Age In England Research Articles

The Critiques of Liberalism in Korea and the New Liberalism

The purpose of this paper to specify many problems from the studies and critiques on liberalism in Korea and to illustrate new liberalism in the late Victorian Age in England, which serves as an alternative to progressive liberalism aiming to overcome neo-liberalism. Those who have critical views on liberalism make their approaches to it based on the two kinds of frameworks above. First, those who consider liberalism a dominant ideology for the bourgeois class accept it as a kind of ideological device fully accomplishing class dictatorship by the bourgeoisie, in terms of a specific paradigm, Marxist historical materialism. Second, another ideology commenting upon liberalism is an equation of liberalism with neo-liberalism, which argues liberal political groups in Korea have led liberalism in Korea to be converted to neo-liberalism by making their choices in favor of neo-liberal policies. Liberalism in Korea has a dominant position as a main political ideology. Studies on liberalism in Korea have very simplistic aspects, and they tend to make critiques on all liberalism. The critiques on liberalism in Korea only take into account a unilateral aspect, dismissing the diversity of liberalism. In this circumstance, the new liberalism that appeared in England in the late eighteenth century is able to serve as a new alternative in Korea. New liberalism presents a framework for Korea that facilitates a free market economy and an advanced welfare state.

Cognitive Ageing in Great Britain in the New Century: Cohort Differences in Episodic Memory.

BackgroundDementias in high income countries are set to be the third major burden of disease even as older people are increasingly required to think for themselves how to provide for their lives in retirement. Meanwhile the period of older age continues to extend with increase in life expectancy. This challenge demands an understanding of how cognition changes over an extended period in later life. But studying cognitive ageing in the population faces a difficulty from the fact that older respondents are liable to leave (attrite) before study completion. This study tested three hypotheses: trajectories of cognitive ageing in Britain show an improvement beyond the age of 50; and they are lifted by secular improvement in cognition across cohorts; lastly they are susceptible to distortion due to attrition.Methods and FindingsUsing the English Longitudinal Study of Ageing, this paper studied trajectories of episodic memory of Britons aged 50–89 from 2002 to 2013 (N = 5931). Using joint models the analysis found that levels of episodic memory follow a curvilinear shape, not a steady decline, in later life. The findings also revealed secular improvement in cognitive ageing such that as a cohort is being replaced episodic memory levels in the population improve. The analysis lastly demonstrated that failure to simultaneously model attrition can produce distorted pictures of cognitive ageing.ConclusionOld age in this century is not necessarily a period dominated by cognitive decline. In identifying behavioural factors associated with better cognitive ageing, such as social connections of traditional and online kinds, the paper raises possibilities of mustering an adequate response to the cognition challenge.

Extending the elderly- and risk-group programme of vaccination against seasonal influenza in England and Wales: a cost-effectiveness study.

BackgroundThe present study aims to evaluate the cost-effectiveness of extending the pre-2013 influenza immunisation programme for high-risk and elderly individuals to those at low risk of developing complications following infection with seasonal influenza.MethodsWe performed an economic evaluation comparing different extensions of the pre-2013 influenza programme to seven possible age groups of low-risk individuals (aged 2–4 years, 50–64 years, 5–16 years, 2–4 and 50–64 years, 2–16 years, 2–16 and 50–64 years, and 2–64 years). These extensions are evaluated incrementally on four base scenarios (no vaccination, risk group only with coverage as observed between 1995 and 2009, risk group and 65+, and risk group with 75 % coverage and 65+). Impact of vaccination is assessed using a transmission model built and parameterised from a previously published study. The study population is all individuals of all ages in England and Wales representing an average total of 52.6 million people over 14 influenza seasons (1995–2009).ResultsThe influenza programme (risk group and elderly) prior to 2013 is likely to be cost effective (incremental cost effectiveness ratio: 7,475 £/QALY, net benefit: 253 M£ [15–829]). Extension to any one of the low-risk target groups defined earlier is likely to be cost-effective. However, strategies that do not include vaccination of school-aged children are less likely to be cost-effective. The most efficient strategy is extension to the 5–16 year age group while universal vaccination (extension to all low-risk individuals over 2 years) will achieve the highest net benefit. While extension to the 2–16 year age group is likely to be very cost effective, the cost-effectiveness of extensions beyond 2–16 years is very uncertain. Extension to the 5–16 year age group would likely remain cost-effective even without herd immunity effects to other age groups. As our study includes a strong historical component, our results depend on the efficacy of the influenza vaccine remaining at levels similar to the ones achieved in the past over a long-period of time (assumed to vary between 28 % and 70 % depending of the circulating strains and age groups).ConclusionsMaking use of surveillance data from over a decade in conjunction with a dynamic model, we find that vaccination of children in the United Kingdom is likely to be highly cost-effective, not only for their own benefit but also to reduce the disease burden in the rest of the community.

