Subscribe: Journal of Public Health - current issue
http://jpubhealth.oxfordjournals.org/rss/current.xml
Preview: Journal of Public Health - current issue

Journal of Public Health Current Issue





Published: Thu, 02 Feb 2017 00:00:00 GMT

Last Build Date: Thu, 02 Feb 2017 16:46:07 GMT

 















Co-owner, service provider, critical friend? The role of public health in clinical commissioning groups

2017-02-02

Abstract
Background
Clinical commissioning groups (CCGs) were in early development when fieldwork took place. Public Health (PH) was moving into the local authority, and new ways of working were being established.
Methods
Three qualitative case studies in the North of England were undertaken using three different data collection methods: observations, interviews and the collection of documents that were related to the project. Comprehensive field notes were taken during observations, analysed alongside interview transcriptions and collected documentation using the software programme Atlas.ti.
Results
The relationship between the CCG and their local PH team was in development at the time of data collection. Three different PH roles could be discerned from the data: ‘co-owner’, ‘service provider’ and ‘critical friend’. These roles impacted on the utilization of PH by CCGs and the wider relationship between the CCG and PH.
Conclusions
These models are ‘ideal types’, and in reality the CCG–PH relationship in most areas will contain elements of all three models. However, to think of them as set out in this paper is instructive for both CCGs and PH. It is important that CCGs and their PH colleagues to think clearly about what they are trying to achieve and how that can most effectively work together.



Classifying the population by socioeconomic factors associated with support for policies to reduce social inequalities in health

2017-02-02

Abstract
Background
To examine citizens' agreement with policy options to reduce social inequalities in health and socio-demographic factors associated with support for these policies.
Methods
A random digit dialling sample of 16 125 households with access to a landline telephone was conducted in Saskatoon, Canada in 2013. Saskatoon is located in the Canadian prairies and had a population of 222 189 in 2011. A total of 1002 individuals aged 18 or older answered a questionnaire indicating their support for policies to improve health equity. Socio-demographic variables of interest were household income, education, occupation and ethnicity. Latent class analysis and logistic regression analyses were conducted.
Results
The latent class analysis showed that 37% of respondents were in the selective agreement group, while 63% were in the high agreement group. The selective agreement group showed lower policy support compared with the high agreement group, in particular for guaranteed annual income, welfare for adults and parents with children, lower tuition for post-secondary students. In the final logistic regression model, socioeconomic factors associated with the likelihood of being in the selective agreement group were: age ≥40 years, male, Caucasian ethnicity and higher household income.
Conclusions
Residents support for policies to reduce poverty and increase funding for education, creation of health promotion and disease prevention programmes. However, support for these policies is different across social groups.



Quantifying the contribution of utility cycling to population levels of physical activity: an analysis of the Active People Survey

2017-02-02

Abstract
Background
Population levels of physical activity are far below recommendations limiting its public health benefits. Utility cycling (i.e. cycling for transport purposes) may be a means of increasing this activity. Empirical evidence quantifying the contribution of utility cycling to the population levels of physical activity is sparse.
Methods
The English Active People Survey (APS) was analysed to assess the likelihood of meeting UK physical activity guidelines in those who reported utility cycling compared with those who did not. Odds ratios were adjusted for important socioeconomic confounders using a logistic regression model.
Results
In the full sample, unadjusted odds ratio for meeting physical activity guidelines in favour of utility cyclists was 5.21 (95% confidence interval (CI) 4.96–5.47) and adjusted odds ratio was 4.08 (95% CI 3.88–4.29). The odds were even higher for utility cyclists in inner London [adjusted OR: 6.08 (4.07–7.86)]. The pattern was consistent regardless of the number of activities through which people met the physical activity guideline.
Conclusion
Utility cycling can make a significant contribution to levels of physical activity. As an activity that can easily integrate into everyday life, utility cycling appears to be a pragmatic policy option for public health decision-makers.



Socioeconomic development of cities and risk factors for non-communicable diseases: a comparative study across Brazilian state capitals

2017-02-02

Abstract
Background
Epidemiological transition in low- and middle-income countries has drawn the attention of public health policymakers to non-communicable diseases (NCDs) and their environmental and individual-level risk factors. We aimed to evaluate the association of socioeconomic indicators of Brazilian state capitals with NCD risk factors.
Methods
We used cross-sectional data from the 2011 Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL) survey. Correlations between various socioeconomic indicators of individual cities (Gross domestic product per capita, illiteracy and Gini index) and the prevalence of NCD risk factors were examined using Kendall's Tau correlation coefficient. Multilevel models were then employed to assess whether the association between these socioeconomic indicators and NCD risk factors was independent of socioeconomic status at the individual level.
Results
Stronger socioeconomic indicators were associated with a lower prevalence of irregular consumption of fruits, vegetables and leisure time physical inactivity, but with a higher prevalence of smoking and soft drink consumption. Adjustment for individual-level characteristics did not substantially alter the magnitude of these associations.
Conclusion
The socioeconomic condition of cities relates in complex ways with the prevalence of various risk factors for NCDs. For smoking and soft drink consumption, the associations observed do not reflect what is frequently reported at the individual level.



The health status of Saudi women: findings from a national survey

2017-02-02

Abstract
Background
We conducted a large national survey in the Kingdom of Saudi Arabia in 2013. We report on the health status of Saudi women and their health challenges.
Methods
A total of 10 735 participants, including 5482 women, completed the survey and were invited to local health clinics for biomedical exams.
Results
About 33.5% of women were obese and 28.0% were overweight. Hypertension was higher among women who were separated, divorced or widowed [adjusted odds ratios (AOR) = 1.6; 95% confidence interval (CI): 1.1–2.4], were obese (AOR = 2.2; 95% CI: 1.6–3.0) and had never received a routine medical exam or last received one prior to the last 2 years (AOR = 1.8; 95% CI: 1.3–2.4). Older women (AOR = 1.0; 95% CI: 1.0–1.1) and those who were separated, divorced or widowed (AOR = 1.9; 95% CI: 1.1–3.3) were more likely to be diabetics. A large proportion of diabetic women were undiagnosed (48.4%), and 27.8% of those receiving treatment had uncontrolled diabetes.
Conclusions
Our study revealed that women need to improve their health behaviors in order to reduce the burden of chronic diseases in the Kingdom. Saudi women need to be involved in the design and implementation of disease prevention and health promotion programs.



