Following the Health and Social Care Act in England, public health teams were formally transferred from the NHS to local authorities in April 2013.
Online survey of Directors of Public Health (DsPH) in local authorities in England (n = 152) to investigate their experience within local government 1 year on. Tests of association were used to explore relationships between the perceived integration and influence of public health, and changes in how the public health budget was being spent.
The organization of and managerial arrangements for public health within councils varied. Most DsPH felt that good relationships had been established within the council, and the move had made them more able to influence priorities for health improvement, even though most felt their influence was limited. Changes in commissioning using the public health budget were already widespread and included the de-commissioning of services.
There was a widespread feeling amongst DsPH that they had greater influence since the reforms, and that this went across the local authority and beyond. Public health's influence was most apparent when the transfer of staff to local government had gone well, when collaborative working relationships had developed, and when local partnership groups were seen as being effective.
Children are uniquely susceptible to environmental health exposures that effect developmental delays and negatively impact long-term health outcomes. Despite extensive hours spent at early child care centers, child care providers (CCPs) lack the knowledge to identify and mitigate environmental hazards to the children.
From 2007 to 2010, we recruited child care centers in the District of Columbia and offered interactive environmental health training to the CCPs. Each center underwent a 90-min environmental health risk assessment (ERA) at baseline and also after the trainings. Dependent t-tests were used to assess the mean change on the ERA score and also the knowledge test administered pre- and post-trainings. Analysis of variance was used to examine the association between knowledge change for the CCPs and the ERA scores of their centers.
Of the 60 facilities, 68% reduced their environmental risk. The 585 CCPs who attended the training session showed significant improvement on all items on the test. However, test scores for the CCPs from centers that reduced their risk were not significantly different from the other CCPs.
The trainings increased knowledge on environmental health hazards among CCPs. Areas of significant risk reduction were under the direct control of the CCPs and corresponded to key items on the knowledge test.
Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a ‘double burden’, especially in African countries undergoing social and economic transition. This systematic review was conducted to investigate the current evidence on maternal obesity in Africa.
MEDLINE, EMBASE, Scopus, CINAHL and PsycINFO were searched (up to August 2014) and identified 29 studies. Prevalence, associations with socio-demographic factors, labour, child and maternal consequences of maternal obesity were assessed. Pooled risk ratios comparing obese and non-obese groups were calculated.
Prevalence of maternal obesity across Africa ranged from 6.5 to 50.7%, with older and multiparous mothers more likely to be obese. Obese mothers had increased risks of adverse labour, child and maternal outcomes. However, non-obese mothers were more likely to have low-birthweight babies. The differences in measurement and timing of assessment of maternal obesity were found across studies. No studies were identified either on the knowledge or attitudes of pregnant women towards maternal obesity; or on interventions for obese pregnant women.
These results show that Africa's levels of maternal obesity are already having significant adverse effects. Culturally adaptable/sensitive interventions should be developed while monitoring to avoid undesired side effects.
To examine the associations of cardiovascular disease risk factors (CVDRF) with wealth, defined by the asset index, in 25- to 74-year-old black Africans in Cape Town.
Assets, including consumer durable goods, and CVDRF were determined in a randomly selected cross-sectional sample. A principal component analysis of the pooled data, based on assets that defined wealth, was used to develop an asset index. Ordinal logistic regression analyses assessed the independent associations of CVDRF with wealth tertiles.
Among the 1099 participants, the least poor compared with the poorest tertile had significantly higher prevalence of diabetes (16.3 versus 9.6%), hypercholesterolaemia (33.9 versus 21.4%), obesity (45.4 versus 26.3%) and fat intake ≥30% of diet (44.2 versus 29.3%). Daily smoking was highest in the poorest (35.8%) versus the least poor (26.4%). Psychosocial stress (low sense of coherence or locus of control) was significantly higher in poorer participants. In the regression analyses, wealth was associated with male gender [odds ratio (OR): 1.89, 95% confidence interval (CI): 1.37–2.60], urbanization (OR: 1.02, 95% CI: 1.01–1.02), high fat intake, obesity and hypercholesterolaemia. Daily smoking, problematic alcohol use (OR: 0.70, 95% CI: 0.52–0.94) and psychosocial stress were inversely related to wealth.
Differential distribution of CVDRF by wealth mandates incorporating equity components when developing tailored interventions.
