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Preview: Journal of Public Health - current issue

Journal of Public Health Current Issue





Published: Sat, 02 Sep 2017 00:00:00 GMT

Last Build Date: Fri, 08 Dec 2017 14:53:36 GMT

 












NICE public health guidance update

Wed, 19 Jul 2017 00:00:00 GMT




Environmental Public Health Tracking: a cost-effective system for characterizing the sources, distribution and public health impacts of environmental hazards

Thu, 01 Dec 2016 00:00:00 GMT

Abstract
Background
The contemporary environment is a complex of interactions between physical, biological, socio-economic systems with major impacts on public health. However, gaps in our understanding of the causes, extent and distribution of these effects remain. The public health community in Sandwell West Midlands has collaborated to successfully develop, pilot and establish the first Environmental Public Health Tracking (EPHT) programme in Europe to address this ’environmental health gap’ through systematically linking data on environmental hazards, exposures and diseases.
Methods
Existing networks of environmental, health and regulatory agencies developed a suite of innovative methods to routinely share, integrate and analyse data on hazards, exposures and health outcomes to inform interventions.
Results
Effective data sharing and horizon scanning systems have been established, novel statistical methods piloted, plausible associations framed and tested, and targeted interventions informed by local concerns applied. These have influenced changes in public health practice.
Conclusion
EPHT is a powerful tool for identifying and addressing the key environmental public health impacts at a local level. Sandwell's experience demonstrates that it can be established and operated at virtually no cost. The transfer of National Health Service epidemiological skills to local authorities in 2013 provides an opportunity to expand the programme to fully exploit its potential.



Corrigendum

Wed, 23 Nov 2016 00:00:00 GMT




Community pharmacists’ evaluation of potentially inappropriate prescribing in older community-dwelling patients with polypharmacy: observational research based on the GheOP³S tool

Mon, 03 Oct 2016 00:00:00 GMT

Abstract
Background
In this study, we aimed to (i) determine the prevalence of potentially inappropriate prescribing (PIP) in community-dwelling older polypharmacy patients using the Ghent Older People's Prescriptions community-Pharmacy Screening (GheOP³S) tool, (ii) identify the items that account for the highest proportion of PIP and (iii) identify the patient variables that may influence the occurrence of PIP. Additionally, pharmacist–physician contacts emerging from PIP screening with the GheOP³S tool and feasibility of the GheOP³S tool in daily practice were evaluated.
Methods
A prospective observational study was carried out between December 2013 and July 2014 in 204 community pharmacies in Belgium. Patients were eligible if they were (i) ≥70 years, (ii) community-dwelling, (iii) using ≥5 chronic drugs, (iv) a regular visitor of the pharmacy and (v) understanding Dutch or French. Community pharmacists used a structured interview to obtain demographic data and medication use and subsequently screened for PIP using the GheOP³S tool. A Poisson regression was used to investigate the association between different covariates and the number of PIP.
Results
In 987 (97%) of 1016 included patients, 3721 PIP items were detected (median of 3 per patient; inter quartile range: 2–5). Most frequently involved with PIP are drugs for the central nervous system such as hypnosedatives, antipsychotics and antidepressants. Risk factors for a higher PIP prevalence appeared to be a higher number of drugs (30% extra PIPs per 5 extra drugs), female gender (20% extra PIPs), higher body mass index (BMI, 20% extra PIPs per 10-unit increase in BMI) and poorer functional status (30% extra PIPs with 6-point increase). The feasibility of the GheOP³S tool was acceptable although digitalization of the tool would improve implementation. Despite detecting at least one PIP in 987 patients, only 39 physicians were contacted by the community pharmacists to discuss the items.
Conclusion
A high prevalence of PIP in community-dwelling older polypharmacy patients in Belgium was detected which urges for interventions to reduce PIP.



Characteristics of good supervision: a multi-perspective qualitative exploration of the Masters in Public Health dissertation

Mon, 03 Oct 2016 00:00:00 GMT

Abstract
Background
A dissertation is often a core component of the Masters in Public Health (MPH) qualification. This study aims to explore its purpose, from the perspective of both students and supervisors, and identify practices viewed as constituting good supervision.
Methods
A multi-perspective qualitative study drawing on in-depth one-to-one interviews with MPH supervisors (n = 8) and students (n = 10), with data thematically analysed.
Results
The MPH dissertation was viewed as providing generic as well as discipline-specific knowledge and skills. It provided an opportunity for in-depth study on a chosen topic but different perspectives were evident as to whether the project should be grounded in public health practice rather than academia. Good supervision practice was thought to require topic knowledge, generic supervision skills (including clear communication of expectations and timely feedback) and adaptation of supervision to meet student needs.
Conclusions
Two ideal types of the MPH dissertation process were identified. Supervisor-led projects focus on achieving a clearly defined output based on a supervisor-identified research question and aspire to harmonize research and teaching practice, but often have a narrower focus. Student-led projects may facilitate greater learning opportunities and better develop skills for public health practice but could be at greater risk of course failure.



