Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.

Children's lives, children's futures: A study of children starting secondary school

This title presents a fascinating analysis of how children in their first year of high school feel about their schools, its place in their lives and its role in their futures. This highly topical monograph focuses on how children in their first year of high school feel about school, its place in their lives and its role in their futures. The theoretical context of the study is the focus in educational studies on children's voice and children's active role in education, together with the focus in the sociology of childhood on children as active constructors of their lives and childhood as a subject of serious study. The importance of young people's life plans and the alignment between education and ambitions was recognized in the Sloan Foundation study of American teenagers. In many Western societies there is concern that children from less advantaged social backgrounds have limited aspirations, and are disproportionately unlikely to go to university. This book is highly relevant to understanding the nature of children's engagement with education, the choices and constraints they experience and the reasons some young people fail to take advantage of educational opportunities. "Continuum Studies in Educational Research" (CSER) is a major new series in the field of educational research. Written by experts and scholars for experts and scholars, this ground-breaking series focuses on research in the areas of comparative education, history, lifelong learning, philosophy, policy, post-compulsory education, psychology and sociology. Based on cutting edge research and written with lucidity and passion, the CSER series showcases only those books that really matter in education - studies that are major, that will be remembered for having made a difference.

The effect of consumption volume on profile and liking of oral nutritional supplements of varied sweetness: sequential profiling and boredom tests

Oral nutrition supplements (ONS) are routinely prescribed to those with, or at risk of, malnutrition. Previous research identified poor compliance due to taste and sweetness. This paper investigates taste and hedonic liking of ONS, of varying sweetness and metallic levels, over consumption volume; an important consideration as patients are prescribed large volumes of ONS daily. A sequential descriptive profile was developed to determine the perception of sensory attributes over repeat consumption of ONS. Changes in liking of ONS following repeat consumption were characterised by a boredom test. Certain flavour (metallic taste, soya milk flavour) and mouthfeel (mouthdrying, mouthcoating) attributes built up over increased consumption volume (p 0.002). Hedonic liking data from two cohorts, healthy older volunteers (n = 32, median age 73) and patients (n = 28, median age 85), suggested such build-up was disliked. Efforts made to improve the palatability of ONS must take account of the build up of taste and mouthfeel characteristics over increased consumption volume.

Proceedings of the West Africa Built Environment Research (WABER) Conference 2010

FOREWORD Welcome to this West Africa Built Environment Research (WABER) conference taking place here in Ghana. Thank you for coming and welcome to Accra. The main aims of the WABER conference are: to help young researchers and early-career scholars in West Africa to develop their research work and skills through constructive face-to-face interaction with experienced academics; to provide a platform for networking and collaborative work among senior built environment academics in West Africa; and to serve as a vehicle for developing the field of construction management and economics in Africa. Waber 2009 The WABER event in 2009 was held at the British Council in Accra, Ghana on 2-3 June. The event was a resounding success. It attracted participation from 32 researchers, from 12 different institutions, who presented their work to an audience of approximately 100 people. Each presenter received immediate and constructive feedback from an international panel. The event was opened by Professor K.K. Adarkwa, Vice Chancellor of KNUST, Kumasi, Ghana, with several senior academics and researchers from universities, polytechnics, and other institutions in Ghana and Nigeria in attendance. There was also a significant level of attendance by senior construction practitioners in Ghana. Thank you to the School of Construction Management and Engineering, University of Reading, UK for funding the inaugural event in 2009. We are also grateful to all of you who helped to make the event a success and to those of you who have joined us here today to build upon the success and legacy of WABER 2009. Waber 2010 This year, we have 60+ peer-reviewed papers and presentations on topics relating to Building services and maintenance, Construction costs, Construction design and technology, Construction education, Construction finance, Construction procurement, Contract administration, Contract management, Contractor development, Decision support systems, Dispute resolution, Economic development, Energy efficiency, Environment and sustainability, Health and safety, Human resources, Information technology, Marketing, Materials science, Organisation strategy and business performance, Productivity, Project management, Quantity surveying, Real estate and planning, Solar energy systems, Supply chain management and Urban development. We hope that these papers will generate interest among delagates and stimulate discussion here and beyond the conference into the wider community of academia and industry. The delegates at this conference come from 10 different countries. This provides a rich international and multicultural blend and a perfect platform for networking and developing collaborations. This year we are blessed to have three high profile keynote speakers in the persons of Professor George Ofori (National University of Singapore), Dr Roine Leiringer (University of Reading, UK) and Professor Will Hughes (University of Reading, UK). We are also thankful to Dr Chris Harty (University of Reading, UK) who is facilitating the Research Skills Workshop on ‘Writing a scientific article’. Thank you to Dr Sena Agyepong of our conference organising team for her capable management of local organising arrangements. And above all, thank you to all of you for coming to this conference. Enjoy and have a safe journey back home. Dr Samuel Laryea School of Construction Management and Engineering University of Reading, July 2010

