Who Cares: Who Pays? A Report on Personalisation in Social Care

This report looks at the impact of recent moves towards personalisation of social care services and assesses their impact on providers, care recipients and gender inequalities more generally. It also provides an alternative vision for the provision of care in a more gender equal future

Reducing gender inequalities to create a sustainable care system

Women mainly provide family care, but as women’s economic opportunities increase they will not continue to bear the costs of providing care unaided. To create a sustainable care system, care and carers must be better supported and more highly valued to involve more men in caring and reduce gender inequalities.Key pointsMost care is still provided through family obligations, unpaid but not free, since it is ‘paid for’ by reduced opportunities for carers. Family carers are mostly women, because of gender norms and also the gender pay gap, which makes it more costly for men to reduce employment hours.As women move increasingly into employment, family carers’ demand for employment will continue to rise, as will the need for paid care. The UK’s long working hours make it difficult to combine caring with full-time employment, but part-time pay rates are often considerably lower.Four in five paid carers are women, in a sector having increasing difficulties with recruitment and retention. The care sector’s poor pay is a large contributor to the gender pay gap.Privatisation of residential and domiciliary care has produced a labour market with insufficient opportunities for training and career development. This is unlikely to attract men, and women will increasingly leave as their employment opportunities improve.This situation will be unsustainable for meeting society’s care needs unless:- pay and conditions improve to retain more women and encourage men to enter the care sector;- unpaid carers receive financial and other support, and working hours are reduced for all, so that more people can combine family care with employment;- cash payments to individuals are not allowed to drive out funding for vital community services; and- policies are judged by the quality of care they support and how much they encourage a stable, less gender-divided workforce, as well as value for moneyAny other solution would be unworkable, unfair and inconsistent with government commitments to reduce gender inequalities.Costs will continue to rise as the paid care sector grows, since to recruit and retain care workers, wages will have to keep up with those elsewhere. Because rising care costs are an effect of rising productivity elsewhere in the economy, paying for them will still let disposable incomes increase. Spending more on social care can be afforded.</br

Reducing gender inequalities to create a sustainable care system

Women mainly provide family care, but as women’s economic opportunities increase they will not continue to bear the costs of providing care unaided. To create a sustainable care system, care and carers must be better supported and more highly valued to involve more men in caring and reduce gender inequalities.Key pointsMost care is still provided through family obligations, unpaid but not free, since it is ‘paid for’ by reduced opportunities for carers. Family carers are mostly women, because of gender norms and also the gender pay gap, which makes it more costly for men to reduce employment hours.As women move increasingly into employment, family carers’ demand for employment will continue to rise, as will the need for paid care. The UK’s long working hours make it difficult to combine caring with full-time employment, but part-time pay rates are often considerably lower.Four in five paid carers are women, in a sector having increasing difficulties with recruitment and retention. The care sector’s poor pay is a large contributor to the gender pay gap.Privatisation of residential and domiciliary care has produced a labour market with insufficient opportunities for training and career development. This is unlikely to attract men, and women will increasingly leave as their employment opportunities improve.This situation will be unsustainable for meeting society’s care needs unless:- pay and conditions improve to retain more women and encourage men to enter the care sector;- unpaid carers receive financial and other support, and working hours are reduced for all, so that more people can combine family care with employment;- cash payments to individuals are not allowed to drive out funding for vital community services; and- policies are judged by the quality of care they support and how much they encourage a stable, less gender-divided workforce, as well as value for moneyAny other solution would be unworkable, unfair and inconsistent with government commitments to reduce gender inequalities.Costs will continue to rise as the paid care sector grows, since to recruit and retain care workers, wages will have to keep up with those elsewhere. Because rising care costs are an effect of rising productivity elsewhere in the economy, paying for them will still let disposable incomes increase. Spending more on social care can be afforded.</br

On the benefits of philosophy as a way of life in a general introductory course

Philosophy as a way of life (PWOL) places investigations of value, meaning, and the good life at the center of philosophical investigation, especially of one’s own life. I argue PWOL is compatible with general introductory philosophy courses, further arguing that PWOL-based general introductions have several philosophical and pedagogical benefits. These include the ease with which high impact practices, situated skill development, and students’ ability to ‘think like a disciplinarian’ may be incorporated into such courses, relative to more traditional introductory courses, as well as the demonstration of philosophy’s value to students by explicitly tying philosophical investigation to students own lives

Reply to the letter to the editor regarding 'Clinical assessment of subacromial shoulder impingement – which factors differ from the asymptomatic population?'

