The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys

Objectives: Multimorbidity is common in the older population, but the impact of combinations of chronic conditions on disability and quality of life (QoL) is not well known. This analysis explores the effect of specific combinations of chronic diseases on disability, QoL and self-rated health (SRH).

Design: We used data from two population representative cross-sectional studies, the Northern Ireland Health and Social Wellbeing Survey (NIHSWS) 2005 and the Survey of Lifestyle, Attitudes and Nutrition (SLAN) 2007 (conducted in the Republic of Ireland).

Setting: Randomly selected community-living participants were interviewed at home.

Participants: A total of 6159 participants aged 50 years and older were included in the analysis.

Outcome measures: Chronic conditions were classified as cardiovascular disease, chronic pain,diabetes or respiratory disease. Interaction terms estimated by logistic regression were used to examine the effects of multiple chronic conditions on disability, SRH and QoL.

Results: Each chronic condition group was correlated with each of the others after adjusting for sociodemographic factors. Those from Northern Ireland were more likely to report a limitation in daily activities (45%) compared to those from the Republic of Ireland (21%). Each condition had an independent effect on disability, SRH and QoL, and those with multiple chronic conditions reported the worst outcomes. However, there were no statistically significant positive interactions between chronic condition groups with respect to any outcome.

Conclusions: Chronic conditions affect individuals largely independent of each other with respect to their effect on disability, SRH and QoL. However, a significant proportion of the population aged 50 years and over across the island of Ireland lives with multimorbidity,and this group is at the highest risk of disability, poor SRH and poor QoL.

Housing booms and media coverage

This article analyses news media coverage of the housing market. Building on theories of media influence where word of mouth is the final mechanism of opinion change but media initiate discourse, I examine the relationship between news media and the recent UK house price boom. Over 30 000 articles on the UK housing market from the period 1993 to 2008 are analysed, and it is found that media Granger-caused real house price changes, suggesting the media may have influenced opinions on the housing market. However, media sentiment on the housing market did not change with the secular increase in house prices in the 2000s, suggesting that the media did not contribute to the UK’s housing boom and may have helped constrain it.

IDEAhaus: A Modular Approach to Climate Resilient UK Housing

This paper describes the result of a project to develop climate adaptation design strategies funded by the UK’s Technology Strategy Board. The aim of the project was to look at the threats and opportunities presented by industrialized and house-building techniques in the light of predicted future increases in flooding and overheating due to anthropogenic climate change. The paper shows that the thermal performance of houses built to the current UK Building Regulations is not adequate to cope with changing weather patterns, and in light of this, develops a detailed design for a new house: one that is industrially produced and climatically resilient, but affordable. This detailed concept IDEAhaus of a modular house is not only flood-proof to a water depth of 750 mm, but also is designed to utilize passive cooling, which dramatically reduces the amount of overheating, both now and in the future.

Use of maternity surveys in improving the care experience – a review of the evidence

The use of surveys and direct feedback from women as a measurement of their maternity experience is seen as a means of stimulating quality improvement. Underpinning the overall rationale behind national maternity surveys is the acknowledgement that there is a need to document women's views of maternity services to inform policymakers with a view to enhancing the delivery of quality care to women. The evidence suggests that using maternity surveys to improve maternity care experience is central to UK health policy. It is also evident that qualitative input from women has the power to highlight mismatches of experience between women and professionals. Trusts are required to look to the future and invest in qualitative methodologies, which elicit rich and detailed information on women's experiences. The aim of this literature review is to critically analyse the use of maternity surveys and their validity in improving the care experienced by users of maternity services.

The Governance of Mandated Partnerships: The Case of Social Housing Procurement

Partnership working is nowadays a seemingly ubiquitous aspect of the management and delivery of public services, yet there remain major differences of opinion about how they best work for the different stakeholders they involve. The balances between mandate and trust, and between hard and soft power, are crucial to current debates about public service partnerships. This paper explores the example of social housing procurement in Northern Ireland, and the requirement to form mandated procurement groups. The research shows that the exercise of hierarchical power is still important in network governance; that mandated partnerships alter the balance between trust and power in partnership working, but the impact is uneven; and that these relationships are (re)shaping the ‘hybrid’ identity of housing associations. The balance between accountability for public resources and the independence of third sector organisations is the key tension in mandated partnerships. The Northern Ireland experience suggests that trust-based networks could provide more productive working relationships in partnerships for service delivery.

Prefab (and preserve): An investigation of retrofitting for Belfast's Victorian terraced social housing

This paper investigates the potential for the reuse of Belfast's existing Victorian terraced housing. The aim is to study methods behind retrofitting these unique pieces of architectural heritage, bringing them up to modern day standards with reduced energy costs and CO2 emissions in line with the Climate Change Act of 2008 (‘the Act’). It also highlights the characteristics of sustainable retrofitting examples and original prefabricated element, which enable the 19th-century properties to be re-adapted to suit modern day needs. The analysis builds on a report by Mark Hines Architects, in association with SAVE Britain's Heritage,1 in which the company explains the detrimental effect that the ‘Pathfinder’ scheme has had on English cities. Similarly, in Belfast, redevelopment schemes such as that in the ‘Village’ district have intended to replace undervalued terraced housing stock, and search for more sustainable options to retain these homes along with with the embodied energy and traditions attached to them.

The inclusion of open-ended questions on quantitative surveys of children: Dealing with unanticipated responses relating to child abuse and neglect

Web surveys have been shown to be a viable, and relatively inexpensive, method of data collection with children. For this reason, the Kids’ Life and Times (KLT) was developed as an annual online survey of 10 and 11 year old children. Each year, approximately 4,000 children participate in the survey. Throughout the six years that KLT has been running, a range of questions has been asked that are both policy-relevant and important to the lives of children. Given the method employed by the survey, no extremely sensitive questions that might cause the children distress are included. The majority of questions on KLT are closed yielding quantitative data that are analysed statistically; however, one regular open-ended question is included at the end of KLT each year so that the children can suggest questions that they think should be asked on the survey the following year. While most of the responses are innocuous, each year a small minority of children suggest questions on child abuse and neglect. This paper reports the responses to this question and reflects on how researchers can, and should, deal with this issue from both a methodological and an ethical perspective.