Portrayal of tobacco smoking in popular women's magazines: a content analysis

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
Whilst many countries have introduced legislation prohibiting tobacco advertising and sponsorship, references to tobacco continue to appear in the media. This study quantified and characterized tobacco smoking content in popular women's magazines.
Methods
The 10 top weekly and 5 monthly women's magazines most popular among 15–34 year olds in Britain published over a 3-month period were included. A content analysis was conducted for both written and visual content.
Results
In 146 magazines, there were 310 instances of tobacco content, the majority of which were positive towards smoking. Instances of celebrities smoking were most common (171, 55%), often in holiday or party settings that could be perceived to be luxurious, glamorous or fun. In all, 55 (18%) tobacco references related to fashion, which generally created an impression of smoking as a norm within the industry; and 34 (11%) text and image references to tobacco in TV and film. There were 50 (16%) reader-initiated mentions of smoking, typically in real-life stories or readers writing in to seek advice about smoking. Anti-smoking references including the hazards of smoking were infrequent (49; 16%).
Conclusions
Although tobacco advertising is prohibited in Britain, women's magazines still appear to be promoting positive messages about tobacco and smoking.



Education and disability trends of older Americans, 2000–2014

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
Trends in disability among older Americans has declined since the 1980s. The study examines whether the trend continues to decline and whether educational disparities exist in the prevalence of functional limitations.
Methods
I used the 2000–2014 National Health Interview Survey and included adults aged ≥65 years. Functional limitations was measured by three outcomes: the need for help with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) and physical function limitations. I used a set of logistic models to estimate the average annual change rate of functional limitations. I examined whether the annual rate of change differed by education, age group and sex.
Results
During 2000–2014, the annual increase rate of ADL limitations was 1.7% (P < 0.001) and was 2.0% (P < 0.001) for physical function limitations; IADL limitation did not change significantly. All subgroups experienced an increase in ADL and physical function limitations except for adults with a more than high school education. The lower-educated group had a higher proportion and a higher annual rate of increase in all outcomes. Increasing trends in chronic conditions may contribute to the increasing trend in functional limitations.
Conclusions
The study highlighted a large educational disparity in late-life disability among older Americans.



Implementing extreme weather event advice and guidance in English public health systems

Wed, 21 Sep 2016 00:00:00 GMT

Abstract
Background
Extreme weather events (EWEs) can significantly impact on mortality and morbidity in the UK. How EWE guidance is disseminated and applied across health and social care systems, at the local, operational level, is not well understood.
Methods
This exploratory study develops tools and resources to assist local stakeholders to cascade national ‘all weather’ EWE guidance across local systems. These resources are also used to evaluate the local interpretation and implementation of this advice and guidance within three local authority areas. In total, five discussion group meetings were held and 45 practitioners took part in the study. A thematic analysis was conducted.
Results
The main themes emerging from the analysis related to awareness of PHE guidance for EWE preparedness, data sharing feasibility, community engagement, specific conditions in remote rural areas and capacity of frontline staff.
Conclusions
The relative difficulty in finding where the study 'best fits’ on local stakeholders’ agendas suggests that year-round and preparedness planning for EWEs may not have been considered a high priority in participating areas. This study adds to the relatively limited evidence internationally concerning the practical implementation at local level of national adaptation advice and guidance and potential barriers to achieving this.



Using mobile technology to optimize disease surveillance and healthcare delivery at mass gatherings: a case study from India's Kumbh Mela

Wed, 21 Sep 2016 00:00:00 GMT

Abstract
Background
Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people.
Methods
We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals.
Results
The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing.
Conclusions
Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data.



Diseases due to unhealthy environments: an updated estimate of the global burden of disease attributable to environmental determinants of health

Mon, 12 Sep 2016 00:00:00 GMT

Abstract
Background
The update of the global burden of disease attributable to the environment is presented. The study focuses on modifiable risks to show the potential health impact from environmental interventions.
Methods
Systematic literature reviews on 133 diseases and injuries were performed. Comparative risk assessments were complemented by more limited epidemiological estimates, expert opinion and information on disease transmission pathways. Population attributable fractions were used to calculate global deaths and global disease burden from environmental risks.
Results
Twenty-three percent (95% CI: 13–34%) of global deaths and 22% (95% CI: 13–32%) of global disability adjusted life years (DALYs) were attributable to environmental risks in 2012. Sixty-eight percent of deaths and 56% of DALYs could be estimated with comparative risk assessment methods. The global disease burden attributable to the environment is now dominated by noncommunicable diseases. Susceptible ages are children under five and adults between 50 and 75 years. Country level data are presented.
Conclusions
Nearly a quarter of global disease burden could be prevented by reducing environmental risks. This analysis confirms that eliminating hazards and reducing environmental risks will greatly benefit our health, will contribute to attaining the recently agreed Sustainable Development Goals and will systematically require intersectoral collaboration to be successful.