A growing body of evidence suggests that childhood overweight may have its roots in early life. This study aimed to explore patterns of weight in children from birth to 40 months, born between 1994 and 2006, in Halton, Northwest England.
Halton infants were compared with the UK-90 reference population at four time points (birth, 2 months, 8 months and 40 months) by converting heights and weights into age–sex adjusted SD scores. The mean and SD of Halton SD scores were calculated for each time point and sex. Cohort trends and gender differences in rates of children above the 85th and 95th centiles at each time point were tested for using Poisson regression modelling.
A total of 16 381 births were analysed. At birth, 8 months and 40 months, proportions of Halton children above the 85th and 95th centiles were consistently higher than reference data. Proportions above the 85th and 95th centiles at birth did not change significantly year on year, but for all other time points the proportions increased with subsequent cohorts.
This study may provide evidence that the development of overweight and obesity has its roots in very early life and has highlighted patterns of infant overweight and obesity not previously reported.
Verocytotoxin-producing Escherichia coli (VTEC) are bacteria that cause infectious gastroenteritis and in certain settings can cause widespread infection due to secondary transmission. We describe the findings of an investigation of a school-based outbreak of VTEC in Staffordshire, England.
Outbreak investigation at a school in February 2012 after two children were diagnosed with VTEC infection. Cases were defined as pupils and staff (or their household contacts) with gastrointestinal symptoms or asymptomatic screened persons, with laboratory confirmed VTEC O157 infection (phage type 32, verocytotoxin 2) occurring on or after 1 February 2012. Microbiological tests of food and faecal samples plus screening of asymptomatic contacts were undertaken. Epidemiological and clinical data were descriptively analysed.
Thirty-eight cases were detected. Nineteen were asymptomatic and identified via screening of 191 pupils. Infection was introduced into the school from an earlier household cluster, followed by extensive person-to-person transmission within the nursery/infant group with limited spread to the wider school population.
Control measures included several interventions, in particular, universal screening of pupils and staff. Screening during school outbreaks is not underpinned by guidance but proved to be a key control measure. Screening of asymptomatic contacts should be considered in similar outbreaks.
It has been shown that higher education associates with health outcomes, but the less is known about the specific mechanisms mediating this association. We examined whether higher education would associate with long-term health transitions from childhood to adulthood and whether health behaviors, self-esteem, social support and work-related health hazards could mediate or confound this association.
The participants were from a population-based sample of 3596 men and women from the Young Finns study aged 3–18 years at the beginning of the study in 1980, and who responded to repeated surveys of educational attainment and self-rated health in four study phases from 1997 to 2012. The associations were tested using multistate Markov models for the health-state transition intensities.
Our results suggested that a 1-year difference in education was related to a 16% higher transition probability from mediocre to good self-rated health over the 5-year follow-up. Depressive symptoms and job strain seemed to partly mediate or confound the association, but self-esteem and social support did not.
These results suggest that educational attainment is associated with good self-rated health transitions from childhood to adulthood, and multiple processes rather than a single underlying mechanism are likely to drive the educational differences in self-rated health.
This study determined annual prevalence and incidence trends of asthma among children in Taiwan from 2002 to 2008. Risk factors and traditional Chinese medicine (TCM) use were examined.
A random sample was selected for a population-based study with a selection probability of 0.5 from all 3–18 years insurants. The annual prevalence and incidence of asthma were estimated according to age, sex, insurance premium and degree of urbanization.
The prevalence of asthma increased from 12.99% in 2002 to 16.86% in 2008. The increase was greatest in 2008, among boys, 11–15 years, ≥medium insurance premium, and high- and medium-density urban area. TCM use in asthma-prevalent children decreased from 1.16% in 2002 to 0.59% in 2008. The incidence fluctuated, ranging from 1.01% in 2002 to 1.49% in 2005. The highest was in 2005, among boys, 3–5 years, ≥medium insurance premium and high-density urban area. TCM use in asthma-incident children decreased from 3.59% in 2002 to 1.69% in 2008.
This study demonstrated a substantial increase in annual prevalence of asthma among children in Taiwan from 2002 to 2008. The incidence fluctuated. The TCM use showed a decreasing linear trend and was higher in incident than in prevalent cases.
