Counties Of England Research Articles

A study of role expansion: a new GP role in cardiology care

BackgroundThe National Health Service is reconfiguring health care services in order to meet the increasing challenge of providing care for people with long-term conditions and to reduce the demand on specialised outpatient hospital services by enhancing primary care. A review of cardiology referrals to specialised care and the literature on referral management inspired the development of a new GP role in Cardiology. This new extended role was developed to enable GPs to diagnose and manage patients with mild to moderate heart failure or atrial fibrillation and to use a range of diagnostics effectively in primary care. This entailed GPs participating in a four-session short course with on-going clinical supervision. The new role was piloted in a small number of GP practices in one county in England for four months. This study explores the impact of piloting the Extended Cardiology role on the GP’s role, patients’ experience, service delivery and quality.MethodsA mixed methods approach was employed including semi-structured interviews with GPs, a patient experience survey, a quality review of case notes, and analysis on activity and referral data.ResultsThe participating GPs perceived the extended GP role as a professional development opportunity that had the potential to reduce healthcare utilisation and costs, through a reduction in referrals, whilst meeting the patient’s wishes for the provision of care closer to home. Patient experience of the new GP service was positive. The standard of clinical practice was judged acceptable. There was a fall in referrals during the study period.ConclusionThis new role in cardiology was broadly welcomed as a model of care by the participating GPs and by patients, because of the potential to improve the quality of care for patients in primary care and reduce costs. As this was a pilot study further development and continuing evaluation of the model is recommended.

The Victoria History of the Counties of England. A History of the County of Staffordshire. Volume XI: Audley, Keele and Trentham. Edited by Nigel J Tringham. 310mm. Pp xxi + 297, 80 figs and maps. Institute of Historical Research, Boydell & Brewer, Woodbridge, 2013. ISBN 9781904356417. £95 (hbk).

The Victoria History of the Counties of England. A History of the County of Staffordshire. Volume XI: Audley, Keele and Trentham. Edited by Nigel J Tringham. 310mm. Pp xxi + 297, 80 figs and maps. Institute of Historical Research, Boydell & Brewer, Woodbridge, 2013. ISBN 9781904356417. £95 (hbk).

Epidemiological survey of suicide ideation and acts and other deliberate self‐harm among offenders in the community under supervision of the Probation Service in England and Wales

There is a dearth of information on suicidal thoughts and acts or other acts of deliberate self-harm by offenders under community supervision. The objective of this study is to estimate lifetime and one month prevalence of deliberate self-harm and to determine ongoing risk among offenders in the community under probation supervision. One hundred and seventy-three randomly selected offenders under supervision by the probation service in one county in England were screened for mental illness. All 88 screened cases and a one-in-five sample of non-cases were interviewed according to the Mini International Neuropsychiatric Inventory Module-B. False negatives (n = 17) were used to weight calculations and estimate prevalence for the whole group. A third of the interviewed sample (n = 56) had a lifetime history of suicide attempts, and 9 (5%) had self-harmed in the month prior to interview. Lifetime suicide history was associated with suicidal ideation and deliberate self-harm in the prior month. Our adjusted findings indicate that 25-40% of offenders serving all or part of their sentence in the community have a lifetime history of self-harm, which is similar to the rate among prisoners, and are at very much higher risk of further such acts or completed suicide than the general population. At a time of change in delivery of probation services the implications are that rates of suicide and other forms of deliberate self-harm should be continually assessed in all probation areas, particularly with reference to service changes;the relationship between deliberate acts of self-harm, suicidal ideation and completion of suicide should be investigated prospectively in larger studies;probation services are likely to need mental health expertise to manage these risks.

