Understanding further education as a context for public health intervention: qualitative findings from a study process evaluation.

BACKGROUND: Over 1.2 million 16-18 year-olds are enrolled in further education (FE-advanced secondary education) in England. Life course transitions provide opportunities to change, establish or reinforce health behaviours. FE presents an opportunity for public health improvement, yet few interventions target this setting. Using a smoking prevention intervention, we explore how young people were viewed in FE and how this affected intervention acceptability. METHODS: Eleven student and five staff focus groups were conducted in three intervention institutions (two colleges, one school sixth-form), as part of the process evaluation of a smoking prevention feasibility study. FE managers in intervention and control institutions were also interviewed (n = 5). Data were analysed using thematic analysis. RESULTS: In both colleges and the sixth-form, students were viewed as emergent adults and treated differently from 'school-children', in practice if not in policy. Colleges permitted smoking in designated areas; in the school sixth-form smoking was unofficially tolerated but concealed from younger students. Using staff to deliver anti-smoking messages reintroduced an unwanted power dynamic which disrupted perceptions of students as young adults. CONCLUSIONS: FE is an important setting for young people's health. Understanding the culture and context of FE is critical in designing acceptable and effective public health interventions.

Making the case for investment in public health: experiences of Directors of Public Health in English local government.

BACKGROUND: Amid local government budget cuts, there is concern that the ring-fenced public health grant is being appropriated, and Directors of Public Health (DsPH) find it difficult to make the case for investment in public health activity. This paper describes what DsPH are making the case for, the components of their case and how they present the case for public health. METHODS: Thirteen semi-structured telephone interviews and a group discussion were carried out with DsPH (November 2013 to May 2014) in the Southern region of England. RESULTS: DsPH make the case for control of the public health grant and investing in action on wider determinants of health. The cases they present incorporate arguments about need, solutions and their effectiveness, health outcomes, cost and economic impact but also normative, political arguments. Many types of evidence were used to substantiate the cases; evidence was carefully framed to be accessible and persuasive. CONCLUSIONS: DsPH are responding to a new environment; economic arguments and evidence of impact are key components of the case for public health, although multiple factors influence local government (LG) decisions around health improvement. Further evidence of economic impact would be helpful in making the case for public health in LG.

Evidence that genetic variation in the oxytocin receptor (OXTR) gene influences social cognition in ADHD.

Some children with ADHD also have social and communication difficulties similar to those seen in children with autistic spectrum disorders and this may be due to shared genetic liability. As the oxytocin receptor (OXTR) gene has been implicated in social cognition and autistic spectrum disorders, this study investigated whether OXTR polymorphisms previously implicated in autism were associated with ADHD and whether they influenced OXTR mRNA expression in 27 normal human amygdala brain samples. The family-based association sample consisted of 450 DSM-IV diagnosed ADHD probands and their parents. Although there was no association with the ADHD phenotype, an association with social cognitive impairments in a subset of the ADHD probands (N=112) was found for SNP rs53576 (F=5.24, p=0.007) with post-hoc tests demonstrating that the AA genotype was associated with better social ability compared to the AG genotype. Additionally, significant association was also found for rs13316193 (F=3.09, p=0.05) with post-hoc tests demonstrating that the CC genotype was significantly associated with poorer social ability than the TT genotype. No significant association between genotype and OXTR mRNA expression was found. This study supports previous evidence that the OXTR gene is implicated in social cognition.

Do falls and falls-injuries in hospital indicate negligent care -- and how big is the risk? A retrospective analysis of the NHS Litigation Authority Database of clinical negligence claims, resulting from falls in hospitals in England 1995 to 2006.