Ethnic differences in the clustering and outcomes of health behaviours during pregnancy: results from the Born in Bradford cohort

Sat, 10 Sep 2016 00:00:00 GMT

Abstract
Background
Pregnancy is a time of optimal motivation for many women to make positive behavioural changes. We aim to describe pregnant women with similar patterns of self-reported health behaviours and examine associations with birth outcomes.
Methods
We examined the clustering of multiple health behaviours during pregnancy in the Born in Bradford cohort, including smoking physical inactivity, vitamin d supplementation and exposure to second-hand smoke.Latent class analysis was used to identify groups of individuals with similar patterns of health behaviours separately for White British (WB) and Pakistani mothers. Multinomial regression was then used to examine the association between group membership and birth outcomes, which included preterm birth and mean birthweight.
Results
For WB mothers, offspring of those in the ‘Unhealthiest’ group had lower mean birthweight than those in the ‘Mostly healthy but inactive’ class, although no association was observed for preterm birth. For Pakistani mothers, group membership was not associated with birthweight differences, although the odds of preterm birth was higher in ‘Inactive smokers’ compared to the ‘Mostly healthy but inactive’ group.
Conclusions
The use of latent class methods provides important information about the clustering of health behaviours which can be used to target population segments requiring behaviour change interventions considering multiple risk factors. Given the dominant negative association of smoking with the birth outcomes investigated, latent class groupings of other health behaviours may not confer additional risk information for these outcomes.






Air pollution, deprivation and health: understanding relationships to add value to local air quality management policy and practice in Wales, UK

Fri, 09 Sep 2016 00:00:00 GMT

Abstract
Background
Air pollution exposure reduces life expectancy. Air pollution, deprivation and poor-health status combinations can create increased and disproportionate disease burdens. Problems and solutions are rarely considered in a broad public health context, but doing so can add value to air quality management efforts by reducing air pollution risks, impacts and inequalities.
Methods
An ecological study assessed small-area associations between air pollution (nitrogen dioxide and particulate matter), deprivation status and health outcomes in Wales, UK.
Results
Air pollution concentrations were highest in ‘most’ deprived areas. When considered separately, deprivation-health associations were stronger than air pollution-health associations. Considered simultaneously, air pollution added to deprivation-health associations; interactions between air pollution and deprivation modified and strengthened associations with all-cause and respiratory disease mortality, especially in ‘most’ deprived areas where most-vulnerable people lived and where health needs were greatest.
Conclusion
There is a need to reduce air pollution-related risks for all. However, it is also the case that greater health gains can result from considering local air pollution problems and solutions in the context of wider health-determinants and acting on a better understanding of relationships. Informed and co-ordinated air pollution mitigation and public health action in high deprivation and pollution areas can reduce risks and inequalities. To achieve this, greater public health integration and collaboration in local air quality management policy and practice is needed.



Cost-effectiveness analysis of eliminating industrial and all trans fats in England and Wales: modelling study

Fri, 09 Sep 2016 00:00:00 GMT

Abstract
Introduction
Coronary heart disease (CHD) remains a leading cause of UK mortality. Dietary trans fats (TFA) represent a powerful CHD risk factor. However, UK efforts to reduce intake have been less successful than other nations. We modelled the potential health and economic effects of eliminating industrial and all TFA up to 2020.
Methods
We extended the previously validated IMPACTsec model, to estimate the potential effects on health and economic outcomes of mandatory reformulation or a complete ban on dietary TFA in England and Wales from 2011 to 2020.We modelled two policy scenarios:1) Elimination of industrial TFA consumption, from 0.8% to 0.4% daily energy2) Elimination of all TFA consumption, from 0.8% to 0%
Results
Elimination of industrial TFA across the England and Wales population could result in approximately 1600 fewer deaths per year, with some 4000 fewer hospital admissions; gaining approximately 14 000 additional life years. Health inequalities would be substantially reduced in both scenarios. Elimination of industrial TFA would be cost saving. This would include approximately £100 m saved in direct healthcare costs. Elimination of all TFA would double the health and economic gains.
Conclusions
Eliminating industrial or all UK dietary intake of TFA could substantially reduce CHD mortality and inequalities, while resulting in substantial annual savings.






Measuring health burden without discriminating against the disabled

Thu, 08 Sep 2016 00:00:00 GMT

Abstract
Background
Summary measures of population health, like the Disability Adjusted Life Year (DALY), are important for health policy and planning. Some worry, however, that these measures discriminate against the disabled.
Methods
This paper provides an analysis of the disability discrimination problem. Then, adapting a fixed-plus-variable framework proposed in welfare economics to the case of health measurement, it proposes a novel measure called the Ethically Adjusted Life Year (EALY).
Results
The EALY, in at least some formulations, can avoid discriminating against the disabled. It is different from, and has some advantages over, alternative ways of avoiding discrimination.
Conclusions
There is reason to consider using the EALY in measuring health burden and the impact of health interventions.






