Preview: Journal of Public Health - current issue
Journal of Public Health Current Issue
Published: Fri, 10 Feb 2017 00:00:00 GMT
Last Build Date: Mon, 13 Mar 2017 01:44:47 GMT
Edging closer to an effective reunion between town planners and public health professionals
The year 2016 was one of milestones for the planning for health agenda. It began with the House of Lords National Policy for the Built Environment Committee report in February, which made several recommendations on health and the built environment.1 NHS England announced 10 ‘Healthy New Towns’ in March (www.england.nhs.uk/ourwork/innovation/healthy-new-towns) and in the same month, the Local Government Association (LGA), Public Health England (PHE) and the Town and Country Planning Association (TCPA) published a report on tackling obesity through planning and development.2 September saw the House of Commons Health Select Committee publish its report on public health post-2013 reforms, which made several recommendations for the planning system to take greater account of health impacts.3 The year ended with the LGA's Housing Commission publishing its report to put housing at the heart of integrated health and care.4
Food safety behaviors observed in celebrity chefs across a variety of programs
BackgroundConsumers obtain information about foodborne illness prevention from many sources, including television media. The purpose of this study was to evaluate a variety of cooking shows with celebrity chefs to understand their modeling of food safety behaviors.
MethodsCooking shows (100 episodes) were watched from 24 celebrity chefs preparing meat dishes. A tabulation of food safety behaviors was made for each show using a checklist.
ResultsProper modeling of food safety behaviors was limited, with many incidences of errors. For example, although all chefs washed their hands at the beginning of cooking at least one dish, 88% did not wash (or were not shown washing) their hands after handling uncooked meat. This was compounded with many chefs who added food with their hands (79%) or ate while cooking (50%). Other poor behaviors included not using a thermometer (75%), using the same cutting board to prepare ready-to-eat items and uncooked meat (25%), and other hygiene issues such as touching hair (21%) or licking fingers (21%).
ConclusionsThis study suggests that there is a need for improvement in demonstrated and communicated food safety behaviors among professional chefs. It also suggests that public health professionals must work to mitigate the impact of poorly modeled behaviors.
Time-trends in rates of hospital admission of adolescents for violent, self-inflicted or drug/alcohol-related injury in England and Scotland, 2005–11: population-based analysis
BackgroundIncidence of emergency admissions for violent injury in 10- to 18-year olds decreased in England and Scotland between 2005 and 2011, but more steeply in Scotland. To generate hypotheses about causes of these differences, we determined whether trends were consistent across admissions for three common types of adversity-related injury (violent, self-inflicted and drug/alcohol-related).
MethodsEmergency admissions to NHS hospitals were captured using Hospital Episode Statistics and Scottish Morbidity Records. Adversity-related injury was defined using ICD-10 codes. Analyses were stratified by sex/age groups (10–12, 13–15 and 16–18 years) and adjusted for background trends in admissions for injury.
ResultsDuring 2005–11, rates declined in all sex/age groups in Scotland (reductions adjusted for background trends ranged from −22.0 to −103.7/100 000) and in girls and boys aged <16 years in England (adjusted reductions −12.0 to −49.9/100 000). However, these rates increased in England for both sexes aged 16–18 years (adjusted increases, girls 71.8/100 000; boys 28.0/100 000). However, throughout 2005–11 overall rates remained relatively similar in England and Scotland for both sexes aged <16 years, and remained higher in Scotland for both sexes aged 16–18 years.
ConclusionsA greater decline in the rates of emergency admissions for adversity-related injury for adolescents in Scotland compared with England could signal more effective policies in Scotland for reducing violence, self-harm, or drug/alcohol misuse, particularly for 16 to 18-year olds.
Mapping the contribution of Allied Health Professions to the wider public health workforce: a rapid review of evidence-based interventions
ObjectivesThe objective was to identify a selection of the best examples of the public health contributions by Allied Health Professionals (AHPs) in order to encourage a wider awareness and participation from that workforce to public health practice.
Study designA mapping exercise was used to identify evidence-based interventions that could lead to health improvements across a population.
MethodsA rapid review was undertaken to identify evidence, followed by a survey of Allied Health Profession (AHP) practitioners and an expert panel consensus method to select the examples of AHP public health interventions.
