Donegall Pass: Towards a sustainable community:Chapter 5, Health and Wellbeing

Key Points

International research has long since established a gradient between health and socio-economic status and it is now clear that the social and physical context in which people live can have a negative influence on health.

Recent research has established an adverse effect on the health of people who remained in an area that had become more deprived over time

The mechanisms thought to influence health in declining communities include stress, loss of self-esteem, stigma, powerlessness, a lack of hope and fatalism.

These mechanisms are related to the concept of social capital, a resource produced when people co-operate for mutual benefit

Residents’ key concerns relating to the decline in the community are housing shortages which are perceived to be contributing to the breakdown of the family-based community, along with traffic; pollution; non-resident parking problems; a lack of youth facilities; and the influx of ethnic minorities who are less inclined to become involved with the community

In the Donegall Pass a dual process of outward migration and business development has resulted in a decline in social capital within the community which was particularly evident amongst the younger generations

People living in deprived areas, such as the Donegall Pass, that are adjacent to affluent areas, such as the new apartment developments surrounding the area, can often feel relatively more deprived due to such direct comparisons. Although relative deprivation was evident, peer comparisons with the Donegal Road/Sandy Row community were more commonly expressed

The area can be described as a ‘food desert’ as no affordable fresh grocery supplies are available within walking distance

Residents expressed mixed opinions about the future of the Donegall Pass including a common sense of resignation towards the decline in the core community

Many residents recognise the need for people to work together and gain empowerment in order to work with the authorities (i.e., the Housing Executive and the Council) towards progressive re-development that is in keeping with the aims of the community members, however, equally many were impervious towards these suggestions feeling that previous efforts had gone unrewarded.

Learning, development, and support needs of community palliative care clinical nurse specialists

Background: The palliative care clinical nurse specialist (PC-CNS) is a core member of the specialist palliative care team. According to professional policy, the role has four specific components: clinical practice, education, research, and leadership and management. Little is known about how to support staff in this role. Aim: The aim of this study was to explore what learning, development, and support PC-CNSs in one hospice need to enable them to fulfil all components of their role. Design: Using a descriptive exploratory approach, semi-structured interviews were undertaken with a purposive sample of community PC-CNSs from a hospice in Northern Ireland. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Findings: Seventeen interviews were analysed and three themes identified: influence of organisational culture, influence of the individual, and learning and development solutions. Conclusions: Participants reported that the PC-CNS role was stressful. They identified that the organisational culture and indeed individuals themselves influenced the learning and development support available to help them fulfil the four components of the role. Working relationships and stability within teams affected how supported individuals felt and had implications for managers in meeting the needs of staff while balancing the needs of the service.

A qualitative study of community pharmacists’ awareness of and involvement with intermediate care facilities

Rationale, aims and objectives: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery and maximising independence. The introduction of IC has created a new interface between primary and secondary care. Older people are known to be at an increased risk of medication-related problems when transferring between healthcare settings and pharmacists are often not included as part of IC multidisciplinary teams. This study aimed to explore community pharmacists’ (CPs) awareness of IC services and to investigate their views of and attitudes towards the medicines management aspects of such services, including the transfer of medication information.

Method: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with CPs practising in the vicinity of IC facilities in Northern Ireland, UK.

Results: Interviews were conducted with 16 CPs. Three themes were identified and named ‘left out of the loop’, ‘chasing things up’ and ‘closing the loop’. CPs felt that they were often ‘left out of the loop’ with regards to both their involvement with local IC services and communication across the healthcare interfaces. As a result, CPs resorted to ‘chasing things up’ as they had to proactively try to obtain information relating to patients’ medications. CPs viewed themselves as ideally placed to facilitate medicines management across the healthcare interfaces (i.e., ‘closing the loop’), but several barriers to potential services were identified.

Conclusion: CPs have limited involvement with IC services. There is a need for improvement of effective communication of patients’ medication information between secondary care, IC and community pharmacy. Increasing CP involvement may contribute to improving continuity of care across such healthcare interfaces, thereby increasing the person-centeredness of service provision.

