How moving home influences appliance ownership: a Passivhaus case study

Low carbon dwellings shift the focus to electricity consumption and appliances by significantly lowering space heating energy consumption. Using a UK Passivhaus (low carbon) case study, interviews and pre/post-move-in appliance audits were employed to investigate how moving home can change the appliance requirements of appliance-using practices. Changes in appliance ownership were due to differences in how appliance-using practices (e.g. cooking, laundering, homemaking) were being performed. Existing/new appliances complemented/conflicted with a new home on the basis of whether the social meanings of specific appliance-using practices (e.g. stylishness, convenience, thermal comfort, cleanliness) could be met. This was evident, when moving home more generally, by households buying new modern appliances and managing spatial constraints. More specifically, regarding Passivhaus, hosting and homemaking practices were performed in ways that met thermal comfort expectations, in addition to appliance purchasing also being influenced by a fear that the Passivhaus technologies could fail. Whilst skills and competences were needed to perform appliance-using practices, these were less prominent in influencing appliance ownership changes. Conclusions include reflections on how the elements of appliance-using practices change when moving home, as well as what adhering to building standards could mean for the standardisation of appliance-using practices and domestic life more generally

Genetic research: the role of citizens, public health and international stakeholders

Background: Genetic research has become an indispensable instrument for medical research, and the subjects involved have both divergent and convergent interests. Objective: The possibility of having more detailed genetic information undoubtedly offers benefits for the health of the subject, but could also pose risks and make the subject vulnerable to discrimination. Methods: The scientific community has viewed very favorably the public health utility of family history, in which data from a family whose members suffer from chronic pathologies is collected and filed, in order to develop a sort of “stratification of family risk.” Even though in the last decade the scientific and juridical literature has contributed greatly to the topic of biobanks, the perplexities that continue to surround this theme give the idea that current ethical protocols on research are inadequate. Results: Researchers, citizens, International stakeholders, mass media, Public Health and Governments play a key role in genetic research. It is obvious that the methods used for genetic research do not present intrinsic risks; they are much less dangerous than other activities of diagnosis and research. Before authorizing a research project, it is important to reflect on the responsibility and transparency of the studies to be conducted, and on the impact they may have on the interests of public health. Conclusion: We believe that the highest priority need is to develop a common language on the theme, as is the case in the sphere of clinical experimentation where rules of good clinical practice, albeit at times conflicting, have led to uniform convergences in the scientific world on the points to be actuated

Prescription of psychotropic medication in patients with type two diabetes mellitus: A multi-practice study from Ireland

Background: Comorbid anxiety and depression and type two diabetes mellitus (T2DM) are commonly managed by General Practitioners (GPs). Objectives: To investigate the proportion of people with T2DM who are prescribed either antidepressant or benzodiazepine medications in general practice; to compare people with T2DM that have a prescription with those that do not in terms of patient characteristics, glycaemic control and healthcare utilization. Methods: Anonymized data was collected by GPs and senior medical students from electronic medical records of patients with T2DM in 34 Irish general practices affiliated with the University of Limerick Graduate Entry Medical School during the 2013/14 academic year. Data included demographics, healthcare utilization, prescriptions and most recent glycosylated haemoglobin (HbA1c) measurement. Results: The sample included 2696 patients with T2DM, of which 733 (36.7%) were female, and with a median age of 66 years. The percentage with a current prescription for an antidepressant or benzodiazepine was 22% (95%CI: 18.9–24.9). Those with a current prescription for either drug were more likely to have attended the emergency department (28.3% vs 15.7%, P<0.001), to have been admitted to hospital (35.4% vs 21.3%, P<0.001) in the past year and attend their GP more frequently (median of 9 vs 7, P<0.001) than those without a prescription. Rates of poor glycaemic control were similar in those with and without a current prescription. Conclusion: Over one-fifth of people with T2DM in Irish general practice are prescribed an antidepressant or benzodiazepine medication. Prescription of these is associated with increased healthcare utilization but not poorer glycaemic control

Survey Field Methods for Expanded Biospecimen and Biomeasure Collection in NSHAP Wave 2