ResultsNine evidence-based interventions are identified and selected as examples of current AHP good practice. These examples represent a contribution to public health and include screening interventions, secondary prevention and risk management.
ConclusionsThis study contributes to a strategy for AHPs in public health by appraising the effectiveness and impact of some exemplar AHP practices that contribute to health improvement. There is a need for AHPs to measure the impact of their interventions and to demonstrate evidence of outcomes at population level.
Comparing online and telephone survey results in the context of a skin cancer prevention campaign evaluation
BackgroundA large proportion of health promotion campaign evaluation research has historically been conducted via telephone surveys. However, there are concerns about the continued viability of this form of surveying in providing relevant and representative data. Online surveys are an increasingly popular alternative, and as such there is a need to assess the comparability between data collected using the two different methods to determine the implications for longitudinal comparisons. The present study compared these survey modes in the context of health promotion evaluation research.
MethodsData were collected via computer-assisted telephone interviewing and an online panel. In total, 688 and 606 respondents aged between 14 and 45 years completed the online and telephone surveys, respectively.
ResultsOnline respondents demonstrated higher awareness of the advertisement, rated the advertisement as more personally relevant and had better behavioural outcomes compared with the telephone respondents.
ConclusionThe results indicate significant differences between the telephone and online surveys on most measures used to assess the effectiveness of a health promotion advertising campaign. Health promotion practitioners could consider the combination of both methods to overcome the deterioration in telephone survey response rates and the likely differences in respondent outcomes.
An estimate of Lyme borreliosis incidence in Western Europe †
BackgroundLyme borreliosis (LB) is the most common zoonotic disease transmitted by ticks in the USA and Europe. This review aims to estimate the regional burden of LB in Western Europe. Data from previous publications will be used to calculate the mean incidence. The mean incidence rates will then be combined to estimate the regional burden and a population-weighted regional burden of disease based on the standardized incidence rate from the included studies and the total population at risk.
MethodsReviews and surveillance reports identified by the initial database search were assessed for eligibility first by their title and abstract and subsequently by a more detailed review of the source by two independent authors for the most recent data regarding LB. Eleven sources of incidence data were included in the review representing 17 countries in total. Incidence estimates were calculated from reported values and population data.
ResultsCountries in Western Europe have a large variance in the incidence rates. The highest reported incidences for LB were reported in southern Sweden with 464/100 000 and the lowest in Italy of 0.001/100 000. The unweighted mean for the included data provided an incidence rate of 56.3/100 000 persons per year, equating to ∼232 125 cases in 1 year throughout the region. The calculated population-weighted average incidence rate for the regional burden of LB in Western Europe was 22.05 cases per 100 000 person-years.
ConclusionsLB is a continually emerging disease and the most common zoonotic infection in Western Europe approaching endemic proportions in many European countries. The population-weighted incidence rate has been estimated by this study to be 22.04/100 000 person-years. Concordant and well-conducted surveillance and disease awareness should continue to be encouraged to monitor LB, as tick numbers and activity are increasing, leading to greater risks of infection.
Food environments of young people: linking individual behaviour to environmental context
BackgroundWe aimed to identify and characterize the food environments from which young people obtain food and to explore associations between the type of food environment and food intakes.
MethodsYoung people (n = 86, mean age 17 years; combined data of two sequential pilot studies (collected in 2008–09) and a study conducted in 2011–12) recorded in 4-day self-complete food diaries what food they consumed and where food was sourced. Nutrient, fruit and vegetable intake was calculated according to the source of food, categorized using a food environment classification tool.
ResultsOver 4 days, respondents sourced food from an average of 4.3 different food environments. Home food was used daily and was more favourable in terms of nutrient profile than out-of-home food. Food sourced from specialist outlets, convenience stores and retail bakers had the highest energy density. Food from retail bakers and ‘takeaway and fast food’ outlets were the richest sources of fat while vending machines and convenience stores had the highest percentage of energy from sugar.
ConclusionsThis work provides details of ‘where’ young people obtain food and the nutritional consequences of choosing those food environments. While home food was a significant contributor to total dietary intake, food was obtained from a broad range of environments; particularly takeaway, fast food and education establishments.
