A Community-Focused Health & Work Service (HWS)

We recommend establishment of a community-focused Health & Work Service (HWS) dedicated to responding rapidly to new health-related work absence among working people due to potentially disabling conditions. The first few days and weeks after onset are an especially critical period during which the likelihood of a good long-term outcome is being influenced, either favorably or unfavorably, by some simple things that either do or do not happen during that interval. It is the optimal window of opportunity to improve outcomes by simultaneously attending to the worker’s basic needs and concerns as well as coordinating the medical, functional restoration, and occupational aspects of the situation in a coordinated fashion

Do healthcare services behave as complex systems? Analysis of patterns of attendance and implications for service delivery

Background: The science of complex systems has been proposed as a way of understanding health services and the demand for them, but there is little quantitative evidence to support this. We analysed patterns of healthcare use in different urgent care settings to see if they showed two characteristic statistical features of complex systems: heavy-tailed distributions (including the inverse power law) and generative burst patterns. Methods: We conducted three linked studies. In study 1 we analysed the distribution of number of contacts per patient with an urgent care service in two settings: emergency department (ED) and primary care out-of-hours (PCOOH) services. We hypothesised that these distributions should be heavy-tailed (inverse power law or log-normal) in keeping with typical complex systems. In study 2 we analysed the distribution of bursts of contact with urgent care services by individuals: correlated bursts of activity occur in complex systems and represent a mechanism by which overall heavy-tailed distributions arise. In study 3 we replicated the approach of study 1 using data systematically identified from published sources. Results: Study 1 involved data from a PCOOH service in Scotland (725,000) adults, 1.1 million contacts) and an ED in New Zealand (60,000 adults, 98,000 contacts). The total number of contacts per individual in each dataset was statistically indistinguishable from an inverse power law (p &gt; 0.05) above 4 contacts for the PCOOH data and 3 contacts for the ED data. Study 2 found the distribution of contact bursts closely followed a heavy-tailed distribution (p &lt; 0.008), indicating the presence of correlated bursts. Study 3 identified data from 17 studies across 8 countries and found distributions similar to study 1 in all of them. Conclusions: Urgent healthcare use displays characteristic statistical features of large complex systems. These studies provide strong quantitative evidence that healthcare services behave as complex systems and have important implications for urgent care. Interventions to manage demand must address drivers for consultation across the whole system: focusing on only the highest users (in the tail of the distribution) will have limited impact on efficiency. Bursts of attendance - and ways to shorten them - represent promising targets for managing demand.</p

English Proficiency Assessments of Primary and Secondary Teachers and Students Participating in English in Action: Third Cohort (2014)

The purpose of the study was to assess the student learning outcomes of English in Action’s (EIA’s) school-based teacher development programme, in terms of improved English language competence (ELC),1 against recognised international frameworks (specifically, the Graded Examinations in Spoken English2 [GESE)]; Trinity College London 2013), which map onto the Common European Framework of Reference for Languages (CEFR)3. Measurably improved student learning outcomes are the ultimate test of success of a teacher development programme. English Proficiency Assessments 2014 is a repeat of the study on the pilot EIA programme (Cohort 14) (EIA 2012), but focusing only on student ELC. The teachers and hence the students of Cohort 3 are substantially greater in number than in the pilot phase (347,000 primary students and almost 1.7 million secondary students compared with around 700 teachers, 35,000 primary students and over 83,000 secondary students in 2011). To enable this increase in scale, the programme has been delivered through a more decentralised model, with much less direct contact with English language teaching (ELT) experts, a greater embedding of expertise within teacher development materials (especially video), and a greater dependence upon localised peer support. This report addresses the following research question: "To what extent do the students of Cohort 3 show improved post-intervention EL proficiencies, in speaking and listening, compared with the Cohort 1 2010 pre-intervention baseline?

Classroom Practices of Primary and Secondary Teachers Participating in English in Action: Third Cohort (2014)

This study reports on the third cohort of teachers and students to participate in EIA (2013–14). While the students and teachers in Cohort 3 underwent an essentially similar programme to those in Cohorts 1 and 2, they are much greater in number (there are over 8,000 teachers and 1.7 million students in Cohort 3, compared to 751 teachers and 118,000 students in Cohort 1). To enable ongoing increases in scale, the SBTD programme became increasingly decentralised, with less direct contact with English language teaching (ELT) experts, a greater embedding of expertise within teacher development materials (especially video) and a greater dependence upon localised peer support. The purpose of this study was to ascertain whether there had been changes in the classroom practice of teachers and students participating in EIA Cohort 3 (2013–14). Previous research in language teaching has established that when teachers take up most of the lesson time talking, this can severely limit students’ opportunities to develop proficiency in the target language (Cook 2008); a general goal of English language (EL) teachers is to motivate their students to speak – and to practise using the target language (Nunan 1991). This study therefore focuses upon the extent of teacher and student talk, the use of the target language by both, and the forms of classroom organisation (individual, pair, group or choral work) in which student talk is situated. The study addresses two research questions: 1. To what extent do the teachers of Cohort 3 show classroom practice comparable to the teachers of Cohort 1, particularly in relation to the amount of student talk and the use of the target language by teachers and students, post-intervention? 2. In what ways do the teachers of Cohort 3 show improved classroom practice (particularly in relation to the amount of student talk and use of the target language by teachers and students) in contrast to the pre-intervention baseline? This study is a repeat of studies on Cohorts 1 & 2 (EIA 2011a, 2012a & 2014)