Finance, social economics and community development

The last three decades have seen social enterprises in the United Kingdom pushed to the forefront of welfare delivery, workfare and area-based regeneration. For critics, this is repositioning the sector around a neoliberal politics that privileges marketization, state roll-back and disciplining community groups to become more self-reliant. Successive governments have developed bespoke products, fiscal instruments and intermediaries to enable and extend the social finance market. Such assemblages are critical to roll-out tactics, but they are also necessary and useful for more reformist understandings of economic alterity. The issue is not social finance itself but how it is used, which inevitably entangles social enterprises in a form of legitimation crises between the need to satisfy financial returns and at the same time keep community interests on board. This paper argues that social finance, how it is used, politically domesticated and achieves re-distributional outcomes is a necessary component of counter-hegemonic strategies. Such assemblages are as important to radical community development as they are to neoliberalism and the analysis concludes by highlighting the need to develop a better understanding of finance, the ethics of its use and tactical compromises in scaling it as an alternative to public and private markets.

A Community Driven Approach to Reconstruction Management

Without human beings, and human activities, hazards can strike but disasters cannot occur, they are not just natural phenomena but a social event (Van Der Zon, 2005). The rapid demand for reconstruction after disastrous events can result in the impacts of projects not being carefully considered from the outset and the opportunity to improve long-term physical and social community structures being neglected. The events that struck Banda Aceh in 2004 have been described as
a story of ‘two tsunamis’, the first being the natural hazard that struck and the second being the destruction of social structures that occurred as a result of unplanned, unregulated and uncoordinated response (Syukrizal et al, 2009). Measures must be in place to ensure that, while aiming to meet reconstruction
needs as rapidly as possible, the risk of re-occurring disaster impacts are reduced through both the physical structures and the capacity of the community who inhabit them. The paper explores issues facing reconstruction in a post-disaster scenario, drawing on the connections between physical and social reconstruction in order to address long term recovery solutions. It draws on a study of relevant literature and a six week pilot study spent in Haiti exploring the progress of recovery in the Haitian capital and the limitations still restricting reconstruction efforts. The study highlights the need for recovery management strategies that recognise the link between social and physical reconstruction and the significance of community based initiatives that see local residents driving recovery in terms of debris handling and rebuilding. It demonstrates how a community driven approach to physical reconstruction could also address the social impacts of events that, in the case of places such as Haiti, are still dramatically restricting recovery efforts.

School and Community Screening Shows Malawi, Africa, to Have a High Prevalence of Latent Rheumatic Heart Disease

Rheumatic heart disease (RHD) is the largest cardiac cause of morbidity and mortality in the world's youth. Early detection of RHD through echocardiographic screening in asymptomatic children may identify an early stage of disease, when secondary prophylaxis has the greatest chance of stopping disease progression. Latent RHD signifies echocardiographic evidence of RHD with no known history of acute rheumatic fever and no clinical symptoms.

OBJECTIVE: Determine the prevalence of latent RHD among children ages 5-16 in Lilongwe, Malawi.

DESIGN: This is a cross-sectional study in which children ages 5 through 16 were screened for RHD using echocardiography.

SETTING: Screening was conducted in 3 schools and surrounding communities in the Lilongwe district of Malawi between February and April 2014.

OUTCOME MEASURES: Children were diagnosed as having no, borderline, or definite RHD as defined by World Heart Federation criteria. The primary reader completed offline reads of all studies. A second reader reviewed all of the studies diagnosed as RHD, plus a selection of normal studies. A third reader served as tiebreaker for discordant diagnoses. The distribution of results was compared between gender, location, and age categories using Fisher's exact test.

RESULTS: The prevalence of latent RHD was 3.4% (95% CI = 2.45, 4.31), with 0.7% definite RHD and 2.7% borderline RHD. There was no significant differences in prevalence between gender (P = .44), site (P = .6), urban vs. peri-urban (P = .75), or age (P = .79). Of those with definite RHD, all were diagnosed because of pathologic mitral regurgitation (MR) and 2 morphologic features of the mitral valve. Of those with borderline RHD, most met the criteria by having pathological MR (92.3%).

CONCLUSION: Malawi has a high rate of latent RHD, which is consistent with other results from sub-Saharan Africa. This study strongly supports the need for a RHD prevention and control program in Malawi.

GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.