The impact of drought in early fourteenth‐centuryEngland

Climatic change is currently viewed as one of the main causes of the so‐called crisis of the early fourteenth century. It is well established thatEngland saw increased storminess and heavy rainfall in this period, but this article suggests that the impact of drought—which became a common feature of theEnglish climate during the 1320s and early 1330s—has been overlooked. Based primarily on a detailed analysis of account rolls for over 60 of the best‐documented manors in this period, the article establishes that drought brought devastating harvest failure and caused severe outbreaks of a number of diseases, plausibly including enteric infections, malaria, and winter and spring fevers. As a result, mortality surged and population levels fell in communities in affected regions, which were mainly confined to the southern and eastern counties ofEngland. The article concludes that such regional variation significantly affects our understanding of demographic, agricultural, and even fiscal trends in this period. Although we should not disregard the human factors influencing the impact of environmental shocks,England was plainly struck with indubitable force by extreme weather in this pivotal phase of the medieval economy.

Spinners and the Law: Regulating Yarn Standards in the English Worsted Industries, 1550–1800

The Worsted Acts, passed between 1777 and 1791, established semi-official industrial police forces in nearly a third of the counties of England, charged with detecting and prosecuting fraudulent reeling of worsted yarn by hand spinners. The Acts have been interpreted as the response of late eighteenth-century employers to new and growing problems of labour discipline associated with the putting-out system. But frauds by spinners in reeling yarn were not new. They had characterised the worsted industry since its rapid expansion began at the end of the sixteenth century. Over the subsequent two centuries, employers addressed the problem repeatedly. How they tackled it depended crucially on the way the different regional worsted industries were organised and on dramatic changes in the willingness and capacity of the state to regulate manufacturing. The Worsted Acts emerge as the product of a distinctive eighteenth-century approach to industrial regulation, reactive and particularistic, but bureaucratically innovative.

Dispatches

Dispatches

COLLABORATORS NOT CAVALIERS: POPULAR POLITICS IN THE NORTHERN COUNTIES OF ENGLAND, 1647–59

On 20 May 1647, John Willson, from the village of Thongsbridge, gave evidence in an examination for the murder of John Litlewood. Willson’s examination began by stating that ‘[he] was drinkeing a s...

The geographical spread of the 1947 poliomyelitis epidemic in England and Wales: spatial wave propagation of an enigmatic epidemiological event

The 1947 epidemic of poliomyelitis was the largest and geographically most widespread outbreak of the disease ever recorded in England and Wales. As a transitional event in the history of poliomyelitis in the British Isles, the 1947 epidemic signalled the sudden onset of a sustained period of heightened epidemicity that continued until the introduction and mass administration of safe and effective poliovirus vaccines in the late 1950s. This paper explores the apparent shift in the spatial dynamics of poliovirus that underpinned the geographical spread of the 1947 epidemic in England and Wales. Drawing on a robust method of spatial epidemiological analysis (swash–backwash model), we demonstrate that the epidemic wave was associated with a pronounced acceleration in the rate of spatial propagation as compared to the preceding years. The velocity of spatial expansion and retreat and the duration of infectivity are shown to have varied by category of geographical area and by county of England and Wales. The weight of available evidence suggests that the so-called ‘hygiene model’ of the epidemic emergence of poliomyelitis, developed in the context of Western countries and generally assumed for England and Wales, does not adequately account for the events of 1947. Rather, we suggest that the features of the epidemic are consistent with the introduction and spread of one or more new strains of poliovirus in England and Wales in the summer of 1947. Possible connections to the epidemic occurrence of poliomyelitis in other European countries at about this time are considered.

Hasty Pudding Versus Tasty Bread: Regional Variations in Diet and Nutrition during the Industrial Revolution

Using parish-level information from Sir F.M. Eden's The state of the poor (1797) we can identify typical diets for the counties of England. These diets varied considerably and afforded very different standards of nutrition. We compute a nutritional score for this diet, paying attention to the presence of vitamins, minerals and micronutrients shown to be essential for health and growth in constructing this measure. Other information in the reports allows us to relate county-level nutrition to factors in the local economy. In particular we find nutrition was positively related to the availability of common land in the area and to women's remunerated work if conducted from home. Lack of common land and little local supply of dairy products also pushed households into buying white wheaten bread rather than baking their own wholemeal loaf. Replicating some of this analysis with household-level data confirms these results. Diet also maps onto stature: male convicts to Australia were significantly taller if they originated in a county with a more nutritious diet. This verifies the important impact of nutrition on stature and demonstrates the sensitivity of height as a measure of key aspects of welfare.

