The impact of personal resources and their goal relevance on satisfaction with food-related life among the elderly.

The study explored how actual resources, perceived levels of different types of resources and goal relevance of these resources affect older people's satisfaction with food-related life using a survey in eight European countries, where 3291 participants above 65 years of age and living in their own homes took part. Satisfaction with food-related life was measured using Satisfaction With Food-related Life (SWFL) scale developed by Grunert, Raats, Dean, Nielsen, Lumbers and The Food in Later Life Team. [(2007). A measure of satisfaction with food-related life. Appetite, 49, 486–493]. Results showed that older people rated the resources that they believed to have plentiful of as being highly relevant to achieve their goals. The individuals who rated the relevance and their level of different resources as high were also more satisfied with their food-related quality of life. Further, satisfaction with food-related life, as was expected, was predicted by income, health measures and living circumstances. However, the study also showed that perceived levels of other resources such as support of family and friends, food knowledge, storage facilities also added to the individuals’ satisfaction with food-related life. In addition, the congruence between perceived level and relevance of a resource was also shown to add to people's satisfaction with food-related life, implying that older people's satisfaction with food-related life depends not only on the level of resources they think they have but also on their goals and how important they think these resources are to achieving their goals.

Risks to home care workers: Professional perspectives

Care at home is fundamental to community care policy, but the simultaneous growth of health and safety regulation has implications for home care services because of the duty of employers towards home care workers. This grounded theory study set in Northern Ireland used data from 19 focus groups and nine semi-structured interviews with a range of health and social services professionals and managers to explore perspectives on planning long term care for older people. Home care workers faced a wide range of hazards in the homes of clients, who themselves were faced with adapting their living habits due to their changing health and care needs and 'risks.' Creative approaches were used to ensure the health and safety of home care workers and simultaneously to meet the choices of clients. Staff experienced feelings of conflict when they judged it necessary to impose their way of providing home care and thus impose their values on clients to create a safe working environment. There was variation between and within organizations in terms of the staff focus on client needs or on their employer responsibility towards home care workers. The planning of home care services must take account of both the choices of clients and the hazards facing home care staff.

The effect of patient characteristics upon uptake of the influenza vaccination: a study comparing community based older adults in two healthcare systems

Background: Uptake of influenza vaccination represents a simple marker of proactive care of older people. However, many still do not receive the vaccine. To understand this challenge better, we investigated the relationship between patient characteristics (demographic, physical and psychological health, and health service use) and vaccination uptake in a sample of community-dwelling older people in two adjacent but differently structured healthcare systems (Northern Ireland (NI) and the Republic of Ireland (RoI)). Methods: 2,033 randomly selected community-dwelling older adults (65 years and older) were interviewed in their homes. Results: Rates of uptake were 78% in NI and 72% in RoI. Uptake was greater with older age (odds ratio (OR) 1.6, 95% confidence interval (CI) = 1.3-2.1, p

An evaluation of a domiciliary blood transfusion serivce for palliative care patients in Northern Ireland

Marie Curie Cancer Care (MCCC) is a national charitable organisation which provides specialist palliative care services to patients with cancer and other life limiting illnesses. Marie Curie Nursing Service (MCNS) provides nursing services to patients in their own homes. The administration of blood transfusions to palliative care patients is required to improve symptom management and quality of life; however this procedure often results in unnecessary hospital admissions. Recognising that the majority of patients wish to be cared for and die in their own home, and with National Guidance recommending that specialist palliative care services should be provided to patients in their preferred place of care, a recent service initiative by MCNS was domiciliary blood transfusions. Whilst this is not a new service within domiciliary care, this pilot project aimed to capture patient views to evaluate this service initiative. Telephone interviews were conducted, using a questionnaire, with 11 patients who had received the service. Findings indicated positive evaluation of the service. Domiciliary blood transfusions helped to avoid unnecessary hospital admissions, the quality of life of patients and their families was improved in the palliative phase of illness and they received the service in their preferred place of care.

To what extent do children with cerebral palsy participate in everyday life situations?