An investigation into factors affecting the occupational choices of nominated farm heirs in Ireland

The resilience of family farming is an important feature of the structure of the farming industry in many countries, due largely to the 'smooth' succession of farms from one generation to the next. The stability of this structure is now threatened by the widening gap between the income expected from farming when compared with non-farming occupations in an economy like Ireland, operating at almost full employment. Nominated farm heirs are increasingly unlikely to choose full-time farming as their preferred occupation. To identify the factors that affect this occupational choice, a multinomial logit model is developed and applied to Irish data to examine the farm, economic and personal characteristics that influence a nominated heir's decision to enter farming as opposed to some non-farming occupation. The results show a significant negative relationship between higher education and the choice of full-time farming as an occupation. The interdependence between education and occupational choices is further explored using a bivariate probit model. The main findings are: the occupational choice and the decision to continue with higher education are made jointly; the nominated heirs on more profitable farms are less likely to pursue tertiary education and therefore more likely to enter full-time farming. The model developed is sufficiently general for studying the phenomenon of succession on farms.

Impact of Bt cotton on farmer livelihoods in South Africa

The economic benefits of Genetically Modified (GM) crops in developing countries have been well documented, but little research has been undertaken to date on the impacts of GM adoption on household livelihoods. The research reported here aimed to assess the livelihood impacts of the adoption of Bt cotton in South Africa., and involved 100 interviews of resource-poor farmers growing Bt cotton in Makhathini Flats, South Africa. Some 88% of respondents reported a higher income from Bt compared to non-Bt varieties previously grown by them, and this higher income was used primarily for greater education of their children (76%), more investment in growing cotton (46%), repaying debt (28%), investment in other crops (20%) and spending money on themselves. Some 89% had increased their asset base due to Bt cotton, primarily by increasing their cultivable land. These benefits of Bt adoption appeared widespread regardless of gender or farm size.

The need of sustainable buildings construction in the Kingdom of Bahrain

This thesis is aimed to initiate implementing sustainable building construction in the kingdom of Bahrain, i.e. Building-Integration PhotoVoltaic (BIPV) or Wind Energy (BIWE). It highlights the main constrains that discourage such modern concept in building and construction. Three groups have been questioned using a questionnaire. These are the policy and decision makers, the leading consultants and the contractors. The main constrains of the dissemination of BIVP and BIWE, according to the policy and decision makers, are: lack of knowledge and awareness of the public in sustainable technology, low cost of electricity, low cost of gas and oil and difficulty in applying local environmental taxes. The consultants had attributed the constrains to ignorance of life cycle cost of PV and Wind turbines systems, lack of education and knowledge in sustainable design, political system, shortage of markets importing sustainable technologies and client worries in profitability and pay-back period. The contractors are found to be very enthusiastic and ready to take over any sustainable building project and prefer to have a construction manger to coordinate between the design and contracting team. Design and Build is found the favorable procurement method in Bahrain for conducting BIPV or BIWE projects.

