This paper examines the recent significant growth in international recruitment of qualified nurse... more This paper examines the recent significant growth in international recruitment of qualified nurses to the United Kingdom (UK). The paper examines trends in recruitment using data from the UK professional register of nurses, and discusses the reasons why employers recruit internationally, and why nurses are internationally mobile. Specific attention is given to the impact of globalisation in the international recruitment of nurses. Recommendations are given for further research in this area.
This paper sets out to establish what is meant by shared governance, analyses the literature on s... more This paper sets out to establish what is meant by shared governance, analyses the literature on shared governance implementation, and discusses emergent issues. The paper is based on research funded by the Department of Health (England) and by North Staordshire NHS Trust. A literature search was undertaken using the terms`shared governance' andèmpowerment', restricted to English language. The databases used were CINAHL, British Nursing Index, Medline, Social Sciences Citation Index and FirstSearch, and the search period was January 1988±May 1998. Initially, nearly 500 articles were identi®ed. This search also highlighted articles describing participative management, professional practice models, and self-managed work teams. For the purposes of this review, only published articles which either described and/or evaluated the implementation of shared governance were analysed. According to these criteria, 48 studies, which were obtained by the cut-o date, were included for detailed assessment. #
This paper provides practical guidelines for managers and health professionals looking to skill m... more This paper provides practical guidelines for managers and health professionals looking to skill mix as a potential solution to health service delivery problems. These guidelines emphasise the need to evaluate the problem, and examine the context, before deciding if skill mix is the answer. The guidelines are provided in the knowledge that skill mix is rarely examined in a " pure " theoretical sense by organisations. They have to adopt a pragmatic approach which takes account of the day-today realities of their priorities and resources. The paper argues that changing skill mix is not a panacea for all the ills of an organisation. It has a role to play in improving organisational effectiveness and quality of care, but it must be recognised for what it is-a process for achieving change. Four phases of the skill mix cycle are described: evaluating the need for change; identifying the opportunities and barriers for change; planning for change; and making change happen. The paper concludes by emphasising that skill mix is not just a technical exercise. It is a method of achieving organisational change which requires careful planning, communication, implementation and evaluation if it is to achieve its objectives. Introduction This paper provides a decision support tool for managers and health professionals interested or involved in skill mix. It builds on the work already undertaken for the WHO in this area, which developed a typology of approaches to skill mix (1,2) and more recent work which examined the application of skill mix in context
The availability of familial and broader social networks has been proposed as a significant influ... more The availability of familial and broader social networks has been proposed as a significant influence on mental health outcomes for resettling refugees. This small-scale local study considered the experience and adjustment of 26 refugees and asylum-seekers resettling in Edinburgh who had been identified as at particular risk of social isolation. While 92 per cent of refugees reported having social contact outside the home, only 19 per cent had established contacts outside refugee networks and language classes. 54 per cent of the sample scored at levels on the Hospital Anxiety and Depression Scale (HADS) indicative of a diagnosis of an anxiety disorder, with 42 per cent scoring at levels indicative of a diagnosis of depression. Levels of both anxiety and depression increased with length of time in the UK. Social contacts outside the home were generally infrequent and, while their frequency was not found to be associated with lower levels of mental health symptoms, refugees themselves prioritized increased social contact above assistance with practical issues and the provision of counselling. Particular interest was expressed in contact with local individuals and groups that could serve as a 'bridge' into host country customs and practices. In the context of a growing literature regarding post-migratory adjustment, the study supports the vulnerability of resettling refugees (particularly those who are single) to poor mental health. While the protective influence on mental health of family linkage and wider social support was not demonstrated by findings, refugees' prioritization of needs suggests that refugee settlement following a 'dispersal' strategy should explicitly seek both to facilitate family and wider co-ethnic linkage and to identify mechanisms for 'bridging' support from indigenous, majority populations.
