Young people's use of NHS Direct: a national study of symptoms and outcome of calls for children aged 0-15

Objectives National Health Service (NHS) Direct provides 24/7 expert telephone-based healthcare information and advice to the public in England. However, limited research has explored the reasons to why calls are made on behalf of young people, as such this study aimed to examine call rate (CR) patterns in younger people to enable a better understanding of the needs of this population in England. Setting NHS Direct, England, UK. Participants and methods CRs (expressed as calls/100 persons/annum) were calculated for all calls (N=358 503) made to NHS Direct by, or on behalf of, children aged 0–15 during the combined four ‘1-month’ periods within a year (July 2010, October 2010, January 2011 and April 2011). χ² Analysis was used to determine the differences between symptom, outcome and date/time of call. Results For infants aged <1, highest CRs were found for ‘crying’ for male (n=14, 440, CR=13.61) and female (n=13 654, CR=13.46) babies, which is used as a universal assessment applied to all babies. High CRs were also found for symptoms relating to ‘skin/hair/nails’ and ‘colds/flu/sickness’ for all age groups, whereby NHS Direct was able to support patients to self-manage and provide health information for these symptoms for 59.7% and 51.4% of all cases, respectively. Variations in CRs were found for time and age, with highest peaks found for children aged 4–15 in the 15:00–23:00 period and in children aged <1 in the 7:00–15:00 period. Conclusions This is the first study to examine the symptoms and outcome of calls made to NHS Direct for and on behalf of young children. The findings revealed how NHS Direct has supported a range of symptoms through the provision of health information and self-care support which provides important information about service planning and support for similar telephone-based services

Differences in the pregnancy gestation period and mean birth weights in infants born to Indian, Pakistani, Bangladeshi and white British mothers in Luton, UK: a retrospective analysis of routinely collected data

Objective To compare mean birth weights and gestational age at delivery of infants born to Indian, Pakistani, Bangladeshi and white British mothers in Luton, UK. Design Retrospective analysis using routinely recorded secondary data in Ciconia Maternity information System, between 2008 and 2013. Setting Luton, UK. Participants Mothers whose ethnicity was recorded as white British, Bangladeshi, Pakistani or Indian and living in Luton, aged over 16, who had a live singleton birth over 24 weeks of gestation were included in the analysis (n=14 871). Outcome measures Primary outcome measures were mean birth weight and gestational age at delivery. Results After controlling for maternal age, smoking, diabetes, gestation age, parity and maternal height and body mass index at booking, a significant difference in infants’ mean birth weight was found between white British and Indian, Pakistani and Bangladeshi infants, F(3, 12 287)=300.32, p Conclusions Results show important differences in adjusted mean birth weight between Indian, Pakistani, Bangladeshi and white British women. Moreover, an association was found between primipara Indian mothers and preterm delivery, when compared with Pakistani, Bangladeshi and white British women.</p

Can travel advisors influence physical activity in personal travel planning projects using the Theory of Planned Behaviour? A longitudinal study

The objective was to examine the effect of travel advisors (TAs) used in personal travel planning interventions (PTP) on physical activity (PA) in an urban, ethnically diverse residential settings. The study assessed the utility of the Theory of Planned Behaviour (TPB) to predict both intention and PA associated with “TAs”. A quasi-experimental longitudinal study was conducted with two groups to examine changes in physical activity levels. The methods involved a survey targeted at residents in a PTP targeted area who spoke to a TA (intervention group) and residents who did not (control group). Participants in the intervention group (n = 147) and control group (n = 95) self-reported their PA levels and constructs of the TPB at three time points. The results show that residents who had spoken to a TA reported significantly higher levels of physical activity at each of the three time points. ANOVA”s revealed significant interaction effects for the TPB constructs. The overall conclusion was that those who had spoken to a TA reported more PA at each of the three time points. Keywords: personal travel planning; physical activity; travel advisor, theory of planned behaviour; travel adviso

Exploring factors that impact the decision to use assistive telecare: perspectives of family care-givers of older people in the United Kingdom

