Area Of North-East England Research Articles

PWE-098 Clostridium difficile diarrhoea—the changing hospital epidemiology and clinical outcomes from a high prevalence area in North East England

IntroductionClostridium difficile associated diarrhoea (CDAD) is an important hospital acquired infection. In 2008–2009 Co. Durham had one of the highest reported annual incidence of CDAD with 232 cases, 74.4 cases/100...

The Do-Well study: protocol for a randomised controlled trial, economic and qualitative process evaluations of domiciliary welfare rights advice for socio-economically disadvantaged older people recruited via primary health care

BackgroundOlder people in poor health are more likely to need extra money, aids and adaptations to allow them to remain independent and cope with ill health, yet in the UK many do not claim the welfare benefits to which they are entitled. Welfare rights advice interventions lead to greater welfare income, but have not been rigorously evaluated for health benefits. This study will evaluate the effects on health and well-being of a domiciliary welfare rights advice service provided by local government or voluntary organisations in North East England for independent living, socio-economically disadvantaged older people (aged ≥60 yrs), recruited from general (primary care) practices.Methods/DesignThe study is a pragmatic, individually randomised, single blinded, wait-list controlled trial of welfare rights advice versus usual care, with embedded economic and qualitative process evaluations. The qualitative study will examine whether the intervention is delivered as intended; explore responses to the intervention and examine reasons for the trial findings; and explore the potential for translation of the intervention into routine policy and practice. The primary outcome is the effect on health-related quality of life, measured using the CASP 19 questionnaire. Volunteer men and women aged ≥60 years (1/household) will be identified from general practice patient registers. Patients in nursing homes or hospitals at the time of recruitment will be excluded. General practice populations will be recruited from disadvantaged areas of North East England, including urban, rural and semi-rural areas, with no previous access to targeted welfare rights advice services delivered to primary care patients. A minimum of 750 participants will be randomised to intervention and control arms in a 1:1 ratio.DiscussionAchieving a trial design that is both ethical and acceptable to potential participants, required methodological compromises. The choice of follow-up length required a trade-off between sufficient time to demonstrate health impact and the need to allow the control group access to the intervention as early as possible. The study will have implications for fundamental understanding of social inequalities and how to tackle them, and provides a model for similar evaluations of health-orientated social interventions. If the health benefits of this intervention are proven, targeted welfare rights advice services should be extended to ensure widespread provision for older people and other vulnerable groups.Current Controlled Trials ISRCTN NumberISRCTN37380518

Promoting environmental citizenship and corporate social responsibility through a school/industry/university partnership

A partnership was formed between King Edward VI School Morpeth (UK) and the pharmaceutical company Merck, Sharp and Dohme within the programme of ‘Joint Responsibility’ operated by the Dove Marine Laboratory (Newcastle University, UK). Pupils surveyed an ecologically important coastal area in northeast England and made 15 recommendations for its sustainable management. Company employees participated in ecological surveys in collaboration with some of the pupils and acted on one of the pupils’ key recommendations: reconstructing, and improving access to, a bird hide. Responses to questionnaires suggest that pupils and employees gained substantial benefits from their involvement in the project. Pupils’ views of industry changed positively as a result of it. Employees felt that public perceptions of industry were improved by projects of this kind. Some pupils and employees were positive about intergenerational learning that occurred as the groups worked together.

The detection of early weight faltering at the 6–8-week check and its association with family factors, feeding and behavioural development

Aims:To identify infants with early weight faltering at the 6–8-week check and examine their family circumstances, feeding and behavioural development.Methods:Over a 2-year period, the weight gain of all infants born...

Sources of total, non-milk extrinsic, and intrinsic and milk sugars in the diets of older adults living in sheltered accommodation

