Smoke-free spaces on the island of Ireland- Snapshot report 2017.

Reducing second-hand smoke (SHS) exposure has become a central component of tobacco control policies across the island of Ireland. The expansion of smoke-free spaces directly reduces exposure of children and adults and further denormalises tobacco use in a variety of social contexts. Challenges remain in terms of persistent health inequalities and significant exposure to SHS in the home, particularly in the context of children. This snapshot report presents a brief overview of progress on the development of smoke-free spaces on the island of Ireland. This snapshot updates on an earlier document published in June 2016. • Smoke-free legislation in the workplace has been implemented successfully across the island of Ireland. Legislation prohibiting smoking in cars where children are present has been in place in RoI since January 2016, with similar measures proposed for NI. • In RoI 19% of all children aged 10-17 years were exposed to SHS in the car (Gavin et al, 2015). • Among children aged 11-16 years who reported that they lived with an adult smoker in NI, 3 in 10 reported that smoking was permitted in the family car (YPBAS, 2013). • In NI among households who own a car, 85% of adults reported smoking is not permitted in any car. Of adults in the most deprived quintile, 51% reported that smoking is not permitted in any car, compared to 81% in the least deprived quintile (HSNI, 2016). • In 2007/08 in NI 61% of adults reported that smoking was not permitted in the home, increasing to 80% in 2015/16 (CHS, 2007/08 and HSNI, 2016). • In NI, over half of children aged 11-16 years in the most deprived areas lived with an adult smoker. Children living in the most deprived areas were more than twice as likely to live with a smoker compared to children living in the least deprived areas (57.9% vs 25.2%) (YPBAS, 2013). • In RoI 18% of the population aged 15+ was exposed to SHS on a daily basis. SHS exposure was highest among those aged15-24 years (28%). Non-smokers in more deprived areas were more likely to be exposed to SHS than those in more affluent areas (Department of Health, 2016b). • In RoI there were slightly stricter rules around smoking in the home, compared to the family car, with pre-teen children more protected than teenagers. 12% of 10-17 year old children reported that adults were allowed to smoke in their house (Gavin et al, 2015). • In RoI more than twice as many 9 year olds living in families in the lowest income quintile (32.7%) were exposed to SHS in the home compared to children in families in the highest quintile (14%) (McAvoy et al, 2013)

Belonging and engaging for successful transition to university

No abstract available

Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Objective To conduct a systematic review of the evidence for when a hospital admission for an older person can be avoided in subacute settings. We examined the definition of admission avoidance and the evidence for the factors that are required to avoid admission to hospital in this setting. Methods Using defined PICOD criteria, we conducted searches in three databases (Medline, Embase and Cinahl) from January 2006 to February 2018. References were screened by title and abstract followed by full paper screening by two reviewers. Additional studies were searched from the grey literature, experts in the field and forward and backward referencing. Data were narratively described, and concept analysis was used to investigate the definition of admission avoidance. Results A total of 17 studies were considered eligible for review; eight provided a definition of admission avoidance and 10 described admission avoidance criteria. We identified three factors which play a key role in admission avoidance in the subacute setting: (1) ambulatory care sensitive conditions and common medical scenarios for the older person, which included respiratory infections or pneumonia, urinary tract infections and catheter care, dehydration and associated symptoms, falls and behavioural management, and managing ongoing chronic conditions; (2) criteria/tools, referring to interventions that have used clinical expertise in conjunction with a range of general and geriatric triage tools; in condition-specific interventions, the decision whether to admit or not was based on level of risk determined by defined clinical tools; and (3) personnel and resources, referring to the need for experts to make the initial decision to avoid an admission. Supervision by nurses or physicians was still needed at subacute level, requiring resources such as short-stay beds, intravenous antibiotic treatment or fluids for rehydration and rapid access to laboratory tests. Conclusion<jats:p/> The review identified a set of criteria for ambulatory care sensitive conditions and common medical scenarios for the older person that can be treated in the subacute setting with appropriate tools and resources. This information can help commissioners and care providers to take on these important elements and deliver them in a locally designed way

Which features of primary care affect unscheduled secondary care use?:A systematic review

OBJECTIVES: To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. SETTING: Observational studies at primary care practice level. PARTICIPANTS: Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. RESULTS: 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. CONCLUSIONS: The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions

Frailty assessment in primary health care and its association with unplanned secondary care use:a rapid review

Background: The growing frail, older population is increasing pressure on hospital services. This is directing the attention of clinical commissioning groups towards more comprehensive approaches to managing frailty in the primary healthcare environment. Aim: To review the literature on whether assessment of frailty in primary health care leads to a reduction in unplanned secondary care use. Design & setting: A rapid review involving a systematic search of Medline and Medline In-Process. Method: Relevant data were extracted following the iterative screening of titles, abstracts, and full texts to identify studies in the primary or community healthcare setting which assessed the effect of frailty on unplanned secondary care use between January 2005–June 2016. Results: The review included 11 primary studies: nine observational studies; one randomised controlled trial (RCT); and one non-randomised controlled trial (nRCT). Eight out of nine observational studies reported a positive association between frailty and secondary care utilisation. The RCT and nRCT reported conflicting findings. Conclusion: Older people identified as frail in a primary healthcare setting were more likely to be admitted to hospital. Based on the limited and equivocal trial evidence, it is not possible to draw firm conclusions regarding appropriate tools for the identification and management of frail older people at risk of hospital admission