A B S T R A C T Background Current levels and patterns of alcohol drinking continue to cause conc... more A B S T R A C T Background Current levels and patterns of alcohol drinking continue to cause concern, particularly amongst young females. Effective interventions remain elusive. The aim of this study was to investigate the levels of knowledge relating to UK 'Sensible Drinking' guidelines, definitions of binge drinking and attitude to drink labelling initiatives amongst female school leavers enrolling at university. Methods Non-standardized questionnaires were administered and completed by researchers during the process of matriculation (response rate 94%; n = 180). Results The survey revealed that recommended daily guidelines for women were not recalled by 54% of participants; 52% could not quote the unit content of their favoured alcoholic drink, whereas only 14% reported the use of the UK unit system to guide drinking. Personal quantitative definitions of binge drinking varied by a factor of 18. Conclusion A rewording of the UK Sensible Drinking message to one recognizing the needs of different population groups and their particular language of consumption measure is timely.
This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). I... more This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned "piloting" of the PA role within the National Health Service (NHS) in Scotland. The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is "new" and unfamiliar, are explored. The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multidisciplinary teams will be prerequisites for effective deployment of this new role in the NHS in Scotland.
— Aims: The aim of this study was to investigate the utility of a short, practical pouring exerci... more — Aims: The aim of this study was to investigate the utility of a short, practical pouring exercise as a means of illustrating the details of the UK 'Sensible Drinking guidelines. Methods: Participants (N = 297, 53% male) recruited at four Edinburgh employment sites, each completed a short non-standardized questionnaire and poured their 'usual measure of wine or spirit' into a glass (purchased from four 'high street' outlets). The actual and estimated unit content of their poured drinks and reactions to feedback were noted. Participants were informed of their daily limit of consumption in terms of this drink. Results: On average, drinks contained 2.05 UK units. Only 27% (N = 79) of respondents estimated the unit content of their drink within 10% of the true value. Of drinkers, 20.5% (N = 61) indicated that the results of the pouring test would influence their future pouring (70% of these were women). When informed of daily limits of consumption in terms of personal drink measure, 46% (N = 132) of drinkers indicated they would usually exceed this. Conclusion: A practical demonstration of health guidelines presented in terms of personal drinking habits may contribute to dissemination of responsible drinking messages. Preliminary evidence suggests women may be particularly open to this approach. The utility of this intervention is underscored by recent figures highlighting the increasing preference for home drinking.
Background: Unhealthy alcohol use among university students is cause for concern, yet the level o... more Background: Unhealthy alcohol use among university students is cause for concern, yet the level of help seeking behavior for alcohol use is low within the student population. Electronic brief interventions delivered via the Internet present an alternative to traditional treatments and could enable the delivery of interventions on a population basis. Further evidence is needed of the effectiveness of Internet-delivered interventions and of their generalizability across educational institutions.
— Aims: To document knowledge and perceptions relating to the professional role in the area of al... more — Aims: To document knowledge and perceptions relating to the professional role in the area of alcohol misuse within a sample of first year (n = 278) and final year (n = 527) medical, nursing and allied health professional (NAHP) students in Scotland. Methods: A cross sectional survey design involving self-completed questionnaires administered in autumn 2008 (first year students) and spring 2009 (final year students) through course websites and lectures. Results: Gaps in the knowledge relating to current UK health guidelines were identified but more so among NAHP students than medical students. Exploration of the perceived role in this area of practice identified three broad groups of students: those clear about their role (medical and nursing students), those advocating a role but not identified by fellow students (occupational therapy and pharmacy) and those uncertain of their role (radiographers, speech and language therapists/audiologists and physiotherapy). Conclusions: Higher education institutions should address the gaps in the knowledge around guidance for alcohol consumption. The effectiveness of brief interventions may depend on it. Additionally, through inter-professional teaching and in collaboration with the relevant professional bodies, more could be done to promote the contribution of practitioners other than those traditionally linked (i.e. medical and nursing) to this important clinical role.