Educational differences in timing and quantum of childbearing in Britain

© 2015 Ann Berrington, Juliet Stone & Eva Beaujouan. Background Increased postponement of fertility, especially among higher-educated women, means it is important to know whether women recuperate births at older ages, but evidence for the UK is lacking. The extent to which the timing and quantum of mothers' fertility underlie the strong educational gradient in completed family size is also unclear. Objective We investigate the relative contributions of childlessness, timing, and quantum to educational differences in completed fertility within cohorts born between 1940 and 1969. Methods We analyse retrospective fertility histories from 44,351 women, born 1940-1969, interviewed in the British General Household Survey (1979-2009) and the UK Household Longitudinal Study (2009-2010). After describing educational differences in the timing of first birth and parity distributions, we quantify the relative contributions of childlessness, delayed entry into motherhood, and fertility rates conditional upon age at entry into motherhood, to educational differences in completed family size. Results Within each cohort, the educational gradient in completed family size is explained, in demographic accounting terms, almost entirely by educational differences in the proportions remaining childless and the age distribution of mothers at entry into motherhood. Conditional upon age at entry into motherhood, subsequent fertility rates are similar across educational groups and across cohorts.Conclusions Unlike for some other European countries, the postponement of motherhood to later ages in Britain has not resulted in a significant increase in childbearing among more-educated women who enter motherhood at later ages. The stability of aggregate measures of completed fertility in Britain is not the result of a straightforward process of postponement followed by recuperation.

'Protection Against Self-Incrimination' as a Fundamental Right in India: A Critical Appraisal

The right against self-incrimination finds its earliest embodiment in the medieval law of the Roman church in the Latin maxim ‘Nemon tenetur seipsum accusare’ which means that ‘No man is obliged to accuse himself’. The right gradually evolved in common law through protests against the inquisitorial and manifestly unjust methods of interrogation of accused persons, back in the middles ages in England. This right is one of the fundamental canons of British System of criminal jurisprudence which the United States of America adopted from the British legal system and incorporated it in their Constitution as “no person shall be compelled in any case to be a witness against himself, and thereafter in the Indian Constitution under Article 20(3). In 1978, under the Constitution (Fourty-fourth Amendment) Act, 1978, the Article 20 of the Constitution of India was granted a non-derogable status i.e. the state has no legal basis, even in a state of emergency, to refuse to honour this right. This is a testimony to the importance it has been accorded in our Constitution. From the very first years of our Constitution, a certain ambiguity on the question of what evidence was accorded protection, and apparent conflicts between Article 20(3) and provisions of the Indian Evidence Act, 1872 have prevailed. This resulted in judgements with apparent imbalance between the right against self-incrimination in Article 20(3) and the necessity to facilitate collection of evidence by investigating trial agencies. These judgements were referred to the Apex Court, which clubbed them and referred them to an eleven-judge bench. The resultant judgement is the landmark judgment of State of Bombay v. Kathi Kalu Oghad (1961) which has made a defining contribution to the case law on the matter as it stands today. M. P. Sharma v. Satish Chandra (1954) was the last significant ruling on the interpretation of Part III of the Constitution soon after independence. Following M.P. Sharma, several cases were referred to the Apex Court. Questions addressed were essentially of interpretation of what constitutes ‘to be a witness against himself’ with respect to the circumstances defining compulsion.The researchers in this paper seek to analyse the concept of protection against self-incrimination as a fundamental right in India in various perspective. The rationale of Article 20(3) has been discussed under Part II. Part III covers the provision contained under Article 20(3) in the Constitutional perspective constituting the fundamental right. The judicial interpretation and approach has been discussed under Part IV. Part V and Part VI covers the Narco-Analysis test and DNA testing that how far they suit to the spirit embedded beneath the Article 20(3). Part VII emphasis on the self-incriminatory evidences and the social media with the ending words under Part VIII.

