Revolution blues: the reconstruction of Health and Safety as a ‘common-sense’ form of regulation

This paper provides a review of the last five years of policymaking in the area of health and safety law; this includes multiple reviews, legislative reform, and the reframing of rhetoric around the issue. It characterises this as a process of social construction of a new ‘universe of meaning’ around health and safety regulation, which provides a basis for a particular, narrow, neoliberal conception of regulation and responsibility to permeate the mainstream. Deliberative and public-facing policymaking processes have been utilised as a key element of this process.

Treatment of child anxiety in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

Background Cognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. Objectives This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. Design Participants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI). Setting A NHS university clinic in Berkshire, UK. Participants Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. Interventions All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. Main outcome measures Primary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty. Results MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. Conclusions Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. Trial registration Current Controlled Trials ISRCTN19762288. Funding This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38.

Peak residential electricity demand and social practices: Deriving flexibility and greenhouse gas intensities from time use and locational data

Peak residential electricity demand takes place when people conduct simultaneous activities at specific times of the day. Social practices generate patterns of demand and can help understand why, where, with whom and when energy services are used at peak time. The aim of this work is to make use of recent UK time use and locational data to better understand: (i) how a set of component indices on synchronisation, variation, sharing and mobility indicate flexibility to shift demand; and (ii) the links between people’s activities and peaks in greenhouse gases’ intensities. The analysis is based on a recent UK time use dataset, providing 1 minute interval data from GPS devices and 10 minute data from diaries and questionnaires for 175 data days comprising 153 respondents. Findings show how greenhouse gases’ intensities and flexibility to shift activities vary throughout the day. Morning peaks are characterised by high levels of synchronisation, shared activities and occupancy, with low variation of activities. Evening peaks feature low synchronisation, and high spatial mobility variation of activities. From a network operator perspective, the results indicate that periods with lower flexibility may be prone to more significant local network loads due to the synchronization of electricity-demanding activities.

Improving the health forecasting alert system for cold weather and heat-waves in England: a proof-of-concept using temperature-mortality relationships

Objectives In this study a prototype of a new health forecasting alert system is developed, which is aligned to the approach used in the Met Office’s (MO) National Severe Weather Warning Service (NSWWS). This is in order to improve information available to responders in the health and social care system by linking temperatures more directly to risks of mortality, and developing a system more coherent with other weather alerts. The prototype is compared to the current system in the Cold Weather and Heatwave plans via a case-study approach to verify its potential advantages and shortcomings. Method The prototype health forecasting alert system introduces an “impact vs likelihood matrix” for the health impacts of hot and cold temperatures which is similar to those used operationally for other weather hazards as part of the NSWWS. The impact axis of this matrix is based on existing epidemiological evidence, which shows an increasing relative risk of death at extremes of outdoor temperature beyond a threshold which can be identified epidemiologically. The likelihood axis is based on a probability measure associated with the temperature forecast. The new method is tested for two case studies (one during summer 2013, one during winter 2013), and compared to the performance of the current alert system. Conclusions The prototype shows some clear improvements over the current alert system. It allows for a much greater degree of flexibility, provides more detailed regional information about the health risks associated with periods of extreme temperatures, and is more coherent with other weather alerts which may make it easier for front line responders to use. It will require validation and engagement with stakeholders before it can be considered for use.

The use of ICT by adults with learning disabilities in day and residential services

The use of Information and Communication Technology (ICT) by adults with learning disabilities has been positively promoted over the past decade. More recently, policy statements and guidance from the UK government have underlined the importance of ICT for adults with learning disabilities specifically, as well as for the population in general, through the potential it offers for social inclusion. The aim of the present study was to provide a picture of how ICT is currently being used within one organisation providing specialist services for adults with learning disabilities and more specifically to provide a picture of its use in promoting community participation. Nine day and 14 residential services were visited as part of a qualitative study to answer three main questions: What kinds of computer programs are being used? What are they being used for? Does this differ between day and residential services? Computers and digital cameras were used for a wide range of activities and ‘mainstream’ programs were used more widely than those developed for specific user groups. In day services, ICT was often embedded in wider projects and activities, whilst use in houses was based around leisure interests. In both contexts, ICT was being used to facilitate communication, although this was more linked to within-service activities, rather than those external to service provision.