Objective: To assess the extent to which university students are following UK Government advice r... more Objective: To assess the extent to which university students are following UK Government advice regarding appropriate consumption of alcohol, and to investigate if students can be placed into distinct clusters based on their drinking behaviour. Design: A descriptive questionnaire study. Setting: One hundred and nineteen undergraduate students from Leeds Metropolitan University, UK. Method: An online survey, which included a diary to record daily alcohol consumption over the previous week, was completed during the winter of 2007/08. Cluster analysis was used to classify students into subgroups based on comparable alcohol-drinking characteristics. National recommended sensible drinking behaviour guidelines in terms of total weekly alcohol intake, maximum daily alcohol intake, number of alcohol-free days and estimated blood alcohol levels were used to compare drinking behaviour the previous week by age, sex and cluster group. Results: Consuming weekly alcohol levels considered hazardous was common (58%) with nearly 70% of responders binge drinking at least once over that period; most students (80%) were, however, following the government's recommendation for two consecutive alcohol-free days per week. No significant differences in drinking behaviour by sex were found, but binge drinkers tended to be younger. Four distinct alcohol-drinking behaviour clusters were identified based on alcohol consumption frequency and quantity. Only students in the non or light drinkers group all remained within national recommended guidelines for weekly intake and alcohol-free days. Conclusion: Students who consume alcohol are commonly drinking daily and weekly alcohol levels in excess of national sensible drinking guidelines; most students, however, abstain from alcohol on at least two consecutive days. The four distinct drinking clusters suggest that students would benefit from targeted interventions. In particular, personalization of interventions to reflect the distinct patterns of drinking behaviour could increase intervention effectiveness.
Objective To explore the role of the relationship between sport and social capital in negotiating... more Objective To explore the role of the relationship between sport and social capital in negotiating improved social outcomes for homeless individuals with mental illness and/or substance abuse issues.
Purpose: To assess the impact of the global financial crisis on the nursing workforce and identif... more Purpose: To assess the impact of the global financial crisis on the nursing workforce and identify appropriate policy responses. Organizing Construct and Methods: This article draws from international data sources (Organisation for Economic Cooperation and Development [OECD] and World Health Organization), from national data sources (nursing regulatory authorities), and the literature to provide a context in which to examine trends in labor market and health spending indicators, nurse employment, and nurse migration patterns. Findings: A variable impact of the crisis at the country level was shown by different changes in unemployment rates and funding of the health sector. Some evidence was obtained of reductions in nurse staffing in a small number of countries. A significant and variable change in the patterns of nurse migration also was observed. Conclusions: The crisis has had a variable impact; nursing shortages are likely to reappear in some OECD countries. Policy responses will have to take account of the changed economic reality in many countries. Clinical Relevance: This article highlights key trends and issues for the global nursing workforce; it then identifies policy interventions appropriate to the new economic realities in many OECD countries. This article examines recent trends and dynamics in the nursing workforce in a world deeply affected by economic change and financial recession. Demographically driven change in healthcare systems and policy responses are now compounded by an economic and financial crisis and its aftermath. Our objectives are to present an overview of the current global profile and dynamics of nursing in this changing situation; to provide country examples of the impact of the economic crisis on nursing mobility; and to discuss critical nursing workforce challenges and related policy responses. Databases of the Organisation for Economic Cooperation and Development (OECD) and of the World Health Organization (WHO) are the main sources; selected country level data and information were also analyzed.
— Aims: To compare characteristics of heavy drinkers who do, or do not, drink white cider during ... more — Aims: To compare characteristics of heavy drinkers who do, or do not, drink white cider during their typical drinking week and to contrast white cider drinkers' behaviour with a similar group recruited in comparable settings 4 years previously. To consider if excessive white cider consumption poses a specific health risk. Methods: Cross-sectional survey of alcohol purchasing and consumption by heavy drinkers consuming white cider in Edinburgh and Glasgow during 2012; comparison of purchasing patterns within Edinburgh in 2008–2009 and 2012. Participants were 639 patients (in-and outpatient settings) with serious health problems linked to alcohol, 345 in Glasgow, 294 in Edinburgh in 2012, and 377 in Edinburgh in 2008–2009. Results: In 2012 white cider consumption was reported by 25% of participants (median consumption (all alcohol) was 249 UK units per week—1 UK unit being 8 g of ethanol). They were more likely to be male and younger. They drank more units of alcohol than non-white cider drinkers and reported more alcohol-related problems. The median price paid for white cider in 2012 was 17 ppu. The period 2008–2012 was associated with decreasing affordability of alcohol, but consumption levels amongst the heaviest drinkers were maintained, associated with an increased proportion of units purchased as white cider. Conclusion: White cider makes an important contribution to the weekly intake of heavy drinkers in Scotland, likely facilitated by low price per unit of alcohol. We suggest these characteristics permit this drink to act as a buffer, supporting the continuation of a heavy drinking pattern when affordability of alcohol falls.