Developing and validating a new national remote health advice syndromic surveillance system in England
BackgroundPublic Health England (PHE) coordinates a suite of real-time national syndromic surveillance systems monitoring general practice, emergency department and remote health advice data. We describe the development and informal evaluation of a new syndromic surveillance system using NHS 111 remote health advice data.
MethodsNHS 111 syndromic indicators were monitored daily at national and local level. Statistical models were applied to daily data to identify significant exceedances; statistical baselines were developed for each syndrome and area using a multi-level hierarchical mixed effects model.
ResultsBetween November 2013 and October 2014, there were on average 19 095 NHS 111 calls each weekday and 43 084 each weekend day in the PHE dataset. There was a predominance of females using the service (57%); highest percentage of calls received was in the age group 1–4 years (14%). This system was used to monitor respiratory and gastrointestinal infections over the winter of 2013–14, the potential public health impact of severe flooding across parts of southern England and poor air quality episodes across England in April 2014.
ConclusionsThis new system complements and supplements the existing PHE syndromic surveillance systems and is now integrated into the routine daily processes that form this national syndromic surveillance service.
Evidence of moderation effects in predicting active transport to school
BackgroundDistance from home to school is an important influence on the decision to use active transport (AT); however, ecological perspectives would suggest this relationship may be moderated by individual, interpersonal and environmental factors. This study investigates whether (i) gender, (ii) biological maturation, (iii) perceived family support for physical activity (PA) and (iv) multiple deprivation moderate the relationship between distance to school and AT.
MethodsA total of 611 children (11–12 years old, 334 females) were recruited from schools in Leicestershire, UK. Gender, family support for PA, and AT were self-reported. Home and school postcodes were used to determine multiple deprivation and distance to school (km). Predicted age at peak height velocity was used to indicate biological maturation.
ResultsLogistic regressions revealed the main effects explained 40.2% of the variance in AT; however; distance to school was the only significant predictor. Further analyses revealed that distance to school had a greater negative impact on the use of AT in late-maturing (OR: 3.60, CI: 1.45–8.96), less deprived (OR: 3.54, CI: 1.17–10.72) and children with low family support of PA (OR: 0.26, CI: 0.11–0.61).
ConclusionsThis study provides evidence that, although distance to school might be the strongest predictor of AT, this relationship is complex.
Antimicrobial resistance in the WHO African region: current status and roadmap for action
AbstractThe high burden of communicable diseases in African countries engenders extensive antimicrobial use and subsequent resistance with substantial health, financial and societal implications. A desktop analysis to ascertain whether countries in the WHO African region have implemented the WHO Policy Package to combat antimicrobial resistance (AMR) revealed that just two countries (4.3%) have national AMR plans in place, 14.9% (7) have overarching national infection prevention and control (IPC) policies, 93.6% (44) have essential medicines lists and 91.5% (43) have national medicines policies and treatment guidelines intimating rational use. None currently have representative national surveillance systems nor do any incentivize research and development into new medicines and diagnostics. A regional situational analysis to identify scalable good practices within African, resource-constrained country contexts under the auspices of WHO-AFRO is a necessary initial step towards the development of national and regional action plans in concert with incremental progress towards achieving the objectives of the policy package and global action plan. While it is clearly the responsibility of governments to develop, resource and implement plans, regular reporting to and/or monitoring and evaluation by an overarching body such as WHO-AFRO will ensure persistent incremental progress within continuous quality and accountability improvement paradigms.
Has increasing public health awareness influenced the size of testicular tumours among adult populations over the last 40 years?
BackgroundTesticular cancer is the commonest malignancy in young men. Improvements in survival rates have led to campaigns to raise awareness in at-risk men. We assessed the changing size of testicular tumours given the public health initiatives promoting testicular self-examination (TSE).
MethodsRetrospective analysis of men (≥16 years) undergoing orchidectomy for testicular cancer at our institution over two time periods (1975–85 and 2007–12) were identified using our cancer registry. Histopathology reports were used to record testicular tumour size as the maximum measured dimension. Significance was indicated by P < 0.05.
ResultsOf 305 orchidectomies performed, 215 had histopathology reports available. Median age was 34 years (16–75 years). Mean tumour size was 7.2 cm in 1975–85 and 4.1 cm in 2007–12 showing a significant reduction (P = 0.02). Significant reduction was seen in all age groups except >60 years. Furthermore there was a significant increase in proportion of men presenting in the youngest age group (16–29 years) in the 2007–12 cohort (43 versus 29%, P = 0.02).
