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This paper reflects on the value of diary methods in the context of a qualitative, longitudinal narrative inquiry exploring the higher education decision-making of further education students in England. Event-based diaries were used alongside interviews and focus groups over a 14-month period to gain in-depth insights into the reasons and influences informing their decision-making trajectories. I explore the challenges, successful approaches and advantages of employing diary methods with young people in this context. Challenges consisted of maintaining participant engagement, which was overcome by combining methods and incorporating a reactive co-participatory element. Yet, a number of advantages emerged from participants' engagement with diary keeping which enhanced the richness of the data; this inspired deeper reflections on decision-making and influences and provided a private space for participants to disclose personal difficulties that could not be obtained via interviews. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to investigate factors associated with loneliness amongst people aged 55 and over living in Coventry, a medium-sized city in the Midlands, UK. Design/methodology/approach – Quantitative community survey of residents, involving postal and online questionnaire and distribution of questionnaire to local community resources used by older people and "ballot boxes" for completed questionnaires in these locations. Findings – Using multivariate regression analysis the study found that living alone, not enjoying life, needing help with personal care and not being in touch with people as often as liked all predicted loneliness. Research limitations/implications – Survey was commissioned by a range of local statutory and voluntary sector providers and had a wider focus than loneliness. Some evidence of under-representation of males, minority ethnic groups and possibly people from lower socio-economic groups is reported. Further qualitative research is needed to better understand consequences and causes of loneliness. Practical implications – The study identified factors associated with loneliness that could be used to identify people who may be lonely in general or, for example, NHS or social care service populations. Originality/value – Loneliness is slowly becoming more recognised as a social problem in its own right and a contributory factor in poor health and well-being. This paper explores a the relationship between lonely and "not lonely" people and a range of factors clustered within the four thematic areas of demographic background, reported health and well-being, access to personal resources and use of community resources of survey participants. [ABSTRACT FROM AUTHOR]

With the continued implementation of the personalisation policy, Personal Budgets (PBs) have moved to the mainstream in adult social care in England. The relationship between the policy goals of personalisation and safeguarding is contentious. Some have argued that PBs have the potential to empower recipients, while others believe PBs, especially Direct Payments, might increase the risk of abuse.This paper provides empirical evidence about levels of uptake of PBs and safeguarding referrals in England based on in-depth analysis of national data at aggregate, local council level in England, covering 152 Councils. This is complemented by analysis of 2,209 individual referral records obtained from three purposively selected study sites. The aim is to explore whether available data could provide evidence of association between the uptake of PBs and safeguarding referrals. Analysis of the national dataset found no significant relationships between PB uptake and the level and type of alleged abuse. However, analysis of individual-level referral data, from the three selected sites did find some significant associations particularly with financial abuse; and found the main perpetrators of the alleged abuse to be home-care employees. The findings are discussed within the context of current policy and practice. [ABSTRACT FROM AUTHOR]

Background Clinical commissioning groups (CCGs) were in early development when fieldwork took place. Public Health (PH) was moving into the local authority, and new ways of working were being established. Methods Three qualitative case studies in the North of England were undertaken using three different data collection methods: observations, interviews and the collection of documents that were related to the project. Comprehensive field notes were taken during observations, analysed alongside interview transcriptions and collected documentation using the software programme Atlas.ti. Results The relationship between the CCG and their local PH team was in development at the time of data collection. Three different PH roles could be discerned from the data: 'co-owner', 'service provider' and 'critical friend'. These roles impacted on the utilization of PH by CCGs and the wider relationship between the CCG and PH. Conclusions These models are 'ideal types', and in reality the CCG-PH relationship in most areas will contain elements of all three models. However, to think of them as set out in this paper is instructive for both CCGs and PH. It is important that CCGs and their PH colleagues to think clearly about what they are trying to achieve and how that can most effectively work together. [ABSTRACT FROM AUTHOR]

