There is no health without Cultural Safety: why Cultural Safety matters.

Background: Nurses and midwives predominately work in western-centric health care settings, which may not align with Indigenous perspectives of health and wellbeing. Nurses and midwives will also view care through their own cultural lens. Culturally inappropriate health care can reduce access and engagement in services and contribute to reduced health outcomes for Indigenous peoples. Australian codes of conduct for nurses and midwives now advocate for care that is holistic, free of bias and racism, challenges beliefs based on assumption, and is culturally safe for Indigenous peoples. However, there are varying understandings of cultural care, what it looks like, and how to best achieve it.Aim: To highlight the importance of cultural safety in health care and discuss the integration into nursing and midwifery practice.Design: Discussion paper.Discussion: Cultural safety has emerged in Australia as the framework to improve the access and quality of health care for Indigenous people and to improve disparities in health care outcomes. However, the application of these principles for nurses and midwives has not been widely explored. Misconceptions around the concept remain despite the inclusion in national standards and practice frameworks.Conclusion: Evaluation and research that contributes to evidence-based knowledge specifically on the integration of cultural safety in nursing and midwifery practice is required.Impact Statement: This paper provides an overview of the importance of cultural safety in nursing and midwifery practice. Although cultural safety is now embedded in professional codes and standards, there is limited evidence of how this is translated to clinical care. Research and evaluation are needed to evaluate the application of cultural safety principles by nurses and midwives.

Absence of bacterial resistance to medical-grade manuka honey.

Clinical use of honey in the topical treatment of wounds has increased in Europe and North America since licensed wound care products became available in 2004 and 2007, respectively. Honey-resistant bacteria have not been isolated from wounds, but there is a need to investigate whether honey has the potential to select for honey resistance. Two cultures of bacteria from reference collections (Staphylococcus aureus NCTC 10017 and Pseudomonas aeruginosa ATCC 27853) and four cultures isolated from wounds (Escherichia coli, methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa and S. epidermidis) were exposed to sub-lethal concentrations of manuka honey in continuous and stepwise training experiments to determine whether the susceptibility to honey diminished. Reduced susceptibilities to manuka honey in the test organisms during long-term stepwise resistance training were found, but these changes were not permanent and honey-resistant mutants were not detected. The risk of bacteria acquiring resistance to honey will be low if high concentrations are maintained clinically.

Increasing prevalence of asthma diagnosis and symptoms in children is confined to mild symptoms.

BACKGROUND: The prevalence of childhood asthma is increasing but few studies have investigated trends in asthma severity. We investigated trends in asthma diagnosis and symptom morbidity between an eight year time period in a paired prevalence study. METHODS: All children in one single school year aged 8-9 years in the city of Sheffield were given a parent respondent questionnaire in 1991 and 1999 based on questions from the International Survey of Asthma and Allergy in Children (ISAAC). Data were obtained regarding the prevalence of asthma and wheeze and current (12 month) prevalences of wheeze attacks, speech limiting wheeze, nocturnal cough and wheeze, and exertional symptoms. RESULTS: The response rates in 1991 and 1999 were 4580/5321 (85.3%) and 5011/6021 (83.2%), respectively. There were significant increases between the two surveys in the prevalence of asthma ever (19.9% v 29.7%, mean difference 11.9%, 95% confidence interval (CI) 10.16 to 13.57, p<0.001), current asthma (10.3% v 13.0%, mean difference 2.7%, 95% CI 1.44 to 4.03, p<0.001), wheeze ever (30.3% v 35.8%, mean difference 5.7%, 95% CI 3.76 to 7.56, p<0.001), wheeze in the previous 12 months (17.0% v 19.4%, mean difference 2.5, 95% CI 0.95 to 4.07, p<0.01), and reporting of medication use (16.9% v 20%, mean difference 3.0%, 95% CI 1.46 to 4.62, p<0.001). There were also significant increases in reported hayfever and eczema diagnoses. CONCLUSIONS: Diagnostic labelling of asthma and lifetime prevalence of wheeze has increased. The current 12 month point prevalence of wheeze has increased but this is confined to occasional symptoms. The increased medication rate may be responsible for the static prevalence of severe asthma symptoms. The significant proportion of children receiving medication but reporting no asthma symptoms identified from our 1999 survey suggests that some children are being inappropriately treated or overtreated.

External and internal tags for the green sea urchin.

