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Aim: To investigate how vision relates to early development by studying vision and cognition in a national cohort of 1-year-old infants with congenital disorders of the peripheral visual system and visual impairment.Method: This was a cross-sectional observational investigation of a nationally recruited cohort of infants with 'simple' and 'complex' congenital disorders of the peripheral visual system. Entry age was 8 to 16 months. Vision level (Near Detection Scale) and non-verbal cognition (sensorimotor understanding, Reynell Zinkin Scales) were assessed. Parents completed demographic questionnaires.Results: Of 90 infants (49 males, 41 females; mean 13mo, standard deviation [SD] 2.5mo; range 7-17mo); 25 (28%) had profound visual impairment (light perception at best) and 65 (72%) had severe visual impairment (basic 'form' vision). The Near Detection Scale correlated significantly with sensorimotor understanding developmental quotients in the 'total', 'simple', and 'complex' groups (all p<0.001). Age and vision accounted for 48% of sensorimotor understanding variance. Infants with profound visual impairment, especially in the 'complex' group with congenital disorders of the peripheral visual system with known brain involvement, showed the greatest cognitive delay.Interpretation: Lack of vision is associated with delayed early-object manipulative abilities and concepts; 'form' vision appeared to support early developmental advance. This paper provides baseline characteristics for cross-sectional and longitudinal follow-up investigations in progress. A methodological strength of the study was the representativeness of the cohort according to national epidemiological and population census data. [ABSTRACT FROM AUTHOR]

The research available on the use of positive risk-taking in clinical practice is surprisingly limited. The purpose of this article is to highlight the limitations and make recommendations about how risk-taking could shape future practice in mental health services. A search of databases including CINAHL and PsycINFO for papers that included the keywords recovery, risk management, positive risk-taking and risk management found that mental health practitioners were keen to promote positive risk-taking with patients to enable their recovery. Barriers to this included a culture of blame should a negative outcome arise, and the need for more support and guidance from management. As positive risk-taking has been shown to be an important part of successful recovery, there is a need for more research to support its application in clinical practice. [ABSTRACT FROM AUTHOR]

Background Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes. Methods A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy. Results Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation. Conclusions Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes. [ABSTRACT FROM AUTHOR]

Gypsies, Roma and Travellers (GRT) experience a significantly high number of measles cases and have low levels of measles, mumps and rubella (MMR) immunisation. There is little evidence on: why immunisation levels are low; beliefs and practices surrounding the MMR vaccine; or the factors that promote or hinder uptake. This paper presents data from five focus groups with 16 GRT mothers in Kent, South East England. Between them, they had 35 children of whom just under half had not received the course of vaccinations. Focus groups explored the issues GRT parents consider when making vaccination decisions in the context of wider social, ideological, material and practical considerations. Four interrelated themes were identified: way of life and access; engaging with health care staff; perceptions and evaluations of risk; and strategies to minimise MMR-related risks. Our findings provide little support for explanations that emphasise cultural values or practices in shaping immunisation behaviour. Poor service provision, situational constraints related to living circumstances, and multifaceted and severe health issues, which precede and inform decisions over childhood immunisation, were more significant in explaining low uptake. [ABSTRACT FROM PUBLISHER]

Housing is a significant determinant of health and substandard housing is a public health issue. East London has long had a shortage of social and affordable housing, worsened in recent years by a combination of stressors. In one of East London's most deprived boroughs, Newham, changes brought about by the 2011 Localism Act and the unique demands of being the host Olympic borough in 2012 have brought considerable pressures to bear on social infrastructure. This paper examines how these pressures were experienced by local residents via their narratives of social housing and health. The data reported here are from a qualitative study comprising two waves of data collection. Narrative family interviews and go-along interviews were conducted with 40 Newham residents at wave one and 28 at wave two. A narrative analysis with a Bakhtinian interpretation was undertaken. This revealed that residents framed experiences of social housing in terms of an inherent system-level ideology based on notions of need and waiting. A particularly striking feature of this ideology was the extent to which descriptions of ill health and impairment were implicated in constructions of housing need; participants directly attributed a range of health complaints to their housing predicaments, including stress, depression, cancer scares, panic attacks and loss of sleep. Understanding the contested ideology of social housing can illuminate both the dynamic processes of social exclusion and the ways in which its subjects seek to resist it. [ABSTRACT FROM AUTHOR]

In recent years, society has witnessed a proliferation of digital technologies facilitate new ways to monitor young people's health. This paper explores a group of English adolescent girls' understandings of 'health' promoted by health and fitness related technologies. Five focus group meetings with the same 8 girls, aged between 14 and 17, were conducted to explore their experiences of using health and fitness apps. The girls' understandings of the digitised body are examined through a Foucauldian lens, with particular attention to conceptualisations of bio-power and technologies of the self. The data reveal how the girls negotiated, and at times critiqued, the multiple health discourses that are manifest through digital health technologies and performative health culture. The results emphasise that individual-based applications (apps) remove the social and interactive elements of physical activity valued by the girls. This research highlights the possibilities digital technologies provide for health promotion, yet also illuminates the limitations of these technologies if used uncritically and inappropriately. [ABSTRACT FROM AUTHOR]

This paper considers the complex task of working with adults with learning disabilities and challenging behaviour in a care home and the impact on relationships within the staff group and wider organisation. Examples are drawn from an organisational consultation to a home with a history of disputes, grievances and sick leave. The metaphor of ghosts is used to explore the processes by which the residents' own traumatic histories come to be played out by the care home staff. The paper concludes that an increased understanding of organisational processes in the residential care sector may help staff form more helpful relationships with service users and hence lead to better outcomes. [ABSTRACT FROM AUTHOR]