BACKGROUND: Accidental falls are very common in older hospital patients -- accounting for 32% of reported adult patient safety incidents in UK National Health Service (NHS) hospitals and occurring with similar frequency in settings internationally. In countries where the population is ageing, and care is provided in inpatient settings, falls prevention is therefore a significant and growing risk-management issue. Falls may lead to a variety of harms and costs, are cited in formal complaints and can lead to claims of clinical negligence. The NHS Litigation Authority (NHSLA) negligence claims database provides a novel opportunity to systematically analyse such (falls-related) claims made against NHS organisations in England and to learn lessons for risk-management systems and claims recording. OBJECTIVES: To describe the circumstances and injuries most frequently cited in falls-related claims; to investigate any association between the financial impact (total cost), and the circumstances of or injuries resulting from falls in "closed" claims; to draw lessons for falls risk management and for future data capture on falls incidents and resulting claims analysis; to identify priorities for future research. METHODS: A keyword search was run on the NHSLA claims database for April 1995 to February 2006, to identify all claims apparently relating to falls. Claims were excluded from further analysis if, on scrutiny, they had not resulted from falls, or if they were still "open" (ie, unresolved). From the narrative descriptions of closed claims (ie, those for which the financial outcome was known), we developed categories of "principal" and "secondary" injury/harm and "principal" and "contributory" circumstance of falls. For each category, it was determined whether cases had resulted in payment and what total payments (damages and costs) were awarded. The proportions of contribution-specific injuries or circumstances to the number of cases and to the overall costs incurred were compared in order to identify circumstances that tend to be more costly. Means were compared and tested through analysis of variance (ANOVA). The association between categorical variables was tested using the chi-square test. RESULTS: Of 668 claims identified by word search, 646 met inclusion criteria. The results presented are for the 479 of these that were "closed" at the time of the census. Of these, 290 (60.5%) had resulted in payment of costs or damages, with the overall total payment being 6,200,737 pound (mean payment 12,945 pound). All claims were settled out of court, so no legal rulings on establishing liability or causation of injury are available. "Falls whilst walking;" "from beds or trolleys" ("with and without bedrails applied") or "transferring/from a chair" were the most frequent source of these claims (n = 308, 64.2%). Clear secondary contributory circumstances were identified in 190 (39.7%) of closed claims. The most common circumstances cited were "perioperative/procedural incidents" (60, 12.5%) and "requests for bedrails being ignored" (54, 11.3%). For primary injuries, "hip/femoral/pelvic fracture" accounted for 203 (42.4%) of closed claims with total payments of 3,228,781 pound (52.1% of all payments), with a mean payment 15,905 pound per closed case. A "secondary" contributory circumstance could be attributed in 133 (27.8%) of cases. Of these, "delay in diagnosis of injury," "recurrent falls during admission" and "fatalities relating to falls" were the commonest circumstances (n = 59, 12.2%). DISCUSSION: Although falls are the highest volume patient safety incident reported in hospital trusts in England, they result in a relatively small number of negligence claims and receive a relatively low total payment (0.019% in both cases). The mean payment in closed claims is also relatively small. This may reflect the high average age of the people who fall and difficulty in establishing causation, especially where individuals are already frail when they fall. The patterns of claims and the narrative descriptions provide wider lessons for improving risk-management strategies. However, the inherent limitations and biases in the data routinely recorded for legal purposes suggest that for more informative research or actuarial claims analysis, more comprehensive and systematic data to be recorded for each incident claim are needed.

The effect of a vinyl floor surface and a carpeted floor surface upon walking in elderly hospital in-patients.

Fifty-eight elderly hospital patients walked along a 10-m length of carpeted corridor and a 10-m length of vinyl-tiled corridor. Gait speed and step length were significantly greater on the carpeted than on the vinyl surface.

Cognitive characteristics and homosexuality.

There have been many studies of psychological characteristics of homosexuals, but cognitive characteristics have been relatively neglected. This study investigated the verbal intelligence of 20 homosexual males, 20 heterosexual males, and 20 females, taking into account variables likely to affect verbal ability such as social class and handedness. There were no differences in overall IQ, but group differences in verbal and nonverbal ability were marked. No other differences between the groups were found. The implications are briefly discussed.

Self-report measures of mood and morale in elderly depressives.

The self-report scales of mood and morale were administered to 45 elderly in-patient depressives and 45 non-patient controls, matched for age and sex. The responses of the two groups differed significantly in the predicted direction. When 18 patients from the depressive group were re-tested 6 to 8 weeks later, at discharge, significant declines in self-reported depression, and increases in "life-satisfaction' were reported. Within the depressive group, there was a significant relationship between "overt' depressive behaviour on the ward and self-reporting of greater depressive symptoms, and lower "life-satisfaction'. The importance of independent validation of self-report measures of mood and morale in elderly populations is discussed.

Comparison of oestriol in mother and fetus during labour and in the baby at birth.

The progressive rise in pregnancy of oestriol values and their significance in assessing fetal viability is well known, although the exact function of this increase is not understood. In considering the problem it was thought that further information of oestriol levels in mother, fetus and newborn could prove of value. The mean cord plasma oestriol was lower in small-for-dates than in normal cases, but in both groups it was ten times higher than in the relative maternal peripheral veins. In pooled capillary fetal scalp samples the mean oestriol was slightly higher in normal compared with small-for-dates cases. The use of gas chromatography--mass spectrometry was investigated and shown to give an accurate measurement of plasma oestriol levels. The expense of this procedure may be offset by its ability to determine simultaneously the nature and amount of other steroids present.

The suppression of puerperal lactation with bromocryptine.

The therapeutic value of 2-Br-alpha-ergocryptine for the suppression of puerperal lactation was studied in 30 normal women; 16 received the drug, 14 were controls. In six women plasma levels of FSH, oestradiol and alpha-lactalbulmin were measured in labour and in the early puerperium. Brom-ergocryptine was found effectively to suppress milk production and alleviate breast pain and congestion, with no side effects and minimum rebound lactation. The inverse relationship between prolactin and FSH levels reported elsewhere in non-pregnant women did not appear to occur in the early postpartum period. Although there was a significant rise in alpha-lactalbumin levels in labour and the puerperium over non-pregnant levels, there was no difference between lactating and non-lactating women.