Health and wellbeing promotion strategies for ‘hard to reach’ older people in England: a mapping exercise.

The version of the article that has been accepted for publication. This version may include revisions resulting from peer review but may be subject to further editorial input by Cambridge University Press.Background: Older people from deprived areas, the oldest old and those from ethnic minorities engage less in health promotion interventions and related research, potentially generating inequities. Aim: To explore and map the extent to which such ‘hard to reach’ groups of older people, are the focus of local health and wellbeing strategies in England. Methods: Document analysis of current health and wellbeing promotion strategies in a purposive sample of 10 localities in England with high proportions of some or all of the three hard-to-reach groups. Documents were analysed using an interpretive approach. Findings: A total of 254 documents were retrieved and reviewed. Much of the content of the documents was descriptive and reported the implications for resources/services of population ageing rather than actual initiatives. All localities had an Older People’s Strategy. Strategies to counter deprivation included redistribution of winter fuel payments, income maximisation, debt reduction and social inclusion initiatives, a focus on older owner occupiers and recruitment of village ‘agents’ to counter rural deprivation. The needs of the oldest old were served by integrated services for older people, a community alarm service with total coverage of the 85+ population, and dietary advice. The needs of Black and Ethnic Minority (BME) older people were discussed in all localities and responses included community work with BME groups, attention to housing needs and monitoring of service use by BME older people. Three other themes that emerged were: use of telecare technologies; a challenge to the idea of ‘hard to reach’ groups; and outreach services to those at most risk. Conclusions: Document analysis revealed a range of policy statements that may indicate tailoring of policy and practice to local conditions, the salience of national priorities, some innovative local responses to policy challenges and even dissenting views that seek to redefine the policy problem.Peer reviewe

Engaging ‘hard to reach’ groups in health promotion: the views of older people and professionals from a qualitative study in England

Background Older people living in deprived areas, from black and minority ethnic groups (BME) or aged over 85 years (oldest old) are recognised as ‘hard to reach’. Engaging these groups in health promotion is of particular importance when seeking to target those who may benefit the most and to reduce health inequalities. This study aimed to explore what influences them practicing health promotion and elicit the views of cross-sector professionals with experiences of working with ‘hard to reach’ older people, to help inform best practice on engagement. Methods ‘Hard to reach’ older people were recruited through primary care by approaching those not attending for preventative healthcare, and via day centres. Nineteen participated in an interview (n = 15) or focus group (n = 4); including some overlaps: 17 were from a deprived area, 12 from BME groups, and five were oldest old. Cross-sector health promotion professionals across England with experience of health promotion with older people were identified through online searches and snowball sampling. A total of 31 of these 44 professionals completed an online survey including open questions on barriers and facilitators to uptake in these groups. Thematic analysis was used to develop a framework of higher and lower level themes. Interpretations were discussed and agreed within the team. Results Older people’s motivation to stay healthy and independent reflected their everyday behaviour including practicing activities to feel or stay well, level of social engagement, and enthusiasm for and belief in health promotion. All of the oldest old reported trying to live healthily, often facilitated by others, yet sometimes being restricted due to poor health. Most older people from BME groups reported a strong wish to remain independent which was often positively influenced by their social network. Older people living in deprived areas reported reluctance to undertake health promotion activities, conveyed apathy and reported little social interaction. Cross-sector health professionals consistently reported similar themes as the older people, reinforcing the views of the older people through examples. Conclusions The study shows some shared themes across the three ‘hard-to-reach’ groups but also some distinct differences, suggesting that a carefully outlined strategy should be considered to reach successfully the group targeted.Peer reviewedFinal Published versio

Spinning a War

Thesis advisor: John J. MichalczykThis thesis explores public relations tactics employed by the United States government during the second Iraq war. It discusses the similarity between public relations and propaganda, giving an in-depth exploration of the strategies used by the government before, during, and after the war to garner support for the effort.Thesis (BA) — Boston College, 2004.Submitted to: Boston College. College of Arts and Sciences.Discipline: Fine Arts.Discipline: College Honors Program

Strategies to improve engagement of 'hard to reach' older people in research on health promotion: : a systematic review