Background: Active for Life Year 5 (AFLY5) is an educational programme for Year 5 children (aged 9-10) designed to increase children's physical activity, decrease sedentary behaviour and increase fruit and vegetable intake. This paper reports findings from a process evaluation embedded within a randomised controlled trial evaluating the programme's effectiveness. It considers the fidelity of implementation of AFLY5 with a focus on three research questions: 1. To what extent was the intervention delivered as planned? 2. In what ways, if any, did the teachers amend the programme? and 3. What were the reasons for any amendments? Methods: Mixed methods were used including data collection via observation of the intervention delivery, questionnaire, teacher's intervention delivery log and semi-structured interviews with teachers and parents. Qualitative data were analysed thematically and quantitative data were summarised using descriptive statistics. Results: Following training, 42 of the 43 intervention school teachers/teaching staff (98 %) were confident they could deliver the nutrition and physical activity lessons according to plan. The mean number of lessons taught was 12.3 (s.d. 3.7), equating to 77 % of the intervention. Reach was high with 95 % of children in intervention schools receiving lessons. A mean of 6.2 (s.d. 2.6) out of 10 homeworks were delivered. Median lesson preparation time was 10 min (IQR 10-20) and 28 % of lessons were reported as having been amended. Qualitative findings revealed that those who amended the lessons did so to differentiate for student ability, update them for use with new technologies and to enhance teacher and student engagement. Teachers endorsed the aims of the intervention, but some were frustrated with having to adapt the lesson materials. Teachers also a reported tendency to delegate the physical activity lessons to other staff not trained in the intervention. Conclusions: Fidelity of intervention implementation was good but teachers' enthusiasm for the AFLY5 programme was mixed despite them believing that the messages behind the lessons were important. This may have meant that the intervention messages were not delivered as anticipated and explain why the intervention was found not to be effective. Trial registration: ISRCTN50133740. [ABSTRACT FROM AUTHOR]

Aim To reflect on the use of photo elicitation as a data collection method when conducting research with primary school age children (nine to 11 years). Background There is recognition that children feel an affinity with the visual medium; as a result, visual methods can be useful when conducting research with children. Photo elicitation is one such method, but there has been little discussion of its use with primary school children within a health context. This paper considers the main issues that researchers should consider. Data sources This paper draws on a research study conducted by the author that used an ethnographic approach and photo elicitation to identify the assets underpinning children’s wellbeing. Review methods A reflective discussion is used to highlight issues relating to the use of photo elicitation to collect data from primary school children. Discussion Photo elicitation is not without its challenges: it creates additional ethical considerations, and can be more time-consuming and expensive. However, children value the opportunity to be involved in research and have their opinions sought, and photo elicitation provides a method of collecting data that is appropriate for children’s developmental and cognitive maturational stages. Conclusion Photo elicitation can be a positive experience for children, and one that is not only fun and engaging, but that is also empowering and valuing of their contributions. Implications for research/practice Research that uses photo elicitation needs to be carefully planned to ensure that the study is supported appropriately. The visual process can offer a unique insight into children’s lives that allows health professionals to deepen their understanding of children’s experiences. [ABSTRACT FROM AUTHOR]

Objectives: To increase understanding about how evaluations of health policy initiatives are commissioned, conducted and used. Methods: A mapping exercise was conducted to identify evaluation of initiatives promoted by the White Paper 'Our health, our care, our say' in the English NHS. All evaluations were subjected to critical appraisal and 21 were purposively selected as case studies, involving documentary analysis and 60 interviews with those commissioning, conducting and affected by the evaluation. Results: Variation in the types of evaluation being undertaken did not reflect the importance of the initiatives being evaluated. Most evaluations collected evidence about uptake, processes of care and users' perceptions. While some provided useful information about how initiatives could be improved, few provided robust evidence about the benefits or costs of the initiatives. Those who commissioned evaluations had similar concerns to those who conducted them. There was a commitment to the concept of evaluation but little clarity about how findings would be used. Evaluation was often commissioned too late to influence decisions about implementation. Compromises over research design and difficulties collecting data limited the potential to provide robust evidence about benefits. There were tensions between the desire of evaluators for methodological rigour and the needs of service providers for swift, contextually relevant findings. There were concerns about the transparency of methods and results. Conclusions: Considerable public resources are committed to evaluation, but this investment is less productive than it could be. This article specifies several ways in which the use of evaluation of initiatives in health and social care could be improved. [ABSTRACT FROM AUTHOR]