Book Review: A Dog's History of the World: Canines and the Domestication of Humans

A Dogs History of the World: Canines and the Domestication of Humans. By Laura Hobgood-Oster. Waco, Tex.: Baylor University Press, 2014. vii + 188 pp. $29.95 (cloth).Many of us have had our lives made more enjoyable, more fulfilling, and more whole with the companionship of a dog. Sometimes we admit this sheepishly, purchasing holiday or birthday gifts for our pets, but with a selfeffacing sense of humor. And sometimes, when a working animal saves a loved one from isolating disability, or when we lose a beloved pet, we are absolutely earnest about the power of an animals love.In A Dogs History of the World: Canines and the Domestication of Humans, Laura Hobgood-Oster traces how human history intersects-and grew to be intertwined with-the history of domesticated dogs. Not only did we become socialized and domesticated together, alongside our working and pet animals, our dogs have served us in a range of relationships as varied as human vocations and needs. For example, fifteen thousand years ago, dogs were our partners in hunting and herding. Rock carvings dating from the third to the first millennium in Armenia reveal that dogs were already helping humans guard and herd animals, and were even serving as household companions. Burial sites of dogs ranging from the Iron Age in Rome, to Japan between 8,500 and 8,000 years ago, to the Victorian age in England, and to North American pet cemeteries in the early twentieth century document the ways we humans have mourned and buried our workmates and companions.Details about burial sites reveal that sometimes dogs were intended to help us enter the afterlife, or protect us in the next world. Some dogs- across centuries and in every place where canines lived with humans-were buried with food, with pillows or blankets, or with little glass bowls of water. Dogs were often buried with their human companions; Hobgood-Oster shares poignant details of such burial sites that remind contemporary readers that we have had dog-loving kindred spirits in eveiy generation.Not all of our interactions have been as heart-warming or simple, however. For example, Hobgood-Oster identifies painful histories of puppies serving as ritual sacrifices, controversies surrounding working dogs in the military, and how war and trauma often leave dogs unable to work or seen as war materials to euthanize and be discarded. In addition to being used as tools of war, dogs have been used to incite fear and facilitate colonizing empires in the Americas and wherever oppression and horror have sought to conquer peoples. …

Can we model a cognitive footprint of interventions and policies to help to meet the global challenge of dementia?

Can we model a cognitive footprint of interventions and policies to help to meet the global challenge of dementia?

