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Preview: Journal of Public Health - current issue

Journal of Public Health Current Issue





Published: Fri, 29 Dec 2017 00:00:00 GMT

Last Build Date: Sun, 31 Dec 2017 23:45:43 GMT

 



Just William

Fri, 29 Dec 2017 00:00:00 GMT




The design and psychometric assessment of a child-friendly TPB-based questionnaire

Thu, 23 Nov 2017 00:00:00 GMT

Abstract
Background
Despite the popularity of the theory of planned behaviour (TPB), a lack of research assessing the efficacy of the model in understanding the health behaviour of children exists. The aim of this study was to develop and test a TPB-based measure suitable for use with schoolchildren aged 9–10 years.
Methods
A mixed-method sequential design was employed. In Phase 1, semi-structured focus group discussions were conducted to elicit the underlying beliefs specific to tooth brushing. Using content thematic analysis, the beliefs were identified and a TPB measure was developed. A repeated measures design was employed in Phase 2 using test–retest reliability analysis in order to assess its psychometric properties. In all, 184 children completed the questionnaire.
Results
The questionnaire proved to be reliable for assessing the tooth brushing beliefs of children. Pearson's product moment correlations were calculated for all of the TPB constructs, achieving substantial to almost perfect agreement levels, providing strong predictive power of the TPB.
Conclusions
The design and development of the measure are described, which could serve as a guide to fellow researchers and health professionals interested in using theoretical models to investigate the health and well-being of children.



NICE public health guidance update

Tue, 17 Oct 2017 00:00:00 GMT




The effects of breastfeeding on childhood BMI: a propensity score matching approach

Sat, 09 Sep 2017 00:00:00 GMT

Abstract
Background
Many studies have found a statistical association between breastfeeding and childhood adiposity. This paper investigates whether breastfeeding has an effect on subsequent childhood body mass index (BMI) using propensity scores to account for confounding.
Methods
We use data from the Millennium Cohort Study, a nationally representative UK cohort survey, which contains detailed information on infant feeding and childhood BMI. Propensity score matching is used to investigate the mean BMI in children breastfed exclusively and partially for different durations of time.
Results
We find statistically significant influences of breastfeeding on childhood BMI, particularly in older children, when breastfeeding is prolonged and exclusive. At 7 years, children who were exclusively breastfed for 16 weeks had a BMI 0.28 kg/m2 (95% confidence interval 0.07 to 0.49) lower than those who were never breastfed, a 2% reduction from the mean BMI of 16.6 kg/m2.
Conclusions
For this young cohort, even small effects of breastfeeding on BMI could be important. In order to reduce BMI, breastfeeding should be encouraged as part of wider lifestyle intervention. This evidence could help to inform public health bodies when creating public health guidelines and recommendations.









‘Transforming lives through music’ as a public health intervention: further reflections on our evaluation of Sistema Scotland

Wed, 09 Aug 2017 00:00:00 GMT

Abstract
We previously contributed a short discussion piece to this section, which described some of the challenges inherent in evaluating the public health impacts of an arts-based social intervention, Sistema Scotland's 'Big Noise' programmes. This contribution aims to follow-up by exploring two interwoven aspects of these difficulties in more detail. The first is the role of participants’ experiences of challenge and struggle, as part of their engagement with the main, orchestral element of this intervention, in generating the impacts on confidence and self-esteem that we identified in our initial evaluation. The second is the role of music, the learning of instrumental skills and the undertaking of orchestral performances in underpinning these outcomes.















A qualitative study exploring awareness and attitudes towards tuberculosis in migrant populations in a Metropolitan District Council in the North of England

Sat, 17 Jun 2017 00:00:00 GMT

Abstract
Background
The majority of tuberculosis (TB) cases in the UK occur among people born in high-burden countries (73%), and are concentrated in large urban centres. This study explores migrants’ attitudes and beliefs towards TB in an English District where the incidence is higher than the UK average.
Methods
Community engagement workers ran 26 focus groups using a standardized questionnaire. Purposeful sampling was used to obtain a cross-section of migrant communities. The summary reports were analysed using thematic analysis.
Results
Most groups did not see TB as a current issue in their community and associated it either with the past or with their country of birth. It appeared to be rarely discussed in their communities and generally not noted as being associated with stigma.
Conclusions
This study revealed a change in social attitudes to TB in migrant groups to those reported in previous literature. Stigma had considerably less effect than expected. However, the evidence revealed that these high-risk groups made the erroneous assumption that, by moving to a low incidence country, they were no longer at risk of the disease. TB services need to respond by revising the information that they provide to take into account the risk perception of these populations.



Addressing London's modern urban health challenges: learning from other global cities

Sat, 18 Mar 2017 00:00:00 GMT

Abstract
Around 150 cities have emerged as notable at a global scale. With a global population of fewer than 12%, they generate 46% of world gross domestic product. There is growing interest in how cities can accelerate health improvements through wider social and economic collaboration. A team led by Public Health England in London visited counterparts in New York City and Paris to examine how city health leaders addressed public health challenges. The three cities have similar health challenges but different legal, political and fiscal resources for promoting and protecting health. Consequently, there is no single model that every city could adopt. Organizational structures, interpersonal relationships and individual skills can play an important part in effective delivery of better city health. Lack of access to published evidence on how practice has been influenced by city health policies hampers learning between cities. There is little easily comparable data to guide those interested in such learning. Municipal governments are ideally situated to join researchers to fill this gap in the literature.



The burden of HPV-related diseases in Italy, 2001–12

Tue, 14 Mar 2017 00:00:00 GMT

Abstract
Background
Human papillomavirus (HPV) infection is the main cause of cervical cancer and plays a relevant role in the development of genital warts and of the cancer of penis and anus, head/neck, oropharynx and genitourinary system. The aim of this study is the evaluation of hospitalizations due to HPV-related pathologies in 2001–12 in Italy.
Methods
The national hospital discharge forms were provided by the Ministry of Health. The HPV-related hospitalizations were identified using specific diagnostic codes, accordingly to the ICD-9-CM coding system. The proportion of hospitalizations of potentially HPV-related pathologies, obtained from the literature, was evaluated as well as the hospitalization rates (hr) and their trend over time.
Results
Uterine cervical cancer and CIN III accounted for 40% of hospitalizations (hr: 15.6/100 000 and 17.6/100 000, respectively). Head/neck and oropharynx pathologies accounted for 24.5% of cases (hr: 16/100 000 and 3.9/100 000, in males and females, respectively), followed by genital warts (17.3% of hospitalizations; hr: 7.5/100 000 in males and 8.52/100 000 in females), anal (8.1% of hospitalizations), genitourinary (7.7%) and penis cancers (2.2%).
Conclusions
The study, even if limited to the evaluation of hospitalizations, points out how HPV-related pathologies continue to be a relevant public health issue in Italy with a high impact on population.



