Non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), cancer, lung disease and diabetes are major public health challenges for emerging economies. However, Masters of Public Health (MPH) curricula in the USA do not provide germane coursework.
To assess the availability of global NCD courses in MPH curricula, we searched the websites of the 50 schools accredited by the Council on Education for Public Health as of 1 July 2013. Our questionnaire queried availability of a global or international health department or track, availability of an NCD track, and the presence of courses on NCD, NCD risk factors, CVD or global NCDs as well as global health infrastructure.
All schools had online course coursework available. Thirty-one schools (62%) offered a global/international health track or certificate; 38 (76%) offered an NCD course but only 4 (8%) offered a global NCD course. Of the schools with a global health program, none required an NCD course but all offered courses on global health economics or infrastructure.
For public health schools to be aligned with global realities and to retain a leadership role, curricular initiatives that highlight the NCD epidemic and its societal complexities will need new emphasis.
The aim of this study was to examine if government spending is associated with an individual's decision to participate in physical activity and sport which is regarded as healthy behavior given the positive health effects documented in previous research.
Individual-level data (n = 25 243) containing socio-demographic information are combined with national-level data on government spending (5-year average) in 27 European countries. Given the hierarchical data structure, i.e. individuals are nested within countries; multi-level analyses are applied.
The multi-level models show that it is mainly education spending that has a significant positive association with participation in sport of various regularities. Health spending has some association with participation in other physical activity and sport of a lower regularity.
While health spending can be considered a relevant policy tool for increasing sport participation rates, education spending is required more since the effects are larger and it affects both physical activity and sport. This suggests that health spending will have most effect combined with earlier influences from education spending.
Risky health behaviours such as tobacco and alcohol abuse, physical inactivity and poor diet may play an important role in disease development. The aim of the present study was to assess the geographical distribution and socio-demographic determinants of risky health-related behaviours in 27 member states (MSs) of the European Union (EU).
Data from the 2009 Eurobarometer survey (wave 72.3; n = 26 788) were analysed. Tobacco use, alcohol consumption, physical activity and fruit consumption were assessed through a self-reported questionnaire provided to participants from 27 EU MSs. Within the analyses, participants with three or more lifestyle risk factors were classified as individuals with co-occurrence of risk factors.
Among respondents aged 15 or older, 28.2% had none of the aforementioned behavioural risk factors, whereas 9.9% had three or more lifestyle risk factors. Males [adjusted odds ratio (aOR) = 2.50; 95% confidence interval (95% CI): 2.17–2.88] and respondents of middle (aOR = 1.60; 95% CI: 1.36–1.89) or lower income (aOR = 2.63; 95% CI: 2.12–3.26) were more likely to report co-occurrence of behavioural risk factors, as well as respondents in Northern (aOR = 1.43; 95% CI: 1.14–1.78), Western (aOR = 1.28; 95% CI: 1.06–1.56) and Eastern Europe (aOR = 1.28; 95% CI: 1.06–1.55), when compared with Southern European respondents.
The above analyses indicate significant geographical and social variation in the distribution of the co-occurrence of behavioural risk factors for disease development.
Hearing and vision problems are common in older adults. We investigated the association of self-reported sensory impairment with lifestyle factors, chronic conditions, physical functioning, quality of life and social interaction.
A population-based cross-sectional study of participants of the British Regional Heart Study aged 63–85 years.
A total of 3981 men (82% response rate) provided data. Twenty-seven per cent (n = 1074) reported hearing impairment including being able to hear with aid (n = 482), being unable to hear (no aid) (n = 424) and being unable to hear despite aid (n = 168). Three per cent (n = 124) reported vision impairment. Not being able to hear, irrespective of use of hearing aid, was associated with poor quality of life, poor social interaction and poor physical functioning. Men who could not hear despite hearing aid were more likely to report coronary heart disease (CHD) [age-adjusted odds ratios (ORs) 1.89 (95% confidence interval 1.36–2.63)]. Vision impairment was associated with symptoms of CHD including breathlessness [OR 2.06 (1.38–3.06)] and chest pain [OR 1.58 (1.07–2.35)]. Vision impairment was also associated with poor quality of life, poor social interaction and poor physical functioning.
Sensory impairment is associated with poor physical functioning, poor health and poor social interaction in older men. Further research is warranted on pathways underlying these associations.
This study sought to describe the total mortality trend by socioeconomic deprivation (SED) in the Madrid Autonomous Region, by sex and age group.
Cross-sectional ecological study by census tract, in two periods: 1994–2000 (P1) with SED of 1996 census and 2001–07 (P2) with SED of 2001 census. We calculated the relative risks (RRs) and their 95% credibility intervals (95% CIs) by SED quintile (Q), taking the quintile of least deprivation as reference. Besag–York–Mollié ecological regression models and the Integrated Nested Laplace Approximation procedure were applied. The absolute differences in age-standardized rates were compared by SED quintile.
Inequalities decreased in young adults: among men aged 20–39 years, the RR in Q5 versus Q1 ranged from 2.73 (95% CI, 2.51–3.02) in P1 to 1.93 (95% CI, 1.76–2.15) in P2, due to the greater improvement in the most underprivileged groups. In contrast, there was an increase in SED-related mortality in the 40–79 age group. Among men aged 40–59 years, the RR in Q5 versus Q1 rose from 1.88 (95% CI, 1.76–2.02) in P1 to 2.29 (95% CI, 2.17–2.43) in P2; the improvement was greater in the most privileged groups.
In a context of an economic boom, inequalities were observed to increase among adults by a greater improvement in the most privileged groups.
Low socioeconomic position (SEP) is associated with increased cardiovascular (CV) disease risk, but the relative importance of SEP in childhood and adulthood, and of changes in SEP between these two life stages, remains unclear. Studies of families may help clarify these issues. We aimed to assess whether SEP in young adulthood, or change in SEP from childhood to young adulthood, was associated with five continuously measured CV risk factors.
We used data from 286 adult Australian families from the Victorian Family Heart Study (VFHS), in which some offspring have left home (n = 364) and some remained at home (n = 199). SEP (defined as the Index of Relative Socioeconomic Disadvantage) was matched to addresses. We fitted variance components models to test whether young adult SEP and/or change in SEP was associated with systolic blood pressure, diastolic blood pressure, body mass index (BMI), total cholesterol or high-density lipoprotein cholesterol, after adjustment for parental SEP and within-family correlation.
An increase in SEP of 100 SEIFA units from childhood to adulthood was associated with a lower BMI (β = –0.49 kg/m2, P < 0.01) only.
These results suggest that a change in SEP in young adulthood is an important predictor of BMI, independent of childhood SEP.
To investigate the influence of premature birth on conditions among children aged 6–17 years.
The National Survey of Children's Health in the USA added a question on premature birth for the first time in the 2011–12 wave. The influence of being born premature on different conditions while controlling for sociodemographic factors was assessed using logistic regression. A total of 6882 out of 62 078 (11.1%) of children aged 6–17 years were born premature.
