8674073
Children, health and gender: recognition in nursing research?
AIM
This paper examines the hitherto mostly unrecognised relationship between gender, health and children; its significance for nursing practice and how it has been considered in nursing research.


BACKGROUND
Holistic nursing practice with children requires adequate assessment and consideration of all potential influences on children's lives. Socioeconomic disparities have received widespread attention and gender inequalities in adult health have been studied in some depth. The links between gender, health and children, however, have received little consideration. The paper first considers this context in depth; it then applies the context to research in practice.


DESIGN
Systematic review.


METHODS
A systematic literature search was undertaken on four mainstream nursing research journals over 38 months up to February 2007. A total of 567 articles met the key word searches. Duplicates, opinion pieces and articles not focusing on children were removed. The remaining 23 nursing studies relevant to child health were examined for their gender sensitivity.


RESULTS
Full consideration of gender issues was found largely to be absent in nursing research on children. Eight studies gave specific consideration to gender relevance, where boys and girls may have responded differently to care. Only six studies specifically addressed gender sensitivity. Allowing children a voice, however, was a strength in these studies, with 18 reflecting children's views directly.


CONCLUSIONS
Major gaps still exist in research and theorisation relating to children, health and gender. These need to be acknowledged and investigated, particularly in relation to how they might impact on nursing care.


RELEVANCE TO CLINICAL PRACTICE
Nursing practice and research needs to account for all potential health issues, of which gender may often be important.
18213491
The smacking controversy: what advice should we be giving parents?
BACKGROUND
Even among countries that have ratified the United Nations Convention on the Rights of the Child there is much disagreement about corporal punishment of children. Last year the Scottish Executive proposed a new law banning the smacking of children under the age of three, becoming the tenth European nation to do so. The proposal, currently abandoned whilst ostensibly still under debate, has raised a wave of controversy in child protection circles. In the nearest neighbouring country, England, a similar proposal was robustly rejected. PURPOSE OF THE PAPER: Given an increasing family and community focus in nursing, the implications of the debate for the profession cannot be ignored. What should we be telling 'ordinary' families about smacking? Thus this paper presents a positional statement on the smacking controversy and outlines some pointers for practice.


DISCUSSION
While for many the legislation proposed does not go far enough, others decry it as a breach of parental rights and, thus, the issue has become hugely controversial. Media opinion and various opposing campaigns dominate both public and professional spheres. Rights, responsibilities, examples from other countries, culture and gender are all used as fodder in the debate. Extreme examples are cited by both sides and used as grist for what are at times tenuous arguments. As there is even a division within child protection arenas, practising professionals may struggle to find a way through the maze of seemingly contradictory findings from research, policy and opinion.


CONCLUSIONS
A wide range of literature suggests that both public and professional opinion is divided on the use of smacking as a form of discipline of young children. Opinion is also divided on the ability of legislation to bring about change in social attitudes and behaviour. Health care professionals need to be in a position to recommend best practice and to do so consistently.
205326823
Practitioner assessments of 'good enough' parenting: factorial survey.
AIM
The aim of this study was to measure health visitors' professional judgements on 'good enough' parenting and identify what factors and combinations of these are important when making such judgements.


BACKGROUND
The relationship between parenting and child health is unclear. Whilst agreement exists that 'good enough' parenting requires boundary setting, consistency and putting the child's needs first, attempting to define 'good enough' parenting in precise terms is complex. When faced with a complex situation, practitioners rely on relatively few factors to form judgements.


DESIGN
Factorial survey methods were employed using vignette techniques.


METHODS
Vignettes were constructed using previous research on those variables, which may influence nurses' judgements, for example, accommodation and child dentition. The level of factors was randomly varied. Two thousand vignettes were administered to a sample of 200 health visitors in two Health Boards who then made a judgement about this scenario.


ANALYSIS
Data were analysed through multiple regression with dummy variables and one-way analysis of variance. Regression equations for both good enough mothering and good enough parenting are reported.


RESULTS
The models used are significant predictors of parenting and mothering. Significant predictors on health visitor judgements' were boundary setting in sleep behaviours, type of housing inhabited and health behaviours. Although parenting and mothering are often conflated, health visitors appear to separate these aspects when making judgements based on type of housing.


CONCLUSIONS
Most professionals can articulate what makes a 'good' parent, equally they may have strong views regarding what constitutes 'poor' parenting. The difficulty is in determining when parenting is 'good enough' to provide a child with a nurturing environment.


RELEVANCE TO CLINICAL PRACTICE
This study suggests that practitioners move their thresholds of what is 'good enough' depending on a narrow range of factors. Awareness of the factors, which influence individuals' judgements is important in safeguarding children.
36834793
Experiences of a feasibility study of children with albinism in Zimbabwe: a discussion paper.
BACKGROUND
Feasibility studies are often a helpful prelude to constructing fundable research proposals. Where the intended research is in a foreign country, focuses on a vulnerable population, and is aggravated by political and pragmatic challenges, feasibility studies become essential. Albinism, a genetic condition of reduced melanin synthesis, is a major public health issue in southern Africa. Whilst much is known about the health needs of children with albinism, little is understood about how to address these effectively in low income countries. Further, the child care and protection needs of children with albinism are largely unexplored. Zimbabwe's current political and economic climate presents additional challenges to research on the topic.


METHOD
The technical, economic, legal, collaborative, operational, schedule and political feasibilities (acronym TELCOSP) to undertaking a study on children with albinism in Zimbabwe were explored over a six week period of fieldwork in the country.


RESULTS
Using the TELSCOSP framework allowed a deconstruction of each challenge to provide innovative solutions. The economic and legal feasibility aspects presented some difficulties that will require flexibility and perseverance to overcome.


