Customers' perspectives on the impact of the Pathways to Work condition management programme on their health, well-being and vocational activity.

AIMS: Pathways to Work is a UK initiative aimed at supporting customers on incapacity benefits to return to work. This qualitative study complements previous evaluations of Pathways to Work by exploring customers' perceptions of the impact of the Condition Management Programme (CMP) offered to claimants with long-term health conditions. METHODS: 39 customers took part in focus groups held at the seven sites where Pathways was originally piloted. The main focus of the discussions was on perceptions of the ways in which participation had impacted on health, well-being and return to work. The discussions were audio-recorded and fully transcribed for analysis using a text analysis framework to enable the development and refinement of categories and overarching patterns in the data. RESULTS: Perceived impacts on health and well-being included a more positive outlook, social contact, changed perceptions of conditions and improvements in health. Some customers also reported an increase in their vocational activity and others felt ready to embark on new activities. Factors associated with positive outcomes included the extent and quality of contact with CMP staff and practical advice about condition management. Factors impeding positive employment outcomes related mainly to obstacles to returning to work. CONCLUSIONS: The results indicated that CMP can assist customers to learn about and manage their health conditions and increase their vocational activity, and that CMP therefore provides a promising means of enabling people with long-term health conditions to regain a fulfilling, productive life.

NICE guidance on long-term sickness and incapacity.

Long-term sickness absence and incapacity benefits (disability pension) rates have increased across industrialised countries. Effective measures are needed to support return to work. The recommendations of this guidance were informed by the most appropriate available evidence of effectiveness and cost-effectiveness. Public health evidence was provided by research using a variety of study designs that attempted to determine the outcome of a particular intervention by evaluating status before and after the intervention had been effected, and was not limited to randomised control trials. Where the evidence base was depleted or underdeveloped, expert witnesses were called to give their opinion on the best available evidence and emerging interventions. The process enabled challenge and contestability from stakeholder groups at different points as the guidance was developed. Forty-five heterogeneous studies were included in the review of interventions to reduce long-term sickness absence and transitions from short-term to long-term absence (mainly covering the former and also mainly examining musculoskeletal conditions). The analysis of evidence was restricted to descriptive synthesis. Three general themes emerged from an analysis of the studies that were more likely to report positive results: early interventions; multidisciplinary approaches; and interventions with a workplace component. Two further reviews were undertaken, one on interventions to reduce the re-occurrence of sickness absence, which identified seven studies on lower back pain, and concluded that early intervention and direct workplace input are important factors. The final evidence review focused on six studies of interventions for those in receipt of incapacity benefit. The evidence was that work-focused interviews coupled with access to tailored support are effective and cost-effective interventions. Practitioners should consider the impact of interventions and management options on work ability for patients of working age. Work ability should be considered a key outcome for future intervention studies.

Reproducibility and validity of a food frequency questionnaire in assessing dietary intakes of low-income Caucasian postpartum women living in Sheffield, United Kingdom.

The aim of this study was to examine the reproducibility and validity of a semi-quantitative food frequency questionnaire (FFQ) for assessing dietary intakes of low-income, Caucasian, English-speaking, postpartum women living in Sheffield, United Kingdom. Data was obtained from a cross-sectional sample of the 'Healthy Start' study; a population-based survey of mothers and infants. Participants completed two FFQs at 4 and 8 weeks postpartum. Measures from 24-hour dietary recalls (24HDRs) were collected at 4, 6, 8 and 12 weeks postpartum. In the reproducibility study, crude Pearson's correlation coefficients ranged from 0.40 (riboflavin) to 0.73 (thiamine), mean value 0.54. In the validation study, crude Pearson correlation coefficients between the FFQ and the measures from the 24HDRs ranged from 0.10 (B12) to 0.55 (manganese), mean value 0.34. Energy-adjustments and corrections for attenuation had no significant effect on the strength of the correlation both observed in the reproducibility and validity study. On average, 68% of the participants were classified correctly, and 3% were misclassified into the extreme opposite quintile of the distribution. The authors conclude that the questionnaire performed well for the majority of nutrients examined and that is a valid tool for ranking individuals according to nutrient distribution.

Are the benefits of the 'Healthy Start' food support scheme sustained at three months postpartum? Results from the Sheffield 'before and after' study.