Systematic review of surveillance by social media platforms for illicit drug use

Tue, 14 Mar 2017 00:00:00 GMT

Abstract
Background
The use of social media (SM) as a surveillance tool of global illicit drug use is limited. To address this limitation, a systematic review of literature focused on the ability of SM to better recognize illicit drug use trends was addressed.
Methods
A search was conducted in databases: PubMed, CINAHL via Ebsco, PsychINFO via Ebsco, Medline via Ebsco, ERIC, Cochrane Library, Science Direct, ABI/INFORM Complete and Communication and Mass Media Complete. Included studies were original research published in peer-reviewed journals between January 2005 and June 2015 that primarily focused on collecting data from SM platforms to track trends in illicit drug use. Excluded were studies focused on purchasing prescription drugs from illicit online pharmacies.
Results
Selected studies used a range of SM tools/applications, including message boards, Twitter and blog/forums/platform discussions. Limitations included relevance, a lack of standardized surveillance systems and a lack of efficient algorithms to isolate relevant items.
Conclusion
Illicit drug use is a worldwide problem, and the rise of global social networking sites has led to the evolution of a readily accessible surveillance tool. Systematic approaches need to be developed to efficiently extract and analyze illicit drug content from social networks to supplement effective prevention programs.



Public health implications of 4 decades of neoliberal policy: a qualitative case study from post-industrial west central Scotland

Thu, 02 Mar 2017 00:00:00 GMT

Abstract
Background
The UK has long had a strong commitment to neoliberal policy, the risks of which for population health are well researched. Within Europe, Scotland demonstrates especially poor health outcomes, much of which is driven by high levels of deprivation, wide inequalities and the persistent impacts of deindustrialisation. The processes through which neoliberalism has contributed to this poor health record are the subject of significant research interest.
Methods
Qualitative case study of a post-industrial town in west central Scotland. Primary data were collected using photovoice (11) and oral history (9) interviews, supplemented by qualitative and quantitative secondary source data.
Results
For those who fared poorly after the initial introduction of neoliberal policy in the 1970s, subsequent policy decisions have served to deepen and entrench negative impacts on the determinants of health. Neoliberalism has constituted a suite of rapidly and concurrently implemented policies, cross-cutting a variety of domains, which have reached into every part of people's lives.
Conclusions
In formerly industrial parts of west central Scotland, policy developments since the 1970s have generated multiple and sustained forms of deprivation. This case study suggests that a turn away from neoliberal policy is required to improve quality of life and health.



Can Memory Assessment Services (MAS) in England be categorized? A national survey

Thu, 02 Mar 2017 00:00:00 GMT

Abstract
Background
The effectiveness and efficiency of memory assessment services (MASs) is unknown. Our aim was to determine if a typology can be constructed, based on shared structural and process characteristics, as a basis for a non-randomized evaluation of their effectiveness and cost-effectiveness.
Methods
Survey of random sample of 73 MASs in 2015; comparison of characteristics and investigation of inter-correlation.
Results
It was not possible to group characteristics to form the basis of a typology of MASs. However, there was considerable variation in staff numbers (20-fold), new patients per whole-time equivalent (WTE) staff (20-fold), skill mix and the nurse:doctor ratio (1–10).The operational performance also varied: first appointments (50–120 minutes); time for first follow-up (2–12 weeks); frequency of follow-up in first year (1–5). These differences were not associated with the number of new patients per WTE staff or the accreditation status of the MAS.Post diagnosis, all MASs provided pharmacological treatment but the availability of non-pharmacological support varied, with half providing none or only one intervention while others providing four or more.
Conclusions
In the absence of any clear typology, evaluation of MASs will need to focus on the impact of individual structural and process characteristics on outcomes.



Perceptual body image and the relationship with weight control across the adult lifespan by sex in Koreans

Mon, 27 Feb 2017 00:00:00 GMT

Abstract
Background
This study aimed to investigate perceptual body image and the relationship between perceived body image (PBI) and weight control differentiated according to obesity categories across the adult lifespan by sex among Koreans.
Methods
We analyzed data on 10 198 adults aged 25 or older from the Korean National Health and Nutrition Examination Survey of a nationally representative sample of non-institutionalized Koreans.
Results
Significant discordance between PBI and body mass index (BMI) or waist circumference (WC) was found in all age groups in both sexes, and the discordance for obesity grew more severe with age. Linear associations between PBI and BMI or WC were found in normal weight and obese groups in all age groups in both sexes, with relatively greater BMI or WC differences for PBI found in obese men aged ≤64 or ≤44, respectively, and obese women of all ages or aged ≥75, respectively, compared to normal weight. Obese women aged ≥65 (BMI) or ≥75 (WC) and obese men in the 45–54 and 65–74 age groups (BMI and WC) had significant association between PBI and weight control.
Conclusions
Interventions regarding accurate body size perception should be prioritized for obese women aged ≥65 or ≥75 and for obese men aged 45–54 and 65–74.



Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government

Fri, 10 Feb 2017 00:00:00 GMT

Abstract
Background
In 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites.
Methods
In depth, interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organizations (‘local authorities’).
Results
Participants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted ‘good’ evidence and (iii) that organizational life is an important mediator in the way evidence is used.
Conclusions
Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made.



Quantifying the global distribution of premature mortality from non-communicable diseases

Fri, 10 Feb 2017 00:00:00 GMT

Abstract
Background
Non-communicable diseases (NCDs) have slowly risen to the top of the global health agenda and the reduction of premature NCD mortality was recently enshrined in Target 3.4 of the UN Sustainable Development Goals. The unequal global distribution of NCDs is inadequately captured by the most commonly cited statistics.
Methods
We analyzed ‘WHO Global Health Estimates’ mortality data to calculate the relative burden of NCDs for each World Bank income group, including the ‘risk of premature NCD death’ based on methods in the WHO Global Status Report. We included all deaths from cardiovascular disease, all cancers, respiratory diseases and diabetes in people aged 30–69 years.
Results
Developing countries experience 82% of absolute global premature NCD mortality, but they also contain 82% of the world's population. Examining relative risk shows that individuals in developing countries face a 1.5 times higher risk of premature NCD death than people living in high-income countries. Premature NCD death rates are highest in lower middle-income countries.
Conclusions
Although numbers of deaths are useful to describe the absolute burden of NCD mortality by country type, the inequitable distribution of premature NCD mortality for individuals is more appropriately conveyed with relative risk.



Pilot evaluation of a school-based health education intervention in the UK: Facts4Life

Fri, 10 Feb 2017 00:00:00 GMT

Abstract
Background
This study assessed short-term changes in children's health and illness attitudes and health status following Facts4Life, a school-based health education intervention.
Methods
Children aged 7–11 years (School Years 3–6) recruited from 10 schools in the UK participated in this study. A quasi-experimental design was utilized with 187 children participating in the intervention, and 108 forming a control condition. Children in both conditions completed measures of health and illness attitudes and health status at baseline and at immediate follow-up. Intervention effects were examined using mixed between-within subjects analysis of variance.
Results
Analysis revealed significant baseline to follow-up improvements in intervention group responses to ‘When I feel unwell I need to take medicine to feel better’ (Years 3 and 4: P = 0.05, η2p = 0.02; Years 5 and 6: P = 0.004, η2p = 0.07). For intervention group children in Years 5 and 6 there was an improvement in response to ‘When I am ill, I always need to see a doctor’ (P = 0.01, η2p = 0.07). There was no evidence that Facts4Life had an impact upon health status.
Conclusions
This study identified some positive intervention effects and results suggest that Facts4Life has potential as a school-based health education intervention.