Anaemia is a public health problem that can lead to a variety of detrimental effects on physical and neurodevelopment in young children. The present study explored the epidemiology of anaemia among infants in Romania, identified risk factors and created a model for predicting it.
Data from 1532 infants aged 6–24 months were selected from a larger nationally representative cross-sectional survey. Demographic predictor variables and haemoglobin concentration were extant variables in the data set. Multiple logistic regression was used to determine the best predictors of anaemia.
Overall, 46% of 6–24 month olds in the sample had anaemia (Hb < 11.0 g/dl). A variety of risk factors were associated with significantly greater odds of anaemia, but a five-factor model best predicted it (67.9% accuracy). These predictors included being male, living in a rural area, being third born or later, being a Hungarian and living in the South, South-West or West region of Romania.
While data indicate a modest decrease in anaemia from earlier Romanian studies, it remains a significant problem. Models like this one have the potential to improve identification and treatment of anaemia in young children.
This meta-analysis addressed the association between substance use disorder (SUD) and suicide outcomes based on current evidence.
We searched PubMed, Web of Science and Scopus until May 2015. We also searched the reference lists of included studies and Psycinfo website. We included observational (cohort, case–control, cross-sectional) studies addressing the association between SUD and suicide. Our outcomes of interest were suicide ideation, suicide attempt and suicide death. For each outcome, we calculated the odds ratio (OR) or risk ratio (RR) with 95% confidence intervals (CI) based on the random-effects model.
We identified a total of 12 413 references and included 43 studies with 870 967 participants. There was a significant association between SUD and suicidal ideation: OR 2.04 (95% CI: 1.59, 2.50; I2 = 88.8%, 16 studies); suicide attempt OR 2.49 (95% CI: 2.00, 2.98; I2 = 94.3%, 24 studies) and suicide death OR 1.49 (95% CI: 0.97, 2.00; I2 = 82.7%, 7 studies).
Based on current evidence, there is a strong association between SUD and suicide outcomes. However, evidence based on long-term prospective cohort studies is limited and needs further investigation. Moreover, further evidence is required to assess and compare the association between suicide outcomes and different types of illicit drugs, dose–response relationship and the way they are used.
Lifestyle risk behaviours show an inverse social gradient, clustering in vulnerable groups. We designed and piloted an intervention to address barriers to lifestyle behaviour change among hospital patients.
We designed our intervention using effective components of behaviour change interventions informed by psychological theory. Delivered by a health psychologist based at the Royal Free London NHS Foundation Trust, the 4-week intervention included detailed baseline assessment, personalized goal setting, psychological skills development, motivation support and referral to community services. Primary outcomes were feasibility and patient acceptability. We also evaluated changes to health and well-being.
From 1 July 2013 to 31 September 2014, 686 patients were referred, 338 (49.3%) attended a first appointment and 172 (25.1%) completed follow-up. Furthermore, 72.1% of attenders were female with the median age 55 years and poor self-reported baseline health. After 4 weeks, self-efficacy, health and well-being scores significantly improved: 63% of lifestyle goals and 89% of health management goals were fully achieved; 58% of referrals to community lifestyle behaviour change services and 79% of referrals to other services (e.g. Citizen's Advice Bureau) were accepted; 99% were satisfied/very satisfied with the service.
Our hospital-based intervention was feasible, acceptable and showed preliminary health and well-being gains.
Although people who inject drugs (IDU) often contend with various health-related harms, timely access to health care among this population remains low. We sought to identify specific individual, social and structural factors constraining healthcare access among IDU in Bangkok, Thailand.
Data were derived from a community-recruited sample of IDU participating in the Mitsampan Community Research Project between July and October 2011. We assessed the prevalence and correlates of healthcare avoidance due to one's drug use using multivariate logistic regression.
Among 437 participants, 112 (25.6%) reported avoiding health care because they were IDU. In multivariate analyses, factors independently associated with avoiding health care included having ever been drug tested by police [adjusted odds ratio (AOR) = 1.80], experienced verbal abuse (AOR = 3.15), been discouraged from engaging in usual family activities (AOR = 3.27), been refused medical care (AOR = 10.90), experienced any barriers to health care (AOR = 4.87) and received healthcare information and support at a drop-in centre (AOR = 1.92) (all P < 0.05).
These findings highlight the need to address the broader policy environment, which perpetuates the criminalization and stigmatization of IDU, and to expand peer-based interventions to facilitate access to health care for IDU in this setting.
