Association of physical activity with future mental health in older, mid-life and younger women

Background: Mental ill-health, particularly depression and anxiety, is a leading and increasing cause of disability worldwide, especially for women.

Methods: We examined the prospective association between physical activity and symptoms of mental ill-health in younger, mid-life and older working women. Participants were 26 913 women from the ongoing cohort Finnish Public Sector Study with complete data at two phases, excluding those who screened positive for mental ill-health at baseline. Mental health was assessed using the 12-item General Health Questionnaire. Self-reported physical activity was expressed in metabolic equivalent task (MET) hours per week. Logistic regression models were used to analyse associations between physical activity levels and subsequent mental health.

Results: There was an inverse dose–response relationship between physical activity and future symptoms of mental ill-health. This association is consistent with a protective effect of physical activity and remained after adjustments for socio-demographic, work-related and lifestyle factors, health and body mass index. Furthermore, those mid-life and older women who reported increased physical activity by more than 2 MET hours per week demonstrated a reduced risk of later mental ill-health in comparison with those who did not increase physical activity. This protective effect of increased physical activity did not hold for younger women.

Conclusions: This study adds to the evidence for the protective effect of physical activity for later mental health in women. It also suggests that increasing physical activity levels may be beneficial in terms of mental health among mid-life and older women. The alleviation of menopausal symptoms may partly explain age effects but further research is required.

Proximity to a tobacco store and smoking cessation:A cohort study

Background
It is not clear whether the availability of tobacco affects the likelihood of smoking cessation. We examined whether the proximity to a tobacco store and
the number of stores were associated with smoking cessation, and compared results for proximity variables based on walking and straight-line (as the crow flies) distance.

Methods
The study population consisted of 8751 baseline smokers from the Finnish Public Sector study in 1997–2005. Smoking intensity (cigarettes/day) was
determined at baseline and smoking cessation was determined from a follow-up survey in 2008–2009. Proximity was measured using straight-line and walking
distance from home to the nearest tobacco store, and another exposure variable was the number of stores within 0.50 km from home. We calculated associations
with log-binomial regression models, adjusting for individual-level and area-level confounders.

Results
Of the participants, 3482 (39.8%) quit smoking during the follow-up (mean follow-up 5.5 years, SD 2.3 years). Among men who were moderate/heavy smokers at baseline and lived <0.50 km walking distance from the nearest tobacco store, the likelihood of smoking cessation was 27% (95% CI 12% to 40%) lower compared with those living ≥0.50 km from a store. Having even one store within 0.50 km walking distance from home decreased cessation in men who were moderate/heavy smokers by 37% (95% CI 19% to 51%). No decrease was found for men who were light smokers at baseline or for women.

Conclusions
Living within walking distance of a tobacco store reduced the likelihood of smoking cessation among men who were moderate/heavy smokers.

Brunetta’s reform swan song? An assessment of its success in local governments through the analysis of its tools

The work aims at assessing the success of Brunetta’s reform (Legislative Decree n. 150/2009), a far-reaching reform that aimed at improving both organizational and individual performance in Italian public administration through a specific planning and control process (the performance cycle) and most of all through two new tools, Performance Plan and Performance Report. The success of the reform is assessed, with particular emphasis on local governments, analyzing the diffusion and use of these new tools. The study has been conducted using a deductive-inductive methodology. Thus, after a study of managerial reforms in Italy and performance measurement literature, a possible model (PerformEL Model) local governments could follow to draw up Performance Plan and Report as effective tools for performance measurement has been designed (deductive phase). Performance Plans 2011-2013 and Performance Report 2011 downloaded from Italian big sized municipalities’ websites have been analyzed in the light of PerformEL Model, to assess the diffusion of the documents and their coherence with legal requirements and suggestions from literature (inductive phase). Data arising from the empirical analysis have been studied to evaluate the diffusion and the effectiveness of big sized municipalities’ Performance Plans and Reports as performance measurement tools and thus to assess the success of the reform (feedback phase). The study shows a scarce diffusion of the documents; they are mostly drew up because of their compulsoriness or to gain legitimization. The results testify the failure of Brunetta’s reform, at least with regard to local governments.