Introduction: There is little discussion in the United Kingdom occupational therapy literature su... more Introduction: There is little discussion in the United Kingdom occupational therapy literature surrounding the topic of older people and alcohol, despite the growing prevalence of alcohol-related health problems in older adults resulting from an ageing population and changing patterns of consumption. Occupational therapists in physical health care settings are likely to work with older people whose drinking pattern may not be alcohol dependent, but may put their physical or psychological health at risk. Method: A survey methodology was employed using open and closed questions, recruiting occupational therapists (band 5 to 9) (n ¼ 122) working with older people (65þ years) in physical health care settings across all, except one, National Health Service Regional Health Boards in Scotland. Results: Responses highlight gaps in occupational therapists' knowledge around alternative 'safe limits' of alcohol intake for older people. Belief in professional role was evident, but the perception was that this was not supported by undergraduate education. Occupation focused theory and assessment were not prioritized when considering alcohol in the older adult. Conclusion: This study has highlighted a need to develop pre-and post-qualification education for occupational therapists, to enhance understanding of theory, assessment and knowledge of alcohol with older adults in physical health care settings.
Objectives: Potential strategies to address alcohol misuse remain contentious. We aim to characte... more Objectives: Potential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socioeconomic status on purchasing behaviour. Study design: Cross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. Methods: 639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in-and outpatient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last week's or a 'typical' weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. Results: Median consumption was 184.8 (IQR ¼ 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those <50 pence (£0.5 UK) per alcohol unit. Corresponding figures for the Scottish population are 69% and 60%. The most popular low-priced drinks were white cider, beer and vodka with the most common off-sales outlet being the corner shop, despite supermarkets offering cheaper options. Consumption levels of the cheapest drink (white cider) were similar across all quintiles apart from the least deprived. Conclusions: Heavy drinkers from all quintiles purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Nonetheless , drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary.
This paper examines the recent significant growth in international recruitment of qualified nurse... more This paper examines the recent significant growth in international recruitment of qualified nurses to the United Kingdom (UK). The paper examines trends in recruitment using data from the UK professional register of nurses, and discusses the reasons why employers recruit internationally, and why nurses are internationally mobile. Specific attention is given to the impact of globalisation in the international recruitment of nurses. Recommendations are given for further research in this area.
This paper sets out to establish what is meant by shared governance, analyses the literature on s... more This paper sets out to establish what is meant by shared governance, analyses the literature on shared governance implementation, and discusses emergent issues. The paper is based on research funded by the Department of Health (England) and by North Staordshire NHS Trust. A literature search was undertaken using the terms`shared governance' andèmpowerment', restricted to English language. The databases used were CINAHL, British Nursing Index, Medline, Social Sciences Citation Index and FirstSearch, and the search period was January 1988±May 1998. Initially, nearly 500 articles were identi®ed. This search also highlighted articles describing participative management, professional practice models, and self-managed work teams. For the purposes of this review, only published articles which either described and/or evaluated the implementation of shared governance were analysed. According to these criteria, 48 studies, which were obtained by the cut-o date, were included for detailed assessment. #
This paper provides practical guidelines for managers and health professionals looking to skill m... more This paper provides practical guidelines for managers and health professionals looking to skill mix as a potential solution to health service delivery problems. These guidelines emphasise the need to evaluate the problem, and examine the context, before deciding if skill mix is the answer. The guidelines are provided in the knowledge that skill mix is rarely examined in a " pure " theoretical sense by organisations. They have to adopt a pragmatic approach which takes account of the day-today realities of their priorities and resources. The paper argues that changing skill mix is not a panacea for all the ills of an organisation. It has a role to play in improving organisational effectiveness and quality of care, but it must be recognised for what it is-a process for achieving change. Four phases of the skill mix cycle are described: evaluating the need for change; identifying the opportunities and barriers for change; planning for change; and making change happen. The paper concludes by emphasising that skill mix is not just a technical exercise. It is a method of achieving organisational change which requires careful planning, communication, implementation and evaluation if it is to achieve its objectives. Introduction This paper provides a decision support tool for managers and health professionals interested or involved in skill mix. It builds on the work already undertaken for the WHO in this area, which developed a typology of approaches to skill mix (1,2) and more recent work which examined the application of skill mix in context