Recent policy initiatives in the UK have underlined the importance of public health education for healthcare professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and make recommendations that may overcome them.
We undertook a cross-sectional survey; questionnaires were sent electronically to 32 teaching leads in academic departments of public health in UK medical schools and followed up by telephone interviews.
We obtained a 75% response rate; 13 public health teaching leads were interviewed. We found much variability between schools in teaching methods, curricular content and resources used. Concerns regarding the long-term sustainability of teaching focus on: staffing levels and availability, funding and the prioritization of research over teaching. We give examples of integration of public health with clinical teaching, innovative projects in public health and ways of enabling students to witness public health in action.
There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative approaches. Suggestions are made as to how undergraduate public health teaching can be strengthened.
The value of e-learning in medical education is widely recognized but there is little evidence of its value in teaching medical students about public health. Such evidence is needed because medical students' engagement with public health has been low. We present three recent case studies from UK medical schools to illustrate diverse ways in which online approaches can increase medical students' engagement with learning public health.
A comparative case study approach was used applying quantitative and qualitative data to examine engagement in terms of uptake/use amongst eligible students, acceptability and perceived effectiveness using an analytic framework based on Seven Principles of Effective Teaching.
Across the three case studies, most (67–85%) eligible students accessed online materials, and rated them more favourably than live lectures. Students particularly valued opportunities to use e-learning flexibly in terms of time and place. Online technologies offered new ways to consolidate learning of key public health concepts. Although students found contributing to online discussions challenging, it provided opportunities for students to explore concepts in depth and enabled students that were uncomfortable speaking in face-to-face discussions to participate.
E-learning can be applied in diverse ways that increase medical student engagement with public health teaching.
Despite National guidance recommending their use, there is uncertainty regarding the best way to deliver weight management services across the UK and worldwide.
To ascertain access, provision and interventions used in lifestyle Tier 2 and specialist Tier 3 weight management services in Scotland, a survey was distributed to all mainland health boards covering pathways for referral, eligibility criteria, intervention format and definitions of attendance completion and adherence.
Nine Health boards provided information on their weight management services. The provision of services was low. Only four health boards offered services for those with a BMI 25–30 kg/m2. Lifestyle Tier 2 services were mainly weekly or fortnightly group sessions for 8–12 weeks delivered by dietitians or community workers. Specialist Tier 3 services were largely similar to lifestyle Tier 2 services. The provision of specialist interventions including pharmacotherapy, cognitive behavioural therapy sessions and low-calorie prescribed diets was low.
This national survey has illustrated large disparities in the provision of weight management across Scotland, a likely consequence of uncertainty regarding best practice. There is a clear requirement for the evaluation of existing services to identify those that lead to the largest improvements in health outcomes and are cost-effective.
Allotments in the UK are popular and waiting lists long. There is, however, little evidence on the health benefits of allotment gardening. The aims of this study were to determine the impacts of a session of allotment gardening on self-esteem and mood and to compare the mental well-being of allotment gardeners with non-gardeners.
Self-esteem, mood and general health were measured in 136 allotment gardeners pre- and post- an allotment session, and 133 non-gardener controls. Allotment gardeners also detailed the time spent on their allotment in the current session and previous 7 days, and their length of tenure.
Paired t-tests revealed a significant improvement in self-esteem (P < 0.05) and mood (P < 0.001) as a result of one allotment session. Linear regression revealed that neither the time spent on the allotment in the current session, the previous 7 days or the length of tenure affected the impacts on self-esteem and mood (P > 0.05). One-way ANCOVA revealed that allotment gardeners had a significantly better self-esteem, total mood disturbance and general health (P < 0.001), experiencing less depression and fatigue and more vigour (P < 0.0083).
Allotment gardening can play a key role in promoting mental well-being and could be used as a preventive health measure.
Demand for healthcare services among older population is expected to rise, especially among those living with disabilities. This study aims to estimate the prevalence rate and identify the factors associated with healthcare service use among Chinese elderly with disabilities.
This study employed a nationally representative survey and defined healthcare service utilization as use of curative care, auxiliary aids or rehabilitation services for elderly with disabilities (aged ≥60 years) in China. Population-weighted numbers, proportions and prevalence rates were calculated. Multivariate logistic regression was used to calculate the adjusted odd ratios and 95% confidence interval (CI).
