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Advances in Dual Diagnosis, vol. 2 no. 4
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 17 May 2013

Tim Battrick, Oliver Hilbery and Sue Holloway

During 2011, the Making Every Adult Matter (MEAM) coalition supported three pilots to better coordinate existing local services for people facing multiple needs and exclusions…

283

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Purpose

During 2011, the Making Every Adult Matter (MEAM) coalition supported three pilots to better coordinate existing local services for people facing multiple needs and exclusions. These individuals experience a combination of problems such as homelessness, substance misuse, mental health problems and offending. Many face difficulties consistent with dual diagnosis in its broadest sense. The purpose of this paper is to summarise the evaluation of the pilots, undertaken by FTI Consulting/Compass Lexecon in partnership with Pro Bono Economics.

Design/methodology/approach

The evaluation examined the three pilots, which took place in Cambridgeshire, Derby and Somerset in England. The study looked at two main effects as individuals engaged with better coordinated services: changes in wellbeing and, changes in the use and cost of wider local services. Primary wellbeing data were collected from clients and primary service use data were collected directly from relevant local agencies (police, health, housing etc). The study followed 39 individuals across the pilot sites. The average period between initial and final measurements was nine months.Findings – The findings show significant improvements in wellbeing for nearly all clients across three quantitative measures. The evaluation also recorded changes in the use and cost of local services. Some costs decreased in the first year of the pilot, for example, criminal justice costs in the Cambridgeshire and Somerset pilot areas. Other costs increased in the first year as people accessed the help they needed. In Cambridgeshire, the reduction in crime costs (£100,000 or 31 percent) was large enough to lead to an overall cost reduction. The total cost of service use in the first year increased in the other two areas.

Originality/value

Collecting primary data on clients’ actual service use directly from local agencies provides a strong methodological base. The evaluation will continue for a further year to examine the longitudinal impact of the pilots. The evaluation findings are of relevance to service providers, commissioners and policy makers interested in improving services for people facing multiple needs and exclusions.

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Advances in Dual Diagnosis, vol. 6 no. 2
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 23 May 2011

562

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Advances in Dual Diagnosis, vol. 4 no. 2
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 17 November 2011

601

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Advances in Dual Diagnosis, vol. 4 no. 4
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 1 August 1950

In both Norway and Sweden the law governing food hygiene is similar to that in Britain. Powers are vested in local authorities by one general Act couched in wide terms, and by…

30

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In both Norway and Sweden the law governing food hygiene is similar to that in Britain. Powers are vested in local authorities by one general Act couched in wide terms, and by more detailed regulations or byelaws drawn up as required. The degree of severity with which local authorities interpret the regulations varies, and in both countries the functions of central government in relation to food hygiene are mainly advisory. Outbreaks of food poisoning are rare. The various salmonella infections and the cattle diseases liable to infect food are well known, and the supervision in slaughterhouses and on farms is such that the organisms, if present, are identified. Salmonella out‐breaks due to infected imported dried eggs have also been traced. Yet such knowledge and careful supervision is common to other countries where notified outbreaks of food poisoning are comparatively numerous. Whether the relative absence of notified outbreaks in Norway and Sweden is entirely due to a higher standard of food hygiene, or to the prevailing custom of preparing food immediately before or even during a meal, is not clear. It is noticeable that in restaurants some time elapses between ordering a meal and receiving it, and that the food is always freshly prepared. In neither country are food handlers examined medically, except those in the milk trade, who are said to be examined every year. Some doubt exists about the value of this examination and the extent to which it is enforced, though in Stockholm enforcement would not be difficult as over 90 per cent of the milk supplied to that city is handled by one combine, controlled by the farmers' co‐operatives. In both countries all milk supplied in towns must be pasteurised, though bovine tuberculosis has been almost eliminated. Owing to a shortage of glass, milk is still sold “ loose ”, but it is hoped to introduce compulsory bottling in the near future. As the result of requests for more detailed instructions from Medical Officers of Health of small towns and country districts new regulations governing the sale of food have recently been drawn up. Restaurants, hotels and food shops must be licensed by local authorities; they are not licensed until they have been inspected and approved. The local authority can revoke a licence, but the proprietor of the establishment concerned has the right of appeal to the courts.

