The relationship between BMI and the prescription of anti-obesity medication according to social factors: a population cross sectional study

Background: Obesity is a global public health problem. There are a range of treatments available with varying short and long term success rates. One option is the use of anti-obesity medication the prescription of which has increased dramatically in recent years. Despite this, little is known about the individual and GP practice factors that influence the prescription of anti-obesity medication. Methods: Multi-level logistic regression analysis was used to investigate factors associated with the prescription of anti-obesity medication in Northern Ireland using a population primary care prescribing database (~1.5 million people aged 16+ years) during 2009/10. Results: While 25.0% of people are obese, only 1.3% (2.1% of females, 0.6% of males) received anti-obesity medication. The relationship between medication rates and age differed by gender (P < 0.001) with prescriptions higher in younger females and older males. Prescribing of anti-obesity medication reflected obesity prevalence across urban/rural areas and deprivation. There was an unexplained two-fold difference, between the 25th and 75th percentile, in the GP practice prescription of anti-obesity medication. Conclusions: There is evidence of relative under-prescribing in males compared to females despite a similar prevalence of obesity. While the prevalence (and presumably the health consequences) of obesity worsens with age, younger females are more likely to be prescribed anti-obesity medication. This suggests an element of patient demand. Educational material to improve the understanding of the role of anti-obesity medication, for patients and practitioners, is recommended. But further study is needed to understand the factors responsible for the variation in prescribing between GP practices.

Asking the Critical Questions: An Evaluation of Social Work Students' Experiences in an International Placement

Preparing social work students for the demands of changing social environments and to promote student mobility and interest in overseas employment opportunities have resulted in an increasing demand for international social work placements. The literature describes numerous examples of social work programmes that offer a wide variety of international placements. However, research about the actual benefit of undertaking an overseas placement is scant with limited empirical evidence on the profile of students participating, their experience of the tasks offered, the supervisory practice and the outcomes for students' professional learning and career. This study contributes to the existing body of literature by exploring the relevance of international field placements for students and is unique in that it draws its sample from students who have graduated so provides a distinctive perspective in which to compare their international placement with their other placement/s as well as evaluating what were the benefits and drawbacks for them in terms of their careers, employment opportunities and current professional practice.

The EU Constitution of Social Governance in an Economic Crisis: in Defence of a Transnational Dimension to Social Europe

Conventional wisdom has it that the EU is unable to promote viable social integration, which contrasts with its commitments to improving working and living conditions and to social values and goals such as solidarity, social protection and social inclusion. This
article challenges two diff erent standpoints: on the one hand, competitive neoliberalism demands that the EU focuses on economic integration through legally binding internal market and competition rules even if Member States can only maintain a limited commitment to social inclusion, while authors defending the social models unique to the continent of Europe demand that the EU rescinds some of its established legal principles in order to make breathing space for Member States to maintain market correcting social policies. Both positions convene that there should be no genuine social policy at EU level.
This article uses scenarios of widely discussed rulings by the Court of Justice to illustrate that legally enforceable economic integration would prevent most Member States from achieving sustainable health services, labour relations and free university education on the basis of national closure. Since the EU has limited legislative competences to create EU level institutions to balance inequalities, it derives a Constitution of Social Governance from the EU’s values, proposing that the Court of Justice develops its urisprudence into an instrument for challenging European disunion induced by new EU economic governance

Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: protocol for a controlled before and after study

Background: Clinical Commissioning Groups (CCGs) are mandated to use research evidence effectively to ensure optimum use of resources by the National Health Service (NHS), both in accelerating innovation and in stopping the use of less effective practices and models of service delivery. We intend to evaluate whether access to a demand-led evidence service improves uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. 

Methods/design: This is a controlled before and after study involving CCGs in the North of England. Participating CCGs will receive one of three interventions to support the use of research evidence in their decision-making:1) consulting plus responsive push of tailored evidence; 2) consulting plus an unsolicited push of non-tailored evidence; or 3) standard service unsolicited push of non-tailored evidence. Our primary outcome will be changed at 12 months from baseline of a CCGs ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes will measure individual clinical leads and managers’ intentions to use research evidence in decision making. Documentary evidence of the use of the outputs of the service will be sought. A process evaluation will evaluate the nature and success of the interactions both within the sites and between commissioners and researchers delivering the service. 

Discussion: The proposed research will generate new knowledge of direct relevance and value to the NHS. The findings will help to clarify which elements of the service are of value in promoting the use of research evidence.Those involved in NHS commissioning will be able to use the results to inform how best to build the infrastructure they need to acquire, assess, adapt and apply research evidence to support decision-making and to fulfil their statutory duties under the Health and Social Care Act.

Social Services of General Interest: The EU Competence Regime and a Constitution of Social Governance

In discussing the potential role of the EU, the Member States, their composite parts and civil society organisations in establishing social services of general interest at sub-national, national, transnational and EU wide levels, this chapter explores the EU competence regime for social services of general interest. Its analysis contradicts a tendency in academic writing to demand protection of national prerogatives for shaping welfare states against EU intervention at all costs, because this would be counterproductive for the progress of the EU project. It submits that an EU constitution of social governance should create mixed responsibilities so that the EU, states and civil society actors support each other in creating preconditions for social integration in the EU. It uses the field of social services of general interests as an example of applying this general theoretical concept.

Demand response to improved walking infrastructure: A study into the economics of walking and health behaviour change

Walking is the most common form of moderate‐intensity physical activity among adults, is widely accessible and especially appealing to obese people. Most often policy makers are interested in valuing the effect on walking of changes in some characteristics of a neighbourhood, the demand response for walking, of infrastructure changes. A positive demand response to improvements in the walking environment could help meet the public health target of 150 minutes of at least moderate‐intensity physical activity per week. We model walking in an individual’s local neighbourhood as a ‘weak complement’ to the characteristics of the neighbourhood itself. Walking is affected by neighbourhood
characteristics, substitutes, and individual’s characteristics, including their opportunity cost of time.  Using compensating variation, we assess the economic benefits of walking and how walking behaviour is affected by improvements to the neighbourhood.  Using a sample of 1,209 respondents surveyed over a 12 month period (Feb 2010‐Jan 2011) in East Belfast, United Kingdom, we find that a policy that increased walkability and people’s perception of access to shops and facilities  would lead to an increase in walking of about 36 minutes/person/week, valued at £13.65/person/week. When focusing on inactive residents, a policy that improved the walkability of the area would lead to guidelines for physical activity being reached by only 12.8% of the population who are currently inactive. Additional interventions would therefore be needed to encourage inactive residents to
achieve the recommended levels of physical activity, as it appears that interventions that improve the walkability of an area are particularly effective in increasing walking among already active citizens, and, among the inactive ones, the best response is found among healthier, younger and wealthier citizens.

Measuring burnout among UK social workers: A Community Care study

Preface Extract: This research was commissioned and funded by Community Care as part of our Stand Up For Social Work campaign. Previous surveys of readers had suggested caseloads, vacancies and stress levels were all on the increase. Community Care decided to do a more scientific examination of burnout on a large scale to assess the real impact of budget cuts and increasing demand on social workers across the UK.