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This paper examines a sample of ninety-three child welfare workers' perceptions of emotional relations in risk assessment situations.Workers from England, Norway and California (USA) are interviewed about risk factors in a vignette. Seventy-three per cent of the total workers identify the emotional issues described in the vignette as a risk factor, but a lower percentage of the American workers do so. Nearly all of these workers identify the mother's lack of meeting her daughter's emotional needs as a risk factor; however, the analysis shows that only approximately one-third of these workers elaborate on the possibleconsequencesandreasons for this lack of attachment. Evenfewersuggest services that can improvethe situation.Thefindings suggest thatemotional issues havea relatively low importance in a risk assessment situation but that there are differences by country. Although the sample is small, it is likely that systemic factors in the child welfare system and the risk assessment approach explain some of these differences. [ABSTRACT FROM AUTHOR]

Deafblindness is a particularly complex impairment and deafblind people are considered to be some of the most vulnerable members of society; this includes vulnerability to abuse and harm. This paper explores this unique impairment in the illustrative case of Beverley Lewis, by reviewing archived published and audio material about the life and circumstances of the death of this young woman, including media reports, parliamentary debates and commentaries. Whilst it appears that the implications of Beverley's deafblindness may have been ‘overshadowed’ in media reports and inquiries, the paper suggests that further lessons for practice can be learned from the case by focusing on this condition. Drawing on contemporary research by specialist charitable organisations (Sense and Deafblind UK), the authors identify research highlighting deficiencies in support for many deafblind adults, which have implications for safeguarding policy and practice. It is concluded that attention is needed in three areas: increased awareness amongst social care and health practitioners of the particular vulnerability to abuse of deafblind adults; improved access to specialist assessment and specialist social care support, including one-to-one human support; and improved communication between social care and health agencies, alongside more tangible signs of acceptance of shared responsibility for supporting deafblind adults. [ABSTRACT FROM AUTHOR]

Background Childhood obesity is a serious public health issue. Understanding environmental factors and their contribution to weight gain is important if interventions are to be effective. Aims The purpose of this research was to assess the relationship between weight gain in children and accessibility of fast-food outlets. Methods A longitudinal sample of 1577 children was created using two time points from the National Child Measurement Programme in South Gloucestershire (2006/7 and 2012/13). A spatial analysis was conducted using a weighted accessibility score on the number of fast-food outlets within a 1-km network radius of each child’s residence to quantify access to fast food. Results The mean accessibility score for all children was 0.73 (standard deviation: 1.14). Fast-food outlets were more prevalent in areas of deprivation. A moderate association was found between deprivation score and accessibilty score (r = 0.4, P < 0.01). Children who had greater access to fast-food outlets were more likely (odds ratio = 1.89, P = 0.04) to gain significant weight (>50 percentile points) compared to children who had no access to fast-food outlets. Conclusions This paper supports previous research that fast-food outlets are more prevalent in areas of deprivation and presents new evidence on fast-food outlets as a potential contributor towards weight gain in mid-childhood. [ABSTRACT FROM AUTHOR]

This paper examines the interlocking roles of ethnicity and deprivation in producing inequities in the proportion of children who are subject to state child protection interventions. In contrast to the USA, ethnic inequities have had little attention in research or policy in the UK and across Europe, and administrative data are limited and methodologically weak. A study of over 10 per cent of all children on child protection plans or who were looked after in out-of-home care in England in March 2012 is reported. Children from ethnic minority categories were much more likely than 'White' children to be living in disadvantaged areas and this has to be taken into account when examining intervention rates. Controlling for deprivation and examining small subgroups of the broad ethnic categories radically alters the simple understanding that 'Black' children are overrepresented compared to White amongst children in out-of-home care, while 'Asian' children are under-represented. While this study could not explain these patterns, it reinforces the importance of both socio-economic circumstances and ethnicity for understanding inequities in intervention rates. The evidence underlines the powerful moral and economic case for action to reduce inequities in powerful state interventions in family life, not only in England, but internationally. [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]

Background: the Falls Efficacy Scale-International (FES-I) is a widely used measure of fear of falling that assesses concerns with respect to falls over a range of physical and social activities. In the original validation study, the methods used (self-selection by participants) were likely to over-represent those with a higher educational level and socio-economic grouping. In addition, the factor analysis method used was potentially less applicable to older individuals and may have been less likely to measure the construct of fear of falling.Objective: to validate the internal validity of the FES-I and assess its suitability as a measure of fear of falling.Design: cross-sectional survey.Setting: community sample.Methods: a random sample of 200 participants aged 60 years completed the FES-I by structured interview. We verify internal validity with a factor analytic approach not previously employed in this study design context, principal factor analysis on the matrix of polychoric correlations.Results: we find no redundancy in the questions on the FES-I. All are found to strongly represent concerns about falling during social and physical activities.Conclusion: the FES-I is an appropriate tool to assess fear or concerns with respect to falls in the general elderly population, and more appropriately represents concern of falling than has previously been found. Future health services research with the FES-I should have its design informed by the results presented in this study, as the structure of the ‘concern with falling’ factor differs markedly from that found in previous validity testing. [ABSTRACT FROM AUTHOR]