The WHO recommends limiting non-milk extrinsic sugars (NMES) consumption to < or = 10 % energy to reduce the risk of unhealthy weight gain and dental caries, and to restrict frequency of intake to < or = 4 times/d to reduce risk of dental caries. Older adults, especially those from low-income backgrounds, are at increased risk of dental caries, yet there is little information on sugars intake (frequency of intake and food sources) in this age group. The aim of this report is to present baseline data from a community-based dietary intervention study of older adults from socially deprived areas of North East England, on the quantity and sources of total sugars, NMES, and intrinsic and milk sugars, and on frequency of NMES intake. Dietary intake was assessed using two 3-d estimated food diaries, completed by 201 participants (170 female, thirty-one male) aged 65-85 years (mean 76.7 (sd 5.5) years) recruited from sheltered housing schemes. Total sugars represented 19.6 %, NMES 9.3 %, and intrinsic and milk sugars 10.3 % of daily energy intake. Eighty-one (40.3 %) exceeded the NMES intake recommendation. Mean frequency of NMES intake was 3.4 times/d. The fifty-three participants (26.4 %) who exceeded the frequency recommendation ( < or = 4 times/d) obtained a significantly greater percentage of energy from NMES compared with those participants who met the recommendation. The food groups 'biscuits and cakes' (18.9 %), 'soft drinks' (13.1 %) and 'table sugar' (11.1 %) made the greatest contributions to intakes of NMES. Interventions to reduce NMES intake should focus on limiting quantity and frequency of intake of these food groups.

Nutrition-related health promotion through an after-school project: The responses of children and their families

UK health policy is concerned with emphasising nutritional status as a factor in the relationship of social inequalities to health outcomes. This paper examines pupil and parent responses to an after-school ‘Food Club’ designed to promote food preparation skills and healthier food choices amongst 12–13 year olds in low-income areas in North East England. The rationale for the intervention was a series of distinct but connected premises: food preparation skills are essential to inexpensive healthier eating; practical cooking skills are given limited emphasis in the secondary school curriculum; children have some choice over what they eat and may serve as a conduit of influence within the family. The qualitative investigation used group discussions and individual interviews with participating pupils and their parents. Most participating pupils enjoyed the practical emphasis upon food preparation, believed their skills developed, and were aware of the underlying message about healthier eating, but only made limited changes to their diet. Interviews with parents showed most to be positive about their child's involvement in such a club, though they varied in their attitude to its underlying message. There was some evidence of children being more involved in cooking at home and making some specific requests about food, but little to suggest they were influencing family food consumption. The findings suggest that an extra-curricular Food Club is an appropriate and feasible approach to developing food preparation skills with pupils in this age group. These findings raise questions about children's opportunities to exercise food preparation skills and make food choices within families, and the extent to which barriers to dietary change may be lowered through educational initiatives directed at pupils.

Health of children considered for adoption.

Children in the 'care' system are known to have poor health. Although health services can respond to and deal with health problems, it is parents, foster parents and social workers who recognize problems, seek advice and keep follow-up appointments. Many health needs remain unmet in such children. This short paper from a deprived area in north-east England shows that once a decision is made to proceed to adoption, the stable and consistent care that can then be provided meets the increased health needs that such children have.

Exploring Connections Between Occupation and Mental Health in Care Homes for Older People

Connections between occupation and the mental health of elderly care home residents are explored with particular reference to depression and dementia. The paper reviews and discusses some of the literature on the prevalence of these conditions in care homes; on resident occupation or inactivity in UK care homes; on the possible role of occupation or its absence in the onset or exacerbation of mental health problems; and on the effects of various kinds off activity programme. The problems of understanding the causation off depression in this context are discussed—does lack off occupation contribute to onset or exacerbate depression or is depressive illness? with its associated loss off interest, the cause of observed inactivity? Some findings from a large study of new admissions to care homes in Northwest England are described, which offer evidence that opportunities for occupation and pleasure in the home contribute both to survival and to mood state 9 months after admission. The paper concludes with an outline of a new trial off an occupational therapy intervention and its effects on depression in care home residents, due to begin in early 2002 in eight homes in two areas of North-East England.

‘Even the birds round here cough’:: stigma, air pollution and health in Teesside

In this paper we explore how the presence of hazardous industry may affect the identity of a place and the people who live there. Drawing on Goffman's seminal work on stigma — together with recent debates on environmental and technological stigma — we extend the concepts of difference and spoiled identity from the individual to place. The paper is based on a qualitative study which explored public perceptions of the risks to health from air pollution in Teesside, a heavily industrialised area in north-east England. We did not set out to study stigma per se in this study, but emergent themes produced by grounded theory analysis highlighted the way in which the presence of technologies, air pollution, poor health and social exclusion may be used as ‘discrediting’ characteristics, to stigmatise one place, whilst confirming the usualness of another. We demonstrate place stigma as a complex, multiple and re-inforcing concept.