OBJECTIVES: The National Social Life, Health, and Aging Project is a nationally representative, longitudinal survey of older adults. A main component is the collection of biomeasures to objectively assess physiological status relevant to psychosocial variables, aging conditions, and disease. Wave 2 added novel biomeasures, refined those collected in Wave 1, and provides a reference for the collection protocols and strategy common to the biomeasures. The effects of aging, gender, and their interaction are presented in the specific biomeasure papers included in this Special Issue. METHOD: A transdisciplinary working group expanded the biomeasures collected to include physiological, genetic, anthropometric, functional, neuropsychological, and sensory measures, yielding 37 more than in Wave 1. All were designed for collection in respondents’ homes by nonmedically trained field interviewers. RESULTS: Both repeated and novel biomeasures were successful. Those in Wave 1 were refined to improve quality, and ensure consistency for longitudinal analysis. Four new biospecimens yielded 27 novel measures. During the interview, 19 biomeasures were recorded covering anthropometric, functional, neuropsychological, and sensory measures and actigraphy provided data on activity and sleep. DISCUSSION: Improved field methods included in-home collection, temperature control, establishment of a central sur- vey biomeasure laboratory, and shipping, all of which were crucial for successful collection by the field interviewers and accurate laboratory assay of the biomeasures (92.1% average co-operation rate and 97.3% average assay success rate). Developed for home interviews, these biomeasures are readily applicable to other surveys

Health and wellbeing of sexual abuse survivors attending sexual assault referral centres in England:the MESARCH mixed-methods evaluation

Background: One million people in England and Wales experience sexual violence and abuse each year with around half experiencing serious sexual offences; 55,000 survivors access Sexual Assault Referral Centres (SARCs).Objectives: Our research was commissioned by NIHR to evaluate access, interventions and care pathways for survivors, specifically those provided through SARCs. Design, setting, participants: The SARC care pathway was investigated through six sub-studies. We conducted two Cochrane Reviews (4,274 participants). A process evaluation of SARCs interviewed 72 providers and 5 survivors at 8 sites; our children and young people (CYP) study involved 12 CYP from 2 SARCs. A cohort study with three waves of data collection over one-year (21 SARCs, 2,602 service users screened, 337 recruited) used a multilevel-modelling framework to explore risk factors for burden of post-traumatic stress disorder (PTSD) symptoms at baseline and change at one-year. We analysed costs and outcomes, and conducted an embedded narrative analysis (42 survivors). We prioritised the safety/welfare of participants and researchers and embedded lived expertise across the project lifecycle.Results: The Cochrane Reviews identified large effects from psychosocial interventions for PTSD and depression. SARCs delivered a high-quality frontline service for adult and young survivors, functioning as a gateway to onward services. Groups underrepresented at SARCs include those experiencing domestic abuse and some ethnic and cultural minorities. The research emphasised inter-agency/sector collaboration for survivor benefit. Supported by our qualitative research with minoritised groups, the cohort study showed a risk ‘triad’ with adverse childhood experiences, chronic mental health problems and economic deprivation. The research evidenced important improvements in trauma symptoms. These were unrelated to different SARC models and persisted for half of people a year later. Health-related quality of life was below population norms at baseline and high levels of service use were reported. Over the 12 month period, costs and outcomes were similar across SARC models and no significant differences were identified. Harmful encounters occurred in relation to police and justice practices/procedures for 25% of participants and our qualitative studies emphasised the vital interactions between experiences of justice and wellbeing. Good practice largely concerned enhanced communication (e.g. trauma-competent interviewing techniques; regular/timely updates; conveying case decisions with care). Limitations: The cohort study lacked a comparison group, reducing confidence in the finding that access to SARC and other health/therapeutic care explained the reduction observed in PTSD. Conclusions and future work: The risk ‘triad’ underscores the value of screening at SARCs and timely access to therapies/advocacy as part of multi-sectoral approach to supporting recovery. Poor mental health was the main barrier to service access beyond SARCs, suggesting the value of Independent Sexual Violence Advisors with mental health specialisation. The persistence of trauma symptoms supports calls for tackling wait-lists, expanding therapy options and commitment to lifelong care. Cohesive commissioning strategies can promote a whole pathway approach by supporting greater collaboration across providers. Access gaps at the population-level and for specific groups call for concerted efforts to support people to reach care early, for example, through outreach, campaigns and implementing trauma-informed universal health services. MESARCH provides a foundation for advancing trauma-informed practices when supporting people exposed to the effects of sexual violence and abuse.Study registration: MESARCH is registered with ISRCTN registry ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825 Funding: Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research