Abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe health facilities.

BACKGROUND: Antenatal care utilization is fundamental in preventing adverse pregnancy and birth outcomes. This paper assessed abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe districts of Zambia. METHODS: The assessment used a cross-sectional study design with a sample size of 505 women of child bearing age (15-49). Eighteen (18) high volume health facilities were identified as benchmarks for catchment areas (study sites) and using cluster sampling, households within catchment areas of health facilities were sampled. Chi-square and poison regression analysis was performed to ascertain associations between abuse and disrespect and antenatal care utilization. RESULTS: One third (33%) of the participants attended less than half of the recommended antenatal visits. Results reveal a statistical significant association between; physical abuse (p value = 0.039); not being allowed to assume position of choice during examination (p value = 0.021); not having privacy during examination (p value = 0.006) and antenatal care service utilization. The difference in the logs of expected count on the number of antenatal care visits is expected to be; 0.066 (CI: -0.115,-0.018) unit lower for women who experienced lack of privacy during examinations; 0.067 (CI: -0.131,-0.004) unit lower for women who were discriminated based on specific attributes and 0.067 (CI: -0.120,-0.014) unit lower for women who were left unattended. CONCLUSION: Abuse and disrespect during antenatal care service impedes demand for health care and service utilization thereby barricading the element of the package of services aimed at improving maternal and newborn health.

About the inconvenience of handling mixed-breed herds; aspects of social behavior as a potential source of stress and economic losses.

The objective of this study was to assess aspects of the social behavior of a mixed-breed herd of beef cows as a potential source for stress and economic losses. Angus (AN; N = 10), Brahman (BR; N = 10), and Senepol (SE; N = 10) cows were assigned to two groups (N = 15 each containing equal breed numbers) on separate pastures. Agonistic interactions (win/loss) during feeding were recorded daily for 45 days. Dominance values were estimated as the proportion of individuals dominated to total herdmates. From this, individuals were placed into social categories based upon linear ranking as follows: dominants (D), intermediate (I), and subordinates (S). Breed influenced (P < 0.01) social category, with SE cows being dominants (P < 0.05) over AN and BR cows. Interactions between AN and BR cows were less (P < 0.0005) than interactions between AN and SE (53 vs 140, respectively). Within breeds, BR (152) and SE (182) cows had more (P < 0.0005) agonistic interactions than AN (107) cows. Although apparently influenced by breed, agonistic interactions occurred more frequently (P < 0.005) between social categories than within social categories (814 vs 310, respectively). Dominant cows were involved in more agonistic interactions with cows from different social categories than were intermediate and subordinate cows (P < 0.0005). However, intermediate (100) and subordinate (157) cows generated more (P < 0.0005) agonistic interactions within their own social category than dominant cows (53). It was concluded that, in mixed-breed herds, breed influences both social organization and agonistic interactions which could be considered as potential sources of stress and economic losses.

What determines the duration of war? Insights from assessment strategies in animal contests.

Interstate wars and animal contests both involve disputed resources, restraint and giving up decisions. In both cases it seems illogical for the weaker side to persist in the conflict if it will eventually lose. In the case of animal contests analyses of the links between opponent power and contest duration have provided insights into what sources of information are available to fighting animals. I outline the theory of information use during animal contests and describe a statistical framework that has been used to distinguish between two strategies that individuals use to decide whether to persist or quit. I then apply this framework to the analysis of interstate wars. War duration increases with the power of winners and losers. These patterns provide no support for the idea that wars are settled on the basis of mutual assessment of capabilities but indicate that settlement is based on attrition. In contrast to most animal contests, war duration is as closely linked to the power of the winning side as to that of the losing side. Overall, this analysis highlights a number of similarities between animal contests and interstate war, indicating that both could be investigated using similar conceptual frameworks.

Exposure to life adversity in high school and later work participation: a longitudinal population-based study.

This paper investigates whether exposure to violence, sexual abuse, or bullying is associated with later work participation and whether high school completion has a potential mediating role. Self-reported junior high school questionnaire data were linked for eight consecutive years to prospective registry data for the demographics, educational progress, employment activity, and social benefits of 11,874 individuals. Ordinal regression analysis showed that violence and/or bullying at 15 years of age predicted negative work participation outcomes eight years later, independent of high school completion and other relevant factors. Although increasing educational level may have some preventive effect, these results indicate that prevention efforts should be initiated at an early age and should target adverse life experiences.

The price of incivility.