Background Dating and relationship violence (DRV) is under-researched in the UK, especially among Further Education (FE) students. This study examines the association between DRV victimization and socio-demographic characteristics, sexual identity and dating and relationship behaviours among 16–19 year olds FE students. Methods Cross-sectional self-report data were collected from 1751 students aged 16–19 at six FE settings in England and Wales. Factor analysis examined the structure of DRV victimization by gender. Multilevel logistic regression examined the odds ratios of DRV victimization according to socio-demographics, sexual identity and dating behaviours. Results DRV victimization clusters into two categories for females, and three for males. Among females, 46.1% experienced controlling behaviours and 31.6% threatening behaviours; 49.9% of males experienced controlling behaviours, 27.1% threatening behaviours and 5.8% online sexual violence. The odds of DRV victimization were 2–8 times greater for males and 2–4 times greater for females who had ever sent a sexually explicit image. No consistent association was found between DRV and age, spending money per week, educational attainment or meeting partners online. Conclusions The high prevalence, absence of gender differences and social patterning, suggests DRV victimization may be becoming normalized and is of significant public health importance for young people in England and Wales. [ABSTRACT FROM AUTHOR]

Organisational settings such as schools, workplaces and hospitals are well recognised as key environments for health promotion. Whilst there is extensive literature on specific types of settings, little empirical research has investigated the transfer of frameworks between sectors. This study analyses Food for Life, an England-wide healthy and sustainable food programme that evolved in schools and is being adapted for children's centres, universities, care homes, and hospital settings. Following a case study design, we interviewed 85 stakeholders in nine settings. Food for Life's systemic framework of 'food education, skills and experience' 'food and catering quality', 'community and partnerships' and 'leadership' carried salience in all types of settings. These were perceived to act both as principles and operational priorities for driving systemic change. However, each setting type differed in terms of the mix of facilitating factors and appropriate indicators for change. Barriers in common included the level of culture-shift required, cost perceptions and organisational complexity. For settings based health promotion practice, this study points to the importance of 'frame-working' (the systematic activity of scoping and categorising the field of change) alongside the development and application of benchmarks to stimulate change. These processes are critical in the transfer of learning from between sectors in a form that balances commonality with sufficient flexibility to adapt to specific settings. Synergy between types of settings is an under-recognised, but critical, part of action to address complex issues such as those emerging from the intersection between food, health and sustainability. [ABSTRACT FROM AUTHOR]

Background The Healthy Prisons Agenda seeks to reduce prisoners' health risks, balance prisoners' rights with a security regime, ensure equivalent prison health service provisions to community health services, and facilitate the whole-prison approach. There is an established assumption that legislation will ensure better implementation of health promotion programmes. This study aimed to examine whether a legislative framework, via a direct regulation, could lead to enhanced implementation of the Healthy Prisons Agenda in England. Methods A qualitative study design was conducted using semi-structured interviews with 30 key prison policy makers in England. Findings Our findings contradict the established assumption that legislation improves the implementation of health promotion programmes. A direct regulation was perceived as restrictive, manifesting excessive compliance and encouraging a risk-averse culture, whilst preoccupation with security, order and discipline amongst prison governors and custody staff was deemed an internal institutional barrier to implementing the Healthy Prisons Agenda. External barriers included diminishing resources, lengthier or delayed sentencing, and an unsympathetic public and political stance towards prisoner rehabilitation. Conclusions A direct regulation should not be used to operationalize the Healthy Prisons Agenda. Rather, self-regulation, along with proactive solutions for the identified barriers to implementing the Agenda, is the most appropriate path forward. [ABSTRACT FROM AUTHOR]

