An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).

DESIGN: Cluster randomized controlled trial.

SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).

INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.

MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.

RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.

CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.

Possible futures for social work with children and families in Australia, the United Kingdom and the United States

There has been considerable interest in recent years in comparing the operation of social work services to children and families internationally, particularly between Australia, the United Kingdom and the United States. Reviewing the respective policy environments and drawing on recent research experience in these three nations the author speculates as to how such services may be placed to respond to a converging agenda to tackle the high social and economic costs of social exclusion. It is argued that a conspiracy of circumstances have led child and family social work away from its more general child welfare objectives of the past and created consolidation of functions in relation to child protection work. This has left services ill prepared to play a central role within a new and resurgent child welfare agenda.

Social Inclusion or Market Competitiveness? A Comparison of Rural Development Policies in the European Union and the United States

The language of EU rural development policy appears more interested in social inclusion and that of US policy more interested in market competitiveness. We seek to determine why policies directed at rural development in the EU and the USA differ. In both contexts new rural development policies emphasize partnership and participation but we find local participation is used to promote social inclusion in the EU and market competitiveness in the USA. An examination of these dimensions illustrates important transcontinental differences and similarities in rural development policies. We explore the socio-historical reasons for differences in the commitment to social inclusion, while also noting similarities in the priority of market competitiveness.

Religion, anti-slavery, and identity: Irish Presbyterians, the United States, and transatlantic evangelicalism, c. 1820-1914

Scholars have devoted much attention to the causes and consequences of Presbyterian emigration from Ulster to the thirteen colonies before 1776. This article moves beyond the eighteenth century to examine the continued religious links between Presbyterians in Ireland and the United States in the nineteenth century. It begins with an examination of the influence of evangelicalism on both sides of the Atlantic and how this promoted unity in denominational identity, missionary activity to convert Catholics, and revivalist religion during the first half of the century. Though Irish Presbyterians had great affection for their American co-religionists, they were not uncritical, and significant tensions did develop over slavery. The article then examines the religious character of Scotch-Irish or Ulster-Scots identity in the late nineteenth century, which was articulated in response to the alleged demoralising influence of large-scale Irish immigration during and after the Famine of the 1840s, the so-called Romanisation of Catholicism, and the threat of Home Rule in Ireland. The importance of identity politics should not obscure religious developments, and the article ends with a consideration of the origins and character of fundamentalism, perhaps one of the most important cultural connections between Protestants in Northern Ireland and the United States in the twentieth century.

The Irish hospitals sweepstake in the United States of America, 1930-1939

The Irish hospitals sweepstake was established by statute in the Irish Free State in 1930 to fund the state’s hospital service. The vast majority of tickets were sold outside Ireland, particularly in countries where such gambling was illegal at the time. Initially the largest market was in the United Kingdom, but following the introduction of restrictive legislation there in 1934, the promoters of the sweepstake turned their attentions to North America and after 1936 the United States became the largest source of contributions to the Irish sweep. This article examines a number of factors concerning the relationship of the Irish sweep with the USA, including: an effort to estimate the amount of money contributed to the sweep by Americans; the role of the Irish diaspora and of prominent republicans, including Joseph McGarrity and Connie Neenan, in the illegal ticket distribution network; the efforts of American Federal agencies and government departments to disrupt the sweepstake organisation in America; how the sweep was used by those who sought to legalise gambling in the USA; the attitudes of both the Irish and American governments to the sweep’s activities in America; and how the legalisation of gambling in America brought about the demise of the Irish sweep.