We've all heard of (or experienced) the "boss from hell." But that's just one form that incivility in the workplace can take. Rudeness on the job is surprisingly common, and it's on the rise. Whether it involves overt bullying or subtle acts of thoughtlessness, incivility takes a toll. It erodes productivity, chips away at morale, leads employees to quit, and damages customer relationships. Dealing with its aftermath can soak up weeks of managerial attention and time. Over the past 14 years the authors have conducted interviews with and collected data from more than 14,000 people throughout the United States and Canada in order to track the prevalence, types, causes, costs, and cures of incivility at work. They suggest several steps leaders can take to counter rudeness. Managers should start with themselves-monitoring their own behavior, asking for feedback on it, and making sure that their actions are a model for others. When it comes to managing the organization, leaders should hire with civility in mind, teach it on the job, create group norms, reward good behavior, and penalize bad behavior. Lest consistent civility seem an extravagance, the authors caution that just one habitually offensive employee critically positioned in an organization can cost millions in Lost employees, lost customers, and lost productivity.

Disruptive or dangerous patients (sample policy and procedure).

UNLABELLED: This sample policy and procedure assumes there is a practice compliance officer and compliance committee. However, in some offices the manager or the physician will be the de facto "compliance officer". Therefore, it is assumed that duties and responsibilities in the sample policy will be assigned to meet the needs of the practice. DISCLAIMER: This information is intended solely to provide risk management recommendations. It is not intended to constitute legal advice and should not be relied upon as a source for legal advice. If legal advice is desired or needed, an attorney should be consulted.

Brief report: impact of applied behaviour analysis (ABA) on carer burden and community participation in challenging behaviour: results from a randomised controlled trial.

BACKGROUND: Applied behaviour analysis (ABA) reduces challenging behaviour in people with intellectual disability. There is interest, however, in whether such interventions reduce carer burden and increase community participation in this group. METHODS: A 6-month randomised controlled trial was followed by a longer-term naturalistic follow-up of participants. We studied the impact of the challenging behaviour on the carers and on the daily activities of the participants measured by the Carer Uplift and Burden Scale and Guernsey Community Participation and Leisure Assessment respectively. RESULTS: Both community participation and carer burden improved at 6 and 24 months. Burden showed significant reduction in family carers compared with paid carers. There was no significant intervention effect on the variables under consideration. CONCLUSIONS: ABA appears to be no more effective than standard care in improving social outcomes in people with intellectual disabilities and challenging behaviour but this requires further examination in a larger trial.

Systems approach to address incivility and disruptive behaviors in health-care organizations.

In response to the growing evidence that disruptive behaviors within health-care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health-care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model--Toxic Organization Change System--that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.

Risk assessment as an evolved threat detection and analysis process.

Risk assessment is a pattern of activities involved in detection and analysis of threat stimuli and the situations in which the threat is encountered. It is a core process in the choice of specific defenses, such as flight, freezing, defensive threat and defensive attack, that counter the threat and minimize the danger it poses. This highly adaptive process takes into account important characteristics, such as type and location (including distance from the subject) of the threat, as well as those (e.g. presence of an escape route or hiding place) of the situation, combining them to predict which specific defense is optimal with that particular combination of threat and situation. Risk assessment is particularly associated with ambiguity either of the threat stimulus or of the outcome of available defensive behaviors. It is also crucial in determining that threat is no longer present, permitting a return to normal, nondefensive behavior. Although risk assessment has been described in detail in rodents, it is also a feature of human defensive behavior, particularly in association with ambiguity. Rumination may be a specifically human form of risk assessment, more often expressed by women, and highly associated with anxiety. Risk assessment behaviors respond to drugs effective against generalized anxiety disorder; however, flight, a dominant specific defense in many common situations, shows a pharmacological response profile closer to that of panic disorder. Risk assessment and flight also appear to show some consistent differences in terms of brain regional activation patterns, suggesting a potential biological differentiation of anxiety and fear/panic systems. An especially intriguing possibility is that mirror neurons may respond to some of the same types of situational differences that are analyzed during risk assessment, suggesting an additional functional role for these neurons.

There is more than the amygdala: potential threat assessment in the cingulate cortex.