Previous research has suggested that poor health is associated with reduced migration; this knowledge stems from models based on past censuses, or longitudinal studies which imply that the factors influencing migration are the same between those in good and poor health. This paper addresses these issues by utilising health-stratified analyses on the 2011 Census Individual Secure Sample for England and Wales. Multilevel models predict the odds of moving for working age adults, controlling for key predictors of migration, estimating the effect of health status on the odds of moving and the destination-specific variance in migration. We find that those in poor health are less likely to move, after controlling for individual level characteristics. In contrast with expectations, economic inactivity, marriage and being in African, Caribbean, Black, Other or Mixed ethnic groups were not significant predictors of migration among the unhealthy sample, but were for the healthy sample. We conclude that migration is health-selective and propose implications for understanding area level concentrations of poor health in England and Wales. [ABSTRACT FROM AUTHOR]

Background: Rising rates of childhood obesity have become a pressing issue in public health, threatening both the mental and physical well-being of children. Attempts to address this problem are multifaceted, and in England include the National Child Measurement Programme (NCMP) which assesses weight status in English primary school children in reception class (aged 4-5) and in year 6 (aged 10-11), with results being sent out to parents. However the effectiveness and impact of this routine parental feedback has yet to be fully understood. This paper reports one component of a mixed methods study undertaken in North East England, examining the impact of the feedback letters on parents' understanding and feelings about their child's weight status and whether or not this seemed likely to lead to behaviour change.Methods: One-to-one semi-structured interviews (n = 16) were conducted with a sample of parents/guardians after they had received their child's weight results letter. Eight parents/guardians were sub-sampled from the group whose child had been indicated to be overweight or obese and eight were from the group whose child had been indicated to be of ideal weight status. Interviews were conducted until data saturation was reached for both groups.Results: The reactions of parents/guardians whose children were identified as being overweight followed a sequence of behaviours ranging from shock, disgust with the programme, through denial and self-blame to acceptance, worry and intention to seek help. On the other hand, the reaction of parents/guardians whose children were identified as being ideal weight ranged from relief, pleasure and happiness through affirmation and self-congratulation to 'othering'.Conclusions: Whilst overweight and obesity is often portrayed as a medical condition, parents/guardians see it as deeply rooted in their social lives and not in health terms. Parents believe that the causes of overeating and lack of exercise relate closely to the obesogenic environment, particularly the complex social and cultural milieu and time pressures within which this sample of people live. Associating this problem in feedback letters with dangerous diseases like cancer, and advising parents to visit GPs to resolve child weight issues was perceived as inappropriate by the parents, and caused controversy and anger. Given the likelihood that the NCMP will continue as a monitoring device, it is evident that the management of the process needs to be reviewed, with particular attention being paid to the feedback process. Local health authorities will need to manage parental expectations and ensure linkage with appropriately commissioned remedial weight management interventions. [ABSTRACT FROM AUTHOR]

cook c. (2012) Email interviewing: generating data with a vulnerable population. Journal of Advanced Nursing 68(6), 1330-1339. Abstract Aims. This paper describes online recruitment and the email interviewing data collection method with women diagnosed with a viral sexually transmitted infection. The paper highlights the advantages of the method to researchers and participants when conducting research where face-to-face participation may difficult. Background. Online recruitment and in-depth email interviewing have been used by only a small number of nurses internationally. The method enables inclusion of people who might otherwise be excluded from research, for reasons such as geographical distance, incompatible time frames, clinicians''gate-keeping' and participants' desire for anonymity for physical or emotional reasons. Methods. In-depth email interviews were conducted with 26 women in New Zealand, United States of America, Canada and England who had a diagnosis of either human papilloma virus or genital herpes simplex virus. Data were collected during 2007-2008 and analysed using a poststructuralist, feminist thematic analysis. Results. Participant retention was high. Women emphasized satisfaction with the process. Asynchronous interviews allowed for additional reflexivity in the researcher's responses and rich data generation. Conclusion. This method has the potential to enable nurses to include vulnerable and relatively inaccessible participants in 'sensitive' research. In-depth email interviews may generate rich data through a process participants deem to be of personal value. [ABSTRACT FROM AUTHOR]

This paper concerns the use of photo-elicitation interviews in constructing migrant narratives of health and well-being. It argues that photo-elicitation can be particularly effective in producing nuanced understandings about relationships among culture, place and health. It explores how, through this method, subject-centred understandings of health and well-being are able to challenge dominant discursive constructions that tend to ‘other’ and potentially stereotype minority groups in explanations of health behaviour. The paper includes discussion of issues of power and representation in research with marginalized populations, which further elaborates the value of photo-elicitation in developing a non-essentializing view of minority groups. The paper concludes with comment on the potential value of this method in the formulation of health and social policies aiming to incorporate the views and needs of marginalized or minority groups. [ABSTRACT FROM PUBLISHER]

This paper will focus on the place of black history in heritage sites in England and discuss how visual methodologies can be used to develop a more inclusive approach to heritage. It will argue that visual archives, from portraits of the aristocracy to asylum portraits, are an essential part of the research process for heritage site staff who are assessing how they connect to (potential) visitors. The paper highlights examples that illustrate the advantages and disadvantages of using the visual record for historical recovery and suggests how visual methodologies can be used to encourage greater participation with historic environments. [ABSTRACT FROM PUBLISHER]

This paper reports on a pilot project to examine the concept of wellbeing as expressed locally by public reaction to the Peace Gardens refurbishment in the city centre of Sheffield completed in 1999. It was immediately popular with the public, but the aim was to find out what benefit people felt they derived from using the space. The study was conducted via a questionnaire delivered on site to pedestrian traffic over three weeks one summer. Over a thousand users of the space were asked one very simple question: How do the Peace Gardens make you feel? The authors' interpretation of the responses indicates a very high level of approval. Users of the space reported high satisfaction across four themes: wellbeing, safety, community and respite. While these findings largely accord with the literature, further planned city-centre development threatens the success of the Peace Gardens. The paper considers whether the planning of such spaces is designed to empower users to meet others on their own terms, or whether planners recognize that social needs require to be more controlled in busy urban environments. [ABSTRACT FROM AUTHOR]

