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.

Microbial community of the deep-sea brine Lake Kryos seawater-brine interface is active below the chaotropicity limit of life as revealed by recovery of mRNA

Within the complex of deep, hypersaline anoxic lakes (DHALs) of the Mediterranean Ridge, we identified a new, unexplored DHAL and named it ‘Lake Kryos’ after a nearby depression. This lake is filled with magnesium chloride (MgCl2)-rich, athalassohaline brine (salinity > 470 practical salinity units), presumably formed by the dissolution of Messinian bischofite. Compared with the DHAL Discovery, it contains elevated concentrations of kosmotropic sodium and sulfate ions, which are capable of reducing the net chaotropicily of MgCl2-rich solutions. The brine of Lake Kryos may therefore be biologically permissive at MgCl2 concentrations previously considered incompatible with life. We characterized the microbiology of the seawater–Kryos brine interface and managed to recover mRNA from the 2.27–3.03 MMgCl2 layer (equivalent to 0.747–0.631 water activity), thereby expanding the established chaotropicity window-for-life. The primary bacterial taxa present there were Kebrit Deep Bacteria 1 candidate division and DHAL-specific group of organisms, distantly related toDesulfohalobium. Two euryarchaeal candidate divisions, Mediterranean Sea Brine Lakes group 1 and halophilic cluster 1, accounted for > 85% of the rRNA-containing archaeal clones derived from the 2.27–3.03 M MgCl2 layer, but were minority community-members in the overlying interface-layers. These findings shed light on the plausibility of life in highly chaotropic environments, geochemical windows for microbial extremophiles, and have implications for habitability elsewhere in the Solar System.

Urban high-density construction sites and their surrounding community:issues encountered and strategiesadopted by contractors

Inner city developments are a common feature within many urban environments. Where these construction sites are not managed effectively, they can negatively impact their surrounding community. The aim of this paper is to identify and document, in an urban context, the numerous issues encounter and subsequent strategies adopted by on-site contractors and local people, in the mitigation of factors which negatively impact their surrounding community. The objectives in achieving this aim are to identify what effect, if any, an urban construction site has on its surrounding environment, the issues and resulting strategies adopted by contractors on the factors identified, and also what measures are put in place to minimise such disturbances to the local community. In order to meet the requirements, a mixed methodology is adopted culminating in a literature review, case study analysis, contractor and community interviews, concluding in the development of two specific questions for both perspectives in question. The data is assessed using severity indices based on mean testing in the development of key findings. The results indicate that the main forms of disturbance to the local community from an urban development include noise, dust and traffic congestion. With respect to a contractor on-site, the key issues include damaging surrounding buildings, noise control and off-site parking. The resulting strategies identified in the mitigation of such issues include the implementation of noise and dust containment measures and minimising disruption to local infrastructure. It is envisaged that the results of this study will provide contractors operating in such environments, with the required information which can assist in minimising disruption and therefore, avoiding disputes with the local community members. By consulting with and surveying those most affected, this research will illustrate to on-site management, the difficulties faced by those who accommodate such developments within their living environment.

Sectarian and Nonsectarian Violence: Mothers' Appraisals of Political Conflict in Northern Ireland

Past research on peace and conflict in Northern Ireland has focused on politically motivated violence. However, other types of crime (i.e., nonsectarian) also impact community members. To study the changing nature of violence since the signing of the Belfast Agreement in Northern Ireland, we used a qualitative approach and the Constant Comparative Method to analyze focus group discussions with mothers from segregated Belfast neighborhoods. Participants articulated clear differences between sectarian and nonsectarian violence, and further distinguished sectarian violence along 2 dimensions—overt acts and perceived intergroup threat. Although both sectarian and nonsectarian antisocial behavior related to insecurity, participants described pulling together and increased ingroup social cohesion in response to sectarian incidents. The findings have implications for the study of violence and insecurity as experienced in the everyday lives of mothers, youth, and families in settings of protracted conflict.

Barriers and Facilitators to Providing Palliative Care in Rural Communities: A Nursing Perspective

Nursing plays a key role in the coordination and delivery of palliative care services in rural settings. The purpose of this study is to identify barriers and enablers to providing palliative care in rural communities from a nursing perspective. This study utilized a qualitative descriptive design. Findings highlighted that the remoteness, limited access to resources and professional practice barriers created challenges for nurses as they tried to provide quality palliative care to their clients. System-related barriers were identified and included: lack of services, funding issues, and poor continuity of care. Despite these barriers, nurses drew from supports to optimize palliative care such as using a team approach to care, centers, utilizing local case managers and informal community members, and using palliative care resources. These results may help inform policy decisions around the needs of nurses who practice in rural settings to provide quality care to individuals who are dying and their families.