Compared with children who were not born premature, those who were born premature were more likely to have cerebral palsy [odds ratio (OR) = 9.6, confidence interval (CI): 7.4–12.4], vision problems (OR = 2.3, CI: 2.0–2.6), hearing problems (OR = 1.7, CI: 1.6–2.0) and a special healthcare need (OR = 1.7, CI: 1.6–1.8). Children who were born premature had an increased likelihood of not being on a sports team or not taking sports lessons after school or on weekends during the past 12 months than those who were not born premature (OR = 1.2, CI: 1.1–1.3).
Prematurity may be associated with negative outcomes as infants transition into childhood and adolescence. Interventions within the life-course perspective are needed to alleviate the long-term consequences of prematurity.
This study explored ethnic inequalities in dental caries among adults and assessed the role of socioeconomic position (SEP) in explaining those inequalities.
We analysed data on 2013 adults aged 16–65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults and children living in East London in 2009–10. Participants completed a questionnaire and were clinically examined for dental caries at home. Dental caries was measured using the number of decayed, missing and filled teeth or DMFT index. Ethnic inequalities in dental caries were assessed in negative binomial regression models before and after adjustment for demographic (sex and age groups) and SEP measures (education and socioeconomic classification).
White Eastern European and White Other had higher DMFT, whereas all Asian (Pakistani, Indian, Bangladeshi and Other) and all Black (African, Caribbean and Other) ethnic groups had lower DMFT than White British. Similar inequalities were found for the number of filled and missing teeth, but there were no differences in the number of decayed teeth between ethnic groups.
This study showed considerable disparities in dental caries between and within the major ethnic categories, which were independent of demographics and SEP.
The aim of this descriptive epidemiological study was to analyze the mortality trend of prostate cancer in Serbia (excluding the Kosovo and Metohia) from 1991 to 2010.
The age-standardized prostate cancer mortality rates (per 100 000) were calculated by direct standardization, using the World Standard Population. Average annual percentage of change (AAPC) and the corresponding 95% confidence interval (CI) was computed for trend using the joinpoint regression analysis.
Significantly increased trend in prostate cancer mortality was recorded in Serbia continuously from 1991 to 2010 (AAPC = +2.2, 95% CI = 1.6–2.9). Mortality rates for prostate cancer showed a significant upward trend in all men aged 50 and over: AAPC (95% CI) was +1.9% (0.1–3.8) in aged 50–59 years, +1.7% (0.9–2.6) in aged 60–69 years, +2.0% (1.2–2.9) in aged 70–79 years and +3.5% (2.4–4.6) in aged 80 years and over. According to comparability test, prostate cancer mortality trends in majority of age groups were parallel (final selected model failed to reject parallelism, P > 0.05).
The increasing prostate cancer mortality trend implies the need for more effective measures of prevention, screening and early diagnosis, as well as prostate cancer treatment in Serbia.
Cancer mortality constitutes a major health burden in Europe. Trends are different for men and women, and across Europe. This study aims to map out Belgian cancer mortality trends for the most common cancer types in both sexes between 1979 and 2010, and to link these with trends in cancer mortality and smoking prevalence across Europe.
Mortality and population data were obtained from the World Health Organization Mortality Database. Age-standardized mortality rates were calculated by direct standardization using the European Standard Population.
Belgian mortality decreased for the most common cancer sites between 1979 and 2010, except for female lung cancer. Yet, Belgian male lung and female breast cancer rates remain high compared with the remainder of Western Europe. For some cancer sites, mortality trends are similar among the European Regions (e.g. stomach cancer), yet for others trends are divergent (e.g. colorectal cancer).
Generally, cancer mortality shows a favorable trend in Belgium and Europe. Yet, female lung cancer mortality rates are increasing in Belgium. Furthermore, Belgium still has higher male lung and female breast cancer mortality rates compared with the European regional averages. Considering this and the current smoking prevalence, enduring tobacco control efforts should be made.
While heavier weight is known to increase the incidence of dyslipidemia, limited data are available on the relationship between weight gain and its development.
A total of 2647 males were categorized into the following four groups according to the difference between their self-reported weight at 20 years of age and their measured weight in 1994–95: a loss of ≥5% (decrease), loss of <5% or gain of <5% (no change), gain of ≥5 to <15% (increase) and gain of ≥15% (sizable increase). They were followed up until their 2002–03 health examination. Using the ‘no change’ group as reference, the multivariable-adjusted odds ratio (adjusted for age, body mass index at 20 years of age, physical activity, smoking and alcohol intake) and 95% confidence interval (95% CI) for the incidence of dyslipidemia were determined using logistic regression models.
A total of 1342 participants developed dyslipidemia during the follow-up period. The ‘increase’ and ‘sizable increase’ groups had odds ratios for the incidence of dyslipidemia of 1.97 (95% CI, 1.59–2.45) and 2.68 (2.15–3.34), respectively, demonstrating that there was a significant dose–response association between weight gain since 20 years of age and the incidence of dyslipidemia (P < 0.001 for trend).
These results suggest that dyslipidemia could be prevented by avoiding weight gain in adulthood.
To examine the relationship between reported high serum or red blood cell (RBC) folate status and adverse health outcomes.
We systematically searched PubMed/Medline and EMBASE (to May 2013), with no limits by study type, country or population, to identify studies reporting high folate concentrations in association with adverse health outcomes. Two reviewers screened studies and extracted data. Study quality was assessed.
We included 51 articles, representing 46 studies and 71 847 participants. Quantiles were used by 96% of studies to identify high folate concentrations. Eighty-three percent of serum folate and 50% of RBC folate studies reported a high folate cutoff that corresponded with a clinically normal concentration. Increasing values of reported high folate concentration did not demonstrate a consistent association with risk of adverse health outcomes. Overall, reported high folate concentrations appeared to be associated with a decreased risk of adverse health outcomes, though substantial methodological heterogeneity precluded complex analyses.
Our interpretation was complicated by methodological variability. High folate cutoffs varied and often corresponded with normal or desirable blood concentrations. In general, a negative association appeared to exist between reported high folate status and adverse health outcomes. Consistent methods and definitions are needed to examine high folate status and ultimately inform public health interventions.
Surveillance of physical activity (PA) is essential for the development of health promotion initiatives. The aim of the present study was to examine the prevalence of PA and sedentary behaviour with respect to socio-demographic factors in Chile.
A representative sample of 5434 adults aged ≥15 years (59% women) who participated in the Chilean National Health Survey (2009–2010) were included. Socio-demographic data (age, sex, environment, education level, income level and smoking status) were collected for all participants. PA levels were assessed using the Global Physical Activity Questionnaire.
19.8% [95% CI: 18.1–21.6] of the Chilean population did not meet PA recommendations (≥600 MET min week–1). The prevalence of physical inactivity was higher in participants aged ≥65 years, compared with the youngest age groups and was higher in women than in men. However, it was lower for participants with high, compared with low, education or income levels. The overall prevalence of sedentary risk behaviour (spending >4 h sitting per day) was 35.9% [95% CI: 33.7–38.2].
