First diagnosis of severe mental handicap: characteristics of unsatisfactory encounters between doctors and parents.

This paper presents data from a study of 190 parents and discusses their reactions to being told that their child was likely to be severely mentally handicapped. Dissatisfaction was related to the child's age when the parents were first told about the impairment, which was itself related to the diagnosis of the child's condition. Parents of children with non-specific handicap were often not informed about the impairment until the second or third year of the child's life, while parents of children with Down's Syndrome were usually informed within a week of birth. The paper compares these two groups of parents and discusses the reasons for their dissatisfaction. The study showed that parents valued early acknowledgement of the problem, a sympathetic approach on the part of medical professionals, and the sharing of information and uncertainty. The reasons why parents of mentally handicapped children may continue to feel dissatisfied are discussed in the light of the theoretical literature on doctor-patient communication.

KIE: Parents of 190 severely mentally handicapped children served by two health districts in southeast England were interviewed to determine their reactions on being told of their children's handicap. The degree of satisfaction was positively related to early disclosure, a sympathetic approach by health personnel, sharing of information, and acknowledgement of uncertainty in diagnosis and prognosis. Parents of children with Down's syndrome, which can be diagnosed early, were generally more satisfied than parents whose children had handicaps of unknown pathology. Parents who encountered evasion, denial, and delay were dissatisfied. The authors briefly describe several lines of research aimed at improving professional parent communication.

Inequalities in pregnancy outcome: a review of psychosocial and behavioural mediators.

The purpose of this paper is to review the literature on psychosocial factors in pregnancy outcome and to present a model which attempts to integrate the findings theoretically. There are four sections. The first presents published data on the incidence of early childhood mortality and low birth weight. Changes over time and differences between countries are noted and attention is drawn to the marked inequalities between occupational groups in the British data. The second section reviews the evidence that a variety of psychosocial risk factors influence pregnancy outcome, notably social, emotional, cognitive and behavioural factors. The third section develops the theme of inequalities and examines theories which have been advanced to account for the differences in adult mortality. We argue that material deprivation goes some way towards explaining inequalities in pregnancy outcome, but that any proper account will have to explain the links between inputs and outcomes--the processes and mechanisms by which material deprivation is translated into observable mortality and morbidity. In the concluding section, we argue that some of the principal links are the psychosocial risk factors described in the second section, and we present a model which traces the pathways of mediation.

Motorcycling safety research: a review of the social and behavioral literature.

The literature on motorcycling safety research is reviewed, and it is argued that there have been two main periods. The first, spanning the 1970's, was based on accident analysis, and the main objective was to identify and control factors that contribute to the severity of motorcycling accidents. The main concerns were to reduce head and brain injuries through safety helmets, to reduce multi-vehicle collisions through daytime use of headlamps, and to reduce drink-riding. The second period, the 1980's shifted the emphasis of research to what might be called 'riding analysis'--that is, analysis of the process of motorcycle riding. Particular attention was paid to skills testing, training evaluation and perceived risk. Now, in the early 1990's, a third period is developing, in which the rider is seen as 'active agent'. The theoretical basis of the new research has come from the models of social psychology, and the main concern is to use riders' beliefs and attitudes about safe riding to predict their behaviour on the roads and so their accident involvement. The three periods of research are reviewed in turn, and the paper concludes with an outline of the key research issues that remain to be addressed.

Age and experience in motorcycling safety.

Official casualty statistics show that young motorcyclists are more likely than older motorcyclists to be killed or seriously injured on the roads. We address two main issues: might the statistics be attributable to inexperience rather than youth; and might accidents be associated with particular patterns of behaviour which may themselves be predictable from riders' beliefs? From a national prospective survey of over 4000 riders in the U.K., the data showed that youth played a much greater role than inexperience, and that accidents were associated with a particular pattern of behaviour, namely a willingness to break the law and violate the rules of safe riding, which was predictable from the riders' beliefs measured 12 months earlier. The implications of the findings are discussed both for theory and for policy and practice, and particular emphasis is placed on suggestions for modifying training courses.

Workplace bullying in nurses.

The article reports a study of workplace bullying in community nurses in an NHS trust. The aims were to determine the prevalence of bullying, to examine the association between bullying and occupational health outcomes, and to investigate whether support at work could moderate the effects of bullying. Forty-four percent of nurses reported experiencing one or more types of bullying in the previous 12 months, compared to 35 percent of other staff. Fifty percent of nurses had witnessed the bullying of others. Nurses who had been bullied reported significantly lower levels of job satisfaction and significantly higher levels of anxiety, depression and propensity to leave. They were also more critical of aspects of the organizational climate of the trust. Support at work was able to protect nurses from some of the damaging effects of bullying.

Perceptions of risk in motorcyclists: unrealistic optimism, relative realism and predictions of behaviour.

