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Research indicates children's exposure to family violence results in long-term negative consequences, hindering social skill development and impacting on the ability to function as healthy, productive adults. Also, there exists a widely accepted theory, called the 'cycle of violence', which hypothesises that children who have experienced violence at the hands of their parents tend to grow up to become violent parents themselves. Some evidence for this theory has been found following research with groups of abusive parents and people who have committed crimes, This study explores the specific impacts of childhood exposure to family violence on the subsequent mothering of a group of women drawn from the general population. A qualitative approach using a methodology that combined feminist and narrative approaches was used. Nine women who have been exposed to family violence in childhood including physical, emotional/psychological, sexual abuse and witness to violence between parents participated in interviews which explored their experiences of mothering Each woman was interviewed twice to collect stories of childhood and of mothering experiences. These were analysed revealing that the women's mothering was affected by their childhood exposure to family violence in several ways, ranging from direct emotional impacts to indirect impacts of conceptualisations formed in the light of childhood experiences. This study adds to the existing knowledge of the long-term impacts of childhood exposure to family violence by focussing specifically on subsequent mothering. The findings encourage social work and health care personnel to appreciate that women exposed to family violence in childhood have specific issues with their mothering and there is a need to address these issues. It also challenges the weight given to the cycle of violence theory in intervention and prevention strategies in child abuse and family violence sectors

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-01, page: 0311. Adviser: Osama Mikhail. Includes bibliographical references.

The purpose of this study was to determine the extent to which nursing home organizational structure and cultural variables were related to the outcomes reported by the Health Care Finance Administration public use data set (HCFA-NHCD). A second purpose was to examine the effects of a new style of nursing home management called the Eden Alternative™ concept. A related purpose was to test the usefulness of the HCFA-NHCD in predicting the quality of care for residents in federally approved nursing homes. Secondary data analysis was conducted on the HCFA-NHCD, as published in December 2001. Descriptive statistics and measures of association were used to assess the degree of relationship between the organizational structure and culture variables and the eight clinical health indicators of the HCFA-NHCD. Multiple regression analyses were conducted to measure the impact of the organizational structure and culture variables on the quality of care for residents in federally approved nursing homes. When compared with previously collected statistics, these findings suggest that there is a nationwide trend towards smaller nursing homes; smaller Eden homes were associated with a higher level of individualized attention. Smaller Eden homes with council representation had better scores on a majority of the eight clinical health indicators when compared to their counterparts with no council representation. Council representation was inversely related to a nursing homes' reliance on RN and LPLVN services. However, a regression model assessing the impact of organizational structure and cultural variables on the quality of care for residents in federally approved nursing homes had very limited predictive power (R2=2.2%). The findings of this study suggest that quality improvements in the HCFA-NHCD are needed in order to better serve families.

Objective(s). An increasing demand exists for psychological interventions to increase recovery from depression and anxiety in people with long-term physical health conditions (LTCs). Guided self-help (GSH) may meet this need, however, there is limited evidence of GSH’s appropriateness for people with LTCs. Design. A mixed-methods study using qualitative interviews with people with stroke and Chronic Obstructive Pulmonary Disease (COPD), and a quantitative survey of professionals who support guided self-help, explored opinions about whether self-help is appropriate, and whether suggested adaptations varied across LTCs. Results. Opinions varied about the appropriateness of standard self-help and adaptations required. Illness beliefs may help explain differences between the two LTCs and individual interviewees. The majority of professionals surveyed felt competent supporting people with LTCs, and reported having access to appropriate self-help material. Conclusions. Recommendations for improving the appropriateness of contents of guided self-help for people with LTCs are provided. Supporting professionals need relevant knowledge and skills to integrate information about the LTC into the intervention, and offer flexible, personalised delivery to support participation.

BACKGROUND:Nephropathic cystinosis is an autosomal recessive disease resulting from intracellular accumulation of cystine leading to multiple organ failure.CASE REPORT:We describe the clinical course of a patient managed from the age of six until his death at the age of 33 years. He underwent multiple surgery, including two renal transplants, developed transplant renal artery stenosis that was managed medically, and progressive heart failure at the age of 33 years. His death from a ruptured pseudoaneurysm associated with a restrictive cardiomyopathy is noteworthy. A limited cardiac autopsy revealed the presence of cystine crystals in interstitial cardiac histiocytes and one myocardial cell, along with 1000-fold higher tissue cystine content of the left ventricular myocardium compared to patients without cystinosis, suggesting the possibility of direct cystine mediated metabolic injury.