Objectives: There is limited literature on the experiences of internationally educated nurses (IENs) who have joined NHS trusts in England in the past 20 years. The objectives of this integrative review included exploring and analysing the experiences of IENs in the NHS in England and identifying the cultural, pastoral and training needs of IENs during their first 2 years working in England and providing research-informed recommendations to better support IENs. Design: An integrative review of primary research studies using quantitative, qualitative, and mixed methods of data collection. Data source: CINAHL, British Nursing Index and Google Scholar. Results: Nine articles met the inclusion criteria for this integrative review. All articles contributed to the findings of three main analytical themes: expectations, challenges and belongingness. Conclusion: Limited research fully met the search criteria. This was concerning since IENs have been working in the NHS for decades, yet so few primary studies have been conducted into their experiences. The findings were in line with previous studies, which found that IENs faced challenges both in the workplace and in settling into an English way of life, and often reported feeling that they were not treated equally to their English counterparts. This integrative review raises issues and increases awareness of how the NHS in England can better support IENs transitioning into their new life and ways of working, to further aid recruitment and retention of the international nursing workforce. [ABSTRACT FROM AUTHOR]

This paper describes the methodological approaches and challenges associated with tracing and contacting former social welfare service users in the course of long-term outcome research. Historical case file data were analysed on 117 ‘hard to reach’ children and young people identified as having behavioural problems, including sexual behavioural problems. Various publicly available internet and social network resources were used to try and trace these individuals in adulthood, at least a decade after the identification of their behaviour problems in childhood. Using these approaches, it was possible to locate individuals in 69 per cent of cases. The use of social network sites, such as Facebook, in social research is discussed, together with an appraisal of the practicalities and ethics of such approaches. The implications for social work practice more generally of the emergence of new technologies for tracing and maintaining contact with service users are also discussed. [ABSTRACT FROM PUBLISHER]

Rationale, aims and objectives Little is known about the quality of occupational health care provided to National Health Service (NHS) staff. We designed the first national clinical audits of occupational health care in England. We chose to audit depression and back pain as health care workers have high levels of both conditions compared with other employment sectors. The aim of the audits was to drive up quality of care for staff with these conditions. The object of this paper is to describe how we developed an audit methodology and overcame challenges presented by the organization and delivery of occupational health care for NHS staff. Methods We designed two retrospective case note audits which ran simultaneously. Sites submitted up to 40 cases for each audit. We used duplicate case entry to test inter-rater reliability and performed selection bias checks. Participants received their site's audit results, benchmarked against the national average, within 4 months of the end of the data entry period. We used electronic voting at a results dissemination conference to inform implementation activities. Results Occupational Health departments providing services to 278 (83%) trusts in England participated in one or both audits. Median kappa scores were above 0.7 for both pilot and full audits, indicating 'good' levels of inter-rater reliability. In total, 79% of participants at a dissemination conference said that they had changed their clinical practice either during data collection (52%) or following receipt of their audit results (27%). Conclusions Clinical audit can be conducted successfully in the occupational health setting. We obtained meaningful data that have stimulated local and national quality improvement activities. Our methodology would be transferable to occupational health settings outside the NHS and in other countries. [ABSTRACT FROM AUTHOR]