In the first phase of a prospective investigation, a national sample of motorcyclists completed a postal questionnaire about their perceptions of risk, their behaviour on the roads and their history of accidents and spills. In the second phase a year later, they reported on their accident history and behaviour over the preceding 12 months. A total of 723 respondents completed both questionnaires. Four sets of findings are reported. First, the group as a whole showed unrealistic optimism: on average, respondents believed themselves to be less at risk than other motorcyclists of an accident needing hospital treatment in the next year. Second, optimism was tempered by 'relative realism', in that respondents who were young and inexperienced saw themselves as more at risk than other motorcyclists, as did riders who reported risky behaviours on the road. Third, there was some evidence of debiasing by personal history, in that having a friend or a relative who had been killed or injured on the roads was associated with perceptions of absolute risk of injury or death--though there were no effects on comparative risk and no effects on any of the judgments of a history of accidents of one's own. Finally, there was good evidence that perceptions of risk predicted subsequent behaviour, though generally in the direction not of precaution adoption but of precaution abandonment: the greater the perceived risk at time 1, the more frequent the risky behaviour at time 2. The implications of the findings are discussed, and possible interpretations are suggested.

Workplace bullying in NHS community trust: staff questionnaire survey.

OBJECTIVES: To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying. DESIGN: Questionnaire survey. SETTING: NHS community trust in the south east of England. SUBJECTS: Trust employees. MAIN OUTCOME MEASURES: Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job satisfaction scale, the support at work scale, and the propensity to leave scale. RESULTS: 1100 employees returned questionnaires-a response rate of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the victims of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2. 7) v 12.2 (2.3), P<0.001) and higher levels of job induced stress (mean 22.5 (SD 6.1) v 16.9 (5.8), P<0.001), depression (8% (33) v 1% (7), P<0.001), anxiety (30% (125) v 9% (60), P<0.001), and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P<0.001). Support at work seemed to protect people from some of the damaging effects of bullying. CONCLUSIONS: Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff.

Effects of stress in an NHS trust: a study.

This study of staff in an NHS trust tests two established models of occupational stress. Payne (1979) suggested that support at work can help to neutralise the strain of work demands, while Karasek (1979) suggested that staff whose jobs are characterised by high demands and low control are at greater risk of poor psychological wellbeing and ill health. Support is found for both models, and it is suggested that the two could usefully be combined.

Experience of workplace bullying behaviours in postgraduate hospital dentists: questionnaire survey.

OBJECTIVES: To determine the prevalence of bullying and experience of bullying behaviours among postgraduate hospital dentists. DESIGN: Questionnaire survey. SETTING: The study was conducted among a sample of dentally qualified trainees within the UK's Hospital Dental Service. SUBJECTS AND METHODS: Two hundred and twenty-seven postgraduate hospital dentists were sent an anonymous questionnaire by the dental deans of participating deaneries. MAIN OUTCOME MEASURES: Prevalence of bullying and prevalence of experience of bullying behaviours; differences in experience of bullying and bullying behaviours by gender and ethnic group. RESULTS: One hundred and thirty-six hospital dentists returned the questionnaire, a response rate of 60%. Thirty-four (25%) identified themselves as victims of bullying, and 63 (47%) had witnessed their colleagues being bullied. Irrespective of whether or not they labelled themselves as victims of bullying, in the previous year 82 (60%) dentists had experienced one or more of the bullying behaviours included in the checklist. Overall, there was no statistically significant difference in experience of bullying behaviours by gender or ethnic group though non-white participants were significantly more likely than white participants to have experienced four of the bullying behaviours. CONCLUSIONS: Rates of bullying and experience of bullying behaviours among postgraduate hospital dentists were consistent with those reported in other NHS settings.

Sleep problems in children with mental handicap.

This paper reports on a longitudinal study of sleep problems in 200 children with severe mental handicap. Sleep problems were extremely common: 51% of children had settling problems, 67% of children had waking problems, and 32% of parents said they rarely got enough sleep. Sleep problems were also very persistent: between a half and two-thirds of children who exhibited sleep problems at Time 1 still had them 3 years later. Sleep problems were associated with a number of child characteristics: poor communication skills, poor academic skills, poor self-help skills, incontinence, daytime behaviour problems and epilepsy. There were no relationships with family variables such as social class, income, family composition or housing tenure. However, maternal stress, maternal irritability and perceived impact on the family were related to sleep problems. A Sleep Index was constructed, and path analysis was used to trace the main causal pathways of the child, family and social characteristics. Ten variables explained 50% of the variance in the Sleep Problems Index. Communication skills played a pivotal role. The implications of the findings for intervention strategies are discussed.

Sleep problems in primary school children: comparison between mainstream and special school children.

This paper reports on a study of the prevalence and social correlates of dyssomnias, features associated with obstructive sleep apnoea, and parasomnias in primary school children aged 4-12. Head teachers of schools selected randomly from lists of local primary and special schools were contacted by telephone and asked to distribute a questionnaire package to the parents of all pupils aged 4-12 years. In all, 890 parents of children from mainstream schools and 300 from special schools were approached. The response rates were 64.7% and 60%, respectively. The results showed that significantly higher proportions of children in special schools than in mainstream schools presented four of the five dyssomnias investigated and all of the features associated with obstructive sleep apnoea. In contrast, only two of the seven parasomnias were presented by higher proportions of the children in special schools. Age and gender differences for the two groups of children are presented. Finally, multiple correlations were computed between a range of child, family, and environmental characteristics and the three problems most frequently reported: frequency of settling problems; sleeping in the parents' bed; and night waking. The findings are discussed with reference to other studies of children's sleep problems, and the implications for treatment are considered.