Impact of the Ebola outbreak on health systems and population health in Sierra Leone

2017-02-02

Abstract
Background
The current Ebola outbreak has proved devastating to vulnerable populations in West Africa. Health needs assessments were conducted in two districts of Sierra Leone to identify and quantify the impact of the outbreak on population health and health systems.
Methods
Mixed qualitative and quantitative methods were employed including interviews, focus groups, and interrogation and analysis of data from health facilities, district health records and burial teams. T-tests were performed to compare periods before and during the outbreak.
Results
A breakdown in relations between the health system and communities was demonstrated leading to marked and significant reductions in utilization of health facilities including: paediatric all-cause and malaria admissions, maternity admissions and attendance in the community. High avoidable all-cause mortality was identified (3.4 times higher than normally registered for the period, 42% deaths in children <5 years, 2% attributed to Ebola). Negative impacts on the health workforce, health system leadership and governance, and disruption of health programmes and systems were demonstrated. Reductions in vaccination coverage and a rise in teenage pregnancy were noted.
Conclusions
The findings indicate a public health emergency as a legacy of the Ebola outbreak. Sustained commitment of the international community is required to support health system re-building.



A statistical model to describe longitudinal and correlated metabolic risk factors: the Whitehall II prospective study

2017-02-02

Abstract
Background
Novel epidemiology models are required to link correlated variables over time, especially haemoglobin A1c (HbA1c) and body mass index (BMI) for diabetes prevention policy analysis. This article develops an epidemiology model to correlate metabolic risk factor trajectories.
Method
BMI, fasting plasma glucose, 2-h glucose, HbA1c, systolic blood pressure, total cholesterol and high density lipoprotein (HDL) cholesterol were analysed over 16 years from 8150 participants of the Whitehall II prospective cohort study. Latent growth curve modelling was employed to simultaneously estimate trajectories for multiple metabolic risk factors allowing for variation between individuals. A simulation model compared simulated outcomes with the observed data.
Results
The model identified that the change in BMI was associated with changes in glycaemia, total cholesterol and systolic blood pressure. The statistical analysis quantified associations among the longitudinal risk factor trajectories. Growth in latent glycaemia was positively correlated with systolic blood pressure and negatively correlated with HDL cholesterol. The goodness-of-fit analysis indicates reasonable fit to the data.
Conclusions
This is the first statistical model that estimates trajectories of metabolic risk factors simultaneously for diabetes to predict joint correlated risk factor trajectories. This can inform comparisons of the effectiveness and cost-effectiveness of preventive interventions, which aim to modify metabolic risk factors.



Leg-to-trunk ratio and the risk of hypertension in children and adolescents: a population-based study

2017-02-02

Abstract
Background
Blood pressure (BP) is positively associated with height in childhood; however its relationship with components of height is unclear. This study aimed to evaluate the association between ratio of height components, leg-to-trunk ratio (LTR) and high blood pressure (HBP) in Chinese children and adolescents aged 9–17.
Methods
Data of 149 073 participants enrolled in Chinese National Survey on Students' Constitution and Health in 2010 were used. HBP was defined according to sex-, age- and height-specific references. LTR was calculated by dividing leg length by sitting height and categorized as low, medium and high according to sex- and age-specific z-score.
Results
Larger LTR was associated with declined levels of BP across the height and age spectrum in both sexes. Boys and girls with high LTR were associated with decreases of 5.4 (95% confidence interval: 4.6, 6.2) and 2.7(2.0, 3.4) % in HBP, respectively, compared with their peers of low LTR. A similar pattern was also observed in different age, urban/rural area and body mass index strata.
Conclusions
Low LTR was associated with elevated risk of HBP in youths. Our findings support using LTR to identify children and adolescents at elevated risk of hypertension in early life.



The serum copper/zinc ratio in childhood and educational attainment: a population-based study

2017-02-02

Abstract
Background
Micronutrients are potentially important determinants of adult outcomes such as educational attainment. Copper and zinc have known effects on several medical conditions and cognitive development. Elevated copper and depressed zinc is a common trace metal imbalance.
Methods
We estimate the correlation between the copper/zinc ratio (Cu/Zn) in childhood (year 1980) and educational attainment in adulthood (year 2010). We use the Young Finns Study (YFS) combined with the Finnish Linked Employer-Employee Data (FLEED). The regression models account for confounders such as other biomarkers and parental observables.
Results
We report a sizeable, negative correlation between Cu/Zn and educational attainment as measured by education in years, grades as well as the likelihood of completing university education. For example, a one standard deviation increase in Cu/Zn decreases the probability of university education by ∼4%.
Conclusions
The findings are consistent with a Cu/Zn effect influencing cognitive functioning early in life. Future research should explore more deeply the precise mechanisms by which Cu/Zn affects educational attainment.



The economic benefits of high CD4 counts among people living with HIV/AIDS in Zambia

2017-02-02

Abstract
Background
The economic effects of poor immunologic recovery among HIV-infected patients receiving antiretroviral therapy (ART) in sub-Saharan Africa are not well understood. We examined the relationship between the CD4 counts of patients on long-term ART and employment outcomes in HIV-affected households in Lusaka, Zambia.
Methods
Administrative data and a household survey captured information on the clinical records, demographics and employment outcomes of the ART-treated adults and their adult family members (n = 311). Multivariable regression analyses were used to assess relationships between CD4 counts of ART-treated adults and household employment outcomes.
Results
Patients with a CD4 count of at least 350 cells/µl were 22 percentage points more likely to be engaged in the labor force (P < 0.05) and worked ∼6 more days per month (P < 0.05) and 9 more hours per week (P = 0.05) compared with patients with a CD4 count <350 cells/µl. Non-patient adults in the HIV-affected household had significantly higher labor participation if the patient's CD4 count was ≥500 compared with <500 cells/µl (P < 0.05), but this was not significant for a CD4 ≥350 versus <350.
Conclusion
These findings suggest that interventions to improve or maintain robust immune recovery during ART may confer economic benefits for both HIV-infected individuals and HIV-affected households.



Script in a Day intervention for individuals who are injecting opioids: a feasibility randomized control trial

2017-02-02

Abstract
Background
Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID feasibility trial explored the processes of conducting a randomized control trial (RCT) with people who inject drugs (PWID) in a low-threshold agency. Feasibility of the intervention investigated whether offering PWID immediate access to OST via specialist primary care increased numbers in OST at 3 months, compared with offering advice and case management.
Methods
Un-blinded RCT was conducted at Bristol Drugs Project needle exchange. A total of 311 individuals were eligible and 100 consented to participate. Trial process outcomes involved exploring OST status at 3 months; secondary outcomes were substance use and health-related quality of life measures.
Results
Follow-up was 86%. At 3 months, 51% intervention and 47% of control participants were in OST (OR of success of intervention 1.17 (0.54–2.57)). Opioid use reduced by 79 and 73%, respectively (OR of intervention success 1.38 (0.5–3.7)). Physical and mental health improved but there was little differences between groups.
Conclusions
The feasibility of conducting the trial was a success, but there was insufficient evidence of an effect compared with intensive case management. Further development and evaluation of case management approaches in low-threshold agencies is warranted.