Purpose -- The paper aims to ascertain how local authorities and other services are responding to central government strategies to make support for family carers a priority. Design/methodology/approach -- A web-based audit of local authority public information for carers was undertaken (n = 50). The sample covered different parts of England and different local authority types. Findings -- A small minority of local authority web sites mention that they operated Carers' Registers. Overall local authorities offer different resources to carers, ranging from discounts in the local area to access to emergency card registration. Some use online information as a communication channel. Overall local authority online information for carers seems to be variable in quality, accessibility and purpose. We conclude that growth in the collection of information by primary care services in England risks duplicating some of the functions of, and problems with, local authority activities. Local commissioning should minimise confusion and make optimal use of carers' information. Carers should not have to navigate confusing, variable, parallel systems and outreach is needed for those who do not use electronic media, such as some older carers. Research limitations/implications -- This was a small-scale study nested within a larger project. It is possible that the web sites we interrogated were atypical, although we did take steps to prevent this. Originality/value -- The study's strength lies in its originality of approach undertaking a specific audit of material that is publicly available and reflecting on a subject that has not previously been explored in the context of information for carers. [ABSTRACT FROM AUTHOR]

Aim: To explore the organizational context in which Type 2 diabetes structured group education is provided. Methods: Four Clinical Commissioning Groups in England providing Type 2 diabetes structured self‐management education participated in a qualitative study exploring the context for provision of that education. Using UK National Diabetes Audit returns, two Clinical Commissioning Groups were selected that had non‐attendance rates of ≤25%, and two that had non‐attendance rates of ≥50%. Between May 2016 and August 2017, 20 interviews were conducted with Clinical Commissioning Group staff including: commissioners, healthcare professionals, managers, general practitioners and diabetes educators. Data gathering was prolonged as it proved challenging to engage with healthcare staff as a result of frequent local restructuring and service disruption. Results: Local audits revealed discrepancies in basic data such as referral and attendance numbers compared with national audit data. There was a commonality in the themes identified from interviews: diabetes education was rarely embedded in service structure; where education uptake was poor, a lack of central support to delivery teams was noticeable; and where education uptake was positive, delivery teams were actively engaged, sometimes relying on enthusiastic individuals. Both situations put the local sustainability of diabetes education at risk. Conclusions: There appears to be a link between attendance rates and organizational issues, therefore, when considering how to increase attendance rates, the state of the diabetes education infrastructure should be reviewed. Good uptake of diabetes education can be too reliant on the enthusiastic commitment of small teams or individuals delivering the education. What's new?: Research into lack of uptake of diabetes structured self‐management education (DSSME) has not previously considered how organizations affect attendance.Absence of communication between the teams providing DSSME and their senior management structure can impede the effectiveness of delivery teams.Clinical teams delivering DSSME are frequently expected to provide administration, marketing and promotional support without proper resources or guidance.Successful implementation of DSSME frequently relies on a few dedicated staff, leaving even the most exemplary delivery of education vulnerable to changes in staffing. [ABSTRACT FROM AUTHOR]

Background Identifying ethnic inequalities in health requires data with sufficiently 'granular' (fine detailed) classifications of ethnicity to capture sub-group variation in healthcare use, risk factors and health behaviors. The Robert Wood Johnson Foundation (RWJF), in the USA, commissioned us to explore granular approaches to ethnicity data collection outside of the USA, commencing with the European Union. Methods We examined official data sources (population censuses/registers) within the EU-28 to determine the granularity of their approach to ethnicity. When ethnic information was not available, related variables were sought (e.g. country of birth). Results Within the EU-28, we found 55% of countries collected data on ethnicity. However, only 26% of these countries (England, Wales, Northern Ireland, Scotland, Republic of Ireland, Hungary, Poland and Slovakia) had a granular approach, with half of these being within the UK. Estonia, Lithuania, Croatia, Bulgaria, Republic of Cyprus and Slovenia collected one to six categories. A 'write-in' option only was found in Latvia, Romania and the Czech Republic. Forty-five percent of countries did not collect ethnicity data but collected other related variables. Conclusions (i) Although there is reasonable attention to the diversity of ethnic groups in data collection, a granular approach does not predominate within EU-28 classifications. (ii) Where ethnicity is collected, it is conceptualized in different ways and diverse terminology is used. (iii) A write-in option provides the most granular approach. (iv) Almost half of the countries did not collect data on ethnicity, but did collect related variables that could be used as a proxy. [ABSTRACT FROM AUTHOR]

