Informal caregiving and mental ill health – differential relationships by workload, gender, age and area-remoteness in a UK region

Informal caregiving can be a demanding role which has been shown to impact on physical, psychological and social wellbeing. Methodological weaknesses including small sample sizes and subjective measures of mental health have led to inconclusive evidence about the relationship between informal caregiving and mental health. This paper reports on a study carried out in a UK region which investigated the relationship between informal caregiving and mental ill health. The analysis was conducted by linking three datasets, the Northern Ireland Longitudinal Study, the Northern Ireland Enhanced Prescribing Database and the Proximity to Service Index from the Northern Ireland Statistics and Research Agency. Our analysis used both a subjective measure of mental ill health, i.e. a question asked in the 2011 Census, and an objective measure, whether the respondents had been prescribed antidepressants by a General Practitioner between 2010 and 2012. We applied binary logistic multilevel modelling to these two responses to test whether, and for what sub-groups of the population, informal caregiving was related to mental ill health. The results showed that informal caregiving per se was not related to mental ill health although there was a strong relationship between the intensity of the caregiving role and mental ill health. Females under 50, who provided over 19 hours of care, were not employed or worked part-time and who provided care in both 2001 and 2011 were at a statistically significantly elevated risk of mental ill health. Caregivers in remote areas with limited access to shops and services were also at a significantly increased risk as evidenced by prescription rates for antidepressants. With community care policies aimed at supporting people to remain at home, the paper highlights the need for further research in order to target resources appropriately.

Under One Umbrella: Problems of Internet Retransmissions of Broadcasts and Implications for New Audiovisual Content Services

The development of broadband Internet connections has fostered new audiovisual media services and opened new possibilities for accessing broadcasts. The Internet retransmission case of TVCatchup before the CJEU was the first case concerning new technologies in the light of Art. 3.1. of the Information Society Directive. On the other side of the Atlantic the Aereo case reached the U.S. Supreme Court and challenged the interpretation of public performance rights. In both cases the recipients of the services could receive broadcast programs in a way alternative to traditional broadcasting channels including terrestrial broadcasting or cable transmission. The Aereo case raised the debate on the possible impact of the interpretation of copyright law in the context of the development of new technologies, particularly cloud based services. It is interesting to see whether any similar problems occur in the EU. The „umbrella” in the title refers to Art. 8 WCT, which covers digital and Internet transmission and constitutes the backrgound for the EU and the U.S. legal solutions. The article argues that no international standard for qualification of the discussed services exists.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Statistics on Smoking Cessation Services in Northern Ireland: 2014/15

This information release, produced by the Department of Health, Social Services and Public Safety’s Information and Analysis Directorate, provides information on smoking cessation services. Data are included on the monitoring of smoking cessation services in Northern Ireland during the period 1st April 2014 to 31st March 2015. This report also provides an analysis of data collected in 2014/15 in respect of clients who set a quit date during 2013/14 (52 week follow-up). Information contained within this report was downloaded from a web based recording system. Figures here are correct as of 1st September 2015. The Ten Year Tobacco Control Strategy for Northern Ireland aims to see fewer people starting to smoke, more smokers quitting and protecting people from tobacco smoke. It is aimed at the entire population of Northern Ireland as smoking and its harmful effects cut across all barriers of class, race and gender. There is a strong relationship between smoking and inequalities, with more people dying of smoking-related illnesses in disadvantaged areas of Northern Ireland than in its more affluent areas. In order to ensure that more focused action is directed to where it is needed the most, three priority groups have been identified. They are: · Children and young people; · Disadvantaged people who smoke; and · Pregnant women, and their partners, who smoke. The Public Health Agency (PHA) is responsible for implementing the strategy and the development of cessation services is a key element of the overall aim to tackle smoking. The 2013/14 Health Survey Northern Ireland reported that 22% of adults currently smoke (23% of males and 21% of females). In addition, in 2013, the Young Persons’ Behaviour and Attitude Survey (YPBAS) found that 6% of pupils aged between and 11 and 16 smoked (7% of males and 5% of females).      

