Julie Houghton

Perceptions of food risk management among key stakeholders : Results from a cross-European study

In designing and implementing appropriate food risk management strategies, it is important to examine how key stakeholders perceive both the practice and effectiveness of food risk management. The objective of this study is to identify similarities and differences in perceptions of, and attitudes to, food risk management practices held by consumers and experts with an interest in food safety. Focus groups were conducted in five European countries chosen for their (hypothesised) cultural differences in attitudes towards risk: Denmark, Germany, Greece, Slovenia and the UK. Content analysis was carried out on the resulting texts and (sub) categories were identified within the analysis framework to facilitate the capture of emerging themes. Five key themes were identified as common to the perceptions of both consumers and experts, although these are not represented in the same way by both groups. These key themes are: (1) efforts made by the responsible authorities to manage food risks; (2) responsibility for prevention and management of food risks; (3) how priorities are established within regulatory systems; (4) scientific progress and its implications for food risk management; and (5) media attention and food safety incidents. Although some similarities emerged between the groups, differences were also identified. For example, experts appeared to be highly negative about media influences, whereas consumers appeared more indifferent about media influences and motives. These different perspectives need to be addressed in order to reduce the perceptual distance between key stakeholders, and in particular, to enhance consumer confidence in the food risk management system. Based on the study findings, recommendations for food risk management policies are outlined.

Consumer perceptions of the effectiveness of food risk management practices : A cross-cultural study

Abstract Consumer perceptions of food hazards and how the associated risks are managed are likely to be an important determinant of consumer confidence in food safety. While there is a body of research that examines public perceptions of various types of food hazards, less attention has been directed to understanding how the public perceives food risk management practices. Utilizing elements of the repertory grid approach in focus group discussions, this research explored public attitudes regarding the effectiveness of current food risk management practices in four European countries (Denmark, Germany, Greece and the UK). While the issue of food safety did not emerge as a key factor in everyday food choice, participants were concerned about health aspects of food. There were three main factors that participants considered to be evidence of ‘good’ food risk management: the existence of identifiable control systems that respond quickly to contain a risk, the instigation of preventive measures and the availability of information that offers individuals the ability to exercise informed choice. These evaluations were similar in each of the countries under consideration and were linked to ideas regarding the controllability of risks and to questions of who is responsible for managing the risks.

Food risk management quality: Consumer evaluations of past and emerging food safety incidents

In European countries, there has been growing consumer distrust regarding the motives of food safety regulators and other actors in the food chain, partly as a result of recent food safety incidents. If consumer confidence in food safety is to be improved, a systematic understanding of what consumers perceive to be best practice in risk management is crucial. Previous qualitative and quantitative research has revealed underlying factors determining consumer perceptions of food risk management quality. The aim of the current case studies is to provide ‘proof of principles’ of these different factors against historic and emerging food safety incidents. Participants in four countries were questioned about country specific case studies, guided by the earlier findings regarding factors that determine perceived good practice in food risk management. In each country, two food safety incidents were selected. Semi-structured interviews with at least 25 participants per case study were conducted in Germany (BSE; nematode worms in fish), Greece (mould in Greek yogurt/carcinogenic honey crisis; avian influenza), Norway (E. coli in meat; contaminants in Norwegian salmon) and the UK (BSE; contaminants in Scottish salmon). The results generally confirm the importance of the previously identified factors, which help to explain relative perceptions of well and poorly managed incidents. Differences and similarities across countries and cases are detailed, and implications for future efforts to communicate about risk management are drawn.

Risk and worry in everyday life: comparing diaries and interviews as tools in risk perception research.