In the United Kingdom (UK), an ageing population met with the reduction of social care funding has led to reduced support for older people marked with an increased demand on family care-givers. Assistive telecare (AT) devices are viewed as an innovative and effective way to support older people. However, there is limited research which has explored adoption of AT from the perspectives of family care-givers. In-depth, semi-structured interviews were conducted with 14 family care-givers of patients who used the Assistive Telehealth and Telecare service in Cambridgeshire, UK. Family care-givers were either the spouse (N = 8) or child of the patient (N = 6). The patients' age ranged from 75 to 98, and either received a telecare standalone device or connected service. Framework analysis was used to analyse the transcripts. This study revealed that family care-givers play a crucial role in supporting the patient's decision to adopt and engage with AT devices. Knowledge and awareness, perceived responsibility, usefulness and usability, alongside functionality of the equipment, were influential factors in the decision-making process. AT devices were viewed positively, considered easy to use, useful and functional, with reassurance of the patient's safety being a core reason for adoption. Efforts to increase adoption and engagement should adapt recruitment strategies and service pathways to support both the patient and their care-giver

A survey study of stalking victims’ experiences of the health-related effects of stalking and their experiences of engaging with health care practitioners

This study aimed to assess the impact stalking has on the physical and psychological wellbeing of survivors and their experiences of accessing of health services. To achieve this a self-assessment questionnaire was developed, circulated through social media channels and promoted on the websites of support services for people who experience stalking. There were 105 respondents to a survey, all who self-defined as being victims of stalking. Results indicated that prior to stalking events, 86% of participants reported no health issues. However, when reviewing health issues after having been stalked, 74% did report health problems. We also found that 23% of survivors experienced some physical injury as a result of being stalked. Results also indicated that while only 30% of participants reported ongoing psychological or mental health problems before stalking, this rose to 95% experiencing such difficulties following stalking events. Healthcare services were accessed due to stalking by 60% of participants and a further 8% of participants accessed the service due to domestic violence. Given the serious impact stalking can have, it is essential that victims have access to appropriate health care services. Conclusions centre around the appropriate training of Health care professionals (HCPs) to recognise when a patient might be a victim of stalking and how to provide appropriate support. Healthcare services could be tailored to the unique needs of stalking victims and be available in multiple locations, including hospitals, primary care settings, and online. Findings also indicate that HCPs also need to understand the different forms of stalking and how to respond appropriately. Additionally, it is important to provide support in terms of safety planning, providing information about legal options, and providing referrals to other appropriate services. The results are discussed in context to the current literature

Exploring the factors that influence the decision to adopt and engage with an integrated assistive telehealth and telecare service in Cambridgeshire, UK: a nested qualitative study of patient 'users' and 'non-users'.

BACKGROUND: There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare. METHODS: Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of 'users' and 'non-users' using this service. 'Users' were defined as patients who used the service (N = 28) with 'non-users' defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method. RESULTS: This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on 'usability', 'usefulness of equipment', and 'threat to identity and independence'. CONCLUSIONS: The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more negative feelings towards technology. In addition, there is a clear need for continued product development and innovation to not only increase usability and functionality of equipment but also to motivate other sections of the population who could benefit from such services. Uncovering these factors has important policy implications in how services can improve access and patient support through the application of assistive technology which could in turn reduce unnecessary cost and burden on overstretched health services.National Institute for Health ResearchThis is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12913-016-1379-

Who uses NHS Direct? Investigating the impact of ethnicity on the uptake of telephone based healthcare

Introduction NHS Direct, a leading telephone healthcare provider worldwide, provided 24/7 health care advice and information to the public in England and Wales (1998-2014). The fundamental aim of this service was to increase accessibility, however, research has suggested a disparity in the utilisation of this service related to ethnicity. This research presents the first national study to determine how the diverse population in England have engaged with this service. Methods NHS Direct call data from the combined months of July, 2010 October, 2010, January 2011 and April, 2011 was analysed (N?=?1,342, 245) for all 0845 4647 NHS Direct core service calls in England. Expected usage of NHS Direct was determined for each ethnic group of the population by age and gender and compared by actual usage using Chi-square analysis. A one-way analysis of variance (ANOVA) was used to determine variations of uptake by ethnic group and Index for Multiple Deprivation (IMD) 2010 rank. Results Results confirmed that all mixed ethnic groups (White and Black Caribbean, White and Black African, White and Asian) had a higher than expected uptake of NHS Direct which held consistent across all age groups. Lower than expected uptake was found for Black (African/Caribbean) and Asian (Bangladeshi/Indian/Chinese) ethnic group which held consistent by age and gender. For the Pakistani ethnic group usage was higher than expected in adults aged 40 years and older although was lower than expected in younger age groups (0¿39). Conclusion Findings support previous research suggesting a variation in usage of NHS Direct influenced by ethnicity, which is evidenced on a national level. Further research is now required to examine the underlying barriers that contribute to the ethnic variation in uptake of this service

Soil property differences and irrigated-cotton lint yield— Cause and effect? An on-farm case study across three cotton-growing regions in Australia