Physical inactivity correlates strongly with socio-demographic factors such as age, gender and educational level. Results identify social and economic groups to which future public health interventions should be aimed to increase PA in the Chilean population.
Understanding patterns of time use of children is helpful in developing target-tailored intervention. The purpose of this study was to investigate the clustering of sedentary behaviours and physical activity in Chinese children and to examine the associations between sociodemographic factors and the time use clusters.
Cluster analysis was conducted among 1013 Chinese children aged 9–13 years (49.5% boys) recruited in a cross-sectional survey study. Physical activity and sedentary behaviours were assessed using a validated questionnaire. Differences in sociodemographic variables were compared across the clusters.
Five clusters were identified for boys and girls, respectively. For boys, the five clusters were labelled ‘Actives’ (9.1%), ‘Inactives’ (59.4%), ‘Sedentary homeworkers’ (4.7%), ‘Sedentary TV viewers’ (16.6%) and ‘Sedentary games players’ (10.2%). For girls, they were labelled ‘Actives’ (11.9%), ‘Uninvolved inactives’ (39.6%), ‘Sedentary homeworkers’ (11.3%), ‘Sedentary TV viewers’ (8.5%) and ‘Sedentary Games players’ (28.8%). Only parental education was found to differ across the five clusters in boys.
The findings demonstrated that sedentariness in youth is multidimensional, and it could not be accurately represented by singular behaviour. There is a potential need when designing specific interventions to reduce a group of sedentary behaviours to tailor these interventions for specific clusters.
Waterpipe tobacco and electronic cigarettes (e-cigarettes) share several features: rising popularity, use of product flavourings and concerns about marketing to youth. We sought to compare prevalence and predictors of waterpipe tobacco and e-cigarette use, and explore knowledge of waterpipe tobacco and support for interventions.
We used convenience sampling methods to conduct a cross-sectional survey among adults in the ethnically diverse southeast London area. Multivariate logistic regression identified predictors of waterpipe and e-cigarette use. Predictor variables were age, gender, ethnicity and current (past 30-day) cigarette use.
Of 1176 respondents (23.0% aged 25–34 years, 56.0% male, 57.4% white ethnicity and 30.4% current cigarette smokers), 31.0% had tried waterpipe tobacco and 7.4% had tried e-cigarettes. Both products were significantly associated with younger age groups, non-white ethnicities and use of each other. Waterpipe tobacco was independently associated with consumption of cigarettes while e-cigarettes were not. Among those aware of waterpipe, a third answered incorrectly to knowledge questions. Among those self-identified as coming from a traditional waterpipe-using community, two-thirds supported further legislative and health promotion waterpipe interventions.
Waterpipe tobacco was common and more prevalent than e-cigarettes in this population. Interventions to prevent and control waterpipe are unlikely to marginalize traditional waterpipe-using communities.
The Neonatal BCG Immunisation programme is a key part of tuberculosis (TB) control efforts in the UK; however, there is considerable variability in the method of delivery of the programme and monitoring of performance. This study aimed to review the extent to which infants at risk of exposure to TB are being identified in Grampian and to assess the uptake of BCG vaccination in eligible infants.
The Practitioner Services database and Scottish Immunisation Recall System records for all babies born in Grampian in 2012 and 2013 were reviewed to identify the number of babies who had a TB risk status recorded and to assess the uptake of BCG immunization in at-risk babies.
The proportion of babies with a risk status recorded was 96.6% in 2012 and 95.5% in 2013. The uptake of BCG vaccination in at-risk babies was 85.9% in 2012 and 89.9% in 2013.
NHS Grampian has an efficient method for identifying infants at risk of exposure to TB and has good neonatal BCG vaccination coverage.
Improving the health of Traveller Communities is an international public health concern but there is little evidence on effective interventions. This study aimed to explain how, for whom and in what circumstances outreach works in Traveller Communities.
A realist synthesis was undertaken. Systematic literature searches were conducted between August and November 2011. Grey literature was sought and key stakeholders were involved throughout the review process. Iterative steps of data extraction, analysis and synthesis, followed by additional searches were undertaken.
An explanatory framework details how, why and in what circumstances participation, behaviour change or social capital development happened. The trust status of outreach workers is an important context of outreach interventions, in conjunction with their ability to negotiate the intervention focus. The higher the outreach worker's trust status, the lower the imperative that they negotiate the intervention focus. A ‘menu’ of reasoning mechanisms is presented, leading to key engagement outcomes.
Adopting a realist analysis, this study offers a framework with explanatory purchase as to the potential of outreach to improve health in marginalized groups.
Recognizing the mindless nature of many food decisions, it has been suggested that attempts to increase healthy eating should not focus on convincing people what is ‘right’ but rather aim to adjust the environment such that people are automatically directed toward healthy choices. This study investigated a nudge aiming to promote healthy food choices in train station snack shops.
The nudge involved a repositioning of food products: healthy foods were placed at the cash register desk, while keeping unhealthy products available elsewhere in the shop. Three snack shops were included: a control condition; a nudge condition repositioning healthy products and a nudge + disclosure condition employing the same nudge together with an explanatory sign. Next to examining its effectiveness during 1 week, the study assessed customers' acceptance of the nudge.
Controlling for a baseline week, more healthy (but not fewer unhealthy) products were sold in both nudge conditions, with no difference between the nudge and the nudge + disclosure condition. A majority of customers reported positive attitudes toward the nudge.
Repositioning healthy foods is a simple, effective and well-accepted nudge to increase healthy purchases. Moreover, disclosing its purpose does not impact on effectiveness.
There is a limited evidence on the effectiveness of lifestyle interventions in achieving and maintaining a significant level of weight loss in morbidly obese patients. This study evaluated the impact on weight loss and psychological well-being of a community-based weight management service for morbidly obese patients [body mass index (BMI) ≥35 with related co-morbidities or BMI >40] in Derbyshire county.
Five hundred and fifty-one participants entered the service since 2010, and 238 participants were still active within the service or had completed the 2-year intervention in April 2013. A one-group pre–post design was used to determine average weight loss (kg) and impact on mental health and well-being [using the validated clinical outcomes of routine evaluation-outcome measure (CORE-OM) questionnaire] among participants. Measurements were recorded at baseline, 12 weeks, 24 weeks, 1 year, 18 months and 2 years, and significance (P ≤ 0.05) was determined using the paired sample t-test.
Statistically significant weight loss was recorded at each measurement point for those participants who remained engaged with the service (4.9 kg weight loss at 12 weeks to 18.2 kg at 2 years). There was a significant positive impact on psychological well-being demonstrated by CORE-OM score.
Findings show clinically and statistically significant weight loss among participants with improvements in physical and mental health.
In India, it has been estimated that 50% of family spending on healthcare is on unnecessary medications or investigations. This, combined with the wide availability of medications, has seemingly contributed to increasing rates of antibiotic resistance and further impoverishment. In this literature review, we aim to characterize the extent of misuse and describe underlying factors contributing to the misuse of medication in India.
This literature review included relevant articles published after 2000 that assessed medication use and misuse in India. A narrative review framework was used to analyse each article, confirm its inclusion, extract relevant information and group the findings under thematic areas.