Two internal and three external tags were tested on the green sea urchin. Desirable qualities of a tag were high sea urchin survival, retention for at least a few months, detection on the sea floor by divers, identification of individuals, quick application, and low cost. These objectives were met by an external nylon screw tag visible to divers and two internal aluminum tags detectable with an underwater metal detector. Successful tags were inserted through a hole drilled in the test and were tested in the laboratory and field. All internal tags were retained for the full duration of the 4-month trial and did not retard growth or affect survival. Divers could identify individual urchins with nylon screw tags, but the tag retention rate was lower.

Wheelchair propulsion: descriptive comparison of hemiplegic and two-hand patterns during selected activities.

Most manual wheelchair users with hemiplegia use both the unaffected arm and leg to propel their wheelchairs. The objective of this study was to compare the wheelchair propulsion of subjects using the hemiplegic pattern (one arm and one leg) with subjects using two hands. In a case-controlled study in a kinesiologic laboratory, nine wheelchair users who used the hemiplegic pattern were compared with nine matched controls who used the two-handed pattern. Participants were tested for propelling and stopping the wheelchair, forward and backward, on a level surface and on a 5 degree incline. Video recording was used to assess deviation from the midline, foot slippage, the number of propulsive cycles, and the propelling velocity. Also, on the 5 degree incline, we noted the need for support when unlocking the wheel locks, instances of grabbing the side rail, or rollback between propulsions. The participants using the hemiplegic pattern when propelling up the incline deviated more to the hemiparetic side (P < 0.05), used more propulsive cycles per unit of distance (P < 0.01), were slower (P < 0.001), and used the side rail more often (P < 0.05). When propelling forward on level ground, the participants using the hemiplegic pattern were slower (P < 0.005). When stopping after moving backward down the incline, they were more likely to deviate to the unaffected side (P < 0.01). In conclusion, wheelchair users who use the hemiplegic pattern experience more difficulties than those using two hands, some of which may be amenable to improvements in wheelchair prescription and training.

Proximal tibiofibular subluxation relationship to lateral knee pain: a review of proximal tibiofibular joint pathologies.

Proximal tibiofibular subluxation is the symptomatic hypermobility of the proximal tibiofibular joint. Pain along the lateral aspect of the knee must be carefully evaluated as the anatomy and biomechanics of this region are very complex. Anatomical variants of the proximal tibiofibular joint may be key to understanding the pathomechanics and, thus, treatment of this joint. The "horizontal" proximal tibiofibular joint has a higher degree of mobility, while the "oblique" joint is relatively immobile to rotational forces on the fibula. Increased fibular external rotation will result in injury to the anterior capsule and ligaments of the proximal tibiofibular joint causing common complaints of "popping" and lateral knee pain. Treatment of proximal tibiofibular subluxation will involve modifications of a patient's activity level and training programs, utilization of a supportive strap, lower leg strengthening, and modifications in the lower kinetic chain biomechanics.

Diagnosis, treatment, and rehabilitation of injuries to the lower leg and foot.

The article provides an overview of specific lower-extremity and foot injuries. The areas of concentration are sinus tarsi syndrome, tendon injuries, stress fractures, ankle sprains, and plantar fascitis. Diagnosis, treatment, and rehabilitation techniques have been discussed for each injury. The authors have also included biomechanical treatment modalities using orthotics for rehabilitation of these injuries.

Gonadotrophin, total oestrogen and progesterone concentrations in plasma of lactating sows with particular reference to lactational oestrus.

Plasma concentrations of LH, FSH, progesterone and total oestrogens were determined (by radioimmunoassay) throughout late pregnancy and lactation in samples taken by cardiac catheter from 10 Camborough hybrid sows. At 2-3 weeks post partum, 5 were housed individually with their litters (Group I) and 5 grouped with their litters, a boar being introduced 1 day later (Group II). Plasma progesterone fell 1-2 days per partum and oestrogens at parturition, each remaining low in early lactation. Plasma LH was undetectable in most samples in this period, but FSH fell slightly during parturition, showing signs of resurgence from Day 10 post partum. Group I sows remained in lactational anoestrus until weaning. In Group II there was increased plasma LH activity, and all Group II sows displayed oestrus during lactation. Only one farrowed to service at the lactational oestrus; of the remainder, oestrus in one was clearly anovulatory, and in two others was incomplete or atypical judged by plasma progesterone concentrations. The data suggest that whilst oestrus can be induced by appropriate lactation management, poor conception rates to service at this oestrus may be due to the absence or impairment of ovulation.