The aims of the study are to describe participation of children with cerebral palsy in everyday life situations, to investigate the relationship between participation (primary outcome variable) with child and parent characteristics (independent variables) and to compare the frequency of participation (secondary outcome variable) of children with cerebral palsy with children without disabilities. A cross-sectional survey of parents of children with cerebral palsy in Northern Ireland was undertaken in families’ homes using standard questionnaires. Children with cerebral palsy born between 31/8/1991 and 1/4/1997 were identified from a case register of people with the condition. A total of 102 parents opted in (51% response rate). Questionnaires included the Life Habits Questionnaire (Life-H) to measure difficulties in participation and The Frequency of Participation Questionnaire (FPQ), to measure frequency of participation with comparative data for children without disability. Overall, children with cerebral palsy participated less often than their non-disabled peers across a number of lifestyle and cultural pursuits. Among the 102 children with cerebral palsy, participation in ‘relationships’ was the least disrupted area of everyday life and aspects of ‘school’, ‘personal care’ and ‘mobility’ were the most disrupted. Children with cerebral palsy and severe co-impairments were significantly less likely to experience higher levels of participation in most areas of everyday life when compared to children with cerebral palsy and no severe co-impairments. Child physical and psychological well-being did not influence participation although higher parenting stress was significantly related to lower child participation in ‘community activities’. Participation is an important health outcome for children with cerebral palsy and should be incorporated in routine clinical practice. Professionals have a role to play both at the level of addressing individual child and family needs as well as influencing legislation and policy to ensure improved access to services and local communities.

A Cluster Randomized Controlled Trial of an Adapted U.S. Model of Pharmaceutical Care for Nursing Home Residents in Northern Ireland (Fleetwood Northern Ireland Study): A Cost-Effectiveness Analysis

OBJECTIVES: To evaluate the cost-effectiveness of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).
DESIGN: Economic evaluation alongside a cluster randomized controlled trial.
SETTING: Nursing homes in NI randomized to intervention (receipt of the adapted model of care; n511) or control (usual care continued; n511).
PARTICIPANTS: Residents aged 65 and older who provided informed consent (N5253; 128 intervention, 125 control) and who had full resource use data at 12 months.
INTERVENTION: Trained pharmacists reviewed intervention home residents’ clinical and prescribing information for 12 months, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to make changes. The control homes received usual care in which there was no pharmacist intervention.
MEASUREMENTS: The proportion of residents prescribed one or more inappropriate psychoactive medications (according to standardized protocols), costs, and a cost-effectiveness acceptability curve. The latter two outcomes are the focus for this article.
RESULTS: The proportions of residents receiving inappropriate psychoactive medication at 12 months in the intervention and control group were 19.5% and 50.4%, respectively. The mean cost of healthcare resources used per resident per year was $4,923 (95% con?dence interval.

The Belfast Victorian Terrace: A Sustainable Approach?

To help the building of new low-carbon housing, recent years have seen the widespread demolition of Victorian housing in UK cities. In this regard, Belfast is no different from its counterparts on the British mainland, where Compulsory Purchase Orders force people to sell and vacate their terraced homes to make way for newly constructed 'sustainable' housing. The global economic downturn has temporarily slowed down this process leaving many Belfast terraces now blocked up awaiting future demolition. This stay of execution is an unlikely but welcome opportunity to review and assess the true value to owner, streetscape and city of this important and common house-type. Important questions need to be asked. Should sound Victorian terraces be demolished? What is the genuine cost of demolition and replacement in terms of community and environment? With reference to case studies in a Belfast context, the argument will be made that new is not necessarily better, that the existing Victorian terrace is an important and valuable resource and one that, with intelligent intervention, offers a genuinely sustainable alternative to new-build housing.

“Building performance evaluation: The case of McClay Library”

The government of the UK has set an ambitious target that all newly built homes be carbon neutral by 2016 and to achieving an overall 80% carbon emission by 2050. Carbon Trust in 2009 published a research revealing that non-domestic buildings accounted for 18% of the emissions in the UK. They argued that to achieve the targets of low carbon emission there is need for better building stock that are better used. The evaluation of the performance of buildings is therefore critical if the understanding of how they are used is to be known. This paper is a brief building performance evaluation of the newly build library at Queens University Belfast carried out during the summer of 2010. It employed the Post-Occupancy Evaluation (POE) methodology to assess its performance. The results reveal that despite the intelligent technologies in the building there was a mismatch between the measured data and the perception of users of its performance. The study suggests the need for further study for reasons of dichotomy of the data. Keywords: building performance evaluation, carbon reduction strategies, passive environmental design techniques, active renewable energy technologies, Northern Ireland

An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).

DESIGN: Cluster randomized controlled trial.

SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).

INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.

MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.

RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.

CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.