Maintaining pre-school children's health and wellbeing in the UK: a qualitative study of the views of migrant parents

Fri, 02 Sep 2016 00:00:00 GMT

Abstract
Background
There is evidence that key health behaviours of people who migrate deteriorate over time, which has a consequent impact upon the health of dependent children. As health in the early years sets the course for lifelong health, it is important to explore parents' views on maintaining children's health following migration.
Methods
Five focus groups were held with parents of preschool children who had migrated to the UK within the last 10 years (n = 28). Parents originated from Romania, Poland, Somalia and Pakistan, with one group of Roma Gypsy parents. Data collection took place in January to March 2015.
Results
All groups, apart from the Roma, perceived barriers to maintaining optimal health and well-being for their preschool children following migration to the UK. Eastern European parents experienced difficulties in ensuring family financial security, while parents from more established communities focused on barriers to children's exercise, play and nutrition.
Conclusions
This study highlights aspects of public health where migrants and their children can experience adverse effects in the UK. These findings have implications for policymakers, commissioners and providers of health services who aim to promote good health among preschool children.



Association of cholesterol and lifestyle markers with type 1 diabetes incidence rates at a population level

Fri, 02 Sep 2016 00:00:00 GMT

Abstract
Background
We investigated the hypotheses that mean population body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and the prevalence of type 2 diabetes (T2DM) are correlated with type 1 diabetes (T1DM) incidence rates.
Methods
Population-based mean incidence rates for T1DM in children aged ≤14 years participating in the World Health Organization Diabetes Mondial (DiaMond) project were compared with population mean values for BMI, SBP, TC and FPG, as well as prevalence rates for T2DM as reported by The Global Burden of Metabolic Risk Factors Chronic Diseases Collaborating Group, using Spearman‘s rank correlation and multiple regression analysis.
Results
The mean incidence rate for T1DM in boys was significantly correlated with country mean BMI, SBP and TC in men and mean TC in women, and negatively correlated with the country incidence of T2DM in either gender. We also found significant correlations between mean incidence rates of T1DM in girls and mean BMI, SBP and TC in men and mean TC in women. In multiple regression analyses, mean TC emerged as the sole significant predictor for T1DM in both boys (P < 0.001, adjusted R2 = 0.393) and girls (P < 0.001, adjusted R2 = 0.372).
Conclusion
Population mean total cholesterol is a significant predictor for country incidence of type 1 diabetes in both boys and girls. This association may fuel the rising incidence rates of type 1 diabetes reported in many countries.



Preparing and sharing food: a quantitative analysis of a primary school-based food intervention

Fri, 02 Sep 2016 00:00:00 GMT

Abstract
Background
Primary schools are increasingly used as arenas for public health initiatives. The aim of this study was to assess a primary school-based food intervention.
Methods
The intervention comprised timetabled kitchen classroom sessions (90 min, fortnightly). Pupils prepared and cooked food, which they then ate together. Children's relationship with food, including food enjoyment, experience and food neophobia, were addressed at the intervention school (baseline n = 154; follow-up n = 164) and at a matched control school (baseline n = 171; follow-up n = 174).
Results
Pupils at the intervention school scored significantly higher (M = 3.90, SD = 1.81) for scores on Kitchen Equipment, compared to the control school (M = 3.06, SD = 2.12); and again scored significantly higher (M = 9.34, SD = 3.79) for the overall Cooking Experience Score compared to the control school (M = 7.98, SD = 4.57). Shifts accompanying the intervention in three outcome measures for pupils (taste description, liking for cooking and helping with cooking at home) were also revealed. No main intervention effect for food neophobia and fussiness was found; a close to significant time by intervention interaction (P = 0.053) was evident.
Conclusions
The study indicates limited but encouraging changes, and contributes to the growing literature regarding school-based food initiatives.



Helpful advice and hidden expertize: pharmacy users’ experiences of community pharmacy accessibility

Fri, 02 Sep 2016 00:00:00 GMT

Abstract
Background
In recent years community pharmacies have emerged as strategically important settings to deliver services aimed at promoting public health. In order to develop evidence-based approaches to public health interventions that exploit the unique accessibility of community pharmacies, it is important to determine how people experience care in this context. This study, therefore, aimed to describe how care is perceived and experienced in community pharmacies with particular focus on community pharmacy access.
Methods
In-depth semi-structured interviews were used to explore the perceptions and experiences’ of people using community pharmacies.
Results
A total of 30 participants were interviewed. Themes specifically emerged in relation to community pharmacy access; these fell into four main categories: relationships; time; lack of awareness; and empowerment.
Conclusions
The experience of developing a trusting relationship with the pharmacist is an important consideration in the context of community pharmacy accessibility. This could be an important consideration when a person uses a community pharmacy to access a public health service. There is also a perceived lack of awareness among the general public about the extended role of community pharmacy; this is a potential barrier toward people using them.



