Young people with disabilities: what happens after 16?

Summary This article presents some findings from a recent postal survey of young adults aged 16–21 years with severe disabilities. The study was funded by the Department of Health and Social Security and is based on a sample of over 1,000 drawn from the register of families helped by the Family Fund. Information was collected on the usual weekday activities of the young people. Parents were asked whether they were satisfied with the way in which their son/daughter was occupied and about any changes or difficulties since he/she left school. The research indicates that: there is a considerable gap in access to paid employment for young people with disabilities compared with young people in general; there is substantial variation in the occupational experience of young adults with different types of impairment; and the transition from school to further education, training, employment, unemployment or day care can be difficult. Implications of these findings are discussed.     

Telemedicine. What happens in remote consultation.

The results of a field study of three sites that used video to link primary care medical centers to hospitals are reported. The analysis was concerned with identifying the people involved, the tasks carried out in collaboration at each end of the link, and how the different communications facilities helped or hindered. The results are summarized as six task characteristics and their design implications for this model of telemedical consultation are discussed.     

Resistance to sexual assault: who resists and what happens?

To determine who resists sexual assault and what happens, data were examined from a probability sample of 3,132 adult community residents of Los Angeles, California. Seventy-five per cent of the respondents reporting an assault (n = 365) indicated that they had attempted to resist their most recent assault; talking was the most frequently used resistance strategy. The strongest predictor to emerge in the multivariate analyses of resistance was timing of assault: respondents assaulted only in childhood were less likely to resist than either respondents assaulted only in adulthood, or respondents assaulted in both phases. Univariate analyses indicated that resistance reduced the probability of sexual contact, however multivariate analyses suggested that assailant use of force was the most important determinant of assault outcome.     

The end of suburbia: what happens when all the cheap oil is gone and what are the health implications?

In isolation, the depletion of the world's stocks of cheap oil is a risk management problem of global proportions. The risk would be manageable given an international agreement by all the developed nations to conserve much of the remaining cheap oil for essential purposes, but there is no such agreement nor is there any intent to create one. Evidence is presented to show that the synergetic interaction of oil depletion with other long‐standing environmental problems will result in world food production peaking and then declining at a rapid rate. Australian Census data for the journey to work and the growth of car ownership are analysed. It reveals that car/ oil dependency is growing in outer suburbia, where most Australians live and where future population growth will be housed. It is argued that oil dependency, if not reduced, will develop into a serious threat to national security in a few years. Health promotion professionals have an important role in activating local, State and Commonwealth governments to implement ‘travel smart’ programs.     

Acute Heart Care: what happens with patients who are not immediately hospitalized?

The clinical course of the first six weeks after discharge after consultation was studied in 527 patient contacts in 460 patients who were evaluated for acute cardiac symptoms in a six-month period at the acute cardiac care facility 'Eerste Harthulp' in the Academic Medical Centre. Analysis revealed that the initial diagnosis of acute ischaemia (261 cases) was correct in 118 (45%) and the initial diagnosis of arrhythmia (114 cases) in 92 (81%). In 220 patients there was no cardiac history; in those instances the initial diagnosis of acute ischaemia was confirmed in only 40% but the initial diagnosis of arrhythmia in 78%. Three patients died within six weeks after evaluation and 28 patients were admitted within that period. Patients without cardiac history and without a clear cardiac diagnosis consulted their general practitioner moderately frequently in the first six weeks and used specialist care only rarely.     

Guinea worm: an in-depth study of what happens to mothers, families and communities

This paper reports on the impact of maternal morbidity due to guinea worm, dracunculiasis, on the care and health of children under 24 months old, and the way in which the mothers and the family coped with the often extended periods of disability. This qualitative study is based on observation and in-depth interviewing, supplemented by focus group discussions. Of 42 mothers with guinea worm in two hyperendemic areas of Oyo and Kwara States, 28 were either bedridden or only able to hobble short distances with the help of a stick; the average period of incapacity was almost 9 weeks. Of the four maternal roles identified (child care, self care, domestic tasks, income generation), the women gave priority to child care; 34 of the 42 mothers needed help in child care. Coping networks operated principally within the extended family, but also included women in other households, and women from beyond the community. Thus the impact of a mother's illness extended beyond her children and family to the wider community. This qualitative study thus reveals the multifaceted impact of a disease on individuals and on the community. The study stresses the need for, and availability of, effective methods for controlling guinea worm by utilizing community cooperation to provide protected water sources and other preventive measures against the disease.     

Who tells and what happens: disclosure and health service responses to screening for intimate partner violence

Routine screening of women for intimate partner violence (IPV) has been introduced in many health settings to improve identification and responsiveness to hidden abuse. This cross‐sectional study aimed to understand more about how women use screening programmes to disclose and access information and services. It follows women screened in ten Australian health care settings, covering antenatal, drug and alcohol and mental health services. Two samples of women were surveyed between March 2007 and July 2008; those who reported abuse during screening 6 months previously (122) and those who did not report abuse at that time (241). Twenty‐three per cent (27/120) of women who reported abuse on screening were revealing this for the first time to any other person. Of those who screened negative, 14% (34/240) had experienced recent or current abuse, but chose not to disclose this when screened. The main reasons for not telling were: not considering the abuse serious enough, fear of the offender finding out and not feeling comfortable with the health worker. Just over half of both the positive and negative screened groups received written information about IPV and 35% of the positive group accessed further services. The findings highlight the fact that much abuse remains hidden and that active efforts are required to make it possible for women to talk about their experiences and seek help. Screening programmes, particularly those with established protocols for asking and referral, offer opportunities for women to disclose abuse and receive further intervention.     

Carriage and community treatment of methicillin-resistant Staphylococcus aureus: what happens to colonized patients after discharge?

During a maternity hospital outbreak of colonization/infection due to methicillin-resistant Staphylococcus aureus (MRSA), mothers and babies from 35 families were known to have been discharged colonized with MRSA. Thirty-two of these families were followed up by screening in the community. After 4 weeks, carriage was still detectable in 22 families. The ten families in which carriage was no longer detectable had MRSA isolated at discharge from enrichment culture only. All of the 11 families who had MRSA isolated on direct culture at discharge continued to carry MRSA. Mothers and babies from the 22 families still carrying MRSA at 4 weeks were offered topical treatment. Carriage persisted in ten of these families despite treatment. The most common site of persistent carriage was the perineum in mothers and the throat in infants.     

Intruders in the consultation

A confidential consultation is the essence of family practice.That confidentiality is currently under attack from a numberof disruptive influences. Several of these are physical intruders:telephone calls, undergraduate and postgraduate students, videorecorders, computers, guidelines, protocols and health promotionactivities. The potential benefits of each of these is analysedto elucidate why they have been allowed into consultations.Their drawbacks in the light of current published evidence ispresented. Conditions which make intrusions permissible areproposed and practical suggestions are made about how to minimisetheir impact.     

Using quantitative and qualitative data in health services research – what happens when mixed method findings conflict? [ISRCTN61522618]

Background  

In this methodological paper we document the interpretation of a mixed methods study and outline an approach to dealing with apparent discrepancies between qualitative and quantitative research data in a pilot study evaluating whether welfare rights advice has an impact on health and social outcomes among a population aged 60 and over.