Background Conducting research on the antecedents of teacher connectedness (TC) is key to inform intervention and policy that can leverage the public health potential of teachers for young people’s well-being. As part of the EU-funded Teacher Connectedness Project, this study aims to examine the contribution of a variety of school-level factors (including type of school, school size, student–teacher ratio, students per class and teacher gender). Methods Sample consisted of 5335 adolescents aged 11, 13 and 15 years that had participated in the HBSC study in England. Multilevel multinomial regression was used to examine the contributions of sociodemographic and school-level factors to TC. Results TC was lower in older adolescents and those from less affluent families, but similar in boys and girls. Regarding school-level factors, it was not the size of the school but the ratio of students per teacher which was significantly associated to TC, with higher student–teacher ratio being significantly associated with lower odds of medium-to-high TC. Some differences between mixed and all-girls schools were also found. Conclusions Health promotion strategies targeting student–teacher relationships need to consider how TC changes by age and SES and give attention to school-level factors, in particular the student–teacher ratio. [ABSTRACT FROM AUTHOR]

Background: social isolation is defined as a lack of meaningful and sustained communication or interactions with social networks. There is limited understanding on the prevalence of social isolation and loneliness in people following hip fracture and no previous understanding of how this changes over time. Objective: to determine the prevalence and trajectory of social isolation and loneliness before a hip fracture, during the recovery phase and a minimum of 2 years post-hip fracture in an English population. Methods: data were from the English Longitudinal Study of Ageing (ELSA) cohort (2004/5-2014/15). The sample comprised of 215 participants who had sustained a hip fracture. Measures of social isolation and loneliness were analysed through multilevel modelling to determine their trajectories during three-time intervals (pre-fracture; interval at hip fracture and recovery; minimum 2 years post-fracture). The prevalence of social isolation and loneliness were determined pre- and post-fracture. Results: prevalence of social isolation was 19% post-hip fracture and loneliness 13% post-hip fracture. There was no statistically significant change in social isolation pre-fracture compared to a minimum of 2 years post-fracture (P = 0.78). Similarly, there was no statistically significant change in loneliness pre-fracture compared to a minimum of 2 years postfracture (P = 0.12). Conclusion: this analysis has determined that whilst social isolation and loneliness do not change over time following hip fracture, these remain a significant problem for this population. Interventions are required to address these physical and psychological health needs. This is important as they may have short and longer term health benefits for people post-hip fracture. [ABSTRACT FROM AUTHOR]

The article discusses the relationship between the Enlightenment and the Christian concept of original sin in England during the 18th century, including through referencing the Christian British wine merchant Pentecost Barker's diary. It discusses the psychology of Barker concerning original sin and salvation.

Background The Health and Social Care Act 2012 (H&SCA) provided for sweeping changes to the health and healthcare system in England. The UK Faculty of Public Health (FPH) considered the risks of the proposed legislation and remains opposed to many of the Act's provisions. Methods Cross-sectional electronic survey of membership, on the severity and likelihood of risks identified in FPH's original risk assessment. Results Combined severity/likelihood scores rated all risks as severe or high. Respondents identified risks to infrastructure for local public health, healthcare planning and delivery and public health careers as most likely and as having the most severe consequences. Proposals for remediation included review, public health advocacy, co-ordinated working across organizational boundaries and further legislation. However, some respondents considered the current arrangements as irredeemable and advocated revoking the act and undertaking structural reorganization. Ten percent of eligible members responded. Respondents were more likely than the general membership to be in senior roles, with longer FPH membership. Conclusions Surveying public health professionals can provide insights into health and healthcare policy and its implementation. Their insights can assist in both further policy formulation and mitigation of risks for population health and health care. [ABSTRACT FROM AUTHOR]

Background: The length of consultations is an important factor affecting the quality of care in general practice. It is however difficult to study as many factors are simultaneously involved. Much that is known is about patient factors as so far, doctor factors have been neglected.Objective: To investigate multiple factors affecting consultation length, how they interact and the association between consultation length and patient-centredness.Methods: Previously collected observational data from 38 National Health Service NHS GPs in England stratified according to doctor's gender, experience and degree of emotional exhaustion were used. Multiple regression analyses were applied to 822 audio-recorded and timed consultations. Each consultation was analysed for the doctor's gender, patient's gender, experience, level of emotional exhaustion and patient-centredness.Results: We previously reported that 261/564 (46%) of GPs in Essex England were emotionally exhausted. Here, we found that male and female doctors respond differently to both experience and emotional exhaustion, which are associated with differences in their consultation length. The effect of experience on consultation length is only observed in male doctors: the more experienced, the shorter their consultation. Emotional exhaustion affected consultation length in opposite ways for females and male GPs: exhausted female GPs had shorter consultations, while exhausted male doctors had longer ones. Longer consultations were significantly more patient-centred and were associated with female patients.Conclusions: We found five factors affecting consultation length significantly. Moreover, these factors can predict the consultation length. [ABSTRACT FROM AUTHOR]