Non-prescription medicine misuse, abuse and dependence: a cross-sectional survey of the UK general population

2017-02-02

Abstract
Background
Non-prescription medicines (NPMs) can be misused, abused or lead to dependence, but the prevalence of these problems within the UK general population was unknown. The aim of this study was to estimate the prevalence of self-reported misuse, abuse and dependence to NPMs.
Methods
A cross-sectional postal survey was sent to 1000 individuals aged ≥18 randomly drawn from the UK Edited Electoral Register.
Results
A response rate of 43.4% was achieved. The lifetime prevalence of NPM misuse was 19.3%. Lifetime prevalence of abuse was 4.1%. Younger age, having a long-standing illness requiring regular NPM use and ever having used illicit drugs or legal highs were predictive of misuse/abuse of NPMs. In terms of dependence, lifetime prevalence was 2% with 0.8% currently dependent and 1.3% dependent in the past. Dependence was reported with analgesics (with and without codeine), sleep aids and nicotine products.
Conclusion
Given the increasing emphasis on self-care and empowering the public to manage their health with NPMs, the findings highlight the need for improved pharmacovigilance of these medicines to maximize benefits with minimal risk. Healthcare providers need to be aware of the potential for misuse, abuse and dependence, particularly in patients with long-term illness.



Greater fruit selection following an appearance-based compared with a health-based health promotion poster

2017-02-02

Abstract
Background
This study investigated the impact of an appearance-based compared with a traditional health-based public health message for healthy eating.
Methods
A total of 166 British University students (41 males; aged 20.6 ± 1.9 years) were randomized to view either an appearance-based (n = 82) or a health-based (n = 84) fruit promotion poster. Intentions to consume fruit and immediate fruit selection (laboratory observation) were assessed immediately after poster viewing, and subsequent self-report fruit consumption was assessed 3 days later.
Results
Intentions to consume fruit were not predicted by poster type (largest β = 0.03, P = 0.68) but were associated with fruit-based liking, past consumption, attitudes and social norms (smallest β = 0.16, P = 0.04). Immediate fruit selection was greater following the appearance-based compared with the health-based poster (β = −0.24, P < 0.01), and this effect remained when controlling for participant characteristics (β = −0.21, P < 0.01). Subsequent fruit consumption was greater following the appearance-based compared with the health-based poster (β = −0.22, P = 0.03), but this effect became non-significant on consideration of participant characteristics (β = −0.15, P = 0.13), and was instead associated with fruit-based liking and past consumption (smallest β = 0.24, P = 0.03).
Conclusions
These findings demonstrate the clear value of an appearance-based compared with a health-based health promotion poster for increasing fruit selection. A distinction between outcome measures and the value of a behavioural measure is also demonstrated.



Preventive behaviors and perceptions of influenza vaccination among a university student population

2017-02-02

Abstract
Background
Every year during influenza season, preventable illnesses occur due to lack of vaccination and failure to adopt the preventive behaviors known as non-pharmaceutical interventions (NPIs). In an effort to study the impact of preventive strategies and policies on behavioral changes during the spread of the H1N1 pandemic in 2009, we examined a sample of undergraduate, graduate and business students at the Massachusetts Institute of Technology (MIT).
Methods
An online survey was completed by 653 students to assess NPI use, perceptions of influenza vaccinations and effectiveness of preventive health policy strategies during the 2009 H1N1 outbreak. Strategies included e-mails and text messages, posters in corridors and restrooms, and videos. These strategies were implemented during both the first and second waves of the 2009 H1N1 pandemic.
Results
Despite the widespread campaign, fewer than half of the respondents reported modifying their behaviors. We discovered that >70% of the respondents did not practice any NPIs, and more than half showed lack of knowledge of flu vaccinations.
Conclusions
Our study results indicate a need for more effective strategies to encourage NPI practices in student populations during outbreaks of infection.



Factors associated with the uptake of seasonal influenza vaccination in adults: a systematic review

2017-02-02

Abstract
Background
Studies on different populations have shown that a variety of factors influence attitudes and decision in the general population on vaccine uptake. This study explores factors associated with the uptake of influenza vaccination among adults.
Methods
A systematic literature review was performed on literature searched in databases EMBASE, MEDLINE, Cochrane Library and Electronic Theses Online Service up until November 2013. A critical appraisal framework was designed to assess the methodological quality of the studies.
Results
Twenty-three articles met the inclusion criteria and were selected for outcome analysis and 21 were quantitative observational studies. Advancement in age (OR 1.06–23.7) and having chronic diseases (OR 1.38–13.7) were strongly indicative of vaccine uptake. Perceptions on vaccine efficacy (OR 2.7–10.55) and vaccine safety and adverse events (OR 10.5) were more influential than the level of knowledge on influenza and its vaccination. Advice from doctors/health professionals/family and/or close friends and free vaccination were also key factors in association with uptake of vaccination.
Conclusions
This review highlighted the finding that perception on vaccine efficacy, perception on vaccine safety and adverse events, advice from doctors/health professionals/family/close friends and free vaccination are changeable factors that are strongly associated with influenza vaccination in adults aged 18–64.



Impact of physical activity on self-rated health in older people: do the effects vary by socioeconomic status?

2017-02-02

Abstract
Background
Many studies have demonstrated the relevance of socioeconomic status (SES) and physical activity (PA) on health among older people. However, little is known about the existence of interaction effects between PA and SES on self-rated health.
Methods
The following questions were investigated among people aged 65–84: (i) What is the impact of SES (school education and income) and PA on good self-rated health of the following year? and (ii) Do individuals with higher SES benefit more from PA than those with lower SES? Based on data of the German Socioeconomic Panel (GSOEP), binary logistic regression analyses were used to calculate odds ratios and synergy indices (SAB).
Results
High education in women and high income in men were positively associated with good self-rated health. Physically active older people with lower SES had a better chance of good health than those with higher SES and without PA. In the presence of PA, the effect of SES on health was attenuated.
Conclusions
Poor evidence was found for synergistic effects between PA and SES, indicating that the effect of PA on health does not differ across SES groups. In support of the mediation hypothesis, our findings suggest that PA accounted for some of the effects of SES on health.



Tuberculosis screening among asylum seekers in Sardinia

2017-02-02

Abstract
Background
In Italy, the guidelines for preventing Tuberculosis (TB) include X-ray screening and application of the Mantoux test for migrants from TB-endemic countries as soon as possible after admission to Italy. This article describes a screening survey conducted in the reception center for asylum seekers in Northern Sardinia.
Methods
The screening tests of Mantoux, chest X-ray, QuantiFERON TB Gold and Inducible-protein-10 were carried out on 109 subjects came from Africa and Asia.
Results
Mantoux was positive in 40 subjects and negative in 69. Chest X-rays were performed in all of the 40 Mantoux-positive subjects, and it was negative. QuantiFERON was positive in 16 refugees, negative in 92 and indeterminate in 1. A positive Inducible-protein-10 response was observed in 29 subjects, while a negative result was detected in 80 subjects.
Conclusions
Our results showed that the Mantoux may not be a suitable screening test in the migrant population considering its low specificity. QFT may be more suitable to identify subjects with tubercular infection may to receive preventive therapy, although its sensitivity could be increased by the Inducible-protein-10.



