Costs of the police service and mental healthcare pathways experienced by individuals with enduring mental health needs.

BACKGROUND: Substantial policy, communication and operational gaps exist between mental health services and the police for individuals with enduring mental health needs. AIMS: To map and cost pathways through mental health and police services, and to model the cost impact of implementing key policy recommendations. METHOD: Within a case-linkage study, we estimated 1-year individual-level healthcare and policing costs. Using decision modelling, we then estimated the potential impact on costs of three recommended service enhancements: street triage, Mental Health Act assessments for all Section 136 detainees and outreach custody link workers. RESULTS: Under current care, average 1-year mental health and police costs were £10 812 and £4552 per individual respectively (n = 55). The cost per police incident was £522. Models suggested that each service enhancement would alter per incident costs by between -8% and +6%. CONCLUSIONS: Recommended enhancements to care pathways only marginally increase individual-level costs.

English health visitors' perceptions of conducting indoor environmental assessments: barriers and facilitators.

OBJECTIVES: The aim of this qualitative research was to explore health visitors' perceptions of assessing their clients' homes and providing evidence-informed advice about environmental health. DESIGN AND SAMPLE: Between 2004 and 2007, an explorative study was conducted in Plymouth, England, during which interviews were held with health visitors trained to conduct environmental assessments in combination with routine visits. MEASURES: Face-to-face, semi-structured interviews were conducted. Content analysis was used to explore emergent themes. RESULTS: The health visitors perceived that assessing the indoor environment was relevant to their role; however, conducting environmental measurements within routine visits was not feasible. The main barriers were the changing roles of health visitors (reducing time available), the time implications of being perceived as an environmental expert, and the impact on clients, such as raising expectations, imposing opinions on the state of clients' homes, and expecting clients to implement advice. Facilitators included the natural link to health visitors' roles, the ability to provide evidence of an environmental risk, and the satisfaction of observing clients implementing advice. CONCLUSIONS: Health visitors lacked propositional knowledge on the indoor environment, highlighting a need for more training. Access to an environmental assessment system increased the health visitors' confidence in dealing with indoor environmental issues.

The Watcombe housing study: the short-term effect of improving housing conditions on the indoor environment.

A three-year study (1999-2001) was initiated in the UK to assess the effect of improving housing conditions in 3-4 bedroom, single-family unit, social rented sector houses on the health of the occupants. The houses were randomised into two groups. Phase I houses received extensive upgrading including wet central heating, on demand ventilation, double-glazed doors, cavity wall and roof/loft insulation. An identical intervention for Phase II houses was delayed for one year. As part of this randomised waiting list study, discrete measurements were made of indoor environmental variables in each house, to assess the short-term effects of improving housing conditions on the indoor environment. Variables representative of indoor environmental conditions were measured in the living room, bedroom and outdoors in each of the three years of the study. In 2000, there was a significant difference between the changes from 1999 to 2000 between Phase I (upgraded) and II (not then upgraded) houses for bedroom temperatures (p=0.002). Changes in wall surface dampness and wall dampness in Phase I houses were also significantly different to the change in Phase II houses in 2000 (p=0.001), but by 2001 the Phase I houses had reverted to the same dampness levels they had before upgrading. The housing upgrades increased bedroom temperatures in all houses. Other indoor environmental variables were not affected.

The paradox of an energy-efficient home: is it good or bad for health?

This article highlights changes to the indoor environment that arise following the introduction of energy efficiency measures in houses. It compares these changes with the indoor environment in unimproved houses and discusses the varying effects of each on health. The article argues that householders need to adapt their lifestyles and house management methods to their new indoor environment. It discusses a range of ways in which health professionals can help.

How can I quit passive smoking?

Passive smoking is a topical subject and there is a concerted movement to increase public understanding of the dangers of passive smoking. Although it looks likely that smoking could be banned in public places in the UK by the year 2008, it will still be difficult to enforce smoking bans in the last bastion for the smokers--their homes. Many smokers are aware of the risk their smoking causes their families through passive smoking but do not realise that the only true method for them to reduce exposure for their family is to smoke outside the home. This is partly because of a lack of understanding of the behaviour of environmental tobacco smoke and how smoking in restricted areas alone will not eliminate passive smoking for other family members in their homes.