Background Since 1 April 2013, local authority (LA) health and well-being boards (HWBs) in England are required to publish a health and wellbeing strategy (HWS). HWSs should identify how population health needs are to be addressed. The extent to which this has been achieved is not known.We analysed HWSs to assess how LAs have interpreted statutory guidance, how evidence has been used within HWSs and the relationship of HWSs to Joint Strategic Needs Assessments (JSNAs). Methods Qualitative thematic content analysis of a random sample of one-third of upper tier LA HWSs in 2013-14. Results Fifty out of 152 LAs were sampled and 47 HWSs analysed. Strategies varied in timescale, length and structure. The term ‘evidence’ was used most commonly referring to local need, rather than evidence of effectiveness. All, except two, referred to JSNAs. Conclusions HWSs are dominated by evidence of need and could be strengthened by greater use of evidence of effectiveness for public health interventions. Public health agencies and academics can support the development of effective HWSs by improving the accessibility of evidence and conducting research when evidence is absent. To strengthen HWSs' impact, the statutory guidance should clarify the distinction between evidence of need and evidence of effectiveness. [ABSTRACT FROM AUTHOR]

Background The public health impact of mass gatherings should not be underestimated, requiring careful planning. This evaluation identified the successes and failures of a programme targeted to mitigate against potential increases in sexual ill health during the London 2012 Olympics. Methods Programme planning was evaluated using documentary analysis. Stakeholders' experiences were explored using an online survey. Finally, selected stakeholders were interviewed in depth. Results Over 100 documents were analysed, 36 survey responses received and 12 interviews conducted. Most respondents felt aims were appropriate, potentially overambitious. ‘Business as usual', with no disruption or increased demand, was reported in sexual health services. Some interviewees felt evidence for increased demand was limited, although contingency planning was needed. Signposting service users and providing ‘residual risk responses' appeared successful. Planned service transformation was not fully achieved and perhaps inappropriate, although new service collaborations emerged. Over 2000 individuals participated; wider public engagement was seen as inappropriate. A ‘Sex Factor 2012' competition was particularly successful. Legacy opportunities included planning work, groundwork for transformation, relationship building and continuing the resilience changes. Conclusions The Games allowed sexual health services to explore new ways of working, engage with stakeholders and develop new relationships, although in reality demand for services did not increase. [ABSTRACT FROM AUTHOR]

Background Although there is substantial epidemiological evidence implicating cold homes in death and morbidity, evidence for the UK on the nature and scale of the costs involved is fragmentary. Policy making in this area is thus not well-informed of the benefit of interventions which arises in the form of costs averted. Methods This pilot study presents estimates of the social cost of harms to health caused by cold homes in the City of Sheffield. All costs are monetized and are for 1 year. Different elements of social cost are distinguished as are different types of harms to health. Because all estimates are derived from readily available secondary data the estimating framework is readily transferable to any other English local authority area. Results The social cost arising from losses of well-being are shown to dominate other elements of social cost including National Health Service and Social Care costs, and the social cost arising from mental illness is shown to dominate that arising from other harms to health including death. Discussion The implications of the results for the application of fiscal rate-of-return and social cost-benefit tests are discussed. Several areas are identified in which research reported in this pilot study could be improved on and expanded. [ABSTRACT FROM AUTHOR]

This article explores the significance of weeping in the lives of late medieval English bishops ( c.1100− c.1400). It considers the lachrymose devotions of saintly bishops alongside tears of grief, friendship and self-pity, and asks how such displays of emotion were understood by contemporary onlookers. It is argued that a bishop's tears were key to perceptions of his masculinity, sexuality and physical body, which in turn had significant implications for his reputation both as a prelate and as a potential saint. [ABSTRACT FROM AUTHOR]

Aims: To ascertain the views of general practitioners (GPs) regarding the prevention and management of alcohol-related problems in practice, together with perceived barriers and incentives for this work; to compare our findings with a comparable survey conducted 10 years earlier. Methods: In total, 282 (73%) of 419 GPs surveyed in East Midlands, UK, completed a postal questionnaire, measuring practices and attitudes, including the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Results: GPs reported lower levels of post-graduate education or training on alcohol-related issues (<4 h for the majority) than in 1999 but not significantly so (P = 0.031). In the last year, GPs had most commonly requested more than 12 blood tests and managed 1–6 patients for alcohol. Reports of these preventive practices were significantly increased from 1999 (P < 0.001). Most felt that problem or dependent drinkers' alcohol issues could be legitimately (88%, 87%) and adequately (78%, 69%) addressed by GPs. However, they had low levels of motivation (42%, 35%), task-related self-esteem (53%, 49%) and job satisfaction (15%, 12%) for this. Busyness (63%) and lack of training (57%) or contractual incentives (48%) were key barriers. Endorsement for government policies on alcohol was very low. Conclusion: Among GPs, there still appears to be a gap between actual practice and potential for preventive work relating to alcohol problems; they report little specific training and a lack of support. Translational work on understanding the evidence-base supporting screening and brief intervention could incentivize intervention against excessive drinking and embedding it into everyday primary care practice. [ABSTRACT FROM AUTHOR]

