Evaluation of a digital consultation and self-care advice tool in primary care: a multi-methods study

Digital services are often regarded as a solution to the growing demands on primary care services. Provision of a tool offering advice to support self-management as well as the ability to digitally consult with a General Practitioner (GP) has the potential to alleviate some of the pressure on primary care. This paper reports on a Phase II, 6-month evaluation of eConsult, a web-based triage and consultation system that was piloted across 11 GP practices across Scotland. Through a multi-method approach the evaluation explored eConsult use across practices, exposing both barriers and facilitators to its adoption. Findings suggest that expectations that eConsult would offer an additional and alternative method of accessing GP services were largely met. However, there is less certainty that it has fulfilled expectations of promoting self-help. In addition, low uptake meant that evaluation of current effectiveness was difficult for practices to quantify. The presence of an eConsult champion(s) within the practice was seen to be a significant factor in ensuring successful integration of the tool. A lack of patient and staff engagement, insufficient support and lack of protocols around processes were seen as barriers to its success

Exposure and risks from wearing asbestos mitts

BACKGROUND: Very high fibre inhalation exposure has been measured while people were wearing personal protective equipment manufactured from chrysotile asbestos. However, there is little data that relates specifically to wearing asbestos gloves or mitts, particularly when used in hot environments such as those found in glass manufacturing. The aim of this study was to assess the likely personal exposure to asbestos fibres when asbestos mitts were used. RESULTS: Three types of work activity were simulated in a small test room with unused mitts and artificially aged mitts. Neither pair of mitts were treated to suppress the dust emission. The measured respirable fibre exposure levels ranged from <0.06 to 0.55 fibres/ml, with no significant difference in fibre exposure between aged and unused mitts. The use of high localised ventilation to simulate convective airflows from a furnace reduced exposure levels by about a factor of five. Differences between tasks were statistically significant, with simulated "rowing" of molten glass lowest and replacement of side seals on the furnace highest. Estimated lifetime cancer risk from 20 years exposure at the upper end of the exposure range measured during the study is less than 22 per 100,000. CONCLUSION: People who wore asbestos mitts were likely to have been exposed to relatively low levels of airborne chrysotile asbestos fibres, certainly much lower than the standards that were accepted in the 1960's and 70's. The cancer risks from this type of use are likely to be very low

The influence of the food environment on overweight and obesity in young children : a systematic review

The increasing prevalence of childhood obesity has led to interest in its prevention, particularly through school-based and family-based interventions in the early years. Most evidence reviews, to date, have focused on individual behaviour change rather than the ‘obesogenic environment’. This paper reviews the evidence on the influence of the food environment on overweight and obesity in children up to 8 years. Electronic databases (including MEDLINE, EMBASE, Cochrane Controlled Trials Register (CCTR), DARE, CINAHL and Psycho-Info) and reference lists of original studies and reviews were searched for all papers published up to 31 August 2011. Study designs included were either population-based intervention studies or a longitudinal study. Studies were included if the majority of the children studied were under 9 years, if they related to diet and if they focused on prevention rather than treatment in clinical settings. Data included in the tables were characteristics of participants, aim, and key outcome results. Quality assessment of the selected studies was carried out to identify potential bias and an evidence ranking exercise carried out to prioritise areas for future public health interventions. Thirty-five studies (twenty-five intervention studies and ten longitudinal studies) were selected for the review. There was moderately strong evidence to support interventions on food promotion, large portion sizes and sugar-sweetened soft drinks. Reducing food promotion to young children, increasing the availability of smaller portions and providing alternatives to sugar-sweetened soft drinks should be considered in obesity prevention programmes aimed at younger children. These environment-level interventions would support individual and family-level behaviour change

In-migrant networks and knowledge economies in the rural North East of England

PhD ThesisOver the last few decades there have been various efforts at stemming the seemingly inexorable decline of rural economies, particularly in terms of employment and skills, and to prevent rural areas becoming heritage areas or dormitories for an urban workforce. Initially efforts to revitalise the rural economy were focused on farm diversification and/or tourism based activities. More recently interest has turned to the knowledge economy, and in particular promoting in-migration to rural areas by entrepreneurs working in knowledge intensive industries as a way of stimulating the rural economy. At the same time rural development policy has shifted away from a focus on sectoral support to area based development policies. This is particularly true of European rural development policies such as Objective 5b and LEADER. The rationale underlying this type of policy intervention is that area based development policy works by building civic and economic capacity in an area. This assumes the social and business networks in an area are interconnected and mutually supportive. Little is understood about whether this is in fact the case and to what extent the social and business networks overlap and interact in a way that supports rural development. This thesis investigates biographical accounts of in-migrants in the rural North East who have started businesses in the knowledge economy. These entrepreneurs are undertaking two significant changes in their lives, the move to a rural area and the shift from employment to self-employment. This thesis seeks to understand how these various changes are effecting rural economies and communities in the North East of England. The biographical nature of the research allows the entire event, both the lead up to the move and subsequent life after the move, to be considered. Using Pierre Bourdieu’s theory of practice as a framework of analysis, the nature of the entrepreneur’s integration into the local community, both socially and as a business person, is examined along with the various networks they engage with. The research has found interesting differences between the way in which entrepreneurs privilege social and cultural capital over economic capital in certain circumstances and strive to maintain a distance between their personal social networks and business social networks to minimise the risk of damage to social and cultural capital. This separation means there is little interaction between migrant entrepreneurs and local business people in a way that would result in local spill-over affects. The findings also highlight an interesting issue around the nature of terms such as ‘creative’ and ‘knowledge’ economies and how these concepts have come to mean a specific form of development, what Bourdieu would consider to be an act of symbolic violence.The Economic and Social Research Council: The Regional Development Agency One North East

Proactive modulation of long-interval intracortical inhibition during response inhibition

Daily activities often require sudden cancellation of preplanned movement, termed response inhibition. When only a subcomponent of a whole response must be suppressed (required here on Partial trials), the ensuing component is markedly delayed. The neural mechanisms underlying partial response inhibition remain unclear. We hypothesized that Partial trials would be associated with nonselective corticomotor suppression and that GABA(B) receptor-mediated inhibition within primary motor cortex might be responsible for the nonselective corticomotor suppression contributing to Partial trial response delays. Sixteen right-handed participants performed a bimanual anticipatory response inhibition task while single- and paired-pulse transcranial magnetic stimulation was delivered to elicit motor evoked potentials in the left first dorsal interosseous muscle. Lift times, amplitude of motor evoked potentials, and long-interval intracortical inhibition were examined across the different trial types (Go, Stop-Left, Stop-Right, Stop-Both). Go trials produced a tight distribution of lift times around the target, whereas those during Partial trials (Stop-Left and Stop-Right) were substantially delayed. The modulation of motor evoked potential amplitude during Stop-Right trials reflected anticipation, suppression, and subsequent reinitiation of movement. Importantly, suppression was present across all Stop trial types, indicative of a “default” nonselective inhibitory process. Compared with blocks containing only Go trials, inhibition increased when Stop trials were introduced but did not differ between trial types. The amount of inhibition was positively correlated with lift times during Stop-Right trials. Tonic levels of inhibition appear to be proactively modulated by task context and influence the speed at which unimanual responses occur after a nonselective “brake” is applied

\u3ci\u3eLa pareja de la luna\u3c/i\u3e: The moon couple

Written by Natalie Rorick, Alana Schaffer, John Cowie, Cody May Translated by Mirela Butnar