Explaining the gap in the use of maternal healthcare services between social groups in India

2017-02-02

Abstract
Background
To further reduce the maternal mortality ratio, India needs to narrow down the social inequity in the use of maternal healthcare services. This study quantifies the contribution of factors explaining the average gap in the use of full antenatal care, medical assistance at delivery and postnatal check-ups between scheduled castes/scheduled tribes (SCs/STs) and the remaining population in India.
Methods
Using the most recent round of the National Family Health Survey conducted during 2005–06, this study quantifies the contribution of selected predictors explaining the gap in the use of maternal healthcare services between SCs/STs and the remaining population.
Results
Coverage of all three services is considerably lower among women of SCs/STs than the remaining population. Differences in household wealth contribute ∼37–55% of the gap in the use of the services between the social groups. A considerable part of the gap in coverage of medical assistance at delivery and postnatal check-ups is contributed by differences in the coverage of antenatal care.
Conclusions
The Indian constitution provides reservation for SCs/STs in enrolment in government educational institutions and jobs. There is a need for special policy in a similar way, to increase the coverage of maternal healthcare services among SC/ST women of the country.



The impact of a co-payment on the cost-effectiveness of screening for diabetic retinopathy

2017-02-02

Abstract
Background
To determine the impact of a co-payment on the cost-effectiveness of systematic screening for diabetic retinopathy in Hong Kong (HK).
Methods
An analysis was conducted from provider and societal perspectives. A Markov cohort model was used to determine the cost-effectiveness of screening with a co-payment of HK$60 (US$7.7) compared with free screening, with and without an assumption that the inverse care law (ICL) would operate in the presence of a fee as seen in our previous data.
Results
From the provider perspective, the incremental cost-effectiveness ratio (ICER) of free versus pay systematic screening was HK$166 558 (US$21 354)/extra quality adjusted life year (QALY) gained assuming an effect of the ICL and free screening was always more cost-effective than pay screening when willingness to pay for a QALY was HK$124 488 (US$15 960) or above. Without an effect of the ICL, the ICER was HK$480 479 (US$61 600)/extra QALY gained. From the societal perspective, the ICER was HK$144 046 (US$18 467)/extra QALY gained with an effect of the ICL and HK$199 741 (US$25 608)/extra QALY gained with no effect.
Conclusions
Free systematic screening was highly cost-effective from the societal perspective compared with screening with a small co-payment irrespective of the effects of the ICL. From the provider perspective, free screening was highly cost-effective if the ICL operates.



Changes in over-the-counter drug misuse over 20 years: perceptions from Scottish pharmacists

2017-02-02

Abstract
Background
Over-the-counter (OTC) medicines are available without prescription, allowing convenience and facilitating self-care. As more OTC drugs become available, concerns regarding misuse have increased. This study explored pharmacists' perceptions about OTC drugs misuse, products involved and measures taken to address misuse.
Methods
This was a cross-sectional postal survey. A questionnaire, based on one used previously (1995, 2000 and 2006), was posted to all community pharmacists in Scotland (n = 1246) in 2014. Questions related to suspected OTC misuse in their area, the products involved and resultant changes in policy. Data were managed and analysed in SPSS. Descriptive frequencies and χ2 tests of association are reported. Responses were compared across the four cohorts.
Results
The 2014 response rate was 57% (709). The proportion of pharmacists reporting suspected OTC misuse increased to 80.8% from 70.8% in 2006. Codeine-containing products were most frequently perceived to be misused; previously Nytol (diphenhydramine) had been most cited. Of pharmacists reporting suspected misuse, 91.3% had altered policies, including refusing sales and referring patients elsewhere.
Conclusions
Pharmacists are increasingly reporting OTC misuse in their areas, particularly involving codeine products. The majority adapted sales policies to reflect these concerns.



Hospital mortality rates and place of death

2017-02-02

Abstract
Background
Hospital standardized mortality rates (HSMRs) are considered to identify unsafe hospital care, but are criticized for disregarding unmeasured variations of both coding practice and outside of hospital palliative provision.
Methods
The validity of HSMR methods is explored by examining whether the additional deaths implied by a Primary Care Trust (PCT) HSMR, as supplied by Dr Foster, are (i) detectable in English PCT mortality data and (ii) correlated with the percentage of PCT deaths out of hospital.
Results
Higher PCT HSMRs were positively associated with higher area mortality, although this effect was significantly smaller than the HSMR model implies. There was a significant negative association between PCT HSMR and the percentage of deaths outside of hospital.
Conclusions
This evidence suggests that the PCT HSMR is associated with all-cause area mortality, but it overstates the in-hospital mortality attributed to unsafe care. It also suggests that this overstatement is partially explained by the PCT HSMR reflecting the adverse case mix associated with a high share of deaths in hospital, i.e. the HSMR does not only reflect quality failings. Policy analyses that compare HSMRs to measure quality change may be biased by unbalanced samples of hospital patients.



Excess winter deaths in 30 European countries 1980–2013: a critical review of methods

2017-02-02

Abstract
Background
Extreme temperatures (both excess heat and excess cold) are associated with elevated mortality risk.
Methods and Results
This article reviews historical data on cold-related deaths in Europe (1980–2013). It outlines the classic ‘excess winter deaths’ methodology used to estimate cold-related mortality and explores the inaccuracies that are associated with this generic estimation method: it yields relatively accurate estimates of the actual public health impacts of cold temperatures in only 2 of 30 European countries. This is an issue of concern, given the prominent role of excess winter deaths monitoring in public health policymaking and research. An alternative estimation method is proposed, based on heating degree days, which could yield more accurate estimations of the public health implications of cold weather in Europe, and how these vary across different countries.
Conclusions
Further research is needed to scrutinize core assumptions underlying excess winter death methodology, particularly as to whether it has equal validity for estimating public health impacts across the widely diverse climatic conditions that prevail across Europe. In the meantime, given data on heating degree days are freely available for European countries, it is recommended that this approach replaces the conventional methodology.



Pilot study linking primary care records to Census, cardiovascular hospitalization and mortality data in Scotland: feasibility, utility and potential

2017-02-02

Abstract
Background
There are substantial ethnic variations in the risk of cardiovascular disease (CVD)-related hospitalization and mortality in Scotland. We piloted extracting and linking primary care risk factors to Scottish Census and health data, to test the feasibility of further investigating these variations.
Methods
Data extracted from 10 general practices were linked at individual level to Census and hospitalization/death records. Linkage rates, reasons for non-linkage and completeness of primary care data were examined. CVD relative risks were calculated, adjusting for age, socioeconomic status and primary care-derived risk factors.
Results
Practice enrolment and data extraction proved challenging. Primary care records for 52 975 (55.2%) people were linked to Census data. Completeness and validity of risk variables were similar across ethnic groups. A total of 48 325 (91.2%) records had a valid smoking status recorded and 2900 (5.5%) people had a primary care record of diabetes. Ethnic-specific adjusted estimates of CVD risk were plausible and consistent with previous work.
Conclusions
Risk factor data extracted from primary care were of good quality and successfully linked to national Census records. Given further methodological refinement, this method illustrates the potential value of linkage using national primary care datasets to contribute to public health surveillance and research.