This study addresses the issue of the sexual needs of ethnic minority groups in the UK. Using focus group discussions with health service users and third-sector providers, it explores the perception of sex education by Black African communities living in a culturally diverse area in East London, focusing specifically on participants' understanding of safe sex, personal experiences in receiving health information, and the relevance of health-promotion messages to their health, social and cultural needs. The paper focuses on the views of the older population group, many of whom are parents; all were born and brought up outside the UK. The paper identifies a number of factors influencing the perception of sex education and health-promotion messages by study participants and discusses some complex interrelationships between the traditions and cultural norms surrounding their lives in Africa and the European context within which they find themselves today. We examine potential links between the levels of cultural adaptation and the perception of sex education in schools and clinical settings, and discuss implications of these perceptions for policy and practice. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to provide an overview of recent reforms to the social care system in England.Design/methodology/approach - The reforms are described and contextualised within a broader account of the history of social care that includes an analysis of the factors that have encouraged reform.Findings - The current reforms of social care will bring about some benefits but their long-term impact is still very uncertain. The changing political and economic environment and the inherent difficulties that reform suggests indicate that these changes will be subject to significant differences in interpretation for some time.Research limitations/implications - This analysis is framed by a set of ethical assumptions about the rights of disabled people and the injustice of arrangements that limit those rights.Practical implications - The paper encourages practitioners to treat new ideas such as individual budgets and self-directed support as positive opportunities for improving practice, while being mindful of tensions and unresolved issues that may harm good practice.Social implications - This research should help policy-makers and the general public to avoid misunderstanding the role of these innovations and to better understand when and how these reforms can be used positively.Originality/value - This paper offers a new and historical perspective on the social care reforms from someone who is closely associated with inventing and implementing those ideas. [ABSTRACT FROM AUTHOR]

This paper looks at hospital midwifery and birth from a psychoanalytic perspective. It is an edited version of a dissertation written for a Masters Degree in Psychoanalytic Observational Studies, undertaken at the Northern School of Child and Adolescent Psychotherapy in Leeds. The paper uses observational material from four births to consider the emotional work of the midwife and the birthing experience. [ABSTRACT FROM AUTHOR]

The aims of this study were to examine the extent and nature of educational psychologist (EP) work related to children in care in five local authority educational psychology services in the south-west region. The study involved an initial internet-based questionnaire for the 107 EPs in these services (86% response rate), followed up by in-depth semi-structured interviews with four EPs in each service. This paper reports some of the findings from this study that show the range of EP work and their roles in regard to children in care. It also examines the kinds of issues and tensions experienced by EPs in their multi-agency work with regards to children in care. The paper concludes with a brief summary of relevant recommendations arising from the findings. [ABSTRACT FROM AUTHOR]

This paper explores the extent to which social activity in England and Wales varies by ethnic group and whether risks of social isolation are higher for some groups than others. It aims to enhance our understanding of social deprivation as a particular dimension of poverty and its variation by ethnicity. It also provides empirical evidence that informs discussions of social capital formation which focus on informal measures of participation, and amplifies our understanding of ethnic capital within groups. Estimating the characteristics associated with four measures of social activity together, using a multivariate probit model, the analysis identifies the extent to which ethnic group is associated with low participation on any given measure. Cross-equation correlations between observables within the model can additionally indicate an underlying propensity to social isolation. The paper concludes that there are distinctive patterns of social activity across ethnic groups, that social isolation is not coterminous with material deprivation, and that greater attention should be paid to social isolation as a particular dimension of deprivation that is unevenly distributed. [ABSTRACT FROM AUTHOR]

This paper reports some of the findings of research which has investigated the inclusion of disabled children in six primary school playgrounds in Yorkshire, in England. Initially the paper sets the policy context before moving on to discuss the importance of play for children, especially in a primary school setting and particularly for disabled children in such a setting. The inclusion of disabled children is discussed with respect to a series of social and organisational issues and the good practice identified relating to these issues. The social issues include the relationships the disabled children have with their peers and with the staff. The organisational issues relate to the individual routines, moving to a new school, the benefit of staff experience and training, encouraging activity in physical education lessons which can be translated in to the playground and the benefits of extra time outside for some disabled children. All these aspects can influence whether all the children can go outside together—an important underlying factor for the inclusion of disabled children in primary school playgrounds. [ABSTRACT FROM AUTHOR]

This paper highlights what psychoanalysis can add to discussions of reflexivity, by specifically describing how reflexivity is conceptualized and fostered on psychoanalytic observation methods courses at the Tavistock Clinic, London. It is demonstrated that this psychological form of reflexivity is relevant to empirical and conceptual work and shown that it shares interesting parallels with debates about reflexivity in social research methods, while also being able to contribute to discussions of what constitutes reflexivity and what kinds of methods course might facilitate it. Reflexivity is often discussed in relation to a researcher’s empirical work, but this paper argues that reflexivity is equally needed in relation to the academic context in which most research and learning takes place. This paper demonstrates how psychoanalytic approaches to learning stimulate a reflexive relation to empirical and conceptual work and it provides examples of reflexivity from a two‐year infant observation and a research project on romantic love (involving conceptual and biographical research). [ABSTRACT FROM AUTHOR]

If HIV and AIDS policy initiatives are to be successful in tackling the spread of infection it is important to understand more about the ways in which people perceive HIV and AIDS. HIV testing is a policy initiative that will work when people take the test and make appropriate changes to their behaviour as a result. This paper is based on a study that used in-depth interviews and a vignette with drug injectors to explore drug injectors' perceptions of HIV risk outside and inside prison. HIV testing was an integral part of drug injectors' perceptions of risk. Three main themes emerged from the analysis of these data: first, reasons for not taking a test; second, reasons for taking a test; and third, the impact of testing upon subsequent behaviour. The paper ends with a summary and conclusions highlighting implications for future research and policy development. [ABSTRACT FROM AUTHOR]