Measles, social media and surveillance in Baltimore City

Sat, 13 Aug 2016 00:00:00 GMT

Abstract
Background
Baltimore City was faced with two potential measles outbreaks in 2015. Both cases occurred in the wake of national media attention paid to the Disneyland outbreaks of the same year.
Methods
A comparative case study approach was used applying qualitative data to elicit best practices in infectious disease protocols in the age of social media. The research also used search engine data from Google Trends to track constituent engagement over time.
Results
Across the two case studies, the Baltimore City Health Department identified a number of best practices to inform the public via social media and minimize levels of misinformation and panic. These practices included clarity in messaging across platforms and public health jurisdictions; pre-emptor alerts of potential measles cases to control and shape the media messaging; and targeted, in-person outreach to engage groups in a culturally competent manner.
Conclusions
The Baltimore City Health Department's response drew out a critical need for re-examining infectious disease protocols in the age of social media (e.g. contact notification, quarantine, media sensitivity) and anti-vaccination movements that pose new obstacles to government intervention. The benefits and challenges of greater connectivity between providers, patients, and public health officers are discussed.



How much excess weight loss can reduce the risk of hypertension?

Sat, 13 Aug 2016 00:00:00 GMT

Abstract
Background
A 25% relative reduction in the prevalence of hypertension is a global target. This meta-analysis estimated the effect of excess weight loss on hypertension.
Methods
We searched PubMed, Web of Science and Scopus until January 2016. We included prospective cohort studies addressing the association between overweight/obesity and hypertension. We expressed the strength of association using risk ratio and the excess risk using attributable risk fraction with 95% CI based on the random-effects model.
Results
We found 7617 references and included 10 studies with 173 828 participants. Compared with normal weight, the risk ratio of hypertension was 1.52 (1.37, 1.67; 9 studies, I2 = 82.4%) for overweight and 2.17 (1.84, 2.50; 9 studies, I2 = 88.9%) for obesity. The excess risk of hypertension attributable to overweight was 32% (24%, 40%; 8 studies, I2 = 85.5%) and that attributable to obesity was 47% (40%, 54%; 8 studies, I2 = 88.2%). That means, excess weight loss may reduce the risk of hypertension by between 24% and 40% in people who are overweight and by between 40% and 54% in people who are obese.
Conclusions
Excess weight loss is a vital strategy for controlling hypertension and is sufficient for achieving the global target, particularly if it is accompanied with other preventive measures.



Differences in substance use between sexual orientations in a multi-country sample: findings from the Global Drug Survey 2015

Fri, 12 Aug 2016 00:00:00 GMT

Abstract
Background
This study examines substance use disparities among homosexual, bisexual and heterosexual adolescents and young adults from nine countries.
Methods
Data from 58 963 respondents (aged 16 and 35 years) to the 2015 ‘Global Drug Survey’ were utilized. Rates of lifetime, last-year, last-month use and age of onset of 13 different substances were compared across sexual identity subgroups.
Results
Adolescents and young adults with a sexual minority identity generally reported higher rates of substance use and an earlier age of onset compared to their heterosexual counterparts. Differences in substance use were larger among female groups than male groups, and rates of substance use were generally higher among bisexuals than homosexuals of both genders.
Conclusion
Higher rates of substance use in bisexuals compared with homosexuals among both genders and larger differences between female groups highlight the importance of differentiating between sexual minority identities in substance use research, and in designing substance misuse interventions for people with a sexual minority identity.



The association of air pollution with birthweight and gestational age: evidence from Hong Kong's ‘Children of 1997’ birth cohort

Fri, 29 Jul 2016 00:00:00 GMT

Abstract
Background
Previous studies from Western settings have found inconsistent associations of air pollutants with birth outcomes, which are open to residual confounding by socioeconomic position (SEP). We assessed this association in the economically developed non-Western setting of Hong Kong, with high levels of air pollution but little social patterning of these outcomes.
Methods
We obtained PM10, SO2, NO and NO2 from monitoring stations, and assessed their associations with birthweight and gestational age in a large population-representative birth cohort ‘Children of 1997’, using partial least-square regression to account for the colinearity between pollutants.
Results
PM10 (per 5.7 µg/m3 higher) and NO2 (per 10.9 µg/m3 higher) were associated with birthweight lower by 47.0 g (95% confidence interval (CI) 36.2–56.3) and 16.9 g (95% CI 10.8–22.6), respectively; and were associated with gestational age shorter by 2.1 days (95% CI 1.7–2.4) and 0.7 days (95% CI 0.5–0.8), respectively.
Conclusions
Given minimal confounding by SEP in our setting, these findings provide unequivocal evidence of adverse effects of PM10 and NO2 exposure during pregnancy on birthweight and gestational age. Physiological mechanisms need to be better understood to support effective public health action globally.