There were 115 articles included in this literature review. The literature demonstrated that the misuse of medications in India is widespread. The factors resulting in this involves all levels of the health system including regulation, enforcement and policy, healthcare providers and consumers.
This is one of the most comprehensive reviews of medication misuse in India. It indicates the widespread nature of the problem and so highlights the need for action. This review provides a detailed understanding as to the complex interplay of factors that result in medication misuse in India.
Ageing of the population often leads to polypharmacy. Consequently, potentially inappropriate prescribing (PIP) becomes more frequent. Systematic screening for PIP in older patients in primary care could yield a large improvement in health outcomes, possibly an important task for community pharmacists. In this article, we develop an explicit screening tool to detect relevant PIP that can be used in the typical community pharmacy practice, adapted to the European market.
Eleven panellists participated in a two-round RAND/UCLA (Research and Development/University of California, Los Angeles) process, including a round zero meeting, a literature review, a first written evaluation round, a second face-to-face evaluation round and, finally, a selection of those items that are applicable in the contemporary community pharmacy.
Eighteen published lists of PIP for older patients were retrieved from the literature, mentioning 398 different items. After the two-round RAND/UCLA process, 99 clinically relevant items were considered suitable to screen for in a community pharmacy practice. A panel of seven community pharmacists selected 83 items, feasible in the contemporary community pharmacy practice, defining the final GheOP3S tool.
A novel explicit screening tool (GheOP3S) was developed to be used for PIP screening in the typical community pharmacy practice.
In most parts of the world, neonatal mortality rates have shown a slower decline when compared with under-5 mortality decline. A sick newborn can die within minutes if there is a delay in presentation, thus early diagnosis and treatment are essential for the survival of a critically ill newborn. This study investigated factors responsible for delays in healthcare services for the sick newborn and maternal socio-demographic variables that influence these delays in Enugu, South-East Nigeria.
This was a community-based descriptive study. A total of 376 respondents were randomly selected from 4 of the 17 local government areas of Enugu State. Mothers and/or caregivers that were nursing or had nursed a child in the previous 2 years were enrolled. Self-reported data on delays encountered during healthcare for sick newborn were collected using pretested structured questionnaire. Chi-square and multivariate logistic regression were used to determine the association between causes of delays in newborn healthcare services, maternal socio-demographics and relationships with newborn mortality.
Delays in reaching healthcare facilities accounted for the most common delays encountered by respondents, 78.0%, in this study, followed by delays at household level, 24.2% and delays at health facility level 16.0% (P = 0.000). Mothers with knowledge of ≥3 WHO recognized danger signs compared with those with ≤2 were significantly less likely to delay at household (level 1: 40.7 versus 59.3%) (P = 0.017) and reaching healthcare service (level 2: 19.9 versus 80.1%) (P = 0.028). Delays at health facility level (level 3) occurred more at tertiary health facilities (59.0%), secondary health facilities (39.1%) and primary healthcare facilities (19.7%) compared with private health facilities (13.5%) (P = 0.000).
Delays in seeking healthcare at all levels especially those related to transporting the sick newborn to the hospital are a contributor to newborn mortality in Nigeria. Improving access to healthcare could potentially reduce mortality in the sick newborn.
Patient registries (PRs) are important tools for public-health surveillance and rare-disease research. The purpose of this study is to identify the most important criteria for the creation of a rare-disease PR that could be used by public-health authorities to develop health policies.
A consensus-development Delphi study was used, with participants selected for their expertize in rare diseases and registries. Participants were asked to complete a questionnaire on the most important criteria for creating PRs. Three rounds were performed.
Agreement was reached on half the questions in the first round and on 89% of questions in the final round, with a total expert participation rate of around 60% by the final stage. This study made it possible to reach a broader consensus starting from experts' initial assessment of the features that should be considered for the creation of a rare-disease PR.
The consensus method used made it possible to define the characteristics of a PR based on expert opinion within a rare-disease framework. This study may serve as a guide for helping other researchers plan and build a rare-disease PR.
The Impact of Weight on Quality of Life for Kids (IWQOL-Kids) is the first self-report questionnaire for assessing weight-related quality of life for youth. However, there is no Chinese version of IWQOL-Kids. Thus, the objective of this research was to translate IWQOL-Kids into Mandarin and evaluate its psychometric properties in a large school-based sample.
The total sample included 2282 participants aged 11–18 years old, including 1703 non-overweight, 386 overweight and 193 obese students. IWQOL-Kids was translated and culturally adapted by following the international guidelines for instrument linguistic validation procedures. The psychometric evaluation included internal consistency, test–retest reliability, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity and discriminant validity.
Cronbach's α for the Chinese version of IWQOL-Kids (IWQOL-Kids-C) was 0.956 and ranged from 0.891 to 0.927 for subscales. IWQOL-Kids-C showed a test–retest coefficient of 0.937 after 2 weeks and ranged from 0.847 to 0.903 for subscales. The original four-factor model was reproduced by EFA after seven iterations, accounting for 69.28% of the total variance. CFA demonstrated that the four-factor model had good fit indices with comparative fit index = 0.92, normed fit index = 0.91, goodness of fit index = 0.86, root mean square error of approximation = 0.07 and root mean square residual = 0.03. Convergent validity and discriminant validity were demonstrated with higher correlations between similar constructs and lower correlations between dissimilar constructs of IWQOL-Kids-C and PedsQL™ 4.0. The significant differences were found across the body mass index groups, and IWQOL-Kids-C had higher effect sizes than PedsQL™4.0 when comparing non-overweight and obese groups, supporting the sensitivity of IWQOL-Kids-C.
IWQOL-Kids-C is a satisfactory, valid and reliable instrument to assess weight-related quality of life for Chinese children and adolescents aged 11–18 years old.
The recruitment process for public health specialty training includes an assessment centre (AC) with three components, Rust Advanced Numerical Reasoning Appraisal (RANRA), Watson-Glaser Critical Thinking Appraisal (WGCT) and a Situation Judgement Test (SJT), which determines invitation to a selection centre (SC). The scores are combined into a total recruitment (TR) score that determines the offers of appointment.
A prospective cohort study using anonymous record linkage to investigate the association between applicant's scores in the recruitment process and registrar's progress through training measured by results of Membership Faculty Public Health (MFPH) examinations and outcomes of the Annual Review of Competence Progression (ARCP).
Higher scores in RANRA, WGCT, AC, SC and TR were all significantly associated with higher adjusted odds of passing Part A MFPH exam at the first attempt. Higher scores in AC, SC and TR were significantly associated with passing Part B exam at the first attempt. Higher scores in SJT, AC and SC were significantly associated with satisfactory ARCP outcomes.
The current UK national recruitment and selection process for public health specialty training has good predictive validity. The individual components of the process are testing different skills and abilities and together they are providing additive value.
The implementation of the ‘Removal of the Spare Room Subsidy’ in April 2013, commonly known as the ‘bedroom tax’, affects an estimated 660 000 working age social housing tenants in the UK, reducing weekly incomes by £12–£22. This study aimed to examine the impact of this tax on health and wellbeing in a North East England community in which 68.5% of residents live in social housing.