Tracing the origins of White Tip disease of Cirsium arvense and its causal agent, Phoma macrostoma

SummaryCirsium arvense (Asteraceae) is known as creeping thistle in its native range in the UK and Canada thistle in its invasive North American range. Recently, the fungus Phoma macrostoma was registered in Canada as a bioherbicide in turfgrass, where it causes severe chlorosis (White Tip disease) and death of C. arvense and other broadleaved weeds. It was hypothesised that the disease originated in the UK on its thistle host and, therefore, that fungal isolates from both countries should be biologically and genetically similar. Twenty‐six strains in the genus Phoma– isolated during surveys in the UK – were compared morphologically with the type culture of P. macrostoma, tested for bioherbicidal activity using the inoculum mat bioassay and genetically screened with bioherbicide‐specific primers. White tip disease was found to be restricted to the eastern and southern counties of England. Phoma macrostoma was isolated consistently from diseased bleached tissues. Bioherbicidal isolates of P. macrostoma occupy a unique clade, which is phylogenetically distinct but morphologically indistinguishable from the type culture. Most isolates from the UK had the same bioherbicidal activity and similar genetic make‐up as strain SRC 94‐44B, the active ingredient in the registered Canadian product. The origin of all bioherbicidal strains found to date has a clear presence in both Canada and the UK, with strong genetic similarities, supporting the view of a common ancestry. Thus, on the evidence presented, the ‘white tip’ clade of P. macrostoma evolved in southern England. Therefore, the bioherbicide based on strain SRC 94‐44B should also be eligible for registration in the UK, based on the pest risk assessment data already available.

The Victoria History of the Counties of England. A History of the County of Gloucester. Volume XII: Newent and May Hill. Edited by A R J Jurica. 310mm. Pp 369, 93 figs and maps. Woodbridge: Boydell & Brewer for the Institute of Historical Research, 2010. ISBN 9781904356363. £90 (hbk).

The Victoria History of the Counties of England. A History of the County of Gloucester. Volume XII: Newent and May Hill. Edited by A R J Jurica. 310mm. Pp 369, 93 figs and maps. Woodbridge: Boydell & Brewer for the Institute of Historical Research, 2010. ISBN 9781904356363. £90 (hbk).

Editorial

Editorial

Edmund Rack's survey of Somerset – Edited by Mark McDermott and Sue Berry. The Victoria history of the counties of England: a history of the county of Somerset, X: Castle Cary and the Brue‐Cary watershed – Edited by Mary Siraut

Edmund Rack's survey of Somerset – Edited by Mark McDermott and Sue Berry. The Victoria history of the counties of England: a history of the county of Somerset, <i>X:</i> Castle Cary and the Brue‐Cary watershed – Edited by Mary Siraut

Practitioner accounts of responding to parent abuse – a case study in ad hoc delivery, perverse outcomes and a policy silence

ABSTRACTParent abuse is becoming recognized as a serious problem in some families. It can have a damaging impact on physical and mental health, family relationships and employment and has been found to be implicated in other past, current and future forms of family abuse and violence. For this reason, many frontline practitioners who work with troubled families frequently find incidents of parent abuse in their caseloads, but we know little of how they respond to it. This study used in‐depth interviews with nine practitioners who work in a range of agencies in one large county in England and explored how they each identify, conceptualize, explain and respond to parent abuse. In a context where there is no national guidance regarding how agencies should respond to this problem, this study finds that practitioners must ‘make do’ without appropriate resources or policy guidance to help them. The study concludes with suggestions for change for the benefit of families who seek support but who currently find little effective response.