PWE-119 Complex symptom burden and unmet need in end-stage liver disease

Introduction End-stage liver disease (ESLD) is now the third most common cause of death in those of working age in England and Wales. Despite this, little is known about the palliative care needs of this population, including symptom burden. This study aims to describe the prevalence and severity of symptoms in end-stage liver disease. Method A cross-sectional survey of adults with ESLD in two UK centres as part of a wider longitudinal study of symptoms, quality of life and other concerns. English-speaking adult patients with Childs Pugh C cirrhosis of any aetiology were eligible for the study. Patients were inelibible if on active antiviral therapy or had persistent grade II (or above) hepatic encephalopathy. Patients were recruited from inpatient and outpatient settings in a tertiary liver unit and a regional liver unit in the southeast of England. Symptoms were assessed using the Intergrated Palliative Care Outcome Scale (IPOS). The IPOS is a ten item questionnaire assessing physical symptoms, emotional, information and support needs in patients with advanced illness. Prevalence and severity of symptoms presented as counts and proportions. Bivariate analysis performed using ordered logistic regression in STATA SE 12.1. Results We present preliminary data from 27 participants; 67% were male with median age of 55 yrs (IQR 48–60 yrs), mean MELD 17.7 (SD 3.9) and UKELD 53.7 (SD 3.4). Disease aetiology included alcohol (12), PSC (5), NASH (4), PBC (2), viral (2), and other causes (2). Participants reported a median of 8 symptoms of any severity (range 2–13). 75% reported one or more ‘severe’ or ‘overwhelming’ symptom (s). The prevalence of severe/overwhelming symptoms largely mirrored the overall prevalence of each individual symptom. The three most common severe symptoms were weakness and lack of energy (46%), drowsiness (34%) and shortness of breath (15%). 24% of particpants reported feeling anxious about their illness most or all of the time. Total number of reported symptoms of any severity and counts of severe/overwhelming symptoms were not associated with age, gender, aetiology, MELD or UKELD. ![Abstract PWE-119 Figure 1][1] Abstract PWE-119 Figure 1 Conclusion This study demonstrates that patients with ESLD have considerable symptom control needs. These needs are not associated with disease severity as assessed by conventional prognostic scores. Patients with ESLD and may benefit from the earlier integration of specialist palliative care services alongside standard hepatological care. Disclosure of interest None Declared. [1]: pending:yes

Later prehistoric vegetation dynamics and Bronze Age agriculture at Hobbister, Orkney, Scotland

The Bronze Age in Britain was a time of major social and cultural changes, reflected in the division of the landscape into field systems and the establishment of new belief systems and ritual practices. Several hypotheses have been advanced to explain these changes, and assessment of many of them is dependent on the availability of detailed palaeoenvironmental data from the sites concerned. This paper explores the development of a later prehistoric landscape in Orkney, where a Bronze Age field system and an apparently ritually-deposited late Bronze Age axe head are located in an area of deep blanket peat from which high-resolution palaeoenvironmental sequences have been recovered. There is no indication that the field system was constructed to facilitate agricultural intensification, and it more likely reflects a cultural response to social fragmentation associated with a more dispersed settlement pattern. There is evidence for wetter conditions during the later Bronze Age, and the apparent votive deposit may reflect the efforts of the local population to maintain community integrity during a time of perceptible environmental change leading to loss of farmland. The study emphasises the advantages of close integration of palaeoenvironmental and archaeological data for interpretation of prehistoric human activity. The palaeoenvironmental data also provide further evidence for the complexity of prehistoric woodland communities in Orkney, hinting at greater diversity than is often assumed. Additionally, differing dates for woodland decline in the two sequences highlight the dangers of over-extrapolation from trends observed in a single pollen profile, even at a very local scale.

Stopping and switching contraceptive methods: findings from Contessa, a prospective longitudinal study of women of reproductive age in England

BackgroundDiscontinuation of, and change in, use of contraceptive methods contributes to high unplanned pregnancy rates. The aims of the Contessa study were to estimate the prevalence of and reasons for discontinuation and change and to assess the implications for preventive intervention. MethodsProspective cohort study of 1091 potentially fertile women aged 18–49, carried out during 2008, using a sample drawn from the Health Survey for England 2006, a random probability survey of health. We carried out a baseline survey followed by three further waves, exploring patterns of contraceptive use, characteristics of women experiencing each, and reasons for discontinuation and change. FindingsA percentage of 3.7 of women were at risk of unplanned pregnancy and discontinued and/or changed a contraceptive method in a year, compared with 4.7% who were at risk of unplanned pregnancy and used no method. Compared with continuous users, stoppers and switchers were younger, better educated and more likely to be single. Women discontinued or changed their contraceptive method for reasons of ease of use, reliability, side effects or concerns over health effects. Barely a quarter of such decisions were influenced by medical staff. InterpretationEffective strategies to aid contraceptive adherence have proved elusive but, if found, could reduce unplanned pregnancy rates appreciably. Understanding of the factors contributing to successful contraceptive practice is essential to prevention of unintended pregnancy.

