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2. Costs of endovascular and open repair of thoracic aortic aneurysms.

Author

Gray, Joanne, McCarthy, Andrew, Samarakoon, Dilupa, McMeekin, Peter, Sharples, Linda, Sastry, Priya, Crawshaw, Paul, Bicknell, Colin, the ETTAA Collaborative Group, Large, Stephen, Vale, Luke, Freeman, Carol, Cook, Andrew, Chiu, Yi-Da, Gray, Jo, Vallabhaneni, S Rao, Watson, Nicky, Devine, Thomas, Duffy, Tom, and Hughes, Victoria

Subjects
ENDOVASCULAR aneurysm repair, THORACIC aneurysms, ENDOVASCULAR surgery, COST analysis, PATIENT readmissions
Abstract

Background: Repair of thoracic aortic aneurysms with either endovascular repair (TEVAR) or open surgical repair (OSR) represents major surgery, is costly and associated with significant complications. The aim of this study was to establish accurate costs of delivering TEVAR and OSR in a cohort of UK NHS patients suitable for open and endovascular treatment for the whole treatment pathway from admission and to discharge and 12-month follow-up. Methods: A prospective study of UK NHS patients from 30 NHS vascular/cardiothoracic units in England aged ≥18, with distal arch/descending thoracic aortic aneurysms (CTAA) was undertaken. A multicentre prospective cost analysis of patients (recruited March 2014–July 2018, follow-up until July 2019) undergoing TEVAR or OSR was performed. Patients deemed suitable for open or endovascular repair were included in this study. A micro-costing approach was adopted. Results: Some 115 patients having undergone TEVAR and 35 patients with OSR were identified. The mean (s.d.) cost of a TEVAR procedure was higher £26 536 (£9877) versus OSR £17 239 (£8043). Postoperative costs until discharge were lower for TEVAR £7484 (£7848) versus OSR £28 636 (£23 083). Therefore, total NHS costs from admission to discharge were lower for TEVAR £34 020 (£14 301), versus OSR £45 875 (£43 023). However, mean NHS costs for 12 months following the procedure were slightly higher for the TEVAR £5206 (£11 585) versus OSR £5039 (£11 994). Conclusions: Surgical procedure costs were higher for TEVAR due to device costs. Total in-hospital costs were higher for OSR due to longer hospital and critical care stay. Follow-up costs over 12 months were slightly higher for TEVAR due to hospital readmissions. Detailed micro-costing of endovascular stent grafting (TEVAR) and open surgical repair (OSR) in a cohort of UK NHS patients for whole of treatment pathway up to 12 months follow-up. Overall costs are higher for OSR, driven by length of stay and critical care post-procedure, compared to TEVAR, with costs driven by stent graft devices. These detailed micro-costing estimates exceed current NHS tariffs for reimbursement. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Diagnostic classifications in child health

Author

Crawshaw, Paul

Subjects
618.92
Abstract

This project was established to answer the following questions: Is the current, (in 1991), classification of paediatric diagnoses adequate for current and predicted future needs? If not, are there any available suitable alternatives? If not, what diagnostic classification will suit the requirements of specialists and generalists in the various fields of child health? How will any new paediatric classification fit in with other new classifications? These questions can only be answered when the following subsidiary questions have been addressed: Why are clinical classification systems necessary? Why is a specific one needed for child health? What systems were available at the start of the project? What problems were inherent in those systems?

Published
1996

9. Men's understandings of social marketing and health: neo-liberalism and health governance

Author

Crawshaw, Paul and Newlove, Chris

Subjects
Unemployed workers -- Reports, Marketing -- Social aspects -- Reports, Health
Abstract

Social marketing for health has become a core component of UK government strategies to improving wellbeing and tackle inequalities amongst diverse populations, including men. Social marketing strategies adopt the methods [...]

Published
2011
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10. Governing the healthy male citizen: men, masculinity and popular health in Men's Health magazine

Author

Crawshaw, Paul

Subjects
Men's periodicals -- Criticism and interpretation, Men -- Health aspects, Men -- Portrayals, Health, Social sciences
Abstract

