COVID-19 and ethnic Inequalities in England and Wales*

The economic and public health crisis created by the COVID-19 pandemic has exposed existing inequalities between ethnic groups in England and Wales, as well as creating new ones. We draw on current mortality and case data, alongside pre-crisis labour force data, to investigate the relative vulnerability of different ethnic groups to adverse health and economic impacts. After accounting for differences in population structure and regional concentration, we show that most minority groups suffered excess mortality compared with the white British majority group. Differences in underlying health conditions such as diabetes may play a role; so too may occupational exposure to the virus, given the very different labour market profiles of ethnic groups. Distinctive patterns of occupational concentration also highlight the vulnerability of some groups to the economic consequences of social distancing measures, with Bangladeshi and Pakistani men particularly likely to be employed in occupations directly affected by the UK's ‘lockdown’. We show that differences in household structures and inequalities in access to savings mean that a number of minority groups are also less able to weather short-term shocks to their income. Documenting these immediate consequences of the crisis reveals the potential for inequalities to become entrenched in the longer term

Teaching Index Numbers to economists

Economic statistics are frequently reported in the form of index numbers. This article considers how the field of Index Numbers should be approached in the teaching of a general economic degree. While the topic finds a natural home in statistics modules, it is emphasised that the area can also be referred to in the teaching of other areas of economics. It is also emphasised that the differences between Index Numbers theory and the practice of compiling economic statistics such as inflation can help students gain a better understanding of applied economic statistics. Methods for assessing learning in the area are also considered and available material to support teaching is also summarised

When work kills

Purpose The purpose of this paper is to examine the rising public health phenomenon of workplace suicide drawing on comparative insights from the French and UK contexts. France has experienced what the media describes as a “suicide epidemic” in the workplace, with rising numbers of employees choosing to kill themselves in the face of extreme pressures at work. Design/methodology/approach The paper uses a comparative approach drawing on insights from the French context, in which workplace suicide is legally and officially recognised, to shed critical light on the UK context where workplace suicide remains a hidden phenomenon. Findings Whilst in France, workplace suicide is treated as an urgent public health phenomenon and data on suicides are collected centrally, in the UK, despite a deterioration in working conditions, suicide is not recognised in legislation and data are not collected centrally. Unless society recognises and document rising workplace suicides, we will be unable to deal with their profound human consequences for suicidal individuals, their families and society more widely. Research limitations/implications Research on workplace suicides in the UK and many other national contexts is hampered by fragmentary statistical data on this phenomenon. Practical implications The paper calls for greater recognition, analysis and monitoring of workplace suicide in the UK. Suicide should be included in the list of workplace accidents that are reported to the authorities for further investigation. In a context where workplace conditions are deteriorating, society need to recognises the profound human costs of these conditions for the individual employee. Social implications The paper has important implications for the contemporary workplace in terms of the contractual relationship between employer and employee. Originality/value Workplace suicide is an urgent, yet under-researched phenomenon. The paper brings a comparative and multidisciplinary perspective to bear on this phenomenon

Which sectors are driving regional economic development? Comparing the effects of changes in employment in knowledge-based and consumption-based sectors on regional economic performance

Despite increasing as a proportion of economic activity, the role of consumption in regional economic development does not feature highly in the policies or debates. Instead, the focus is on the promotion of innovative activity and knowledge assets. Using NUTS 3 level data this paper examines the changing level of employment in consumption-based and knowledge-based sectors in order to assess the contribution of each to regional economic development

Disseminating Research Information through Facebook and Twitter (DRIFT): presenting an evidence based framework