The Developing Habitus of the Anti-Social Behaviour Practitioner: From Expansion in Years of Plenty to Surviving the Age of Austerity

Specialist anti-social behaviour units are common within social housing providers, with many established in response to the policies of the New Labour governments of 1997–2010. These units now find themselves operating in a different political and financial environment. Following the English riots of 2011, the Coalition government, whilst imposing budgetary cuts across the public sector, called on social housing providers to intensify their role in tackling disorder. This article explores the habitus or working cultures within anti-social behaviour units post-New Labour. It does so through empirical research conducted in the aftermath of the English riots. The research finds that practitioners view their work as a core function of social housing provision. They have developed an understanding of human behaviour, which crosses the criminal and social policy fields with a wide skillset to match. A number of factors including national policy, community expectations, and multi-partnership engagement influence their dynamic working culture.

Comparing the decline in coronary heart disease and stroke mortality in neighbouring countries with different healthcare systems

Objective
To examine age and gender specific trends in coronary heart disease (CHD) and stroke mortality in two neighbouring countries, the Republic of Ireland (ROI) and Northern Ireland (NI). Design Epidemiological study of time trends in CHD and stroke mortality.

Setting/patients
The populations of the ROI and NI, 1985–2010.

Interventions
None.

Main outcome measures
Directly age standardised CHD and stroke mortality rates were calculated and analysed using joinpoint regression to identify years where the slope of the linear trend changed significantly. This was performed separately for specific age groups (25–54, 55–64, 65–74 and 75–84 years) and by gender. Annual percentage change (APC) and 95% CIs are presented.

Results
There was a striking similarity between the two countries, with percentage change between 1985 and 1989 and between 2006 and 2010 of 67% and 69% in
CHD mortality, and 64% and 62% in stroke mortality for the ROI and NI, respectively. However, joinpoint analysis identified differences in the pace of change between the two countries. There was an accelerated pace of decline (negative APC) in mortality for both CHD and stroke in both countries from the mid-1990s (APC ROI −8% (95% CI −9.5 to 6.5) and NI −6.6% (−6.9 to −6.3)), but the accelerated decrease started later for CHD mortality in the ROI. In recent years, a levelling off in CHD mortality was observed in the 25–54 year age group in NI and in stroke mortality for men and women in the ROI.

Conclusions
While differences in the pace of change in mortality were observed at different time points, similar, substantial decreases in CHD and stroke mortality were achieved between 1985 and 1989 and between 2006 and 2010 in the ROI and NI despite important differences in health service structures. There is evidence of a levelling in mortality rates in some groups in recent years.

Open Data: European Ambitions and Local Efforts. Experiences from Austria

The member states of the European Union are faced with the challenges of handling “big data” as well as with a growing impact of the supranational level. Given that the success of efforts at European level strongly depends on corresponding national and local activities, i.e., the quality of implementation and the degree of consistency, this chapter centers upon the coherence of European strategies and national implementations concerning the reuse of public sector information. Taking the City of Vienna’s open data activities as an illustrative example, we seek an answer to the question whether and to what extent developments at European level and other factors have an effect on local efforts towards open data. We find that the European Commission’s ambitions are driven by a strong economic argumentation, while the efforts of the City of Vienna have only very little to do with the European orientation and are rather dominated by lifestyle and administrative reform arguments. Hence, we observe a decoupling of supranational strategies and national implementation activities. The very reluctant attitude at Austrian federal level might be one reason for this, nationally induced barriers—such as the administrative culture—might be another. In order to enhance the correspondence between the strategies of the supranational level and those of the implementers at national and regional levels, the strengthening of soft law measures could be promising.