Recommodification and the social determinants of health: unemployment benefits, pensions and health inequalities in Sweden and England, 1991–2011

Sat, 04 Feb 2017 00:00:00 GMT

Abstract
Background
’Recommodification’ describes the withdrawal of previously extended social welfare, making living standards more dependent on market position. Since health is influenced by living standards, recommodification is expected to be associated with increased health inequalities.
Aim
This study investigates the recommodification of two policy domains: unemployment insurance and pensions, and their link to health inequalities between 1991 and 2011.
Methods
Two case studies were used. Using data from Health Survey for England and the Swedish Study of Income and Living Conditions, the magnitudes of health inequalities between the employed and unemployed, and between high and low educated pensioners, were computed. The magnitudes were then associated with net replacement rates of pensions and unemployment benefits.
Results
Recommodification had a stronger association with health inequalities in Sweden than in England, and a stronger association with health inequalities between the employed and unemployed than in the retired population.
Conclusion
The relationship between decommodification is not linear, but is shaped by other factors in the social context. However, recommodification has a positive or negligible association with health inequalities. In no case was there a negative association between recommodification and health inequalities.



Advertising to children initiatives have not reduced unhealthy food advertising on Australian television

Thu, 02 Feb 2017 00:00:00 GMT

Abstract
Background
In response to rising childhood obesity rates, the Australian food industry implemented two initiatives in 2009 to reduce the marketing of unhealthy food to children. This study evaluated the efficacy of these initiatives on the rate of unhealthy food advertising to children on Australian television.
Methods
The rates of food advertisements on three free-to-air commercial television channels and a youth-oriented digital channel in Sydney, Australia were analysed over 2 weekdays (16 h) and two weekend days (22 h). Advertisements were categorized according to the healthiness of foods advertised (non-core, core, miscellaneous) and signatory status to the food industry advertising initiatives.
Results
Total food advertising rates for the three channels increased from 5.5/h in 2011 to 7.3/h in 2015, due to an increase of 0.8/h for both core and miscellaneous foods. The rate of non-core food advertisements in 2015 (3.1/h) was similar to 2011 (3.0/h). The youth-oriented channel had fewer total food advertisements (3.7/h versus 7.3/h) but similar fast-food advertisement rates (1.3/h versus 1.3/h).
Conclusions
There was no change in the rate of unhealthy food advertising since 2011, suggesting minimal impact of the current food industry initiatives on reducing children's exposure to unhealthy food advertising.



New sources of value for health and care in a carbon-constrained world

Wed, 18 Jan 2017 00:00:00 GMT

Abstract
Background
Due to the climate crisis, it is increasingly evident that countries will have to decarbonize. Healthcare, which has a large carbon footprint and uses vast quantities of resources, will have to undergo significant transformation. In this research, we sought the ideas of leading thinkers in the field, to address the question of how health systems can provide high-quality care in a carbon-constrained world.
Methods
Semi-structured, qualitative in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the USA and New Zealand. The interviews were transcribed and analysed by matrix display and thematic analysis.
Results
‘Green’ initiatives such as improving energy efficiency and implementing travel plans will be insufficient to achieve the scale of decarbonization required. According to the thought leaders in our study, it is likely that greater carbon and resource savings will come from thinking much more broadly about innovative models of care and using ‘new’ sources of ‘value’ such as ‘people’ and ‘relationships’.
Conclusions
Using human resources and human interactions as low-carbon sources of value in healthcare are promising models.



Reframing inequality? The health inequalities turn as a dangerous frame shift

Mon, 09 Jan 2017 00:00:00 GMT

Abstract
Background
Politicians in many countries have embraced the notion that health inequalities derive from socioeconomic inequalities, but European governments have for the most part failed to enact policies that would reduce underlying social inequalities.
Methods
Data are drawn from 84 in-depth interviews with policy-makers in four European countries between 2012 and 2015, qualitative content analysis of recent health inequalities policy documents, and secondary literature on the barriers to implementing evidence-based health inequalities policies.
Results
Institutional and political barriers are important barriers to effective policy. Both policy-making institutions and the ideas and practices associated with neoliberalism reinforce medical-individualist models of health, strengthen actors with material interests opposed to policies that would increase equity, and undermine policy action to tackle the fundamental causes of social (including health) inequalities.
Conclusions
Medicalizing inequality is more appealing to most politicians than tackling income and wage inequality head-on, but it results in framing the problem of social inequality in a way that makes it technically quite difficult to solve. Policy-makers should consider adopting more traditional programs of taxation, redistribution and labor market regulation in order to reduce both health inequalities and the underlying social inequalities.



Development and validation of the Alzheimer's prevention beliefs measure in a multi-ethnic cohort—a behavioral theory approach

Mon, 09 Jan 2017 00:00:00 GMT

Abstract
Background
Understanding health beliefs and how they influence willingness will enable the development of targeted curricula that maximize public engagement in Alzheimer’s disease (AD) risk reduction behaviors.
Methods
Literature on behavioral theory and community input was used to develop and validate a health beliefs survey about AD risk reduction among 428 community-dwelling adults. Principal component analysis was performed to assess internal consistency. Linear regression was performed to identify key predictors of Willingness to engage in AD risk reduction behaviors.
Results
The measure as well as the individual scales (Benefits, Barriers, Severity, Susceptibility and Social Norm) were found to be internally consistent. Overall, as Benefits and Barriers scores increased, Willingness scores also increased. Those without prior AD experience or family history had lower willingness scores. Finally, we observed an interaction between age and norms, suggesting that social factors related to AD prevention may differentially affect people of different ages.
Conclusions
The Alzheimer Prevention Beliefs Measure provides assessment of several health belief factors related to AD prevention. Age, Family History, Logistical Barriers and total Benefits are significant determinants of willingness to engage in AD risk reduction behaviors, such as seeing a doctor or making a lifestyle change.



The absence of birthweight paradox as a marker of disadvantages faced by low maternal education children

Thu, 15 Dec 2016 00:00:00 GMT

Abstract
Background
This study tested the hypothesis that the birthweight paradox would not be observed when assessing the effect of maternal education on neonatal mortality in the presence of socioeconomic inequality in access to health care.
Methods
Non-concurrent cohort study. Passive follow-up of live-born infants using probabilistic record linkage of birth and death records for Rio de Janeiro (2004–2010; n = 1 445 367). Maternal age, birthweight and neonatal death were evaluated according to maternal educational level strata (<4, 4–11 and ≥12 years of study). We estimated the association between maternal educational level and neonatal mortality using logistical regression models adjusted for maternal age and birthweight (<2500 g and ≥2500 g).
Results
Neonatal mortality was 1.8 times higher in low educational level group compared with high educational level. We did not find birthweight-specific mortality curves crossing over in the stratum under 2500 g (birthweight paradox). The odds of a low birthweight child being born in facilities without neonatal intensive care units was about 70% higher in the group of low education when compared with mothers with high education.
Conclusions
The absence of crossing birthweight-specific mortality curves may be a reason for concern about the severity of the disadvantages faced by low maternal education women.



Testing and testing positive: childhood adversities and later life HIV status among Kenyan women and their partners

Sat, 03 Dec 2016 00:00:00 GMT

Abstract
Background
Adverse childhood experiences are a critical feature of lifelong health. No research assesses whether childhood adversities predict HIV-testing behaviors, and little research analyzes childhood adversities and later life HIV status in sub-Saharan Africa.
Methods
We use regression models with cross-sectional data from a representative sample (n = 1974) to analyze whether adverse childhood experiences, separately or as cumulative exposures, predict reports of later life HIV testing and testing HIV+ among semi-rural Kenyan women and their partners.
Results
No significant correlation was observed between thirteen cumulative childhood adversities and reporting prior HIV testing for respondent or partner. Separately, childhood sexual abuse and emotional neglect predicted lower odds of reporting having previously been tested for HIV. Witnessing household violence during one's childhood predicted significantly higher odds of reporting HIV+. Sexual abuse predicted higher odds of reporting a partner tested HIV+.
Conclusions
Preventing sexual abuse and household violence may improve HIV testing and test outcomes among Kenyan women. More research is required to understand pathways between adverse childhood experiences and partner selection within Kenya and sub-Saharan Africa, and data presented here suggest understanding pathways may help improve HIV outcomes.



