Fiona O'May

Providing web-based feedback and social norms information to reduce student alcohol intake: a multisite investigation.

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. Objective Our objective was to evaluate the effectiveness across 4 UK universities of a Web-based intervention for student alcohol use. Methods In total, 1112 participants took part. Participants were stratified by educational institution, gender, age group, year of study, and self-reported weekly consumption of alcohol and randomly assigned to either the control arm or to the immediate or delayed intervention arms. Intervention participants gained access to the intervention between weeks 1 to 7 or weeks 8 to 15, respectively. The intervention provided electronic personalized feedback and social norms information on drinking behavior accessed by logging on to a website. Participants registered interest by completing a brief screening questionnaire and were then asked to complete 4 further assessments across the 24 weeks of the study. Assessments included a retrospective weekly drinking diary, the Alcohol Use Disorders Identification Test (AUDIT), and a readiness-to-change algorithm. The outcome variable was the number of units of alcohol consumed in the last week. The effect of treatment arm and time on units consumed last week and average units consumed per drinking occasion were investigated using repeated measures multivariate analysis of covariance (MANCOVA). In addition, the data were modeled using a longitudinal regression with time points clustered within students. Results MANCOVA revealed a main effect of time on units of alcohol consumed over the last week. A longitudinal regression model showed an effect of assessment across time predicting that participants who completed at least 2 assessments reduced their drinking. The model predicted an additional effect of being assigned to an intervention arm, an effect that increased across time. Regression analysis predicted that being male or being assigned to an intervention arm increased the odds of not completing all assessments. The number of units of alcohol consumed over the last week at registration, age, university educational institution, and readiness to change were not predictive of completion. Conclusions Delivering an electronic personalized feedback intervention to students via the Internet can be effective in reducing weekly alcohol consumption. The effect does not appear to differ by educational institution. Our model suggested that monitoring alone is likely to reduce weekly consumption over 24 weeks but that consumption could be further reduced by providing access to a Web-based intervention. Further research is needed to understand the apparent therapeutic effect of monitoring and how this can be utilized to enhance the effectiveness of brief Web-based interventions.

Nursing Workforce Policy and the Economic Crisis: A Global Overview

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 Co-operation 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.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 Co-operation 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.

Social capital and sport events : spectator attitudinal change and the Homeless World Cup

Increasingly, the staging of sport events promoting a social cause has become commonplace. This study collects data from spectators at two consecutive Homeless World Cups (Melbourne 2008 and Milan 2009) – an event that seeks to raise awareness of the global issue of homelessness. This paper aims to advance the understanding of specific attitude changes in spectators and to identify how these can be activated towards behaviours to produce enduring social impacts for events. The role of social capital in attitudinal change is emphasized, specifically bridging capital that signifies the creation of relationships between disparate individuals. Quantitative analysis provides insight into spectator demographics and attendance patterns, and contributes to the understanding of spectator attitudes towards homelessness. Patterns and trends suggest demographic and attendance variables align with differing forms of attitudinal change, and further suggest a hierarchy of effects may be relevant to the findings and provide a valuable contribution to future research.

People seem confused about sensible drinking messages.

EDITOR—Eleven years after publication of guidelines on sensible drinking,1 the social repercussions from the abuse of alcohol remain worrying in the UK. Unit labelling of alcohol drink containers was introduced in 1998 on a voluntary basis. In 2004 the government encouraged manufacturers to add messages on sensible drinking.2 We investigated two interrelated aspects of public health education—recall of sensible drinking messages and awareness of drink labelling—among Scottish supermarket shoppers. The supermarket visited has pre-empted UK drink labelling innovations—since 2003 wine sourced from its own …

Is It My Job? Alcohol Brief Interventions: Knowledge and Attitudes among Future Health-care Professionals in Scotland

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.

Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity

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 socio-economic 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 out-patient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last weeks 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 = 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. Non-etheless, 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.

GPs' and clients' views of art therapy in an Edinburgh practice.

Art therapy, as a relative newcomer to the family of therapies, has not yet produced a large body of academic literature, particularly in the important areas of evaluation and outcome studies. A previous evaluation of art therapy in primary care carried out by Sowton (1997) included evaluation of patient / professional acceptability, and compliance. However, there was a high drop-out rate and effectiveness of therapy could not be gauged; reasons for referral varied widely, e.g. personality disorders, suicidal tendencies and alcohol abuse, as well as anxiety and depression. For those who stayed in therapy, acceptability was high.

The Topic of Alcohol within the Scottish Occupational Therapy Curricula

Introduction: Scotland has witnessed a large rise in all types of alcohol-related illnesses, and in alcohol-related deaths. Despite this escalating problem, previous research in Scotland has demonstrated that gaps exist in the knowledge base of graduate occupational therapists. This study therefore aimed to document the content of alcohol in Scottish occupational therapy curricula. Method: This study was conducted during 2010–11. A questionnaire was sent to the programme leader of all the Scottish Higher Education Institutes offering a BSc (Hons) degree in occupational therapy, and to the only Further Education College in Scotland offering a Higher National Certificate in occupational therapy. The response rate was 100%. Findings: There is a lack of cohesive approach to alcohol misuse education within the occupational therapy curricula delivered in Scotland. Key proposals of the Scottish Government targeting alcohol misuse are inadequately addressed. Conclusion: The topic of alcohol and alcohol misuse is taught to varying degrees within the curricula offered in Scotland and further emphasis needs to be placed on understanding alcohol misuse and associated potential interventions, irrespective of practice context.

The enigma of 'harmful' alcohol consumption: evidence from a mixed methods study involving female drinkers in Scotland

Background/aims: An appreciation of the drinking patterns of population subgroups may usefully inform tailored interventions. For this purpose, research has highlighted a need to better describe the drinking behaviour of UK women. This study aims to characterise the purchasing and consumption behaviour of female heavy, harmed, drinkers in contact with Scottish health services in two cities and to explore the factors that influence the link to harm. Methods: Mixed methods study involving cross-sectional survey questionnaires and one-to-one interviews (5). The questionnaires documented (1) demographic data (including derived deprivation score), last week’s (or ‘typical’ weekly) consumption (type, brand, volume, price, place of purchase), self-reported illnesses, and (2) Alcohol-Related Problem Questionnaire score. A total of 181 patients with serious health problems linked to alcohol were recruited within National Health Service (NHS) hospital clinics (in- and outpatient settings), in two Scottish cities during 2012. Results: Median consumption was 157.6 UK units for the recorded week, with almost exclusive purchase from ‘off-sale’ retail outlets. Preferred drinks were white cider, vodka and white wine. Increasing problems was positively associated with drinking more in the week, being younger and belonging to Glasgow. Conclusion: For Scottish women, the current definition of ‘harmful’ consumption likely captures a fourfold variation in alcohol intake, with gender differences less apparent. While current alcohol-related harm is positively associated with dose and being younger, there is clear evidence of an influence of the less tangible ‘Glasgow effect’. Future harm concerns are warranted by data relating to pattern, alcohol dose and cigarette use.

Nursing Workforce Policy and the Economic Crisis: A Global Overview: Nursing and the Economic Crisis

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 Co-operation 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.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 Co-operation 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.