Early results examining nutritional behaviour of Caucasian, English-speaking, postpartum women living in Sheffield, who were beneficiaries or eligible for the Welfare Food Scheme (WFS) or the Healthy Start (HS) scheme, suggested significant between-groups differences. The aim of this study was to examine whether differences observed at 4 weeks postpartum were sustained over time. Eighty-six WFS and 64 HS participants were recruited at baseline and, thereafter, 53 WFS and 33 HS participants at week 8, and 47 WFS and 39 HS participants at week 12. Dietary intakes were assessed by an interviewer-administered, semi-quantified food frequency questionnaire. At 4 weeks, HS women had higher energy intakes compared to WFS women, (9.7 MJ and 8.1 MJ, respectively). Differences were also sustained at 8 weeks, (8.8 MJ and 7.2 MJ) and 12 weeks (9.4 MJ and 7.6 MJ) for the HS and WFS participants, respectively. Within-groups, energy and most of nutrient intakes did not change appreciably over time. Consumption of fruit and vegetables at baseline, were significantly higher (P = 0.023) for participants under the HS scheme (3.4 portions) compared to WFS participants (2.7 portions). Differences were sustained over time as HS women reported consuming 4.1 and 3.7 portions/day respectively at 8 and 12 weeks, as opposed to 2.8 and 2.7 portions/day reported by WFS women. The study findings provided evidence of the potential effectiveness of the HS scheme in a population subgroup at risk of dietary deficiencies. Early findings could provide a useful snapshot of the diet of such mobile population and should be further exploited.

The role of interprofessional working in the Pathways to Work Condition Management Programmes.

Condition Management Programmes (CMPs) were established in seven pilot sites in the UK as one strand of the Incapacity Benefit Pathways to Work programme, an initiative that exemplifies interprofessional working beyond traditional healthcare boundaries. The qualitative evaluation of the pilot sites employed a realistic evaluation approach and used focus group discussions and telephone interviews to examine stakeholders' perceptions of interprofessional working and its impact on service provision and practice. Although teething problems were experienced in establishing the interprofessional working necessary for success, a shared commitment to the CMP ethos enabled these to be largely overcome. Outstanding issues raised by participants concerned the boundaries around the CMPs' new ways of working, in particular around treatment versus self-management and around the combined health and work focus of the pilots. One of the recommendations from a recent review of the health of Britain's working population was for a drive to promote the understanding of the positive relationship between health and work. The experiences of the staff involved in the CMP pilots provides a useful insight into the benefits and difficulties experienced in relation to interprofessional working between different professional groups in this area.

Effect of the introduction of 'Healthy Start' on dietary behaviour during and after pregnancy: early results from the 'before and after' Sheffield study.

The aim of the study was to examine the effect of the introduction of a new food-support benefit 'Healthy Start' (HS) on dietary intakes and eating patterns of low-income, Caucasian, pregnant and postpartum women living in Sheffield (UK). A before-and-after study comparing nutritional behaviour of participants, who were beneficiaries or eligible for the Welfare Food Scheme (WFS) (phase 1) or HS (phase 2), was conducted. Dietary intakes and eating patterns were assessed using a validated semi-quantified FFQ. In phase 1, 176 WFS subjects (ninety pregnant and eighty-six postpartum) were recruited and in phase 2, there were 160 HS subjects (ninety-six pregnant and sixty-four postpartum). The results suggested that pregnant and postpartum HS women significantly increased their daily intakes of energy, Fe, Ca, folate and vitamin C compared with the WFS women. Observed differences remained significant after controlling for potential confounding effects of known factors, i.e. education and age. HS women were more likely to meet the recommended nutrient intakes for Fe, folate, Ca and vitamin C. HS women ate significantly more mean portions of fruit and vegetables per d (P = 0.004 and P = 0.023) respectively. None of the HS recipients was receiving HS vitamin supplements. The present study showed that pregnant and postpartum HS women increased their food consumption, and a higher proportion of them than the earlier WFS scheme met the recommended intakes for Ca, folate, Fe and vitamin C.

Dietary assessment of a population of pregnant women in Sheffield, UK.