Correlates of self-rated health in Southern Europe: evidences from national representative samples in Italy and Serbia

Sat, 03 Dec 2016 00:00:00 GMT

Abstract
Background
Self-rated health (SRH) is a widely adopted tool to compare health across countries. Our aim was to examine SRH differences between Italy and Serbia and to observe the role of predictors of SRH referring to health behaviors within and between both countries.
Methods
We used cross-sectional population-based data from Italian and Serbian national health surveys carried out in 2013. Post hoc cross-standardization was undertaken to ensure that the information from both data sets was comparable.
Results
Univariate and multivariate multinomial logistic regressions showed that Serbians reported bad-SRH significantly more often than Italians. Moreover, consistently across national groups, younger participants, males, higher educated participants and participants with lower body mass index (BMI) had more chances than older, lower educated and higher BMI participants, respectively, to report better SRH. Finally, smoking and drinking behaviors did not correlate with SRH, while the frequency of fruits and vegetables intake was differently associated with SRH across countries.
Conclusion
Health assessments based on SRH in Italian and Serbian national surveys are directly comparable and show similar relationships with socio-demographic correlates and BMI. However, the effect of health behaviors on SRH may differ according to national and cultural contexts.



Evaluation of a community-based intervention to improve routine childhood vaccination uptake among migrants in urban slums of Ludhiana, India

Sat, 03 Dec 2016 00:00:00 GMT

Abstract
Background
Evidence on the effectiveness of community-based interventions in improving vaccination uptake in migrant populations is limited. This study aims to evaluate the effectiveness of a community-based intervention to improve access to and uptake of childhood vaccinations among urban slum-dwelling migrant communities in Ludhiana, India.
Methods
A mixed-methods evaluation was conducted involving a post-intervention comparison of vaccination uptake in six randomly selected intervention and control slum communities. Multilevel logistic regression to account for clustering of effects was used to investigate the impact of the intervention on vaccination uptake. Thematic analysis was used to analyse qualitative data.
Results
Overall, vaccination uptake was significantly higher in the intervention clusters and the likelihood of full immunization by the age of 1 year was more than twice that in the control clusters [OR: 2.27 (95%CI: 1.12–4.60); P = 0.023]. Qualitative findings showed that stakeholders felt ownership of the intervention and that it was effective in increasing accessibility to and uptake of vaccinations. However, they emphasized the importance of continued government support for the intervention.
Conclusions
Community-based interventions can significantly increase vaccination coverage in deprived populations with previously low uptake of childhood immunization but such initiatives need to be delivered in partnership with the government.



Could the Transition movement help solve the NHS's problems?

Sat, 03 Dec 2016 00:00:00 GMT

Abstract
Background
The NHS Five Year Forward View identifies a range of approaches for addressing the NHS's challenges. The Transition movement helps communities to reframe and rebuild their world by working on issues such as climate change, food, community relationships and localizing the economy.
Methods
This paper describes Transition using five short example projects and, informed by these, identifies mechanisms by which Transition could potentially help reduce pressure on the NHS.
Results
Transition is characterized by people self-organizing to address local challenges with benefits arising from both the outcomes and the process of the projects. Transition may be able to help the NHS reframe change, prevent disease, improve staff well-being and increase local economic resilience.
Discussion
The evidence base for the relationship between Transition and health is growing but is not yet well developed. This reflects the complexity of establishing an evidence base for wider determinants of health. There is substantial potential learning for those in the NHS about change outside formal institutional structures.
Conclusions
Transition provides new ways of thinking and acting to develop greater ‘community intelligence’, which could help the NHS in the face of increasing pressures.



‘Standing Outside the Junkie Door’—service users’ experiences of using community pharmacies to access treatment for opioid dependency

Sat, 03 Dec 2016 00:00:00 GMT

Abstract
Aim
To explore experiences of service users attending a community pharmacy to receive opiate replacement therapy (ORT).
Method
Qualitative study involving seven focus groups undertaken within care centres and prison educational centre in Tayside, Scotland using 41 participants. Thematic analysis undertaken of experiences of different groups of service users and carers.
Results
Participants described the social context surrounding attendance at community pharmacies. Their voices suggested that people prescribed ORT may be treated differently from others accessing care through pharmacies. Participants felt they experienced stigma and discriminatory practices in pharmacies, elsewhere within the healthcare environment, and more generally in society. Participants explained that the way services were organized in pharmacies often denied them the right to confidentiality. However, there were positive experiences of care. The discriminating factor between good and bad experiences was being treated with dignity and respect.
Conclusion
Participants readily identified examples of poor experiences and of stigma and discrimination, yet valued positive relationships with their pharmacy. Constructive attitudes of pharmacy staff and the ability to form positive relationships improved their experience. The social exclusion delivered through stigmatization mitigates against delivery of a recovery agenda and contributes to health inequalities experienced by this marginalized group.



The NIHR public health research programme: intervention approaches to tackle health inequalities

Sat, 03 Dec 2016 00:00:00 GMT

Abstract
Background
The National Institute for Health Research (NIHR) Public Health Research (PHR) Programme evaluates interventions intended to improve the health of the public and reduce inequalities in health in the UK. The aim of the research was to establish how projects funded by the PHR Programme between 2009 and 2014 addressed health inequalities.
Methods
A health inequalities intervention framework developed by Bambra et al. was used to map PHR funded studies to a typology. The framework is based on interventions that are characterized by their level of action and their approach to tackling inequalities.
Results
A total of 57 primary research projects funded by the PHR Programme were categorized using the framework; 16 PHR research projects were classified as strengthening individuals, 24 strengthening communities, 15 improving living and school/work conditions and 2 promoting healthy macro policies. Eighteen were classified as targeted interventions whereas 39 were universal.
Conclusions
Mapping the interventions being evaluated by the PHR Programme to a typology differentiated health inequality interventions and illustrates how they are expected to have an impact. Emerging findings will contribute to the evidence base for addressing health inequalities to inform research and future commissioning of public health services.



The Prevention Paradox Mark II: an appeal for diversity in public health

Sat, 26 Nov 2016 00:00:00 GMT

Abstract
The vast majority of public health students exhibit the kind of ‘clean living’ that is routinely advocated as highly desirable by health promoters. However, this social and cultural distance from many of the most important health issues faced in our society creates a barrier for understanding and working with other population groups. Insider status, knowledge and understanding is essential in developing true insight in developing culturally appropriate interventions. Referencing Rose's influential prevention paradox, a revision is suggested stating that prevention measures are often developed by individuals outside the population in question and may offer little actual benefit to that population. Diversity is public health is essential. This diversity needs to encompass not just traditional foci such as race and ethnicity, but also socio-economic status and numerous other demographic variables.



