Housing and credit crunch: follow-up

Eight Report of Session 2008-200

Research needs for an improved primary care response to chronic non-communicable diseases in Africa.

With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa

"Well the Future, that is Difficult": a hermeneutic phenomenological analysis exploring the maternal experience of parenting a young adult with a developmental disability

- Background: The predominant focus of extant literature exploring maternal experience of developmental disability has been stress, adaptation, efficacy of interventions and the burden of care. Most studies involve mothers of children, with scant attention given to what life is like later. This study qualitatively explores the experience of mothers of young adults (aged 19–28). - Materials and methods: Semi-structured interviews conducted with six women aged 48–60 were transcribed and analysed using interpretative phenomenological analysis. - Results: Three themes illustrate how mothers are confronted with their adult children's continuing need for support and how a lack of trust in social care creates anxiety about the future, increasing awareness of mortality. - Conclusions: Vulnerability represents a useful concept for understanding these findings theoretically. Galvin & Todres’ (2013) conceptual framework for the humanization of care provides the opportunity to prioritize the needs of individuals by highlighting dimensions of existence which confer meaning

The mental health expert patient: findings from a pilot study of a generic chronic condition self-management programme for people with mental illness

Author version made available in accordance with the publisher's policyBackground Less than optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management. Aims This study aimed to test the feasibility and utility of combining a generic, clinician administered and peer-led self-management group approach for people with serious mental illness. Method General practitioners and mental health case managers used a patient-centered care model (the Flinders Model) to assist 38 patients with serious mental illness to identify their self-management needs, and match these with interventions including Stanford peer-led, self-management groups and one-to-one peer support. Self-management and quality of life outcomes were measured and qualitative evaluation elicited feedback from all participants. Results Collaborative care planning, combined with a problems and goals focused approach, resulted in improved self-management and mental functioning at 3 to 6 months follow up. The Stanford self-management course was applicable and acceptable to patients with serious mental illnesses. Qualitative feedback was highly supportive of this approach. Conclusions Generic, structured assessment and care planning approaches, resulting in self-management education targeted to the individual, improved self-management and quality of life. Patients and service providers reported considerable gains despite the challenges associated with introducing a generic model within the mental health and general practice sector

The mental health expert patient: findings from a pilot study of a generic chronic condition self-management programme for people with mental illness

Author version made available in accordance with the publisher's policyBackground Less than optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management. Aims This study aimed to test the feasibility and utility of combining a generic, clinician administered and peer-led self-management group approach for people with serious mental illness. Method General practitioners and mental health case managers used a patient-centered care model (the Flinders Model) to assist 38 patients with serious mental illness to identify their self-management needs, and match these with interventions including Stanford peer-led, self-management groups and one-to-one peer support. Self-management and quality of life outcomes were measured and qualitative evaluation elicited feedback from all participants. Results Collaborative care planning, combined with a problems and goals focused approach, resulted in improved self-management and mental functioning at 3 to 6 months follow up. The Stanford self-management course was applicable and acceptable to patients with serious mental illnesses. Qualitative feedback was highly supportive of this approach. Conclusions Generic, structured assessment and care planning approaches, resulting in self-management education targeted to the individual, improved self-management and quality of life. Patients and service providers reported considerable gains despite the challenges associated with introducing a generic model within the mental health and general practice sector

The Limits of Entrapment: The Negotiations on EU Reduction Targets, 2007-11

In 2007, the EU decided to cut greenhouse gas emissions by 20/30 per cent, something which was considered a proof of the EU's willingness to take on high targets independently of others. In the period 2009-11, the EU was debating but could not reach an agreement on stepping up to a 30 per cent reduction target. This raises the question: why did the EU go from being capable of adopting high targets independently of others to being incapable of agreeing whether it should increase its mitigation effort? It is argued that whereas actors sceptical of a high target could be rhetorically entrapped in 2007, such entrapment was impossible in the 2009-11 period. The lack of entrapment can be explained in terms of changes in the international and socio-economic contexts, which led to changes in the policy processes and the normative environment, which again made effective entrapment impossible

Exploratory evaluation of solar radiation and ambient temperature in twenty locations distributed in United Kingdom

Solar radiation and ambient temperature is a foundation resource programs of large-scale deployment of solar energy technologies. This paper summarizes the analysis of a weather station network in United Kingdom. Whistle 3 years (January 2015 – December 2017) of data from twenty weather stations distributed across the country. The data comprises of Global Horizontal Irradiance (GHI), Diffuse Horizontal Irradiance (DHI), Direct Normal Irradiance (DNI), ambient temperature, wind speed, and the humidity. Network design, implementation, and data quality assurance are described, in order to document the network extent and quality. From all observed datasets, it was found that Plymouth (located in southwest England) has the dominant GHI, and ambient temperature among all other 19 locations. The least GHI is observed for Aberdeen (located in northeast Scotland) estimated at 77.3 kWh/m2. However, the least average ambient temperature is equal to 9.1 °C, this data was detected from the weather station located in the capital of Scotland (Edinburgh). Although continued measurements are needed to understand the interannual resource variability, the current study provides significant guidance for preliminary technology selection, power plant modeling, and resource forecasting

Primary care reform using a layered approach to the Medicare Benefits Scheme: unpredictable and unmeasured

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Justin J Beilb