A Community-Focused Health & Work Service (HWS)

We recommend establishment of a community-focused Health & Work Service (HWS) dedicated to responding rapidly to new health-related work absence among working people due to potentially disabling conditions. The first few days and weeks after onset are an especially critical period during which the likelihood of a good long-term outcome is being influenced, either favorably or unfavorably, by some simple things that either do or do not happen during that interval. It is the optimal window of opportunity to improve outcomes by simultaneously attending to the worker’s basic needs and concerns as well as coordinating the medical, functional restoration, and occupational aspects of the situation in a coordinated fashion

A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

MSS1 and MSS2 were supported by grants from the Chief Scientist Office of the Scottish Government (references CZG/2/412 and CZH/4/945). We are grateful to the general practitioners and patients who participated in these studies.Peer reviewedPostprin

Population assessment of the vermilion snapper, Rhomboplites aurorubens, from the Southeastern United States

Changes in the age structure and population size of vermilion snapper, Rhornboplites aurorubens, from North Carolina through the Florida Keys were examined using records of landings and size frequencies of fish from commercial, recreational, and headboat fisheries from 1986-1996. Population size in numbers at age was estimated for each year by applying separable virtual population analysis (SVPA) to the landings in numbers at age. SVPA was used to estimate annual, age-specific fishing mortality (F) for four levels of natural mortality (M = 0.20, 0.25, 0.30, and 0.35). Although landings of vermilion snapper for the three fisheries have declined, minimum fish size regulations have resulted in an increase in the mean size of fish landed. Age at entry and age at full recruitment were age-1 andage-3 fDr 1986-1991, compared with age-1 and age-4, respectively, for 1992-1996. Levels of mortality from fishing (F) ranged from 0.38 - 0.61 for the entire period. Current spawning potential ratio (SPR) is 21% or 27% depending on the natural mortality estimate. SPR could be raised to 30% or 40% with a reduction in F, or by increasing the age at entry to the fisheries. The latter could be enhanced now if fishermen, particularly recreational, comply with minimum size regulations. However, released fish mortality, modeled in the assessment at 27%, will continue to make the achievement of 30% and 40% SPR more difficult. (PDF contains 63 pages

Developing an Intervention Toolbox for the Common Health Problems in the Workplace

Development of the Health ↔ Work Toolbox is described. The toolbox aims to reduce the workplace impact of common health problems (musculoskeletal, mental health, and stress complaints) by focusing on tackling work-relevant symptoms. Based on biopsychosocial principles this toolbox supplements current approaches by occupying the zone between primary prevention and healthcare. It provides a set of evidence-informed principles and processes (knowledge + tools) for tackling work-relevant common health problems. The toolbox comprises a proactive element aimed at empowering line managers to create good jobs, and a ‘just in time’ responsive element for supporting individuals struggling with a work-relevant health problem. The key intention is helping people with common health problems to maintain work participation. The extensive conceptual and practical development process, including a comprehensive evidence review, produced a functional prototype toolbox that is evidence based and flexible in its use. End-user feedback was mostly positive. Moving the prototype to a fully-fledged internet resource requires specialist design expertise. The Health ↔ Work Toolbox appears to have potential to contribute to the goal of augmenting existing primary prevention strategies and healthcare delivery by providing a more comprehensive workplace approach to constraining sickness absence

New care home admission following acute hospitalisation: a mixed methods approach