Mental health coverage in needs assessments and associated opportunities

Sat, 26 Nov 2016 00:00:00 GMT

Abstract
Background
Mental disorders account for almost a third of UK disease burden. Cost effective public mental health interventions have broad public health relevant impacts. Since coverage of such interventions is low, assessment of local coverage is important.
Methods
A total of 23 Joint Strategic Needs Assessments (JSNAs) around London were assessed for different mental health intelligence.
Results
Mental health was poorly covered and difficult to locate in JSNAs. Only a minority of JSNAs mentioned most mental disorders while far fewer JSNAs provided local prevalence estimates or numbers receiving treatment. Only 6% JSNAs included local wellbeing levels and any mental wellbeing promotion initiative mentioned included no information about coverage. Most JSNAs provided little information about impact of mental disorder or broader determinants on mental health. No JSNAs included associated economic implications or information about size of mental health unmet need.
Conclusions
Lack of mental health representation in JSNAs means local authorities and clinical commissioning groups cannot perform statutory duties to assess local health needs to inform strategic development and commissioning. This perpetuates poor coverage of public mental health interventions. Actions to improve mental health representation in JSNAs are suggested. Improved coverage of such interventions will result in broad public health relevant impacts and associated economic savings.



Within-person analysis of welfare transitions in a longitudinal panel survey reveals change in mental health service use

Sat, 26 Nov 2016 00:00:00 GMT

Abstract
Background
While international research shows that receipt of welfare benefits is associated with poor mental health, less is known about the relationship between welfare receipt and mental health service use. We investigate whether within-person change in welfare recipient status is associated with change in mental health service use.
Methods
Analysis of two waves of data from an Australian national household survey. Random- and fixed-effect models considered the effect of change in welfare receipt status, and assessed whether change in mental health service use differed by type of welfare benefit or the direction of welfare transition.
Results
Individuals were more likely to report greater mental health service use at times of welfare receipt. These associations were attenuated, but remained significant, after adjusting for mental health. Increased health service use was not tied to specific types of welfare benefits. The increase in mental health service use associated with a transition onto welfare benefits was much greater than the decline in service use associated with the transition off benefits.
Conclusions
Within individuals, welfare receipt is associated with greater mental health service use. While this does reflect poorer mental health at the time of welfare receipt, other factors seem to facilitate health service use.



One-year prospective study on the presence of chronic diseases and subsequent cognitive decline in older adults

Sat, 26 Nov 2016 00:00:00 GMT

Abstract
Background
The literature is inconsistent regarding the effect of the presence of chronic physical and mental diseases on cognitive decline in older adults. The objectives of this study were to explore the effect of chronic diseases on subsequent cognitive decline assessed via the Mini Mental State Examination (MMSE) in community living older adults.
Methods
We used data from individuals (n = 2010) participating in the ESA (Étude sur la Santé des Aînés) study. Cognitive status was measured with the MMSE at baseline and after 1 year. Chronic diseases were identified via administrative databases in accordance with International Classification of Diseases 9/10. Multivariate linear regression was used to assess the change in MMSE as a function of chronic physical and mental disorders, while adjusting for socio-demographic and clinical factors
Results
Significant decreases in MMSE scores were found in patients who had a stroke (β value: –2.83) or diabetes (β value: –1.06) and in older adults aged older than 75 years (β value: −0.91).
Conclusions
When adjusting for other chronic diseases, stroke, diabetes and advanced age were associated with subsequent cognitive decline in older adults during a one-year follow-up. Longer follow-up is recommended to assess long-term effect.



Predictors of prenatal smoking and attempted smoking cessation during pregnancy: a community-based study of Romani women in Southeastern Europe

Sat, 26 Nov 2016 00:00:00 GMT

Abstract
Background
The objective of this study was to examine predictors of prenatal smoking, and attempted smoking cessation during pregnancy among Romani women.
Methods
A community-based, cross-sectional study (November 2012 to February 2013) of 410 Romani women in Roma settlements in Serbia and Macedonia was conducted. Logistic regression was used to identify predictors of prenatal smoking and attempted smoking cessation during pregnancy.
Results
Romani women older than 30 years and those who were living with a man were over twice as likely (adjusted odds ratio (aOR) 2.48, 95% confidence interval (CI) 1.12–5.46; aOR 2.09, 95% CI 1.27–3.43) to smoke during pregnancy, compared to women <20 and married women, respectively. An inverse relationship between education and prenatal smoking was observed (for primary education versus no education, aOR 0.56, 95% CI 0.32–0.98; for secondary or higher education versus no education, aOR 0.38, 95% CI 0.16–0.90). Having a husband/partner who smokes was associated with significantly increased likelihood of prenatal smoking (aOR 3.71, 95% CI 2.20–6.25) and decreased likelihood of attempting to quit (aOR 0.51, 95% CI 0.24–1.06).
Conclusions
Culturally sensitive and comprehensive prevention strategies and intervention programs are needed to reduce smoking during pregnancy among Romani women, including interventions targeting male partners.



Retrospective cohort study of the South Tyneside Exercise Referral Scheme 2009–14: predictors of dropout and barriers to adherence

Sat, 26 Nov 2016 00:00:00 GMT

Abstract
Background
Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout.
Methods
ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors.
Results
Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P < 0.001) with dropouts being significantly younger (P < 0.001). Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29–1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25–1.73). Increasing age (OR = 0.98, 95% CI: 0.98–0.99), drinking alcohol (OR = 0.82, 95% CI: 0.71–0.95), secondary care referrals (OR = 0.68, 95% CI: 0.52–0.90), having a lack of motivation (OR = 0.81, 95% CI: 0.69–0.95) or a lack of childcare (OR = 0.69, 95% CI: 0.50–0.95) decreased the likelihood of dropout.
Conclusion
ERS dropout continues to be problematic. Smoking and having moderate-high comorbidities predicted dropout. Increasing age and patient-reported barriers of a lack of time or childcare decreased dropout risk. The reasons for dropout require further investigation.



A formative review of physical activity interventions for minority ethnic populations in England

Sat, 26 Nov 2016 00:00:00 GMT

Abstract
Background
Physical activity (PA) levels are lower among some UK Black and minority ethnic (BME) groups than the majority White British population and a variety of tailored interventions have emerged. This study documents the characteristics and logic of local adaptations, a vital first step in evaluating such innovations.
Methods
An English PA data set was examined to identify and characterize PA programmes focussed on BME populations. Three case studies were conducted, employing documentary analysis and qualitative interviews. Netto et al.’s principles of adapting health promotion interventions for BME populations guided the analysis.
Results
Out of 861 PA interventions, 57 focussed on BME populations. These were typically aimed to engage the most inactive groups, improve both health and social outcomes and were largely publically/charitably funded. Tailored approaches matched Netto et al.’s five principles: using community resources for publicity, identifying and addressing barriers, developing sensitive communication strategies, working with values and accommodating cultural identification. Another common principle was identified: building community capacity for sustainability.
Conclusions
PA interventions tailored to the needs of BME groups reflect their largely disadvantaged position in society and focus on inactivity. The six principles could be used as a framework for developing, designing and evaluating tailored interventions for BME populations.



Exploring men's perceptions of a community-based men's shed programme in England

Wed, 23 Nov 2016 00:00:00 GMT

Abstract
Background
Sheds have been used in Australia for decades as an intervention to try and promote ‘health by stealth’ among men by providing a social space for those who may be particularly vulnerable to poor mental health. Little is known about the impact of men's sheds in England.
Methods
Members of 19 sheds from one local authority area were invited to participate in focus groups to explore their perceptions of their shed. In total, 32 men participated in five focus groups which were analysed using applied thematic analysis.
Results
While some sheds run activities, the main driving factor of sheds was the social aspect, with many coming along for nothing more than a chat and a cup of tea, allowing men to recapture lost social networks from their working days. However, it was felt that there could be more formal links forged between individual groups, which may result in a better range of activities on offer.
Conclusions
This study indicates that the shed can be an effective way of reducing social isolation in older men. However, further work is needed to understand what impact the shed has on physical and mental well-being.