Earthquakes, Sin and John Shower

The article is about the earthquake of September 8, 1692, that hit the southeastern counties of England and parts of the Continent. It focuses on the contemporary account of John Shower in his Practical Reflections on the Late in Jamaica, England, Sicily, Malta, &c. Anno 1692. With a Particular, Historical Account of Those, and Divers Other Earthquakes (1693). It represent a preacher's view of a natural disaster that moderates between religion and the new scientific spirit.

Meeting patient needs with a risk-stratified colorectal cancer follow-up

Managing the increasing numbers of colorectal cancer survivors with complex needs while minimizing recurrence or secondary cancer is bringing fresh challenges to healthcare providers. A baseline study completed in five counties in England with eight acute care organizations highlighted the importance of developing a risk-stratified follow-up pathway that goes beyond the traditional follow-up. In the absence of guidelines, this follow-up pathway was developed in consultation with the Network Site Specific Group consisting of specialist care clinicians from all the acute care providers. This comprehensive follow-up pathway encourages healthcare providers and clinicians to address complex patient needs by a process of shared decision making and holistic needs assessment (HNA), providing optimum surveillance testing combined with various coping and self-management strategies

Frances Trollope (1779–1863): Life and Adventures of a Clever Woman

This paper aims to pay tribute to the courage of Frances Trollope in depicting the cruelty of industrial practices in the northern counties of England, particularly as they affected young children. It suggests that Charlotte Brontë’s ridicule of Michael Armstrong, amounting almost to contempt, sprang mainly from her lack of personal experience of the conditions of near slavery that dominated working-class life in Haworth and in the north generally.

Rural transport and social inclusion: The DalesBus Initiative

The importance of rural transport in addressing social exclusion has been acknowledged for some time. We report and comment on one particular case in North Yorkshire, a predominantly rural county in England, of how state, non-state and third/societal sectors worked together to market and improve public transport links and reduce social exclusion. The article examines the outcomes of a SIS (Stimulating Innovation for Success) project: a leisure-based public transport network located in North Yorkshire. It comments on the efficacy of this relationship and in particular with one agency, the Dales and Bowland Community Interest Company.

Eliciting symptoms interpreted as normal by patients with early-stage lung cancer: could GP elicitation of normalised symptoms reduce delay in diagnosis? Cross-sectional interview study

ObjectivesTo investigate why symptoms indicative of early-stage lung cancer (LC) were not presented to general practitioners (GPs) and how early symptoms might be better elicited within primary care.Design, setting and...

Use of the theory of planned behaviour to assess factors influencing the identification of individuals at ultra‐high risk for psychosis in primary care

To design and assess the psychometric properties of a questionnaire to identify and measure factors that influence the identification of individuals at ultra-high risk for psychosis in primary care. It will inform the subsequent design of educational interventions to help general practitioners (GPs; primary care physicians) detect these individuals. The questionnaire was developed using the theory of planned behaviour (TPB). A semistructured discussion group elicited beliefs underlying GPs' motivations to detect these individuals and informed the construction of a preliminary 106-item questionnaire incorporating all constructs outlined in the TPB. A pilot phase followed, involving 79 GPs from 38 practices across 12 counties in England, to define the determinants of intention to identify these individuals. A psychometric model of item response theory was used to identify which items could be removed. The final instrument comprised 73 items and showed acceptable reliability (α = 0.77-0.87) for all direct measures. Path analysis models revealed that all the TPB measures significantly predicted intention. Subjective norm, reflecting perceived professional influence, was the strongest predictor of intention. Collectively, the direct measures explained 35% of the variance of intention to identify individuals at ultra-high risk for psychosis, indicating a good fit with the TPB model. The TPB can be used to identify and measure factors that influence identification of individuals at ultra-high risk for psychosis in primary care.