Home accidents amongst elderly people: A locality study in Scotland

Aim The aim of this locality study was to collect information on reported and unreported accidents amongst elderly people living in one locality in Scotland. Method Postal Survey- A postal questionnaire was sent to 3,757 men and women aged 65+ years living in one locality. The questionnaire asked respondents to indicate how many accidents they had experienced in the past twelve months, plus to indicate type and location. Information was gathered on living arrangements, ethnicity, gender, age and deprivation. Respondents were asked if they would be willing to take part in an interview study. Interview Study - One hundred elders who had had at least one accident in the previous twelve months were interviewed. Results Postal Survey - Over a third of the respondents in the postal survey reported having had an accident in the previous twelve months. Bumps and drops and falls were the most common type of accident. Most accidents happened in the kitchen. Women reported more falls than men and those living alone reported more accidents than those living with others. Age was associated with the prevalence of accidents, but the association was somewhat curvilinear, with accidents decreasing with age and then increasing again. Interview Study – Interviewees found it hard to differentiate one accident from another. Considerable reluctance to visit the GP after an accident was noted, with many not attending even for serious accidents. Almost forty percent were ‘very’ distressed after their accident, and a quarter reported a loss of confidence. However, most did not worry about accidents. Few thought that their age, health or medications were a cause of their accidents

Method of Extracting Starch from Bacteria

Corynebacterium kutscheri required 10 days of growth on semisolid medium to accumulate intracellular starch, but when the same medium was used as a broth, only l day of growth was required. C. kutscheri synthesized starch when amylose was added to nutrient agar in the substrate, but did not do so when amylopectin was substituted for amylose. Dimethyl sulfoxide (DMSO) was superior to water as a cell wash for removing substrate starch from cells before chemical treatment to remove intracellular starch. Bacterial starch was extracted from C. kutscheri cells by destroying cell walls with lysozyme and sodium lauryl sulfate, removing cellular debris by centrifugation, and precipitating the starch from the supernatant with butanol. A qualitative method for the separation of this starch into amylose and amylopectin fractions is described. Use of DMSO in cell washes established that the bacterial starch molecule was too large to pass through the membrane of the bacterial cell because DMSO passes through the cell membrane and cells gave a positive test for starch after the treatment

People who inject drugs experiences of skin and soft tissue infections and harm reduction: A qualitative study.

Background: Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are considered a public health concern. There is a lack of qualitative research examining the lived experience of PWID who have had SSTI. This paper explores PWID views and experiences of their SSTI, their perceptions on the causes of their SSTI and their harm reduction (HR) behaviours. The implications for HR service delivery and practice will be discussed. Methods: Between October 2015-January 2016, 22 in-depth interviews were conducted with PWID who had experienced a SSTI within the past year. Interviewees were recruited from an injecting equipment provision service and a drug treatment service in Glasgow and Edinburgh respectively. The interview transcripts were transcribed verbatim and underwent thematic analysis. Results: We found that the experience of SSTI can cause strong negative feelings, including panic and stigma and that there was limited knowledge of SSTI prior to first hand experience. The awareness of the unacceptable social and physical consequences of SSTI fostered a sense of personal responsibility and agency which led to the introduction or improved HR uptake. However, when PWID were struggling to inject or when their physical and political environments were compromised there was an increased risk for SSTI and reduced effectiveness of HR. Conclusion: Compared to HCV and HIV, SSTI as an injecting related harm has received less policy attention. Policy makers need to address SSTI HR within enabling environments, such as ‘safer environment interventions’. It is recommended that peer based support, improved NSP provision and medically supervised injecting facilities are needed to deliver SSTI HR

Housing theory, housing research and housing policy

Jim Kemeny in 1992 criticised existing housing research for neglecting social theory and being overly positivist and policy focused. The result has been a strengthening of the conceptual basis of housing research in general, but also a growing schism between researchers who focus on policy relevancy and those that pursue more theoretical work. This paper challenges this schism and argues for theoretically based and policy relevant research. First the paper argues that the policy-making process is complex and can vary between different countries, situations and over time. Therefore, it is argued that many styles of research can influence policy in the right circumstances. Second, the paper challenges the idea that there can be theoretically-free housing research arguing that all research has a theoretical foundation even though in many studies it is not explicit. Finally, the paper engages with the debate about where theory for housing research should come from and what it would look like

Symptom management in people dying with COVID-19: multinational observational study

Objectives To describe multinational prescribing practices by palliative care services for symptom management in patients dying with COVID-19 and the perceived effectiveness of medicines.Methods We surveyed specialist palliative care services, contacted via relevant organisations between April and July 2020. Descriptive statistics for categorical variables were expressed as counts and percentages. Content analysis explored free text responses about symptom management in COVID-19. Medicines were classified using British National Formulary categories. Perceptions on effectiveness of medicines were grouped into five categories; effective, some, limited or unclear effectiveness, no effect.Results 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world, 1 missing country. 358 services had managed patients with confirmed or suspected COVID-19. 289 services had protocols for symptom management in COVID-19. Services tended to prescribe medicines for symptom control comparable to medicines used in people without COVID-19; mainly opioids and benzodiazepines for breathlessness, benzodiazepines and antipsychotics for agitation, opioids and cough linctus for cough, paracetamol and non-steroidal anti-inflammatory drugs for fever, and opioids and paracetamol for pain. Medicines were considered to be mostly effective but varied by patient’s condition, route of administration and dose.Conclusions Services were largely consistent in prescribing for symptom management in people dying with COVID-19. Medicines used prior to COVID-19 were mostly considered effective in controlling common symptoms

A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015

Abstract Background People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date. Methods A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Results Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected. Conclusions The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID

Forty years studying British politics : the decline of Anglo-America

The still present belief some 40 years ago that British politics was both exceptional and superior has been replaced by more theoretically sophisticated analyses based on a wider and more rigorously deployed range of research techniques, although historical analysis appropriately remains important. The American influence on the study of British politics has declined, but the European Union dimension has not been fully integrated. The study of interest groups has been in some respects a fading paradigm, but important questions related to democratic health have still to be addressed. Public administration has been supplanted by public policy, but economic policy remains under-studied. A key challenge for the future is the study of the management of expectations

Experiences of staff providing specialist palliative care during COVID-19: a multiple qualitative case study

Objective: To explore the experiences of, and impact on, staff working in palliative care during the COVID-19 pandemic. Design: Qualitative multiple case study using semi-structured interviews between November 2020 and April 2021 as part of the CovPall study. Data were analysed using thematic framework analysis. Setting: Organisations providing specialist palliative services in any setting. Participants: Staff working in specialist palliative care, purposefully sampled by the criteria of role, care setting and COVID-19 experience. Main outcome measures: Experiences of working in palliative care during the COVID-19 pandemic. Results: Five cases and 24 participants were recruited (n = 12 nurses, 4 clinical managers, 4 doctors, 2 senior managers, 1 healthcare assistant, 1 allied healthcare professional). Central themes demonstrate how infection control constraints prohibited and diluted participants’ ability to provide care that reflected their core values, resulting in experiences of moral distress. Despite organisational, team and individual support strategies, continually managing these constraints led to a ‘crescendo effect’ in which the impacts of moral distress accumulated over time, sometimes leading to burnout. Solidarity with colleagues and making a valued contribution provided ‘moral comfort’ for some. Conclusions: This study provides a unique insight into why and how healthcare staff have experienced moral distress during the pandemic, and how organisations have responded. Despite their experience of dealing with death and dying, the mental health and well-being of palliative care staff was affected by the pandemic. Organisational, structural and policy changes are urgently required to mitigate and manage these impacts