Demographic and regional characteristics of road traffic injury deaths in Jiangsu Province, China

Fri, 29 Jul 2016 00:00:00 GMT

Abstract
Background
The study investigates the magnitude and distribution of fatal road traffic injuries (RTIs) in the Chinese province of Jiangsu by road user.
Method
The 13 694 RTI deaths and years of potential life lost (YPLL) that occurred in 2012 were analysed; vulnerable and non-vulnerable road users were considered separately. Age-adjusted mortality and YPLL were compiled and the association between demographic characteristics and RTI mortality rate was analysed using negative binomial regression.
Results
The age-adjusted RTI mortality and YPLL in Jiangsu in 2012 were 18.14 (95% CI: 17.84–18.45) and 494.3 (95% CI: 492.7–496.0) per 100 000 population. Half of the deaths were among pedestrians and for vulnerable road users as a whole, male fatalities were over three times that of female (adjusted incidence rate ratio = 3.26, 95% CI: 1.89–3.77). Fatalities in the oldest age group (80+ years) were over 14 times that of the youngest one (0–9 years) (adjusted incidence rate ratio = 14.13, 95% CI: 9.49–21.01). Fatality rates in the central and northern regions surpassed that of the south.
Conclusion
As in the rest of the country, RTIs are a considerable public health problem in Jiangsu where fatality and YPLL rates fall heavily on pedestrians, men, and older persons and are more pronounced in the less developed regions.



Is being resolute better than being pragmatic when it comes to breastfeeding? Longitudinal qualitative study investigating experiences of women intending to breastfeed using the Theoretical Domains Framework

Fri, 29 Jul 2016 00:00:00 GMT

Abstract
Background
In the UK, initiating then discontinuing breastfeeding before two weeks post-partum is common. The aim of this longitudinal qualitative study was to explore which psychosocial factors may influence discontinuation.
Methods
A sample of 10 pregnant women intending to breastfeed were recruited. A longitudinal qualitative design was used to capture views prior to and two weeks following birth. Semi-structured interviews were conducted underpinned by the Theoretical Domains Framework to explore a comprehensive list of psychosocial factors.
Results
Four women discontinued breastfeeding at the time of the second interview. Pre-partum differences were identified between maintainers and discontinuers; discontinuers appeared to have stronger intentions to breastfeed based on their self-determination, self-confidence and perception of fewer barriers to breastfeeding. Post-partum, discontinuers highlighted how they felt physically unable to carry on; their feeding experiences elicited negative emotions and pain. Negative emotions appeared to be exacerbated by original breastfeeding beliefs and advice given by healthcare professionals.
Conclusions
The women in this study who discontinued breastfeeding showed less cognitive flexibility, which appeared to exacerbate post-partum emotional distress, when they encountered difficulties. Women with strong intentions and self-determination might benefit from support in anticipating potential barriers and identifying ways of overcoming them.



Patient choice and private provision decreased public provision and increased inequalities in Scotland: a case study of elective hip arthroplasty

Thu, 28 Jul 2016 00:00:00 GMT

Abstract
Background
This is the first research to examine how the policy of patient choice and commercial contracting where NHS funds are given to private providers to tackle waiting times, impacted on direct NHS provision and treatment inequalities.
Methods
An ecological study of NHS funded elective primary hip arthroplasties in Scotland using routinely collected inpatient data 1 April 1993–31 March 2013.
Results
An increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13, territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with the greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002.
Conclusions
NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates.



Novel public health risk assessment process developed to support syndromic surveillance for the 2012 Olympic and Paralympic Games

Sat, 23 Jul 2016 00:00:00 GMT

Abstract
Background
Syndromic surveillance aims to provide early warning and real time estimates of the extent of incidents; and reassurance about lack of impact of mass gatherings. We describe a novel public health risk assessment process to ensure those leading the response to the 2012 Olympic Games were alerted to unusual activity that was of potential public health importance, and not inundated with multiple statistical ‘alarms’.
Methods
Statistical alarms were assessed to identify those which needed to result in ‘alerts’ as reliably as possible. There was no previously developed method for this. We identified factors that increased our concern about an alarm suggesting that an ‘alert’ should be made.
Results
Between 2 July and 12 September 2012, 350 674 signals were analysed resulting in 4118 statistical alarms. Using the risk assessment process, 122 ‘alerts’ were communicated to Olympic incident directors.
Conclusions
Use of a novel risk assessment process enabled the interpretation of large number of statistical alarms in a manageable way for the period of a sustained mass gathering. This risk assessment process guided the prioritization and could be readily adapted to other surveillance systems. The process, which is novel to our knowledge, continues as a legacy of the Games.



