Sharing Health Services: Two Universities,a Seminary,and a Community

Abstract

“The Inverse Relation Between Fish Consumption and 20-Year Mortality From Coronary Heart Disease,” DAAN KROMHOUT, et al. The low death rate from coronary heart disease among the Greenland Eskimos has been ascribed to their high fish consumption. We therefore decided to investigate the relation between fish consumption and coronary heart disease in a group of men in the town of Zutphen, the Netherlands. Information about the fish consumption of 852 middle-aged men without coronary heart disease was collected in 1960 by a careful dietary history obtained from the participants and their wives. During 20 years of follow-up 78 men died from coronary heart disease. An inverse dose-response relation was observed between fish consumption in 1960 and death from coronary heart disease during 20 years of follow-up. This relation persisted after multiple logistic-regression analyses. Mortality from coronary heart disease was more than 50 per cent lower among those who consumed at least 30g of fish per day than among those who did not eat fish.

We conclude that the consumption of as little as one or two fish dishes per week may be of preventive value in relation to coronary heart disease. (New England Journal of Medicine 1985;312:1205–9.)

“Teaching Touch at Medical School,” JULES OLDER. The association between touch and healing is ancient and worldwide. Skilled hands are among the physician's most important diagnostic and therapeutic tools. Yet a survey of medical schools in the English-speaking world revealed that most offer no touch training in their curricula. Of 169 medical schools, only 12 give any formal instruction in the uses and meaning of therapeutic touch in medicine. The teaching modes of these 12 schools are discussed, and the program of the most touch-conscious school, the University of Otago, is described. (Journal of the American Medical Association 1984;252:931–3.)

“Tubal Infertility and the Intrauterine Device,” DANIEL W. CRAMER, et al. To study the association between intrauterine devices (IUDs) and pelvic inflammatory disease, we compared contraceptive histories in 4185 white women—283 nulliparous women with primary tubal infertility, 69 women with secondary tubal infertility, and 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with IUD use was calculated by means of multivariate logistic regression to control for confounding factors, including region, year of menarche, religion, education, smoking, and reported number of sexual partners. The adjusted risk of primary tubal infertility associated with any IUD use before a first live birth was 2.0 (95 per cent confidence limits, 1.5 to 2.6) relative to nonuse. Users of the Dalkon Shield had an adjusted risk of 3.3 (1.7 to 6.1), users of the Lippes Loop or Saf-T-Coil had a risk of 2.9 (1.7 to 5.2), and users of copper IUDs had a risk of 1.6 (1.1 to 2.4). Women who reported having only one sexual partner had no increased risk of primary tubal infertility associated with IUD use. The adjusted risk of secondary tubal infertility associated with use of a copper IUD after a first live birth was not statistically significant (1.5; 95 per cent confidence limits, 0.8 to 3.0), whereas the risk from similar use of noncopper devices was significant (2.8; 1.3 to 5.9). We conclude that tubal infertility is associated with IUD use, but less so with copper IUDs. (New England Journal of Medicine 1985;312:941–7.)     

Protesters on message? Explaining demonstrators’ differential degrees of frame alignment

The frame alignment perspective emphasizes the importance of congruence in beliefs between protest participants and protest organizers. Although frame alignment is widely used in social movement research and matters for important movement processes, it has remained largely unclear how we can explain different degrees of frame alignment among protesters. We use empirical evidence regarding organizers’ and participants’ frames, surveying 4000 protesters in twenty-nine demonstrations between 2009 and 2012 in Belgium, the Netherlands and the United Kingdom. The results show that frame alignment depends on variables that tap into protesters’ exposure to organizational and alternative messages. Participants who are recruited by staging organizations, and events organized by strong and more professionalized organizations, display higher levels of frame alignment, whereas salience of the protest issue in the political arena severely constrains frame alignment.     

Moving from ‘what we know works’ to ‘what we do in practice’: An evidence overview of implementation and diffusion of innovation in transition to adulthood for care experienced young people

Global research has shown that most young people who are care experienced are not prepared to transition to independent living at 18 years of age and require support into early adulthood. We used rigorous systematic methods to identify English-based peer reviewed and grey literature describing innovations relevant to care experienced young people as they transition into adulthood, with a focus upon lessons for their implementation and diffusion. We synthesised the evidence narratively and organise data linked to seven key areas important to the transition to adulthood: (1) Health and well-being; (2) relationships; (3) education and training; (4) employment; (5) participation in society; (6) accommodation; (7) other. Twenty-five papers met our inclusion criteria. This review has found that, whilst there are a broad spectrum of innovations taking place within the social care environment for care experienced young people to support their transition into adulthood, there exists limited insight into how best to support implementation and diffusion of evidence-based innovation. We drew upon the ‘Consolidated Framework for Implementation Research’, developed in the setting of clinical service delivery, to highlight challenges in implementing and diffusing evidence-based innovation for care experienced young people transitioning into adulthood.     