Multinomial logistic regression to estimate and predict perceptions of bicycle and transportation infrastructure in a sprawling metropolitan area

2017-02-02

Abstract
Background
Inactivity levels in the USA are considered a critical public-health issue. Promoting physical activity through active transportation may prove effective to increase activity levels. The purpose of this study was to understand perceptions and likelihood of using various bicycle infrastructures for transportation by Las Vegas residents.
Methods
A survey was developed and administered (n = 457). Multinomial regression was used to create predictions to determine which infrastructures were perceived as safe and most likely to be used for transportation; frequencies were analyzed.
Results
The infrastructure chosen least often (2.2%) had the least amount of distance separating bikers from vehicles, and the least amount of protection. The type most likely to be used (27.6%) contained the most signage and significant separation from vehicles. The infrastructure least likely perceived to be adequate for biker safety was a shared bus/bike lane with 19.4% agreeing this was safe. Probabilities revealed differences in infrastructure preferences based on demographic characteristics.
Conclusions
In order to increase active transportation rates effectively, residents' perceptions of safety and infrastructure preferences should be considered. Results from this study showed that respondents had many safety concerns with the current bicycling infrastructure in Las Vegas and provided ideas for future infrastructure investments and related policies.



Economic shocks and health resilience: lessons from the Russian Federation

2017-02-02

Abstract
Background
Despite extensive research on determinants of health, there is much less information on factors protecting health among those exposed to economic shocks. Using longitudinal data from the Russian Federation in the post-Soviet period, we examined individual-level factors that enhance resilience of health to economic shocks.
Methods
Logistic regression analysed factors associated with good self-assessed health (SAH) and health resilience, using pooled samples from the Russia Longitudinal Monitoring Survey-Higher School of Economics (1994–2012).
Results
The general population consistently reported ‘average’ SAH, indicating almost invariant trends over the years. Male gender was the strongest predictor of good SAH and health resilience. Other factors positively associated with good SAH were age, higher education, employment, residing in rural areas, living in a larger and/or non-poor household. Among unemployed and those remaining unemployed, residing in rural areas, living in a larger and/or non-poor household remained the strongest predictors of good SAH and health resilience. These same factors were also important for males with recent job loss.
Conclusions
Several factors predicting good SAH in the general population also influence health resilience factors among those remaining unemployed and experiencing a job loss. Such factors help to identify those most vulnerable and aid targeting assistance during economic crises.



Does access to water matter? A study on the nutritional status of primary-aged children in India

2017-02-02

Abstract
Background
Although the determinants of nutritional status, which is critical to children's well-being, have been extensively studied in developing countries, there is very little understanding of the relationship between nutritional status among children and water access. This study attempts to fill this gap in the literature by studying primary-aged children (aged between 6 and 14) in India.
Methods
Using individual-level data from the India Human Development Survey, the article employs an ordered response model to analyze the impact of access to water and its implications for children's nutritional status outcomes. Other than access to water, a variety of confounding factors such as sex, age, measure of family income status and composition of food consumption are included as independent variables.
Results
The results show that access to water decreases primary-aged children's likelihood of being thin and super thin by ∼1%, while it will increase their chances of having a normal weight by ∼2% in India. Transferring these estimates into population size, access to water can potentially decrease the number of thin and super thin primary-aged children by 1 841 101, and it can possibly increase the number of normally weighted primary-aged children by 3 682 203.
Conclusions
These empirical findings show that improving access to drinking water is critical to advance the nutritional status of children in India.



Meeting and missing targets: the public health dynamics of water and sanitation in Ghana

2017-02-02

Abstract
Background
Access to clean water and good sanitation are very important barometers of a healthy nation as the two are sine qua non to reducing many diseases. The interaction between water and sanitation on the one hand and the public health issues arising from in(efficient) systems of water and sanitation on the other hand have been well encapsulated in the Millennium Development Goals (MDGs) 7c. However, very little is known about the public health dynamics of water and sanitation and the rural–urban divide in accessing these services. This article analyses the trends and distributional concerns of the two MDGs to inform public health policy.
Methods
The study is a survey of secondary data on water and sanitation obtained from the World Development Indicators of the World Bank and the Joint Monitoring Programme (JMP) of UNICEF and WHO. An unobserved component model was used to decompose the data into its permanent and temporal components. Forecasts are then carried out to ascertain the ability of Ghana to meet the targets of MDG 7c.
Results
The results of the study showed that Ghana has achieved the MDG target of access to improved water. The sanitation target has been missed, and there is no evidence that it would be met in the short to medium term.
Conclusions
An integrated approach to bridging the rural–urban divide in access to improved water and sanitation in Ghana is recommended.



Optimizing intersectoral collaboration between health and education: the Health Bridges study

2017-02-02

Abstract
Background
Schools are increasingly asked to participate in a range of public health programs, but there has been little consideration of the impact of these programs on policy and/or implementation. We investigated intersectoral collaboration between the health and education sectors using a case study of a school-based immunization program (SBIP).
Methods
The study was undertaken in South Australia. We undertook an ethnographic review examining health and education system functioning at a variety of levels using a mixed methods approach, informed by an interactive and multidirectional knowledge transfer framework.
Results
Facilitators for intersectoral collaboration included: explicit responsibilities for specific activities; clear communication channels; including the core values of each sector in planning and implementation; and collaborative development of health educational programs. Including consumers as key stakeholders in planning and implementing intersectoral programs is important. While the SBIP itself is currently successful, threats to its sustainability were identified.
Conclusions
Outcomes included: (i) a clearer understanding of the functioning of the SBIP in SA including wide-ranging and practical recommendations to facilitate the implementation of the program in both sectors, including revisions to enhance the experience for students; (ii) a broader outcome focusing on identification of barriers and facilitators for intersectoral collaboration and suggestions for enhancing such collaborations.



Revisiting the risks associated with health and healthcare reform in England: perspective of Faculty of Public Health members

2017-02-02

Abstract
Background
The Health and Social Care Act 2012 (H&SCA) provided for sweeping changes to the health and healthcare system in England. The UK Faculty of Public Health (FPH) considered the risks of the proposed legislation and remains opposed to many of the Act's provisions.
Methods
Cross-sectional electronic survey of membership, on the severity and likelihood of risks identified in FPH's original risk assessment.
Results
Combined severity/likelihood scores rated all risks as severe or high. Respondents identified risks to infrastructure for local public health, healthcare planning and delivery and public health careers as most likely and as having the most severe consequences. Proposals for remediation included review, public health advocacy, co-ordinated working across organizational boundaries and further legislation. However, some respondents considered the current arrangements as irredeemable and advocated revoking the act and undertaking structural reorganization. Ten per cent of eligible members responded. Respondents were more likely than the general membership to be in senior roles, with longer FPH membership.
Conclusions
Surveying public health professionals can provide insights into health and healthcare policy and its implementation. Their insights can assist in both further policy formulation and mitigation of risks for population health and health care.