How the ship of fools was ship-wrecked - The Irish crisis and response

For a decade and half the Irish economy was the poster-boy of Europe. With substantial growth rates, an open economy, flexible labour markets and low levels of taxation, Ireland was seen as evidence of the success of neoliberal policies. Yet in the matter of a few short years Ireland has turned into a one of the peripheral black-holes (along with Greece and Portugal) that are threatening to bring down the whole Eurozone project. Given this context the paper will address two key questions. Firstly how did the much eulogised Celtic Tiger fall so far and so fast? And, secondly, what has been the government’s response to the fall and crash of the Irish economy? These two questions will be addressed through both a general historical analysis of the developments of Irish society up to the crash in 2008 and then the responses to it. Secondly by an analysis of two specific elements of that development; namely the much discussed low corporation tax rate and the failure of social housing to deliver decent affordable homes for those at the bottom of society. The third element is a review of the banking and sovereign debt crisis that led to the IMF/EU deal in November 2010 and a brief outlining of its implications for public finances, especially the question of default. The paper concludes by placing the Irish crisis in a global context.

Longitudinal Pathways Between Political Violence and Child Adjustment: The Role of Emotional Security about the Community in Northern Ireland

Links between political violence and children's adjustment problems are well-documented. However, the mechanisms by which political tension and sectarian violence relate to children's well-being and development are little understood. This study longitudinally examined children's emotional security about community violence as a possible regulatory process in relations between community discord and children's adjustment problems. Families were selected from 18 working class neighborhoods in Belfast, Northern Ireland. Participants (695 mothers and children, M=12.17, SD=1.82) were interviewed in their homes over three consecutive years. Findings supported the notion that politically-motivated community violence has distinctive effects on children's externalizing and internalizing problems through the mechanism of increasing children's emotional insecurity about community. Implications are considered for understanding relations between political violence and child adjustment from a social ecological perspective.

Nostalgically Man dwells on this Earth: Objects and domestic space in The Royal Tenenbaums and The Darjeeling Ltd

The films of Wes Anderson feature a peculiar attention to the representation of dwellings in relation to narrative development, filmic style and characters' identities. As is true of clothing, in Anderson's cinema homes with their architecture, furniture and objects strongly contribute to a nostalgic dislocation of the characters from contemporary time. Considering the house as the prime locus of identity and the core of the patriarchal family, the family home is often depicted by Anderson as the last physical trace left by the absent father; a utopian place that the characters aim to rebuild or to recall through its objectification. This paper aims to analyse the (re)construction of the family home in The Royal Tenenbaums, and will investigate its absence and surrogates in The Darjeeling Ltd.

Parenting Control in Contexts of Political Violence: Testing Bidirectional Relations Between Violence Exposure and Control in Post-Accord Belfast

Objective. The authors examined bidirectional relations between youth exposure to sectarian and nonsectarian antisocial behavior and mothers' efforts to control youths' exposure to community violence in Belfast, Northern Ireland. Design. Mother-child dyads (N = 773) were interviewed in their homes twice over 2 years regarding youths' exposure to sectarian and nonsectarian community antisocial behavior and mothers' use of control strategies, including behavioral and psychological control. Results. Youths' exposure to nonsectarian antisocial behavior was related to increases in mothers' use of behavioral and psychological control strategies over time, controlling for earlier levels of these constructs. Reflecting bidirectional relations, mothers' behavioral control strategies were associated with youths' reduced exposure to nonsectarian and sectarian antisocial behavior over time, whereas psychological control was not related to reduced exposure. Conclusion. Only nonsectarian community violence was associated longitudinally with mothers' increased use of control strategies, and only behavioral control strategies were effective in reducing youths' exposure to community antisocial behavior, including sectarian and nonsectarian antisocial behavior.

Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep 'my home'

Background Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors.
Aims To analyse the probability of admission to residential and nursing home care according to housing tenure and house value.
Methods Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of approximate to 28% of the population of Northern Ireland.
Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters.
Conclusions The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.

The Association of Ownership Type With Job Insecurity and Worry About Job Stability The Moderating Effects of Fair Management, Positive Leadership, and Employment Type

This study examined whether the ownership type is associated with job insecurity and worry about job stability and whether the type of employment contract, positive leadership, and fair management moderated these associations. Survey data from 1249 Finnish female elderly care staff aged 18 to 69 years were used. Job insecurity and worry about job stability were highest in not-for-profit sheltered homes. However, positive leadership and fair management were able to mitigate this insecurity and worry. Job insecurity was highest among fixed-term employees in public sheltered homes or not-for-profit nursing homes. Thus, promoting good leadership and fair management would be of importance.