Fear conditioning with its neurological basis in the amygdala and associated structures provides an important model of anxiety disorders. However, this review will argue for a distinction between fear-provoking immediate and anxiety-provoking potential threats, with the amygdala processing immediate threats and the cingulate cortex (and insular) processing potential threats. Four independent but related literatures are reviewed to bolster this argument: (1) rodent remote contextual fear conditioning, (2) symptom provocation in obsessive compulsive disorder (OCD), (3) fMRI investigations of risk assessment, and (4) behavioural and neurological studies of precautionary reasoning. These four literatures converge in suggesting that the cingulate cortex (and in more specific instances the insula) underlie potential threat assessment, providing support for a number of recent models posting the existence of a separate potential threat system that is dysfunctional in obsessive compulsive disorder (e.g., Szechtman and Woody, 2004; Woody and Szechtman, 2011).

Measuring and managing the economic impact of disruptive behaviors in the hospital.

Disruptive behaviors have been shown to have a significant negative impact on staff relationships, team collaboration, communication flow, and patient outcomes of care. They can be a major factor in contributing to the occurrence of adverse events that compromise quality care and patient safety and can put the patient and organization at increased risk. Whereas organizations generally are not reticent to make system enhancements designed to improve patient safety, they are more reluctant to address human factor issues such as disruptive behaviors for a variety of reasons. This article presents a 10-step process for addressing both the economic and quality impact of disruptive behaviors in an attempt to stimulate a call to action.

Overseas nurses' experiences of discrimination: a case of racist bullying?

AIM: We present three case studies of discrimination to illustrate how racist bullying as discriminatory practices operates in the workplace. BACKGROUND: Workplace bullying in the British health care sector is reported along with evidence of discrimination towards overseas-trained nurses recruited to work in the United Kingdom (UK). METHODS: The three interviews, which form the basis of the discussion in this paper, were selected purposively from a national study of overseas nurses because they present strong examples of the phenomenon of workplace bullying. The data on which this paper draws were collected through semi-structured, audio-recorded interviews and thematically re-analysed using nvivo V2. RESULTS: The national study showed how racism is entrenched in health workplaces. Our findings in this paper suggest that racism can be understood by the concept of racist bullying. There are four key findings which illustrate racist bullying in the workplace: abusive power relationships, communication difficulties, emotional reactions to racist bullying and responses to bullying. CONCLUSIONS: We argue that the literature on workplace bullying adds a layer of analysis of discrimination at the individual and organizational levels which enables us to further delineate racist bullying. We conclude that racist bullying can be specifically identified as a form of bullying. IMPLICATIONS FOR NURSING MANAGERS: Our data may assist managers to challenge current workplace working practices and support bullied employees. The three interviews show different responses to racist bullying which allow us to explore some implications for management practice.

Bullying, incivility, and disruptive behaviors in the healthcare setting: identification, impact, and intervention.

Bullying, incivility, and their associated disruptive behaviors are insidious and destructive forces with negative consequences that require identification and intervention at the individual and organizational level. Costs incurred secondary to these insensitive behaviors are substantial and involve matters of patient safety, absenteeism, turnover, turnover intentions, organizational commitment, and employee healthcare. Factors that increase the risk of hostile behaviors include changing hierarchies, conflicting loyalties, stress, and the state of the science. Each organization has the responsibility to develop processes for managing threatening and intimidating actions. New criteria are proposed to guide the implementation of successful programs.

Social environments and physical aggression among 21,107 students in the United States and Canada.

BACKGROUND: Physical aggression is an important issue in North American populations. The importance of students' social environments in the occurrence of physical aggression requires focused study. In this study, reports of physical aggression were examined in relation to social environment factors among national samples of students from Canada and the United States. METHODS: Students in grades 6-10 from the United States (n = 14,049) and Canada (n = 7058) who had participated in the Health Behaviour in School-aged Children Survey (HBSC) were studied. Rates of students' physical aggression were compared between the 2 countries. School, family, socioeconomic, and peer-related factors were considered as potential risk factors. A simple social environment risk score was developed using the US data and was subsequently tested in the Canadian sample. RESULTS: Risks for physical aggression were consistently higher among United States versus Canadian students, but the magnitude of these differences was modest. The relative odds of physical aggression increased with reported environmental risk. To illustrate, US boys in grades 6-8 reporting the highest social environment risk score (5+) experienced a relative odds of physical aggression 4.02 (95% CI 2.7-5.9) times higher than those reporting the lowest score (adjusted OR for risk scores 0 through 5+ was 1.00, 1.19, 2.10, 2.01, 3.71, and 4.02, respectively, p(trend) < .001). CONCLUSIONS: Unexpectedly, rates of physical aggression and associations between social environments and students' aggression were remarkably similar in Canada and the United States. Family, peer, and school social environments serve as risk or protective factors, with significant cumulative impact on physical aggression in both countries. Given the observed high rates and the many negative effects of aggression on long-term health, school policies aimed at the reduction of such behavior remain a clear priority.