Quality Management and Managerialism in Healthcare:: A Critical Historical Survey

Quality Management and Managerialism in Healthcare creates a comprehensive and systematic international survey of various perspectives on healthcare quality management together with some of their most pertinent critiques. Chapter one starts with a general discussion of the factors that drove the introduction of management paradigms into public sector and health management contexts in the mid to late 1980s. Chapter two explores the rise of risk awareness in medicine; which, prior to the 1980s, stood largely in isolation to the implementation of managerial performance targets. Chapter three investigates the widespread adoption of performance management and clinical governance frameworks during the 1980s and 1990s. This is followed by Chapters four and five which examine systems based models of patient safety and the evidence-based medicine movement as exemplars of managerial perspectives on healthcare quality. Chapter six discusses potential future avenues for the development of alternative perspectives on quality of care which emphasise workforce involvement. The book concludes by reviewing the factors which have underpinned the managerialist trajectory of healthcare management over the past decades and explores the potential impact of nascent technologies such as 'connected health' and 'telehealth' on future developments.

Shared Services in Ireland

The global financial crisis has forced governments across the globe to seek new ways of achieving efficiencies and savings in running their state administrations. Prominent amongst the variety of approaches adopted is the concept of shared services, which purports to offer a means of consolidating common tasks, reducing duplication, and achieving greater value for money. Based on successful experiences in the private sector, the phenomenon of shared service centres (SSCs) as a new co-ordination practice is of particular interest. In this chapter, the use of shared services and SSCs in Ireland is considered.

State retrenchment and administrative reform in Ireland: Probing comparative policy paradigms

Policy choices in response to crisis may carry consequences both for distributive outcomes and for the future policy capacity of the state itself. In this paper, we use conceptual heuristics to interpret policy practice. We examine the underlying policy paradigms shaping Irish government decisions in the aftermath of the European financial and economic crisis. We distinguish between two such paradigms- market-conforming and social equity - and apply them to three reform themes: reconfiguration of public budgets, the public service pay bargain, and the organizational profile of state competences. Our findings entail lessons for understanding the malleability of policy choice, and how state policy choices in response to crisis are framed and implemented.

When innovation fails: An institutional perspective of the (non)adoption of boundary spanning IT innovation

We combine the concepts of legitimacy, institutional (mis)alignments, strategic responses and organizing visions to develop a conceptual framework to analyse the adoption of innovations that span organisational fields. We apply the framework to examine a telehealth innovation connecting a public sector hospital-based eye clinic with private sector optometry practices. We find that while compromise strategies were successful in encouraging adoption within each field, the innovation ultimately failed as fields developed different organising visions which could not be reconciled. The findings suggest that institutional misalignments within and between fields interact to amplify their overall effect on the adoption of hybrid innovations.

Meeting the needs of visually impaired people living in Lifetime Homes

This article explores perceptions on the suitability and effectiveness of Lifetime Homes Standards (LTHS) for those with visual impairment in Northern Ireland.
LTHS are a series of mandatory United Kingdom (UK) public sector housing design interventions, providing a model for ensuring accessible and adaptable homes throughout an occupant's lifespan. An ageing demographic with increasing incidence of diabetes, has led to rising numbers of elderly visually impaired people wanting to remain in their homes for longer.
Qualitative semi structured interviews were conducted with thirteen key stakeholders and thematically analysed. Although findings show that employing LTHS offers benefits to visually impaired residents, short-comings were also identified. Evidence indicates a need for Policy Makers, Health Care Professionals and Housing Associations to modify practices to better meet the housing needs of visually impaired people. Findings may also be applicable to those with other impairments and disabilities in relation to housing for elderly residents.