Qualitative study using interviews and a focus group with 38 social housing tenants and 12 service providers.
Income reduction affected purchasing power for essentials, particularly food and utilities. Participants recounted negative impacts on mental health, family relationships and community networks. The hardship and debt that people experienced adversely affected their social relationships and ability to carry out normal social roles. Residents and service providers highlighted negative impacts on the neighbourhood, as well as added pressure on already strained local services.
The bedroom tax has increased poverty and had broad-ranging adverse effects on health, wellbeing and social relationships within this community. These findings strengthen the arguments for revoking this tax.
Fuel poverty negatively impacts a population's health affecting life chances along the life course. Moreover, it represents a substantial inequality in the UK. Healthcare practitioners (HCPs) have a key role in identifying and supporting patients who are fuel poor.
A qualitative inquiry with District Nurses and General Practitioners, to explore their understanding and experiences of dealing with patients living in fuel poverty.
Participants recognize fuel poverty by observing material cues. They perceive their relationship with the patient as pivotal to recognizing the fuel poor. Practitioners' sense of responsibility for their patients' social concerns is determined by their knowledge about the link to health outcomes. The services that they sign-post to are motivated by their experience dealing with the service, or their patients' experiences of the service.
Participants' reliance on temporary material cues resulted in few experiences of recognition of the fuel poor. HCPs' perceptions of patient pride and the lack of personal relationship between doctor and patient presented barriers to identifying fuel poor patients. A limitation of this study is the small sample size of nine participants. These came from two professional groups, which afforded more depth of exploration, but may limit applicability to other professionals.
Data on diseases' determinants and health status of asylum seekers (ASs) are limited.
We performed a cross-sectional retrospective study in a large ASs centre in Italy. Data were collected during a 1-year period. Descriptive statistics were calculated. A 2 test was used to assess the association between socio-demographics characteristics of ASs and screening test results. A multiple logistic regression analysis was performed to identify diseases' predictors by using ICD-10 diagnoses classification as outcome variable, socio-demographic characteristics as independent variable and visits' number as confounding variable.
Overall, data on 792 ASs (mean age 27 years, 80% males, 58% from Africa) were assessed, 43% underwent voluntary infectious diseases screening and 2843 diagnoses were recorded. The most frequent diagnoses were: respiratory diseases, symptoms/signs not elsewhere classified, digestive diseases and infectious diseases. Gender was the most frequent predictor of ICD-10 diagnoses, while African origin, civil status and education were, respectively, predictive of cardiovascular and infectious diseases, genitourinary diseases and pregnancy-related disorders. Higher mean age was associated with syphilis, HIV and HCV infection and African origin with HIV infection.
Communicable diseases were not prevalent in the ASs population we analysed. A stronger cultural mediation support is needed to facilitate prevention, access and continuity of care for ASs.
The incidence of aplastic anemia (AA) is common in Asia than in western countries.
In a case–control study conducted at a tertiary care hematology center in northern India, 102 patients of AA and 201 controls of other blood disorders (OBD) were included. Sociodemographic data and exposure to drugs, toxins and radiation were collected from the study population using a standard questionnaire. Socioeconomic status (SES) was classified based on a calculated standard of living (SL) score. Univariate and multivariate analyses were carried out to delineate the factors associated with incidence of AA.
Patients with AA were significantly younger than those in control groups (mean age 27.5 ± 12.3 years, P < 0.01). The mean SL score was significantly lower in AA group (26.76 ± 12.88, P < 0.01) than in the controls. The mean monthly family income was significantly lower in AA group than in the controls (83.3% with monthly income <8000 INR, P < 0.01). On univariate analysis, AA group with lower SL score had >3 times higher odds of having the disease (odds ratio 3.41, 95% confidence interval 1.72–6.79, P < 0.0001) compared with the controls. On multivariate analysis, young age and low SES were found to be significantly associated with AA.
Lower SES is associated with higher incidence of AA in Indian population.
This study analysed the distribution of lung cancer deaths in areas with different urbanization levels in the Madrid Region and whether such differences persisted when deprivation and air pollution were considered.
This was a population-based cross-sectional study covering lung cancer deaths (2001–07). The exposure indicators were: a deprivation index based on 2001 census data; and the daily mean NO2 measurement (2002–07), both at the census tract level. Analysis was stratified by sex and age group and the Poisson regression models were applied to obtain rate ratios (RRs).
After adjustment for age, deprivation index and NO2, mortality was similar in the city and Greater Madrid areas and lower in the rural area for the over-64 age group (RR: 0.84 in men and RR: 0.66 in women, with respect to the city of Madrid), and significantly lower in the Greater Madrid area (RR: 0.84 in men and RR: 0.74 in women) and in the rural area (RR: 0.73 in men and RR: 0.51 in women) with respect to the city of Madrid for the under-65 age group.
The most urbanized areas of the Madrid Region are characterized by higher lung cancer mortality.
Amid local government budget cuts, there is concern that the ring-fenced public health grant is being appropriated, and Directors of Public Health (DsPH) find it difficult to make the case for investment in public health activity. This paper describes what DsPH are making the case for, the components of their case and how they present the case for public health.
Thirteen semi-structured telephone interviews and a group discussion were carried out with DsPH (November 2013 to May 2014) in the Southern region of England.
DsPH make the case for control of the public health grant and investing in action on wider determinants of health. The cases they present incorporate arguments about need, solutions and their effectiveness, health outcomes, cost and economic impact but also normative, political arguments. Many types of evidence were used to substantiate the cases; evidence was carefully framed to be accessible and persuasive.
DsPH are responding to a new environment; economic arguments and evidence of impact are key components of the case for public health, although multiple factors influence local government (LG) decisions around health improvement. Further evidence of economic impact would be helpful in making the case for public health in LG.
Rubella is usually a mild viral illness, but during pregnancy, it can have potentially devastating effects causing fetal losses and severe congenital malformations (congenital rubella syndrome). Rubella is now rare in most developed countries following a successful vaccination programme. We aimed to investigate differences in epidemiological profile of pregnant women screened antenatally in Liverpool to identify risk factors for rubella immunity.
All samples were tested with the Elecsys Rubella IgG immunoassay kit. A result <10 IU/ml was considered to be seronegative.
The seronegativity prevalence among pregnant women in Liverpool (6.3%) is higher than average value for the North West region (3.7%). The seronegative rates varied with age (15.4% for <15 years, 18.7% for 15–20 years, compared with 2% for 30–35 years). The areas with the highest seronegative rates correspond with areas of Liverpool with high pockets of socioeconomic deprivation.
The highest proportion of seronegative women were among the youngest age groups. Local areas with highest level of deprivation should be given priority and additional resources to develop targeted programmes and pathways to implement appropriate interventions such as MMR catch-up programmes and put in place arrangements for offering MMR vaccination in maternity units.
Rates of tuberculosis (TB) in UK South Asian communities are up to 17 times higher than in white British groups. Latent infection in new migrants provides only a partial explanation. We undertook a systematic review of the literature to establish existing knowledge about TB in South Asian communities.