A systematic review of placement-related attrition in nurse education.

BACKGROUND: Attrition in nurse education is a worldwide issue. Clinical placements form a major part of nurse education and have an important role in students' perceptions of nursing. Student nurses cite unsatisfactory placement experiences as a reason for leaving nursing education. OBJECTIVE: To conduct a systematic review to establish nursing students' placement-related reasons for leaving their programme. DATA SOURCES: Major health literature databases were searched, including studies from 1995 to 2011. REVIEW METHODS: This review considered quantitative and qualitative research investigating student nurse attrition, with an emphasis on placement-related issues. After a systematic selection process, included studies were quality assessed by three researchers. RESULTS: Eighteen studies were included in the review. The studies investigated personal reasons for leaving, demographic and other factors, and students' attributes. As for all student attrition, there was no single reason (related to placements) why students chose to leave, however, being a young or a male student were major factors, along with being exposed to unpleasant placement experiences, the attitudes of placement staff, and lack of support. Perceptions of the nursing profession and practice assessments were also factors in placement-related attrition. CONCLUSIONS: There is a need for more high quality reporting in the area of attrition in student nursing, whether this is due to placement issues or other reasons. Prior work experience in healthcare settings is important in enabling students to complete their programmes and recruitment and retention strategies should consider this. When students are recruited with limited or no healthcare experience, targeting retention strategies and support on these students may be useful.

Investigation of different approaches to reduce allergens in asthmatic children's homes--the Breath of Fresh Air Project, Cornwall, United Kingdom.

During 2001 to 2004, a study was conducted to assess the indoor environmental and health impact of installing allergen-reducing interventions in the homes of asthmatic children. Based on the results of a pilot study, to determine an intervention that would provide improved symptom scores and a reduction in house dust mite allergen (Der p 1), mechanical ventilation and heat recovery (MVHR) systems were installed in 16 homes. Environmental and respiratory health assessments were conducted before and after the installation of the MVHR systems. The results indicated that the installation of MVHR systems reduced Der p 1 concentrations in living room carpets and mattresses. There were significant reductions in symptom scores for breathlessness during exercise, wheezing, and coughing during the day and night. Although, there was not a parallel control group for the main study, the lack of change in the pilot study control group (who did not receive an intervention), indicated that the changes in symptom scores were in part to do with the intervention. Larger scale trials are needed to determine the efficacy of MVHR systems in homes to improve indoor air quality and reduce asthma symptoms.

How is the indoor environment related to asthma?: literature review.

AIMS: This paper reports a review conducted to identify the factors in the indoor environment that have an evidence-based link with the exacerbation or development of asthma and to identify measures that healthcare professionals can promote to reduce exposure to these risk factors in the home. BACKGROUND: The indoor environment, particularly at home, has been recognized as a major source of exposure to allergens and toxic chemicals. Exposure to allergens and toxins is thought to exacerbate respiratory conditions, in particular, asthma. METHODS: Searches were made of health and indoor environment databases, including Cochrane Library, National Health Services Centre for Reviews and Assessment Reports, British Medical Journal, CINAHL and Ovid library, MEDSCAPE/MEDLINE, EMBASE, INGENTA, Science Citation Index, Web of Science. Searches were also made of other Internet-based resources, including those of international and government bodies. The following keywords were used: allergens, allergen avoidance, asthma, asthma prevention, cat, damp, Der p 1, dog, environmental control, house dust mites, indoor air quality, indoor environment, meta analysis, mould, pets, remedial actions, respiratory illnesses and systematic reviews. FINDINGS: There is evidence of a link between asthma and a small number of indoor environmental factors. There is currently only reasonable evidence for one causative factor for asthma in the indoor environment and that is house dust mite allergen. Although there are many studies of different remedial actions that can be taken in the home, often these give evidence of reduced risk of exposure but not clinical improvement in asthma. Although there is a lack of medical evidence for the reduction of known sensitizers such as mould, this is because of a dearth of research rather than evidence of no association. CONCLUSIONS: There is some evidence of a link between the indoor environment and asthma. There are measures, which could be promoted by healthcare professionals to alleviate asthmatic symptoms.