Care home admission following acute hospitalisation is a lived reality across Scotland, experienced by over 8,000 people annually. The aim of this thesis was to develop an understanding of new care home admission following acute hospitalisation. Methods and findings from the mixed-methods approach are presented in three parts. Part One: Identifying relevant research – includes a review of quality assessment tools for systematic reviewing; a systematic review and meta-analysis of quantitative data from observational studies of predictors of care home admission from hospital; and a methodological chapter on developing a search filter to improve accessibility of existing research findings supported by the findings of an international survey of care home researchers. The systematic review identified 53 relevant studies from 16 countries comprising a total population of 1,457,881 participants. Quantitative synthesis of the results from 11 of the studies found that increased age (OR 1.02 per year increase; 95%CI 1.00-1.04), female sex (OR 1.41; 95%CI 1.03-1.92), dementia & cognitive impairment (OR 2.14; 95%CI 1.24-3.70) and functional dependency (OR 2.06; 95%CI 1.58-2.69) were all associated with an increased risk of care home admission after hospitalisation. Despite international variation in service provision, only two studies described the model of care provided in the care home setting. The survey identified that there is a lack of shared terminology in the published literature to describe settings for adults who are unable to live independently in their own homes and require care in a long-term institutional setting. A search filter to identify relevant research could help to overcome differences in terminology and improve synthesis of existing research evidence. Part Two: Exploring current clinical practice – reports the findings of a retrospective cohort study of new care home admissions from hospital using case-note review methodology accompanied by findings from inductive thematic analysis of a single dataset from a qualitative case study design exploring the experiences of a patient, their family, and practitioners (n=5). The cohort study (n=100) found a heterogeneous picture with long hospital admissions (range 14-231 days), frequent transfers of care (31% experienced three or more transfers), varied levels of documented assessment and a lack of documented patient involvement in the decision-making processes. The qualitative interviews allowed the patient voice to emerge, alongside the professional and family narrative which dominated case-note documentation. Inductive thematic analysis identified nine major themes exploring how decisions are made to discharge individuals directly into a care home from the acute hospital setting: biography & personality; professional role; family role; limitations in local model of care; ownership of decision; risk; realising preferences; uncertainty of care home admission process; and psychological impact of in-hospital care. Part Three: Harnessing routinely-collected data – includes the challenges of identifying care home residency at admission and discharge from hospital, presenting analysis of the accuracy of Scottish Morbidity Record 1 (SMR01) coding in NHS Fife and the Community Health Index (CHI) Institution Flag in NHS Fife and NHS Tayside. This is followed by a descriptive analysis of the Scottish Care Home Census (2013-16) as a novel social care data source to explore care home admissions from hospital and the methodology for a data linkage study using these data. Identifying care home residents in routine data sources is challenging. In 18,720 admissions to NHS Fife, SMR01 coding had a sensitivity of 86.0% and positive predictive value of 85.8% in identifying care home residents on admission. At discharge the sensitivity was 87.0% and positive predictive value was 84.5%. From a sample of 10,000 records, the CHI Institution Flag had a sensitivity of 58.6% in NHS Fife and 89.3% in NHS Tayside, with positive predictive values of 99.7% and 97.7% respectively. From 2013-16, of 21,368 admissions to care homes in Scotland, 56.7% were admitted from hospital. There was significant regional variation in rates of care home admission from hospital (35.9-64.7%) and proportion of Local Authority funded places provided to admissions from hospital (34.4-73.9%). Those admitted from hospital appeared to be more dependent and sicker than those admitted from home. This thesis has established a series of challenges in how care homes and their residents are identified. It has questioned the adequacy of the evidence to guide practitioners and sought to raise the profile of this vulnerable and complex population and how best to support them in making decisions regarding admission from the acute hospital. It has progressed our understanding of this under-explored area and proposes a programme of future mixed-methods research involving patients, families, practitioners and policy-makers

Age, Growth and Natural Mortality of Blackfin Snapper Lutjanus buccanella from the Southeastern United States and U. S. Caribbean

We determined ages of Blackfin Snapper (Lutjanus buccanella Cuvier 1828; n = 622) collected from the southeastern United States coast and U.S. Caribbean from 1979–2015 using sectioned sagittal otoliths. Opaque zones were determined to be annular, forming March – July (peaking in April–June). Blackfin Snapper ranged from 1–27 years and from 180–609 mm total length (TL). Body size relationships for Blackfin Snapper were: TL = 1.09 FL + 0.81 (n = 203, r2 = 0.99); FL = 0.91 TL + 3.38 (n = 203, r2 = 0.99); TL = 1.23 SL + 14.27 (n = 83, r2 = 0.97); FL = 1.14 SL + 10.84 (n = 83, r2 = 0.99); W = 7.79 x 10—9 TL3.09 (n = 216); and W = 9.54 x 10—9 FL3.11 (n = 228). The von Bertalanffy growth equation was: Lt = 549 (1 — e—0.20 (t +1.51)) (n = 622). Point estimate of natural mortality was M = 0.16, while age—specific estimates of M ranged from 0.65–0.21/y for ages 1–27. This study presents the first findings of life history parameters for Blackfin Snapper from the Atlantic waters off the southeastern United States and U.S. Caribbean

Developing an intervention toolbox for common health problems in the workplace

The project brief was to develop the content for an intervention toolbox for common health problems in the workplace - musculoskeletal, mental health and stress complaints. The intention was to develop a prototype toolbox that can be taken forward to (1) minimise the occurrence of work-relevant common health problems (CHPs) and (2) reduce avoidable sickness absence, healthcare use and long-term disability for CHP complaints that inevitably occur in the workplac

The importance of scientific peer review at SETAC

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102196/1/etc2449.pd