Ecological and social drivers of coffee pollination in Santander, Colombia

Bees and other insects provide pollination services that are key to determining the fruit set on coffee plantations. These pollination services are influenced by local ecology as well as human factors, both social and economic. To better understand these different factors, we assessed their effect on pollinators and coffee pollination services in Santander, Colombia. We quantified the effect of key ecological drivers on pollinator community composition, such as the method of farm management (either conventional or organic) and the surrounding landscape composition, specifically the proximity to forest. We found that ambient levels of pollination services provided by the local pollinator fauna (open pollination) accounted for a 10.5 ± 2.0% increase in final coffee fruit set, and that the various pollinators are affected differently by the differing factors. For example, our findings indicate that conventional farm management, using synthetic inputs, can promote pollinators, especially if they are in close proximity to natural forest fragments. This is particularly true for stingless bees. Honeybee visitation to coffee is also positively influenced by the conventional management of farms. Factors associated with greater numbers of stingless bees on farms include greater shade cover, lower tree densities, smaller numbers and types of trees in bloom, and younger coffee plantations. A forested landscape close to farms appears to enhance these factors, giving increased stability and resilience to the pollinating bees and insects. However we found that organic farms also support diverse pollinator communities, even if distant from forest fragments. The contribution of honeybees to pollination value (US$129.6/ha of coffee) is greater than that of stingless bees (US$16.5/ha of coffee). Since the method of farm management has a major impact on the numbers and types of pollinators attracted to farms, we have analysed the statistically significant social factors that influence farmers’ decisions on whether to adopt organic or conventional practices. These include the availability of technology, the type of landowner (whether married couples or individual owners), the number of years of farmers’ formal education, the role of institutions, membership of community organizations, farm size, coffee productivity and the number of coffee plots per farm. It is hoped that the use of our holistic approach, which combines investigation of the social as well as the ecological drivers of pollination, will help provide evidence to underpin the development of best practices for integrating the management of pollination into sustainable agricultural practices.

Parenthood in transition : Somali-born parents' experiences of and needs for parenting support programmes

BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting. METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied. RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities. CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

Enviromental health

Edited by two leading public health physicians with chapters written by 48 experts in various aspects of social injustice, this book addresses social injustice and its relationship to public health. Major sections of the book focus on how the health of specific population groups is affected by social injustice, how specific areas of public health and medical care are affected by social injustice, and what needs to be done to reduce social injustice and its impact on health. This book will be of value to a wide range of practitioners and students in health and human services, including medicine, nursing, and social services, as well as in law and other fields.

Playing their part: the role of physical activity and sport in sustaining the health and well being of small rural communities

It is widely recognised that the health of rural Australians is poor in comparison with their urban counterparts. Similarly, the role played by physical activity in maintaining health has been well researched and is well documented. However, little appears to have been published in recent years about the links between physical activity and health in rural communities. The objective of this article was to begin to address that gap. To achieve this, the article drew on research conducted in two small rural communities in Victoria Australia, and highlighted the role that physical activity and sport played in sustaining the health and wellbeing of individuals and communities in rural areas. Taking the World Health Organisation's definition of health (a state of complete physical, mental and social well-being and not merely the absence of disease) as its measure, the paper highlighted the many ways in which physical activity and sport in rural communities contribute to physical health, mental wellbeing and social cohesiveness. Based this finding, the authors suggest that physical activity and sport make a significant contribution to the health and wellbeing of rural people and their communities and suggest that further research is necessary to better define this apparent contribution.

Using environmental interventions to create sustainable solutions to problems to health and wellbeing

Recent research by Deakin University, in collaboration with Parks Victoria and its Strategic Partners, indicates that contact with nature may promote human health and wellbeing. International research indicates that simply viewing a natural scene or watching wildlife reduces stress and tension, improves concentration, remedies mental fatigue, boosts immunity, and enhances psychological health. This is aside from any physical health benefits flowing from reduced stress, increased exercise and improved air quality when contact with nature involves activities in natural environments. The literature suggests that interacting with nature through gardening or having a companion animal is also beneficial for health, and where these activities involve contact with other humans, might extend benefits beyond the individual to the community, through enhanced social capital. This paper sets out the potential scope of work flowing from the initial research, in terms of target groups, research foci, intervention strategies, and likely benefits, and reports on progress in establishing a program of Australian,based empirical research. It proposes the establishment of alliances between researchers and practitioners in a range of disciplines (including environmental health) to ensure that the links between contact with nature and human health and wellbeing are explored and expressed in ways that are both beneficial and sustainable.

