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In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood.
Aims
To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions.
Method
Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data.
Results
No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate.
Conclusions
The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.
Hoarding disorder is a surprisingly common problem which impacts on most areas of life. People who hoard typically have multiple agencies involved in their care due to the complex health and safety impact and risks associated with hoarding. ‘Treatment’ involves finding ways of supporting discarding large amounts, typically underpinned by CBT principles. We evaluated the impact and outcomes of a conference designed to boost professionals’ confidence and understanding in working with hoarding problems, both individually and with other agencies with a view to improving inter-agency service provision. Changes in professionals’ confidence and understanding were evaluated immediately before and after the conference. Conference participants’ qualitative responses related to service improvements were analysed using content analysis. People with personal experience of hoarding issues subsequently participated in a focus group where the results of the conference were presented. These data were analysed using thematic analysis. Confidence and understanding in working with hoarding problems substantially increased from pre- to post-conference. Professionals identified a range of possible improvements, most commonly working more closely and improving communication with other agencies. People with personal experience suggested improvements across three over-arching themes: developing an improved understanding of hoarding, the need for improved resources, and improved multi-agency working. A multi-agency conference increased confidence and understanding in professionals working with hoarding problems, and improvements specified by both people with personal experience and professionals provide a useful guide to service improvement. Results provide a framework in which CBT approaches should be embedded.
Key learning aims
(1) To assess the effectiveness of a multi-agency hoarding conference at improving understanding and confidence in working with hoarding problems.
(2) To explore professionals’ perceptions of improvements to multi-agency service provision.
(3) To explore perceptions of improvements that could be made to multi-agency service provision from people with personal experience of hoarding problems.
The education of Indigenous and Torres Strait Islander students in Australian universities has received considerable attention in both the literature and government policy in the 21st century. The participation and graduation rates for Indigenous and Torres Strait Islander students in higher education Science, Technology, Engineering and Mathematics (STEM) programs have remained low and are becoming a particular focus in universities across Australia. This paper reflects on the life and contribution of David Unaipon, the enrolment data from a small sample of universities across Australia and the literature to discuss potential strategies for improving the access to, participation in and graduation from higher education STEM courses.
Personal budgets (PBs) have been described as the highest profile strand of the personalisation agenda (Needham and Glasby, 2014: 12). PBs aim to provide service users with control over their care by providing them with choices over the type of care they receive as well as choices over who provides that care. Their introduction was the result of a sustained disability rights campaign, but the extent to which they are appropriate for all social care users has been questioned. Older people, in particular, as a group have been problematically situated in this policy shift to self-directed support. Where older people have money for self-directed support, this is far more likely to be as a budget managed by the local authority (Age UK, 2013). An evaluation of the early implementation of PBs suggested a substantial proportion of older people were likely to experience personal budgets as a burden rather than as leading to improved control over their care (Glendinning et al, 2008: 44) and more recent assessments continue to highlight problems for older service users (Lymbery, 2010; Woolham and Benton, 2013; Moran et al, 2013; Age UK, 2013).
This chapter examines the position of older people in relation to the move to personal budgets for social care from the perspective of the feminist ethic of care as articulated by Gilligan (1982) and Tronto (1993), which emphasises the fundamentally relational and contextual nature of care. Our overarching argument is that when it comes to the care of older people, the stark ‘line in the sand’ between autonomy and paternalism that the current discourse of rights-based personalisation and individualised funding marks out, is hard to discern and, therefore, an inadequate basis for care policy for people in later life. First, we briefly set out the emergence and intentions of personalisation and personalbudgets. We then contrast the rights-based nature of personalisation, selfdirected support and personal budgets, contrasting this with the ethic of care perspective. We then draw briefly on original research on care relationships in later life to illustrate the unavoidably relational nature of need and care.
As with all knowledge-creating communities, strategy-as-practice scholarship constitutes itself through the production of networks of texts that frame and focus topics of interest. SAP scholarship seeks to advance knowledge in ‘the doing of strategy: who does it, what they do, how they do it, what they use, and what implications this has for shaping strategy’ (Jarzabkowski and Spee 2009: 69). In mapping the growing work in this area (Jarzabkowski and Spee 2009; Vaara and Whittington 2012), reviews have shown that recent SAP texts advance a research agenda developed in foundational publications (such as those of Jarzabkowski, Balogun and Seidl 2007; Johnson et al. 2007; and Whittington 2006) and contribute to strategic management by moving ‘beyond the strategy discipline's usual focus on economic performance per se’ (Vaara and Whittington 2012: 3) to actively integrate social theories of practice and broaden the scope of outcomes regarded as important to study.
Although these reviews discern specific findings and a general understanding of what knowledge is being produced, they yield little insight into how SAP authors position their work and make claims of knowledge regarded as contributions by the academic community. Understanding how authors craft arguments to persuade an intended audience is important, because written texts ‘do not simply array “facts” and evidence logically’ (Locke and Golden-Biddle 1997: 1060) but, rather, use certain rhetorical strategies to convey novelty and even surprise vis-à-vis existing knowledge (Davis 1971).
