Reduced street lighting at night and health: A rapid appraisal of public views in England and Wales

Financial and carbon reduction incentives have prompted many local authorities to reduce street lighting at night. Debate on the public health implications has centred on road accidents, fear of crime and putative health gains from reduced exposure to artificial light. However, little is known about public views of the relationship between reduced street lighting and health. We undertook a rapid appraisal in eight areas of England and Wales using ethnographic data, a household survey and documentary sources. Public concern focused on road safety, fear of crime, mobility and seeing the night sky but, for the majority in areas with interventions, reductions went unnoticed. However, more private concerns tapped into deep-seated anxieties about darkness, modernity ‘going backwards’, and local governance. Pathways linking lighting reductions and health are mediated by place, expectations of how localities should be lit, and trust in local authorities to act in the best interests of local communities.     

Everyday use of assistive technology devices in school settings

Purpose: To gain more knowledge about ATDs as social–cultural objects in school settings, particularly from the children’s perspective. Methods: Nine children with cerebral palsy, aged five to six years, were observed 3?days in kindergarten and twice in the first year at primary school. At the primary school, we interviewed the children. During the interviews, the children were shown photos taken during the observations. In addition, dialogues with parents, therapists and school staff were carried out. Results and discussions: ATDs seem to have the potential both to exacerbate disability and to enhance selfhood, embodied capacities and participation. Through use, ATDs become social objects with symbolic values that influence their use. Devices corporally embedded into the child’s body schema appeared as facilitators for participation in culturally valued activities. In contrast, devices prescribed as medical interventions tended to be greeted with ambivalence by the children themselves, their parents and school staff. A device incorporated into one situation was not necessarily relevant for use in another. Conclusions: In recognizing the value of exploring children’s experiences, professionals are left with the challenge of creating space for children to reflect on the worthiness of an ATD across place, time and functionality.

• Implications for Rehabilitation

• Used in everyday life, ATDs become social objects with potential both to exacerbate disability and to enhance selfhood, embodied capacities and participation.

• The child’s everyday environment is a vulnerable setting for implementing rehabilitation interventions, such as ATDs.

• Creating space for children to reflect on the worthiness of an ATD, regarding place, time and functionality, may enhance their participation in everyday life.

     

Current Issues in Undergraduate Psychiatry Education: The Findings of a Qualitative Study

Background  Recruitment into psychiatry is correlated with the quality of undergraduate medical school teaching programmes and with a commitment of major resources to teaching students. There is an extensive literature related to attitudes towards psychiatry but less on the learning and teaching of psychiatry. Aims  To identify the current issues in undergraduate psychiatric education in the UK for lead teachers at UK medical schools. Method  Semi-structured telephone interviews with psychiatric leads at UK medical schools. A total of 26 participants were interviewed from 23 different medical schools. Results  Three key areas of problems were identified: issues related to teaching personnel (e.g. conflict of time), teaching resources and impact of teaching on recruitment (e.g. role models; stigma). Eight potential solutions to address the problems were identified and these included improving the quality of teaching, improving the perceived value of the discipline and recruiting teachers. Conclusion  There are several problems facing teachers in psychiatry but the teachers are also able to identify solutions which need support from both education and health if they are to be implemented. Nisha Dogra, BM DCH MRCPsych MA PhD is Senior lecturer and honorary consultant in child and adolescent psychiatry at the University of Leicester. She was involved in the design and supervision, data analysis for the study and drafted the paper. Ruth Edwards, BSc is a research associate at the University of Leicester. She was involved in the design of the project, carrying out the interviews, data analysis and reviewing the final version of the paper. Khalid Karim, MB ChB BSc MRCPsych is Senior Lecturer and honorary consultant in child and adolescent psychiatry at the University of Leicester. He was involved in the design of the study and reviewing the final draft. Susan Cavendish, Cert Ed., BSc, PhD is Head of the Medical Education Research Division of the Leicestershire, Northamptonshire and Rutland Healthcare Workforce Deanery. She was involved in the writing of the paper.     

