A more interdisciplinary approach can help us understand why research evidence does or doesn’t make it into policy

Effective communication of research is often cited as being most important to gaining the attention of policymakers. This arguably underestimates the sheer complexity of the policymaking process, assuming a linear route from evidence to policy and practice. Fiona Blyth and Carmen Huckel Schneider explain why breaking down walls between different academic disciplines could enhance our understanding of why research evidence does − or doesn’t − make it into policy, and also suggest questions that researchers might ask as a “gateway” to understanding these different approaches to evidence-informed policymaking

A grounded theory of successful Educational Psychology practice in Key Stage 4 Pupil Referral Units: A jointly constructed perspective

School exclusion rates in England have risen consistently in recent years, and Pupil Referral Units (PRUs) and other alternative provisions (APs) are often destinations for those excluded. Many of these young people have identified special educational needs and disabilities (SEND). Whilst there is a large body of research around school exclusion, and some specifically looking at ‘good practice’ in PRUs, very little research has looked at Educational Psychology (EP) practice in these provisions, and how Educational Psychologists (EPs) can be utilised most effectively. This is particularly relevant for Key Stage 4 (KS4), given the high levels of exclusion in this age group and consequently, the poor life outcomes associated with this cohort as they transition to adulthood. This study aimed to explore ‘successful’ EP practice in KS4 PRUs and to identify and explain the mechanisms and factors that can facilitate this. Taking a grounded theory approach (Charmaz, 2014) from a social constructionist perspective, five joint interviews were conducted with EPs and commissioners of EPs working in KS4 PRU settings. 12 participants (six EPs and six commissioners) from five London boroughs were included. Findings frame the EP-commissioner relationship as ‘parents’ who play a ‘parental’ role and function, impacting all other aspects of the system or ‘family’. Relationships across the ‘family’ were fundamental for facilitating change through joint working, reflection and learning. The importance of shared values, goals, approaches and language were highlighted, such as strengths-based approaches, prioritising young people’s involvement and agency, flexibly supporting needs, going above and beyond, taking a systemic approach and planning for positive futures. Literature relating to ‘containment’ (Bion, 1962b) in APs and ideas related to systems psychodynamics (Neumann, 1999) are discussed in relation to EP practice in PRUs

Comorbidities only account for a small proportion of excess mortality after fracture: A record linkage study of individual fracture types

Background: Non-hip non-vertebral fractures (NHNV) constitute the majority of osteoporotic fractures but few studies have examined the association between these fractures, co-morbidity and mortality. Objective: To examine the relationship between individual non-hip non-vertebral fractures, co-morbidities and mortality. Methods: Prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 - 2013. Associations between fracture and mortality examined using multivariate, time dependent Cox models, adjusted for age, prior fracture, body mass index, smoking and co-morbidities (cardiovascular disease, diabetes, stroke, thrombosis and cancer) and survival function curves. Population attributable fraction calculated for each level of risk exposure. Results: During 1,490,651 person-years, women and men experienced 7,571 and 4,571 fractures and 7,064 deaths and 11,078 deaths, respectively. In addition to hip and vertebral fractures, pelvis, humerus, clavicle, rib, proximal tibia/fibula, elbow and distal forearm fractures in both sexes, and ankle fractures in men, were associated with increased multivariable adjusted mortality hazard ratios ranging from 1.3 to 3.4. Co-morbidity independently added to mortality such that a woman with a humeral fracture and one co-morbidity had a similarly reduced 5 year survival to that of a woman with a hip fracture and no co-morbidities. Population mortality attributable to any fracture without co-morbidity was 9.2% in women and 5.3% in men. Conclusion: All proximal non-hip, non-vertebral fractures in women and men were associated with increased mortality risk. Co-existent co-morbidities independently further increased mortality. Population attributable risk for mortality for fracture was similar to cardiovascular disease and diabetes, highlighting their importance and potential benefit for early intervention and treatment

Smoking and use of primary care services : findings from a population-based cohort study linked with administrative claims data