The average lint yield of irrigated cotton in Australia ranges from 2270 to 3700kg/ ha, but yields vary substantially between farms and also between fields on the same farm. Differences in soil properties may cause these yield variations. Identifying which factors are causal and what management can be implemented to mitigate the impacts should help optimize inputs and improve profits. During the 2018–2019 summer cotton-growing season, a paired-field comparison approach was used to investigate and improve the understanding of soil property induced irrigated cotton yield differences within five farms across three regions of NSW, Australia. The paired fields at each farm recorded an average lint yield difference of &gt;284kg/ha (measured in 2018–2019 or 5-year average lint yield). Several soil properties differed between the paired fields at each farm comparison. The soil organic carbon stocks were higher in the higher-yielding fields at all the farm comparisons and the normalized lint yield percentage was positively correlated with soil organic carbon stocks. Soil sodicity was higher in the lower yielding fields at 3 of the 5 comparisons. Results for most soil nutrient tests were above the recommended critical concentrations for Australian cotton production. A stepwise linear regression excluding soil nutrients that were above soil test critical values for crop response and below crop toxicity levels indicated the lint yield was positively correlated with SOC stocks and negatively correlated with sodicity and bulk density. No earthworms were detected during visual soil assessment or soil sampling across all the sites. Visual soil assessment was not a sensitive predictor of cotton crop performance. Comparing soil properties using a paired field approach may assist cotton growers in understanding the factors behind yield differences. A similar strip comparison approach could be adopted for within-field variability by dividing the fields into discrete performance zones and assessing the soil properties of each zone separately.284kg/ha (measured in 2018–2019 or 5-year average lint yield). Several soil properties differed between the paired fields at each farm comparison. The soil organic carbon stocks were higher in the higher-yielding fields at all the farm comparisons and the normalized lint yield percentage was positively correlated with soil organic carbon stocks. Soil sodicity was higher in the lower yielding fields at 3 of the 5 comparisons. Results for most soil nutrient tests were above the recommended critical concentrations for Australian cotton production. A stepwise linear regression excluding soil nutrients that were above soil test critical values for crop response and below crop toxicity levels indicated the lint yield was positively correlated with SOC stocks and negatively correlated with sodicity and bulk density. No earthworms were detected during visual soil assessment or soil sampling across all the sites. Visual soil assessment was not a sensitive predictor of cotton crop performance. Comparing soil properties using a paired field approach may assist cotton growers in understanding the factors behind yield differences. A similar strip comparison approach could be adopted for within-field variability by dividing the fields into discrete performance zones and assessing the soil properties of each zone separately

Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks

Background NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual’s ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. Methods NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. Results The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50–75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with ‘White British’ ‘Black Caribbean’ and ‘Indian’ patients most likely to take up a NHS Health Check. However, patients from ‘Any Other White Background’ and ‘Black African’ were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. Conclusions The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities

A comparison of antenatal classifications of ‘overweight’ and ‘obesity’ prevalence between white British, Indian, Pakistani and Bangladeshi pregnant women in England; analysis of retrospective data

Background Maternal obesity increases women’s risk of poor birth outcomes, and statistics show that Pakistani and Bangladeshi women (who are born or settled) in the UK experience higher rates of perinatal mortality and congenital anomalies than white British or white Other women. This study compares the prevalence of maternal obesity in Indian, Pakistani, Bangladeshi and white British women using standard and Asian-specific BMI metrics. Method Retrospective cross-sectional analysis using routinely recorded secondary data in Ciconia Maternity information System (CMiS), between 2008 and 2013. Mothers (n = 15,205) whose ethnicity was recorded as white British, Bangladeshi, Pakistani or Indian. Adjusted standardised residuals and Pearson Chi-square. Main outcome measures: Percentage of mothers stratified by ethnicity (Indian, Pakistani, Bangladeshi and white British) who are classified as overweight or obese using standard and revised World Health Organisation BMI thresholds. Results Compared to standard BMI thresholds, using the revised BMI threshold resulted in a higher prevalence of obesity: 22.8% of Indian and 24.3% of Bangladeshi and 32.3% of Pakistani women. Pearson Chi-square confirmed that significantly more Pakistani women were classified as ‘obese’ compared with white British, Indian or Bangladeshi women (χ 2 = 499,88 df = 9, p Conclusions There are differences in the prevalence of obese and overweight women stratified by maternal ethnicity of white British, Indian, Pakistani and Bangladeshi. Using revised anthropometric measures in Indian, Pakistani and Bangladeshi women has clinical implications for identifying risks associated with obesity and increased complications in pregnancy.</p