Background Community pharmacies are now commissioned nationally in England to provide a seasonal influenza vaccination service. However, there is little evidence about the effectiveness of a pharmacy-based immunization service in improving uptake. Methods The Donabedian framework was used to evaluate a community pharmacy service in the West Midlands from a commissioning perspective. A mixed methods approach was adopted, including provider and patient surveys, data from the national influenza vaccination returns and an electronic pharmacy data recording system. Results Patient satisfaction with the service was high. There was no increase in uptake rates. Impact on reaching new patients was limited. The service had an appropriate information system to record activity. Promotion and signposting for the service was weak. Poor engagement with stakeholders led to dissatisfaction and General Practitioner complaints. Commissioners responded to emerging issues to ensure the pharmacies’ set up was compliant with the Service Level Agreement. Conclusions Improvements in convenience and choice for patients did not result in an increase in uptake rates. With a national pharmacy influenza programme, local arrangements to optimize the service may be limited. Clear arrangements for activity transfer and recording, partnership working and a good communications strategy are crucial in achieving a positive outcome. [ABSTRACT FROM AUTHOR]

BackgroundThe number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective.ObjectivesTo critically evaluate how the NHS works with care homes.MethodsA review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose.ResultsFive surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient.ConclusionsHistorical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population. Clinical commissioners seeking to improve the quality of care of care home residents need to consider how best to provide fair access to health care for older people living in a care home, and to establish a specification for service delivery to this vulnerable population. [ABSTRACT FROM PUBLISHER]

The need to effectively promote safe staffing levels in community settings challenges commissioners and providers of services to find rigorous methods of capturing workforce evidence that can be systematically used to shape effective services and skill mix for the future. This article presents a brief review of current approaches and challenges to measuring community nursing workload activity in England. Specifically, it shows phase 1 pilot results using the Cassandra Matrix activity tool and review of ongoing developments and progress to demonstrate scalability for national implementation. As part of a much larger practice development project to develop community nursing, the pilot used mixed methods to collect 10 days of workload activity data from a self-selected sample of band 5–7 nurses working in general and specialist community nursing roles in three community organisations, and to evaluate their experiences of using the tool via an electronic survey. The findings indicate that the tool has significant potential for capturing the complexity and multiple dimensions of nursing work in community contexts, and phase 2 work has led to a community version of the tool being piloted on a larger scale across six community organisations. [ABSTRACT FROM AUTHOR]

Introduction Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved. Methods A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/ issues. Interviews were recorded, transcribed and thematically analysed. Results Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics. Conclusions Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties. [ABSTRACT FROM AUTHOR]

Aim To determine what encourages or discourages AIDS/HIV patients from completing questionnaires. Background Data from surveys can provide important information but response rates can be poor. Factors that affect this in an HIV clinic population have not been assessed previously. Review methods The researchers used a qualitative approach and a structured interview schedule. Ten patients were recruited and participated in one-to-one interviews. Discussion Most patients saw the potential value of completing a questionnaire in the clinic. Lack of privacy during completion was raised as a concern, particularly if there were sensitive questions to respond to. Lack of technical competence was identified by some as a barrier to participation in electronic surveys. Tickboxes were preferred over rating scales or open answers. Participants did not expect a cash incentive or entry in a prize draw when asked to complete a questionnaire in-clinic. Conclusion Generally, AIDS/HIV patients were willing to participate in surveys. Availability of a private area to complete the questionnaire, avoiding complex electronic systems, completion in the clinic, tickbox answers and a length of under two sides of A4 were the most important features that improved acceptability of the questionnaire to patients. Implications for research Surveys that evaluate care need to be short, easy to complete and have clear relevance to the patients' experience. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated challenges associated with the use of systematic review evidence in the decommissioning procedure for ineffective health services. It reports study details which include interviewing of Primary Care Trusts (PCT) health care commissioners in England, data collection about usage of various therapeutic interventions, and the categorization of evidence gathered. A brief overview of the decommissioning process being handled by clinicians is given.