This paper describes the design and evaluation of a computer-assisted learning program called Link, which was designed to be used by psychology students to review their understanding of correlation. Unlike existing computer-assisted learning programs that were reviewed, Link makes use of data from authentic research studies in psychology and provides learner activities that are specifically designed to address students' misconceptions about correlation. A summative evaluation study of Link involving fifty psychology students was carried out to assess the effect on students' understanding of correlation. It was found that the use of Link significantly contributed to students' general understanding of correlation. However, it was found that students use of paper-based instructional materials could also achieve this. The implication of this research outcome is considered in relation to the design and use of computer-assisted learning applications for statistics in higher education. [ABSTRACT FROM AUTHOR]

Disabled men have traditionally been seen as incomplete men or as entirely gender-less. Research which has looked at the intersection of disability and male gender has largely treated disabled men as a homogeneous group with little reference to, for example, impairment-related differences. The ongoing move towards self-directed, personalised social care in England suggests that support needs relating to gender may be taken more seriously. A qualitative study with 20 men with Duchenne muscular dystrophy in England in 2013 explored the men's experiences of the organisation and delivery of social care as it pertained to their sense of being men. Our main finding was that social care in its broadest sense did little to support a positive sense of masculinity or male gender. More often than not the organisation and delivery of social care people de-gendered or emasculated many of the men who took part in the study. Our paper speaks to the need to explore impairment-specific issues for disabled men; to deliver a more person-centred approach to social care which recognises the importance of the social and sexual lives of disabled men; and to create ways in which men can support and empower each other to assert essential human rights relating to independence, dignity and liberty. [ABSTRACT FROM AUTHOR]

Background: The outcomes of psychological therapies for anxiety and depression vary across individuals and symptom domains. Being able to predict treatment response from readily available patient data at presentation has potentially important benefits in aiding decisions about the most suitable interventions for a patient. This paper presents a method of identifying subgroups of patients using latent profile analysis, and comparing response to psychological treatments between these profiles.Methods: All outpatients taken into treatment at two psychological treatment services in London, UK and who provided basic demographic information and standardized symptom measures were included in the analysis (n=16636).Results: Latent Profile Analysis was performed on intake data to identify statistically different groups of patients, which were then examined in longitudinal analyses to determine their capacity to predict treatment outcomes. Comparison between profiles showed considerable variation in recovery (74-15%), deterioration rates (5-20%), and levels of attrition (17-40%). Further variation in outcomes was found within the profiles when different intensities of psychological intervention were delivered.Limitations: Latent profiles were identified using data from two services, so generalisability to other services should be considered. Routinely collected patient data was included, additional patient information may further enhance utility of the profiles.Conclusions: These results suggest that intake data can be used to reliably classify patients into profiles that are predictive of outcome to different intensities of psychological treatment in routine care. Algorithms based on these kinds of data could be used to optimize decision-making and aid the appropriate matching of patients to treatment. [ABSTRACT FROM AUTHOR]

This paper focuses on the diversity in patients' experience of biomedicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to explore supposed inevitable personal decline for long-term prisoners, particularly those serving a sentence of life without parole. Design/methodology/approach - Using the prison records of a life without parole sentenced prisoner. Findings - Findings suggest that prisoner deterioration is not inevitable in a whole life prison sentence. Research limitations/implications - Findings are based on one account, of a female prisoner. Practical implications - Distinct services and support are required for those with a natural life prison sentence. Originality/value - To date, there is limited research of prisoners serving life without parole, particularly the mental health implications of denying a prisoner future parole. [ABSTRACT FROM AUTHOR]

Background: Increasingly, it is being suggested that translational gaps might be eradicated or narrowed by bringing research users and producers closer together, a theory that is largely untested. This paper reports a national study to fill a gap in the evidence about the conditions, processes and outcomes related to collaboration and implementation.Methods: A longitudinal realist evaluation using multiple qualitative methods case studies was conducted with three Collaborations for Leadership in Applied Health Research in Care (England). Data were collected over four rounds of theory development, refinement and testing. Over 200 participants were involved in semi-structured interviews, non-participant observations of events and meetings, and stakeholder engagement. A combined inductive and deductive data analysis process was focused on proposition refinement and testing iteratively over data collection rounds.Results: The quality of existing relationships between higher education and local health service, and views about whether implementation was a collaborative act, created a path dependency. Where implementation was perceived to be removed from service and there was a lack of organisational connections, this resulted in a focus on knowledge production and transfer, rather than co-production. The collaborations' architectures were counterproductive because they did not facilitate connectivity and had emphasised professional and epistemic boundaries. More distributed leadership was associated with greater potential for engagement. The creation of boundary spanning roles was the most visible investment in implementation, and credible individuals in these roles resulted in cross-boundary work, in facilitation and in direct impacts. The academic-practice divide played out strongly as a context for motivation to engage, in that 'what's in it for me' resulted in variable levels of engagement along a co-operation-collaboration continuum. Learning within and across collaborations was patchy depending on attention to evaluation.Conclusions: These collaborations did not emerge from a vacuum, and they needed time to learn and develop. Their life cycle started with their position on collaboration, knowledge and implementation. More impactful attempts at collective action in implementation might be determined by the deliberate alignment of a number of features, including foundational relationships, vision, values, structures and processes and views about the nature of the collaboration and implementation. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to consolidate policy, research, evidence and good practice around strategies tackling fuel poverty and affordable warmth for older people aged over 60 to support the development of more effective services for this life course stage and to tackle physical and mental health inequalities. Design/methodology/approach – The authors consolidate current policy, research, evidence and examples of good practice in exploring effective interprofessional approaches that contribute to affordable warmth for older people through “desktop analysis”. The authors support this with qualitative data from Health and Wellbeing Boards (HWBs), health inequalities and environmental health from research comprising four longitudinal case studies in the Midlands and North of England over 18 months and semi-structured interviews with members and support officers. A total of 50 interviews were undertaken and 55 hours of HWB meetings observed. Findings – There are numerous older people living in fuel poverty. The depth of fuel poverty increases with age particularly the over 75s and physical and mental ill health are affected. There are an increasing number of tools to help estimate health care costs around the cost effectiveness of interventions and there is a real need for more local evidence about what is working well, how and why. However, there is no mandatory requirement for fuel poverty strategies and more creative local strategies are required taking organisational and interprofessional relationships into account. The emphasis in integrated care provides new impetus and scope to encourage preventative services but these new partnerships need to be effective in what is a complex policy environment. There is still a long way to go in places. The challenges of ageing are numerous, complex and not fully understood and sit across multiple policy areas. Originality/value – Fuel poverty strategies tend to be delivered on a geographical or income bases rather than by life course approach and a focus on older people. We need to focus more specifically on older people, a rapidly growing population and to better understand thermal properties of our ageing housing stock and how best to intervene to protect and improve health and safety. Emerging approaches need to overcome artificial statutory and non statutory divides and move towards sustainable, evidence based affordable warmth strategies for older people to protect and improve health. [ABSTRACT FROM AUTHOR]