Background: In England, although some studies report better health among rural populations, few have examined social inequalities in health within rural areas and how they compare to inequalities observed in urban settings. The objectives of this study are to examine (i) whether living in rural, in more affluent and in more socially cohesive areas is associated with better mental health; and (ii) whether being in employment is more protective for mental health in rural than in urban areas. Methods: Data on common mental disorders (CMD) and socio-demographic characteristics of 12 962 adults are from the Health Survey for England. Individuals resided in 892 areas categorized as urban or rural. Area deprivation is measured using the employment deprivation domain from the 2004 Index of Multiple Deprivation. Area social cohesion is derived from individuals’ perceptions using ecometric procedures. Data are analysed using multilevel logistic models. Results: Living in rural areas is significantly associated with lower risk of reporting CMD [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.71–0.92], independently of individuals’ characteristics, and of area deprivation and social cohesion. The mental health advantage of being in employment is more important in rural areas (OR: 0.74; 95% CI: 0.58–0.95) than in urban settings. Conclusion: Living in rural areas is associated with better overall mental health. Yet inequalities in mental health between people in the workforce and those who are not are more important in rural settings. More studies are needed to understand the patterning of social inequalities in health in rural communities. [ABSTRACT FROM AUTHOR]

BackgroundEmotional distress has major implications for employees and employers. Cognitive behavioural therapy (CBT) is a recommended treatment, but demand outstrips supply. CBT is well suited to computerization. Most employee assistance programmes have not been systematically evaluated and computerized CBT has not previously been studied in the workplace.AimsTo evaluate the effect of an 8 week computerized cognitive behavioural therapy programme, ‘Beating The Blues’, on emotional distress in employees with recent stress-related absenteeism, and to explore the reasons for non-participation.MethodsAn open, randomized trial in a London NHS occupational health department. Forty-eight public sector employees, with 10 or more cumulative days stress-related absenteeism in the last 6 months, randomized equally to ‘Beating The Blues’ plus conventional care, or conventional care alone. Main outcome measures were Hospital Anxiety and Depression Scale and Attributional Style Questionnaire scores at end of treatment and 1, 3 and 6 months later; and reasons for non-participation.ResultsAt end of treatment and 1 month later, adjusted mean depression scores and adjusted mean negative attributional style scores were significantly lower in the intervention group. One month post-treatment, adjusted mean anxiety scores were also significantly lower in the intervention group. The differences were not statistically significant at 3 and 6 months post-treatment. Non-participation was common and related to access problems, preference for other treatments, time commitment, scepticism about the intervention and the employer connection.Conclusions‘Beating The Blues’ may accelerate psychological recovery in employees with recent stress-related absenteeism. Greater flexibility and accessibility might improve uptake. [ABSTRACT FROM AUTHOR]

Background Lesbian, gay, bisexual and transgender (LGBT) youth have a higher risk of suicidality and self-harm than heterosexual youth populations but little is known about the underlying mechanisms. We aimed to investigate the social determinants of this mental health inequality. Methods A two-stage sequential mixed method study was conducted. Firstly, 29 semi-structured interviews with LGBT youth (aged 13–25 years old) were completed. Data was analysed thematically. Stage 2 involved a self-completed questionnaire employing an online community-based sampling strategy (n = 789). Logistic regression analysis was performed to predict suicidality. Results Five social determinants explained suicidal risk: (i) homophobia, biphobia or transphobia; (ii) sexual and gender norms; (iii) managing sexual and gender identities across multiple life domains; (iv) being unable to talk; (v) other life crises. Youth who were transgender (OR = 1.50, P < 0.022), disabled (OR = 2.23, P < 0.000), had self-harmed (OR = 7.45, P < 0.000), were affected by abuse (OR = 2.14, P < 0.000), and affected by not talking about their emotions (OR = 2.43, P < 0.044) were most likely to have planned or attempted suicide. Conclusions Public health universal interventions that tackle bullying and discrimination in schools, and selected interventions that provide specific LGBT youth mental health support could reduce LGBT mental health inequalities in youth suicidality. [ABSTRACT FROM AUTHOR]