English Proficiency Assessments of Primary and Secondary Students Participating in English in Action: Third Cohort (2014) Large-Scale Quantitative Study

The purpose of the study was to assess the student learning outcomes of English in Action’s (EIA’s) school-based teacher development programme, in terms of improved English language competence (ELC), against recognised international frameworks (specifically, the Graded Examinations in Spoken English [GESE)]; Trinity College London 2013), which map onto the Common European Framework of Reference for Languages (CEFR). Measurably improved student learning outcomes are the ultimate test of success of a teacher development programme. English Proficiency Assessments 2014 is a repeat of the study on the pilot EIA programme (Cohort 14) (EIA 2012), but focusing only on student ELC. The teachers and hence the students of Cohort 3 are substantially greater in number than in the pilot phase (347,000 primary students and almost 1.7 million secondary students compared with around 700 teachers, 35,000 primary students and over 83,000 secondary students in 2011). To enable this increase in scale, the programme has been delivered through a more decentralised model, with much less direct contact with English language teaching (ELT) experts, a greater embedding of expertise within teacher development materials (especially video), and a greater dependence upon localised peer support. This report addresses the following research question: To what extent do the students of Cohort 3 show improved post-intervention EL proficiencies, in speaking and listening, compared with the Cohort 1 2010 preintervention baseline

System influences on work disability due to low back pain: an international evidence synthesis

Work disability due to low back pain is a significant global health concern. Current policy and practice aimed at tackling this problem is largely informed by the biopsychosocial model. Resultant interventions have demonstrated some small-scale success, but they have not created a widespread decrease in work disability. This may be explained by the under-representation of the less measurable aspects in the biopsychosocial evidence base; namely the influence of relevant systems. Thus, a ‘best-evidence’ synthesis was conducted to collate the evidence on how compensatory (worker’s compensation and disability benefits), healthcare and family systems (spouse/partner/close others) can act as obstacles to work participation for those with low back pain. Systematic searches of several scientific and grey literature sources were conducted, resulting in 1,762 records. Following a systematic exclusion process, 57 articles were selected and the evidence was assessed using a system adapted from previous large-scale policy reviews conducted in this field. Results indicated how specific features of relevant systems could act as obstacles to individual efforts/interventions aimed at tackling work disability due to LBP. These findings reinforce the need for a ‘whole-systems’ approach, with all key players onside and have implications for the revision of current biopsychosocial-informed policy and practice

UVM Tobacco Use and Attitudes After Implementation of a Tobacco-Free Policy

Introduction: Widespread public health initiatives have led to falling smoking rates. Currently, 1,620 U.S. colleges have adopted smoke-free policies. In August 2015, the University of Vermont (UVM) adopted a tobacco-free policy that bans all forms of tobacco use on university property. The purpose of this study was to compare tobacco use and attitudes before and after policy implementation.https://scholarworks.uvm.edu/comphp_gallery/1230/thumbnail.jp

University of Vermont Community Tobacco Use and Attitudes Survey

Introduction: Smoking remains an important public health issue in U.S. Colleges. 17.3% of U.S. smokers are 18-24 years old. 28% of U.S. college students began smoking at age 19 or older. Currently 1,104 U.S. Colleges have adopted Tobacco-Free policies.https://scholarworks.uvm.edu/comphp_gallery/1216/thumbnail.jp

A qualitative exploration of triggers for alcohol use and access to support during the COVID-19 pandemic among people identifying as problem drinkers in the United Kingdom

Introduction: A polarisation of drinking behaviour was observed during the coronavirus disease (COVID‐19) pandemic, with some people reported to be drinking more alcohol and others less. We aimed to understand how and why the COVID‐19 pandemic and associated restrictions impacted alcohol use and access to support and services during this time. / Methods: We conducted semi‐structured qualitative interviews with 27 participants, including 20 people identifying as problem drinkers and seven alcohol service providers. Data were analysed using thematic analysis. / Results: We identified two main triggers for alcohol use during the pandemic: (i) loss of daily routine and activity resulted in drinking to cope with social isolation and boredom; and (ii) drinking alleviated feelings of fear, anxiety and anger over the imposition of pandemic restrictions. Regarding access to services, two main themes were generated: (i) remote service provision was perceived as inferior to in‐person services; and (ii) the need to offer choice and flexibility in how services were provided, with service providers reporting more positive experiences of online and telephone service delivery than service users. / Discussion and Conclusions: This study provides new insights into potential triggers for alcohol use among people identifying as problem drinkers during the COVID‐19 pandemic. The acceptability of remote forms of service provision were dependent on service user access to, and comfort with using technology. Hybrid delivery models may therefore be suitable in some but not all circumstances, and efforts should be made to promote equitable access to services