We undertook a search for literature relating to TB and its management in South Asian communities in the UK. Articles initially identified were screened for relevance. A narrative review of relevant articles was then conducted.
We found 18 relevant articles. Associated risk factors for TB included poverty, deprivation, return visits to the Indian subcontinent, history of close contact with a case, gender, religion, possible dietary factors such as Vitamin D deficiency, duration of stay in the UK and country of birth. However, the evidence for these factors was often conflicting or weak, and suggests that commonly proposed hypotheses may not provide robust explanations for the higher rates of diagnosis.
Migration patterns and the demographic profile of the South Asian communities are constantly changing. Further research into the determinants of TB infection in these communities in the UK is urgently needed to inform the commissioning of TB health services.
Body mass index (BMI) can be used to group individuals in terms of their height and weight as obese. However, such a distinction fails to account for the variation within this group across other factors such as health, demographic and behavioural characteristics. The study aims to examine the existence of subgroups of obese individuals.
Data were taken from the Yorkshire Health Study (2010–12) including information on demographic, health and behavioural characteristics. Individuals with a BMI of ≥30 were included. A two-step cluster analysis was used to define groups of individuals who shared common characteristics.
The cluster analysis found six distinct groups of individuals whose BMI was ≥30. These subgroups were heavy drinking males, young healthy females; the affluent and healthy elderly; the physically sick but happy elderly; the unhappy and anxious middle aged and a cluster with the poorest health.
It is important to account for the important heterogeneity within individuals who are obese. Interventions introduced by clinicians and policymakers should not target obese individuals as a whole but tailor strategies depending upon the subgroups that individuals belong to.
Neural tube defects are largely preventable by the maternal periconceptual consumption of folic acid. The aim of this study was to examine the levels of synthetic folic acid in foods and the range of food stuffs with added folic acid available to consumers in Ireland at the current time.
Three audits of fortified foods available in supermarkets in the Republic of Ireland were conducted. Researchers visited supermarkets and obtained folic acid levels from nutrition labels in 2004, 2008 and 2013/4. Levels were compared using MS Excel.
The profile of foods fortified with folic acid in 2013/4 has changed since 2004. The percentage of foods fortified with folic acid has decreased as has the level of added folic acid in some food staples, such as fat/dairy spreads.
Bread, milk and spreads no longer contain as much folic acid as previously (2004 and 2008). This may contribute to a decrease in folate intake and therefore may contribute to an increase in NTD rates. Research on current blood concentrations of folate status markers is now warranted.
Prolonged sitting is linked to various deleterious health outcomes. The alterability of the sitting time (ST)–health relationship is not fully established however and warrants study within populations susceptible to high ST.
We assessed the mortality rates of post-menopausal women from the Women's Health Initiative (WHI) observational study, a 15-year prospective study of post-menopausal women aged 50–79 years, according to their change in ST between baseline and year six. A total of 77 801 participants had information at both times on which to be cross-classified into the following: (i) high ST at baseline and follow-up; (ii) low ST at baseline and follow-up; (iii) increased ST and (iv) decreased ST. Cox regression was used to assess the relationship between all-cause, CVD and cancer mortality with change in ST.
At the end of follow-up, there were 1855 deaths. Compared with high ST maintainers, low ST maintainers had a 51 and 48% lower risk of all-cause and cancer mortality, respectively. Reducing sitting also resulted in a protective rate of 29% for all-cause and 27% for cancer mortality.
These results highlight not only the benefit of maintaining minimal ST, but also the utility of decreasing ST in older women, if current levels are high.
Many families rely on formal day care provision, which can be problematic when children are unwell. Attendance in these circumstances may impact on the transmission of infections in both day care and the wider community.
Thirty-one semi-structured interviews were conducted to investigate how parents make decisions about nursery care when children are unwell. Topics for discussion included: illness attitudes, current practice during childhood illness and potential nursery policy changes that could affect decision-making.
A combination of illness perceptions and external factors affected decision-making. Parents: (i) considered the severity of respiratory and non-respiratory symptoms differently, and stated that while most other contagious illnesses required nursery exclusion, coughs/colds did not; (ii) said decisions were not solely based on nursery policy, but on practical challenges such as work absences, financial penalties and alternative care availability; (iii) identified modifiable nursery policy factors that could potentially help parents keep unwell children at home, potentially reducing transmission of infectious illness.
Decision-making is a complex interaction between the child's illness, personal circumstance and nursery policy. Improving our understanding of the modifiable aspects of nursery policies and the extent to which these factors affect decision-making could inform the design and implementation of interventions to reduce the transmission of infectious illness and the associated burden on NHS services.
Food behaviours are important in the context of health and obesity. The aim was to explore the environments and food behaviours of a sample of young people in the North East of England to further understanding of the relationship between eating behaviours and environmental context.
Focus groups were conducted with four groups of young people aged 16–20 years (n = 40; 28 male, 12 female) between November 2006 and June 2007. Analysis was informed by grounded theory methods and was an iterative process of identifying themes across the transcripts.
Topics explored included: their main environment, home food responsibility and cooking, food outside of the home, where food was purchased/obtained and where food was eaten and with whom. Emergent themes included: the value for money in food purchases, time convenience, the car as a means of accessing food and health perceptions.
The complexities of the food environment were illustrated. This work has highlighted the importance of the home food environment and parents, and indicated the importance of factors such as time and cost in this age group's food choices. The behavioural norms around food behaviours merit further exploration for this population in transition between adolescence and adulthood.
Alcohol, tobacco and other drug use (ATOD) among adolescent and young adult couples during prenatal and postnatal periods is a significant public health problem, and couples may mutually influence each others' ATOD behaviors.
The current study investigated romantic partner influences on ATOD among adolescent and young adult couples during pregnancy and postnatal periods.
Participants were 296 young couples in the second or third trimester of pregnancy recruited from OBGYN clinics between July 2007 and February 2011. Participants completed questionnaires at prenatal, 6 months postnatal, and 12 months postnatal periods. Dyadic data analysis was conducted to assess the stability and interdependence of male and female ATOD over time.
Male partner cigarette and marijuana use in the prenatal period significantly predicted female cigarette and marijuana use at 6 months postnatal (b = 0.14, P < 0.01; b = 0.11, P < 0.05, respectively). Male partner marijuana use at 6 months postnatal also significantly predicted female marijuana use at 12 months postnatal (b = 0.11, P < 0.05). Additionally, significant positive correlations were found for partner alcohol and marijuana at pre-pregnancy and 6 months postnatal, and partner cigarette use at pre-pregnancy, 6 months and 12 months postnatal.
Partner ATOD among young fathers, particularly during the prenatal period, may play an important role in subsequent ATOD among young mothers during postnatal periods.
Clustering of lifestyle risk behaviours is very important in predicting premature mortality. Understanding the extent to which risk behaviours are clustered in deprived communities is vital to most effectively target public health interventions.
