Pattern of childhood falls in a low-income setting: a cross-sectional study in Dar es Salaam

The objective was to determine patterns and circumstances of childhood falls in a low-income setting in Dar es Salaam, Tanzania. This cross sectional study is based on a household survey conducted in July 2009. A total of 3927 children up to age 18 from 1928 households in 15 sampled wards were surveyed through a structured questionnaire. The current study includes information regarding fall occurrence, socio-demographic and economic factors. Data were analysed using chi-square, t-test and logistic regression. Male children had 42% higher odds of falls compared to females, and rural residents had more than two times higher odds compared to urban residents. Falls occurred three times more among age group 1-4 and two times more among age group 5-9 compared to those between 15 and 18 years. Most falls occurred outdoors (62%) while playing (51%) with boys being over-represented. Females and children aged 1-4 years fell more from stairs whereas most infants fell from furniture. Male gender, younger age groups and rural residence were significant factors for fall injuries. The circumstances in which these falls occur also differ significantly. Intervention efforts should emphasise these patterns.     

Telephone advisory services—nursing between organisational and occupational professionalism

In this paper, we explore how telephone advisory services (TAS) and the implementation of new technology affect nurses and the nursing profession. This study shows that TAS and applied technology embodies ideas of standardisation and efficiency, and promotes an organisational professionalism such that it challenges occupational professionalism. Torn between organisational and occupational professionalism, the nurses develop strategies to deal with their contradictory demands.     

First car-to-car crashes involving young adult drivers: main patterns and their relation to car and driver characteristics

The primary objective of the study was to examine the relationship between patterns in car-to-car crashes involving young drivers and car and driver characteristics and the research design was a national register-based prospective cohort study. Individual records in a cohort born 1970-1972 are linked to road-traffic-crash data (1988-2000). Subjects' first police-registered two-car crash leading to severe or fatal injury (n = 4875) are identified. Typical crash patterns are highlighted and associations between pattern and both car and individual socio-demographic characteristics are tested. Four crash patterns are highlighted. Male drivers and those with lower educational attainment are over-represented in all patterns. Pattern-based risk levels vary considerably according to car safety level and driver's age at time of injury and socio-economic status. Crash patterns might be considered in young adult driver education systems, bearing in mind the consistent higher risks of male drivers and of drivers with lower educational attainment.     

Knowing how to use and understand recipes: What arithmetical understanding is needed when students with mild intellectual disabilities use recipes in practical cooking lessons in Home Economics?

The aim of this study was to explore what arithmetical understanding is needed when students with mild intellectual disabilities use recipes during practical cooking lessons in Home Economics. The settings were compulsory schools in Sweden attended by students with intellectual disabilities. Sixteen lessons in Home Economics during which cooking took place were observed. In total, 37 students and three teachers participated. All students had a mild intellectual disability. Their ages varied, but most were between 13 and 14 years old. The sociocultural perspective on learning, combined with a literacy framework, was used as a theoretical foundation for the study. Main findings are that students need an arithmetical understanding of (i) how to interpret numbers, (ii) how to interpret and use units, and (iii) how to compute when using recipes. The knowledge and skills needed to be able to use a recipe are featured in the concept recipe literacy, capturing both theoretical, declarative knowledge and the more practical, procedural knowledge. Recipe literacy can be used to theorize the use of recipes when learning to cook, as in Home Economics.     

Selecting representative case vignettes for clinical judgement studies: Examples from two heart failure studies

In the Clinical Judgement Analysis (CJA) tradition there are strong arguments in favour of using representative case vignettes. Due to methodological and practical constraints, however, it is often necessary to make compromises regarding representativity. In this article, we discuss our experiences in working with these problems in connection with two studies about general practitioners heart failure diagnoses. CJA is a method for investigating and describing decision-making in which both judges and judgement situations are taken into consideration. This means that when we want to study physicians diagnoses, both the participating physicians as well as the case vignettes should be sampled to be representative for the diagnostic situation. If representativity is interpreted in a strictly statistical sense, the case vignettes should reflect a well identified population of patients regarding values, distribution and intercorrelations of the relevant patient characteristics (variables). Creating a set of representative case vignettes meeting all theoretical requirements will often be difficult. Selecting a relevant population and relevant variables, deciding about the appropriate number of variables and case vignettes, and deciding whether authentic patients or constructed case vignettes should be used are some of the problems that must be dealt with.     

The clash of managerial and professional logics in public procurement: Implications for innovation in the health-care sector

This article addresses the enactment of public procurement and its influence on adoption and diffusion of innovation, using a case study of public procurement of a low-tech medical device innovation in Swedish healthcare. Based on interviews and documentation, the article illustrates the various perspectives of the different professions involved in the complex task of setting the requirement specification for the tender. The technology identities of the medical device (innovation) are constructed and negotiated by the actors: procurement administrators, health-care professionals and suppliers within the adoption space. Examining the enactment of the procurement process as part of the adoption space is a way to deepen our understanding of the social component within public procurement.