Social enterprises' impact on older people's health and wellbeing: exploring Scottish experiences.

The global aging demographic is putting pressure on state-delivered health and social care services. As the austerity agenda in the UK cuts state-funded service provision for older people despite increasing demand, social enterprise has become a politically and economically attractive model for the sustainable delivery of some public services. Yet little is known about the impact of social enterprise on the health and wellbeing of older people. In this paper we address this gap in understanding and consider social enterprise activities as complex public health-promoting interventions. Our study aimed to understand what impact social enterprise activities had on the health and wellbeing of participants aged over 50, and also how that impact was created. To achieve this, we conducted qualitative semi-structured interviews with a sample (n = 43) of staff, volunteers, clients and carers aged over 50 who were involved in activities delivered by three social enterprises. Using a thematic analysis to explore manifest and latent themes, two antecedents of subjective younger age emerged explaining how benefit was created, namely downward social comparison and identity. The social enterprise activities we studied benefited participants' health and wellbeing, impacting positively on participants' sense of purpose, social support, connectedness and inclusion. These health and wellbeing benefits can be considered as outcomes of complex public health interventions for older people, and we relate these outcomes to beneficial conditions within the intermediary social determinants of health. We conclude by discussing the future impact of social enterprise activities and current UK policy on the structural determinants of health.

Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis.

INTRODUCTION: Vitamin-D deficiency has been linked to an increased risk of respiratory infections. The objective of this study was to determine the frequency and clinical importance of vitamin-D deficiency in patients with bronchiectasis. METHODS: 25-hydroxyvitamin-D was measured by immunoassay in 402 stable patients with bronchiectasis. Patients were classified as vitamin-D deficient (serum 25-hydroxyvitamin-D <25 nmol/l), insufficient (25 nmol/l-74 nmol/l) or sufficient (≥ 75 nmol/l). Disease severity was assessed, including exacerbation frequency, measurement of airway inflammatory markers, sputum bacteriology and lung function over 3 years follow-up. RESULTS: 50% of bronchiectasis patients were vitamin-D deficient, 43% insufficient and only 7% sufficient. This compared to only 12% of age and sex matched controls with vitamin-D deficiency (p<0.0001). Vitamin-D deficient patients were more frequently chronically colonised with bacteria (p<0.0001), 21.4% of vitamin-D deficient subjects were colonised with Pseudomonas aeruginosa compared to 10.4% of insufficient patients and 3.6% of sufficient patients, p=0.003. Vitamin-D deficient patients had lower FEV(1)% predicted (p=0.002), and more frequent pulmonary exacerbations (p=0.04). Vitamin-D deficient patients had higher sputum levels of inflammatory markers and demonstrated a more rapid decline in lung function over 3 years follow-up. Defects in neutrophil function and assessment of airway LL-37 levels did not provide a mechanistic explanation for these findings. Vitamin-D deficient patients had, however, higher levels of Vitamin-D Binding Protein in sputum sol. CONCLUSIONS: Vitamin-D deficiency is common in bronchiectasis and correlates with markers of disease severity. The mechanism of this association is unclear.

Winter diet of Japanese macaques from Chubu Sangaku National Park, Japan incorporates freshwater biota.

The Japanese macaque (Macaca fuscata) is native to the main islands of Japan, except Hokkaido, and is the most northerly living non-human primate. In the Chubu Sangaku National Park of the Japanese Alps, macaques live in one of the coldest areas of the world, with snow cover limiting the availability of preferred food sources. Winter is typically a bottleneck for food availability potentially resulting in marked energy deficits, and mortality may result from famine. However, streams with groundwater upwelling flow during the winter with a constant water temperature of about 5 °C are easily accessible for Japanese macaques to search for riverine biota. We used metabarcoding (Cytochrome c oxidase I) of fecal samples from Japanese macaques to determine their wintertime diet. Here we provide the first robust evidence that Japanese macaques feed on freshwater biota, including brown trout, riverine insects and molluscs, in Chubu Sangaku National Park. These additional food sources likely aid their winter survival.

Macroinvertebrate communities in streams with contrasting water sources in the Japanese Alps.

Alpine streams are typically fed from a range of water sources including glacial meltwater, snowmelt, groundwater flow, and surface rainfall runoff. These contributions are projected to shift with climate change, particularly in the Japanese Alps where snow is expected to decrease, but rainfall events increase. The overarching aim of the study was to understand the key variables driving macroinvertebrate community composition in groundwater and snowmelt-fed streams (n = 6) in the Kamikochi region of the northern Japanese Alps (April-December 2017). Macroinvertebrate abundance, species richness, and diversity were not significantly different between the two stream types. Community structure, however, was different between groundwater and snowmelt-fed streams with macroinvertebrate taxa specialized for the environmental conditions present in each system. Temporal variation in the abundance, species richness, and diversity of macroinvertebrate communities was also significantly different between groundwater and snowmelt streams over the study period, with snowmelt streams exhibiting far higher levels of variation. Two snowmelt streams considered perennial proved to be intermittent with periodic drying of the streambed, but the macroinvertebrates in these systems rebounded rapidly after flows resumed with no reduction in taxonomic diversity. These same streams, nevertheless, showed a major reduction in diversity and abundance following periods of high flow, indicating floods rather than periodic drying was a major driver of community structure. This conclusion was also supported from functional analyses, which showed that the more variable snowmelt streams were characterized by taxa with resistant, rather than resilient, life-history traits. The findings demonstrate the potential for significant turnover in species composition with changing environmental conditions in Japanese alpine stream systems, with groundwater-fed streams potentially more resilient to future changes in comparison to snowmelt-fed streams.

A practical review of energy saving technology for ageing populations.

Fuel poverty is a critical issue for a globally ageing population. Longer heating/cooling requirements combine with declining incomes to create a problem in need of urgent attention. One solution is to deploy technology to help elderly users feel informed about their energy use, and empowered to take steps to make it more cost effective and efficient. This study subjects a broad cross section of energy monitoring and home automation products to a formal ergonomic analysis. A high level task analysis was used to guide a product walk through, and a toolkit approach was used thereafter to drive out further insights. The findings reveal a number of serious usability issues which prevent these products from successfully accessing an important target demographic and associated energy saving and fuel poverty outcomes. Design principles and examples are distilled from the research to enable practitioners to translate the underlying research into high quality design-engineering solutions.