Will health trainers reduce inequalities in health?

The Health Trainer initiative was a public policy initiative designed to tackle health inequalities. Despite considerable improvements in the health of the population in the United Kingdom, there continues to be a gap between the rich and the poor in terms of deaths from cancer, stroke and coronary heart disease. There is a relationship between these health problems and lifestyle behaviours such as smoking, physical inactivity and poor diet. The Health Trainer initiative was created as part of the white paper Choosing Health. Following initial implementation across targeted Primary Care Trusts (The Spearhead Group), a rigorous evaluation of the initiative is taking place prior to a national roll out. This paper uses Whitehead's framework to examine the decision to implement health trainers as a stated aim of tackling health inequalities. The four purposes of health policy as identified by Whitehead (1995) and the categories of healthy living initiatives (Visram and Drinkwater 2005) are examined and applied to the health trainer initiative and its potential for reducing health inequality.     

Occupational health and school health: a natural alliance?

BACKGROUND: The United Kingdom National Health Service aims to provide a holistic 'cradle to grave' service. In order to achieve this, systems are in place for effective communication between providers of services for babies and children. However, when children leave school, communication between the school health services and workplace health services to protect and promote the health of the new workforce is rare. Working together is a commonly-stated rhetoric of contemporary nursing theory, but often this is not applied in practice. School health and occupational health have similar aims and objectives and, by working together, may be able to improve the health of large populations for a lifetime. AIM: This paper aims to examine the similarities in principles and practices between school health and occupational health nurses, and to identify areas of overlap in which collaboration could improve care for clients of both services. DISCUSSION: The paper examines the nature of nursing in occupational and school settings, and similarities and differences in policy, law and principles. It also examines these two areas of practice within a public health framework, looking for areas of overlap. A basis is suggested for collaborative working between the two areas, and barriers, facilitators and benefits of this practice are examined. CONCLUSION: We conclude that there does exist a natural alliance between occupational and school health nursing, and that the two should work together to provide continuity of care for clients on leaving school, and to prepare children and young people for the workplace and any special health issues in their chosen careers.     

Should we or shouldn't we? Mental health nurses' views on physical health care of mental health consumers

People diagnosed with a mental illness experience poorer physical health than the general population. Nurses have been identified for their potential role in addressing physical health needs of consumers of mental health services. This paper reports on preliminary findings of a qualitative study on health-care services for physical and mental health in a regional area in Australia. A key purpose of the study was to explore the perceptions of nurses working in mental health settings of their physical care with consumers. A qualitative, exploratory approach was undertaken. Semi-structured focus groups were conducted with 38 nurses from one mental health service. Nurse participants described a common co-occurrence of physical problems and mental illness and expressed the importance of health-care services to treatment and prevention. Participants expressed divergent views on nurses' capacity to contribute to better health-care processes.     

System impact research – increasing public health and health care system performance

Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population.

Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs).

Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs.

Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality.

Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.

• Key messages

• The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.

• SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services.

• SIR creates the scientific basis for policy decisions. Leaders at all levels of health and social care can use the evidence from SIR for the benefit of the patients and the population.

     

Running for health: how much running for how much health?

Increasing physical activity has been shown to reduce physiological markers of cardiovascular disease, such as high blood pressure, vascular endothelial cell reactivity and arterial stiffness. In this issue of Clinical Science, H?gg and colleagues have chosen the spontaneously hypertensive rat model to investigate the effect of exercise on vascular function. They found that spontaneous running increased aortic compliance and antioxidant capacity with decreased oxidative stress in mesenteric arteries, presenting support for the cardiovascular protective effects of physical activity. Two important aspects of their study include the magnitude of the running stimulus and the choice of artery to evaluate.     

Social determinants of mental health: the missing dimensions of mental health nursing?

In this paper we explore how aspects of the social world may be linked to mental health and psychiatric morbidity and propose that conditions should be created which allow individuals and communities greater opportunities for self-care and self-management. Specifically the focus is on social connections, disability and homelessness and work stress. There is a clear policy direction pursued by many national governments and international organizations such as the World Bank to build healthy communities. The environment as it relates to health and well-being can be thought of in terms of physical and social dimensions. We will argue that self-care and self-management at both the individual and the community level, in partnership with economic and health policies, are necessary to effectively address social determinants. It will also be suggested that although many in the profession will make the usual refrain that this has little relevance to mental health nurses, the opposite may be the case as mental health nurses have an important, albeit ill-defined, role to play in tackling social determinants.     

Talking or avoiding? Mental health nurses' views about discussing sexual health with consumers

Mental health consumers are sexual beings; however, their sexual desire, capacity, and ability to maintain previous sexual patterns can be altered by their illness or by the effects and side-effects of medications. The sexuality of consumers has been poorly addressed, and the limited evidence suggests that mental health nurses remain ambivalent to including sexuality in their care. This paper presents the findings of a research project investigating the practices of mental health nurses in assessing and supporting the sexuality of consumers. A qualitative, exploratory approach underpinned individual interviews with 14 mental health nurses from inpatient and community settings. The participants acknowledged the importance of sexuality; however, most were reluctant to enquire about consumer concerns and tended to either ignore the issue or refer it to another clinician. Four themes were identified: talking about or avoiding sexuality concerns with consumers; sexuality is not an important priority; refer to others, as talking about sexuality is not 'my' job; and sexuality is poorly addressed by others. It is important that barriers to the assessment and discussion of sexuality are identified, and measures are taken to overcome them.     

Are men shortchanged on health? Perspective on health care utilization and health risk behavior in men and women in the United States

Background: Significant gender disparities exist in life expectancy and major disease morbidity. There is a need to understand the major issues related to men’s health that contributes to these significant disparities. It is hypothesized that, high‐risk behaviors and low utilization of all and preventive health services contribute to the higher mortality and the higher and earlier morbidity in men. Methods: Data was collected from CDC: Health United States, 2007; Health Behavior of Adults: United States 2002–04; and National Ambulatory Medical Care Survey: 2005 Summary. Results: In United States, men are more likely to be regular and heavy alcohol drinkers, heavier smokers who are less likely to quit, non‐medical illicit drug users, and are more overweight compared to women. Men are less likely to utilize health care visits to doctor’s offices, emergency departments (ED), and physician home visits than women. They are also less likely to make preventive care, hospice care, dental care visits, and have fewer hospital discharges and shorter hospital stays than women. Conclusions: High‐risk behaviors and low utilization of health services may contribute to the lower life expectancy in men. In the context of public health, behavioral and preventive interventions are needed to reduce the gender disparity.