No time to think: protecting the reflective space in children's services

Over the past few years, first line managers in child care have faced mounting pressure on their time from both the national performance management agenda and the professional demands associated with the Framework for the Assessment of Children in Need and their Families and Working Together to Safeguard Children: A Guide to Inter‐Agency Working to Safeguard and Promote the Welfare of Children. This paper briefly discusses the policy context surrounding this period of unprecedented change and focuses on the potential erosion of the reflective space in supervision as first line managers struggle to cope with the ever‐increasing expectations. An argument is made for the creative use of multi‐agency action learning/ research projects within the workplace to supplement individual supervision and promote reflective multi‐agency child care practice; some examples of successful projects are given. Copyright © 2003 John Wiley & Sons, Ltd.     

Intent to receive an HPV vaccine among university men and women and implications for vaccine administration

OBJECTIVE AND PARTICIPANTS: In 2006, the authors examined intention to receive an HPV vaccine among 340 college students. METHODS: A total of 138 men and 202 women completed questionnaires. The authors measured intention by asking participants how likely they would be to accept an HPV vaccine that prevented against (1) all HPV, (2) cervical cancer but not genital warts, (3) genital warts but not cervical cancer, and (4) both genital warts and cervical cancer. RESULTS: Men and women reported high intent to receive an HPV vaccine, although women did so at a significantly higher rate (77.5% vs 88.6%, respectively; p < .01). Men were less willing to receive a vaccine that prevents cervical cancer alone than they were to receive one that prevents cervical cancer and genital warts (34.1% vs 77.5%, p < .001). Intent to receive the vaccine was significantly greater among participants who reported more than 5 sex partners and correctly answered 2 or 3 HPV knowledge questions. CONCLUSIONS: Interest varied according to sexual history, according to knowledge about HPV, and (in men) according to vaccine target.     

Cultural aspects of bipolar disorder: Interpersonal meaning for clients & psychiatric nurses

Bipolar disorder is a complicated mental illness to diagnose and treat. The symptoms of the disorder cause a multitude of fluctuations in mood and behavior, affecting the way individuals function and interact with others on a daily basis. Individuals diagnosed with bipolar disorder experience symptoms within a framework that is grounded in their cultural beliefs, values, and norms. Culture is a complex and personal biopsychosocial phenomenon that provides meaning within life for an individual, a group, or a community. It is essential that psychiatric-mental health (PMH) nurses understand the role of culture and integrate this knowledge into the biopsychosocial care of clients. The development and maintenance of the interpersonal therapeutic relationship between PMH nurses and their clients requires the use of a cultural framework, which refers to the connection of culture and cultural competence. The purposes of this article are to define culture and the process of cultural competence, provide a brief overview of bipolar disorder, propose the use of a cultural framework for bipolar disorder, and discuss the implications for PMH nurses who care for culturally and ethnically diverse clients.     

Hysteroscopy in the diagnosis of postmenopausal bleeding

Postmenopausal bleeding (PMB) accounts for 5% of gynaecology referrals. Investigations should exclude malignancy and pre-malignancy, and diagnose the benign conditions that need treatment. The three modalities that are most commonly used are transvaginal ultrasound scan (TVS), endometrial biopsy (EB) and hysteroscopy. Most authors agree that the first-line investigation should be TVS, followed by endometrial assessment (EB or hysteroscopy) if the endometrial thickness is >4 mm. When scanning demonstrates the possibility of pathology, outpatient hysteroscopy and biopsy are the gold standard for investigating the endometrial cavity. Focal pathology can be removed during the hysteroscopy, thereby reducing hospital admissions and costs.     

Assessment of physical exposures and comparison of exposure definitions in a repetitive sawmill occupation: trim-saw operator

This paper describes the physical exposures required to perform a sawmill job associated with a high incidence of upper extremity musculoskeletal injury. Exposure variables are described by multiple posture, exertion and frequency definitions and the comparability of those definitions are examined. Effective industrial prevention efforts require an accurate assessment of risk. Surface electromyography and electrogoniometry were used to quantify the physical exposures of 29 trim-saw operators in four sawmill facilities. Average wrist ranges of motion of 32, 57 and 58 degrees in wrist radial/ulnar deviation, flexion/extension and pronation/supination respectively were required to perform the job. Defining wrist range of motion by the peak postures observed versus those required to perform the primary task resulted in significantly different ranges of motion (p<0.05). Job performance required an average of 33% of maximum voluntary contraction. Repetitions per day ranged from 3,549 to 14,460. Percentage of maximum voluntary contraction was not associated with psychophysical measures of exertion.     

Sleep Behaviors in Older African American Females Reporting Nonmalignant Chronic Pain: Understanding the Psychosocial Implications of General Sleep Disturbance

This study examined factors that influence sleep quality in older African American women (N = 181) reporting chronic pain. Participants completed a series of questions assessing demographic and behavioral characteristics, health status, pain intensity, and sleep disturbance. Findings indicated that younger participants and those experiencing poorer physical functioning reported more difficulty sleeping due to pain. Similarly, participants who reported being awakened from sleep due to pain were younger and experienced greater pain intensity. Understanding the relationship between sleep and pain in this group of women may be useful in promoting effective disease management and sleep awareness among patients, caregivers, and healthcare professionals.     

Spatial parameter variation by Orthogonal Trend Surface Expansions: An application to the analysis of welfare program participation rates

This paper describes Orthogonal Trend Surface Expansions (OTSEs), a technique for investigating the spatial variation of a model's parameters. OTSEs implement in spatial contexts the Expansion Method's approach to the study of parametric stability/drift. Here OTSEs are used to test for parameter variation in a model of participation in Aid to Families with Dependent Children (AFDC), a large U.S. welfare program.