The availability of familial and broader social networks has been proposed as a significant influ... more The availability of familial and broader social networks has been proposed as a significant influence on mental health outcomes for resettling refugees. This small-scale local study considered the experience and adjustment of 26 refugees and asylum-seekers resettling in Edinburgh who had been identified as at particular risk of social isolation. While 92 per cent of refugees reported having social contact outside the home, only 19 per cent had established contacts outside refugee networks and language classes. 54 per cent of the sample scored at levels on the Hospital Anxiety and Depression Scale (HADS) indicative of a diagnosis of an anxiety disorder, with 42 per cent scoring at levels indicative of a diagnosis of depression. Levels of both anxiety and depression increased with length of time in the UK. Social contacts outside the home were generally infrequent and, while their frequency was not found to be associated with lower levels of mental health symptoms, refugees themselves prioritized increased social contact above assistance with practical issues and the provision of counselling. Particular interest was expressed in contact with local individuals and groups that could serve as a 'bridge' into host country customs and practices. In the context of a growing literature regarding post-migratory adjustment, the study supports the vulnerability of resettling refugees (particularly those who are single) to poor mental health. While the protective influence on mental health of family linkage and wider social support was not demonstrated by findings, refugees' prioritization of needs suggests that refugee settlement following a 'dispersal' strategy should explicitly seek both to facilitate family and wider co-ethnic linkage and to identify mechanisms for 'bridging' support from indigenous, majority populations.
A B S T R A C T Background Current levels and patterns of alcohol drinking continue to cause conc... more A B S T R A C T Background Current levels and patterns of alcohol drinking continue to cause concern, particularly amongst young females. Effective interventions remain elusive. The aim of this study was to investigate the levels of knowledge relating to UK 'Sensible Drinking' guidelines, definitions of binge drinking and attitude to drink labelling initiatives amongst female school leavers enrolling at university. Methods Non-standardized questionnaires were administered and completed by researchers during the process of matriculation (response rate 94%; n = 180). Results The survey revealed that recommended daily guidelines for women were not recalled by 54% of participants; 52% could not quote the unit content of their favoured alcoholic drink, whereas only 14% reported the use of the UK unit system to guide drinking. Personal quantitative definitions of binge drinking varied by a factor of 18. Conclusion A rewording of the UK Sensible Drinking message to one recognizing the needs of different population groups and their particular language of consumption measure is timely.
This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). I... more This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned "piloting" of the PA role within the National Health Service (NHS) in Scotland. The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is "new" and unfamiliar, are explored. The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multidisciplinary teams will be prerequisites for effective deployment of this new role in the NHS in Scotland.
— Aims: The aim of this study was to investigate the utility of a short, practical pouring exerci... more — Aims: The aim of this study was to investigate the utility of a short, practical pouring exercise as a means of illustrating the details of the UK 'Sensible Drinking guidelines. Methods: Participants (N = 297, 53% male) recruited at four Edinburgh employment sites, each completed a short non-standardized questionnaire and poured their 'usual measure of wine or spirit' into a glass (purchased from four 'high street' outlets). The actual and estimated unit content of their poured drinks and reactions to feedback were noted. Participants were informed of their daily limit of consumption in terms of this drink. Results: On average, drinks contained 2.05 UK units. Only 27% (N = 79) of respondents estimated the unit content of their drink within 10% of the true value. Of drinkers, 20.5% (N = 61) indicated that the results of the pouring test would influence their future pouring (70% of these were women). When informed of daily limits of consumption in terms of personal drink measure, 46% (N = 132) of drinkers indicated they would usually exceed this. Conclusion: A practical demonstration of health guidelines presented in terms of personal drinking habits may contribute to dissemination of responsible drinking messages. Preliminary evidence suggests women may be particularly open to this approach. The utility of this intervention is underscored by recent figures highlighting the increasing preference for home drinking.
Background: Unhealthy alcohol use among university students is cause for concern, yet the level o... more Background: Unhealthy alcohol use among university students is cause for concern, yet the level of help seeking behavior for alcohol use is low within the student population. Electronic brief interventions delivered via the Internet present an alternative to traditional treatments and could enable the delivery of interventions on a population basis. Further evidence is needed of the effectiveness of Internet-delivered interventions and of their generalizability across educational institutions.