Background.Depression and anxiety persist within and across diagnostic boundaries. The manner in which common v. disorder-specific genetic and environmental influences operate across development to maintain internalizing disorders and their co-morbidity is unclear. This paper investigates the stability and change of etiological influences on depression, panic, generalized, separation and social anxiety symptoms, and their co-occurrence, across adolescence and young adulthood.Method.A total of 2619 twins/siblings prospectively reported symptoms of depression and anxiety at mean ages 15, 17 and 20 years.Results.Each symptom scale showed a similar pattern of moderate continuity across development, largely underpinned by genetic stability. New genetic influences contributing to change in the developmental course of the symptoms emerged at each time point. All symptom scales correlated moderately with one another over time. Genetic influences, both stable and time-specific, overlapped considerably between the scales. Non-shared environmental influences were largely time- and symptom-specific, but some contributed moderately to the stability of depression and anxiety symptom scales. These stable, longitudinal environmental influences were highly correlated between the symptoms.Conclusions.The results highlight both stable and dynamic etiology of depression and anxiety symptom scales. They provide preliminary evidence that stable as well as newly emerging genes contribute to the co-morbidity between depression and anxiety across adolescence and young adulthood. Conversely, environmental influences are largely time-specific and contribute to change in symptoms over time. The results inform molecular genetics research and transdiagnostic treatment and prevention approaches. [ABSTRACT FROM PUBLISHER]

Background: Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed. Adolescents who show problematic sexual behaviour have a range of negative psychosocial outcomes, and they and their parents can experience stigma, hostility and rejection from their community. Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour. This paper describes the protocol for Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B), a feasibility trial of MST for problem sexual behaviour (MST-PSB) in antisocial adolescents at high risk of out-of-home placement due to problematic sexual behaviour.Methods/design: Eighty participants and their families recruited from five London boroughs will be randomized to MST-PSB or management as usual with follow-up to 20 months post-randomization. The primary outcome is out-of-home placement at 20 months. Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs. Feasibility outcomes include mapping the clinical service pathways needed to recruit adolescents displaying problematic sexual behaviour, acceptability of a randomized controlled trial to the key systems involved in managing these adolescents, and acceptability of the research protocol to young people and their families. Data will be gathered from police computer records, the National Pupil Database and interviews and self-report measures administered to adolescents and parents and will be analysed on an intention-to-treat basis.Discussion: The STEPS-B feasibility trial aims to inform policymakers, commissioners of services and professionals about the potential for implementing MST-PSB as an intervention for adolescents showing problem sexual behaviour. Should MST-PSB show potential, STEPS-B will determine what would be necessary to implement the programme more fully and at a scale that would warrant a full trial.Trial Registration: ISRCTN28441235 (registered 25 January 2012). [ABSTRACT FROM AUTHOR]

Children taken into care and custody are arguably the most vulnerable and problematic groups within the wider debate and responses developing to the ‘troubled families’ agenda in England. They represent what the state most wants to avoid when it intervenes in the life of a family. This paper is based on an analysis of the service involvement and needs of the 196 children taken into care or custody over a 3‐year period (2008–2011) in one city local authority in England. The research was undertaken to inform the response to prevention of entry into care and custody which was the original focus of the most intensive part of the troubled families programme in the city. Interviews with 10 senior professionals from a range of agencies involved in setting up this local programme, explored the way the emerging troubled families agenda was shaping ideas about the understanding of and response to the needs of these children and their families. Key findings of the study illustrate the range and complexity of need as well as the sequence and amount of agency involvement. Professionals were often critical of the thinking behind the troubled families agenda, but were positive and creative about new ways of working with these families. [ABSTRACT FROM AUTHOR]

This article highlights three dimensions to understanding children's well-being during and after parental imprisonment which have not been fully explored in current research. A consideration of 'time' reveals the importance of children's past experiences and their anticipated futures. A focus on 'space' highlights the impact of new or altered environmental dynamics. A study of 'agency' illuminates how children cope within structural, material and social confines which intensify vulnerability and dependency. This integrated perspective reveals important differences in individual children's experiences and commonalities in broader systemic and social constraints on prisoners' children. The paper analyses data from a prospective longitudinal study of 35 prisoners' children during and after their (step) father's imprisonment to illustrate the arguments. [ABSTRACT FROM AUTHOR]