In order to consider how strategy-as-practice research constructs opportunities for contribution, its written texts must be regarded as ‘first-order data’ and examined directly for rhetorical strategies. For this purpose, we turn our analytic attention to the genre of journal articles that are the location of crucial public discourse among researchers (Winsor 1993; Yearley 1981; Zuckermann 1988). Our sample consisted of seventy empirical SAP studies published in peer-reviewed journals from 2002 to early 2014. We divided our sample into two subsets in order to analyse the development of contribution constructions over time: (1) the first wave contained articles published from 2002 to 2008; and (2) the second wave contained articles published from 2009 to 2014. To guide our analysis, we drew on an extant framework of constructing opportunities for contribution in management and organization studies (Locke and Golden-Biddle 1997).
Food packages were objectively assessed to explore differences in nutrition labelling, selected promotional marketing techniques and health and nutrition claims between countries, in comparison to national regulations.
Design
Cross-sectional.
Setting
Chip and sweet biscuit packages were collected from sixteen countries at different levels of economic development in the EPOCH (Environmental Profile of a Community’s Health) study between 2008 and 2010.
Subjects
Seven hundred and thirty-seven food packages were systematically evaluated for nutrition labelling, selected promotional marketing techniques relevant to nutrition and health, and health and nutrition claims. We compared pack labelling in countries with labelling regulations, with voluntary regulations and no regulations.
Results
Overall 86 % of the packages had nutrition labels, 30 % had health or nutrition claims and 87 % displayed selected marketing techniques. On average, each package displayed two marketing techniques and one health or nutrition claim. In countries with mandatory nutrition labelling a greater proportion of packages displayed nutrition labels, had more of the seven required nutrients present, more total nutrients listed and higher readability compared with those with voluntary or no regulations. Countries with no health or nutrition claim regulations had fewer claims per package compared with countries with regulations.
Conclusions
Nutrition label regulations were associated with increased prevalence and quality of nutrition labels. Health and nutrition claim regulations were unexpectedly associated with increased use of claims, suggesting that current regulations may not have the desired effect of protecting consumers. Of concern, lack of regulation was associated with increased promotional marketing techniques directed at children and misleadingly promoting broad concepts of health.
Twenty-two normally developing five-year-olds were asked to judge, identify, repair and explain phonological and morphological errors. All of the errors involved the addition, substitution or omission of a single phoneme, which in the morphological task, was also an inflectional morpheme. Stimuli were controlled for type of error (omission, addition, substitution), location of the error (word final) and word status of the resulting error (word, non-word). Children performed significantly better on the phonological task than on the morphological task. It is proposed that the results are due to differences in the type and location of linguistic information to be analysed and to differences in memory demands in the tasks.
The issue of detention as a tuberculosis control measure has resurfaced following the prolonged detention of a patient with an extensively drug-resistant strain of tuberculosis in a prison cell in Arizona, and the attempted detention in Italy and subsequent detention in Atlanta, Georgia of an American sufferer thought to have XDR-TB in May 2007. These cases have reignited the debate over the evidence that supports detention policy in the control of tuberculosis, and its associated legal and ethical ramifications. This paper considers whether involuntary detention is justified where voluntary measures have failed or where a patient poses a danger, albeit uncertain, to the public, and discusses the need for strengthening evidencebased assessments of public health risk.
To estimate the burden of disease attributable to low fruit and vegetable intake in the 15 countries that were members of the European Union (EU) before May 2004 (EU-15) and the 10 countries that then joined it (EU-10).
Design
Data on fruit and vegetable intake, target levels of intake and estimates of relative risks, deaths and disability were combined to obtain the burden of ischaemic heart disease, ischaemic stroke and four types of cancer (lung/bronchus/trachea, stomach, oesophagus, and colon/rectum) attributable to low fruit and vegetable consumption.
Setting
EU-15 and EU-10 Member States.
Results
The number of lives potentially saved annually from the selected outcomes if fruit and vegetable intake increased to 600 g person−1 day−1 reached 892 000 and 423 000 in the EU-15 and EU-10, respectively; total disease burden could decrease by 1.9% and 3.6%, respectively. The burden of ischaemic heart disease and stroke could be reduced by up to 17% and 10%, respectively, in the EU-15 and by 24% and 15%, respectively, in the EU-10; potential reductions for the selected cancers varied from 1% to 12% in the EU-15 and from 2% to 17% in the EU-10.
Conclusions
The potential health gain of increased fruit and vegetable intake is particularly large in the new Member States, and particularly high for cardiovascular diseases, a main cause of health divide in Europe. This stresses the need for better nutrition programmes and policies that take account of economic, social and cultural specificities.
Although food supply statistics are commonly used in ecological studies of diet and disease, little information is available on how they compare with reported intakes of foods. The objective of the present study was to compare fruit and vegetable availability with estimates of national mean intakes derived from national food consumption surveys. Food availability statistics from the FAO were used. For each country, mean national supply, based on at least 3 years of FAO data, was calculated. National estimates of mean fruit and vegetable intakes were derived from population-based surveys from fifteen countries, gathered for the World Health Organization Global Burden of Disease Study revision for 2000. Extrapolations were made when survey data did not cover all age groups. For each country, the FAO:survey estimate ratio was calculated. This ratio ranged from 0·93 to 2·70 (median value=1·39). Although there was a tendency for FAO data to overestimate intakes (fourteen out of fifteen countries), the degree of overestimation varied greatly among the countries included in this study (5–270 %). As food supply statistics are the only source of information on dietary patterns in most countries of the world, further information on how they reflect food intakes is needed. Obtaining detailed and valid estimates of dietary intakes in more countries around the world will be essential for such comparisons.
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