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North-west England (north-west + england)
Selected Abstracts,Hope, Colour, and Comradeship': Loyalty and Opportunism in Early Twentieth-Century Church Attendance Among the Working Class in North-West EnglandJOURNAL OF RELIGIOUS HISTORY, Issue 1 2001Dorothy Entwistle [source] The impact of psoriasis guidelines on appropriateness of referral from primary to secondary care: a randomized controlled trialBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2006C.E.M. Griffiths Summary Background, Most patients with psoriasis have limited disease which can be managed effectively in primary care. There is a marked variation in the frequency of referrals between practices reflecting, in part, inadequate training of general practitioners (GPs) in the management of psoriasis. Objectives, To assess the effectiveness of guidelines and training sessions on the management of psoriasis in reducing inappropriate referrals from primary care. Methods, Patients aged 18 years or over with psoriasis were eligible for the cluster-randomized, randomized controlled trial if they were referred by their GP between 9 September 2002 and 31 December 2003 to one of four hospital dermatology departments in Greater Manchester, North-West England. All GPs from 165 health centres were invited to a lecture by a local dermatologist on the diagnosis and management of psoriasis. Health centres in the intervention arm received guidelines on the management of psoriasis in primary care, developed by local dermatologists, supplemented by the offer of a practice-based nurse-led training session; those in the control arm received neither guidelines nor training sessions. Results, Eighty-two health centres were randomized to the intervention arm and 83 to the control arm. Outcome data were available for 188 of the 196 eligible patients referred during the study period. Patients in the intervention arm were significantly more likely to be appropriately referred in comparison with patients in the control arm [difference = 19·1%; odds ratio (OR) 2·47; 95% confidence interval (CI) 1·31,4·68; intracluster correlation coefficient (ICC) = 0]. Only 25 (30%) health centres in the intervention arm took up the offer of training sessions. There was no significant difference in outcome between health centres in the intervention arm that received a training session and those that did not (OR 1·28, 95% CI 0·50,3·29, ICC = 0). Conclusions, Dissemination of guidelines on the management of psoriasis in primary care can significantly enhance the appropriateness of referral of patients to secondary care. [source] The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trialJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Linda Mason Aim., This article reports a randomised controlled trial to determine the efficacy of antenatal pelvic floor muscle exercises in the primary prevention of postpartum stress incontinence in primiparous women. Background., Pelvic floor muscle exercises are effective in treating stress incontinence, yet prevention studies demonstrate equivocal findings. Design., Randomised controlled trial. Method., Pregnant women recruited from two hospitals in North-west England were randomised to an intervention (n = 141) or control group (n = 145). Data were collected from 2005,2006. The intervention comprised four sessions of taught pelvic floor muscle exercise training during pregnancy and 8,12 maximal contractions repeated twice daily at home. A modified Bristol Female Lower Urinary Tract Symptom questionnaire, Leicester Impact Scale and Three Day Diary were administered at 20 and 36 weeks of pregnancy and three months postpartum. Results., The intervention group was more likely to exercise their pelvic floor muscles compared to controls at 36 weeks (p = 0·019) and three months (0·022), reporting fewer episodes of incontinence and a lower score on the Leicester Impact Scale. However, these differences were not statistically significant. Conclusion., Significant differences were not demonstrated between the groups in relation to incontinence episodes and degree of bother of symptoms postpartum, although trends indicate a positive effect. Further research is necessary to address issues of adherence and the effect of pelvic floor muscle exercise undertaken during pregnancy on postpartum stress urinary incontinence. Relevance to clinical practice., A proportion of women did not meet the required attendance at antenatal class, furthermore, few exercised their pelvic floor muscles during pregnancy according to instructions. Health professionals need to find ways to instruct and motivate women to perform pelvic floor muscles exercises regularly during pregnancy and the postpartum. [source] In Search of Causality: A Regional Approach to Urban Growth in Eighteenth-century EnglandGEOGRAFISKA ANNALER SERIES B: HUMAN GEOGRAPHY, Issue 3 2000Jon Stobart The simple equation of industrialisation