Purpose – Homeless populations are a politically contentious problem and researchers struggle to achieve a balanced approach. They place emphasis on sharply contrasting factors, such as; institutional structures, ideologies or individual dispositions and differences. Central questions remain unanswered, i.e., is homelessness an outcome of society’s failings related to housing shortages, or a personal choice, as in the status of “intentional homelessness?” The purpose of this paper is to set aside assumptions, to explore experiences of homelessness and psychosis. Design/methodology/approach – An existentially informed hermeneutic phenomenological analysis; exploring transcribed narratives from semi-structured interviews with three men. Findings – These participants started to wander as a spontaneous response to distressing life experiences. Without any plan they travelled to new locations living on the street. Being contained and treated against their will in the psychiatric system was another source of distress. They did not choose homelessness through a rational calculation of their best interests. They felt at odds with society, which did not protect them and failed to meet their needs. Research limitations/implications – In qualitative research, findings are not generalisable to other settings. Practical implications – Homeless services should be enhanced by psychological expertise along with more person-centred emphatic approaches; the authors of social policies should consider their philosophical assumptions. Social implications – Systemised mental healthcare does not solve complex problems; fails to meet needs. Originality/value – The analysis informs the design of further research, prompts practitioners to review their understandings and provides grounds for the rewriting of policies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report on a small telehealth pilot in local authority sheltered housing in NE England. This explored the training and capacity building needed to develop a workforce/older person, telehealth partnership and service that is integrated within existing health, social care and housing services. Design/methodology/approach – A qualitative case study approach on the implementation and deployment of a pilot telehealth service, supporting sheltered housing tenants with Chronic obstructive pulmonary disease (n=4). Findings – Telehealth training and capacity building, needs to develop from within the workforce/older person partnership, if a usable and acceptable telehealth service is to be developed and integrated within existing health, care and housing services. To be adaptable to changing circumstances and individual need, flexible monitoring is also required. Practical implications – Service users and workforces, need to work together to provide flexible telehealth monitoring, that in the longer term, may improve service user, quality of life. Originality/value – The pilot explored a workforce/older person partnership to consider how to add and implement telehealth services, into existing health and housing services. [ABSTRACT FROM AUTHOR]

The paper investigates whether, how and in what circumstances boundary blurring or boundary maintenance is productive or destructive of sense in collaborative research based on a case study involving researchers from two universities and two principal organisational stakeholders in a local healthcare system in England between 2009 and 2012. Adopting a narrative method, using meeting observation, document analysis and interviews, we describe two key sets of activities in the evolution of collaboration, which allows us to tackle the question at two levels. Studying the production of documents and their use as boundary objects in project management meetings, we show how these were used to enable cooperation by establishing a truce between worldviews, giving participants a better feel for the game and a clearer perception of its stakes. Studying how the partnership expanded to take in other organisations besides the two formal partners, we show how the project accommodated pre-existing organisational interests but thereby sacrificed its experimental ethos. In showing how actors needed to subvert their experimental script to enact collaborative partnership, we argue for understanding and evaluating the latter as the co-produced outcome of disputes and co-orientations towards a practical ideal, not as an organisational format for knowledge co-production. [ABSTRACT FROM AUTHOR]

This paper reports on a study of experiences of young people aged 14 to 18 years who were nursed on acute adult hospital wards in NHS hospitals in England. In spite of British government guidelines, young people from 14 years of age continue to be admitted to adult wards in the UK. Although much has been written about the transition of the young person to adult services, there is little research about the experiences of young people who are nursed on adult wards. Hermeneutic phenomenology was used to explore the lived experiences of eight young people who had been nursed on adult wards between 2004 and 2010. Data were collected in 2010. In-depth interviews were recorded, transcribed and analysed using Colaizzi’s framework (Colaizzi, 1978). Themes explored included expectations of what the experience may be like, young people’s first impressions of the ward environment, the feelings of the young person while in hospital, the attitudes of people towards them including, both staff and other patients, and future admissions and how they would cope with readmissions. Better provision needs to be made for young people including appropriately trained staff, adolescent-friendly environments and areas in adult wards that are dedicated to adolescents. [ABSTRACT FROM AUTHOR]

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision. [ABSTRACT FROM PUBLISHER]

Despite media and political rhetoric to the contrary, there is persuasive evidence to suggest an association between deprivation and those involved in the English riots of 2011, which continues to be downplayed when developing responses to crime and crime prevention policy. This study explores empirical evidence from two major cities in the North West of England, which highlights an association between deprivation and rioting in both criminal charge and sentencing data allowing further exploration of some of these issues. The paper argues that to mask the rioting as ‘mindless criminality’ is to ignore wider social-structural inequalities and to silence important messages contained in the rioting behaviour from disenfranchised youth and communities about the inequalities they suffer. [ABSTRACT FROM PUBLISHER]

Since 1977 homelessness legislation in England has offered limited statutory accommodation rights to unintentionally homeless people who are judged to be in priority need and able to demonstrate a local connection. Using data generated in interviews with homeless people and staff working to support them, this paper considers the impact of current homelessness policy and practice and explores how decisions about intentionality, priority need and local connection serve to exacerbate the social exclusion experienced by single homeless people with multiple support needs. It is concluded that a more genuinely inclusive welfare state will only emerge when, and if, policymakers and wider society are able to abandon their current fixation with using welfare policy to punish ‘irresponsible’ behaviour and refocus instead on providing services to adequately meet the basic needs of marginalised people. [ABSTRACT FROM PUBLISHER]

The context of this article is the use of employer sanctions, in the form of raids and fines on businesses found to be employing people who do not have permission to work in the UK, as a method of in-border immigration control. Drawing on qualitative interviews with undocumented migrants and ethnic enclave employers in London, this article examines the impact of sanctions from the perspectives of those who have been or are most likely to be affected. More specifically the article sheds light on individual experiences of and strategies against immigration enforcement raids, and the effect of raids on the labour market, conditions of work and more widely, on local community relations. The paper concludes that there is a disjuncture between the real impact of sanctions and at least some of the stated policy aims. [ABSTRACT FROM PUBLISHER]