CONCLUSION
With the assistance of the local communities and people with albinism in Zimbabwe, the obstacles appear surmountable. The feasibility study provided a productive framework for addressing potential challenges in studying the needs of Zimbabwe's children living with albinism.
39760502
Commentary on Kong S and Bernstein K (2009) Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders Journal of Clinical Nursing 18, 1897-1907.
46164621
The rhetoric vs. the reality in child care and protection: ideology and practice in working with fathers.
Within child care and protection, practitioners can be paralysed by a fundamental gap between the rhetoric and the reality in engaging fathers in their children's care. In an earlier paper we argued that there is a lack of an effective framework to guide practice with fathers in child care and protection work. We examined how health visitors and social workers could begin to assess how fathers could be categorized as either (or both) a risk or an asset to the child. Based on a review of the literature we now explore the limitations of current models of practice and trace the theoretical strands that influence them, drawing from the legal framework, attachment theory and models for anti-oppressive practice. We then highlight messages for practice with fathers for health care professionals involved in child protection. The working context for this paper is Scotland, although we believe that the ideas may be extrapolated to other geographical areas.
33756647
Individual differences in electrodermal responsivity to predictable aversive stimuli and substance dependence.
To determine if the inability to take advantage of the predictability of an aversive stimulus to diminish its psychological impact reflects a deficit in inhibitory control related to the development of substance dependence, we recorded skin conductance responses (SCRs), heart rate (HR), and anticipatory electrodermal nonspecific fluctuations (NSFs) from 175 16-18-year-old boys when a white noise blast was either unpredictable or temporally predictable. Compared with boys who had moderately reduced or augmented SCRs to predictable blasts (moderate and poor modulators, respectively), boys whose SCRs were greatly reduced (good modulators) had fewer symptoms of alcohol and nicotine dependence and more anticipatory NSFs. HR appeared to index an active coping response for good and moderate modulators. The autonomic response pattern evident for good modulators may index an inhibitory control mechanism protecting them from developing substance dependence.
32584830
Genetic and Environmental Influences on Psychopathy Trait Dimensions in a Community Sample of Male Twins
Psychopathy appears to be comprised of two broad dimensions: impulsivity/antisocial behavior and interpersonal detachment/callousness. This study examined the extent to which variance in these 2 psychopathy trait dimensions was associated with common or unique genetic, shared, and nonshared environmental factors in two independent samples of reared together 16–18-year-old male twins. One sample included 142 monozygotic (MZ) and 70 dizygotic (DZ) pairs; the other sample included 128 MZ and 58 DZ pairs. Boys completed the Minnesota Temperament Inventory (MTI), a 19-item measure that contains separate subscales: Antisocial and Detachment. Variance in the Antisocial and Detachment scales was associated with additive genetic factors and neither scale was associated with shared environmental factors. As expected, the bivariate biometric analysis suggested genetic influence on the covariance of the scales. The results are consistent with theoretical models of psychopathy that posit some independence in the etiology of the two major trait dimensions of psychopathy.
41450335
Evidence-based rural general practice: barriers and solutions in South Australia.
INTRODUCTION
This paper reports on research to ascertain the views of general practitioners (GPs) practising in rural and remote areas of South Australia, on evidence-based medicine (EBM). It follows our previous paper that identified, through a literature search, the key issues in moving towards EBM in general practice in these areas1. The objective of the paper was to identify perceived barriers and potential solutions to evidence-based general practice in rural and remote South Australia.


METHODS
An interview survey was conducted in the year 2000 at 89 of 104 GPs' (86%) surgeries in three rural Divisions of General Practice in South Australia.


RESULTS
EBM was viewed positively by 85%, and 94% reported practising EBM. However, barriers to EBM were identified by 84% and four key themes were identified. GP-related barriers identified by 60% included difficulty finding, appraising and applying evidence and lack of time to read, reflect and update practice. Patient related barriers (23%) included an apparent conflict between some patients' expectations and evidence. Environmental barriers (43%) related to remoteness included high workload, limited information and poor resources for continued medical education. Resource related barriers included a lack of computer hardware and software and slow, unreliable and expensive Internet access (14%). Potential solutions were suggested by 82%. The most frequent was improved hardware, software and Internet access (41%). Only 19% suggested formal training for GPs, while 26% suggested improved clinical practice guidelines and 23% suggested non-Internet based dissemination of information including a service to provide evidence-based answers to clinical problems.


CONCLUSION
EBM was viewed positively by the surveyed GPs and many believed they already practised it. Most identified barriers to full and effective use of EBM but also suggested solutions.
28899577
Ribonucleic acid directed deoxyribonucleic acid synthesis by the purified deoxyribonucleic acid polymerase of Rous sarcoma virus. Characterization of the enzymatic product.
25074678
Towards evidence-based general practice in rural and remote Australia: an overview of key issues and a model for practice.
There is an extensive global move towards evidence-based practice intended to increase the quality and effectiveness of health care. However there are barriers and issues when rural general practitioners attempt to incorporate evidence-based medicine in their practice. Key issues affecting the uptake of evidence-based medicine by rural general practitioners include the gaps in the scientific evidence relevant to general practice, time limitations, and the cost of Internet access, geographical isolation from centres of evidence-based practice and limited training opportunities. General practitioner consultations may involve multiple, ill-defined problems and the patients' views about their treatment may conflict with an evidence-based treatment approach. Rural general practitioners may require additional supports to access information from research through Internet-based resources, accessible summaries of evidence or clinical practice guidelines. In addition a model to assist rural general practitioners use evidence-based medicine is suggested. This model may enable the clinical decision-making process to integrate clinical experience, patient preferences and an understanding of the rural context of practice with the best available evidence, to in turn produce best practice.