— Aims: To document knowledge and perceptions relating to the professional role in the area of al... more — Aims: To document knowledge and perceptions relating to the professional role in the area of alcohol misuse within a sample of first year (n = 278) and final year (n = 527) medical, nursing and allied health professional (NAHP) students in Scotland. Methods: A cross sectional survey design involving self-completed questionnaires administered in autumn 2008 (first year students) and spring 2009 (final year students) through course websites and lectures. Results: Gaps in the knowledge relating to current UK health guidelines were identified but more so among NAHP students than medical students. Exploration of the perceived role in this area of practice identified three broad groups of students: those clear about their role (medical and nursing students), those advocating a role but not identified by fellow students (occupational therapy and pharmacy) and those uncertain of their role (radiographers, speech and language therapists/audiologists and physiotherapy). Conclusions: Higher education institutions should address the gaps in the knowledge around guidance for alcohol consumption. The effectiveness of brief interventions may depend on it. Additionally, through inter-professional teaching and in collaboration with the relevant professional bodies, more could be done to promote the contribution of practitioners other than those traditionally linked (i.e. medical and nursing) to this important clinical role.
Objective: To assess the extent to which university students are following UK Government advice r... more Objective: To assess the extent to which university students are following UK Government advice regarding appropriate consumption of alcohol, and to investigate if students can be placed into distinct clusters based on their drinking behaviour. Design: A descriptive questionnaire study. Setting: One hundred and nineteen undergraduate students from Leeds Metropolitan University, UK. Method: An online survey, which included a diary to record daily alcohol consumption over the previous week, was completed during the winter of 2007/08. Cluster analysis was used to classify students into subgroups based on comparable alcohol-drinking characteristics. National recommended sensible drinking behaviour guidelines in terms of total weekly alcohol intake, maximum daily alcohol intake, number of alcohol-free days and estimated blood alcohol levels were used to compare drinking behaviour the previous week by age, sex and cluster group. Results: Consuming weekly alcohol levels considered hazardous was common (58%) with nearly 70% of responders binge drinking at least once over that period; most students (80%) were, however, following the government's recommendation for two consecutive alcohol-free days per week. No significant differences in drinking behaviour by sex were found, but binge drinkers tended to be younger. Four distinct alcohol-drinking behaviour clusters were identified based on alcohol consumption frequency and quantity. Only students in the non or light drinkers group all remained within national recommended guidelines for weekly intake and alcohol-free days. Conclusion: Students who consume alcohol are commonly drinking daily and weekly alcohol levels in excess of national sensible drinking guidelines; most students, however, abstain from alcohol on at least two consecutive days. The four distinct drinking clusters suggest that students would benefit from targeted interventions. In particular, personalization of interventions to reflect the distinct patterns of drinking behaviour could increase intervention effectiveness.
Objective To explore the role of the relationship between sport and social capital in negotiating... more Objective To explore the role of the relationship between sport and social capital in negotiating improved social outcomes for homeless individuals with mental illness and/or substance abuse issues.
Purpose: To assess the impact of the global financial crisis on the nursing workforce and identif... more Purpose: To assess the impact of the global financial crisis on the nursing workforce and identify appropriate policy responses. Organizing Construct and Methods: This article draws from international data sources (Organisation for Economic Cooperation and Development [OECD] and World Health Organization), from national data sources (nursing regulatory authorities), and the literature to provide a context in which to examine trends in labor market and health spending indicators, nurse employment, and nurse migration patterns. Findings: A variable impact of the crisis at the country level was shown by different changes in unemployment rates and funding of the health sector. Some evidence was obtained of reductions in nurse staffing in a small number of countries. A significant and variable change in the patterns of nurse migration also was observed. Conclusions: The crisis has had a variable impact; nursing shortages are likely to reappear in some OECD countries. Policy responses will have to take account of the changed economic reality in many countries. Clinical Relevance: This article highlights key trends and issues for the global nursing workforce; it then identifies policy interventions appropriate to the new economic realities in many OECD countries. This article examines recent trends and dynamics in the nursing workforce in a world deeply affected by economic change and financial recession. Demographically driven change in healthcare systems and policy responses are now compounded by an economic and financial crisis and its aftermath. Our objectives are to present an overview of the current global profile and dynamics of nursing in this changing situation; to provide country examples of the impact of the economic crisis on nursing mobility; and to discuss critical nursing workforce challenges and related policy responses. Databases of the Organisation for Economic Cooperation and Development (OECD) and of the World Health Organization (WHO) are the main sources; selected country level data and information were also analyzed.
