The meaning of autonomy when living with dementia: A Q-method investigation.

BACKGROUND AND AIMS: Sensitivity to the rights of people with dementia is a key principle cited in the World Health Organisation's global action plan on dementia. Some critics question whether rights-based approaches embody loose and ill-defined ideas incapable of bringing about meaningful change. Exercising the right to autonomy is considered a core problem for people living with dementia. The tradition of individual sovereignty dominates ideas about autonomy, although the person as an individual is not a cross-culturally universal concept. This study explored the viewpoints of people with dementia and family carers regarding the meaning of autonomy with a view to informing rights-based practice. METHODS: Twenty participants, people living with dementia and family carers, each conducted a Q-sort of statements regarding the meaning of autonomy. A by-person factor analysis was used to identify patterns in how the range of statements about autonomy were ranked. RESULTS: Three factors emerged: retaining independence and self-expression, accepting dependence but being included and opportunity for connection. There was some agreement across these different views regarding the importance of being given time to think before making decisions and being kept active. CONCLUSIONS: This study highlights the need for a person-centred approach to supporting people with dementia to claim their rights and the importance of adopting a stance of curiosity and critical thinking in rights-based training and professional practice. The findings suggest a variety of meaningful stories of autonomy and the possibility of further developing existing rights-based frameworks for dementia care.

Development of a predictive risk model for school readiness at age 3 years using the UK Millennium Cohort Study.

OBJECTIVES: The aim of this study is to develop a predictive risk model (PRM) for school readiness measured at age 3 years using perinatal and early infancy data. DESIGN AND PARTICIPANTS: This paper describes the development of a PRM. Predictors were identified from the UK Millennium Cohort Study wave 1 data, collected when participants were 9 months old. The outcome was school readiness at age 3 years, measured by the Bracken School Readiness Assessment. Stepwise selection and dominance analysis were used to specify two models. The models were compared by the area under the receiver operating characteristic curve (AUROC) and integrated discrimination improvement (IDI). RESULTS: Data were available for 9487 complete cases. At age 3, 11.7% (95% CI 11.0% to 12.3%) of children were not school ready. The variables identified were: parents' Socio-Economic Classification, child's ethnicity, maternal education, income band, sex, household number of children, mother's age, low birth weight, mother's mental health, infant developmental milestones, breastfeeding, parents' employment, housing type. A parsimonious model included the first six listed variables (model 2). The AUROC for model 1 was 0.80 (95% CI 0.78 to 0.81) and 0.78 (95% CI 0.77 to 0.79) for model 2. Model 1 resulted in a small improvement in discrimination (IDI=1.3%, p<0.001). CONCLUSIONS: Perinatal and infant risk factors predicted school readiness at age three with good discrimination. Social determinants were strong predictors of school readiness. This study demonstrates that school readiness can be predicted by six attributes collected around the time of birth.

Delivering health care through community pharmacies: are working conditions deterring female pharmacists' participation?

OBJECTIVE: Recent UK government policy has placed community pharmacists at the frontline of health care delivery in order to improve patient access. Community pharmacy has been beset by recruitment and retention problems which potentially threaten health service delivery. This is largely a consequence of an increased demand for pharmacists. Additionally, the proportion of female pharmacists in the profession has risen. Consequently, interrupted career patterns and part-time working practices have increased, shrinking the pool of available workers. This study aimed to examine the importance of factors influencing female community pharmacists' work patterns. METHOD: Q methodology was used in a sample of 40 female UK-based community pharmacists. RESULTS: Nine distinct factors emerged from a factor analysis of Q sorts: fulfilled pharmacists; family first or pharmacy shelved; low stress altruist; permanent part-time employees; focused on free time and finances; pressurized modernizers; wandering wage slaves; overloaded and under resourced for the new contract; and pin money part-timers. Female community pharmacists often worked below their potential and part-time at a practitioner level in response to a combination of domestic commitments and intensifying work place pressures. CONCLUSIONS: Family-friendly flexible work environments, adequate staffing levels and improved management support, might be more effective in increasing workforce participation than enhanced salary levels in this group of workers.