ConclusionThe trend in reduction of tumour size at presentation and increased proportion of younger men presenting with testicular cancer supports an increased awareness. Promotion of TSE and public education should remain important initiatives given the increasing incidence of testicular cancer. Awareness still needs addressing in older men.
A novel strategy to reduce very late HIV diagnosis in high-prevalence areas in South-West England: serious incident audit
BackgroundVery late diagnosis of HIV is a serious public health issue. We used serious incident reporting (SIR) to identify and address reasons for late diagnoses across the patient pathway.
MethodsCases of very late HIV diagnosis were reported via SIR in two 6-month batches between 2011 and 2012 in Bournemouth, Poole and Bristol. Case notes were reviewed for missed opportunities for earlier diagnosis using a root-cause analysis tool.
ResultsA total of 33 patients (aged 30–67 years, 66% male) were diagnosed very late. Although the majority were white British (n = 17), Black African (n = 9) and Eastern European (n = 4) ethnicities were over-represented. Twenty-four (73%) patients had clinical indicator conditions for HIV, 30 (91%) had a risk factor for HIV acquisition, with 13 (39%) having 2 or more (men-who-have-sex-with-men (n = 11), partner HIV positive (n = 11), from high-prevalence area (n = 12)). Actions resulting from SIR included increasing awareness of indicator conditions, HIV education days within primary care, and initiatives to increase testing within hospital specialities.
ConclusionsSIR allowed identification of reasons for very late HIV diagnosis and provided an impetus for initiatives to address them. SIR may be part of an effective strategy to prevent late diagnosis of HIV which would have important benefits for individual and population health.
Factors associated with access to care and healthcare utilization in the homeless population of England
BackgroundPeople experiencing homelessness are known to have complex health needs, which are often compounded by poor access to healthcare. This study investigates the individual-level factors associated with access to care and healthcare utilization among homeless people in England.
MethodsA cross-sectional sample of 2505 homeless people from 19 areas of England was used to investigate associations with access to care and healthcare utilization.
ResultsRough sleepers were much less likely to be registered with a general practitioner (GP) (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.30–0.66) than single homeless in accommodation (reference group) or the hidden homeless (OR 1.48, 95% CI 0.88–2.50). Those who had recently been refused registration by a GP or dentist also had lower odds of being admitted to hospital (OR 0.67, 95% CI 0.49–0.91) or using an ambulance (OR 0.73, 95% CI 0.54–0.99).
ConclusionsThe most vulnerable homeless people face the greatest barriers to utilizing healthcare. Rough sleepers have particularly low rates of GP registration and this appears to have a knock-on effect on admission to hospital. Improving primary care access for the homeless population could ensure that some of the most vulnerable people in society are able to access vital hospital services which they are currently missing out on.
Adolescent self-harm in the community: an update on prevalence using a self-report survey of adolescents aged 13–18 in England
BackgroundTo establish an estimate of prevalence in a nationally representative sample of community adolescents. To examine associations between self-harm and wellbeing.
MethodsAn anonymous self-report survey completed by 2000 adolescents aged 13–18 years across England. Wellbeing was measured using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS).
ResultsIn total 15.5% (n = 309) of participants reported ever having self-harmed (95% confidence intervals 13.9–17.1). The median age of onset was 13.0 years. Females aged 13–15 years reported the highest incidence of self-harm within the past year (54.9%). Cutting elsewhere (other than on the arms) was more prevalent amongst females (56.4%). The mean wellbeing score for the whole sample (45.6) was lower than the WEMWBS validation score (48.8). Self-harm was associated with a significantly lower wellbeing score, with mean scores of 38.7 (ever self-harmed) and 46.8 (never self-harmed).
ConclusionsSelf-harm remains prevalent amongst adolescents aged 13–18 years in England. An awareness of the age of peak incidence and risks associated with preferred harming behaviours is crucial during assessment and intervention. The promotion of wellbeing is important for all young people. Further study is needed on the ways in which wellbeing may prevent, or ameliorate, the distress associated with self-harm.