A recent structured review of the qualitative risk perception literature (Hawkes and Rowe 2008) found that research has tended to focus on a narrow range of samples, using a limited range of techniques, looking at immediate perceptions (rather than changes over time), and focusing upon a limited range of hazards. As such, it may be argued that the risk perception ‘universe’ remains relatively unexplored. One method little utilised in the risk perception domain is the diary. Diaries are more commonly associated with historical, personal documents, and rarely have been used in wider social research. Nevertheless, contemporary, solicited diaries can provide a different perspective on risk than that acquired through the more traditional route of interviews and focus groups. Diaries may allow the elicitation of narratives of risk contextualised within peoples everyday lives, as well as allowing consideration of how peoples perceptions of risk develop and change over time. In this paper, we discuss the benefits of diary research, reporting results from a pilot qualitative study about peoples everyday concerns. We focus on the comparative nature of the study and contrast the findings from diaries with data attained from interviews, highlighting qualitative and quantitative differences in the results obtained by the two methods. The findings emphasise the importance of taking a multi-method approach to understanding risk perception.

A EuroPrevall review of factors affecting incidence of peanut allergy: priorities for research and policy

Peanuts are extensively cultivated around the world, providing a foodstuff that is both cheap to produce and nutritious. However, allergy to peanuts is of growing global concern, particularly given the severity of peanut‐allergic reactions, which can include anaphalaxis and death. Consequently, it is important to understand the factors related to the prevalence of peanut allergy in order to inform efforts to ameliorate or pre‐empt the condition. In this article we review evidence for the relevance of factors hypothesized to have some association with allergy prevalence, including both genetic and environmental factors. Although our analysis does indicate some empirical support for the importance of a number of factors, the key finding is that there are significant data gaps in the literature that undermine our ability to provide firm conclusions. We highlight these gaps, indicating questions that need to be addressed by future research.

Multi-professional clinical medication reviews in care homes for the elderly: study protocol for a randomised controlled trial with cost effectiveness analysis

BackgroundEvidence demonstrates that measures are needed to optimise therapy and improve administration of medicines in care homes for older people. The aim of this study is to determine the clinical and cost effectiveness of a novel model of multi-professional medication review.MethodsA cluster randomised controlled trial design, involving thirty care homes. In line with current practice in medication reviews, recruitment and consent will be sought from general practitioners and care homes, rather than individual residents. Care homes will be segmented according to size and resident mix and allocated to the intervention arm (15 homes) or control arm (15 homes) sequentially using minimisation. Intervention homes will receive a multi-professional medication review at baseline and at 6 months, with follow-up at 12 months. Control homes will receive usual care (support they currently receive from the National Health Service), with data collection at baseline and 12 months. The novelty of the intervention is a review of medications by a multi-disciplinary team. Primary outcome measures are number of falls and potentially inappropriate prescribing. Secondary outcome measures include medication costs, health care resource use, hospitalisations and mortality.The null hypothesis proposes no difference in primary outcomes between intervention and control patients. The primary outcome variable (number of falls) will be analysed using a linear mixed model, with the intervention specified as a fixed effect and care homes included as a random effect. Analyses will be at the level of the care home. The economic evaluation will estimate the cost-effectiveness of the intervention compared to usual care from a National Health Service and personal social services perspective.The study is not measuring the impact of the intervention on professional working relationships, the medicines culture in care homes or the generic health-related quality of life of residents.DiscussionThis study will establish the effectiveness of a new model of multi-professional clinical medication reviews in care homes, using novel approaches to recruitment and consent. It is the first study to undertake an examination of direct patient outcomes, together with an economic analysis.Trial RegistrationISRCTN: ISRCTN90761620

The potential for deprescribing in care home residents with Type 2 diabetes

Background Type 2 diabetes is a common diagnosis in care home residents that is associated with potentially inappropriate prescribing and thus risk of additional suffering. Previous studies found that diabetes medicines can be safely withdrawn in care home residents, encouraging further investigation of the potential for deprescribing amongst these patients. Objectives Describe comorbidities and medicine use in care home residents with Type 2 diabetes; identify number of potentially inappropriate medicines prescribed for these residents using a medicines optimisation tool; assess clinical applicability of the tool. Setting Thirty care homes for older people, East Anglia, UK. Method Data on diagnoses and medicines were extracted from medical records of 826 residents. Potentially inappropriate medicines were identified using the tool ‘Optimising Safe and Appropriate Medicines Use’. Twenty percent of results were validated by a care home physician. Main outcome measure Number of potentially inappropriate medicines. Results The 106 residents with Type 2 diabetes had more comorbidities and prescriptions than those without. Over 90 % of residents with Type 2 diabetes had at least one potentially inappropriate medication. The most common was absence of valid indication. The physician unreservedly endorsed 39 % of the suggested deprescribing, and would consider discontinuing all but one of the remaining medicines following access to additional information. Conclusion UK care home residents with Type 2 diabetes had an increased burden of comorbidities and prescriptions. The majority of these patients were prescribed potentially inappropriate medicines. Validation by a care home physician supported the clinical applicability of the medicines optimisation tool.