La transition verte: analyser la croissance de l'emploi vert

Les auteurs estiment le nombre des emplois verts en Écosse et analysent son évolution dans le temps en s'appuyant sur les données de l'Enquête sur la main‐d'œuvre du Royaume‐Uni (2011‐2014) et en croisant deux systèmes de classification professionnelle (CITP‐08 et O*NET). Leur cadre méthodologique est transposable à n'importe quelle région. Ils montrent qu'il vaut mieux retenir une définition large des emplois verts, plutôt qu'une définition étroite, pour mesurer correctement l'impact de la transition verte sur l'emploi en général. Ils concluent par ailleurs qu'il faudrait s'intéresser davantage à la qualité des emplois verts et au caractère inclusif de la croissance de l'emploi vert.     

Company spokesperson vs. customer testimonial: Investigating quoted spokesperson credibility and impact in business-to-business communication

Through the framework of source credibility, this study examines the impact of quoting a company executive versus a customer testimonial in a business communication context. A 2 (spokesperson) × 7 (media channel) full factorial experiment (N = 514) showed partial support for enhanced perceived credibility of information conveyed by a customer testimonial compared to a company spokesperson in independent and controlled media channels online. When evaluated through a measure of media credibility, a customer spokesperson rates higher than a company spokesperson. In addition, a product is viewed more positively by an audience receiving information quoting a customer spokesperson rather than a company spokesperson. An audience with low business expertise considers both types of spokespersons as more trustworthy than a high-expertise audience; however, a customer is considered more trustworthy than a company spokesperson. The study provides public relations professionals with insight in determining the use of spokespersons when communicating to businesspeople.     

Midwifery care: A perinatal mental health case scenario

The establishment of the National Perinatal Depression Initiative (NPDI, 2008–2013) has brought a focus across Australia for the need to identify women at risk of perinatal mental health disorders, suggesting that routine screening by relevant health professionals may aid earlier detection, better care and improved outcomes. Midwives are frequently the primary point of contact in the perinatal period and thus ideally placed to identify, interpret and manage complex situations, including screening for perinatal mental health disorders.This paper offers strategies that could be implemented into daily midwifery practice in order to achieve the goals consistent with the National Perinatal Depression Initiative. A case study (Jen) and discussion, guided by recommendations from the Australian Nursing and Midwifery Competency standards and beyondblue Clinical Practice Guidelines, are used to demonstrate how midwifery care can be provided.In accordance with her legal obligations, the midwife should act within her scope of practice to undertake a series of psychosocial and medical assessments in order to best determine how midwifery care and support can be of benefit to Jen, her infant and her family. Suggestions described include administration of validated screening questionnaires, clinical interview, physical assessment, discussion with partner, awareness of the mother–infant interactions and questioning around baby's sleep and feeding. Based on evaluation of the information gained from a bio-psycho-social assessment, suggestions are made as to the midwifery care options that could be applied.     

Do fertility transitions influence infant mortality declines? Evidence from early modern Germany

The timing and sequencing of fertility transitions and early-life mortality declines in historical Western societies indicate that reductions in sibship (number of siblings) may have contributed to improvements in infant health. Surprisingly, however, this demographic relationship has received little attention in empirical research. We outline the difficulties associated with establishing the effect of sibship on infant mortality and discuss the inherent bias associated with conventional empirical approaches. We offer a solution that permits an empirical test of this relationship while accounting for reverse causality and potential omitted variable bias. Our approach is illustrated by evaluating the causal impact of family size on infant mortality using genealogical data from 13 German parishes spanning the sixteenth, seventeenth, eighteenth, and nineteenth centuries. Overall, our findings do not support the hypothesis that declining fertility led to increased infant survival probabilities in historical populations.     

Child protection revisited: balancing state intervention and family autonomy through social work processes

This paper explores selected findings from a qualitative study of the 1989 Children Act, which examined ways in which the new definitions of significant harm were being interpreted in practice. Significant harm is seen as a major site where state intervention and family autonomy are balanced, especially through establishing thresholds for intervention. The data are analysed in relation to the social work processes of assessment, intervention and evaluation. These are seen as a series of interactions between families and practitioners, in which goals are identified, methods used and resources mobilized. Key decisions and levels of change address the paramountry of the child's welfare. These processes are also under-pinned by new legislative requirements. The practitioners displayed their professionalism during a period of transition and change. Social work processes facilitated non-judgemental practices which empowered the families in the difficult circumstances of their lives. The paper concludes that balancing state intervention and family autonomy requires social work of a high order and a profound understanding of complex issues.