— Aims: To compare characteristics of heavy drinkers who do, or do not, drink white cider during ... more — Aims: To compare characteristics of heavy drinkers who do, or do not, drink white cider during their typical drinking week and to contrast white cider drinkers' behaviour with a similar group recruited in comparable settings 4 years previously. To consider if excessive white cider consumption poses a specific health risk. Methods: Cross-sectional survey of alcohol purchasing and consumption by heavy drinkers consuming white cider in Edinburgh and Glasgow during 2012; comparison of purchasing patterns within Edinburgh in 2008–2009 and 2012. Participants were 639 patients (in-and outpatient settings) with serious health problems linked to alcohol, 345 in Glasgow, 294 in Edinburgh in 2012, and 377 in Edinburgh in 2008–2009. Results: In 2012 white cider consumption was reported by 25% of participants (median consumption (all alcohol) was 249 UK units per week—1 UK unit being 8 g of ethanol). They were more likely to be male and younger. They drank more units of alcohol than non-white cider drinkers and reported more alcohol-related problems. The median price paid for white cider in 2012 was 17 ppu. The period 2008–2012 was associated with decreasing affordability of alcohol, but consumption levels amongst the heaviest drinkers were maintained, associated with an increased proportion of units purchased as white cider. Conclusion: White cider makes an important contribution to the weekly intake of heavy drinkers in Scotland, likely facilitated by low price per unit of alcohol. We suggest these characteristics permit this drink to act as a buffer, supporting the continuation of a heavy drinking pattern when affordability of alcohol falls.
Introduction: There is little discussion in the United Kingdom occupational therapy literature su... more Introduction: There is little discussion in the United Kingdom occupational therapy literature surrounding the topic of older people and alcohol, despite the growing prevalence of alcohol-related health problems in older adults resulting from an ageing population and changing patterns of consumption. Occupational therapists in physical health care settings are likely to work with older people whose drinking pattern may not be alcohol dependent, but may put their physical or psychological health at risk. Method: A survey methodology was employed using open and closed questions, recruiting occupational therapists (band 5 to 9) (n ¼ 122) working with older people (65þ years) in physical health care settings across all, except one, National Health Service Regional Health Boards in Scotland. Results: Responses highlight gaps in occupational therapists' knowledge around alternative 'safe limits' of alcohol intake for older people. Belief in professional role was evident, but the perception was that this was not supported by undergraduate education. Occupation focused theory and assessment were not prioritized when considering alcohol in the older adult. Conclusion: This study has highlighted a need to develop pre-and post-qualification education for occupational therapists, to enhance understanding of theory, assessment and knowledge of alcohol with older adults in physical health care settings.
Objectives: Potential strategies to address alcohol misuse remain contentious. We aim to characte... more Objectives: Potential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socioeconomic status on purchasing behaviour. Study design: Cross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. Methods: 639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in-and outpatient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last week's or a 'typical' weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. Results: Median consumption was 184.8 (IQR ¼ 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those <50 pence (£0.5 UK) per alcohol unit. Corresponding figures for the Scottish population are 69% and 60%. The most popular low-priced drinks were white cider, beer and vodka with the most common off-sales outlet being the corner shop, despite supermarkets offering cheaper options. Consumption levels of the cheapest drink (white cider) were similar across all quintiles apart from the least deprived. Conclusions: Heavy drinkers from all quintiles purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Nonetheless , drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary.
... CAREY-WOOD, J., DUKE, K., KARN, V. and MARSHALL, T. (1995) The Settlement of Refugees in Brit... more ... CAREY-WOOD, J., DUKE, K., KARN, V. and MARSHALL, T. (1995) The Settlement of Refugees in Britain ... WESTERMEYER, J., VANG, TF and NEIDER, J. (1983) &amp;#x27;Refugees Who Do and Do Not Seek Psychiatric Care: An Analysis of Premigratory and Postmigratory Characteristics ...
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Papers by Fiona O'May