The restoration of Tynemouth Railway Station canopy

Tynemouth railway station was built in 1882 and characterises the zenith of the railway age in Britain. The elegant cast and wrought iron roof is a Grade II* listed structure, an important regional example of its type. It fell into disrepair in the 1960s through lack of maintenance and by 2008 the larger part of the eastern canopy was in an appalling state with widespread corrosion. This paper describes the restoration. Basic calculations of capacity were undertaken prior to survey, to inform observations and the measurements of residual thickness. A comprehensive survey of defects was carried out and a document outlining the conservation philosophy was compiled, which formed the basis of the listed building consent. Almost all iron columns were found to have cracked near the top of the casting. Replacement of columns was considered to be too great a loss of historic fabric and unnecessary; the reasons for this are discussed. The paper concludes with an appraisal of the project's successes.

Insights from the Army's Drawdowns

Abstract: This article provides five insights extracted from discussions concerning the Army's long history of drawdowns. Perhaps the most important take-away is the Army can, and should, use the current drawdown constructively. ********** With the termination of the recent campaign in Iraq and the winnowing of forces in Afghanistan, the US military faces a drawdown of standing force structure and capabilities. The policy debate concerning how best to carry out this force reduction, however, lacks proper historical perspective. Twenty-four civilian historians and military professionals recently offered such a perspective by focusing on previous drawdowns over the span of American history. Beginning with a consideration of the cyclical nature of drawdowns and whether a crisis mentality is warranted in such periods, three major questions emerged. Was the attempt to preserve military effectiveness during drawdowns contradictory to traditional American values? Given the reoccurrence of force reductions in American history, how did the military best preserve combat capabilities? What was the relationship between the regular standing Army and militia/National Guard forces, and how did these reflect broader attitudes towards the military? Insights from the discussions follow. (1) 1. The drawdown of American forces has been a cyclical part of the nation's military experience. Whether they allowed colonial forts to fall into disrepair or furloughed hundreds of thousands of battle-hardened Union troops after the US Civil War, Americans historically have tightened their financial belts at the conclusion of major conflicts. This attitude reflects traditional Anglo-American values dating back to the late-Middle Ages in England. Latent fears of regular armies surfaced before the Revolutionary War with both the Quartering Act and the Boston Massacre. Americans carried these attitudes forward into the twenty-first century. The debate over the US military establishment has never been a purely rational one with biases inherent in the American cultural framework. Concerns over previous drawdowns have not run counter to traditional American values, and have not always been justified even by initial combat effectiveness. For example, the Kennedy/Johnson administrations reversed conventional drawdowns of the Eisenhower era in time to create the most competent US Army ever to engage in the initial battle of any war up to 1965. American forces also met with initial successes in 2001 and 2003 after a decade of drawdowns, paralleling the US experience nearly forty years earlier. However, American forces have not always reconstituted effectively for battle. Significant drawdowns left the Army unprepared for initial campaigns in the early 1790s against Native Americans, the War of 1812, the US Civil War, the Spanish-American War, both World Wars, and the Korean War. Significantly, these wars ended in American military victory, indicating the initial risk of fielding forces based on reduced military infrastructure, though costly in first battles, has often been acceptable in terms of overall strategic costs. Put differently, US foreign policy and national strategy objectives often exceeded military means. There was unanimous agreement among conference participants on this point. 2. Competition between the Regular Army and National Guard (militia) has always been part of the American military discourse. A number of scholars highlighted the historical importance of this competition. This debate is both rational and irrational as it stems from Anglo-Americans' historic preference for virtuous militia over suspect standing armies, while overlooking the sometimes poor initial military performance of militia/National Guard forces. A serving officer's presentation detailed how the relationship between active and reserve components works best in a complementary (but not interchangeable) arrangement. …

A ‘most imperial’ contribution: New Zealand and the old age pensions debate in Britain, 1898–1912

AbstractThe extent of imperial influences upon nineteenth- and early twentieth-century British life, including in the development of social policy, has attracted significant scholarly interest in the past decade. The bearing of New Zealand's 1898 Old-Age Pensions Act upon the British debate over elderly poverty exemplifies the contested transfer of social policy ideas from settler colony to ‘Mother Country’. Reformers in Britain hailed a model non-contributory pension system with an imperial pedigree. However, the widely acknowledged distinction between ‘old’ countries such as Britain, and ‘new’ countries of English-speaking settlement, characterized the New Zealand example's reception. While progressives identified the colony as a ‘clean slate’ lacking the obstructive historical inheritance of the Poor Law, critics of state-funded pensions warned against drawing policy-making lessons from New Zealand. Yet when a reformist Liberal government introduced an Old Age Pensions Bill in 1908, it used Britain's age to justify the legislation's relative conservatism.