[Extract] Not surprisingly, impingement is a term which does not reflect the underlying cause of all shoulder pain. Hence there is healthy debateregarding alternate terminology (Braman et al., 2013; J. S. Lewis, 2011 ; McFarland et al., 2013). However, it continues to be a term used throughout the medical literature and in an attempt to embrace this wider audience, until there is agreement about terminology, it was chosen for use in this paper

Isokinetic clinical assessment of rotator cuff strength in subacromial shoulder impingement

Background: Current conservative management of subacromial shoulder impingement (SSI) includes generic strengthening exercises, especially for internal (IR) and external (ER) shoulder rotators. However, there is no evidence that the strength or the ratio of strength between these muscle groups is different between those with SSI (cases) and an asymptomatic population (controls). Objective: To identify if isokinetic rotator cuff strength or the ratio of strength is significantly different between cases and controls. Study Design: Case Control Study. Method: Fifty one cases with SSI and 51 asymptomatic controls matched for age, gender, hand dominance and physical activity level completed isokinetic peak torque glenohumeral IR and ER testing. Within the SSI group, 31 dominant limbs were symptomatic and 20 non-dominant limbs were symptomatic. IR and ER were measured separately using continuous reciprocal concentric (con) and eccentric (ecc) contraction cycles at a speed of 600 degrees per second and again at 1200 degrees per second. Values of peak torque (PT), relative peak torque (RPT) and ratios were compared using independent t-tests between the SSI and asymptomatic groups. Results: Significant strength differences between the two groups were present only when the symptomatic SSI shoulder was the dominant shoulder (con ER PT at 600 /second, ecc ER PT at 1200 /second, ecc ER RPT at 1200 /second and ecc IR PT at 600 /second and 1200 /second). Conclusions: Changes in rotator cuff strength in SSI may be related to limb dominance, which may have implications for strengthening regimes

Clinical assessment of subacromial shoulder impingement – Which factors differ from the asymptomatic population?

Copyright © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author manuscript is made available following 12 month embargo from date of publication (19 Dec 2016) in accordance with publisher’s copyright policyBackground To date, the significance of factors purported to be associated with subacromial shoulder impingement (SSI) and what differences, if any, are present in those with SSI compared to a matched asymptomatic population has not been identified. Gaining information about differences between people with SSI and asymptomatic people may direct clinicians towards treatments that impact upon these differences. Objective Compare the assessment findings of factors suggested to be associated with SSI; passive posterior shoulder range, passive internal rotation range, resting cervical and thoracic postures, active thoracic range in standing and scapula positioning between cases experiencing SSI and a matched asymptomatic group (controls). Method Fifty one SSI cases and 51 asymptomatic controls were matched for age, gender, hand dominance and physical activity level. The suggested associated factors were measured bilaterally. Independent t-tests were used to compare each of these measurements between the groups. Any variables for which a significant difference was identified, were then included in a conditional logistic regression analysis to identify independent predictors of SSI. Results The SSI group had significantly increased resting thoracic flexion and forward head posture, as well as significantly reduced upper thoracic active motion, passive internal rotation range and posterior shoulder range than the matched asymptomatic group. No independent predictors of SSI were identified in conditional logistic regression analysis. Conclusion Thoracic posture, passive internal rotation range and posterior shoulder range were significantly different between cases experiencing SSI and a matched asymptomatic group

Volume of white matter hyperintensities in healthy adults: Contribution of age, vascular risk factors, and inflammation-related genetic variants