Developing virtual public health networks: aspiration and reality

2017-02-02

Abstract
Background
This paper presents the results of an exercise to scope the potential of a virtual network to support dissemination, collaboration and innovation among the UK research community on the topic of ‘work and health and well-being’.
Methods
Through a search of the literature and internet searches, a database of 333 individuals and 10 organizations (stakeholders) was developed to whom an online questionnaire was sent. The questionnaire scoped the potential of a virtual network on work and health and well-being. We compared respondents' aspirations for a network with the critical management literature examining the core conditions under which networks work best.
Results
We identified 1435 papers, published since 2008. In the UK, 333 individuals and 10 organizations were identified as working within the broad topic of Work and Health and Well-being. Of the 110 (a 34% response) responses to our online questionnaire, the majority (80%, n = 88) stated they would be interested in joining a virtual network.
Conclusions
Respondents indicated a willingness to engage with the network. They had a range of ideas regarding how a network could operate, which broadly match the conditions that support network effectiveness. A virtual-enabled network would be best supplemented by opportunities for face-to-face interaction.



Variations in coronary mortality rates between English primary care trusts: observational study 1993–2010

2017-02-02

Abstract
Background
In England, coronary heart disease (CHD) mortality has declined, but variations remain.
Methods
This study aimed to describe under 75-year CHD mortality variations across geographically defined populations. Regression slopes for mortality data as a function of time were calculated for all 151 English primary care trusts (PCTs), giving the change in the expected age adjusted rate for each extra year.
Results
Between 1993 and 2010, the mean age-standardized CHD mortality rate decreased from 107.76 to 35.12 per 100 000, but the coefficient of variation increased from 0.21 to 0.27. The slope of decline was significantly less after 2004 (β −4.91 for 1993–2003, −3.04 for 2004–2010). The proportion of smokers decreased by 24.6%. The estimated proportion of the population with controlled hypertension increased by 74.4% (2003–2010), but diabetes increased by 138% (1994–2010) and the proportion of obese people increased by 74.3% (1993–2010). There was a greater decline in CHD mortality in PCTs with greater deprivation and smoking (2006–2010).
Conclusions
Since 2004, there has not been a relative reduction of variations in CHD mortality. Appropriate strategies to improve early detection and effective management of risk factors are needed to lower overall CHD mortality further and to reduce persistent variations across England.



The impact of injuries on health service resource use and costs in primary and secondary care in the English NHS

2017-02-02

Abstract
Background
Injuries in working age adults are common, but few studies examine NHS resource use or costs.
Methods
Costing study based on a cohort of 16- to 70-year olds admitted to hospital following unintentional injury in NHS Trusts in four UK centres. Participants completed resource-use questionnaires up to 12 months post-injury. Primary and secondary care, aids, adaptations, appliances and prescribed medications were costed. Mean costs by injury type and age group and costs per clinical commissioning group (CCG) were estimated.
Results
A total of 668 adults participated. Follow-up rates ranged from 77% at 1 month to 65% at 12 months. The mean cost of injuries over 12 months was £4691 per participant. Costs were highest for hip fractures (£5159), lower limb fractures (£4969) and multiple injuries (£4969). Secondary care accounted for 87% of mean costs across all injuries and primary care for 10%. The mean cost per CCG was £7.3 million (range £1.8 million–£25.6 million). The total cost across all English CCGs was £1.53 billion.
Conclusions
Unintentional injuries in working age adults result in high levels of NHS resource use and costs in the year following injury. Commissioning effective injury prevention interventions may reduce these costs.



Do social factors affect the place of death? Analysis of home versus institutional death over 20 years

2017-02-02

Abstract
Background
Understanding determinants of place of death is important for public health policy aimed at improving the quality of end-of-life care. This study examines whether place of death is correlated with socioeconomic position (SEP).
Method
Examined data are 92 283 deceased between 1977 and 1999, issued from a 1% sample of the French population linked to corresponding death certificate data. A multivariate logistic regression was used to examine the associated factors.
Results
The place of death varied according to time period, demographic factors (age and gender), marital status and causes of death. Individuals with higher levels of education died more frequently at home. No clear link was found between place of death and social class. However, the self-employed and farmers were more likely to die at home. These results varied little among the study periods.
Conclusion
Although people in France often prefer to die at home, most people do not. The chances that they were able to die where they preferred seem to vary according to SEP. The home deaths are coincident with social and educational resources, as well as lifestyle and family solidarity.



The association between taxation increases and changes in alcohol consumption and traffic fatalities in Thailand

2017-02-02

Abstract
Background
In 2005, 2007 and 2009, alcohol taxation rates changed in Thailand. It is unknown if these changes are associated with alcohol consumption and traffic fatality rates.
Methods
Using monthly data from October 2004 to September 2011, we examined the relationship between alcohol taxation rate changes adjusted for inflation and changes in adult per capita consumption of alcohol (data obtained from the Excise Department) and the rate of traffic fatalities (data obtained from the National Police Institute).
Results
Only the taxation increase in 2009 was significantly associated with an immediate and sustained reduction of 0.38 (95% confidence interval (CI): 0.24–0.52) fatalities per 100 000 people per 30 days. The 2005, 2007 and 2009 taxation increases were associated with immediate and sustained reductions of 0.07 (95% CI: 0.04–0.09), 0.06 (95% CI: 0.02–0.10) and 0.05 (95% CI: 0.01–0.09) litres of pure alcohol consumption per capita per 30 days, respectively.
Conclusions
This is the first study to examine the impact of taxation on alcohol-related harms in a low- to middle-income country. Taxation changes were associated with reductions in the rate of traffic fatalities and in alcohol consumption; however, reductions of traffic fatalities were not always significant.



Improving the help and support provided to people who take new psychoactive substances (‘legal highs’)

2017-02-02

Abstract
Background
There are over 450 new psychoactive substances (NPS) circulating in Europe. In 2013, NPS were found to be a potential contributor to 60 drug deaths in Scotland. However, beyond these statistics, we know very little about the public health impact of NPS.
Methods
We used mixed methods to inform a needs assessment for Tayside: (i) routine data analysis, (ii) anonymous online survey and (iii) discussions with professionals and local community groups with either first-hand experience of NPS or knowledge of others who had taken NPS.
Results
Routine data are limited. Six hundred and eighty-seven people responded to the survey, 401 with direct or indirect experience of NPS. NPS were most commonly obtained from shops (n = 173) or friends (n = 110). Respondents replied with 94 different names for NPS taken. One hundred and nine respondents reported instances where emergency medical help for NPS use had been required. Qualitative survey answers and discussions highlighted the adverse impact NPS can have on mental health and well-being in particular.
Conclusions
NPS are varied, easily accessible and can cause significant harm. We recommend that there should be improved data collection, raised awareness, restricted access, improved information sharing around NPS and the development, monitoring and evaluation of NPS-specific support delivered by services.