Background: The social media platform Facebook boasts over 1,284 million daily active users globally. It is also known that a large proportion of adults use the internet to seek health related information.Aim: to critically analyse the use of social media to engage parents of children with ADHD with clinical research findings.Methods: Observation and qualitative content analysis combined with Facebook insights was used to evaluate the levels of engagement and interaction with different types of research information.Results: Over 1100 people from 41 nations have engaged with the group. Sharing information through a range of Facebook functions was found to successfully achieve engagement and reach nationally and internationally for this demographic.Conclusion: Lay research users are eager to engage and understand clinical research and social media is an appropriate way to disseminate this. This article has proposed some methods and explanatory reasons for this phenomena.Implications for practice: It is known that social media can be used for effective communication. This article presents a much-needed evidence based framework that may be used by nursing and health researchers to successfully achieve this

Public Spaces Protection Orders: a critical policy analysis

Purpose: The purpose of this paper is to critically appraise the Public Spaces Protection Orders (PSPOs) policy that was introduced by the Anti-Social Behaviour, Crime and Policing Act (2014). Within a designated area assigned by the local council, PSPOs can prohibit or require specific behaviours to improve the quality of life for people inhabiting that space. Those who do not comply face a fixed penalty notice of £100 or a fine of £1000 on summary conviction. However, the practical and theoretical impact associated with the development of these powers has yet to be fully explored. Design/methodology/approach: Using Bannister and O’Sullivan’s (2013) discussion of civility and ASB policy as a starting point, we show how PSPOs could create new frontiers in exclusion, intolerance and criminalisation; as PSPOs enable the prohibition of any type of behaviour perceived to negatively affect the quality of life. Findings: Local councils in England and Wales now have unlimited and unregulated powers to control public spaces. We suggest this has the potential to produce localised tolerance thresholds and civility agendas that currently target and further marginalise vulnerable people, and we highlight street sleeping homeless people as one such group. Originality: There has been little academic debate on this topic. This article raises a number of original, conceptual questions that provide an analytical framework for future empirical research. We also use original data from Freedom of Information requests to contextualise our discussions

Comparing routine inpatient data and death records as a means of identifying children and young people with life limiting conditions

Background Recent estimates of the number of children and young people with life limiting conditions derived from routine inpatient data are higher than earlier estimates using death record data. Aim To compare routine inpatient data and death records as means of identifying life limiting conditions in children and young people. Design Two national cohorts of children and young people with a life limiting condition (primary cohort from England with a comparator cohort from Scotland) were identified using linked routinely collected healthcare and administrative data. Participants 37563 children and young people with a life limiting condition in England who died between 1 April 2001 and 30 March 2015 and 2249 children and young people with a life limiting condition in Scotland who died between 1 April 2003 and 30 March 2014. Results In England, 16642 (57%) non-neonatal cohort members had a life limiting condition recorded as the underlying cause of death; 3364 (12%) had a life limiting condition -related condition recorded as the underlying cause and 3435 (12%) had life limiting conditions recorded only among contributing causes. 5651 (19%) non-neonates and 3443 (41%) neonates had no indication of a life limiting condition recorded in their death records. Similar results were seen in Scotland (overall, 16% had no indication of life limiting conditions). In both cohorts, the recording of life limiting condition was highest amongst those with haematology or oncology diagnoses and lowest for genitourinary and gastrointestinal diagnoses

Falls assessment and prevention in older people: an evaluation of the Crisis Response Service

The elderly population of the world is growing, with increasing trends of older people falling and accessing emergency services. The Crisis Response Falls Service in Northamptonshire (UK) was designed to identify health and social care needs, promote independence and limit the impact of falls. This paper presents the findings of an evaluation of the service. A mixed-method approach was applied, drawing on the views of service users (via a survey and telephone interviews) and reviewing existing East Midlands Ambulance Service NHS Trust (EMAS) data with routinely collected data from the service. A decrease in the numbers of patients conveyed to hospital following a fall was observed. Best estimates of financial calculations suggest savings. High levels of patient satisfaction were achieved; patients felt treated with dignity and staff were considered friendly, approachable and well-informed. First responder services can provide positive impacts for those who fall in the community. The development and impact of the CRS shows the importance of evidence-based client centred training to inform the approaches taken to supporting those who fall, and the impact of a strong values based approach on the experiences of patients