Reducing low birth weight: prioritizing action to address modifiable risk factors
BackgroundLow birth weight (LBW) affects 6.9% of all UK births and has remained largely unchanged for many years. The United Nations and the World Health Assembly have set targets to substantially reduce global incidence. Understanding the contribution of modifiable risk factors to the burden of LBW is required to ensure appropriate interventions are in place to achieve this reduction.
MethodsData from published studies on the risks from key modifiable factors were used alongside prevalence data from the Welsh population to calculate the population attributable risk for each factor individually and in combination.
ResultsFourteen risk factors accounted for nearly half of LBW births, and 60% of those to younger mothers (<25 years). Tobacco smoke exposure was the largest contributor. We estimated that smoking in pregnancy was a factor in one in eight LBW births, increasing to one in five for women aged under 25.
ConclusionsRisk factors are interrelated and inequitably distributed within the population. Exposure to one factor increases the likelihood of exposure to a constellation of factors further increasing risk. Action to address LBW must consider groups where the risk factors are most prevalent and address these risk factors together using multi-component interventions.
Associations between self-reported concussion with later violence injury among Australian early adolescents
BackgroundThere is growing research finding associations between adolescents' concussion and negative outcomes, including violence, rarely however are the experiences of community-based early adolescents considered.
MethodsThis study examined associations between reports of concussion (Time-1) and reports of violence 1-year later (Time-2). Australian adolescents from 13 high-schools completed two identical surveys administered 12-months apart (n = 734 retained, initial mean age = 13.45).
ResultsAt the first survey, 91 students (13%) reported they had a concussion, and of these students, 40% reported seeing a doctor/attending hospital during the prior 3 months. Both self-reported experience of violent injury (from getting in a fight) and violent behaviour (getting in a fight) were predicted by reports of concussion in Year 9. This prediction held, when adding sex, Year 9 reports of violence, alcohol use, truancy and engagement in passenger and driving risk-taking to logistic regression models. Year 9 concussion was not predictive of later injury in other contexts, including transportation, falls or sports.
ConclusionThe study highlights the need to understand concussion among community-based early adolescents including consider associations with violence.
Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain
BackgroundSocioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age.
MethodsThis was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed.
ResultsA statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15–44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group.
ConclusionPeople with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age.
The impact of daycare attendance on outdoor free play in young children
BackgroundOutdoor free play is important for healthy growth and development in early childhood. Recent studies suggest that the majority of time spent in daycare is sedentary. The objective of this study was to determine whether there was an association between daycare attendance and parent-reported outdoor free play.
MethodsHealthy children aged 1–5 years recruited to The Applied Research Group for Kids! (TARGet Kids!), a primary care research network, were included. Parents reported daycare use, outdoor free play and potential confounding variables. Multivariable linear regression was used to determine the association between daycare attendance and outdoor free play, adjusted for age, sex, maternal ethnicity, maternal education, neighborhood income and season.
ResultsThere were 2810 children included in this study. Children aged 1 to <3 years (n = 1388) and ≥3 to 5 years (n = 1284) who attended daycare had 14.70 min less (95% CI −20.52, −8.87; P < 0.01) and 9.44 min less (95% CI −13.67, −5.20; P < 0.01) per day of outdoor free play compared with children who did not attend daycare, respectively.
ConclusionsChildren who spend more time in daycare have less parent-reported outdoor free play. Parents may be relying on daycare to provide opportunity for outdoor free play and interventions to promote increased active play opportunities outside of daycare are needed.
Women's interest in a personal breast cancer risk assessment and lifestyle advice at NHS mammography screening
BackgroundAlthough mortality from breast cancer is declining, incidence continues to increase and is often detected at routine NHS screening. Most middle aged and older women in England attend for screening every 3 years. Assessing their personal breast cancer risk and providing preventative lifestyle advice could help to further reduce breast cancer incidence.
MethodsA cross-sectional, self-complete postal survey measured attendees' interest in having a personal risk assessment, expected impact on screening attendance, knowledge of associations between lifestyle and breast cancer and preferred ways of accessing preventative lifestyle advice.
ResultsA total of 1803/4948 (36.4%) completed questionnaires were returned. Most participants (93.7%) expressed interest in a personal risk assessment and 95% (1713/1803) believed it would make no difference or encourage re-attendance. Two-thirds (1208/1803) associated lifestyle with breast cancer, but many were unaware of specific risks such as weight gain, obesity, alcohol consumption and physical inactivity. NHS sourced advice was expected to be more credible than other sources, and booklets, brief counselling or an interactive website were most preferred for accessing this.