Physical activity mediates the relationship between fruit and vegetable consumption and cognitive functioning: a cross-sectional analysis

Mon, 31 Oct 2016 00:00:00 GMT

Abstract
Background
Excess adiposity is associated with impairments in cognitive functioning, whereas physical activity (PA) and fruit and vegetable consumption (FVC) may be protective against cognitive decline. Therefore, this study investigated the interrelationships between FVC, body mass index (BMI), PA and cognitive functioning in younger and older adults.
Methods
Cross-sectional data of 45 522 participants (≥30 years) were examined from the 2012 annual component of the Canadian Community Health Survey. Cognitive function was assessed using a single six-level question of the Health Utilities Index. PA was classified according to the Physical Activity Index kilocalories per kilogram per day  as active, moderately active and inactive; BMI was measured in kg/m2 and FVC (servings/day) was classified as low, moderate or high. To assess the interrelationship between FVC, BMI, PA, age and cognitive functioning, general linear models and mediation analyses were used.
Results
Higher BMIs, lower PA and FVC were associated with poorer cognitive functioning. Additionally, PA statistically mediated the relationship between FVC and cognitive function (Sobel test: t = −3.15; P < 0.002); and higher education levels and daily FVC were associated with better cognitive function (P < 0.001).
Conclusion
Higher PA levels were associated with better cognitive functioning in younger and older adults. Also, higher daily FVC and education levels were associated with better cognitive scores.



Three decades of inequality in neonatal and early childhood mortality in singleton births in Scotland

Wed, 26 Oct 2016 00:00:00 GMT

Abstract
Background
Socioeconomic inequality in child mortality highlights opportunities for policies to reduce child deaths.
Methods
We used singleton birth, death and maternity records from Scotland, 1981–2011, to examine mortality rate differences by age across deprivation quintiles over time. We measured the difference between the most and least deprived quintiles (Q5–Q1) and the slope index of inequality (SII) across all quintiles—measures of the absolute deprivation gap, providing an indication of the public health impact.
Results
Q5–Q1 remained relatively constant from 1990 onwards for early neonates, widened in the mid-2000s for late neonates, increased in the 1990 s then decreased in the 2000 s in the post-neonates and declined over time in early childhood. The trend over time in SII showed no significant change for early neonates (P = 0.440), significant decrease for post-neonates (P = 0.010) and early childhood (P = 0.043), and significant increase for late neonates (P = 0.011).
Conclusions
Over three decades, the absolute deprivation gap in mortality widened in late neonates but stabilized or declined at other ages. This may reflect improved survival beyond the early neonatal period of babies with conditions related to socioeconomic inequality such as prematurity. Monitoring birth cohort data could enhance understanding of this vulnerable group.



The relation between indicators of low employment quality and attendance behavior in countries of the European Union

Sat, 15 Oct 2016 00:00:00 GMT

Abstract
Background
Previous research demonstrated an association between low employment quality and lower sickness absence, which may be explained by presenteeism. Therefore, this study aimed exploring the relation between three indicators of employment quality (long working hours, precarious employment, job insecurity) and attendance behavior.
Methods
The association between employment quality and attendance behavior was investigated in 28.999 workers (mean age: 40.0 years, 53% males) of the fifth wave of the European Working Conditions Survey, using multilevel multinomial logistic regression analysis. Attendance behavior was operationalized as different combinations of sickness absence and presenteeism.
Results
Those working >48 h/week, had a higher risk to report presenteeism (with or without sickness absence). They had a lower risk to report sickness absence without presenteeism. Workers with a precarious contract had a lower risk to report absenteeism without presenteeism and the combination of both presenteeism and absenteeism. Finally, for workers perceiving job insecurity, the risk for presenteeism without sickness absence was significantly higher.
Conclusions
Several indicators of low employment quality were associated with attendance behavior, suggesting a complex behavioral mechanism in workers facing low job quality employment. Therefore, policy makers are recommended to re-establish the indefinite contractual employment as the standard, avoiding long working hours.



Non-partner sexual violence against women in Spain: lifetime prevalence, perpetrators and consequences on mental health

Thu, 13 Oct 2016 00:00:00 GMT

Abstract
Background
Research on sexual violence by non-partners based on representative samples is scarce. The objectives of the study were (i) to analyse the prevalence of different forms of non-partner sexual violence in Spain and their perpetrators, (ii) to analyse the consequences of non-partner sexual violence on mental health and (iii) to estimate the percentage of rapes that are reported to the police.
Methods
Data from the 2015 Spanish Survey on Violence against Women, a nationally representative sample of 10 171 women, were used. Three mutually exclusive categories of non-partner sexual violence were created to measure the effects of violence on health. Logistic regression models were fitted.
Results
The lifetime prevalence of non-partner sexual violence was 7.2%. All the categories of non-partner sexual violence were strongly associated with the different health outcomes. Rape increased the likelihood of reporting anxiety [odds ratio, OR: 3.77 (2.65–5.37)], sadness because of feelings of worthlessness [OR: 3.31 (2.32–4.73)] and the desire to cry without reason [OR: 3.46 (2.45–4.89)] more than 3-fold. The relationship of the victim with the perpetrator varied by the type of sexual victimization. Less than 6% of rapes were reported to the police in 2014.
Conclusions
All forms of non-partner sexual violence, from unwanted sexual touching to rape, can lead to a multitude of mental health consequences. A public health approach to addressing this violence is needed.



Does the social gradient remain in the dietary habits of a health-conscious population? A study of Seventh-Day Adventists in West Malaysia

Thu, 13 Oct 2016 00:00:00 GMT

Abstract
Background
Socioeconomic status (SES) is a strong predictor of health, and individuals with higher SES generally have better health than those with lower SES. One of the pathways that SES influences health is through health behaviors, such as dietary intake, and a higher SES has been associated with a better diet. The purpose of this study was to determine whether there was a social gradient in dietary habits among the Seventh-Day Adventists, a group of conservative Christians, where healthy eating is part of the doctrinal teaching.
Methods
Data from a survey of 574 Adventists residing in West Malaysia, aged 18–80 years, were analyzed. Dietary habits were measured using the Nutrition subscale of Health Promoting Lifestyle Profile II.
Results
Education and income were significantly associated with dietary habits before and after controlling for demographics. There was a gradient of association; a higher level of education and higher income were associated with better dietary habits. However, only education remained significantly associated with dietary habits when the other two socioeconomic variables were included. Employment was not significantly associated with dietary habits before or after controlling for demographic variables and the other two sociodemographic variables.
Conclusions
This study showed that education is the strongest predictor of healthy diet, and a social gradient in dietary habits still exists even among health-conscious population.