Iowa Immunization Program Annual Report 2013, April 30, 2014

The Bureau of Immunization is part of the Division of Acute Disease Prevention and Emergency Response (ADPER) at the Iowa Department of Public Health (IDPH). The ADPER division provides support, technical assistance and consultation to local hospitals, public health agencies, community health centers, emergency medical service programs and local health care providers regarding infectious diseases, disease prevention and control, injury prevention and public health and health care emergency preparedness and response. The division encompasses the Center for Acute Disease Epidemiology (CADE), the Bureau of Immunization and Tuberculosis (ITB), the Bureau of Emergency Medical Services (EMS), the Bureau of Communication and Planning (CAP), the Office of Health Information Technology (HIT), and the Center for Disaster Operations and Response (CDOR). The Bureau of Immunization and Tuberculosis includes the Immunization Program, the Tuberculosis Control Program, and the Refugee Health Program. The mission of the Immunization Program is to decrease vaccine‐preventable diseases through education, advocacy and partnership. While there has been major advancement in expanding immunizations to many parts of Iowa’s population, work must continue with public and private health care providers to promote the program’s vision of healthy Iowans living in communities free of vaccine‐preventable diseases. Accomplishing this goal will require achieving and maintaining high vaccination coverage levels, improving vaccination strategies among under‐vaccinated populations, prompt reporting and thorough investigation of suspected disease cases, and rapid institution of control measures. The Immunization Program is comprised of multiple programs that provide immunization services throughout the state: Adolescent Immunization Program, Adult Immunization Program, Immunization Registry Information System (IRIS), Vaccines for Children Program (VFC), Perinatal Hepatitis B Program, and Immunization Assessment Program.

Chief Medical Officer's Report - Evidential Base and Clinical Practice Aspects of Congenital Cardiac Services (August 2013) (PDF 77KB)

Report on Evidential Base and Clinical Practice Aspects of Congenital Cardiac Services The principle drivers that should determine the optimal arrangements for the provision of congenital cardiac services, including  paediatric and adult cardiac surgery, for the population of Northern Ireland is how best those services can be configured to ensure the safest possible care that is of the highest quality possible in order to optimise outcomes and experience for patients and carers. Of necessity, this requires consideration of all requisite supporting services and arrangements to ensure access across the continuum of care. Such a configuration should support safe, high quality service provision on an on-going basis i.e. ensure sustainability as far as can be determined. In addressing this issue, consideration to the changing profile of population need and the evolving nature specialist services is required.  

“Digital Diagnostics and Communication (DDC) system” Redesigning the Emergency Ambulance

During the development of a new treatment space for the UK emergency ambulance participatory observations with front-line clinicians revealed the need for an integrated patient monitoring, communication and navigation system. The research identified the different information touch-points and requirements through modes of use analysis, day-in-the-life study and simulation workshops with clinicians. Emergency scenario and role-play with paramedics identified 5 distinct ambulance modes of use. Information flow diagrams were created and checked by paramedics and digital User Interface (UI) wireframes were developed and evaluated by clinicians during clinical evaluations. Feedback from clinicians defined UI design specification further leading to a final design proposal. This research was a further development from the 2007 EPSRC funded “Smart Pods” project. The resulting interactive prototype was co-designed in collaboration with ambulance crews and provides a vision of what could be achieved by integrating well-proven IT technologies and protocols into a package relevant in the emergency medicine field. The system has been reviewed by over 40 ambulance crews and is part of a newly co-designed ambulance treatment space.

Disentangling trade-offs and synergies around ecosystem services with the influence network framework: illustration from a consultative process over the French Alps

An important aspect of sustainability is to maintain biodiversity and ecosystem functioning while improving human well-being. For this, the ecosystem service (ES) approach has the potential to bridge the still existing gap between ecological management and social development, especially by focusing on trade-offs and synergies between ES and between their beneficiaries. Several frameworks have been proposed to account for trade-offs and synergies between ES, and between ES and other components of social-ecological systems. However, to date, insufficient explicit attention has been paid to the three facets encompassed in the ES concept, namely potential supply, demand, and use, leading to incomplete descriptions of ES interactions. We expand on previous frameworks by proposing a new influence network framework (INF) based on an explicit consideration of influence relationships between these three ES facets, biodiversity, and external driving variables. We tested its ability to provide a comprehensive view of complex social-ecological interactions around ES through a consultative process focused on environmental management in the French Alps. We synthetized the interactions mentioned during this consultative process and grouped variables according to their overall propensity to influence or be influenced by the system. The resulting directed sequence of influences distinguished between: (1) mostly influential variables (dynamic social variables and ecological state variables), (2) target variables (provisioning and cultural services), and (3) mostly impacted variables (regulating services and biodiversity parameters). We discussed possible reasons for the discrepancies between actual and perceived influences and proposed options to overcome them. We demonstrated that the INF holds the potential to deliver collective assessments of ES relations by: (1) including ecological as well as social aspects, (2) providing opportunities for colearning processes between stakeholder groups, and (3) supporting communication about complex social-ecological systems and consequences for environmental management.

