‘’It just happens’. Care home residents’ experiences and expectations of accessing GP care.

Background: Care homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health care services. Our aim was to understand how older people resident in care homes access health services using the Andersen model of health care access. Methods: Case studies were conducted in six care homes with different socio-economic characteristics, size and ownership in three study sites. Residents in all care homes with capacity to participate were eligible for the study. Interviews explored how residents accessed NHS professionals. The Andersen model of health seeking behaviour was our analytic framework. Findings: Thirty-five participants were interviewed with an average of 4 different conditions. Expectations of their health and the effectiveness of services to mitigate their problems were low. Enabling factors were the use of intermediaries (usually staff, but also relatives) to seek access. Residents expected that care home staff would monitor changes in their health and seek appropriate help unprompted. Conclusions: Care home residents may normalise their health care needs and frame services as unable to remediate these which may combine to disincline older care home residents to seek care. Care access was enabled using intermediaries -either staff or relatives-and the expectation that staff would proactively seek care when they observed new/changed needs. Residents may over-estimate the health-related knowledge of care home staff and their ability to initiate referrals to NHS professionals.Peer reviewedFinal Accepted Versio

Using Decision Analysis to Improve Malaria Control Policy Making

Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets (ITNs) and artemesinin combination therapies (ACTs) for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision analysis can help to address and overcome these challenges. A prototype decision analysis framework for malaria control in Tanzania is presented, highlighting the key components that a decision support tool should include. Developing and applying such a framework can promote stronger and more effective linkages between research and policy, ultimately helping to reduce the burden of malaria and other vector-borne diseases

Relevant Recruiting for Online Survey Participation

Administering a survey online has a number of practical benefits including lower costs, reductions in paper use and data entry time, and a faster data collection time period. A significant challenge, however, entails creating and recruiting a relevant sample of respondents with specific characteristics when email lists are unavailable. In this case, we seek to encourage researcher conversation about relevant and effective recruitment strategies by describing the extensive pretesting process we undertook to develop our survey sampling and recruitment strategy for a study of wildfire mitigation behaviors in Western Colorado. Pretesting response rates varied from 3% to 30%, with the inclusion of a US$2 billion in the recruitment envelope yielding the highest response rate. The actual study subsequently used this approach and resulted in a 35% response rate

Integrated working between primary health care services and care homes for older people: challenges from the approach study

IntroductionWithin the UK health and social care policy is placing an increasing emphasis on improving the quality of care for older people in care homes through integrated working between health and social care services. This study aims to clarify the research available on integrated working and evaluate its impact on older people in order to devise a typology for informing future service development.TheoryKodner and Spreeuwenberg [1] argue that patient/person centred integrated working between health and social care should include methods and models which involve the different levels of organisation, management, funding and clinical care within and between them.MethodsPhase one included a systematic review to evaluate interventions utilising integrated working between care home staff and health care practitioners, and a survey to describe care homes’ experiences of integrated working. Phase one will inform phase two; a case study evaluating six different approaches to integrated working currently in use in three different areas of England.Results and conclusionsThe review found evidence of integrated working between health care and care homes at the patient level of care, but minimal evidence of models that extended beyond this level. Findings from the survey, currently in progress, will also be presented.DiscussionThe discussion will provide an overview of the challenges and issues surrounding integrated working

Algorithms for Olfactory Search across Species

Localizing the sources of stimuli is essential. Most organisms cannot eat, mate, or escape without knowing where the relevant stimuli originate. For many, if not most, animals, olfaction plays an essential role in search. While microorganismal chemotaxis is relatively well understood, in larger animals the algorithms and mechanisms of olfactory search remain mysterious. In this symposium, we will present recent advances in our understanding of olfactory search in flies and rodents. Despite their different sizes and behaviors, both species must solve similar problems, including meeting the challenges of turbulent airflow, sampling the environment to optimize olfactory information, and incorporating odor information into broader navigational systems

Identifying barriers in the malaria control policymaking process in East Africa : insights from stakeholders and a structured literature review

BACKGROUND : The complexity of malaria and public health policy responses presents social, financial, cultural, and institutional barriers to policymaking at multiple stages in the policy process. These barriers reduce the effectiveness of health policy in achieving national goals. METHODS : We conducted a structured literature review to characterize malaria policy barriers, and we engaged stakeholders through surveys and workshops in Kenya, Tanzania, and Uganda. We compared common barriers presented in the scientific literature to barriers reported by malaria policy stakeholders. RESULTS : The barriers identified in the structured literature review differ from those described in policymaker surveys. The malaria policy literature emphasizes barriers in the implementation stage of policymaking such as those posed by health systems and specific intervention tools. Stakeholder responses placed greater emphasis on the political nature of policymaking, the disconnect between research and policymaking, and the need for better intersectoral collaboration. CONCLUSIONS : Identifying barriers to effective malaria control activities provides opportunities to improve health and other outcomes. Such barriers can occur at multiple stages and scales. Employing a stakeholder - designed decision tool framework has the potential to improve existing policies and ultimately the functioning of malaria related institutions. Furthermore, improved coordination between malaria research and policymaking would improve the quality and efficiency of interventions leading to better population health.Global Environment Facility, United Nations Environment Programme and World Health Organization under the project Malaria Decision Analysis Support Tool: Evaluating Health, Social and Environmental Impacts and Policy Tradeoffs.http://www.biomedcentral.com/bmcpublichealthhb201

Rural-urban differences in cooking practices and exposures in Northern Ghana

Key differences between urban and rural populations can influence the adoption and impacts of new cooking technologies and fuels. We examine these differences among urban and rural households that are part of the REACCTING study in Northern Ghana. While urban and rural populations in the study area all use multiple stoves, the types of stoves and fuels differ, with urban participants more likely to use charcoal and LPG while rural households rely primarily on wood. Further, rural and urban households tend to use different stoves/fuels to cook the same dishes—for example, the staple porridge Tuo Zaafi (TZ) is primarily cooked over wood fires in rural areas and charcoal stoves in urban settings. This suggests that fuel availability and ability to purchase fuel may be a stronger predictor of fuel choice than cultural preferences alone. Ambient concentrations of air pollutants also differ in these two types of areas, with urban areas having pollutant hot spots to which residents can be exposed and rural areas having more homogeneous and lower pollutant concentrations. Further, exposures to carbon monoxide and particulate matter differ in magnitude and in timing between urban and rural study participants, suggesting different behaviors and sources of exposures. The results from this analysis highlight important disparities between urban and rural populations of a single region and imply that such a characterization is needed to successfully implement and assess the impacts of household energy interventions