Engagement in sex work does not increase HIV risk for women who inject drugs in Ukraine

Fri, 22 Jul 2016 00:00:00 GMT

Abstract
Background
We studied the association between sex in exchange for money, drugs or goods and HIV for women who inject drugs (WWID) in Ukraine, as previous data on this association from the post-USSR region are contradictory.
Methods
Data come from the Integrated Bio-Behavioral Survey of Ukrainian people who inject drugs collected in 2011 using respondent-driven sampling. Participants were interviewed and tested with rapid HIV tests.
Results
The sample included 2465 WWID (24% HIV positive); 214 (8.7%) of which reported having had exchange sex during the last 90 days. Crude analysis showed no association between exchange sex and HIV (OR = 0.644; 95% CI 0.385–1.077). No confounders were found to alter this result in a multivariable analysis. Further modeling showed that exchange sex modifies association between HIV and alcohol use: no association between HIV and daily alcohol use was found for those women who exchanged sex (OR = 1.699, 95% CI 0.737–3.956); while not engaging in sex work and daily using alcohol reduced odds to be HIV infected (OR = 0.586, 95% CI 0.389–0.885).
Conclusions
Exchange sex may have less impact on the HIV status of WWID who are exposed to injecting risks. The finding that daily alcohol use appears protective against HIV among WWID who do not exchange sex requires more research.



How are the undocumented migrants in Rome? Assessment of quality of life and its determinants among migrant population

Fri, 15 Jul 2016 00:00:00 GMT

Abstract
Aim
The aim of this study is to evaluate the level of Health-Related Quality of Life (HRQoL) and its determinants among migrants in irregular situations in Italy.
Methods
This cross-sectional study was held in Rome in 2014. HRQoL was assessed through SF-12 questionnaire and physical (PCS) and mental component scores (MCS) were calculated; socio-demographic information and medical conditions were collected. Bivariate and multivariate analyses were performed to assess the impact of demographic and pathological variables on the HRQoL.
Results
The median PCS among the 200 migrants enrolled was 46.5 and the median MCS was 37.9, some points below the Italian average. The multivariate analysis revealed a negative association between PCS and age (P < 0.01), respiratory (P: 0.03) and Poverty-Related Diseases (PRDs) (P < 0.01). MCS, on the other hand, resulted negatively associated with neuropsychiatric diseases (P: < 0.01) and PRDs (P < 0.01).
Conclusion
Although multivariate analyses revealed that gender acts as an effect modifier the negative association between PRDs and the two dimensions of HRQoL is confirmed in both genders. This suggests a great impact of socio-economic status on the HRQoL. Public health could contribute to improve the HRQoL of migrants only taking into account social aspects of diseases and tailoring intervention on the specific needs of migrants.



Knowledge, attitudes and awareness of the human papillomavirus amongst primary care practice nurses: an evaluation of current training in England

Wed, 13 Jul 2016 00:00:00 GMT

Abstract
Background
The incorporation of Human papillomavirus (HPV) testing into the English cervical screening programme has been met with fear and anxiety. Healthcare professionals need to be adequately informed about HPV to help alleviate patient concerns.The aim of this study was to evaluate the HPV training provided to practice nurses (PNs) and determine their level of HPV knowledge.
Method
A web-based survey was distributed to 147 General Practice surgeries in the Leicester, Leicestershire and Rutland regions, between May and July 2015. The survey explored four broad areas; demographics/level of experience, HPV knowledge, attitudes towards the HPV vaccine and self-perceived adequacy of HPV knowledge.
Results
A total of 128 surveys were completed, with 94 complete responses. Overall awareness of basic HPV facts was adequate; however, detailed, and in some cases basic, knowledge was lacking. 9.6% failed to identify that HPV can cause cervical cancer and 62.8% believed that HPV requires treatment. Not all PNs felt adequately informed about HPV and a need to improve the provision of training was identified.
Conclusion
PNs play a key role in increasing public awareness of HPV and implementing cervical cancer screening. The provision of education to PNs needs to be a priority and current methods of training need to be re-evaluated.



Publication ethics in public health emergencies

Wed, 13 Jul 2016 00:00:00 GMT

Abstract
In this article, we describe and analyse three issues in publication ethics that are raised when conducting research in emergencies and disasters. These include reluctance to share data and samples because of concerns about publications, loss of individual authorship in high high-profile multi-entity publications, and the deaths of authors during dangerous research projects. An emergency research pledge may be useful in avoiding some of these issues.