ConclusionsAttendees appear to welcome an intervention that would facilitate more proactive clinical and lifestyle prevention and address critical research gaps in breast cancer prevention and early detection.
Experiences of accessing obesity surgery on the NHS: a qualitative study
BackgroundAlthough surgical treatment is recommended for morbid obesity where other interventions have failed, there is evidence that access to NHS surgery is heavily rationed. This study aimed to investigate how patients experienced accessing referrals for obesity surgery.
MethodsData collection was undertaken using in-depth interviews with patients and clinicians working in a specialist secondary care facility, and analysis took a constant comparative approach.
ResultsTwenty-two participants with morbid obesity were followed up for a period of up to 3 years. All participants had made multiple attempts to lose weight prior to consulting their GPs yet felt this was rarely acknowledged by clinicians. Participants were frustrated when they received insufficient support to comply with primary care interventions, and when it came to obtaining a referral to secondary care, most had to raise this issue with GPs themselves.
ConclusionsThere is an urgent need for interventions for morbid obesity in primary care that are accessible to patients to facilitate weight loss and prevent weight re-gain. For those at very high weights, better integration between primary and secondary care is required to ensure appropriate and timely referral for those who need assessment for surgery.
Impact of combined lifestyle factors on metabolic syndrome in Korean men
BackgroundThe purpose of this study was to determine the relationship between combined poor lifestyle factors and metabolic syndrome (MetS) in Korean men.
MethodsData from the Korean National Health and Nutrition Examination Survey 2010 were classified according to the number and combination patterns of poor lifestyle factors, namely, current smoking, high-risk alcohol use, low physical activity and poor dietary habits. We analyzed the association between the combined poor lifestyle factors and MetS. The definition of MetS was based on the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention in 2009.
ResultsA total of 1408 men aged 20–75 were included in this study. Approximately one-third of the 30–49 age group had ≥3 combined poor lifestyle factors. Compared with those with no poor lifestyle factors, the ORs for MetS were 3.57 (95% CI 1.16–11.02), 3.62 (95% CI 1.18–11.08) and 6.31 (95% CI 2.08–19.26) in subjects with one, two and three or more poor lifestyle factors, respectively. When current smoking, high-risk alcohol use and low physical activity were concurrently present, the ORs for MetS, hyperglycemia, and hypertriglyceridemia were 14.32 (95% CI 3.64–56.30), 4.49 (95% CI 1.62–12.40), and 5.07 (95% CI 2.18–11.81), respectively.
ConclusionsComprehensive lifestyle modifications need to be stressed in public health programs.
Measuring the impact of Health Trainers Services on health and health inequalities: does the service's data collection and reporting system provide reliable information?
BackgroundThe Health Trainers Service is one of the few public health policies where a bespoke database—the Data Collection and Reporting System (DCRS)—was developed to monitor performance. We seek to understand the context within which local services and staff have used the DCRS and to consider how this might influence interpretation of collected data.
MethodsIn-depth case studies of six local services purposively sampled to represent the range of service provider arrangements, including detailed interviews with key stakeholders (n = 118).
ResultsCapturing detailed information on activity with clients was alien to many health trainers' work practices. This related to technical challenges, but it also ran counter to beliefs as to how a ‘lay’ service would operate. Interviewees noted the inadequacy of the dataset to capture all client impacts; that is, it did not enable them to input information about issues a client living in a deprived neighbourhood might experience and seek help to address.
ConclusionsThe utility of the DCRS may be compromised both by incomplete ascertainment of activity and by incorrect data inputted by some Health Trainers. The DCRS is also underestimate the effectiveness of work health trainers have undertaken to address ‘upstream’ factors affecting client health.
Access to water provides economic relief through enhanced relationships in Kenya
IntroductionSub-Saharan Africa is comprised of low- and middle-income countries subject to the residual effects of chronic poverty. Poverty contributes to health disparities and social inequities. Public health strategies and solutions seek to remedy the effects of poverty. Providing access to quality water is one priority public health project that alleviates adverse health effects, but may have additional outcomes. Previous research has not thoroughly reviewed the economic relief and relationship changes from implemented water interventions.