Women's perceptions of heart disease and breast cancer and the association with media representations of the diseases

2017-02-02

Abstract
Background
This research examined differences in perceptions of heart disease compared with breast cancer and if the differences are reflected in media presentations of the diseases. Relationships of differences in perceptions to demographic groups, heart disease risk factors and health behaviors were examined.
Methods
Study 1 was a quantitative content analysis of articles and advertisements related to heart disease or breast cancer.
Results
There were greater perceptions of susceptibility, preventability and controllability of heart disease and lower perceptions regarding seriousness, fearfulness and extent to which family history determines disease development of heart disease compared with breast cancer. Five times more pieces related to breast cancer were found compared with heart disease. Study 2 was a survey of 1524 women. More articles and advertisements about breast cancer than heart disease were found, and survey participants reported seeing significantly more breast cancer than heart disease media. Younger women had greater perceived susceptibility of breast cancer relative to heart disease while the content analysis revealed that the heart disease pieces were more likely to feature women older than 40 years of age.
Conclusions
This research is an important step in the development of theories regarding causal effects of media on health perceptions and behaviors.



Sports participation as an investment in (subjective) health: a time series analysis of the life course

2017-02-02

Abstract
Background
The causal relationship between sports participation, as physical activity, and subjective health is examined accounting for the London 2012 Olympic Games, which it was hoped would ‘inspire a generation’ by contributing to public health. Improvements to weaknesses in the literature are offered. First, stronger causal claims about the relationship between sports participation and health and second, the actual minutes and intensity of different measures of participation are used.
Methods
The rolling monthly survey design of the annually reported Taking Part Survey (TPS) is used to create time series data. This is analysed using a time series modelling strategy.
Results
Increases in the level of subjective health requires accelerating sport participation, but no effect from the 2012 Olympics is revealed. Reductions in the level of health are brought about by increases in sports participation in early adulthood, although this gets reversed in middle age. However, a reduction in health re-emerges for older males compared with females.
Conclusions
For the population as a whole, sport can contribute to health, with diminishing impact, but impacts vary across the life course and genders. Policy accounting for these variations is necessary. Policy aspirations that London 2012 would produce health benefits from increased sports participation are misplaced.



The need to implement effective new entrant tuberculosis screening in children: evidence from school ‘outbreak’

2017-02-02

Abstract
Background
In January 2013 a secondary school pupil in London was diagnosed with sputum-smear positive pulmonary tuberculosis (TB) and was started on treatment. In April 2013 another pupil in the same year group at the same school was diagnosed with sputum-smear positive pulmonary TB. Pupils in the same year were then screened for tuberculosis.
Methods
Interferon gamma release assay (IGRA) testing was used to identify those infected with tuberculosis. Further tests were conducted to identify contacts with active tuberculosis disease and specimens were sent for genotypic testing.
Results
Two hundred and seventy-one contacts were identified, of whom 202 (75%) attended for screening. Two further cases of culture confirmed TB were diagnosed and six cases of latent TB were diagnosed. Molecular typing of the four TB cases revealed three genotypically unrelated strains.
Conclusions
The genotyping has helped challenge widely held assumptions that TB cases detected via contact tracing in schools indicate in-school transmission. Routine screening of children newly arrived from TB endemic countries should be proactively carried out, as recommended by National Institute for Clinical Excellence (NICE) guidelines, in order to avoid preventable morbidity from TB disease in children.



Evaluation of NHS Health Checks provided by community pharmacies

2017-02-02

Abstract
Background
Community pharmacy is a potentially useful, easily accessed provider of NHS Health Checks. Little published work has reported outcomes or sought views of pharmacy Health Check attenders. This evaluation assessed findings of pharmacy Health Checks plus subsequent attendance after referral to general practices and obtained client views.
Methods
Mixed methods including: data abstraction from Health Check and practice records, questionnaire to all attenders and interviews with sample of questionnaire respondents.
Results
Data from 190 pharmacy Health Checks, performed in four pharmacies, showed that the majority of attenders (58%) were female, 53% white, with 80% aged under 55. Seventy five per cent had at least one modifiable cardiovascular risk factor, 8% had a cardiovascular disease risk score of ≥20%, 30% were referred to their practice for further tests/consultation, but only half of these attended. Lifestyle advice was offered to 74% and referral for support with changing lifestyle accepted by 20%. Survey respondents (66) were unrepresentative and fewer had modifiable risk factors. Many indicated that making lifestyle changes and their views on pharmacy Health Checks were positive, particularly reflecting accessibility.
Conclusions
Pharmacy NHS Health Checks reach people with modifiable risk factors, identify those requiring further investigation and refer appropriately. Greater emphasis and encouragement are required to act on referrals if Health Checks are to maximize benefits.



Trends in amenable deaths based on township income quartiles in Taiwan, 1971–2008: did universal health insurance close the gap?

2017-02-02

Abstract
Background
Few studies have explored the association between income and mortality in Asian populations. We documented the temporal trend in amenable mortality in Taiwan based on township income quartiles between 1971 and 2008, and analyzed whether universal access to care implemented in 1995 eliminated any income-based mortality disparities.
Methods
Data were obtained from Taiwan's National Death Certification Registry and the National Statistics Bureau. Age-standardized mortality rates (ASMRs) were calculated, disaggregated by gender and township income quartiles. Segmented regression analyses were performed and slope indices of inequality were calculated to assess the impact of universal access on amenable mortality.
Results
ASMRs for deaths amenable to medical care fell for all income quartiles, but by greater magnitudes for the richer townships from 1971 to 2008. For virtually all deaths amenable to medical care, the richer townships had the lowest ASMRs by 2006–08. Universal access to care may have slowed the growth of ischemic heart disease for men living in the poorest townships, but its impact on aggregate amenable mortality was limited.
Conclusions
An income gradient persisted throughout the study period. Guaranteed access to medical care may have helped reduce but did not eliminate the income gradient in mortality disparities.



Psychosocial exposures and mental health: distribution by gender and occupational class in a population-based study

2017-02-02

Abstract
Background
To estimate the association between exposures to psychosocial risks and risk of minor psychiatric disorder (MPDR) among the working population of Catalonia in 2010, by gender and occupational class.
Methods
The analysis is based on a sample, corresponding to the year 2010, of workers in Catalonia (n = 2741). We calculated the prevalence [and 95% confidence interval (95% CI)] of MPDR, stratifying by occupational class, age and sex, and by the different psychosocial exposures. Prevalence ratios (PR) were estimated between MPDR and the different psychosocial exposures using Poisson regression modelling with robust variance estimates.
Results
The main results show that the prevalence of MPDR was ∼12.3% (95% CI: 10.8; 13.8), being higher in women than in men (15.1 and 9.7%, respectively). Workers exposed to each of the various psychosocial dimensions, except for low Control and Double Presence, present significantly higher prevalences of MPDR than non-exposed workers. Differences in terms of gender and occupational class were glimpsed.
Conclusion
These results highlight the important contribution of psychosocial risk exposures to the MPDR among the working population, and consequently that there is a need to improve workplace psychosocial environments.