A weighted total of 45 005 026 Chinese elderly with disabilities were reported. The weighted prevalence rate of healthcare service use was 36.6% (95% CI: 35.6–37.5). Significantly less use of healthcare services was observed among those who were older, males, less educated, singles, rural dwellers, non-eastern residents, with lower annual family income, without medical insurance coverage, without a disability certificate, with a single disability and with less severe disabilities.
Low use of healthcare services indicates an unmet need among Chinese elderly with disabilities especially for the old–old. More effort should be warranted to enhance healthcare service use among the elderly with disabilities.
Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of ‘prudent healthcare’ championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted.
A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest.
A sum of £86.9 million was spent on respiratory care in 2012–13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment.
This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored.
Non-attendance at TB contact screening clinics has been highlighted as a common phenomenon across a number of sites during recruitment to the PREDICT TB Study. This has obvious implications for the safety of patients, their communities and for NHS resources. The objective of this study was to explore why adults who have been in contact with TB do, and do not, attend their screening appointment, thereby allowing identification of interventions to reduce non-attendance.
A multi-method approach was taken using 15 questionnaires with adults who attended for screening, 15 telephone questionnaires with adults who did not attend and in-depth interviews with 8 TB nurses. Interviews were coded to trace emerging descriptive themes, then refined through an iterative process of interpretation and recoding.
Findings from the questionnaires and interviews were categorized into three principle themes following analysis: awareness, hospital factors and leadership. These themes deconstruct the complex phenomena of patients' lack of attendance at this TB contact screening service.
Recommendations related to issues of leadership, outreach services, flexibility of clinic timing and awareness amongst both the local community and GPs were made.
Opioid dependence treatment, comprising opioid substitution treatment (OST) and psychosocial intervention, is accepted to improve outcomes in opioid addiction for both the individual and public health. OST medication such as methadone or buprenorphine may be misused or diverted. This results in failure to recover from addiction, increased crime and the spread of blood-borne viruses. Worldwide, attempts to address misuse and diversion have been proposed and implemented with varying impact.
A structured, expert-led process recommended the most impact. As an initial step, a broad range of strategies were defined, and a systematic review of published literature identified 37 highly relevant sources of evidence. Experts reviewed this evidence and ranked the list of strategies for effectiveness and ease of implementation, based on their clinical experience.
Three groups of strategies to address misuse or diversion are defined, depending on impact (effectiveness and ease of implementation). Preferred strategies include the promotion of access to treatment and the use of product formulations less likely to be misused. However, additional data and innovative approaches to address this complex problem are needed.
To analyse the scientific evidence that exists for the advertising claims made for two products containing Lactobacillus casei and Bifidobacterium lactis and to conduct a comparison between the published literature and what is presented in the corporate website.
Systematic review, using Medline through Pubmed and Embase. We included human clinical trials that exclusively measured the effect of Lactobacillus casei or Bifidobacterium lactis on a healthy population, and where the objective was related to the health claims made for certain products in advertising. We assessed the levels of evidence and the strength of the recommendation according to the classification criteria established by the Oxford Centre for Evidence Based Medicine (CEBM). We also assessed the outcomes of the studies published on the website that did not appear in the search.
Of the 440 articles identified, 16 met the inclusion criteria. Only four (25%) of these presented a level of evidence of 1b and a recommendation grade of A, all corresponding to studies on product containing Bifidobacterium lactis, and only 12 of the 16 studies were published on the corporate website (47).
There is insufficient scientific evidence to support the health claims made for these products, especially in the case of product containing Lactobacillus casei.
In this Perspectives paper, I outline the limitations of the concept of ‘intentionality’ in public reproductive health understandings of pregnancy. ‘Intentionality’, ‘plannedness’, ‘wantedness’ and ‘timing’ place individual cognitions, psychology and/or behaviors at the center of public health conceptualizations of pregnancies, thereby leaving the underlying social and structural dynamics under-examined. I propose a model that places ‘supportability’ at the center of thinking about pregnancies and that allows for an analysis of the intersection of individual cognitions, emotions and behavior with micro-level interactive spaces and macro-level issues.
Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification.
We included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011.
Compared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records with a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE.
Different definitions should be used for different study purposes. The definition of ‘diagnosis code or two abnormal blood pressure records with a 2-year period’ could be used for hypertension surveillance in THIN.