AbstractAging is associated with appearance of white matter hyperintensities (WMH) on MRI scans. Vascular risk and inflammation, which increase with age, may contribute to white matter deterioration and proliferation of WMH. We investigated whether circulating biomarkers and genetic variants associated with elevated vascular risk and inflammation are associated with WMH volume in healthy adults (144 volunteers, 44–77years of age). We examined association of WMH volume with age, sex, hypertension, circulating levels of total plasma homocysteine (tHcy), cholesterol (low-density lipoprotein), and C-reactive protein (CRP), and four polymorphisms related to vascular risk and inflammation: Apolipoprotein ε (ApoE ε2,3,4), Angiotensin-Converting Enzyme insertion/deletion (ACE I/D), methylenetetrahydrofolate reductase (MTHFR) C677T, C-reactive protein (CRP)-286C>A>T, and interleukin-1β (IL-1β) C-511T. We found that larger WMH volume was associated with advanced age, hypertension, and elevated levels of homocysteine and CRP but not with low-density lipoprotein levels. Homozygotes for IL-1β-511T allele and carriers of CRP-286T allele that are associated with increased inflammatory response had larger WMH than the other allelic combinations. Carriers of the APOE ε2 allele had larger frontal WMH than ε3 homozygotes and ε4 carriers did. Thus, in healthy adults, who are free of neurological and vascular disease, genetic variants that promote inflammation and elevated levels of vascular risk biomarkers can contribute to brain abnormalities. This article is part of a Special Issue entitled: Imaging Brain Aging and Neurodegenerative disease

Using Electronic Referrals to Address Health Disparities and Improve Blood Pressure Control

INTRODUCTION: Massachusetts developed and used bidirectional electronic referrals to connect clinical patients across the state to interventions run by community organizations. The objective of our study was to determine whether the use of Massachusetts\u27s electronic referral system (MA e-Referral) reached racial/ethnic groups experiencing health disparities and whether it was associated with improved health outcomes. METHODS: We assembled encounter-level medical records from September 2013 through June 2017 for patients at Massachusetts clinics funded by the Clinical Community Partnerships for Prevention into 2 cohorts. First, all patients meeting program eligibility guidelines for an e-Referral (N = 21,701) were examined to assess the distribution of e-Referrals among populations facing health disparities; second, a subset of 3,817 people with hypertension were analyzed to detect changes in blood pressure after e-Referral to an evidence-based community intervention. RESULTS: Non-Hispanic black (OR, 1.4; 95% confidence interval [CI], 1.2-1.6) and Hispanic patients (OR, 1.3; 95% CI, 1.1-1.4) had higher odds than non-Hispanic white patients of being referred electronically. Patients completing their hypertension intervention had 74% (95% CI, 1.2-2.5) higher odds of having an in-control blood pressure reading than patients who were not electronically referred. CONCLUSION: Clinical to community linkage to interventions through MA e-Referral reached non-Hispanic black, Hispanic, and Spanish-speaking populations and was associated with improved blood pressure control

APOE and FABP2 Polymorphisms and History of Myocardial Infarction, Stroke, Diabetes, and Gallbladder Disease

Dysfunctional lipid metabolism plays a central role in pathogenesis of major chronic diseases, and genetic factors are important determinants of individual lipid profiles. We analyzed the associations of two well-established functional polymorphisms (FABP2 A54T and APOE isoforms) with past and family histories of 1492 population samples. FABP2-T54 allele was associated with an increased risk of past history of myocardial infarction (odds ratio (OR) = 1.51). Likewise, the subjects with APOE4, compared with E2 and E3, had a significantly increased risk of past history myocardial infarction (OR = 1.89). The OR associated with APOE4 was specifically increased in women for past history of myocardial infarction but decreased for gallstone disease. Interactions between gender and APOE isoforms were also significant or marginally significant for these two conditions. FABP2-T54 allele may be a potential genetic marker for myocardial infarction, and APOE4 may exert sex-dependent effects on myocardial infarction and gallbladder disease