Behaviour problems in severely mentally handicapped children.

A population study was undertaken in two health districts of children with severe mental handicap. Prevalence figures for behaviour problems are presented. A stratified random sample of 200 families was drawn from the population. Detailed structured interviews were carried out with the children's parents. The children were divided into two groups, comprising those with behaviour problems and those with no problems. There was a significant association between behaviour disorder and incontinence, lack of self-help skills, poor reading, writing and counting skills, and poor communication skills. Environmental correlates were few. There were no differences between groups in family size, birth order, age of parents, marital discord, social class or income. However, behaviour problems were more common in one-parent families. An association was found between maternal stress and problem behaviour. The possible mechanisms underlying this association are discussed.

Patterns of take-up of the Family Fund, the characteristics of eligible non-claimants and the reasons for not claiming.

This paper examines application to the Family Fund by families with severely handicapped children and attempts to find out whether eligible families have basic knowledge of the fund, what motivates them to apply and why some eligible families do not apply. Five local registers are used to investigate levels of take-up and a Kent survey of families with severely subnormal children is used to examine the characteristics of non-claimants. The Kent survey is also used to investigate whether extra publicity promotes application and to identify reasons for non-take-up.

First diagnosis of severe handicap: a study of parental reactions.

This paper reports the results of interviews with 190 parents of severely mentally handicapped children. Questions were asked about parents' satisfaction with the way they were first informed of the child's impairment. Most parents were informed by a doctor, and almost two-thirds were dissatisfied with the first information given. Satisfaction was associated with being told early in the child's life. There was a significant association between the time of telling and the diagnostic condition of the child: parents of children with handicap of no known pathology were more likely to be told during or after the second year of the child's life, while parents of children with Down's syndrome were most likely to be told at birth. The authors discuss ways in which parents can be helped through this difficult time and suggest procedures for breaking the news to parents in a sensitive way.

First diagnosis of severe mental and physical disability: a study of doctor-parent communication.

This study investigates factors associated with satisfaction with medical communication at the time of diagnosis of a child's severe mental or physical disability. Two competing social psychological models that have been used to account for parent patient satisfaction are tested: Korsch's (1968) affective model and Ley's (1977) cognitive model. One hundred and sixty six mothers of children with severe learning disabilities were questioned about the time when their child's disability was first diagnosed. Measures included the child's age when diagnosis was made, the length of time parents had been anxious, and how satisfied they were with the way they were told the diagnosis. They were asked to rate the doctor's affective behaviour and their understanding and memory of the information they received. Fifty-eight per cent of parents reported dissatisfaction with the communication. Stepwise multiple regression analysis showed that Korsch's affective scale was much the strongest predictor, entering the equation first, and explaining 35.7% of the variance in satisfaction. Ley's cognitive scale entered second, explaining a further 1.4% of the variance. Further analysis including the other predictors found that six predictors explained 40% of the variance. The implications of the findings for the training of medical staff are discussed.

Long-stay hospital closure. Managing the staff.

The gradual closure of a long-stay hospital is stressful for staff. Some may have doubts about the case for community care, and almost all are affected by uncertainty and by the provisional step-by-step changes as patients gradually move out. The maintenance of staff morale during the transition is therefore important and difficult. This article examines some of the stresses and misunderstandings, and suggests how they could be managed.

Professional collaboration in services for mentally handicapped people.

There has been growing academic and practitioner interest in the problems of and opportunities for joint working in the care of mentally handicapped people. The paper outlines alternative methods of such joint working and tests these against survey and case study evidence. Attention is drawn to the danger that joint working may have little impact at patient level and the paper recommends an emphasis on the appointment of frontline key workers.

A questionnaire survey of stress and bullying in doctors undertaking research.

BACKGROUND: Research is an increasingly important aspect of higher medical training for many doctors. Studies investigating sources of stress, isolation, and workplace bullying have not previously sought information in this setting. METHODS: An internet based questionnaire survey of doctors undertaking research (n = 259) was conducted to examine stressors and levels of job satisfaction in this potentially vulnerable group. In order to assess overall levels of satisfaction, we asked whether doctors would recommend their research post to a colleague. RESULTS: There was a statistically significant association between those who would not recommend their post to a colleague and those who had difficulties in arranging funding and in writing up (p<0.001). Further significant correlations were found between dissatisfaction with the post and lack of help, support, and advice from supervisors and colleagues, wanting to change supervisors, experience of the major categories of workplace bullying, and having an inadequate clinical commitment (p<0.001). When the significant variables were entered into a multivariate analysis, the results showed that dissatisfaction was associated with wanting to change supervisors and with a threat to professional status. CONCLUSIONS: Stress and bullying are common in doctors undertaking research. These findings have important implications for medical training and for doctors choosing research projects. Setting up systems of support may have important benefits.