and urbanisation contains much truth: recent national surveys confirm that rapid coal-based industrial growth spawned massive urban development in Britain. And yet at the local level a wide diversity of growth experiences reflect a complex and overlapping nexus of growth stimuli which defy attempts at generalisation. In taking a regional perspective, this paper seeks to occupy a productive middle ground in this ongoing debate. Placing urban growth in north-west England into its real economic and geographical context, it recognises the complexities of urban growth but transcends the narrowness of the particular. In so doing, it challenges some of the certainties of industrial urbanisation, emphasising instead the importance of rural industry, urban commercial functions and inter-place linkages. Most fundamentally, it argues for a more nuanced understanding of the geography of causality. [source] Local annual survival of booming male Great Bittern Botaurus stellaris in Britain, in the period 1990,1999IBIS, Issue 1 2002Gillian Gilbert Male Great Bitterns Botaurus stellaris have individually distinctive boom vocalizations which have been used since 1990 to count the British population accurately. We used vocal individuality to identify birds between years and analyse the survival of the British booming population. We used six instances of Great Bitterns known to be the same birds (from radio tracking and re-sighting of darvic rings) in successive years to provide a means of identification independent from vocalizations. All of these birds remained in the same territory from one year to the next. Seven spectrogram measures were chosen as quantitative descriptors of Great Bittern booms. Boom similarity was expressed in terms of Euclidean ,acoustic' distance between descriptors of pairs of birds. Great Bitterns that were known to be the same birds had more similar booms across years than those known to be different. The acoustic distances and knowledge of site fidelity were used to construct parsimonious rules on which to base re-identification decisions and to build survival histories. Great Bittern local survival in Britain as a whole was estimated as 70% (± 5.1 se) with survival in north-west England (at Leighton Moss) higher (82.8%, ± 7.3 se) than that in East Anglian sites (65.2%, ± 5.4 se) (,12 = 3.4, P = 0.07). Movements of males between years were apparent between sites within the Suffolk and Norfolk coastal regions but not on a large scale. Survival of adult males in East Anglia was positively related to winter rainfall, but there was no significant relationship with winter temperature. There was a positive relationship between the annual population change in East Anglia and the annual local adult survival rate. [source] A comparison of regeneration dynamics following gap creation at two geographically contrasting heathland sitesJOURNAL OF APPLIED ECOLOGY, Issue 5 2000A.J. Britton 1.,Lowland Calluna -dominated heathlands are a high priority for conservation in Europe. As an anthropogenic subclimax community they require regular management intervention to maintain their conservation interest. 2.,Increasingly, Calluna is disappearing from lowland heathlands and being replaced by grasses, especially in the Netherlands and more recently in south-east England. While Calluna is highly competitive over much of its life cycle, its competitive ability is reduced during the regeneration phase that follows the death of stands or results from management activity. 3.,We examined the influence of five factors on regeneration of vegetation in gaps in two broadly similar lowland dry heaths over a 3-year period. These were: geographical location (combining a variety of environmental contrasts); dominant species (Calluna or grasses); management techniques; gap size; and seed source availability. 4.,Site location had the greatest effect on patterns of regeneration. Regeneration on the Wirral (north-west England) was faster and more dominated by Calluna than regeneration in Breckland (south-east England), which was dominated by other species including grasses and annual plants. Addition of Calluna seed at the Breckland site failed to increase Calluna cover. It was concluded that climatic or other environmental factors were the most probable cause of poor regeneration. 5.,Cover of grasses in regenerating areas was greatest in Breckland, where Deschampsia was able to establish in all gaps where there was a seed source (either in the surrounding vegetation or applied as a treatment). On the Wirral, Deschampsia establishment was limited, even in gaps where a seed source was applied. 6.,This work has implications for the conservation management of heathlands, which currently follows a standard prescription throughout the UK. It is suggested that management regimes should be tailored to suit the conditions prevailing at individual sites as regeneration dynamics may be extremely variable. [source] | ||||||||||||||||