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: This review aimed to identify facilitators, barriers and strategies for engaging 'hard to reach' older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas. Methods: Eight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people. Results: Twenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions. Conclusions: This review identified facilitators, barriers and strategies for engaging 'hard to reach' older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches.Peer reviewedFinal Published versio

Systematic review of conservation interventions to promote voluntary behavior change

Understanding human behavior is vital to developing interventions that effectively lead to proenvironmental behavior change, whether the focus is at the individual or societal level. However, interventions in many fields have historically lacked robust forms of evaluation, which makes it hard to be confident that these conservation interventions have successfully helped protect the environment. We conducted a systematic review to assess how effective nonpecuniary and nonregulatory interventions have been in changing environmental behavior. We applied the Office of Health Assessment and Translation systematic review methodology. We started with more than 300,000 papers and reports returned by our search terms and after critical appraisal of quality identified 128 individual studies that merited inclusion in the review. We classified interventions by thematic area, type of intervention, the number of times audiences were exposed to interventions, and the length of time interventions ran. Most studies reported a positive effect (n = 96). The next most common outcome was no effect (n = 28). Few studies reported negative (n = 1) or mixed (n = 3) effects. Education, prompts, and feedback interventions resulted in positive behavior change. Combining multiple interventions was the most effective. Neither exposure duration nor frequency affected the likelihood of desired behavioral change. Comparatively few studies tested the effects of voluntary interventions on non-Western populations (n = 17) or measured actual ecological outcome behavior (n = 1). Similarly, few studies examined conservation devices (e.g., energy-efficient stoves) (n = 9) and demonstrations (e.g., modeling the desired behavior) (n = 5). There is a clear need to both improve the quality of the impact evaluation conducted and the reporting standards for intervention results

A scoping review into the impact of animal imagery on pro-environmental outcomes

With the recognition that most global environmental problems are a result of human actions, there is an increasing interest in approaches which have the potential to influence human behaviour. Images have a powerful role in shaping persuasive messages, yet research on the impacts of visual representations of nature is a neglected area in biodiversity conservation. We systematically screened existing studies on the use of animal imagery in conservation, identifying 37 articles. Although there is clear evidence that images of animals can have positive effects on people’s attitudes to animals, overall there is currently a dearth of accessible and comparable published data demonstrating the efficacy of animal imagery. Most existing studies are place and context-specific, limiting the generalisable conclusions that can be drawn. Transdisciplinary research is needed to develop a robust understanding of the contextual and cultural factors that affect how animal images can be used effectively for conservation purposes

Isotopic constraints on lightning as a source of fixed nitrogen in Earth's early biosphere

Bioavailable nitrogen is thought to be a requirement for the origin and sustenance of life. Before the onset of biological nitrogen fixation, abiotic pathways to fix atmospheric N2 must have been prominent to provide bioavailable nitrogen to Earth's earliest ecosystems. Lightning has been shown to produce fixed nitrogen as nitrite and nitrate in both modern atmospheres dominated by N2 and O2 and atmospheres dominated by N2 and CO2 analogous to the Archaean Earth. However, a better understanding of the isotopic fingerprints of lightning-generated fixed nitrogen is needed to assess the role of this process on the early Earth. Here, we present results from spark discharge experiments in N2-CO2 and N2-O2 gas mixtures. Our experiments suggest that lightning-driven nitrogen fixation may have been similarly efficient in the Archaean atmosphere, compared to modern times. Measurements of the isotopic ratio {\delta}15N of the discharge-produced nitrite and nitrate in solution show very low values of -6 to -15 permil after equilibration with the gas phase with a calculated endmember composition of -17 permil. These results are much lower than most {\delta}15N values documented from the sedimentary rock record, which supports the development of biological nitrogen fixation earlier than 3.2 Ga. However, some Paleoarchean records (3.7 Ga) may be consistent with lightning-derived nitrogen input, highlighting the potential role of this process for the earliest ecosystems.Comment: Accepted manuscript. Version of record published in Nature Geoscience. 29 pages (main text, methods, supplementary material), 5 figures + 4 supplementary figure

Service use of older people who participate in primary care health promotion: a latent class analysis

