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Interprofessional collaboration is understood to improve efficiencies and quality of care but is associated with challenges such as professionals’ differing routines, knowledge, and identities, as well as professional hierarchies and time constraints. Given these challenges, there is limited understanding of how professionals collaborate effectively in providing patient-centred care. This study, with a convergence triangulation mixed-methods study design, explored interprofessional staffs’ perceptions of interprofessional collaboration and patient-centred care when working with hospitalized older adults. Thirty-six staff responded to a survey which included the Patient-Centred Care measure and the Modified Index of Interdisciplinary Collaboration; we also interviewed 14 nursing staff. Although all scores suggested a high value was placed on interprofessional collaboration, scores were low related to activities that facilitated team processes. We identified three themes from the data: knowing the patient/family, functional needs, and communication processes. Staff identified daily rounds with interprofessional teams as supportive of interprofessional collaboration and patient-centred-care.
Despite declines in tobacco use during pregnancy and after childbirth, smoking remains unacceptably high among many parents. Smoking maintenance or relapse may be common in couple relationships when the other parent continues to smoke, when relationship satisfaction is low, or parental stress high.
To examine the longitudinal influence of partner tobacco use, relationship satisfaction and parental stress on tobacco use after childbirth.
Data was obtained from 115 Australian heterosexual adult couples (Mean age = 31.8) who reported being pregnant in the previous year and the female partner was a previous or current smoker. A household longitudinal survey was administered in which measures of tobacco use, relationship satisfaction and parental stress were assessed on four occasions over nine years.
Overall reductions in tobacco use occurred over the nine-year assessment period, although a small percentage (9.6%) of parents reported being daily smokers at every assessment. Similarly, a small proportion (13.1%) of parents relapsed to using tobacco during the assessment period. A random effects binary logit model indicated that mothers and fathers were more likely to continue or relapse to tobacco use if their partners smoked. Mothers were more likely to quit smoking if they became pregnant between the assessment waves, but for males, having a pregnant partner was not a significant predictor of tobacco cessation.
While pregnancy is associated with smoking cessation for mothers, both mothers and fathers are at elevated risk of continued tobacco smoking or relapse if their partner smokes during the first nine years after childbirth. For parents who continue to smoke cigarettes or relapse after childbirth, engagement of the partner in smoking cessation may be a key factor in promoting positive outcomes.
Healthcare institutions may often prohibit “cold-calling” or direct contact with a potential research participant when the person initiating contact is unknown to the patient. This policy aims to maintain patient privacy, but may have unintended consequences as a result of physician gatekeeping. In this review, we discuss recruitment policies at the top academic institutions. We propose an ethical framework for evaluating cold-call policies based on three principles of research ethics. In order to maximize engagement of potential research participants, while maintaining patient privacy and autonomy, we then propose several alternative solutions to restrictive cold-call policies, including opt-in or opt-out platforms, a team-based approach, electronic solutions, and best practices for recruitment. As healthcare has evolved with more collaborative, patient-centered, data-driven care, the engagement of potential research participants should similarly evolve.
Dietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand.
Prospective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence.
Emerging hypertension and changing diets in Thailand.
TCS participants who were normotensive at baseline in 2005.
Among 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: ‘Modern’ and ‘Prudent’. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51; 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI.
Modern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.
In the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15–87 at baseline and lived in all regions of the country. Cohort members’ citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.
This study looked at lay theories of how people with personality disorders (PDs) are perceived to cope with their interpersonal relationships. In all, 213 participants read 14 vignettes derived from Oldham's and Morris's (2000) book describing DSM III personality disorders for a popular audience. Participants were invited to do six ratings, including how happy each person in each vignette appeared to be and how successful at establishing long-term relationships. Effect sizes for each question across the 14 vignettes were small to medium. The six ratings factored into a single social adjustment scale, and there were many differences across the PDs on this measure. Those with dependent PD were judged as most successful in their social relationships while those who were schizoid PD were judged as least successful. A similar analysis using the three higher order clusters showed significant differences: Cluster C disordered people were judged as better adjusted than Cluster A people. Limitations of the methodology and implications are discussed.
Though it is the one of the best attested members of the ‘Epic Cycle’, and the only poem of that group to have taken its title from one of the Homeric epics, the Ilias parva illustrates how difficult it is to reconstruct, let alone understand, the history of Greek epic poetry after Homer.
Author – title – date
The author most widely named in modern literature, Lesches from the city of Pyrrha on Lesbos, is also the most cited figure in ancient discussions, but only from the middle of the fourth century BC; as with other ‘Cyclic’ poems, the earliest attestations take the form of ‘the one who made the Ilias parva’, while the inevitable Homeric attributions are few and late. The poem' epithet is therefore doubly surprising, for such differentiations usually qualify works by the same author, and yet the title was settled as early as Aristotle. A range of similarities with the Iliad (and Odyssey) can reasonably be invoked as the cause, as perhaps can the first word of PEG F 28 (= F 1 D. = F 1 W.), though it may not have been the poet' own choice.
The meagre linguistic evidence of the fragments does not help to determine the date of the Ilias parva, for none of those features usually judged to be ‘late’ lack some genuinely Archaic epic parallel or explanation. A post-Homeric genesis is overwhelmingly likely, tallying with the ancient chronographers and the poem' title, and modern scholars' datings therefore range rather freely between the seventh and sixth centuries BC. The earliest reliable terminus ante quem comes with its first, roughly contemporaneous quotations, (i) in Aristophanes' Knights (1056–7) of 424 BC (PEG F 2 = D. = F 2 W.) and (ii) on two potsherds (PEG F 28 = F 1 D. = F 1 W.) from the Black Sea region, one (420–410 BC) from Chersonesos and another (less precisely datable) from Olbia.9 Getting back beyond this point, as we shall see, is fraught with difficulty.