Physical activity types and life expectancy with and without cardiovascular disease: the Rotterdam Study

Thu, 13 Oct 2016 00:00:00 GMT

Abstract
Background
We aimed to determine the contribution of specific physical activity (PA) types (i.e. walking, cycling, domestic work, sports and gardening) on total life expectancy (LE) and LE with and without cardiovascular disease (CVD).
Methods
We constructed multistate life tables to calculate the effects of total PA and PA types on LE, among individuals older than 55 years from the Rotterdam Study. For the life table calculations, we used sex-specific prevalences, incident rates and hazard ratios for three transitions (healthy-to-CVD, healthy-to-death and CVD-to-death) by levels of PA and adjusted for confounders.
Results
High total PA was associated with gains in total and CVD-free LE. High cycling contributed to higher total LE in men (3.7 years) and women (2.1 years) and higher LE without CVD in men (3.1 years) and women (2.4 years). Total and CVD-free LE were increased by high domestic work in women (2.6 and 2.4 years, respectively) and high gardening in men (2.7 and 2.0 years, respectively).
Conclusions
Higher PA levels are associated with increased LE and more years lived without CVD. Of the different PA types, cycling provided high effects in both men and women. Cycling could be more strongly encouraged in activity guidelines to maximize the population benefits of PA.



The future of dementia risk reduction research: barriers and solutions

Mon, 03 Oct 2016 00:00:00 GMT

Abstract
BACKGROUND
We examine why dementia prevention and risk reduction are relatively underfunded and suggest potential remediation strategies. The paper is aimed at researchers, funders and policy-makers, both within dementia and also the wider health prevention field.
METHODS
A discussion-led workshop, attended by 58 academics, clinicians, funders and policy-makers.
RESULTS
The key barriers identified were the gaps in understanding the basic science of dementia; the complex interplay between individual risk factors; variations in study methodology; disincentives to collaboration; a lack of research capacity and leadership and the broader stigma of the condition. Recommendations were made to encourage strategic leadership, provide greater support for grant applications, promote collaboration and support randomized control trials for the research field.
CONCLUSION
Having identified the barriers, the key challenge is how to implement the potential solutions. This will require engagement with decision-makers within funding, policy and research to ensure that action takes place.



Papillomavirus and cancers: should we extend vaccination to boys in France?

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
In 2006, the HPV (Human papillomavirus) 6/11/16/18 quadrivalent vaccine was approved by the European Medicines Agency and obtained its marketing authorization in both girls and boys. Currently, the French guidelines recommend and refund vaccination of girls aged 11 to 14 with a catch-up program for females from 15 to 19 years old.
Discussion
In France, HPV vaccination coverage tends to decrease. At the end of 2015, the vaccination coverage with three doses reached only 14% in 16-year-old girls (three doses). Although men are also affected by HPV-related diseases such as anal cancer, ano-genital warts, penile cancer or upper aerodigestive tract cancer, vaccine recommendations in France are for girls only. To face the high prevalence of anal cancer and related diseases, the best option is vaccination. Moreover, by offering men a way to prevent diseases against which they do not have any protection yet, universal vaccination could better take into account the ethical issues of prevention. In this paper, we present the point of view of different medical specialties concerning the potential benefit of extending vaccination to boys.
Conclusion
HPV vaccination of both genders could benefit from a better public acceptance and contribute to a better coverage, especially in countries with low vaccination rates.



Maternal nutrient intakes from food and drinks consumed in early pregnancy in Ireland

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
The aim of this observational study was to measure food, macronutrient and micronutrient intakes of women presenting for antenatal care and assess compliance with current nutritional recommendations.
Methods
Women were recruited in the first trimester of pregnancy. Maternal weight and height were measured and body mass index (BMI) calculated. Body composition was measured using bioelectrical impedance analysis. Maternal energy and nutrient intakes were estimated using a validated Willett Food Frequency Questionnaire and misreporting of energy intakes (EI) determined.
Results
Plausible EIs were reported in 402 women. Mean age, weight and BMI were 30.8 years, 67.1 kg and 24.6 kg/m2 respectively. Median EIs were 2111 kcal, and median protein, carbohydrate and fat intakes were 17.3, 48.1 and 36.2 g/MJ/day, respectively. More than 90% of women exceeded the recommended daily allowance for saturated fat. Nearly all of the women (99%) did not meet estimated average requirements (EAR) for vitamin D. One in three women failed to achieve a dietary folate intake of 400 µg/day. Over one in five women failed to meet the EAR for iron, and 14% failed to achieve the EAR for calcium.
Conclusions
Our findings highlight concerning deficits in nutrient intakes among women and will help guide professional dietary advice to women attending for future obstetric care in Ireland.



Do people's goals for mass participation sporting events matter? A self-determination theory perspective

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
Non-elite mass participation sports events (MPSEs) may hold potential as a physical activity promotion tool. Research into why people participate in these events and what goals they are pursuing is lacking. Grounded in self-determination theory, this study examined the associations between MPSE participants’ goals, event experiences and physical activity.
Methods
A prospective cohort study was conducted; pre-event, participants reported their goals for the event. Four weeks post-event, participants reported their motivation for exercise, perceptions of their event achievement and moderate-to-vigorous intensity physical activity (MVPA). Bivariate correlations and path analysis were performed on data from 114 adults.
Results
Intrinsic goals (e.g. health, skill and social affiliation) for the event were positively associated with perceptions of event achievement, whereas extrinsic goals (e.g. appearance or social recognition) were not. Event achievement was positively associated with post-event autonomous motivation, which in turn was positively associated with MVPA.
Conclusions
Pursuing intrinsic but not extrinsic goals for MPSEs is associated with greater perceptions of event achievement, which in turn is associated with post-event autonomous motivation and MVPA.



A content analysis of the UK press response to the diagnosis of Ebola in a British healthcare worker

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
The Ebola epidemic led to considerable media attention, which may influence public risk perception. Therefore, this study analysed the UK press response following diagnosis of a British healthcare worker (HCW) with Ebola.
Methods
Using the Nexis database, the frequency of Ebola-related articles in UK national newspaper articles was mapped. This was followed by a content analysis of Ebola-related articles in the four newspapers with highest UK net readership from November 2014 to February 2015.
Results
During the 16-week study period, 1349 articles were found. The day with the highest number of Ebola-related articles was 31 December 2014, the day after the diagnosis of Ebola in a UK HCW. Seventy-seven articles were included in the content analysis. Content analysis demonstrated a shift from West African to UK-focused articles, increased discussion of border control, UK policy decisions and criticism, and an increased number of articles with a reassuring/threatening message.
Conclusions
UK press coverage of Ebola increased following a HCW's diagnosis, particularly regarding discussion of screening measures. This is likely to have increased risk perception of Ebola in the UK population and may have contributed to subsequent strengthening of UK screening policy beyond World Health Organisation requirements.



Dispositional pandemic worry and the health belief model: promoting vaccination during pandemic events

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
Promoting vaccination during pandemics is paramount to public health, yet few studies examined theoretical motivations for vaccination during pandemics. Thus, the relationships between dispositional pandemic worry, constructs of the health belief model (HBM) and vaccination during the H1N1 pandemic were studied.
Methods
Participants (N = 1377) completed surveys assessing dispositional pandemic worry, HBM variables and H1N1 vaccination. Principle axis factor analysis and point biserial correlations were conducted. Differences in worry and vaccination were assessed via independent samples t-tests. Relationships between vaccination, demographics and worry were investigated using hierarchical linear regression. PROCESS analysis was conducted to explicate the relationship between worry and vaccination intention.
Results
A two-factor structure of dispositional pandemic worry—worry frequency and worry severity—was confirmed. Dispositional worry was higher among those who intended to and received H1N1 vaccine. Worry frequency and worry severity were positively related to vaccination. Threat, benefits and barriers mediated the impact of worry severity and threat and barriers mediated the impact of worry frequency on vaccination intentions.
Conclusions
Messages increasing dispositional worry and benefits while decreasing barriers may boost vaccination behavior during a pandemic event. Future study of relationships between dispositional worry and HBM variables is warranted.