Locating the place and meaning of physical activity in the lives of young people from low-income, lone-parent families

Background: In the United Kingdom (UK), it is predicted that economic cuts and a subsequent increase in child poverty will affect those already on the lowest incomes and, in particular, those living in lone-parent families. As a result, the informal pedagogic encounters within the family that contribute to the development of physical activity-related values, beliefs and dispositions from a very early age will be affected. Therefore, it is vital that we gain an understanding of the place and meaning of physical activity in the lives of young people, as well as the informal pedagogic practices and the socio-cultural forces that influence individual agency. Purpose: Based on Bourdieu's key concepts, this paper explores the interplay of structural conditions and personal agency with regard to physical activity in the lives of young people from low-income, lone-parent families. Methods: This study reports on the voices of 24 participants (aged 11–14) from low-income, lone-parent families in the West Midlands, UK. These participants were engaged in paired, semi-structured interviews to explore issues of personal agency by listening to how they reported on their present lives, past experiences and future possibilities with regard to physical activity. All corresponding interview data were analysed using analytical induction. Findings: This paper suggests that young people exhibited diminished desires to engage in activity due to structural constraints of time, parents' work commitments and a lack of transport that resulted in engagement in sedentary alternatives. Informal pedagogic practices within these families were restricted due to the associated structural conditions of living in a lone-parent family. As such, young people's choice to not seek out physical activities when at home reflected a ‘taste for necessity’ resulting from a lack of cultural and economic capital, placing restrictions on physical activity opportunities that stemmed from their family doxa. Conclusions: To succeed in fostering dispositions and opportunities to participate in physical activity, we must engage with young people from low-income, lone-parent families from an early age. Certainly though, further consideration of the informal pedagogic practices within, and the demands on, lone-parent families is required when designing any intervention or policy that seeks to enhance their current circumstances and provide opportunities for engagement in a variety of contexts

First-trimester combined screening for trisomy 21 at 7-14 weeks' gestation.

OBJECTIVE: To establish an algorithm for first-trimester combined screening for trisomy 21 with biochemical testing from 7 to 14 weeks' gestation and ultrasound testing at 11-13 weeks. METHODS: This was a multicenter study of 886 pregnancies with trisomy 21 and 222 475 unaffected pregnancies with measurements of free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 7-14 weeks' gestation. Multiple regression modeling of log-transformed marker values was used to produce log multiples of the median (MoM) values for PAPP-A and free β-hCG. The models included terms for the center attended and the machine used for biochemical analysis, gestational age, maternal racial origin, maternal weight, smoking status and method of conception. Bivariate Gaussian distributions were fitted to log MoM PAPP-A and log MoM free β-hCG in trisomy 21 and in unaffected pregnancies. In each case the patient-specific risk for trisomy 21 was estimated by multiplying the individual maternal age-related risk with the likelihood ratio (LR) for fetal nuchal translucency (NT) according to the mixture model and the combined LR for maternal serum free β-hCG and PAPP-A. Estimates of detection rates for trisomy 21 and false-positive rates were calculated for combined screening with measurements of NT at 12 weeks together with measurements of free β-hCG and PAPP-A from 8 to 13 weeks. RESULTS: In trisomy 21 pregnancies the mean log MoM free β-hCG increased linearly with gestation between 7 and 14 weeks, whereas the relation between log MoM PAPP-A and gestation was fitted by a quadratic equation such that the maximum separation between trisomy 21 and unaffected pregnancies occurs at 9-10 weeks. At a false-positive rate of 3% the detection rate of combined screening at 12 weeks was 86% and this increased to 90% by biochemical testing at 9 weeks and ultrasound scanning at 12 weeks. The detection rate increased to 92% by measuring PAPP-A at 9 weeks and free β-hCG at the time of the scan at 12 weeks. CONCLUSION: The performance of first-trimester biochemical screening for trisomy 21 is best at 9-10 weeks rather than at 7-8 or 11-14 weeks