Recent commentators have noted the potential of newer neo-liberal discourses of health care to position responsibility for the management of well-being with the individual. Often promoted through the inculcation of risk avoidance and management, such discourses are played out in myriad settings, including the popular media. Magazines are one such media site in which diverse exhortations for the achievement of health, well-being and the perfectible body are made, and Bunton [1997. Popular health, advanced liberalism and good housekeeping magazine. In A. Petersen & Bunton R. (Eds.) Foucault. health and medicine (pp. 223-247). London: Routledge] has identified 'magazine medicine' as a significant manifestation of more dedifferentiated models of health care. Recent discussions have placed men's health high on research and policy agendas, with a concomitant interest in more popular realms. The UK magazine Men's Health (MH) is indicative of these trends, and represents a site at which discourses of men, health and masculinity are constructed. Typically reflecting neo-liberal models of health, here men are constructed as active and entrepreneurial citizens able to maintain their own health and well-being through the judicious management of risk in contexts appropriate to dominant discourses of hegemonic masculinity. Data which resulted from a critical discourse analysis of a 2-year sample (21 issues) of MH are considered and findings related to medicalisation, individualisation and risk discussed. It is suggested that magazine texts such as MH reflect newer individualised neo-models of health care and neo-liberal strategies of health governance premised upon constructing a healthy male citizen, willing and able to take responsibility for their own well-being. Keywords: Men's health: Masculinity: Media: Magazines: Governance: UK: Neo-liberalism

Published
2007

13. Health inequalities and health-related economic inactivity: Why goodwork needs goodhealth

Author

Crawshaw, Paul, Gray, Joanne, Haighton, Catherine, and Lloyd, Scott

Abstract

Tackling health inequalities demands whole systems strategies with reach beyond the traditional sphere of influence of health care systems. Practitioners and researchers have long recognised that wider social determinants, where people are born, the communities they live in, their built environment, access to education and resources and, most significantly for this discussion, their relationship to the labour market, profoundly shape health experiences and expectations over the lifecourse. At macro-level, economic structures and systems play a fundamental role in the distribution of good health and incidence of inequalities. Regionally, the health of local labour markets, a phenomenon shaped by macro, national and global economic forces, is a powerful determinant of opportunities to access and remain in work. Simultaneously, health status impacts significantly on ability to participate in paid employment. Absence from the labour market is both a causeand symptomof health inequalities.

Published
2024
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15. Development of an exergame to deliver a sustained dose of high-intensity training: Lessons learned in a formative pilot randomized trial

Author

McBain, Tom, Weston, Matthew, Crawshaw, Paul, Haighton, Catherine, and Spear, Iain

Subjects
C600
Abstract

Background: Sport science can play a critical role in reducing health inequalities. The inverse relationship between life-expectancy, cardiorespiratory fitness and socioeconomic status could be addressed by performing high-intensity training (HIT), delivered in a class salient and accessible approach. Commercially available exergames have shown encouraging compliance rates but are primarily designed for entertainment purposes rather than focussing on health-related outcomes. A serious game tailored towards delivering an exercise stimulus, whilst reducing the aversive protocols associated with HIT, could be beneficial to engage and improve health outcomes in socially deprived males.\ud Objective: The aims were to develop an exergame capable of delivering HIT and evaluate the effect on selected health outcomes in men recruited in regions of socioeconomic deprivation.\ud Methods: We conducted an exploratory trial in our target population and participants were allocated to intervention (n = 14) or control groups (n = 10) by third-party minimisation. The intervention was a 6-week training program consisting of 3 sessions of exergaming per week. The sessions involved a structured warm-up then brief intermittent repetitions in the form of boxing rounds (10, 20 and 30-sec) against their peers with a work/rest ratio of 0.25.\ud Results: Retention to the intervention was 87%. Over the duration of the intervention, session attendance was 68%, repetition mean and peak heart rates (% of maximal) and session ratings of perceived exertion (arbitrary units) were 86.3±5.4%, 89.9±6.1% and 7.5±2.2AU, respectively. The effect of the intervention, when compared to the control, was a likely small beneficial improvement in predicted VO2max (3.0; 90% confidence limits ± 2.6%). Effects on body mass, waist circumference and blood pressure were either trivial or unclear.\ud Conclusions: Over the 6-week intervention, the exergame delivered a consistent and sustained dose of HIT, with some beneficial effects on aerobic fitness in the target population.

Published
2018

20. The Impact of Welfare Reform in the North East

Author

Shaw, Keith, Irving, Adele, Jarvis, Alison, Crow, Robert, Edwards, Philip, Crawshaw, Paul, Teeside University, North East region of Citizens Advice, and University of Durham

Subjects
L400
Published
2013

34. The Paediatric Board of the Royal College of Physicians

Author

Crawshaw, Paul

Subjects
Medical Audit, Education, Medical, education, Licensure, Medical, Pediatrics, United Kingdom, Interinstitutional Relations, London, Workforce, Occasional Papers, Humans, Organizational Objectives, Ethics, Medical, Curriculum, Educational Measurement, Letters to the Editor, Societies, Medical
Abstract