Governmentality, Social Policy and the Social Construction of Old Age in England

This article looks in more detail at the incidence and consequence of social policies for older people through the distinctly French post-structuralist lens of governmentality (Foucault, 1977). This will enable us to consider the implications of the re-figuring of the relationship between the state, older people and social work. This re-figuring constructs an ambiguous place for older people: they feature either as a resource - captured in the idea of the „active citizen‟, as affluent consumers, volunteers or providers of child care - or as a problem in the context of poverty, vulnerability and risk. In many ways, policy provides three trajectories for older people: first, as independent self-managing consumers with private means and resources; second, as people in need of some support to enable them to continue to self-manage; and third, as dependent and unable to commit to self-management. Governmentality provides the theoretical framework through which to view policy and practice that is largely governed by discourses of personalisation, safeguarding, capability and risk.

Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study

ObjectiveTo investigate temporal trends in multiple birth rates and associated stillbirth and neonatal mortality by socioeconomic deprivation and maternal age in England.DesignPopulation cohort study.SettingEngland.ParticipantsAll live births and stillbirths (1 January...

Adolescent decision-making and the zone of parental control: a missed opportunity for legislative change

SummaryIssues relating to the consent of individuals under 18 years of age in England and Wales are covered by the Family Law Reform Act 1969, the Children Act 1989, the Mental Health Act 1983 (to some extent) and case law. Legislation on the consent of minors to hospital admission and treatment is complicated and contradictory, leaving clinicians unsure when to rely on the consent of the minor or that of someone with parental responsibility. This article reviews the concept of the zone of parental control (ZPC), introduced in England in 2008. It argues that this concept is too vague and subjective to provide any clear guidance on who can give consent for a minor's admission and treatment.LEARNING OBJECTIVES•Understand the concept of the ZPC and its relevance to clinical practice.•Determine the appropriate legal source of consent or refusal for children and young people.•Consider using formal powers (as against parental consent) with children and young people refusing admission and/or treatment.

Lord Mansfield: justice in the age of reason

In the first modern biography of Lord Mansfield (1705-1793), Norman Poser details the turbulent political life of eighteenth-century Britain's most powerful judge, serving as chief justice for an unprecedented thirty-two years. His legal decisions launched England on the path to abolishing slavery and the slave trade, modernized commercial law in ways that helped establish Britain as the world's leading industrial and trading nation, and vigorous opposition to the American colonists stoked Revolutionary fires. Although father and brother were Jacobite rebels loyal to the deposed King James II, Mansfield was able to rise through English society to become a member of its ruling aristocracy and a confidential advisor to two kings. Poser sets Mansfield's rulings in historical context while delving into Mansfield's circle, which included poets (Alexander Pope described him as his country's pride), artists, actors, clergymen, noblemen and women, and politicians. Still celebrated for application of common sense and moral values to the formal and complicated English common law system, Mansfield brought a practical and humanistic approach to the law. His decisions continue to influence the legal systems of Canada, Britain, and the United States to an extent unmatched by any judge of the past. An illuminating account of one of the greatest legal minds, Lord Mansfield presents a vibrant look at Britain's Age of Reason through one of its central figures.