We examined co-occurrence and associations between risk behaviours (smoking, alcohol consumption, poor diet, low physical activity and high sedentary time) reported by adults living in deprived London neighbourhoods. Associations between sociodemographic characteristics and clustered risk behaviours were examined. Latent class analysis was used to identify underlying clustering of behaviours.
Over 90% of respondents reported at least one risk behaviour. Reporting specific risk behaviours predicted reporting of further risk behaviours. Latent class analyses revealed four underlying classes. Membership of a maximal risk behaviour class was more likely for young, white males who were unable to work.
Compared with recent national level analysis, there was a weaker relationship between education and clustering of behaviours and a very high prevalence of clustering of risk behaviours in those unable to work. Young, white men who report difficulty managing on income were at high risk of reporting multiple risk behaviours. These groups may be an important target for interventions to reduce premature mortality caused by multiple risk behaviours.
Attitudes towards physical activity are largely developed during childhood meaning that school physical education classes can have a strong influence.
National level data of school pupils (n = 21 515) in England were analysed to examine the association between school provision of physical education with sex, age, geographic and socioeconomic factors.
Children attending independent schools had more scheduled physical education time (P < 0.001; 95% confidence interval (CI) 18 to 30 extra min per week). This association was true for males (P = 0.024); schools located in the South (P < 0.001; 95% CI 2 to 3) and rural areas (P < 0.001; 95% CI 3 to 5); or with a higher percentage of pupils eligible for free school meals (P < 0.001; 95% CI 3 to 4). Schools in more affluent areas (P < 0.001; 95% CI –1 to –2) and those with lower percentages of pupils from ethnic minorities (P < 0.001; 95% CI –1 to –2) also had higher minutes of physical education provision per week. Regarding age, 93% of schools met the guidelines in Years 1–9; only 45% did in Years 10–13.
Differences in physical education were found in relation to school type, socioeconomic status and geographical factors. Age-related differences in compliance with guidelines are of concern; ways to increase provision for older children should be investigated.
Truancy has been linked to risky sexual behaviours in teenagers. However, no studies in England have examined the association between truancy and teenage pregnancy, and the use of truancy as a marker of teenagers at risk of pregnancy.
Using logistic regression, we investigated the association between truancy at age 15 and the likelihood of teenage pregnancy by age 19 among 3837 female teenagers who participated in the Longitudinal Study of Young People of England. We calculated the areas under the ROC curves of four models to determine how useful truancy would be as a marker of future teenage pregnancy.
Truancy showed a dose–response association with teenage pregnancy after adjusting for ethnicity, educational intentions at age 16, parental socioeconomic status and family composition (‘several days at a time’ versus ‘none’, odds ratio 3.48 95% confidence interval 1.90–6.36, P < 0.001). Inclusion of risk behaviours improved the accuracy of predictive models only marginally (area under the ROC curve 0.76 full model versus 0.71 sociodemographic characteristics only).
Truancy is independently associated with teenage pregnancy among English adolescent girls. However, the discriminatory powers of models were low, suggesting that interventions addressing the whole population, rather than targeting high-risk individuals, might be more effective in reducing teenage pregnancy rates.
We assessed the relationship between screening uptake and socioeconomic deprivation for London women aged 50–52 invited to their first routine screening appointment between 2006 and 2009.
We examined uptake for London overall and within six screening areas, using deprivation quintile, based on post code of residence.
After adjustment for age, area and ethnicity, overall uptake decreased with increasing deprivation (adjusted odds ratio (OR) = 0.95, P < 0.001). However, in two screening areas with lower uptake, women living in deprived areas had higher uptake than women from affluent areas.
These potential inequalities in early diagnosis across London require further investigation.
Social support may have an impact on screening participation. We studied the association between social support in 2006, defined as frequencies of contacts, instrumental support and emotional support and participation in breast cancer screening in 2008–09.
This population-based cohort study included 4512 women who had participated in a Health Survey in 2006 and who also were in the target group for the first round of organized breast cancer screening in the Central Denmark region in 2008–09.
Women with infrequent contacts with friends and family in 2006 were more likely not to participate in screening in 2008–09 [prevalence ratio (PR) 1.69, 95% confidence interval (CI) 1.26–2.26, P-value < 0.001 and PR 1.56, 95% CI 1.21–2.20, P-value < 0.001, respectively] as were women who reported not to have someone to look after her home if she was away for some time and women who reported usually not or never having someone to turn to with personal concerns (PR 1.97, 95% CI 1.53–2.54, P-value < 0.001 and PR 1.42, 95% CI 1.14–1.77, P-value = 0.002, respectively).
Low social support, indicated by items in each social support attribute, was associated with non-participation in breast cancer screening in 2008–09. Targeted social interventions may, therefore, have an impact on future screening behaviour, which calls for further research.
Recent evidence suggests that small increases in the physical activity of those considered least active can have a bigger health impact than raising levels of those already achieving or close to achieving recommendations. Profiling the characteristics of those who are least active allows for appropriate targeting of interventions. This study therefore examined the characteristics of people in the lowest physical activity bracket.
Data were taken from the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) funded ‘South Yorkshire Cohort’, a longitudinal observational dataset of residents of South Yorkshire, England. Five separate outcomes based on a shortened version of the GPPAQ were used to represent the lowest levels of physical activity. Potential predictors examined were age, sex, body mass index, ethnicity, chronic conditions, current employment and deprivation. Descriptive statistics and logistic regression were conducted.
Individuals with chronic mental and physical conditions (fatigue, insomnia, anxiety, depression, diabetes, breathing problems, high blood pressure, heart disease, stroke and cancer) were more likely to report the lowest levels of physical activity across all five outcomes. Demographic variations were also observed.
Targeting people with chronic mental and physical conditions has the potential to reduce the impact of physical inactivity.
We evaluated the accuracy, limitations and potential sources of improvement in the clinical utility of the administrative dataset for acute medicine admissions.
Accuracy of clinical coding in 8888 patient discharges following an emergency medical hospital admission to a teaching hospital and a district hospital over 3 years was ascertained by a coding accuracy audit team in respect of the primary and secondary diagnoses, morbidities and financial variance.
There was at least one change to the original coding in 4889 admissions (55%) and to the primary diagnosis of at least one finished consultant episodes of 1496 spells (16.8%). There were significant changes in the number of secondary diagnoses and the Charlson morbidity index following the audit. Charlson score increased in 8.2% and decreased in 2.3% of patients. An income variance of £816 977 (+5.0%) or £91.92 per patient was observed.
The importance and applications of coded healthcare big data within the NHS is increasing. The accuracy of coding is dependent on high-fidelity information transfer between clinicians and coders, which is prone to subjectivity, variability and error. We recommend greater involvement of clinicians as part of multidisciplinary teams to improve data accuracy, and urgent action to improve abstraction and clarity of assignment of strategic diagnoses like pneumonia and renal failure.
Clinical governance has been promoted in recent years as core to improving patient safety. Effective clinical governance requires partnerships between ‘management’ and health professionals as well as equal involvement of all professional groups. Professionals must also be willing to engage in clinical governance activities such as working to improve care systems and patient safety. There is limited research into the relative understanding of core clinical governance concepts amongst different professional groups or the extent to which professionals are prepared to take up opportunities to ‘change the system’.