Changes in biodiversity and trade-offs among ecosystem services, stakeholders, and components of well-being: the contribution of the International Long-Term Ecological Research network (ILTER) to Programme on Ecosystem Change and Society (PECS)

The International Long-Term Ecological Research (ILTER) network comprises > 600 scientific groups conducting site-based research within 40 countries. Its mission includes improving the understanding of global ecosystems and informs solutions to current and future environmental problems at the global scales. The ILTER network covers a wide range of social-ecological conditions and is aligned with the Programme on Ecosystem Change and Society (PECS) goals and approach. Our aim is to examine and develop the conceptual basis for proposed collaboration between ILTER and PECS. We describe how a coordinated effort of several contrasting LTER site-based research groups contributes to the understanding of how policies and technologies drive either toward or away from the sustainable delivery of ecosystem services. This effort is based on three tenets: transdisciplinary research; cross-scale interactions and subsequent dynamics; and an ecological stewardship orientation. The overarching goal is to design management practices taking into account trade-offs between using and conserving ecosystems toward more sustainable solutions. To that end, we propose a conceptual approach linking ecosystem integrity, ecosystem services, and stakeholder well-being, and as a way to analyze trade-offs among ecosystem services inherent in diverse management options. We also outline our methodological approach that includes: (i) monitoring and synthesis activities following spatial and temporal trends and changes on each site and by documenting cross-scale interactions; (ii) developing analytical tools for integration; (iii) promoting trans-site comparison; and (iv) developing conceptual tools to design adequate policies and management interventions to deal with trade-offs. Finally, we highlight the heterogeneity in the social-ecological setting encountered in a subset of 15 ILTER sites. These study cases are diverse enough to provide a broad cross-section of contrasting ecosystems with different policy and management drivers of ecosystem conversion; distinct trends of biodiversity change; different stakeholders’ preferences for ecosystem services; and diverse components of well-being issues.

Scale and ecosystem services: how do observation, management, and analysis shift with scale—lessons from Québec

Ecosystem service assessment and management are shaped by the scale at which they are conducted; however, there has been little systematic investigation of the scales associated with ecosystem service processes, such as production, benefit distribution, and management. We examined how social-ecological spatial scale impacts ecosystem service assessment by comparing how ecosystem service distribution, trade-offs, and bundles shift across spatial scales. We used a case study in Québec, Canada, to analyze the scales of production, consumption, and management of 12 ecosystem services and to analyze how interactions among 7 of these ecosystem services change across 3 scales of observation (1, 9, and 75 km²). We found that ecosystem service patterns and interactions were relatively robust across scales of observation; however, we identified 4 different types of scale mismatches among ecosystem service production, consumption, and management. Based on this analysis, we have proposed 4 aspects of scale that ecosystem service assessments should consider.

The challenges of integrating biodiversity and ecosystem services monitoring and evaluation at a landscape-scale wetland restoration project in the UK

There is an increasing emphasis on the restoration of ecosystem services as well as of biodiversity, especially where restoration projects are planned at a landscape scale. This increase in the diversity of restoration aims has a number of conceptual and practical implications for the way that restoration projects are monitored and evaluated. Landscape-scale projects require monitoring of not only ecosystem services and biodiversity but also of ecosystem processes since these can underpin both. Using the experiences gained at a landscape-scale wetland restoration project in the UK, we discuss a number of issues that need to be considered, including the choice of metrics for monitoring ecosystem services and the difficulties of assessing the interactions between ecosystem processes, biodiversity, and ecosystem services. Particular challenges that we identify, using two pilot data sets, include the decoupling of monetary metrics used for monitoring ecosystem services from biophysical change on the ground and the wide range of factors external to a project that influence the monitoring results. We highlight the fact that the wide range of metrics necessary to evaluate the ecosystem service, ecosystem process, and biodiversity outcomes of landscape-scale projects presents a number of practical challenges, including the need for high levels of varied expertise, high costs, incommensurate monitoring outputs, and the need for careful management of monitoring results, especially where they may be used in making decisions about the relative importance of project aims.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Assessing the impacts of community participation policy and practice in Scotland and England