A sample of women ( n = 5) participated in a qualitative service evaluation concerning an open-ended, therapeutic group for women only. Data analysis followed suggestions by Halcomb and Davidson (2006). Main themes derived from the evaluation included: 'Groups are different from individual work', 'Belonging/ not being alone', 'Performance in the group', 'The group as a safety net', 'Life improvements and hope for the future' and 'The extent of emotional despair felt'. In this paper, several sub-themes within the main themes and relevant theories and implications for theory and service provision are discussed. [ABSTRACT FROM AUTHOR]

This paper describes the appearance and subsequent disappearance of ‘Barrow Man’ and uses anthropological and social psychological theory to examine the socio-cultural, psychological and economic conditions for the existence of the phenomenon. It argues that these conditions were the result of both specific local labour market circumstances and of the effects of global political changes, and argues that to talk about ‘Barrow Man’ as if it was a psychiatric diagnosis was to identify a moral construct as a mental disorder. It also argues that at the same time the phenomenon was expressive of certain core values that were not readily acknowledged in everyday clinical practice and that it might therefore best be understood as an institutional category. [ABSTRACT FROM PUBLISHER]

One of the major shifts in the form and experience of contemporary family life has been the increasing insertion of the ‘expert’ voice into the relationship between parents and children. This paper focuses on an exploration of mothers’ engagement with advice around the combined measles, mumps and rubella (MMR) vaccine. Much of the previous literature utilises a ‘decision-making’ framework, based on ‘risk assessment’ whereby mothers’ decisions are conceptualised as rooted in complex belief systems, and supposes that that by gaining an understanding of these systems, beliefs and behaviour can be modified and uptake improved. However, less attention has been paid to the ways in which mothers negotiate such advice or the ways in which advice is mediated by positionings, practices and relationships. Analysis of data from a focus group with five mothers identified three themes: (i) Sourcing advice and information, (ii) Constructing ‘Mother knows best’ and (iii) Negotiating agency. Despite the trustworthiness of advice and information being questioned, an awareness of concerns about the MMR, and health professionals being constructed as remote, ultimate conformity to, and compliance with, the ‘system’ and ‘society’ were described as determining MMR ‘decisions’. [ABSTRACT FROM PUBLISHER]

Background A 'blended' (e-learning and facilitated workshops) training course for Group C staff (i.e. staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes. This paper evaluates the impact of the course on participants' understandings of and confidence in delivering end of life care in one nursing home, while also considering barriers to change in practice. Methods A mixed-methods case study approach, incorporating pre- and post-course questionnaires (SHA East of England End of Life Care Education Programme 'ABC' Project Work Force C or Non Nurse Workforce B Pre and Post Course Questionnaire; E-Learning in End of Life Care Study Pre and Post Course Questionnaire), documentary analysis, semi-structured interviews, and observation of course workshops. Participants were 20 members of staff at a nursing home in a city in the East of England, including 14 Health Care Assistants (carers) and 6 others (administrative, activities, hosting, and catering staff). The questionnaires and interviews assessed understandings of and confidence towards end of life care delivery. Results Improvements in participants' confidence in delivering end of life care were observed, particularly in the core competency areas of symptom management, communication, and advance care planning. A shift towards more detailed and more holistic understandings of end of life care was in evidence; some participants also championed end of life care in the home as a result of the course. Several barriers to changes in practice were encountered, including uneven participation, the absence of mechanisms for disseminating new insights and knowledge within the home, and a widespread perception that nurses' professional dominance in the home made sustainable change difficult to enact. Conclusions While blended e-learning courses have the potential to generate positive change in participants' understandings of and confidence about End of Life Care, organizational and inter-professional obstacles must be overcome in order to translate these changes into improved end of life care delivery in nursing (and residential) homes. [ABSTRACT FROM AUTHOR]

Background: We evaluated end of life care services in two English counties including: coordination centres, telephone advice line, ‘Discharge in Reach’ nurses, a specialist community personal care team and community nurse educators. Elsewhere, we published findings detailing high family carer satisfaction and fewer hospital admissions, Accident and Emergency attendances and hospital deaths for service users compared to controls. The aim of this paper is to discuss what contributed to those outcomes. Methods: Using realist evaluation, data collection included documentation (e.g. referral databases), 15 observations of services and interviews with 43 family carers and 105 professionals. Data were analysed using framework analysis, applying realist evaluation concepts. Findings were discussed at successive team meetings and further data was collected until team consensus was reached. Results: Services ‘worked’ primarily for those with cancer with ‘fast track’ funding who were close to death. Factors contributing to success included services staffed with experienced palliative care professionals with dedicated (and sufficient) time for difficult conversations with family carers, patients and/or clinical colleagues about death and the practicalities of caring for the dying. Using their formal and informal knowledge of the local healthcare system, they accessed community resources to support homecare and delivered excellent services. This engendered confidence and reassurance for staff, family carers and patients, possibly contributing to less hospital admissions and A&E attendances and more home deaths. Conclusions: With demand for 24-hour end of life care growing and care provision fragmented across health and social care boundaries, services like these that cut across organisational sectors may become more important. They offer an overview to help navigate those desiring a home death through the system. [ABSTRACT FROM AUTHOR]