The present study examined the dietary intakes of a population of pregnant women living in the North of England. The objectives of the paper were to assess and describe the dietary intakes of the population and relate the findings to existing data on the diet of pregnant and non-pregnant women in the UK. A total of 250 pregnant women attending their first antenatal appointment at the Jessop Wing Hospital, Sheffield, UK were recruited. Information on their diet was assessed by an interviewer-administered semi-quantified food frequency questionnaire (FFQ). The mean intakes as assessed by the FFQ were similar to other studies of UK pregnant population; however Sheffield pregnant women had lower intakes of calcium and folate. Study findings were also related to the National Diet and Nutrition Survey and to the Estimated Nutrient Intakes (EAR). Of the study participants, 40 % did not meet the EAR for calcium, 67 % for iron and 69 % for folate. Subgroup comparisons suggested lower nutrient intakes of participants living in the 40 % most deprived electoral wards. The study findings suggest that the diet of pregnant women in Sheffield is characterised by low intakes of important nutrients for pregnancy such as folate and nutrient variations by electoral wards.

Validation of a food-frequency questionnaire for use in pregnancy.

OBJECTIVES: As a part of an ongoing project to develop a nutritional screening tool, we evaluated the performance of a semi-quantitative food-frequency questionnaire (FFQ) in terms of validity in a Sheffield Caucasian pregnant population using two different statistical approaches--the correlation coefficient and the limits of agreement (LOA). The FFQ was designed specifically for pregnant women and previously used in a large-scale study. DESIGN: A validation study. SETTING: A community-based field study of a general population of pregnant women booked for their first antenatal appointment at the Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK. SUBJECTS: One hundred and twenty-three women of different socio-economic status, aged between 17 and 43 years, provided complete dietary data. RESULTS: The validity of the FFQ was tested against a series of two 24-hour recalls. As expected, the intakes of all examined nutrients, except for iodine, carotene, vitamin E, biotin, vitamin C and alcohol, were higher when determined by the FFQ than when determined by 24-hour recall. Pearson's correlation coefficient between the two methods ranged from 0.19 (added sugar, zinc) to 0.47 (Englyst fibre). The LOA were broader for some of the nutrients, e.g. protein, Southgate fibre and alcohol, and an increasing lack of agreement between the two methods was identified with higher dietary intakes. CONCLUSIONS: The FFQ gave useful estimates of the nutrient intakes of Caucasian pregnant women and appears to be a valid tool for categorising pregnant women according to dietary intake. The FFQ performed well for most nutrients and had acceptable agreement with the 24-hour recall.

Patient factors associated with duration of certified sickness absence and transition to long-term incapacity.

BACKGROUND: Despite a considerable increase in claims for long-term sickness benefits, and the impact of certifying sickness upon general practitioner (GP) workload, little is known about transition to long-term incapacity for work. AIM: To explore the relationship between patient factors and the transition from short-term to long-term work incapacity, in particular focusing on mild mental health and musculoskeletal problems. SETTING: Nine practices comprising the Mersey Primary Care R&D Consortium. DESIGN: Prospective data collection and audit of sickness certificate details. METHOD: GPs issued carbonised sickness certificates for a period of 12 months. The resulting baseline dataset included claimant diagnosis, age, sex, postcode-derived deprivation score, and sickness episode duration. Associations of patient factors with sickness duration outcomes were tested. RESULTS: Mild mental disorder accounted for nearly 40% of certified sickness. Relatively few claimants had their diagnosis changed during a sickness episode. Risk factors for longer-term incapacity included increasing age, social deprivation, mild and severe mental disorder, neoplasm, and congenital illness. For mild mental disorder claimants, age, addiction, and deprivation were risk factors for relatively longer incapacity. For musculoskeletal problems, the development of chronic incapacity was significantly related to the nature of the problem. Back pain claimants were likely to return to work sooner than those with other musculoskeletal problems. CONCLUSIONS: In addition to the presenting diagnosis, a range of factors is associated with the development of chronic incapacity for work, including age and social deprivation. GPs should consider these when negotiating sickness certification with patients.

Health benefits of omega-3s for the whole family.

A research dietitian summarises the health benefits of omega-3 fatty acids in the diet as suggested by recent research. Reasons for the current shortfall in intakes are explained and readily available dietary sources of omega-3s given. Although the public is now better educated about saturated and unsaturated fats, health professionals need to give people more guidance on the sources and health benefits of omega-3 fatty acids in the diet.

Coeliac disease and infertility: making the connection and achieving a successful pregnancy.

Undiagnosed coeliac disease is not uncommon in adults in the UK and can be a cause of unexplained infertility in women. Studies suggest that dietary treatment of women with coeliac disease may result in successful conception. The diet of a woman with coeliac disease during pregnancy is discussed and agencies offering support are listed.