A 2012 national survey study of health professionals employed in New Zealand health boards sought to probe understanding of and commitment to clinical governance following introduction of a 2009 policy.
Respondent data showed only limited policy implementation had occurred. Regression analyses revealed statistically significant differences in perceptions of knowledge of clinical governance concepts and structures by gender, age, experience and profession, as well as in seeking opportunities to change the system.
These findings have implications for policy makers in terms of ensuring that clinical governance implementation provides equal opportunity for engendering involvement of different health professionals.
After a long civil war that destroyed much of the country's health infrastructure, Angola faced the challenge of reconstruction while fighting HIV/AIDS. This paper analyses recent progress in access and use of prevention of mother-to-child transmission (PMTCT) services in Angola.
National level PMTCT data between 2005 and 2012 were analysed. Data were collected from national and international databases and reports. This study assesses progress made, developed best-fit regression models and predicted future points for four major PMTCT indicators.
Between 2005 and 2012, the number of PMTCT sites increased from 9 to 347, and the number of HIV tests preformed to pregnant women increased from 12 061 to 314 805. However, in 2012, 46% of the pregnant women who tested positive for HIV at PMTCT sites and only 36% HIV exposed infants were receiving antiretroviral (ARV) prophylaxis. Based on current trends, this study predicts that by 2015, 35.5% of pregnant women will be tested for HIV, 1.1% of women will test positive for HIV at PMTCT and 46% of HIV-positive pregnant women will receive antiretroviral therapy.
Despite expansion of PMTCT services, urgent action is needed to rapidly scale-up HIV prevention and treatment services for HIV-positive pregnant women and for children.
Hospital-acquired pneumonia (HP) is the most common infection in adult intensive care units (ICUs). To develop effective strategies to prevent it, we identified factors that independently increased the risk of contracting HP while admitted at an ICU.
We performed a prospective cohort study during 4 years in which we included all patients who had been admitted for at least 24 h to the ICU at a university reference hospital in Spain. We conducted a multivariable Cox regression analysis to obtain adjusted hazard ratios (HR). The dependent variable for patients with HP was duration of ICU stay prior to the onset of HP. For those without HP, the dependent variable was duration of stay between admission and discharge from the ICU. The independent variables were intrinsic characteristics of the patients already present at admission to the ICU and diagnostic or therapeutic procedures performed during admission.
We studied 4427 patients, of which 233 (5.3%) developed HP while admitted to the ICU. The strongest independent risk factors associated with the occurrence of HP were mechanical ventilation (HR = 8.2; 95% CI = 3.6–18.9) and the use of a nasogastric tube (HR = 2.3; 95% CI = 1.6–3.3). The intrinsic risk factors that were part of the model were the presence of decreased level of consciousness upon admission (HR = 2.0; 95% CI = 1.5–2.7) and the APACHE II index (HR = 1.018; 95% CI = 1.002–1.035).
Although severity of illness upon admission (APACHE II index) and decreased level of consciousness were relevant predisposing factors to contract HP in the ICU, the strongest association corresponded to extrinsic factors such as mechanical ventilation and use of a nasogastric tube. The fact that these are therapeutic interventions facilitates developing prevention and control measures that can contribute to reduce the risk for HP.
This study explores the implications of the UK Department of Health's intention to introduce charging for undocumented migrants for primary health care.
Following a background review of relevant recent literature, 12 in-depth qualitative interviews were conducted with experts on vulnerable populations in England and/or the English health care system, in collaboration with Doctors of the World UK. Data were analysed qualitatively using thematic coding and framework analysis.
Stakeholders were concerned that implementing charging for migrants in England could deter medically necessary treatment, leading to threats to public health and increased health care costs. Interviewees identified potential challenges and opportunities provided by the Health and Social Care Act 2012 to improve health care for migrants.
There are considerable concerns about adverse consequences of implementing charges for undocumented migrants. It will be essential to evaluate the effects of this policy once it is implemented.
Despite well-established treatment regimens, tuberculosis (TB) remains a public health burden; it disproportionately affects poor and marginalized populations who may not have access to social support, including migrants, homeless people and those dependent on drugs or alcohol. There is a clearly demonstrated need for housing and other appropriate social support, as part of a package of integrated clinical and social care. However, TB prevention and control efforts in the UK often do not address the specific vulnerabilities of these groups and it can be a challenge to support the continued TB treatment of these underserved populations. This challenge is exacerbated by complex issues concerning funding, immigration and the law. In this paper, we have reviewed current UK guidance and legislation, discussed several case studies and highlighted examples of existing models of community support for TB patients. Finally, we lay out our recommendations for ensuring a co-ordinated, whole system approach to successful TB treatment.
Healthcare metrics have been used to drive improvement in outcome and delivery in UK hospital stroke and cardiac care. This model is attractive for chronic obstructive pulmonary disease (COPD) care because of disease frequency and the burden it places on primary, secondary and integrated care services.
Using ‘hospital episode statistics’ (UK ‘coding’), we examined hospital ‘bed days/1000 population’ in 150 UK Primary Care Trusts (PCTs) during 2006–07 and 2007–08. Data were adjusted for COPD prevalence. We looked at year-on-year consistency and factors which influenced variation.
There were 248 996 COPD admissions during 2006–08. ‘Bed days/1000 PCT population’ was consistent between years (r = 0.87; P < 0.001). There was a >2-fold difference in bed days between the best and worst performing PCTs which was primarily a consequence of variation in emergency admission rate (P < 0.001) and proportion of emergency admissions due to COPD (P < 0.001) and to only a lesser extent length of hospital stay (P < 0.001).
Bed days/1000 population appears a useful annual metric of COPD care quality. Good COPD care keeps patients active and out of hospital and requires co-ordinated action from both hospital and community services, with an important role for integrated care. This metric demonstrates that current care is highly variable and offers a measurable target to commission against.
Waterpipe tobacco smoking (WTS) is highly prevalent in the Eastern Mediterranean region. While studies have identified socio-demographic factors differentiating smokers from non-smokers, validated tools predicting WTS are lacking.
Over 1000 (n = 1164) sixth and seventh grade students in Lebanon were randomly assigned to a prediction model group and validation model group. In the prediction model group, backward stepwise logistic regression enabled the identification of socio-demographic and psychosocial factors associated with ever and current WTS. This formed risk scores which were tested on the validation model group.
The risk score for current WTS was out of four and included reduced religiosity, cigarette use and the perception that WTS was associated with a good time. The risk score for ever WTS was out of seven and included an additional two variables: increased age and the belief that WTS did not cause oral cancer. In the validation model group, the model displayed moderate discrimination [area under the curve: 0.77 (current), 0.68 (ever)], excellent goodness-of-fit (P > 0.05 for both) and optimal sensitivity and specificity of 80.1 and 58.4% (current), and 39.5 and 94.4%, (ever), respectively.
WTS use can be predicted using simple validated tools. These can direct health promotion and legislative interventions.