MethodsA qualitative phenomenological approach used 52 semi-structured interviews to understand relationship experiences among primary water gatherers and their families after implemented water interventions in a community. This study took place throughout the historically semi-arid eastern region in Kitui, Kenya, where community members have been beneficiaries of various water interventions.
ResultsPrior to the water intervention, relationships were strained because of economic hardships. Households experienced economic difficulties in paying for children's school fees, buying bricks for housing structures, having water for house gardens, trees for shade in the compound, crops and providing water for their animals. After receiving access to water, relationships improved, because families were able to discuss and address economic challenges. Additional financial revenue was gained and used to pay for water to make bricks to sell or use on housing structures, expand on house gardens and agricultural crops, build new businesses, purchase water for animals, and construct local water spouts near the household.
DiscussionAccess to water improved relationships, which encouraged economic growth. This information provides a critical component in understanding the interconnected nature between access to water, poverty and family relationships. Ultimately, this research suggests an increased need for access to quality water worldwide to improve both economic situations and relationships in low- and middle-income countries.
A family-based model for Iranian women's health: a grounded theory study
BackgroundIn many societies, women are vulnerable to specific situations and inequalities, which may negatively impact their own and their family's health. The purpose of this qualitative study was to explore Iranian women's perspectives on this issue and to develop a categorical model for their health.
MethodsThe study was conducted using a grounded theory approach via 25 semi-structured interviews.
ResultsThe results revealed that family dynamism was the core variable and identified four main categories: understanding of health, reduction of women's health, the pleasure and difficulties of motherhood, cultural and/or social factors influencing women's health.
ConclusionPolicymakers should consider policies that empower women, reduce gender inequality and provide social security to maximize the probability of women being healthy.
Quality of life in caregivers with and without chronic disease: Welsh Health Survey, 2013
BackgroundThe aim of the present study was to investigate and compare quality of life after regular care provision in people with and without currently treated chronic disease in a country-wide and population-based setting.
MethodsData were retrieved from Welsh Health Survey, 2013. Information on demographics, lifestyle factors, health conditions, regular care provision and quality of life was obtained by household interview. Chi-square test, t-test and survey-weighted multi-nominal regression modelling were performed.
ResultsOf 15 007 Welsh adults aged 16 and above, 2751 (19.1%) people reported that they have been giving care for any sick, disabled or frail person. They tended to be aged 40–74, being female, education 25, physically active, current smokers and living in second-hand smoking households. In caregivers with current chronic disease (n = 1562), they have experienced physical health limits, bodily pains, emotional problems, less calm and less cheerful. In caregivers without current chronic diseases (n = 1151), they have experienced physical health limits, bodily pains, less cheerful, downhearted and unhappiness.
ConclusionsThis is the first study to examine quality of life in caregivers both with and without currently treated chronic disease. Longitudinal monitoring and increasing education, training and support to lessen caregiving burden would be suggested.
Associations between neighbourhood environmental factors and the uptake and effectiveness of a brief intervention to increase physical activity: findings from deprived urban communities in an English city
BackgroundEvidence suggests behavioural interventions may exacerbate health inequalities, potentially due to differences in uptake or effectiveness. We used a physical activity intervention targeting deprived communities to identify neighbourhood-level factors that might explain differences in programme impact.
MethodsIndividuals aged 40–65 were sent a postal invitation offering a brief intervention to increase physical activity. We used postcodes linkage to determine whether neighbourhood indicators of deprivation, housing, crime and proximity to green spaces and leisure facilities predicted uptake of the initial invitation or an increase in physical activity level in those receiving the brief intervention.
ResultsA total of 4134 (6.8%) individuals responded to the initial invitation and of those receiving the intervention and contactable after 3 months, 486 (51.6%) reported an increase in physical activity. Area deprivation scores linked to postcodes predicted intervention uptake, but not intervention effectiveness. Neighbourhood indicators did not predict either uptake or intervention effectiveness.
ConclusionsThe main barrier to using brief intervention invitations to increase physical activity in deprived, middle-aged populations was the low uptake of an intervention requiring significant time and motivation from participants. Once individuals have taken up the intervention offer, neighbourhood characteristics did not appear to be significant barriers to successful lifestyle change.