First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing

Objective: To examine the performance of screening for trisomies 21, 18 and 13 at 11-13 weeks' gestation using specific algorithms for these trisomies based on combinations of fetal nuchal translucency thickness (NT), fetal heart rate (FHR), ductus venosus pulsatility index for veins (DV PIV), and serum free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PLGF) and α-fetoprotein (AFP). Methods: Model-based estimates of screening performance were produced for the distribution of maternal ages in England and Wales in 2011, and prospectively collected data on fetal NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP from singleton pregnancies undergoing aneuploidy screening. Results: In screening by NT, FHR, free β-hCG and PAPP-A, using specific algorithms for trisomy 21 and trisomies 18 and 13 at the risk cutoff of 1:100, the estimated detection rate (DR) was 87.0% for trisomy 21 and 91.8% for trisomies 18 and 13, at a false-positive rate (FPR) of 2.2%. Addition of PLGF, AFP and DV PIV increased the DR to 93.3% for trisomy 21 and 95.4% for trisomies 18 and 13 and reduced the FPR to 1.3%. Conclusions: Effective screening for trisomies can be achieved using specific algorithms based on NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP.

Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

SummaryBackgroundPhysical and mental health could greatly affect sexual activity and fulfilment, but the nature of associations at a population level is poorly understood. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) to explore associations between health and sexual lifestyles in Britain (England, Scotland, and Wales).MethodsMen and women aged 16–74 years who were resident in households in Britain were interviewed between Sept 6, 2010, and Aug 31, 2012. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data for self-reported health status, chronic conditions, and sexual lifestyles, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures.FindingsInterviews were done with 15 162 participants (6293 men, 8869 women). The proportion reporting recent sexual activity (one or more occasion of vaginal, oral, or anal sex with a partner of the opposite sex, or oral or anal sex or genital contact with a partner of the same sex in the past 4 weeks) decreased with age after the age of 45 years in men and after the age of 35 years in women, while the proportion in poorer health categories increased with age. Recent sexual activity was less common in participants reporting bad or very bad health than in those reporting very good health (men: 35·7% [95% CI 28·6–43·5] vs 74·8% [72·7–76·7]; women: 34·0% [28·6–39·9] vs 67·4% [65·4–69·3]), and this association remained after adjusting for age and relationship status (men: adjusted odds ratio [AOR] 0·29 [95% CI 0·19–0·44]; women: 0·43 [0·31–0·61]). Sexual satisfaction generally decreased with age, and was significantly lower in those reporting bad or very bad health than in those reporting very good health (men: 45·4% [38·4–52·7] vs 69·5% [67·3–71·6], AOR 0·51 [0·36–0·72]; women: 48·6% [42·9–54·3] vs 65·6% [63·6–67·4], AOR 0·69 [0·53–0·91]). In both sexes, reduced sexual activity and reduced satisfaction were associated with limiting disability and depressive symptoms, and reduced sexual activity was associated with chronic airways disease and difficulty walking up the stairs because of a health problem. 16·6% (95% CI 15·4–17·7) of men and 17·2% (16·3–18·2) of women reported that their health had affected their sex life in the past year, increasing to about 60% in those reporting bad or very bad health. 23·5% (20·3–26·9) of men and 18·4% (16·0–20·9) of women who reported that their health affected their sex life reported that they had sought clinical help (>80% from general practitioners; <10% from specialist services).InterpretationPoor health is independently associated with decreased sexual activity and satisfaction at all ages in Britain. Many people in poor health report an effect on their sex life, but few seek clinical help. Sexual lifestyle advice should be a component of holistic health care for patients with chronic ill health.FundingGrants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and Department of Health.

Austerity, personalisation and older people: the prospects for creative social work practice in England

In common with other European countries population ageing in England creates particular problems for social care and social work. This is exacerbated by the continuing financial crisis, which has led to an unprecedented assault on the resources needed to maintain older people within the community. At the same time, a policy of ‘personalisation’ is being introduced within social care that is intended to change the nature and balance of services. The effect of financial cuts means that there is substantially less money to respond to people's needs, despite the demographic changes that indicate there will be an increasing number of vulnerable older people in society. As a result the need for stringent rationing of resources will continue to be a priority, as it has been for many years. This has particular implications for the development of social work practice with older people: there are distinct possibilities that it will reduce in size and scale. This is despite the international recognition that has been given to the specific circumstances of older people, as well as social work's commitment to challenge injustice. If the needs of older people in England are to be more effectively addressed the implications of these factors needs to be considered and strategies for the full engagement of social workers within them need to be agreed.