Background: Available evidence suggests that smokers have a lower propensity than others to use primary care services. But previous studies have incorporated only limited adjustment for confounding and mediating factors such as income, access to services and health status. We used data from a large prospective cohort study (the 45 and Up Study), linked to administrative claims data, to quantify the relationship between smoking status and use of primary care services, including specific preventive services, in a contemporary Australian population. Methods: Baseline questionnaire data from the 45 and Up Study were linked to administrative claims (Medicare) data for the 12-month period following study entry. The main outcome measures were Medicare benefit claimed for unreferred services, out-of-pocket costs (OOPC) paid, and claims for specific preventive services (immunisations, health assessments, chronic disease management services, PSA tests and Pap smears). Rate ratios with 95% confidence intervals were estimated using a hierarchical series of models, adjusted for predisposing, access-and health-related factors. Separate hurdle (two part) regression models were constructed for Medicare benefit and OOPC. Poisson models with robust error variance were used to model use of each specific preventive service. Results: Participants included 254,382 people aged 45 years and over of whom 7.3% were current smokers. After adjustment for predisposing, access-and health-related factors, current smokers were very slightly less likely to have claimed Medicare benefit than never smokers. Among those who claimed benefit, current smokers claimed similar total benefit, but recent quitters claimed significantly greater benefit, compared to never-smokers. Current smokers were around 10% less likely than never smokers to have paid any OOPC. Current smokers were 15-20% less likely than never smokers to use immunisations, Pap smears and prostate specific antigen tests. Conclusions: Current smokers were less likely than others to use primary care services that incurred out of pocket costs, and specific preventive services. This was independent of a wide range of predisposing, access-and health-related factors, suggesting that smokers have a lower propensity to seek health care. Smokers may be missing out on preventive services from which they would differentially benefit

Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia

ACKNOWLEDGMENTS: The authors thank the many thousands of people participating in the 45 and Up Study. The authors also thank the Sax Institute, the NSW Ministry of Health, and the NSW Register of Births, Deaths, and Marriages for allowing access to the data, and the Centre for Health Record Linkage for conducting the probabilistic linkage of records.Peer reviewedPublisher PD

Pain and Its Impact on Functional Health: 7-Year Longitudinal Findings among Middle-Aged and Older Adults in Indonesia

Pain is a growing public health issue worldwide, but there is limited population-based evidence in low- and middle-income country settings. Using nationwide Indonesian Family Life Survey (IFLS) data in 2007 and 2014, this research sets out to investigate the associations between changes in pain status between two time points and its impact on functional health outcomes among middle-aged and older adults in Indonesia. Analyses focused on 7936 adults aged 50 years and older in 2014 who responded to both waves. Functional health was assessed using a composite score of functional limitations (range 20-100), representing difficulty in performing activities of daily living, and grip strength (kilograms). Multivariate linear regression models were used to analyse associations between pain measured in 2007 and 2014 and functional health in 2014. Severe pain in the latest wave of IFLS was associated with older age, female, lower education, having chronic conditions or depressive symptoms. Notably, those who reported 'low-medium' pain in 2007 and 'severe' pain in 2014 belonged to the most vulnerable group with worst functional health outcomes (4.96 points higher limitation scores and 1.17 kg weaker average grip strength). Findings have implications for public health policy in monitoring and management of pain including related co-morbidities as an increasingly critical component of population ageing.This research was funded by the Australian Research Council Centre of Excellence in Population Ageing Research (ARC CEPAR), grant number CE170100005

Evaluation of Project ECHO (Persistent Pain)

Western Victoria Primary Health Network (WVPHN) in partnership with the Transport Accident Commission (TAC) and WorkSafe Victoria (‘WorkSafe’) implemented Project ECHO (Persistent Pain) Series 1 in February-June 2020 and Series 2 in July-December 2020. The Menzies Centre for Health Policy and Economics, University of Sydney was commissioned by WVPHN to undertake the evaluation of Project ECHO (Persistent Pain) Series 2

Adequacy of nutritional intake among older men living in Sydney, Australia: findings from the Concord Health and Ageing in Men Project (CHAMP)

Previous research shows that older men tend to have lower nutritional intakes and higher risk of under-nutrition compared with younger men. The objectives of this study were to describe energy and nutrient intakes, assess nutritional risk and investigate factors associated with poor intake of energy and key nutrients in community-dwelling men aged 75 years participating in the Concord Health and Ageing in Men Project - a longitudinal cohort study on older men in Sydney, Australia. A total of 794 men (mean age 81.4 years) had a detailed diet history interview, which was carried out by a dietitian. Dietary adequacy was assessed by comparing median intakes with nutrient reference values (NRV): estimated average requirement, adequate intake or upper level of intake. Attainment of NRV of total energy and key nutrients in older age (protein, Fe, Zn, riboflavin, Ca and vitamin D) was incorporated into a "key nutrients" variable dichotomised as "good" (5) or "poor" (4). Using logistic regression modelling, we examined associations between key nutrients with factors known to affect food intake. Median energy intake was 8728 kJ (P5=5762 kJ, P95=12 303 kJ), and mean BMI was 27.7 (sd 4.0) kg/m(2). Men met their NRV for most nutrients. However, only 1 % of men met their NRV for vitamin D, only 19 % for Ca, only 30 % for K and only 33 % for dietary fibre. Multivariate logistic regression analysis showed that only country of birth was significantly associated with poor nutritional intake. Dietary intakes were adequate for most nutrients; however, only half of the participants met the NRV of 5 key nutrients