Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks

Background NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual’s ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. Methods NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. Results The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50–75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with ‘White British’ ‘Black Caribbean’ and ‘Indian’ patients most likely to take up a NHS Health Check. However, patients from ‘Any Other White Background’ and ‘Black African’ were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. Conclusions The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities

Assessing the effectiveness of business support services in England: evidence from a theory based evaluation

In England, publicly supported advisory services for small firms are organised primarily through the Business Link (BL) network. Based on the programme theory underlying this business support services we develop four propositions and test these empirically using data from a new survey of over 3,000 English small firms. Our empirical results provide a broad validation of the programme theory underlying BL assistance for small firms in England during 2003, and more limited support for its effectiveness. More specifically, we find strong support for the value of BL operators maintaining a high profile as a way of boosting take-up. We also find some support for the approach to market segmentation adopted by BL allowing more intensive assistance to be targeted on younger firms and those with limited liability status. In terms of the outcomes of BL support, and allowing for issues of sample selection, we find no significant effects on growth from ‘other’ assistance but do find positive and significant employment growth effects from intensive assistance. This provides partial support for the programme theory assertion that BL support will lead to improvements in business growth performance and stronger support for the proposition that there would be differential outcomes from intensive and other assistance. The positive employment growth outcomes identified here from intensive assistance, even allowing for sample selection, suggest something of an improvement in the effectiveness of the BL network since the late 1990s

From Navas to Kaltoft: The European Court of Justice’s evolving definition of disability and the implications for HIV-positive individuals

This article will examine the definition of disability developed by the European Court of Justice for the purposes of the Employment Equality Directive and examine whether it is sufficient for the purpose of bringing People Living with HIV/AIDS within its scope. The article will argue that in order to adequately protect People Living with HIV/AIDS within the EU from discrimination, the European Court of Justice needs to ensure that a coherent EU wide definition of disability, based fully upon the social model of disability, is adopted. This is necessary in order to ensure adequate protection not only for People Living with HIV/AIDS but for all individuals with disabilities from discrimination throughout the EU. In addition to this central argument, this paper will argue that the lack of a coherent definition of disability grounded in the social model fragments protection for People Living with HIV/AIDS across the EU leading to a number of possible unintended consequences

Decay of escherichia coli in soil following the application of biosolids to agricultural land

The decay of Escherichia coli in a sandy loam soil, amended with enhanced and conventionally treated biosolids, was investigated in a field experiment following spring and autumn applications of sewage sludge. Control soils, without the application of biosolids, were also examined to determine the background indigenous populations of E. coli which are present in the environment. The survival of indigenous E. coli and populations of E. coli applied to soil in biosolids, is assessed in relation to environmental factors influencing pathogen-decay processes in soil

Photosynthetic activity and population dynamics of Amoebobacter purpureus in a meromictic saline lake

Abstract A dense population of the purple sulfur bacterium Amoebobacter purpureus in the chemocline of meromictic Mahoney Lake (British Columbia, Canada) underwent consistent changes in biomass over a two year study period. The integrated amount of bacteriochlorophyll reached maxima in August and declined markedly during early fall. Bacteriochlorophyll was only weakly correlated with the light intensity and water temperature in the chemocline. In the summer, bacterial photosynthesis was limited by sulfide availability. During this period the intracellular sulfur concentration of A. purpureus cells decreased. A minimum concentration was measured at the top of the bacterial layer in August, when specific photosynthetic rates of A. purpureus indicated that only 14% of the cells were photosynthetically active. With the exception of a time period between August and September, the specific growth rates calculated from CO2 fixation rates of A. purpureus were similar to growth rates calculated from actual biomass changes in the bacterial layer. Between August and September 86% of the A. purpureus biomass disappeared from the chemocline and were deposited on the littoral sediment of Mahoney Lake or degraded within the mixolimnion. This rise of cells to the lake surface was not mediated by an increase in the specific gas vesicle content which remained constant between April and November. The upwelling phenomenon was related to the low sulfur content of A. purpureus cells and a low resistance of surface water layers against vertical mixing by wind