Does sensory relearning improve tactile function after carpal tunnel decompression? A pragmatic, assessor-blinded, randomized clinical trial.

Despite surgery for carpal tunnel syndrome being effective in 80%–90% of cases, chronic numbness and hand disability can occur. The aim of this study was to investigate whether sensory relearning improves tactile discrimination and hand function after decompression. In a multi-centre, pragmatic, randomized, controlled trial, 104 patients were randomized to a sensory relearning (n = 52) or control (n = 52) group. A total of 93 patients completed a 12-week follow-up. Primary outcome was the shape-texture identification test at 6 weeks. Secondary outcomes were touch threshold, touch localization, dexterity and self-reported hand function. No significant group differences were seen for the primary outcome (Shape-Texture Identification) at 6 weeks or 12 weeks. Similarly, no significant group differences were observed on secondary outcomes, with the exception of self-reported hand function. A secondary complier-averaged-causal-effects analysis showed no statistically significant treatment effect on the primary outcome. Sensory relearning for tactile sensory and functional deficits after carpal tunnel decompression is not effective. Level of Evidence: II

Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort

Objectives The Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care. Methods Prospective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model. Results 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity. Conclusions Patient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.

A Pragmatic, Assessor-Blinded, Randomized Trial of the Clinical Effectiveness of a 6-Week Sensory Relearning Home Program on Tactile Function of the Hand After Carpal Tunnel Decompression

Background: Surgery for carpal tunnel syndrome (CTS) is effective in 80% to 90% of cases, but greater neurophysiological severity is more likely to result in chronic numbness and functional hand disability. Sensory relearning, which is based on the principles of learning-dependent cortical plasticity, has been shown to improve tactile sensibility after nerve trauma. Objective: The objective of this study was to investigate whether a sensory relearning intervention taught as an unsupervised 6-week home therapy program can improve tactile discrimination and self-reported hand function in patients with chronic sensory deficits after carpal tunnel decompression. Methods: This study is a multicentered, pragmatic, randomized, controlled trial. A total of 104 patients with chronic sensory impairment after surgical decompression for CTS were randomized to receive either a standardized 6-week home sensory relearning program (n = 52) or were allocated to the control group (n = 52). The primary outcome was the Shape-Texture Identification (STI) test. Secondary outcomes were touch threshold (Weinstein Enhanced Sensory Test), touch localization test, Moberg pickup test, and 3 subscales of the Michigan Hand Questionnaire (MHQ). All patients were assessed at baseline, 6 weeks, and 12 weeks. Results: Intention-to-treat analysis showed no statistically significant differences between the groups at 6 weeks on the STI test (adjusted mean, −0.47; 95% confidence interval [CI], −1.09 to 0.143; P = 0.129) or at 12 weeks (adjusted mean, −0.18; 95% CI, −0.78 to 0.42; P = 0.549). Similarly, differences between groups on secondary outcomes were not statistically significant, with the exception of the patient-reported subscales of the MHQ (overall hand function, activities of daily living—affected hand and both hands) at 6 weeks. The significant differences in the MHQ were retained in 2 subscales by 12 weeks. A secondary analysis found that adherence with the recommended exercise frequency and duration did not have a significant effect on the primary outcome. Conclusions: At present, there is no evidence to support the use of an unsupervised sensory relearning home program as an intervention for patients with tactile sensory and functional deficits after carpal tunnel decompression. Targeting of therapies to improve functional sensibility in this population may require alternative strategies.