Creating and Sustaining an Inter-Agency Training Pool

The following paper offers an account of the authors' experience of setting up an Inter-Agency Training Pool in Nottinghamshire. The purpose of this is to enable others in similar or parallel posts to learn from both the successes and mistakes of their venture, to avoid ‘re-inventing wheels’, and as a tool for discussion should they be considering using such a model in their work setting.     

Graphical representation of survival curves in the presence of time-dependent categorical covariates with application to liver transplantation

Graphical representation of survival curves is often used to illustrate associations between exposures and time-to-event outcomes. However, when exposures are time-dependent, calculation of survival probabilities is not straightforward. Our aim was to develop a method to estimate time-dependent survival probabilities and represent them graphically. Cox models with time-dependent indicators to represent state changes were fitted, and survival probabilities were plotted using pre-specified times of state changes. Time-varying hazard ratios for the state change were also explored. The method was applied to data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Survival curves showing a ‘split’ at a pre-specified time t allow for the qualitative comparison of survival probabilities between patients with similar baseline covariates who do and do not experience a state change at time t. Time since state change interactions can be visually represented to reflect changing hazard ratios over time. A2ALL study results showed differences in survival probabilities among those who did not receive a transplant, received a living donor transplant, and received a deceased donor transplant. These graphical representations of survival curves with time-dependent indicators improve upon previous methods and allow for clinically meaningful interpretation.     

Living with dementia,interdependence and citizenship: narratives of everyday decision-making

This article argues that interdependent relationships are key in realising inclusion and citizenship for people living with dementia. We focus on decision-making as one aspect of everyday life which reflects opportunities and challenges associated with citizenship. Accounts of everyday decision-making from people living with dementia provide insight into strategies for negotiating responsibilities as they shifted with dementia. An inductive, secondary data analysis developed decision narratives from the data of 61 interviews conducted in the United Kingdom. The interviews were with 12 people with a diagnosis of dementia plus their nominated care-partner in a qualitative study which focused on information management and sense of self. The secondary data analysis identified strategies for inclusion, emphasising relational interdependency amidst challenges. The five-stage framework of an Ethic of Care positions this interdependency as a response to barriers to inclusion and citizenship. Interdependency, therefore, emerges as key to realising relational citizenship.     

Spatio-temporal patterns of pre-eclampsia and eclampsia in relation to drinking water salinity at the district level in Bangladesh from 2016 to 2018

Population and Environment - This analysis examines whether salinity in drinking water is associated with pre-eclampsia and eclampsia (PE/E), a leading cause of maternal morbidity and mortality....     

Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual,Family, Community,and Socio‐Political Contexts

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.     

‘We are actually,after all,just children’: caring societies and South African infantilisation of adults with intellectual disability

This article comments on infantilisation by attending to South African adult intellectual disability (ID) care through an intersubjective ethics of care lens, and shows how such an ethic can shine light on shifting our responses towards ID. Care performance data were gathered from three sources within two South African specialist ID care sites – from 10 adult residents, 16 nurses as spatiotemporal carers, and three wards as ethnographic sites. Deeply embedded and interwoven throughout various care practices is the disabling of adults with intellectual impairment when literally referred to as ‘children’. These adult-unmaking processes constitute practices that fall short of Tronto and Kittay’s caring societies ethic. Care exchanges generate relational and intersubjective spaces in which people are understood as never meeting full criteria for personhood. Infantilising care dynamics require urgent attention if we wish to change ways in which ID is viewed and responded to in South Africa.     

“Let’s Talk About Children” resource: A parallel mixed method evaluation

Psycho-education interventions for families affected by parental mental illness have been found to be effective. This study aimed to assess the feasibility of a psycho-educational resource for parents, designed to initiate family discussions about parental mental illness and educate parents about the impact of their illness on children. In a mixed methods design, 19 parents read the “Let’s Talk About Children” psycho-educational resource and completed pre-and-post questionnaires measuring their perspectives of mental illness and awareness of the impact of mental illness on their children and family. 18 of these participated in a follow-up, one hour, individual interview to obtain further feedback on the resource. After viewing the resource, changes in parents’ attitudes and/or behavior in relation to mental illness and parenting were recorded. Interview findings indicate that the resource gave parents an awareness of the skills and knowledge needed for initiating family discussions about parental mental illness. The results of this study can be used to inform future interventions targeting parents who experience mental illness.     

Building ‘cowshed cultures’: A cultural perspective on the promotion of stockmanship and animal welfare on dairy farms

Improving animal welfare is an important part of the development of the agricultural industry, particularly at a time when intensification and the encroachment of factory-style production systems is making the maintenance of human-animal relations increasingly difficult. Animal science deals with the issue of improving stockmanship by focusing on the relationships between attitudes and behaviour, under the premise that improved attitudes will lead to improved behaviour. From an analysis of 42 interviews with owners, sharemilkers and workers on dairy farms in New Zealand we present a different view, seeing behaviour instead as part of a self-reinforcing culture in which animals, humans and the physical structure all contribute to the development of farm specific ways of doing and being. We further suggest that changing one stockperson's attitude alone is insufficient to ensure a change in the culture as other actors – including animals and non-human actors – reinforce any existing culture that has developed, making both attitudinal and behavioural change difficult. We conclude by discussing the key importance of designing farm systems and structures that promote positive interactions between animals and humans and suggest that this, rather than simply promoting knowledge and attitudinal change, is likely to be the most effective way of maintaining stockmanship in the face of an industrialising agriculture.