Processes structuring macrophyte metacommunities in Mediterranean ponds: combining novel methods to disentangle the role of dispersal limitation, species sorting and spatial scales

Aim: Metacommunity ecology is a vibrant area of research that has received increased attention in recent years, since it provides a framework to assess the underlying dispersal- and niche-based processes that create non-random and ecologically meaningful patterns in species assemblages across the landscape. Here we set out to test for the role of dispersal limitation, species sorting and shared effects in the assembly of pond macrophyte metacommunities across an extensive area within the Iberian Plateau, and to identify which traits, environmental variables and spatial scales are driving local community structure. Location: North-western Spain (Iberian Plateau). Taxon: Pond macrophytes. Methods: We established a novel combination of robust methods capable of identifying the processes and most important landscape scales involved in the assembly of communities. We used metacommunity assembly modelling and multivariate multi-scale codependence analysis (mMCA) to first estimate the relative importance of spatial and environmental effects on community structure, and then to identify significant trait–environment relationships and spatial scales. Results: Analyses showed that the greatest effects were seen for the spatial and mixed spatial and niche-based scenarios, particularly among wind-dispersed species. Thus, dispersal limitation interfered with species sorting in determining assemblage structure by hindering species’ tracking of local environmental conditions. After accounting for this, the metacommunity assembly model revealed that species’ traits were involved in determining abundance structure. mMCA identified the main trait–environment relationships (and spatial scales) as fruit size-nutrient status (~300 km) and growth form-mean pond depth (~250 km). Main conclusions: Our study suggests that dispersal limitation acted in concert with species sorting to influence the community assembly processes underlying selection for particular traits in functional niche space. Accordingly, we emphasize the need to go beyond the traditional taxonomic-based analyses of community composition and the predominant thinking of considering spatial and environmental processes as two alternative and mutually exclusive scenarios of community assembly.</p

Towards a realistic microscopic description of highway traffic

Simple cellular automata models are able to reproduce the basic properties of highway traffic. The comparison with empirical data for microscopic quantities requires a more detailed description of the elementary dynamics. Based on existing cellular automata models we propose an improved discrete model incorporating anticipation effects, reduced acceleration capabilities and an enhanced interaction horizon for braking. The modified model is able to reproduce the three phases (free-flow, synchronized, and stop-and-go) observed in real traffic. Furthermore we find a good agreement with detailed empirical single-vehicle data in all phases.Comment: 7 pages, 7 figure

Theorizing healthy settings: a critical discussion with reference to Healthy Universities

The settings approach appreciates that health determinants operate in settings of everyday life. Whilst subject to conceptual development, we argue that the approach lacks a clear and coherent theoretical framework to steer policy, practice and research. Aims: To identify what theories and conceptual models have been used in relation to the implementation and evaluation of Healthy Universities. Methods: A scoping literature review was undertaken between 2010-2013, identifying 26 papers that met inclusion criteria. Findings: Seven theoretical perspectives or conceptual frameworks were identified: the Ottawa Charter; a socio-ecological approach (which implicitly drew on sociological theories concerning structure and agency); salutogenesis; systems thinking; whole system change; organisational development; and a framework proposed by Dooris. These were used to address interrelated questions on the nature of a setting, how health is created in a setting, why the settings approach is a useful means of promoting health, and how health promotion can be introduced into and embedded within a setting. Conclusion: Although distinctive, the example of Healthy Universities drew on common theoretical perspectives that have infused the settings discourse more generally. This engagement with theory was at times well-developed and at other times a passing reference. The paper concludes by pointing to other theories that offer value to healthy settings practice and research and by arguing that theorisation has a key role to play in understanding the complexity of settings and guiding the planning, implementation and evaluation of programmes