Background: Community participation has become an integral part of many areas of public policy over the last two decades. For a variety of reasons, ranging from concerns about social cohesion and unrest to perceived failings in public services, governments in the UK and elsewhere have turned to communities as both a site of intervention and a potential solution. In contemporary policy, the shift to community is exemplified by the UK Government’s Big Society/Localism agenda and the Scottish Government’s emphasis on Community Empowerment. Through such policies, communities have been increasingly encouraged to help themselves in various ways, to work with public agencies in reshaping services, and to become more engaged in the democratic process. These developments have led some theorists to argue that responsibilities are being shifted from the state onto communities, representing a new form of 'government through community' (Rose, 1996; Imrie and Raco, 2003). Despite this policy development, there is surprisingly little evidence which demonstrates the outcomes of the different forms of community participation. This study attempts to address this gap in two ways. Firstly, it explores the ways in which community participation policy in Scotland and England are playing out in practice. And secondly, it assesses the outcomes of different forms of community participation taking place within these broad policy contexts. Methodology: The study employs an innovative combination of the two main theory-based evaluation methodologies, Theories of Change (ToC) and Realist Evaluation (RE), building on ideas generated by earlier applications of each approach (Blamey and Mackenzie, 2007). ToC methodology is used to analyse the national policy frameworks and the general approach of community organisations in six case studies, three in Scotland and three in England. The local evidence from the community organisations’ theories of change is then used to analyse and critique the assumptions which underlie the Localism and Community Empowerment policies. Alongside this, across the six case studies, a RE approach is utilised to examine the specific mechanisms which operate to deliver outcomes from community participation processes, and to explore the contextual factors which influence their operation. Given the innovative methodological approach, the study also engages in some focused reflection on the practicality and usefulness of combining ToC and RE approaches. Findings: The case studies provide significant evidence of the outcomes that community organisations can deliver through directly providing services or facilities, and through influencing public services. Important contextual factors in both countries include particular strengths within communities and positive relationships with at least part of the local state, although this often exists in parallel with elements of conflict. Notably this evidence suggests that the idea of responsibilisation needs to be examined in a more nuanced fashion, incorporating issues of risk and power, as well the active agency of communities and the local state. Thus communities may sometimes willingly take on responsibility in return for power, although this may also engender significant risk, with the balance between these three elements being significantly mediated by local government. The evidence also highlights the impacts of austerity on community participation, with cuts to local government budgets in particular increasing the degree of risk and responsibility for communities and reducing opportunities for power. Furthermore, the case studies demonstrate the importance of inequalities within and between communities, operating through a socio-economic gradient in community capacity. This has the potential to make community participation policy regressive as more affluent communities are more able to take advantage of additional powers and local authorities have less resource to support the capacity of more disadvantaged communities. For Localism in particular, the findings suggest that some of the ‘new community rights’ may provide opportunities for communities to gain power and generate positive social outcomes. However, the English case studies also highlight the substantial risks involved and the extent to which such opportunities are being undermined by austerity. The case studies suggest that cuts to local government budgets have the potential to undermine some aspects of Localism almost entirely, and that the very limited interest in inequalities means that Localism may be both ‘empowering the powerful’ (Hastings and Matthews, 2014) and further disempowering the powerless. For Community Empowerment, the study demonstrates the ways in which community organisations can gain power and deliver positive social outcomes within the broad policy framework. However, whilst Community Empowerment is ostensibly less regressive, there are still significant challenges to be addressed. In particular, the case studies highlight significant constraints on the notion that communities can ‘choose their own level of empowerment’, and the assumption of partnership working between communities and the local state needs to take into account the evidence of very mixed relationships in practice. Most importantly, whilst austerity has had more limited impacts on local government in Scotland so far, the projected cuts in this area may leave Community Empowerment vulnerable to the dangers of regressive impact highlighted for Localism. Methodologically, the study shows that ToC and RE can be practically applied together and that there may be significant benefits of the combination. ToC offers a productive framework for policy analysis and combining this with data derived from local ToCs provides a powerful lens through which to examine and critique the aims and assumptions of national policy. ToC models also provide a useful framework within which to identify specific causal mechanisms, using RE methodology and, again, the data from local ToC work can enable significant learning about ‘what works for whom in what circumstances’ (Pawson and Tilley, 1997).

Customer Support, Motivation to participate and participation in services : a first step.

International audience

Agency Accountability Report Fiscal Year 1998-99

This accountability report from the Department of Probation, Parole and Pardon Services describes the agency's mission, key strategic changes, major accomplishments and strategic planning.