Abstract: In England from 2002 to 2013, Primary Care Trusts (PCTs) were responsible for commissioning healthcare for their local populations. The NHS has recently undergone rapid organisational change whereby clinicians have assumed responsibility for local commissioning decisions. This change in commissioning arrangements alongside the current financial pressures facing the NHS provides an impetus for considering the use of technical prioritisation methods to enable the identification of savings without having a detrimental effect on the health of the population. This paper reports on the design and implementation of a technical prioritisation method termed PBMA applied within NHS Plymouth, an English PCT responsible for commissioning services for a population of approximately 270,000. We evaluated the effectiveness of the process, the extent to which it was appropriate for local healthcare commissioning and whether it identified budget savings. Using qualitative research methodology, we found the process produced clear strategic and operational priorities for 2010/11, providing staff with focus and structure, and delivered a substantial planned reduction in hospital activity levels. Participants expressed satisfaction with the process. NHS Plymouth adhered to the PBMA process, although concerns were raised about the evidence for some priorities, decibel rationing, and a lack of robust challenge at priority-setting meetings. Further work is required to enhance participants' understanding of marginal analysis. Participants highlighted several external benefits, particularly in terms of cultural change, and felt the process should encompass the whole local health and social care community. This evaluation indicates that the prioritisation method was effective in producing priorities for NHS Plymouth, and that PBMA provides an appropriate method for allocating resources at a local level. In order for PBMA to identify savings, cultural and structural barriers to disinvestment must be addressed. These findings will interest other healthcare commissioners in developing their own approaches to priority-setting. [Copyright &y& Elsevier]

Abstract: This paper reports on the moral work done in routine diabetes review consultations in primary care with nurses. Consultations with fluent English speakers are compared with consultations where an interpreter was present, largely involving patients of Bangladeshi origin. The study setting was Tower Hamlets in London, where type 2 diabetes is particularly common. Existing research has shown some dissatisfaction with diabetes care amongst Bangladeshi patients, and studies of care providers in other locations suggest that they at times experience the care of this group as particularly challenging. Through analysis of video-recorded consultations recorded in 2010–2011 we shed light on possible reasons for these difficulties. The 12 non-English speakers often experienced difficulties in raising issues that concerned them, particularly if their interpreter did not translate their utterance because it was deemed to be unrelated to diabetes. These difficulties were not shared by the 24 fluent English speakers, who also found it easier to convey a positive moral reputation and to excuse behaviour that deviated from recommended self-management practices. Interpreters at times also acted as moral mediators. For example, where a participant in the consultation made statements that appeared to convey a negative moral judgement of an other participant, these would often go untranslated. Probably, neither health care providers nor patients are fully aware of the nature of their communication difficulties. Given this, interpreters possess considerable power to influence matters. Understanding the moral work of consultations is important in explaining the findings of other studies showing difficulties in the provision of diabetes care to people with limited English language skills. [Copyright &y& Elsevier]

Purpose. Supporting Offenders through Restoration Inside (SORI) is a programme that aims to: increase victim empathy in offenders; motivate offenders to change their offending behaviour; and to take personal responsibility for the harm that he has caused. A 5-day course based on the SORI principles has been piloted across seven prison sites in the UK. The aim of the study reported here was to evaluate the effectiveness of the programme across these sites. Methods. Three psychometric questionnaires [Victim Concerns, Locus of Control, and Stages of Change (SoC) scales] were administered to the participants immediately before and after the programme had taken place (data were available for 131 participants for the Victim Concern Scale, 82 participants for the Locus of Control measure, and 96 participants for the SoC questionnaire). These psychometric measures were the primary research outcome. Statistical analyses were employed to assess whether any changes had been effected by the programme. Results. The results of this study found that: participants had an enhanced victim concern for all types of victims, were more motivated to change their offending behaviours, and were more willing to take responsibility for their actions, after completion of the course. No change was found in terms of participants seeing themselves as being more in control of their actions/environment. Conclusions. The results lend support for the notion that the 5-day SORI course is effective in increasing participants' levels of victim concern and motivation to change, while not really impacting upon levels of ownership for one's ownership for one's actions. Suggestions for future research and limitations of the study are discussed in the paper. [ABSTRACT FROM AUTHOR]

Historical studies have shown that, since its beginnings, sex education in England has mostly focused on ‘damage limitation’, emphasising only the dangerous inevitability of pregnancy and childbirth after unprotected sex and the hazards of sexually transmitted diseases. This approach is largely based on restrictive notions of teenage sexuality, characterising teenagers as hypersexual beings for whom sexual drives continuously threaten to produce unwanted babies unless preventive action is taken. Analysis of current materials from many curricular areas reveals that this is still the case. Yet, recent demographic evidence shows that educated women in Europe continue to delay first childbirth for a number of reasons. At the same time they are also subject to seductive and deceptive media messages about the possibilities of conception at late reproductive age through reporting on ‘older’ celebrity mothers, and the role that reproductive technologies play in conquering infertility. In the light of these demographic trends, and the misleading hidden curriculum, this paper contends that discourses of damage limitation are no longer appropriate in sex education. Instead, if educated women are to gain full reproductive autonomy then new, more balanced conceptualisations of sex education that also incorporate appropriate messages about the finite nature of the reproductive lifespan are needed. Not only will this help schools provide comprehensive, quality, progressive sex education, it will also ultimately contribute to future national health and well-being. [ABSTRACT FROM PUBLISHER]

Eyewitness identification decisions from 1,039 real lineups in England were analysed. Identification procedures have undergone dramatic change in the United Kingdom over recent years. Video lineups are now standard procedure, in which each lineup member is seen sequentially. The whole lineup is seen twice before the witness can make a decision, and the witness can request additional viewings of the lineup. A key aim of this paper was to investigate the association between repeated viewing and eyewitness decisions. Repeated viewing was strongly associated with increased filler identification rates, suggesting that witnesses who requested additional viewings were more willing to guess. In addition, several other factors were associated with lineup outcomes, including the age difference between the suspect and the witness, the type of crime committed, and delay. Overall, the suspect identification rate was 39%, the filler identification rate was 26% and the lineup rejection rate was 35%. [ABSTRACT FROM AUTHOR]