Background: The role of community matron (CM) was introduced to provide a single point of access to patients living with co-morbid long-term conditions who had, or were at risk of, frequent emergency admissions to hospital. CMs utilised case management as a means of managing this growing population of patients with fragile health. Since its inception, many changes in service delivery have impacted on the role. Aim: The aim was to undertake a mixed methodology study of the factors that have affected embedding of the community matron role in 3 geographical areas. Methodology: A pragmatic mixed methods approach (QUAL quan) was utilised. Settings and participants: The studies were based in health services within 2 cities and a rural area in central England. Participants for the qualitative components of the study were purposefully sampled. The sample comprised professionals: community matrons (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). Quantitative data for 212 people with long-term conditions were derived from the anonymised Patients at Risk of Rehospitalisation database (PARR data) held by area 1. Methods: Qualitative data were collected from participants using semi-structured interviews and audio diaries. For the quantitative component using PARR, some patient journeys within area 1 were explored. In addition, a sample of patients who were case managed by a CM (n=106) were matched with a set of patients who were not (n=106) and the data was examined. Findings: Participants were largely positive about the role of CM. However, difficulties with role setup had led to numerous changes which affected how the role has embedded. Additionally, this impacted understanding of the role by health care professionals, and caused practical and emotional difficulties for some CMs as they perceived the role to be eroded. The quantitative findings showed that CMs did not make a significant difference to hospital bed days used by patients on their caseload. Evaluating the role and finding an effective means of showing the work undertaken by CMs, which is often invisible, proved difficult. Conclusion: Embedding of the CM role has been affected by numerous changes in service delivery. Invisibility of community nursing rather than autonomy of the community matron role seems to be a key factor in the challenges of embedding the role. The significance of these findings is that using a mixed method approach and Liaschenko and Fisher’s adapted model may help CMs to improve the visibility of their role, and so helping the role to be less prone to the challenges of service redesign.

This thesis follows the research portfolio format and is carried out in part fulfilment of the academic component of the Doctorate in Clinical Psychology at the University of Edinburgh. An abstract provides an overview of the entire portfolio thesis. Chapter One contains a systematic review of published research investigating the experience of living with incurable forms of haematological malignancy. Chapter Two is an empirical study exploring adults’ experiences of living with follicular lymphoma while being maintained under the ‘watch and wait’ protocol. Both chapters are prepared for submission to the European Journal of Cancer Care, and follow their author guidelines.

Despite a general consensus concerning the relevance of supply partnerships to agility, the literature reveals disagreements and contradictions regarding their characteristics and, in particular, their duration. This is, whether partnerships in an agile strategy should be long-term (strategic partnerships) or short-term (agile partnerships). The research joins this debate by investigating the types and characteristics of supply partnerships to achieve agility. The underlying premise of the work is that the type of supply partnership is contingent on the degree of turbulence an agile strategy is designed to face. The research was carried out in the fashion industry, given the relevance of agility in this industry. Specifically, the research focused the supply partnerships developed by the footwear companies in the Macerata-Fermo district, the largest footwear district in Italy. The focus on district companies allow the comparison of several companies sharing a very similar business context, allowing a better control of external variables and increasing the internal validity of the study. The field research consisted of a preliminary survey on agility drivers and agile capabilities in the Macerata-Fermo footwear district, followed by an in-depth investigation on supply partnerships using multiple embedded cases studies. Overall six medium-large footwear companies have been analysed in their supply relationships with respect to five key supply categories. For each supply category, the buyer view of the focal firms has been complemented with a view from the supplier side. In total the fieldwork is built upon 30 interviews with 22 informants from 18 companies for a total of more than 23 hours of interviews. In all cases, except two, the key informant was owner, CEO or general manager of the company, eventually supported by another company manager. In two cases, the interviews data have been strengthened by a longitudinal analysis of purchase orders over eight years. The fieldwork highlights that agility drivers and agile capabilities impact on the footwear companies’ decision of developing agile supply partnerships. Specifically footwear companies that are under the pressure of high-turbulence agility drivers (here represented by a high collection renewal rate) and that have developed strong agile capabilities (here represented by a local supply network and a purchase orders postponement) choose agile supply partnerships with respect to supply categories that are sensitive to the fashion trends and therefore difficult to be sourced in a stable way – season after season – from the same suppliers. The main contribution to theory is related to the characteristics of supply partnerships in an agile strategy and specifically to the apparent paradox of “high-involvement & short- term” relationships (i.e. agile supply partnerships). In spite of the presence of time compression diseconomies in building up partnership and of the loss of relational (non- redeployable) benefits in closing down partnerships, scenarios of high-turbulence can give companies an incentive to look for short-term partnerships. Such finding can support a wider claim that different levels of turbulence call for different agility strategies requiring different capabilities and practices. The main contribution to practice is related to the way agile partnerships are selected, started and ended. Given that many industries are facing an increase in market turbulence, it appears that many companies – even outside the fashion industry – might have to learn how to balance high-involvement supply relationships with respect to a shorter time horizon.