The flip-side of social capital: the distinctive influences of trust and mistrust on health in rural China.

Despite increasing evidence that social capital is positively associated with health, the pathways that link social capital to health are not definitive and invite further investigation. This paper uses household survey data from 22 villages in China in 2002 to test the relationship between social capital and the self-reported health status of the rural population. Focusing on the cognitive dimension of social capital, this paper complements current social capital research by introducing an overlooked distinction between trust and mistrust. Trust and mistrust are measured at the individual and aggregate levels, and the distinct ways in which they affect general and mental health are explored. We adopt an ordered logistic regression using survey procedures in SAS version 9.1 to account for the stratified and clustered data structure. The results suggest that: (1) individual-level trust and mistrust are both associated with self-reported health in rural China--trust is positively associated with both general health and mental health, while mistrust is more powerfully associated with worse mental health; and (2) the effects of individual-level trust and mistrust are dependent on village context--village-level trust substitutes for individual-level trust, while individual-level mistrust interacts positively with village-level mistrust to affect health. However, an unexpected protective health effect of mistrust is found in certain types of villages, and this unique result has yet to be examined. Overall, this study suggests the conceptual difference between trust and mistrust and the differential mechanisms by which trust and mistrust affect health in rural China. It also suggests that effective policies should aim at enhancing trust collectively or reducing mistrust at the personal level to improve health status in rural areas of China.

Lameness, activity time-budgets, and estrus expression in dairy cattle.

The aim of the present study was to identify specific behavioral patterns that contribute to diminished estrus expression in lame cows. Behavioral scan and focal sampling were used to examine the effect of lameness on daily activity budgets, sexual behavior, feeding activities, and body condition score. A total of 59 milking cows (51.8 +/- 1.4 d postpartum) were monitored on a commercial dairy farm for 5 d following estrus synchronization. Overall, lame cows (n = 39) spent proportionately less time elevated on their feet and more time lying down compared with nonlame cows (n = 20). This included lame cows spending less time walking or standing. Overall, the total proportion of scans in which an estrous behavior was observed was very small but tended to be smaller for lame compared with nonlame cows. Throughout a day, lame cows displayed a lower proportion of estrous behaviors in the early morning. Lameness did not affect durations of drinking, grazing, or ruminating, or how these behavioral states fluctuated throughout the day. Similarly, rumination chewing rates were the same for lame and nonlame cows, and there was no association between lameness and dominance/displacement while feeding at a feed-fence. Lame cows did, however, have a slower bite rate at pasture and had a lower body condition score. Lame cows were also nearer the rear of the herd, both as they left the field and when entering the milking parlor. In conclusion, lame cows have longer lying times and spend less time standing, walking, and expressing an estrous behavior. Lame cows also have a lower bite rate at pasture and are more likely to be of lower body condition score.

No change in weight-based teasing when school-based obesity policies are implemented.

OBJECTIVES: To examine rates of weight-based teasing before initiation of school-based childhood obesity prevention policies (Arkansas Act 1220 of 2003) and during the 2 years following policy implementation, as well as demographic factors related to weight-based teasing. DESIGN: Analysis of consecutive random cross-sectional statewide telephone surveys conducted annually across 3 years. SETTING: Sample representative of Arkansas public school students with stratification by geographic region, school level (elementary, middle, and high school), and school size (small, medium, and large). PARTICIPANTS: Parents of children enrolled in Arkansas public schools and index adolescents 14 years or older. Intervention Statewide school-based obesity policies, including body mass index screening. MAIN OUTCOME MEASURES: Survey items about weight-based teasing, other teasing, body weight and height, and sociodemographic factors, as well as school characteristics obtained from the Common Core of Data of the National Center for Education Statistics. RESULTS: At baseline, 14% of children experienced weight-based teasing by parental report. The prevalence of weight-based teasing did not change significantly from baseline in the 2 years following school-based policy changes. Children and adolescents most likely to be teased because of weight were those who were overweight, obese, white, female, and 14 years or older, as well as those teased for other reasons. Adolescent report of weight-based teasing yielded similar patterns. CONCLUSION: Although the effectiveness of school-based obesity prevention policies remains unclear, policy changes did not lead to increased weight-based teasing among children and adolescents.