Health-seeking behaviour during times of illness: a study among adults in a resource poor setting in Ghana

2017-02-02

Abstract
Background
The implementation of the National Health Insurance Scheme (NHIS) in Ghana aims to bridge the gap between the poor and rich in health-care access and utilization. Guided by Andersen's behavioural model of health services utilization, we examine the factors that influence health-care services utilization in a resource poor setting.
Methods
Data for the study were obtained through randomly selected respondents in our study location (n = 1137). Logistic regression models were fitted to the data to examine the impact of enabling, predisposing and need factors on health-care-seeking behaviour during last illness.
Results
Individuals in the poor and poorest wealth quintiles who are enrolled in the NHIS were less likely to seek treatment in a health facility during their last illness compared with individuals in the richest wealth quintile who are enrolled in the NHIS (β = 0.41, ρ < 0.01 and β = 0.45, ρ < 0.05, respectively).
Conclusions
Although health insurance is supposed to increase the likelihood of utilizing health services, poor people in our study who are enrolled in the NHIS are still less likely to utilize health services, suggesting that the NHIS has not succeeded in bridging inequalities in health services utilization between the poor and rich.



Hepatitis C in a prison in the North East of England: what is the economic impact of the universal offer of testing and emergent medications?

2017-02-02

Abstract
Background
Over 90% of new hepatitis C virus (HCV) infections occur in people who inject drugs (PWIDs) and ∼60% of PWIDs have been in prescribed places of detention (PPDs). In 2013, Public Health England, NHS England (NHSE) and the National Offender Management Service published guidance on universal HCV testing for PPDs. Recent National Institute of Health and Care Excellence (NICE) guidance has recommended sofosbuvir for the treatment of genotype 1 disease, with further guidance expected for ledipasvir–sofosbuvir for the treatment of genotype 1 and 3 disease.
Methods
Health-care representatives from Northumberland prison provided data on HCV testing and treatment for 2013–14. Economic modelling of current screening and treatment arrangements and future predicted costs (based on the universal offer of testing and new treatments recently approved by NICE) was then undertaken.
Results
The results of economic modelling suggest that current annual HCV costs at Northumberland prison are around £300 675, but that costs could escalate to £1 625 794 with a 70% uptake of the universal offer of testing, and consideration given to the higher costs associated with treatments approved by NICE.
Conclusions
This study demonstrates that costs associated with changes to testing and treating HCV in PPDs have the potential to increase significantly for commissioners of prison health-care services, and those funding medication.



Healthcare costs in chronically ill community-living older adults are dependent on mental disorders

2017-02-02

Abstract
Background
The economic impact on society associated with the healthcare of older adults depends on their health status. The aim was to estimate the excess costs associated with co-morbid mental and physical disorders.
Methods
Data were from a health survey of 2004 older adults. Two-year healthcare costs were identified from administrative databases. Generalized linear models were used to study healthcare costs as a function of co-morbid mental disorders (MDs) and heart disease (HD), arthritis, diabetes, cancer, respiratory disease (RD) and cerebral vascular accident (CVA).
Results
Participants with HD and CVA with MD incurred higher costs reaching $1696 (95% confidence interval (CI): $30, $3422) and $14 772 (95% CI: $1909, $31 454) than those without MD. RD and MD incurred higher costs reaching $5343 (95% CI: $343, $10 343) than those without RD. The excess annual adjusted healthcare costs associated with co-morbid MD and physical disorders reach close to $600 M per 1 000 000 population of older adults.
Conclusion
The presence of MDs with HD, CVA and RDs has a synergistic effect on healthcare costs. These findings underline the need for improved primary care for the prevention and treatment of co-mental and physical disorders that can potentially save hundreds of millions to society.



Income-related inequalities in visual impairment and eye screening services in patients with type 2 diabetes

2017-02-02

Abstract
Objective
We aimed to measure income-related inequalities in visual impairment and use of eye screening services amongst Canadian living with type 2 diabetes, and to examine contribution of various socio-demographic factors to identified income-related inequalities.
Methods
We used data from the Survey on Living with Chronic Disease in Canada-Diabetes Component 2011 (SLCDC-DM) to derive the relative concentration index (RCI) and decomposition of the RCI.
Results
Individuals with lower income tended to have more visual impairment compared with those with higher income. The main contribution to the observed income inequality in visual impairment came from age and marital status. Regarding eye screening services, patients with higher income were more likely to use eye screening and preventive eye screening services. The main contributors to increased use were income, having private health insurance and patient's experience in discussing diabetic complications with health professionals.
Conclusion
Identified contributors of income-related inequality should be considered when health and healthcare policies are developed in order to minimize and mitigate the observed inequalities.



Use of neuraminidase inhibitors for prophylaxis and treatment of pandemic influenza: summary of a Faculty of Public Health meeting

2017-02-02

Abstract
On 15th December 2014, a meeting was held at the Faculty of Public Health (FPH) to gain views and where possible consensus on the prophylactic use among the general population of neuraminidase inhibitors (NIs) for pandemic influenza. These perspectives were to be used to help inform the FPH's position on current policy. This was felt to be necessary in response to the controversy that followed the publication of the updated Cochrane systematic review of the use of oseltamivir for seasonal influenza by Jefferson et al. (Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. 2014) and the disparate views held by members of the FPH on its implications for the relative benefits and harms of mass chemoprophylaxis for pandemic influenza.






Ebola as a course: uniting basic sciences, public health and the humanities

2017-02-02

Abstract
The most recent epidemic of Ebola virus disease (EVD), beginning in Guinea in December 2013 and still underway as of September 2015, has claimed almost 11 300 lives and resulted in almost 28 000 cases. The first EVD epidemic in history to span multiple countries at once; the outbreak caught the world unprepared, undoubtedly leading to higher illness and death counts that may have occurred in areas with solid medical infrastructure. An analysis of the many facets of the epidemic touches on many important topics covered in an introductory global health course, including issues of economics, ethics, culture, infectious disease, policy, preparedness and technology. However, in contrast to many global health offerings, a study of Ebola provides a unifying narrative throughout the course.



Tea and bread: poetic transcription and representational practice in public health

2017-02-02

Abstract
This paper presents and analyses the poem ‘Tea and Bread’. It is about content and process, about a struggle for survival as an asylum seeker in a UK city and about exploring poetic transcription, as pioneered by sociologist Laurel Richardson, as representational practice in public health. The asylum seeker, known by the pseudonym of Peter, was interviewed as part of a project to compare the destitution of the past with that of today.