The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

A methodological framework for studying policy coherence for development

The purpose of this article is to develop a methodological framework for analyzing Policy Coherence for Development (PCD). With this goal, we analyze different views of PCD in order to establish a comprehensive approach of Coherence adapted to globalization process. In this context, the article proposes a methodological framework based on four dimensions of analysis in CPD. In each dimen-sion, we set the areas and actors to investigate and we put forward research questions that could be use as a guide for a comprehensive approach to study PCD.

Bolsa Familia Program and school enrolment: An analysis of the 2010 Brazilian demographic census

The Bolsa Família Program goal is to promote social development and poverty reduction, through the direct transfer of conditional cash, in association with other social programs. This study aims to analyze whether Bolsa Família had an association with children’s school attendance, which is one of the educational conditions of the program. Our main hypothesis is that children living in households receiving Bolsa Família had greater chances of attending school. Data from the Ministry of Social Development and Combating Famine indicated that children living in households with Bolsa Família had greater school enrolment levels. By using data from the 2010 Demographic Census, collected by the Brazilian Institute of Geography and Statistics (IBGE), some descriptive analyzes and binary logistic regression models were performed for different thresholds of household per capita income. These estimates were made by comparing children who lived in households receiving Bolsa Família to those children not receiving the program. We took into consideration characteristics about the household, mothers, and children. The results were clustered by the municipality of residence of the child. In all income thresholds, children benefi ting from Bolsa Família were more likely to be enrolled in school, compared to children not receiving the benefi t.

Dynamic analysis of employment trajectories through the concept of fl exicurity

The paper presents a dynamic study of the Spanish labour market which tries to determine if it matches the characteristics of transitional labour markets from a fl exicurity approach. Employment trajectories of Spanish workers during the years 2007-2010 are studied using the Continuous Sample of Working Lives. This period covers the end of the expansion of the Spanish economy and the beginning of the current employment crisis. From the combination of the chosen topic, the approach, and the database used, this is a novel perspective in our country. The article shows evidence of the evolution of the employment and unemployment spells, the Spanish labour market turnover degree, and the diffi culties of some groups for carrying out transition between employment and unemployment. The results obtained show a labour market in which a) transitions have come to a halt, and b) there is high job insecurity.

The training in social and solidarity economy. Analysis of the university offer in Spain

This research analyses the importance of the training for the promotion of the social economy in two ways: 1) focusing on the characteristics of the educational offer of Social Economy and 2) analyzing its differences regarding to those studies from the Management, entrepreneurship, and innovations areas. To this aim, it is carried out as a first step a literature review of the contributions that study the relationships that can exist between the education and Economy. Then, being based on this previous analysis, we already center our research on the Social Economy sector and its relations with the education system. To get this objective, it has been developed a database that includes all the postgraduate titles related to the Economics area. Likewise, a questionnaire has been designed with the aim of characterize the training in social Economy. As a conclusion, it is obtained that the training in social economy in postgraduate studies in the Spanish Universities is very poor. On the other hand, there are significant differences between Social Economy degrees and Business Management, entrepreneurship and innovation degrees with regard to different aspects such as: values to transmit, competencies, skills, the way of understanding the Economy, etc. Based on these conclusions, different recommendations are proposed in order to promote and boost this other way of doing Economy through the training and education in postgraduate studies.

The influence of gender in the direction of Spanish cooperative societies on profitability and indebtedness: an empirical analysis

In this paper the claim for the market for a new business management to ensure the presence of women in decision -making to respond to new social needs addressed. Thus, this paper analyzes the influence of gender diversity of the directors on the profitability and the level of debt for a sample of 5,199 Spanish cooperatives. Unlike capitalist societies, these organizations have a number of peculiarities in their government, and that the partners are themselves major time, agents and customers. The study focuses on the Spanish context, where there is an open debate on the importance of women's business management, as in other countries, driven by the proliferation of legislation on gender equality, being, in addition, Spain, the pioneer in having specific legislation on Social Economy. The results show that cooperatives with greater female representation in theirs Boards have higher profitability. On the other hand, those Boards with a higher percentage of women show a lower level of indebtedness.

Determining factors of the innovative behavior of cooperatives: an analysis of the case of Castilla y León

Cooperatives have a long historical experience in the Spanish economy and have demonstrated their ability to compete against traditional firms in the market. To maintain this capability, while taking advantage of the competitive advantages associated with their idiosyncrasies as social economy enterprises, they should take into consideration that the economy is increasingly globalized and increasingly knowledge-based, especially with regards to technological content. As a consequence, the innovative capacity appears to be a key aspect in order to be able to challenge competitors. This article characterizes the innovative behavior of cooperatives in the region of Castile and Leon and analyses the internal and external factors affecting their innovative performance, based on data from a survey of 581 cooperatives. The results of the empirical analysis, which is performed by multivariate binary logistic regression on various types of innovation, lead us to identify the size of the organizations, the existence of planning, the R & D activities and the human capital as the main determining factors.

Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between service user and professional social work discourses and provides a critical commentary on their respective contributions to the recent review of mental health policy and legislation in Northern Ireland. The analysis indicates that dominant trends in mental health care, as mediated through service structures and institutional identities, have tended to prioritize the more coercive aspects of the social work role and reinforce existing power inequalities with service users. It is argued that such developments underline the need for a ‘refocusing’ debate in mental health social work to consider how a more appropriate balance can be achieved between its participatory/empowering and regulatory/coercive functions. Whilst highlighting both congruence and dissonance between respective discourses, the paper concludes that opportunities exist within the current change process for service users and social workers to build closer alliances in working together to reconstruct practice, safeguard human rights and develop innovative alternatives to a traditional bio-medical model of treatment.

Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study

Objective : To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design : Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. Setting : Acute district hospital, Northern Ireland. Participants : Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. Results : Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in `real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. Conclusions : The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. Palliative Medicine 2007; 21 : 305—312 Key Words: do not attempt resuscitation (DNAR) • end stage illness • inter-professional • policy • resuscitation decisions

Recent policy initiatives in early childhood and the challenges for the social work profession

The Labour Government in the UK has announced, as part of its launch of The Children's Plan, that it 'wants to make this country the best place in the world for children and young people to grow up' in. This latest Plan is further evidence of the surge of interest that there has been in children (and, in particular, early childhood) over the last ten years in the UK and indeed elsewhere. Many of the recent policy and practice initiatives have implications for social workers working with young children. Yet, social work as a profession, in comparison with education, has remained relatively silent on these initiatives and it is hard to find any critical analysis of these developments in terms of either their underlying discourses or their implications for social workers. This article sets out to address these gaps by providing a critical analysis of: what types of knowledge regarding the early years have gained political currency; why and how this is the case; and what the implications are for the role and practices of social workers. The article proposes that discourses of 'need' and 'provision' mask more powerful discourses of economics, social control and risk avoidance, and it concludes by advocating more critically reflexive social work practice with young children and their families.