid employment. Conclusions highlight theoretical and policy implications arising from the research