The Impact of the Recent Economic Recession on the NEC Contract in Northern Ireland: A Preliminary Study

In comparison to the rest of the United Kingdom (UK) the Northern Irish Construction Industry was disproportionately affected by the recent economic recession. During this period, use of the New Engineering Contract (NEC) has proliferated in the public sector, however no study has been undertaken to examine the impact of the recession on this contract in Northern Ireland. The aim of this paper is to explore NEC contract implementation in Northern Ireland and the impact of the recession on its operation. A qualitative methodology is adopted using a literature review and semi structured interviews with six construction professionals. A qualitative analysis identifies themes and issues arising exploring connections and links between them using thematic coding. The initial findings are that the introduction of the NEC contract in Northern Ireland makes demands of contractors and consultants in terms of additional resources and training. Some consultants show a clear lack of understanding of the contract and its provisions. Whilst there is general agreement that the contract does help to stimulate good project management, the interviewees find the contract time consuming and complicated to administer, describing it as “unforgiving for the architect and unforgiving to the contractor.” Due to the impact of the recession, both contractors and consultants are still reporting a drop in income from pre-recession levels. Project resourcing levels have dropped significantly since the onset of the recession. Adversarial and opportunistic behaviour has increased. Many consultants and contractors are struggling to adequately administer the NEC contract at current income levels. The introduction of the NEC contract and the economic recession have exerted opposing forces on the implementation of the contract, hindering its execution. As the pressures exerted by the economic recession abate and a greater understanding of the contract develops, these opposing forces will ease leading to a more consistent implementation of the contract.

Understanding Risk: Contributions from the Journal of Risk and Governance

During recent years, news headlines have been rife with criticisms of the risk management practices of public and private sector entities. These criticisms have often been accompanied by calls for greater transparency in the way government entities manage risks and communicate dangers to the public. Similarly, in the private sector, the internationalisation of economic activity has heightened concerns over the potential adverse implications of mismanagement and financial scandals, and has led to calls for greater regulation and supervision. While the responses of public sector agencies and private sector actors to these challenges have differed, they share a common acknowledgement that effective governance relies on the pro-active identification, assessment, and management of risks as well as appropriate regulatory frameworks.

This edited book covers a number of divergent topics illustrating the emergence of several novel themes in the area of economic and social risks. As a communality, these novel themes relate to the complexity in which human activity in this late stage of capitalist development is embedded. This risk-generating complexity, in turn, can be observed at several levels, including workplace hazards, governance problems within the private sector or the intersection between public and private, and in relation to the economic risks faced by larger entities such as national governments.

Understanding Risk: Recent Contributions from the Journal of Risk and Governance

Following on from the format of the previous Book Understanding Risk: Contributions from the Journal of Risk and Governance, this collection of recent contributions (including work by the editor) this book is divided in three sections .  The first section examines issues relating to corporate governance in the private sector, with emphasis being placed on issues of 'Board Decision Making,' Earnings Management and Audit Committee Effectiveness'  and ' Corporate Governance Failures.'  These contributions are complemented by the second sections which looks at governance and risk issues affecting the public sector, with a focus being places on 'Public Private Partnerships' and regulation of activities in the Life Sciences.'  Section three focuses on societal risk management in relation to health, safety and the environment.  In this context, contributions are presented in relation to major debates surrounding 'Rising Trends in Cancer Cases,' dilemmas surrounding 'Medical Self Help,' 'Mental Health Policy' and the use of 'Information Technology in Health Care.'

Risking peace in the ‘War against the Poor’? Social exclusion and the legacies of the Northern Ireland conflict

Discourses around poverty, dependency and austerity take a particular form when it comes to Northern Ireland which is seen as ripe for economic ‘rebalancing’ and public sector reduction. The Welfare Reform Act 2012 is pivotal in that it provides the muscle for disciplining claimants for a low-waged, flexible labour market. But the Northern Ireland Assembly has not passed the Act or agreed a budget and the return of Direct Rule beckons as a result. The article sheds light on the stand-off over the Welfare Reform Act using data from the 2012 PSE Survey. It demonstrates that the impact of violent conflict is imprinted on the population in terms of high rates of deprivation, poor physical and mental health, and significant differences between those experiencing little or no conflict, and those with ‘high’ experience. In ignoring these legacies of the conflict, the Westminster government is risking peace in its ‘war against the poor’.