Background: Competing demands on the clinical time of nurses and midwives presents challenges to developing a research active culture. Aim: To engage nurses and midwives in a trust-wide research project. Method: A needs assessment of the local obstacles to participating in research was undertaken and a nursing and midwifery research strategy developed by representatives from clinical, research and academic departments. Following consultation with nursing and midwifery groups, an infection control research project was initiated and participatory workshops established. Findings: In total 50 nurses and midwives contributed to questionnaire design, data collection and analysis. Initial results were discussed at nursing/midwifery forums and presented at a newly formed grand round. Overall there were 573 nursing and midwifery contacts throughout the research process. Conclusions: This approach to facilitating nursing and midwifery research across an NHS trust has enabled large numbers of clinical staff to experience and contribute to a 'live' research project. [ABSTRACT FROM AUTHOR]

Context: Performance measures are increasingly widely used in health care and have an important role in quality. However, field studies of what organizations are doing when they collect and report performance measures are rare. An opportunity for such a study was presented by a patient safety program requiring intensive care units (ICUs) in England to submit monthly data on central venous catheter bloodstream infections (CVC-BSIs). Methods: We conducted an ethnographic study involving ∼855 hours of observational fieldwork and 93 interviews in 17 ICUs plus 29 telephone interviews. Findings: Variability was evident within and between ICUs in how they applied inclusion and exclusion criteria for the program, the data collection systems they established, practices in sending blood samples for analysis, microbiological support and laboratory techniques, and procedures for collecting and compiling data on possible infections. Those making decisions about what to report were not making decisions about the same things, nor were they making decisions in the same way. Rather than providing objective and clear criteria, the definitions for classifying infections used were seen as subjective, messy, and admitting the possibility of unfairness. Reported infection rates reflected localized interpretations rather than a standardized dataset across all ICUs. Variability arose not because of wily workers deliberately concealing, obscuring, or deceiving but because counting was as much a social practice as a technical practice. Conclusions: Rather than objective measures of incidence, differences in reported infection rates may reflect, at least to some extent, underlying social practices in data collection and reporting and variations in clinical practice. The variability we identified was largely artless rather than artful: currently dominant assumptions of gaming as responses to performance measures do not properly account for how categories and classifications operate in the pragmatic conduct of health care. These findings have important implications for assumptions about what can be achieved in infection reduction and quality improvement strategies. [ABSTRACT FROM AUTHOR]

Data was collected on nine supported employment agencies over one financial year on staffing ratio, staff qualifications, job finding approach, management structure, supervision arrangement, referral and funding sources, and typicalness of jobs and job placement approaches, replicating elements of Mank et al. (1997). Data was also collected on individual client wage and hours worked outcomes. An ANOVA revealed strong differences among agencies in hours worked, wages in the extent to which they acquired Job Acquisition, Compensation packages, Work Roles and Orientation and induction and programmes that were typical for the company they were placing into. An ANOVA on hours worked, wages earned and typicalness in these key processes revealed a significant independent effects of management model and job finding approach. Stepwise regression analysis was used to quantify the impact on wage and hours worked outcomes of management model. Job coach approach, staff ratio and typicalness in these four key areas. Significant Beta coefficients were found between monthly wage and hours worked and typicalness of Compensation, Work Roles and Orientation scores. Management model impacted only on monthly wages. [ABSTRACT FROM AUTHOR]

