Rural maternity care: Can we learn from Wal-Mart?

In many countries rural maternity care is under threat. Consequently rural pregnant women will have to travel further to attend larger maternity units to receive care and deliver their babies. This trend is not dissimilar from the disappearance of other rural services, such as village shops, banks, post offices and bus services. We use a comparative approach to draw an analogy with large-scale supermarkets, such as the Wal-Mart and Tesco and their effect on the viability of smaller rural shops, depersonalisation of service and the wider community. The closure of a community–maternity unit leads to women attending a different type of hospital with a different approach to maternity care. Thus small community–midwifery units are being replaced, not by a very similar unit that happens to be further away, but by a larger obstetric unit that operates on different models, philosophy and notions of risk. Comparative analysis allows a fresh perspective on the provision of rural maternity services. We argue that previous discussions focusing on medicalisation and change in maternity services can be enhanced by drawing on experience in other sectors and taking a wider societal lens

Health Care Insurance Key Political issue in the USA

Letter to news item in the British Medical Journa

Modified Administration of the WAIS-IV for Visually Impaired Examiners: A Validity Study

Opportunities in all areas of life including education, vocation, and access to general information have historically been slower for minorities. The visually impaired have continued to struggle with access to education, equal opportunities at work, and access to general information. Significantly fewer blind and visually impaired individuals pursue graduate education with the most commonly pursued graduate degree being psychology (American Federation for the Blind, 2010). A core area of graduate training [defined by the American Psychological Association (APA)] is declarative knowledge, which is not accessible for the visually impaired student for neurological assessments (Johnson-Greene, Braden, Dial, Fitzpatrick, Leung, Schneider, & Willis, 2007). The same 27 participants (all with at least 19 years of education) were given both the standardized and the modified WAIS-IV. Participants scored significantly lower on the full scale IQ, the verbal comprehension index, and the processing speed index of the modified version. Validity of the modified WAIS-IV was assessed by comparing the correlation between it and the WIAT-II and the correlation between the standardized WAIS-IV and the WIATII. Despite the significant differences between the modified and standardized WAIS-IV, the standardized WAIS-IV and the WIAT-II, suggesting the modified WAIS-IV is a valid intellectual assessment instrument. The differences between the modified WAIS-IV and the standardized WAIS-IV can be accounted for by three predominate factors: the modifications of the block design and symbol search subtests, the multiple examiners that both administered and scored the WAIS-IV, and potential practice effects resulting from the high level of education of the participants. These findings suggest that the modified WAIS-IV should be further explored as a viable assessment option for visually impaired examiners due to the similarities found between the standardized and modified versions. These findings also highlight exciting potential opportunities for the field as a whole and more specifically for the visually impaired psychology doctoral student and professional psychologist

Advocating mixed-methods approaches in health research

This methods paper provides researchers in Nepal with a broad overview of the practical and philosophical aspects of mixed-methods research. The three authors have a wide-ranging expertise in planning and conducting mixed-methods studies. The paper outlines the different paradigms or philosophies underlying quantitative and qualitative methods and some of the on-going debates about mixed-methods. The paper further highlights a number of practical issues, such as (a) the particular mix and order of quantitative and qualitative methods; (b) the way of integrating methods from different philosophical stance; and (c) how to synthesise mixed-methods findings

Delphi Method and Nominal Group Techniques in Family Planning and Reproductive Health Research

Both the Delphi method and nominal group technique offer structured, transparent and replicable ways of synthesising individual judgements and have been used extensively for priority setting and guideline development in health-related research including reproductive health. Within evidence-based practice they provide a means of collating expert opinion where little evidence exists.They are distinct from many other methods because they incorporate both qualitative and quantitative approaches. Both methods are inherently flexible; this article also discusses other strengths and weaknesses of these methods

Emotional Response to Auditory and Visual Stimuli

Emotion can be studied by measuring physiological, behavioral, and verbal responses to specific stimuli. In current research, it is most common to use visual stimuli to measure the emotional response. One of the most common sets of stimuli used for this purpose is the International Affective Picture Systems (IAPS). An additional set of stimuli, the International Affective Digital Sounds (IADS), was created to be an auditory equivalent of the IAPS. The present study sought to compare the emotional response (measured with Heart Rate, Skin Conductance, and a self-report measure of emotion called the SAM) to sounds from the IADS and images from the IAPS. The self-report measure has participants rate each stimulus for arousal, valence, dominance, and interestingness by using a nine point scale anchored at one end by calm, unpleasant, not in control, and boring and at the other by excited, pleasant, in full control, and riveting, respectively. The present study also looked at differences in emotional response to sounds and images when they were presented in a pure block (all images and then all sounds or reverse) compared to a mixed block (a block of sounds and images, followed by a block of sounds and images). There were a total of 40 participants (34 female, 4 male; mean age 27.08), all of whom were recruited from a local university. Results revealed a significant difference (p \u3c .05) in the heart rate and skin conductance response to sounds versus images. There was also a significant (p \u3c .05) difference in self-reported arousal and dominance to images and sounds. Furthermore, there was a significant difference (p \u3c .05) between the Pure Stimulus and Mixed Stimulus groups for heart rate and self-reported arousal and dominance. Results from this study do not support the theory that auditory and visual stimuli evoke similar physiological and self-reported emotional responses. Results also suggest that stimulus presentation may play a role in the observed or perceived difference in emotional response

Specialist services in the community: a qualitative study of consultants holding novel types of employment contracts in England.

The aim of this study was to understand, from consultants' experiences, the potential benefits and limitations of specialists being employed by a community organisation. We carried out a qualitative study using semi-structured interviews with consultants holding novel contracts across three specialties: geriatric, respiratory and palliative medicine. Consultants in our study reported that community-based roles offered a number of potential benefits. They felt better able to take a population perspective, to treat patients in a holistic sense and to form good working relationships with community-based colleagues. A number of challenges were also evident, including a lack of clarity about their role, professional isolation and, for those in geriatric and respiratory medicine, a lack of training and career development opportunities. Our study suggests that community-based consultant posts are often taken up by highly motivated individuals who report the benefits in terms of being able to provide more appropriate care for patients but that the long-term development of these posts may be constrained by a number of factors. Their idiosyncratic nature, the lack of clarity around the role, challenges to professional identity and lack of training opportunities or professional development suggest that current approaches to their development may not be sustainable.This work was supported by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme [ref:12/135/02]. This paper presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the author accepted manuscript. The final version is available from the Royal College of Physicians via http://dx.doi.org/10.7861/futurehosp.2-3-17

What is the evidence on the economic impacts of integrated care?

This new policy summary reviews the existing evidence on the economic impact of integrated care approaches. Whereas it is generally accepted that integrated care models have a positive effect on the quality of care, health outcomes and patient satisfaction, it is less clear how cost effective they are. As the evidence-base in this field is rather weak, the authors suggest that we may have to revisit our understanding of the concept and our expectations in terms of its assessment. Integrated care should rather be seen as a complex strategy to innovate and implement long-lasting change in the way services in the health and social-care sectors are delivered. This policy summary (number 11) is based on a report for the European Commission to inform the discussions of the EU’s Reflection process on modern, responsive and sustainable health systems on the objective of integrated care models and better hospital management. Both authors are affiliated to RAND Europe

The economics of health

This report presents results from the Economics of Health project funded by the East Midlands Development Agency. The work was undertaken between November 2007 and February 2008. The main aim of the project was to examine the relationship between mental and physical health and employability, labour market participation and economic performance, with specific attention given to the direction of causal relationships