Conscious of its responsibilities to its Fellows and Members who are paediatricians, the Royal College of Physicians (RCP) is anxious to play its part, along with others, in maintaining and improving standards in paediatrics. Recognising the importance and prominence of the specialty within the generality of specialist medicine, and alongside general internal medicine, it has established a Paediatric Board, reporting directly to Council, which will deal with and advise on all matters concerning paediatrics and child health, and thus enhance the autonomy and influence of the specialty both within the College and on medical affairs in general. It will do this in close association with the British Paediatric Association (BPA) which will nominate members of the Board. In particular the RCP will continue to set standards in paediatrics through examinations, accreditation, representatives on consultant advisory appointment committees, and its membership of the GMC and the Conference of Medical Royal Colleges and their Faculties, to which the Paediatric Board will make a substantial contribution. The network of regional paediatric advisers to the RCP will ensure that the Board is kept in touch with paediatric opinion throughout England, Wales and Northern Ireland. Relationships with Scottish paediatrics and paediatricians will be important, for example, in the organisation and development of the MRCP(UK) examination and its paediatric Part II. Links with paediatricians in the Irish Republic exist through the Joint Committee on Higher Medical Training.

Published
1992

37. "Men Behaving Badly": Patriarchy, Public Policy and Health Inequalities.

Author

SCOTT-SAMUEL, ALEX, CRAWSHAW, PAUL, and OAKLEY, ANN

Subjects
*BEHAVIOR, *CULTURE, *FAMILIES, *MASCULINITY, *MEDICAL care research, *PSYCHOLOGY of men, *SEX distribution, *GOVERNMENT policy, *SOCIAL attitudes, *HEALTH equity, *HEALTH & social status, *ROOT cause analysis
Abstract

Gender is under-represented in the literature on health inequalities and social determinants of health; the latter are in turn under-represented in the literature on gender in general and on men and masculinities in particular. Furthermore, research and policy on gender and health frequently individualise issues of inequality, neglecting structural and systemic root causes of differential rates and experiences of morbidity and mortality. This article highlights the patriarchal social structures, attitudes and practices that, we argue, are common antecedents of these inequalities and suggests ways in which research and public policy can begin to address them. Patriarchy and hegemonic masculinity must be challenged as part of a wider set of social structural determinants of health. [ABSTRACT FROM AUTHOR]

Published
2015
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42. Shaking the Foundations.

Author

Whitehead, Philip and Crawshaw, Paul

Subjects
*CRIMINAL justice system, *SOCIOCULTURAL factors, *ETHNICITY, *CULTURAL intelligence, *SAVINGS, *PSYCHOSOCIAL factors
Abstract

During the last three decades, criminal justice, in England and Wales, has been subjected to ethico-cultural disturbances. Fiscal realignments, punitive and bureaucratic expansion, reducing cultural divides between probation and prison, and the diminution of psychosocial curiosity are some of the features which have eroded the concept of moral economy. There are also pressing threats and dangers, during 2010–15, as the criminal justice system is embedded within a new material platform through deeper integration into the circuits of capital accumulation and market expansion. This article advances an intellectual case for reanimating the lineaments of moral economy through dialectical contestation, to renew interest in justice, truth and fairness, by forging links between Judaeo-Christian ethics and Continental philosophy. [ABSTRACT FROM PUBLISHER]

Published
2013

44. Representing public health.

Author

Bunton, Robin and Crawshaw, Paul

Subjects
*PUBLIC health, *HEALTH behavior, *RISK-taking behavior, *EPIDEMIOLOGY
Abstract

The article discusses on public health which is the concern about the surveillance and regulation of potentially risky behaviors, practices, and public policies. Every individual should be responsible enough to understand epidemics and pandemics, as well as the so-called diseases of civilization which dominate contemporary public health practice.

Published
2006
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45. CORRESPONDENCE.

Author

Loftus, Ian M., Gill, D.B.E.C., Gennery, B.A., Solomon, Tom, Crawshaw, Paul, Dawnay, A., Lipkin, G.W., Solomon, Neil A., Hansen, Klavs Wurgler, Mathiesen, Elisabeth R., Hunt, Beverly J., Yacoub, Magdi, Stanners, A.J., Silver, J.R., Monsell, Fergal, Lacey, J. Hubert, Smoleniec, J.S., and James, D.K.

Subjects
HEALTH, MEDICINE, DIABETIC nephropathies
Abstract

Presents a correspondence related to health and medicine in Great Britain. Development of diabetic nephropathy; Comments on aprotinin and cardiac surgery; Lack of evidence to justify the treatment of risk factors for cardiovascular disease.