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Abstract Background Recruiting patients to health promotion programmes who will benefit is crucial to success. A key policy driver for health promotion in older people is to reduce health and social care use. Our aim was to describe service use among older people taking part in the Multi-dimensional Risk Appraisal for Older people primary care health promotion programme. Methods A random sample of 1 in 3 older people (≥65 years old) was invited to participate in the Multi-dimensional Risk Appraisal for Older people project across five general practices in London and Hertfordshire. Data collected included socio-demographic characteristics, well-being and functional ability, lifestyle factors and service use. Latent class analysis (LCA) was used to identify groups based on use of the following: secondary health care, primary health care, community health care, paid care, unpaid care, leisure and local authority resources. Differences in group characteristics were assessed using univariate logistic regression, weighted by probability of class assignation and clustered by GP practice. Results Response rate was 34% (526/1550) with 447 participants presenting sufficient data for analysis. LCA using three groups gave the most meaningful interpretation and best model fit. About a third (active well) were fit and active with low service use. Just under a third (high NHS users) had high impairments with high primary, secondary and community health care contact, but low non-health services use. Just over a third (community service users) with high impairments used community health and other services without much hospital use. Conclusion Older people taking part in the Multi-dimensional Risk Appraisal for Older people primary care health promotion can be described as three groups: active well, high NHS users, and community service users.Peer reviewe

Salinity and temperature affect the symbiont profile and host condition of Florida USA blue crabs Callinectes sapidus

Subtropical Florida blue crabs, Callinectes sapidus, exhibit differing life history traits compared to their temperate counterparts, likely influencing symbiont infection dynamics. Little information exists for Florida C. sapidus symbiont profiles, their distribution among various habitats, and influence on crab condition. Using histopathology, genomics, and transmission electron microscopy, we describe the first symbiont profiles for Florida C. sapidus occupying freshwater to marine habitats. Twelve symbiont groups were identified from 409 crabs including ciliophorans, digenean, microsporidian, Haplosporidia, Hematodinium sp., Nematoda, filamentous bacteria, gregarine, Callinectes sapidus nudivirus, Octolasmis sp., Cambarincola sp., and putative microcell. Overall, 78% of C. sapidus were documented with one or more symbiont groups demonstrating high infection rates in wild populations. Environmental variables water temperature and salinity explained 48% of the variation in symbiont groups among Florida habitats, and salinity was positively correlated with C. sapidus symbiont diversity. This suggests freshwater C. sapidus possess fewer symbionts and represent healthier individuals compared to saltwater populations. Crab condition was examined using the reflex action mortality predictor (RAMP) to determine if reflex impairment could be linked to symbiont prevalence. Symbionts were found positively correlated with crab condition, and impaired crabs were more likely to host symbionts, demonstrating symbiont inclusion may boost predictive ability of the RAMP application. The microsporidian symbiont group had a particularly strong effect on C. sapidus reflex response, and impairment was on average 1.57 times higher compared to all other symbiont groups. Our findings demonstrate the importance of considering full symbiont profiles and their associations with a spatially and temporally variable environment to fully assess C. sapidus population health.</p

The role of Gray’s revised RST in the P–psychopathy continuum: the relationships of Psychoticism with a lack of fear and anxiety, and increased impulsivity

Gray's revised Reinforcement Sensitivity Theory (rRST; Gray & McNaughton, 2000) may play a role in explaining deficits in Psychoticism (P) and psychopathy (Corr, 2010). In this paper, we examine the relationships of P with anxiety, fear, impulsivity and reward reactivity in normal populations to assess whether these associations mirror the hypothesized role of RST motivations in psychopathy. Two hundred and twelve participants completed measures of Psychoticism, impulsivity and rRST motivations (BIS-anxiety, FFFS-fear and BAS). BIS-anxiety mediated the association of P with FFFS-fear and BAS-fun seeking. An exploratory factor analysis distinguished between trait impulsivity (P, impulsivity and BIS) and reward reactivity (BAS-reward responsiveness and BAS-drive). Subsequent moderation analyses showed that whilst neither BIS nor BAS moderated the P-impulsivity link, the association between P and impulsivity was more pronounced in individuals with raised levels of FFFS-fear. Findings are discussed in terms of the roles of fear versus anxiety and impulsivity versus reward reactivity in the P-psychopathy continuum