Pharmacist prescribing in primary care: the views of patients across Great Britain who had experienced the service

OBJECTIVE To evaluate the views of patients across primary care settings in Great Britain who had experienced pharmacist prescribing. METHODS All Royal Pharmaceutical Society of Great Britain (RPSGB) prescribers (n = 1622) were invited to participate. Those consenting were asked to invite up to five consecutive patients who had experienced their prescribing to participate. Patients were mailed one questionnaire and a reminder. The questionnaire included five sections: demographics; you and your pharmacist prescriber; you and your general practitioner; your views and experiences based on your most recent pharmacist prescriber consultation; and additional views. KEY FINDINGS Of the 482 (29.7%) pharmacists who responded, 92 (19.1%) were eligible to participate, of whom 49 (53.3%) consented. Of those excluded, 193 (49.5%) were prescribing in secondary care and 171 (43.8%) were not prescribing. Between September 2009 and March 2010, 143 patients were recruited. Patient response rate was 73.4% (n = 105/143). Consultation settings were largely general practice (85.7%) or community pharmacy (11.4%). Attitudes were overwhelmingly positive with the vast majority agreeing/strongly agreeing that they were totally satisfied with their consultation and confident that their pharmacist prescribed as safely as their general practitioner (GP). Pharmacists were considered approachable and thorough, and most would recommend consulting a pharmacist prescriber. A slightly smaller majority would prefer to consult their GP if they thought their condition was getting worse and a small minority felt that there had been insufficient privacy and time for all their queries to be answered. CONCLUSIONS Patients were satisfied with, and confident in the skills of, pharmacist prescribers. However, the sample was small, may be biased and the findings lack generalisability.     

Referral and attendance at a specialist antenatal clinic: qualitative study of women's views

OBJECTIVE: To explore women's views on being referred to and attending a specialist antenatal hypertension clinic. DESIGN: Qualitative interview study. SETTING: A pregnancy hypertension clinic in a large teaching hospital in the East Midlands. POPULATION: Twenty-one women (aged 18 years and above) attending the pregnancy hypertension clinic for the first time during their current pregnancy. METHODS: Women who had been referred to and attended a specialist antenatal clinic participated in semi-structured interviews. Data analysis was based on the constant comparative method. MAIN OUTCOME MEASURES: Women's experiences and perceptions of being referred to and attending a specialist antenatal clinic. RESULTS: Being referred to the clinic conferred an 'at risk' status on women. Some women welcomed the referral but others experienced it as unsettling. Many were unclear about why they had been identified as being at risk or had difficulties in accepting the legitimacy of the reason for referral. Women were often inadequately informed about why they were referred to the clinic, what they could expect and the benefits of attending the clinic over management in the community. Although attendance at the clinic was cited as a source of reassurance, the reassurance was often made necessary by concern raised by the initial referral. CONCLUSIONS: Women's accounts suggest that the interface between community and secondary antenatal services needs improvement to minimise possible adverse effects from identifying women as being 'at risk' during pregnancy.     

Late termination of pregnancy: law, policy and decision making in four English fetal medicine units:

OBJECTIVE: UK abortion law allows terminations for fetal abnormality without gestational limit. This study aimed to understand the decision-making experiences of fetal medicine professionals working within this legal framework. DESIGN: Qualitative study using semistructured interviews. SETTING: Four English fetal medicine units. SAMPLE: Fifteen doctors and midwives working in fetal medicine units and the Director of a related voluntary sector group. METHODS: Thematic analysis of transcribed interviews. MAIN OUTCOME MEASURES: Attitudes to abortion legislation; how decisions are made about the offer of late abortion and feticide. RESULTS: Fetal medicine specialists acknowledged the difficulties of ensuring that they worked within the law and within their own ethical frameworks when making decisions about offering terminations after viability. Practice regarding which abnormalities meet the legal criteria appeared to be governed largely by consensus between colleagues within their own and other units and in discussion with other specialists. Study participants reported individual differences about abnormalities where they personally would not wish to be involved in a termination, and also noted a shift in general attitudes over time as to conditions that meet the legal criteria. A proscribed list was believed to be both unworkable, given the variability in diagnoses and unhelpful, leading to reduced patient care. CONCLUSIONS: Research is needed to monitor attitudes to, and interpretation of, UK abortion legislation, which permits termination after a late diagnosis of fetal abnormality without gestational limit. If attitudes are changing, it is important to understand why, and what the consequences will be for parents and for health professionals.