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British Food Journal, vol. 52 no. 8
Type: Research Article
ISSN: 0007-070X

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Article
Publication date: 1 March 1942

Twenty‐three years ago the most frequently met among many slogans was “ Food Will Win the War.” To‐day our food problems are fully as important to our defence; but they present…

53

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Twenty‐three years ago the most frequently met among many slogans was “ Food Will Win the War.” To‐day our food problems are fully as important to our defence; but they present many new aspects. Then our prime duty was to save food : now it is to consume food in the way most conducive to fitness. Our knowledge of nutrition has advanced so rapidly that much of it is too new to have been assimilated into our everyday thought and practice. Yet it is precisely as guidance to everyday use of our familiar foods that the newest knowledge of nutrition can be of most benefit: of benefit both to the one‐third of our people who are officially declared “ ill‐nourished,” and to the great majority of the rest of us as well. For while finding that much of our previously baffling disease and frustration is due to shortage of certain nutritional factors in the food supply, research has also shown that a more scientifically guided use of our everyday foods constitutes a sort of superior chemical engineering of our own mechanisms which can increase the vitality and efficiency even of those people who are already healthy and efficient. The relations of nutrition to the functioning of the mind are, of course, more difficult of controlled investigation and not yet as objectively demonstrable as to the effects of food upon bodily functions and length of life. But careful research is now showing that even within the range of fully normal conditions, our daily food choices have much more important effects than science ever previously supposed upon that internal chemistry that directly environs and conditions all our life processes. The blood is the great mediator of this internal environment, and the same blood circulates through the brain as through all the other organs of the body, bringing its help or its hindrance to both mental and muscular activities. True there is much which remains to be clarified by further research; but the already established findings, of recent and current nutritional investigation, need only to be more widely known and used in order to make our people much stronger for the defence of our civilisation, and for its permanent advancement when the emergency has passed. In our “ intellectual climate ” of the moment there is still a good deal of inertia because the newest knowledge is not yet sufficiently understood, while at the same time the new view is perhaps being over‐coloured by some writers. This paper therefore does not seek to add more assertions; but rather to review objectively the evidence on what the Council of National Defence has announced as one of our present‐day needs, “ to make the American people nutrition‐conscious in terms of the nutritional science of to‐day.” Nutrition presents three major aspects : (1) that in which food serves as fuel to supply energy for the activities of the bodily machine; (2) that of the assimilation of certain food constituents into structural material first for the growth and later for the upkeep of the body tissues; and (3) the utilisation of food substances either directly or indirectly to serve the body in those self‐regulatory processes by which it maintains its relatively “ steady states ” or essential internal environment. It is in its energy aspect that nutrition has most fully arrived at the status of an exact science. Expert opinion is well agreed on the fundamental principles of the energy transformations in the body, on the values of the foodstuffs as sources of energy, and on at least the broad lines of theory as to the influence of different bodily conditions in determining the energy need. On the latter points, especially, many laboratories are actively engaged in increasing the precision of present knowledge, and at least three well‐endowed nutrition laboratories—those of the Carnegie Institution, of the Russell Sage Institute, and of the Rochester University Department of Vital Economics—are devoting their resources especially to the perfection of the energy aspects of nutritional knowledge. The protein aspect of nutritional research has also reached a relatively mature status with well‐defined objectives. Among many other laboratories working in this field, that of the United States Department of Agriculture is giving special attention to the purification and description of the proteins themselves; and the laboratory of physiological chemistry of the University of Illinois is very actively investigating the nutritional relationships of the individual amino acids, with the generous support of the Rockefeller Foundation. We may look forward with confidence and great gratification to a presumably fairly near future in which this aspect of nutritional need can be stated quantitatively in terms of ten individually indispensable amino acids. The catalysts which make the chemical processes in the body go fast enough to support life overlap and in a measure integrate the subject matter divisions of the chemistry of nutrition. They function in the energy aspect; and in their own chemical constitutions they are derivatives of proteins (or their amino acids), mineral elements, and vitamins. This very active field of research is quite as frequently classified with general biochemistry as with nutrition. Until its current era of “ newer knowledge,” the chemistry of food and nutrition had for several decades faced the dilemma that foods could be analysed as elaborately, and their composition accounted for with as close an approach to one hundred per cent., as other natural materials; and yet nutrition could not be sustained with pure mixtures of the substances that the analyses revealed. Seeking deeper insights, chemists broadened their research methods to include the systematic use of feeding experiments with laboratory animals, carried on with as careful attention to accuracy of controls as in other experimental researches in the exact sciences. This extension of method in chemical research has been rewarded with a rapid series of discoveries of substances which are essential to our nutrition, but whose very existence was, until recent years, either entirely unknown or only vaguely apprehended. Neither in chemical nature nor in nutritional function do these substances have much in common with each other. That they came to be called by the group name vitamins was not the result of their being naturally related, but rather of the two circumstances, (1) that they were all discovered through the use of the same development of research method, and (2) that the discoveries of their existence and importance followed each other too rapidly for physical isolation and chemical identification and nomenclature to keep pace. The latter, however, are steadily catching up, and in several cases new names, which are individually distinctive of either the chemical structures or the historic associations of the substances, have been coined and are coming into general use.

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British Food Journal, vol. 44 no. 3
Type: Research Article
ISSN: 0007-070X

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