Published
1991

46. Implementing the 'new scientific spirit': a response to de Leuuw et al.

Author

Crawshaw, Paul

Subjects
*REALITY, *TRUTH, *RESEARCH, *KNOWLEDGE base, *SCIENCE, *EMPIRICAL research, *SCIENTIFIC method
Abstract

Knowledge of reality is a light that always casts a shadow in some nook or cranny. It is never immediate, never complete. Revelations of reality are always recurrent. Reality is never 'what we might be believe it to be': it is always what we ought to have thought. Empirical thought is clear in retrospect, when the apparatus of reason has been developed. (Bachelard 2002: 24) [ABSTRACT FROM AUTHOR]

Published
2008
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47. Neoliberal policy, quality and inequality in undergraduate degrees

Author

Whitehead, Philip, Crawshaw, Paul, Abbas, Andrea, Ashwin, Paul, McLean, Monica, Whitehead, Philip, Crawshaw, Paul, Abbas, Andrea, Ashwin, Paul, and McLean, Monica

Abstract

The chapter presents analysed data from the ESRC funded Pedagogic Quality and Inequality in University First Degrees project. It utlises the analytical potential provided by Bernstein's concept of 'pedagogic rights' and demonstrates how the process of neo-liberalism in universities miscasts students as consumers and has the potential to undermine universities educational potential for disadvantaged students.

48. Death and grief in working-class communities : narratives of recently bereaved carers

Author

Mulrine, Stephanie, Van Der Graaf, Peter, Crawshaw, Paul, and Van Der Graaf, Peter

Abstract

The sociology of death, dying and bereavement has sought to understand how social divisions, including gender and ethnicity, impact at the end-of-life and into subsequent bereavement. Despite the prevalence of epidemiological evidence indicating continuing health inequalities and a higher mortality rate for those from working class communities, this area has hitherto received little attention (Howarth, 2007b). This research seeks to address the dearth in understanding of the experience of end-of-life and bereavement in disadvantaged and working-class communities by undertaking a series of narrative interviews with bereaved carers in Teesside, UK. The findings illustrate that end-of-life and grief are complicated by many care, familial and non-death issues. These issues are not simply personal troubles but must be understood in a broader societal and cultural context in which bereaved carers have to respond to both overt (e.g. intervention by mental health care workers) and tacit (e.g. limitations for which grief is acceptably performed) social expectations about 'doing grief'. Findings from interviews suggest a desire for 'normal' bereavement, however this was frustrated by complex circumstances (unemployment, criminality, mental health issues, substance misuse) and a perception that grief required justification against a prevailing, neo-liberal discourse of grief being shameful (Peacock, Bissell and Owen, 2014b), and an expectation that achieving acceptance and 'moving on' was required. These struggles make explicit a latent power struggle, which results in those whose social position is comparatively lower experiencing more difficulties in resisting perceived stigma and shame, based on their difference from healthcare professionals, and cultural beliefs and choices in bereavement. The narratives given by participants give examples of societal internalised oppression (symbolic violence), causing distress but also instances of resistance. The comparative absence of similar experiences of more affluent members in the sample, suggests that this hardship points to social class, shame and stigma being a determining factor at end-of-life and into subsequent bereavement.

Published
2020

49. Notions of community, professionalism and volunteering in community-centred, public health approaches : a qualitative case study

Author

Machaira, Theodora, Azevedo, Liane, Lingam, Raghu, Crawshaw, Paul, Van Der Graaf, Peter, and Azevedo, Liane

Abstract

Background: Community-centred approaches are increasingly popular in public health practice. The use of volunteers as part of such approaches is common, as it recognises people as assets within communities; assets that can help improve community public health and wellbeing outcomes and aid community development. Case study: Given the widely accepted importance of early years in providing children with the best possible start in life, and in recognition of the need for a shift to bottom-up approaches, a community volunteer programme was designed and implemented in a deprived ward of Stockton-on-Tees in the North East of England. Using this programme as a case study, this PhD thesis aimed to explore what volunteering is and how it works in a community-centred volunteer programme, through examining professionals', volunteers' and parents' accounts. Methods: Qualitative intrinsic case study methodology was used. Rich qualitative data were collected through forty-four interviews, five focus groups, observations and documents. Findings: This study contributes to current understandings around community, professionalism and volunteering within community-centred approaches. A profound lack of a shared understanding of the term 'community' amongst different stakeholders was identified. It was also found that volunteering presents development opportunities for disadvantaged community members and particularly asylum seekers. Their strong reciprocal feelings and their willingness to volunteer as well as the plethora of human, social, cultural and political capital they can offer presents opportunities to widen the volunteer workforce. The findings also emphasised the detrimental effect tensions between professionals and volunteers can have on a community-centred approach. Conclusions: This PhD has implications for theory and research. Equally, it has implications for public health practice through the development of a model which can be used as a tool to design community-centred approaches. This model, informed by literature, previous research and the findings from this thesis, can be valuable for commissioners, practitioners, professionals, volunteers and the wider community.

Published
2019

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