The cost effectiveness of the SIMPle intervention to improve antimicrobial prescribing for urinary tract infection in primary care

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Background
Antimicrobial resistance is a major public health issue. This study examines the cost effectiveness of the SIMPle (Supporting the Improvement and Management of Prescribing for Urinary Tract Infections (UTI)) intervention to improve antimicrobial prescribing in primary care in Ireland.
Methods
An economic evaluation was conducted alongside a cluster randomized controlled trial of 30 general practices and 2560 patients with a diagnosis of UTI. Practices were randomized to the usual practice control or the SIMPle intervention (arm A or B). Data at 6 months follow-up were used to estimate incremental costs, incremental effectiveness in terms of first-line antimicrobial prescribing for UTI and cost effectiveness acceptability curves.
Results
The SIMPle intervention was, on average, more costly and more effective than the control. The probability of intervention arm A being cost effective was 0.280, 0.995 and 1.000 at threshold values of €50, €150 and €250 per percentage point increase in first-line antimicrobial prescribing respectively. The equivalent probabilities for intervention arm B were 0.121, 0.863 and 0.985, respectively.
Conclusions
The cost effectiveness of the SIMPle intervention depends on the value placed on improving antimicrobial prescribing. Future studies should examine the wider and longer term costs and outcomes of improving antimicrobial prescribing.



Investigating what works to support family carers of people with dementia: a rapid realist review

Tue, 27 Sep 2016 00:00:00 GMT

Abstract
Introduction
Advances in longevity and medicine mean that many more people in the UK survive life-threatening diseases but are instead susceptible to life-limiting diseases such as dementia. Within the next 10 years those affected by dementia in the UK is set to rise to over 1 million, making reliance on family care of people with dementia (PWD) essential. A central challenge is how to improve family carer support to offset the demands made by dementia care which can jeopardise carers’ own health. This review investigates ‘what works to support family carers of PWD’.
Methods
Rapid realist review of a comprehensive range of databases.
Results
Five key themes emerged: (1) extending social assets, (2) strengthening key psychological resources, (3) maintaining physical health status, (4) safeguarding quality of life and (5) ensuring timely availability of key external resources. It is hypothesized that these five factors combine and interact to provide critical biopsychosocial and service support that bolsters carer ‘resilience’ and supports the maintenance and sustenance of family care of PWD.
Conclusions
‘Resilience-building’ is central to ‘what works to support family carers of PWD’. The resulting model and Programme Theories respond to the burgeoning need for a coherent approach to carer support.



Final transitions to place of death: patients and families wishes

Wed, 21 Sep 2016 00:00:00 GMT

Abstract
Purpose
This four-country study (Belgium, the Netherlands, Italy and Spain) examines prevalence and types of final transitions between care settings of cancer patients and the extent to which patient/family wishes are cited as a reason for the transition.
Methods
Data were collected from the EUROSENTI-MELC study over a 2-year period. General practitioners within existing Sentinel Networks registered weekly all deaths of patients within practices using a standardized questionnaire. This registration included place of care in the final 3 months and wishes for the final transition to place of death. All non-sudden deaths due to cancer (+18 years) were included in the analyses.
Results
We included 2048 non-sudden cancer deaths; 63% of patients had at least one transition between care settings in the final 3 months of life. ‘Hospital death from home’ (25–55%) and ‘home death from hospital’ (16–30%) were the most frequent types of final transitions in all countries. Patients’ or families’ wishes were mentioned as a reason for a final transition in 5–27% (P < 0.001) and 10–22% (P = 0.002) across countries.
Conclusions
‘Hospital deaths from home’ is the most prevalent final transition in three of four countries studied, in a significant minority of cases because of patient/family wishes.



Vaccine uptake in the Irish Travelling community: an audit of general practice records

Mon, 19 Sep 2016 00:00:00 GMT

Abstract
Background
Compared to the general population, the Traveller community has substantial health inequalities. Vaccination coverage in Traveller children is estimated to be low and Travellers are at higher risk of vaccine-preventable diseases due to their social circumstances.
Methods
Audit of vaccination history of Traveller (n = 214) and non-Traveller (n = 776) children registered at a general practice in England. The Green Book childhood immunization schedule was used as a reference standard.
Results
There was significantly lower coverage for Traveller children compared to non-Traveller children for all vaccinations in the routine childhood immunization schedule. The percentage of children completing the schedule at all time points was significantly lower in the Traveller community.
Conclusions
Traveller communities have significantly lower uptake of vaccinations, and therefore Travellers’ children should be targeted by general practitioners for catch-up vaccination to improve outcomes for individuals and local herd immunity.



Dose-response effect of smoking status on quality-adjusted life years among U.S. adults aged 65 years and older

Fri, 09 Sep 2016 00:00:00 GMT

Abstract
Background
To estimate the impact of smoking on quality-adjusted life years (QALY) for US adults aged 65 years and older.
Methods
Using the 2003–08 National Health and Nutrition Examination Survey Linked Mortality File, we estimated the mean QALY throughout the remaining lifetime by participants' smoking status as well as smoking intensity and time since cessation.
Results
Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. Among current smokers, those who started smoking before age 18 had fewer QALYs than those who started at or after age 18 (6.0 and 8.5 years, respectively) and those smoking ≥20 cigarettes per day had fewer QALYs than those smoking <20 cigarettes per day (6.6 and 8.1 years, respectively). QALYs also declined with a longer duration of smoking and a shorter time since cessation. The potential gains if a person quit smoking would be 5.4 QALYs, and the gains would increase with a longer time since quitting as well as quitting at a younger age.
Conclusions
This study demonstrated the dose–response effect of smoking status on QALY. The results indicate the health benefits of tobacco cessation at any age and sizeable losses for former or current smokers.



Epidemiology of chromosomal trisomies in the East of Ireland

Fri, 02 Sep 2016 00:00:00 GMT

Abstract
Background
Chromosomal trisomies are associated with advancing maternal age. In Ireland, information on the total prevalence and outcome of trisomy affected pregnancies is unavailable. This study aimed to ascertain more precise data on Trisomies 21, 18 and 13 in a large Irish region during the period 2011–2013.
Methods
Multiple information sources were used in case finding, including a regional congenital anomaly register, all maternity and paediatric hospitals in the region and the regional Department of Clinical Genetics.
Results
There were 394 trisomy cases from 80 894 total births, of which 289 were Trisomy 21, 75 were Trisomy 18 and 30 were Trisomy 13. The total prevalence rate was 48.9/10 000 births, 35.7, 9.3 and 3.7 for Trisomies 21, 18 and 13, respectively. Over 90% of Trisomies 18/13 and 47% of Trisomy 21 were diagnosed prenatally; 61% of Trisomy 21 cases and nearly 30% of Trisomies 18/13 were live births; 38% all trisomy affected pregnancies ended in a termination.
Conclusions
This study provides precise data on the total prevalence and outcome of trisomy affected pregnancies in the East of Ireland. Total prevalence rates were higher than previously reported. Prenatal diagnosis had a significant impact on outcome. These data provide a better basis for planning of services for live-born children affected by trisomy.