Primary teachers as readers

In the context of the continued pressure and politicisation of the teaching of reading in England, the United Kingdom Literacy Association (UKLA) sought to ascertain patterns in primary teachers' reading, both personally and professionally. The project, undertaken in 11 Local Authorities in England, explored 1200 primary teachers' personal reading habits and preferences, investigated their knowledge of children's literature, and documented their reported use of texts in the classroom through a questionnaire. In addition, it sought to establish the extent of the teachers' involvement with and use of local area/school library services. This paper reports on the findings with reference to the teachers' personal reading, the frequency of this reading and the sources they use to select their reading material. It also considers the teachers' favourite childhood texts and the books they identified as highly significant to them, as well as their perceptions of the importance of literature. Connections are made to the data gathered about their knowledge of children's literature, and how primary teachers decide which literature to work with in the classroom.

Exploring teachers' knowledge of children's literature

In the context of the current debate about teaching reading, research to ascertain primary teachers' personal and professional reading practices was undertaken. The study explored teachers' reading habits and preferences, investigated their knowledge of children's literature, and documented their reported use of such texts and involvement with library services. Questionnaire responses were gathered from 1200 teachers. The data were analysed and connections made between the teachers' own reading habits and preferences, their knowledge of children's literature, their accessing practices and pedagogic use of literature in school. This paper reports on part of the dataset and focuses on teachers' knowledge of children's literature; it reveals that primary professionals lean on a narrow repertoire of authors, poets and picture fiction creators. It also discusses teachers' personal reading preferences and considers divergences and connections between these as well as the implications of the teachers' limited repertoires on the reading development of young learners.

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

Aims and objectives. To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers. Background. The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. Design. A prospective randomized pre/post-test experimental design. Methods. Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards. Results. Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi(2) = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi(2) = 0, P 0.987). Conclusions. Clear, concise written instruction improved practice but verbal education was not additionally beneficial. Relevance to clinical practice. Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Comparison of small and large deformation rheological properties of wheat dough and gluten

The rheological properties of dough and gluten are important for end-use quality of flour but there is a lack of knowledge of the relationships between fundamental and empirical tests and how they relate to flour composition and gluten quality. Dough and gluten from six breadmaking wheat qualities were subjected to a range of rheological tests. Fundamental (small-deformation) rheological characterizations (dynamic oscillatory shear and creep recovery) were performed on gluten to avoid the nonlinear influence of the starch component, whereas large deformation tests were conducted on both dough and gluten. A number of variables from the various curves were considered and subjected to a principal component analysis (PCA) to get an overview of relationships between the various variables. The first component represented variability in protein quality, associated with elasticity and tenacity in large deformation (large positive loadings for resistance to extension and initial slope of dough and gluten extension curves recorded by the SMS/Kieffer dough and gluten extensibility rig, and the tenacity and strain hardening index of dough measured by the Dobraszczyk/Roberts dough inflation system), the elastic character of the hydrated gluten proteins (large positive loading for elastic modulus [G'], large negative loadings for tan delta and steady state compliance [J(e)(0)]), the presence of high molecular weight glutenin subunits (HMW-GS) 5+10 vs. 2+12, and a size distribution of glutenin polymers shifted toward the high-end range. The second principal component was associated with flour protein content. Certain rheological data were influenced by protein content in addition to protein quality (area under dough extension curves and dough inflation curves [W]). The approach made it possible to bridge the gap between fundamental rheological properties, empirical measurements of physical properties, protein composition, and size distribution. The interpretation of this study gave indications of the molecular basis for differences in breadmaking performance.

Cyclins, cyclin-dependent kinases, and cyclin-dependent kinase inhibitors: detection methods and activity measurements

The cyclin/cyclin-dependent kinase (Cdk) complexes and the Cdk inhibitors (CDKI) are crucial regulators of cell cycle progression in all eukaryotic cells. Using rat cardiac myocytes as a model system, this chapter provides a detailed account of methods that can be employed to measure both cyclin/Cdk activity in cells and the extent of CDKI inhibitory activity present in a particular cell type.