This study addresses the epidemiology of knee injuries in adolescent males. Data were collected prospectively from 41 Premiership soccer academies over a 5 year period from July 2000 to June 2005. A total of 12,306 player seasons were registered in the U9 to the U16 age categories with a total of 1750 recordable injuries specific to the knee joint. There was a mean incidence of 0.71 (95% confidence interval ± 0.05) knee injuries per player per year, and a median of 17 (inter-quartile range 9–38) training days and 2 (inter-quartile range 1–4) matches missed per knee injury. Knee injuries were found to be most common in the 14–16 year age group. Six hundred and nine (35% of total) injuries were classed as severe resulting in more than 28 days' absence. Injuries were more likely to be sustained in a competitive or match-play environment (862 or 52%) than in training (796 or 48%), and a non-contact mechanism was implicated in 823 (55%) of recorded cases. Peaks in injury numbers were seen in early season and subsequent to the winter break. Sprain was the most common diagnosis recorded, with the medial collateral ligament affected in 23% of all knee injuries. Knee injuries are common in elite youth footballers. In this uninsured age group, it could be argued that earlier medical intervention may reduce long-term damage tothe immature skeleton. [ABSTRACT FROM PUBLISHER]

Background Widespread testing for chlamydia is expected to result in a reduction in prevalence. In 2008, coverage indicators introduced by the Department of Health (DH) required collection and submission of all tests performed outside of genitourinary medicine clinics. No mechanism existed to collect community-based tests conducted outside of the National Chlamydia Screening Programme. The Health Protection Agency Regional Epidemiology Unit in the East of England (EoE) set up a new system to routinely collect and submit these tests on behalf of the regional Primary Care Organizations (PCOs). Methods Testing data were requested from all laboratories commissioned to undertake chlamydia testing by EoE PCOs. Data were imported into a bespoke Structured Query Language server database and automated data processing routines were run. Data fulfilling national criteria were submitted for inclusion in the DH indicators. Results High-quality data were submitted to set deadlines with minimum impact on laboratories. Completeness of data variables varied by laboratory and by variable type. After complex data processing, 96% of laboratory reported tests in the 15–24 year age range were eligible for submission. Conclusions This centralized method of data collection provides high-quality data, allowing for further analysis, which can be used to inform improvements in health care. These methods could be transferred to any of the hundreds of organisms for which similar laboratory data exist. [ABSTRACT FROM PUBLISHER]

Background Many practices in the UK have computerised information dating back to the 1990s. These health records provide contemporaneous collected longitudinal data for analysis of health trends and their management in primary care over time. Objective This study examines the trends in common mental health problems (CMHPs), prescription of antidepressant, anxiolytics and hypnotics and medical certificates over four years to highlight the strengths and pitfalls in trends analysis using primary care data. Method Relevant clinical information for the first six months of each of the calendar years 2004, 2005, 2006 and 2007 were extracted from participating practices in a London locality and in the North. Results Between 2004 and 2007 recorded episodes of CMHPs rose from 33 to 45 per thousand adults in the northern site, and from 19 to 22 in the London site. Prescriptions of antidepressants, anxiolytics and hypnotics rose (from 381.4 to 418 per thousand adults) in the northern site but did not increase in the London site. Medical certificates increased steadily (from 32.7 to 61.6 per thousand adults with a CMHP) in the London site but not in the northern. Recorded episodes of CMHPs and prescriptions of antidepressants, anxiolytics or hypnotics are much higher in the northern site than the London site; the rate of medical certificates per thousand adults with CMHPs in the northern site is more than ten times that in the London site. Conclusions Demographics, diagnostic and prescribing data are of high quality in primary care, and they could be used more to understand local health needs and inform commissioning decisions. [ABSTRACT FROM AUTHOR]