Promoting the health and well being of older carers : a proactive strategy

Research has indicated that carers are concerned about their ageing status, their deteriorating health and their ability to continue to care for their dependants. Given that the health care system will become increasingly reliant on carers the health care needs of carers should be a concern for all health care professionals. This paper describes the first stage of a project designed to enhance older carers health promotion knowledge and skills and improve their health promoting behaviours. This stage investigated the mental and physical health status of older carers. It also sought information on older carers' levels of participation in health related and social activities and identification of barriers to participation in these types of activities. The results highlighted that carers responding to the survey experienced compromised physical and mental health. Many carers reported being unable to participate in social and health-type activities as they were unable to leave the care recipient. Of note, is that carers identified their own mental fragility and felt they needed further emotional support.

Service provision factors that affect the health and wellbeing of people living in a lower SES environment: the perspective of service providers

Inequalities in health and wellbeing within low socioeconomic (SES)  environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate seroiceprovision, contribute to the poorer health status ofresidents oflow SES areas. This paper explores the issues ofseroice provision in low SES areas, documenting the perceptions of seroice providers about the seroice needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of54 health and welfare seroice providers from two adjacent low SES suburbs within regional Victoria were interoiewed using qualitative research methods. Keyfindings indicate that successful navigation of health care seroices by residents within these low SES environments is being impeded by issues ofaccess, a lack ofappropriate early interoention options or measures, and general resident disempowerment. Central to the improvement of seroice provision is the need for seroices to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting seroices must be reflected in the ethos ofseroice provision.

Teaching social work online: dilemmas and debates

The stampede towards delivering tertiary education online has been well documented in the academic literature and newspaper media. A great deal of this writing has been characterised by an acute division between those who support and those who deplore this paradigm shift in the way education is offered to students. Not withstanding a few notable exceptions, social work as a discipline has yet to fully engage in this debate, watching, as emerging technologies radically change the way education and social services are delivered. This article provides an overview of the literature related to online learning in social work. In particular the global context influencing the delivery of education is investigated; the major themes emerging from the literature are highlighted; the opportunities and obstacles for teaching and learning social work online are examined, and finally questions relating to the cultural implications for delivering social work education online are identified using a constructivist framework.

Population health and wellbeing: identifying priority areas for Victorian children

Background
Population health information, collected using soundly-designed methodologies, is essential to inform policy, research, and intervention programs. This study aimed to derive policy-oriented recommendations for the content of a health and wellbeing population survey of children 0–12 years living in Victoria, Australia.

Results
Qualitative interviews were conducted with 54 academic and policy stakeholders, selected to encompass a wide breadth of expertise in areas of public health and inter-sectoral organisations relevant to child health outcomes, including universities, government and non-government agencies across Victoria. These stakeholders were asked to provide advice on strategic priorities for child health information (data) using a structured interview technique. Their comments were summarised and the major themes were extracted. The priority areas of health and wellbeing recommended for regular collection include obesity and its determinants, pregnancy and breastfeeding, oral health, injury, social and emotional health and wellbeing, family environment, community, health service utilisation, illness, and socioeconomic position. Population policy questions for each area were identified.

Conclusion
In contrast to previous population survey programs nationally and internationally, this study sought to extract contemporary policy-oriented domains for inclusion in a strategic program of child health data collection, using a stakeholder consultation process to identify key domains and policy information needs. The outcomes are a rich and relevant set of recommendations which will now be taken forward into a regular statewide child health survey program.

Health and well-being naturally: 'contact with nature' in health promotion for targeted individuals, communities and populations

Issue addressed: The increase in mental health disorders worldwide makes it important to recognise health promotion interventions that are effective, accessible and affordable. Although natural spaces are coming to be recognised as health-promoting settings for general populations, little is understood about the use of nature contact in treatment and care for individuals experiencing ill-health.

Methods: This paper provides a summary of key research findings and presents a case study examining the self reported health and well-being benefits of nature contact for a small clinical sample. The 'Spectrum of Interventions for Mental Health Problems and Mental Disorders' provides a conceptual framework for ordering current and future information relating to nature-based interventions.

Results: Evidence demonstrates that separately, physical activity, social connection, and contact with nature enhance human health and well-being. The case example illustrates how 'active', 'social' and 'adventurous' contact with nature may be combined within a treatment intervention to protect and enhance the health of individuals experiencing chronic mental, emotional and physical health difficulties.

Conclusions: 'Contact with nature' constitutes a health promotion strategy with potential application in prevention, early intervention, treatment and care. Recommendations include further research to investigate the benefits of nature contact within existing interventions, and the impacts of 'active' and 'social' nature contact within tailored interventions for targeted individuals and communities.