Prospects for progress on health inequalities in England in the post-primary care trust era : professional views on challenges, risks and opportunities

Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario. Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations. Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards. Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.</p

Tizanidine does not affect the linear relation of stretch duration to the long latency M2 response of m. flexor carpi radialis

The long latency M2 electromyographic response of a suddenly stretched active muscle is stretch duration dependent of which the nature is unclear. We investigated the influence of the group II afferent blocker tizanidine on M2 response characteristics of the m. flexor carpi radialis (FCR). M2 response magnitude and eliciting probability in a group of subjects receiving 4 mg of tizanidine orally were found to be significantly depressed by tizanidine while tizanidine did not affect the significant linear relation of the M2 response to stretch duration. The effect of tizanidine on the M2 response of FCR is supportive of a group II afferent contribution to a compound response of which the stretch duration dependency originates from a different mechanism, e.g., rebound Ia firing

A pathway to a stronger research culture in health policy

There are currently limited pathways into a career in health policy research in Australia, due in part to a serious absence of health policy research capability in Australian universities. The authors define what they consider health policy research and education should comprise, then examine what is currently on offer and propose ways to strengthen health policy research in Australia. This paper, which is part analysis and part commentary, is offered to provoke wider debate about how health policy research can be nurtured in Australia

Re-visiting Meltsner: Policy Advice Systems and the Multi-Dimensional Nature of Professional Policy Analysis

10.2139/ssrn.15462511-2

Direction-dependent excitatory and inhibitory ocular vestibular-evoked myogenic potentials (oVEMPs) produced by oppositely directed accelerations along the midsagittal axis of the head

Oppositely directed displacements of the head need oppositely directed vestibulo-ocular reflexes (VOR), i.e. compensatory responses. Ocular vestibular-evoked myogenic potentials (oVEMPs) mainly reflect the synchronous extraocular muscle activity involved in the process of generating the VOR. The oVEMPs recorded beneath the eyes when looking up represent electro-myographic responses mainly of the inferior oblique muscle. We aimed: (1) to study the properties of these responses as they were produced by head acceleration impulses to the forehead and to the back of the head; (2) to investigate the relationships between these responses and the 3-D linear head accelerations that might reflect the true stimulus that acts on the vestibular hair cells. We produced backward- and forward-directed acceleration stimuli in four conditions (positive and negative head acceleration impulses to the hairline and to the inion) in 16 normal subjects. The oVEMPs produced by backward- and forward-directed accelerations of the head showed consistent differences. They were opposite in the phase. The responses produced by backward accelerations of the head began with an initial negativity, n11; conversely, those produced by accelerations directed forward showed initially a positive response, p11. There was a high inter-subject correlation of head accelerations along the head anteroposterior and transverse axes, but almost no correlation of accelerations along the vertical axis of the head. We concluded that backward-directed head accelerations produced an initial excitatory response, and forward-directed accelerations of the head were accompanied by an initial inhibitory response. These responses showed dependence on acceleration direction in the horizontal plane of the head. This could be consistent with activation of the utricle

Fingertip force control during bimanual object lifting in hemiplegic cerebral palsy

In the present study we examined unimanual and bimanual fingertip force control during grasping in children with hemiplegic cerebral palsy (CP). Participants lifted, transported and released an object with one hand or both hands together in order to examine the effect on fingertip force control for each hand separately and to determine whether any benefit exists for the affected hand when it performed the task concurrently with the less-affected hand. Seven children with hemiplegic CP performed the task while their movement and fingertip force control were measured. In the bimanual conditions, the weight of the instrumented objects was equal or unequal. The durations of the all temporal phases for the less-affected hand were prolonged during bimanual control compared to unimanual control. We observed close synchrony of both hands when the task was performed with both hands, despite large differences in duration between both hands when they performed separately. There was a marginal benefit for two of the five force related variables for the affected hand (grip force at onset of load force, and peak grip force) when it transported the object simultaneously with the less-affected hand. Collectively, these results corroborate earlier findings of reaching studies that showed slowing down of the less-affected hand when it moved together with the affected hand. A new finding that extends these studies is that bimanual tasks may have the potential to facilitate force control of the affected hand. The implications of these findings for recent rehabilitative therapies in children with CP that make use of bimanual training are discussed

A rigorous model of reflex function indicates that position and force feedback are flexibly tuned to position and force tasks

This study aims to quantify the separate contributions of muscle force feedback, muscle spindle activity and co-contraction to the performance of voluntary tasks (“reduce the influence of perturbations on maintained force or position”). Most human motion control studies either isolate only one contributor, or assume that relevant reflexive feedback pathways during voluntary disturbance rejection tasks originate mainly from the muscle spindle. Human ankle-control experiments were performed, using three task instructions and three perturbation characteristics to evoke a wide range of responses to force perturbations. During position tasks, subjects (n = 10) resisted the perturbations, becoming more stiff than when being relaxed (i.e., the relax task). During force tasks, subjects were instructed to minimize force changes and actively gave way to imposed forces, thus becoming more compliant than during relax tasks. Subsequently, linear physiological models were fitted to the experimental data. Inhibitory, as well as excitatory force feedback, was needed to account for the full range of measured experimental behaviors. In conclusion, force feedback plays an important role in the studied motion control tasks (excitatory during position tasks and inhibitory during force tasks), implying that spindle-mediated feedback is not the only significant adaptive system that contributes to the maintenance of posture or force