Understanding the urban–rural disparity in HIV and poverty nexus: the case of Kenya

Wed, 13 Jul 2016 00:00:00 GMT

Abstract
Background
The relationship between HIV and poverty is complex and recent studies reveal an urban–rural divide that is not well understood. This paper examines the urban–rural disparity in the relationship between poverty and HIV infection in Kenya, with particular reference to possible explanations relating to social cohesion/capital and other moderating factors.
Methods
Multilevel logistic regression models are applied to nationally-representative samples of 13 094 men and women of reproductive age from recent Kenya Demographic and Health Surveys.
Results
The results confirm a disproportionate higher risk of HIV infection among the urban poor, despite a general negative association between poverty and HIV infection among rural residents. Estimates of intra-community correlations suggest lower social cohesion in urban than rural communities. This, combined with marked socio-economic inequalities in urban areas is likely to result in the urban poor being particularly vulnerable. The results further reveal interesting cultural variations and trends. In particular, recent declines in HIV prevalence among urban residents in Kenya have been predominantly confined to those of higher socio-economic status.
Conclusion
With current rapid urbanization patterns and increasing urban poverty, these trends have important implications for the future of the HIV epidemic in Kenya and similar settings across the sub-Saharan Africa region.



Barriers and facilitators to the use of an immunization application: a qualitative study supplemented with Google Analytics data

Tue, 31 May 2016 00:00:00 GMT

Abstract
Background
Barriers and facilitators of mobile app adoption are not known. This study examined usage of a new Pan-Canadian immunization app to identify factors that contributed to usage.
Methods
Women in their third trimester of pregnancy or had given birth in the previous 3 months were recruited from a hospital obstetrical unit. Fifty-five participants were instructed to download the ImmunizeCA app. After at least 6 months, 10 interviews were conducted, transcribed and coded. Themes identified were compared with aggregate ImmunizeCA usage data (n = 74 212 users).
Results
Facilitators included features that address logistical challenges, improved convenience and information access. Barriers included absence of system integration. Concerns regarding the privacy and security of personal health information were not an inhibitor as long as best practices are followed. Google Analytics data on usage supported qualitative findings.
Conclusion
Future studies should evaluate the quantitative impact of factors we identified on app uptake and usage. Subsequent mobile app studies may benefit from the use of analytic data as they were found to be effective in helping to validate qualitative data derived from interviews with study participants.



Impact of maternal and paternal smoking on birth outcomes

Tue, 24 May 2016 00:00:00 GMT

Abstract
Background
The adverse effects of maternal and paternal smoking on child health have been studied. However, few studies demonstrate the interaction effects of maternal/paternal smoking, and birth outcomes other than birth weight have not been evaluated. The present study examined individual effects of maternal/paternal smoking and their interactions on birth outcomes.
Methods
A follow-up hospital-based study from pregnancy to delivery was conducted from 1997 to 2010 with parents and newborn infants who delivered at a large hospital in Hamamatsu, Japan. The relationships between smoking and growth were evaluated with logistic regression.
Results
The individual effects of maternal smoking are related to low birth weight (LBW), short birth length and small head circumference. The individual effects of paternal smoking are related to short birth length and small head circumference. In the adjusted model, both parents’ smoking showed clear associations with LBW (odds ratio [OR] = 1.64, 95% confidence interval [CI] 1.18–2.27) and short birth length (−1 standard deviation [SD] OR = 1.38, 95% CI 1.07–1.79; −2 SD OR = 2.75, 95% CI 1.84–4.10).
Conclusions
Maternal smoking was significantly associated with birth weight and length, but paternal smoking was not. However, if both parents smoked, the risk of shorter birth length increased.



Factor associated with risky sexual behaviors among the French general population

Tue, 24 May 2016 00:00:00 GMT

Abstract
Background
Despite prevention programs, a rising incidence of sexually transmitted infections is currently reported in France.
Aims
Research factors associated with risky sexual behaviors (RSBs) among the French population.
Methods
Subjects aged 15–54 years from the French national survey ‘Baromètre santé 2010’ were included (n = 16 598). RSB was defined as having multiple partners or failure to use condom at first intercourse with a new partner over past 12 months. Factors associated were identified using one logistic regression by gender.
Results
The overall RSB prevalence was 9.5%, being higher among men (P < 0.001). Factors associated with RSB for both genders were young age (OR = 1.5), single status (men: OR = 7.1; women: OR = 6.4), homosexual relations (men: OR = 2.0; women: OR = 3.2), low incomes (men: OR = 1.5; women: OR = 1.4), use of cannabis (men: OR = 1.4; women: OR = 3.0). Men-specific factors were history of STI (OR = 2.5) and alcohol drunkenness (OR = 2.2), and women-specific factors history of suicide attempt (OR = 1.6) and history of sexual assault (OR = 1.6).
Conclusions
Confirming most of known determinants of RSB, this study also identified some specific risky patterns for whom preventive actions can be developed: multiusers of psychoactive substances, people living with low incomes, women having sex with women or presenting history of psychological vulnerability (suicide attempts, sexually harassed).