Reduced community integration in persons following traumatic brain injury, as measured on the Community Integration Measure: An exploratory analysis

Objective: To explore the community integration of individuals who had suffered a Traumatic Brain Injury (TBI) and compare this to members of the general public. Design: Independent groups design. Setting: All participants were resident in Northern Ireland (NI). The brain injured participants were drawn from a Belfast-based social skills programme. Participants: Thirty participants, ten survivors of TBI, ten male and ten female controls from the general public. Main Outcome Measure: The Community Integration Measure (CIM) Results: Analysis of variance showed no significant differences between males and females or between males and brain injured individuals. A significant difference was found between females and brain injured individuals (F(1,18)=4.51, P=0.048). Conclusion: Females were more integrated into their communities than males, who were more integrated than brain injured individuals. It would appear that brain injury survivors are doubly disadvantaged. Their gender (mainly male), and the injury itself, conspires to reduce their integration with the wider community.

Assessing the extent to which temporal changes in waterbird community composition are driven by either local, regional or global factors.

1. Lough Neagh and Lough Beg Special Protection Area (SPA, hereafter Lough Neagh) is an important non-estuarine site in Britain and Ireland for overwintering wildfowl. Multivariate analysis of the winter counts showed a state-shift in the waterbird community following winter 2000/2001, mostly due to rapid declines in abundance (46–57% declines in the mean mid-winter January counts between 1993–2000 and 2002–2009) of members of the diving duck guild (pochard Aythya ferina, tufted duck Aythya fuligula and goldeneye Bucephala clangula) and coot (Fulica atra), a submerged macrophyte feeder.
2. Only pochard showed correlations between declines at Lough Neagh and those of overall species flyway population indices to suggest that global changes could contribute to declines at the site. However, indices from the Republic of Ireland showed no overall decline in the rest of Ireland. Tufted duck indices at the site were inversely related to indices in Great Britain. Lough Neagh goldeneye indices were positively correlated with indices in the Republic of Ireland and Great Britain, suggesting that short-stopping could contribute to declines at the site. Coot declines at Lough Neagh did not correlate with trends elsewhere, suggesting local factors involved in the decline.
3. These analyses indicate that although there are potentially different explanations for the dramatic declines in these four waterbird species at this site, the simultaneous nature of the declines across two feeding guilds strongly
suggest that local factors (such as loss of submerged macrophytes and benthic invertebrates) were involved. An assessment of the food supply, local disturbance and other factors at Lough Neagh is required to find an explanation for the observed adverse trends in wintering numbers of the affected species.
4. This study highlights the potential of waterbird community structure to reflect the status of aquatic systems, but confirms the need to establish site-specific factors responsible for the observed changes in abundance of key waterbird species at a site.

Evaluating the effectiveness of community-based dementia care networks:The Dementia Care Networks' Study

Purpose: The Dementia Care Networks' Study examined the effectiveness of four community-based, not-for-profit dementia networks. The study involved assessing the relationship between the types of administrative and service-delivery exchanges that occurred among the networked agencies and the network members' perception of the effectiveness of these exchanges. Design and Methods: With the use of a case-study method, the evolution, structure, and processes of each network were documented. Social network analysis using a standardized questionnaire completed by member agencies identified patterns of administrative and clinical exchanges among networked agencies. Results: Differences were found between the four networks in terms of their perceptions of service-delivery effectiveness; perceptions of administrative effectiveness did not factor significantly. Exchanges between groups of agencies (cliques) within each of the four networks were found to be more critical than those between individual agencies within each network. Implications: Integration-measured by the types of exchanges within as opposed to across networks-differentiated the four networks studied. This research contributes to our understanding of the use of multiple measures to evaluate the inner workings of service delivery and their impact on elder health and elder health care. Copyright 2005 by The Gerontological Society of America.

Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis

Objective: To determine the pooled effect of exposure to one of 11 specialist palliative care teams providing services in patients’ homes.Design: Pooled analysis of a retrospective cohort study.Setting: Ontario, Canada.Participants: 3109 patients who received care from specialist palliative care teams in 2009-11 (exposed) matched by propensity score to 3109 patients who received usual care (unexposed).Intervention: The palliative care teams studied served different geographies and varied in team composition and size but had the same core team members and role: a core group of palliative care physicians, nurses, and family physicians who provide integrated palliative care to patients in their homes. The teams’ role was to manage symptoms, provide education and care, coordinate services, and be available without interruption regardless of time or day.Main outcome measures: Patients (a) being in hospital in the last two weeks of life; (b) having an emergency department visit in the last two weeks of life; or (c) dying in hospital.Results: In both exposed and unexposed groups, about 80% had cancer and 78% received end of life homecare services for the same average duration. Across all palliative care teams, 970 (31.2%) of the exposed group were in hospital and 896 (28.9%) had an emergency department visit in the last two weeks of life respectively, compared with 1219 (39.3%) and 1070 (34.5%) of the unexposed group (P<0.001). The pooled relative risks of being in hospital and having an emergency department visit in late life comparing exposed versus unexposed were 0.68 (95% confidence interval 0.61 to 0.76) and 0.77 (0.69 to 0.86) respectively. Fewer exposed than unexposed patients died in hospital (503 (16.2%) v 887 (28.6%), P<0.001), and the pooled relative risk of dying in hospital was 0.46 (0.40 to 0.52).Conclusions: Community based specialist palliative care teams, despite variation in team composition and geographies, were effective at reducing acute care use and hospital deaths at the end of life.

The impact of patient suicide on community mental health teams

Suicide in Scotland is considered an urgent public health issue affecting all aspects of society. The aim of this study was to explore how a patient suicide impacts on members of a community mental health team (CMHT). Six members of one CMHT were interviewed on two occasions, approximately nine months following a patient suicide. An interpretative descriptive model, drawing on elements of grounded theory, phenomenology end ethnography was chosen, using semistructured interviews for data collection. Three main themes of emotional response, communication and clinical implications were clearly described. Emotional response included feelings of shock and surprise, concern and personal impact. Communication included examples of personal, team and management communication in the days and weeks following the suicide. Clinical aspects discussed included the non-replacement of staff and training and experience as sub-themes. Findings in relation to the wider published literature are discussed

‘Plugging the Gap’: Shared Education and the promotion of community relations through schools in Northern Ireland

Although there is no consensus amongst educationalists as to the role schools play as drivers of hostilities in divided societies, there is broad agreement that they can facilitate more positive intergroup relations. In Northern Ireland the promotion of school based inter-group contact has been offered as a means through which this can happen. Until 2007, the approach was twofold, reflected on the one hand in short-term contact opportunities for pupils in predominantly Catholic and Protestant schools, and on the other, in support for integrated schools which educate Catholics and Protestants together. In 2007 the Shared Education Programme was introduced to ‘bridge the gap’ between short-term opportunities for contact, and ‘full immersion’ integrated schools. Informed by contact theory, shared education offers curriculum based interaction between pupils attending all school types, aimed at promoting the type of contact likely to reduce negative social attitudes and ultimately contribute to social harmony. In this paper, we examine the impact of shared education thus far. Our analysis suggests that whilst shared education is generally effective in promoting positive assessments of other group members, there is a danger that programme impact may be inhibited by the foregrounding of educational over reconciliation priorities. Appreciating that the downplaying reconciliation objectives may have been necessary when the programme was established in order to maximize recruitment to it, we argue that if the full potential of shared education is to be realized, moving forward, it is important for schools to engage with issues of group differences.

Community dynamics and the lower airway microbiota in stable chronic obstructive pulmonary disease, smokers and healthy non-smokers

RATIONALE: The role bacteria play in the progression of COPD has increasingly been highlighted in recent years. However, the microbial community complexity in the lower airways of patients with COPD is poorly characterised.

OBJECTIVES: To compare the lower airway microbiota in patients with COPD, smokers and non-smokers.

METHODS: Bronchial wash samples from adults with COPD (n=18), smokers with no airways disease (n=8) and healthy individuals (n=11) were analysed by extended-culture and culture-independent Illumina MiSeq sequencing. We determined aerobic and anaerobic microbiota load and evaluated differences in bacteria associated with the three cohorts. Culture-independent analysis was used to determine differences in microbiota between comparison groups including taxonomic richness, diversity, relative abundance, 'core' microbiota and co-occurrence.

MEASUREMENT AND MAIN RESULTS: Extended-culture showed no difference in total load of aerobic and anaerobic bacteria between the three cohorts. Culture-independent analysis revealed that the prevalence of members of Pseudomonas spp. was greater in the lower airways of patients with COPD; however, the majority of the sequence reads for this taxa were attributed to three patients. Furthermore, members of Bacteroidetes, such as Prevotella spp., were observed to be greater in the 'healthy' comparison groups. Community diversity (α and β) was significantly less in COPD compared with healthy groups. Co-occurrence of bacterial taxa and the observation of a putative 'core' community within the lower airways were also observed.

CONCLUSIONS: Microbial community composition in the lower airways of patients with COPD is significantly different to that found in smokers and non-smokers, indicating that a component of the disease is associated with changes in microbiological status.