Impact and management of visitor pressure on rocky intertidal algal communities

1. Human trampling was investigated in order to quantify the ‘recreational carrying capacity’ of two rocky intertidal areas in northeast England. 2. Estimation of ‘recreational carrying capacity’ was made by subjecting experimental plots in pristine areas of shore to different intensities of sustained trampling. The algal community was subsequently monitored for 16 months. 3. Changes in algal community composition occurred at both sites at all intensities. Compositional changes were rapid (1–2 months) and timing was dependent on both trampling intensity and site. 4. Trampling resulted in consistently reduced abundances of some species, for example fucoids, Phymatolithon lenormandii and turf species. 5. Open space was present in greater quantities in trampled than untrampled plots. In the summer months, this was subsequently colonized primarily by Enteromorpha spp. 6. ‘Recreational carrying capacity’ is being exceeded in some areas at both sites in the summer months. Possible management strategies are discussed in the light of these experimental results. copy 1996 by John Wiley & Sons, Ltd.

Impact and management of visitor pressure on rocky intertidal algal communities

1. Human trampling was investigated in order to quantify the ‘recreational carrying capacity’ of two rocky intertidal areas in northeast England. 2. Estimation of ‘recreational carrying capacity’ was made by subjecting experimental plots in pristine areas of shore to different intensities of sustained trampling. The algal community was subsequently monitored for 16 months. 3. Changes in algal community composition occurred at both sites at all intensities. Compositional changes were rapid (1–2 months) and timing was dependent on both trampling intensity and site. 4. Trampling resulted in consistently reduced abundances of some species, for example fucoids, Phymatolithon lenormandii and turf species. 5. Open space was present in greater quantities in trampled than untrampled plots. In the summer months, this was subsequently colonized primarily by Enteromorpha spp. 6. ‘Recreational carrying capacity’ is being exceeded in some areas at both sites in the summer months. Possible management strategies are discussed in the light of these experimental results. copy 1996 by John Wiley & Sons, Ltd.

The delivery of palliative care

Specialist palliative care services are now widespread throughout the U.K. There exist over 200 specialist inpatient hospices and many more palliative care teams in acute hospitals and in the community. Nearly all are headed by one or more doctors who are specialists in palliative medicine. However, such specialists are thinly spread and it is essential to ensure that there is wise use of this scarce and expensive resource. In an area of north-east England that has a completely integrated Specialist Palliative Care Unit (SPCU), giving an advisory service in acute hospitals and in the patients’ homes, as well as day hospice, inpatient hospice, research and education facilities, two aspects of the palliative specialist’s work were studied. Advisory visits to homes and the acute hospitals, which were done at the request of the specialist or the general practitioner, were studied for 3 months. Doctors, nurses, patients and relatives were questioned 1 week after the consultation, aiming to discover whether the visit had been prompt, helpful and effective. The palliative medicine specialist who made the visit was also asked whether the intervention had been effective, whether it had resulted in admission of the patient from home to hospice or hospital, and whether the visit had given him a better understanding of the patient’s physical, emotional and social needs. Secondly, a study was undertaken in a town where the clinical care of patients in the hospice is shared between the specialist in palliative medicine and the patient’s own family doctor. The family doctors were asked by means of a questionnaire how, after 4 years, they felt this was working, whether they favoured this shared care, whether they would prefer a change of staffing by full-time palliative medicine doctors, whether they would prefer to have total care of inpatients in the hospice without any consultant, whether their knowledge of palliative medicine had increased since the hospice opened, and whether their own practice in their care of other patients in their homes had changed.

Mortality Variations Within Two Poor Areas in North-East England

Mortality Variations Within Two Poor Areas in North-East England

Increase in cerebral palsy in normal birthweight babies.

A register has been compiled of the 421 children with congenital cerebral palsy born between 1960 and 1975 from a defined geographical area of North East England (population 770 000). There was a fall in the rate of cerebral palsy among very low birthweight babies between 1964 and 1975 and also in the small group with dyskinetic cerebral palsy. The rate rose, however, among babies weighing more than 2.5 kg at birth in the second half of the study, in parallel with changes in perinatal mortality. The net effect is that the overall congenital cerebral palsy rate (mean 1.64 per 1000 livebirths) showed a gradual rise between 1968 and 1975. This conclusion is reinforced by evidence of a rise in incidence among the subgroup of patients with severe cerebral palsy (as defined by an interval measurement of handicap) during the same period.

Voluntary sterilization in North Tyneside.

SummarySince 1975, sterilization operations, on both men and women, have been performed with increasing frequency within the National Health Service in the North Tyneside Area in north-east England. Some characteristics of people seeking this form of contraception are described, and selected aspects are compared with the results from earlier studies.