There are growing calls within public health for researchers and practitioners working to improve and protect the public's health to become more involved in politics and advocacy. Such a move takes practitioners and researchers beyond the traditional, evidence-based public health paradigm, raising potential dilemmas and risks for those who undertake such work. Drawing on the example of the People's Health Movement, this short paper argues that advocacy and social movements are an essential component of public health's efforts to achieve great health equity. It outlines how the Scottish branch of the People's Health Movement sought to overcome potential tensions between public health evidence and advocacy by developing a regional manifesto for health via transparent and democratic processes which combine empirical and experiential evidence. We suggest that this is an illustrative example of how potential tensions between public health research and advocacy can be overcome, through bottom–up movements of solidarity and action.
It is unclear why rates of homelessness claims in England have risen since 2010. We used variations in rates across local authorities to test the impact of economic downturns and budget cuts.
Using cross-area fixed effects models of data from 323 UK local authorities between 2004 and 2012, we evaluated associations of changes in statutory homelessness rates with economic activity (Gross Value Added per capita), unemployment, and local and central government expenditure.
Each 10% fall in economic activity was associated with an increase of 0.45 homelessness claims per 1000 households (95% CI: 0.10–0.80). Increasing rates of homelessness were also strongly linked with government reductions in welfare spending. Disaggregating types of welfare expenditure, we found that strongest associations with reduced homelessness claims were spending on social care, housing services, discretionary housing payments and income support for older persons.
Recession and austerity measures are associated with significant increases in rates of homelessness assistance. These findings likely understate the full burden of homelessness as they only capture those who seek aid. Future research is needed to investigate what is happening to vulnerable groups who may not obtain assistance, including those with mental health problems and rough sleepers.
The manifesto Start Well, Live Better by the UK Faculty of Public Health (Start Well, Live Better—A Manifesto for the Public's Health. London: UK Faculty of Public Health, 2014) sets out 12 compelling priorities for the protection of people's health. The focus of this document is preventative, calling for a comprehensive strategy to target a wide-ranging set of challenges to public health; however, it fails to mention child maltreatment and its negative impact on long-term health outcomes. In this article, we explore the long-term negative consequences of child maltreatment and how these can be conceptually aligned with four different characteristics of long-term health conditions. We suggest that situating child maltreatment within a long-term conditions framework could have significant advantages and implications for practice, policy and research, by strengthening a commitment across disciplines to apply evidence-based principles linked with policy and evaluation and recognizing the chronic effects of maltreatment to concentrate public, professional and government awareness of the extent and impact of the issue. We argue that a public health approach is the most effective way of focusing preventative efforts on the long-term sequelae of child maltreatment and to foster cooperation in promoting children's rights to grow and develop in a safe and caring environment free from violence and abuse.
Prior research identified associations between residential moves during adolescence and depression, but studies used small or nonrepresentative samples. The aim of this study was to examine the associations between residential moves and major depressive episode (MDE) in a large, nationally representative sample of adolescents in the USA.
This study analyzed data on 139 606 adolescents (12–17 years old) from the National Survey on Drug Use and Health, an annual cross-sectional survey from 2005 to 2012. We analyzed data on MDE prevalence within the past 12 months and residential moves within the past 5 years, using multivariable logistic regression models to control for observable covariates.
Adolescents who moved at least once in the past 5 years had 35% higher odds of MDE than those who did not (odds ratio, 1.35; 95% confidence interval, 1.28–1.43), with odds of MDE increasing as the number of moves increased. Associations were particularly strong among younger and higher income adolescents.
Findings suggest that adolescents who move often may be a vulnerable group in need of mental health screening and services. Next steps in research include longitudinal studies with data on preexisting mental health issues and childhood adverse events.
We used an expanded conceptualization of ethnic density at the neighborhood level, tailored to Hispanic majority communities in the USA, and a robust measure of children's acculturation at the individual level, to predict Hispanic children's respiratory health.
We conducted a cross-sectional survey of 1904 children in 2012 in El Paso, TX, USA. One thousand one hundred and seven Hispanic children nested within 72 census tracts were analyzed. Multilevel logistic regression models with cross-level interactions were used to predict bronchitis, asthma and wheezing during sleep.
A neighborhood-level ethnic density factor was a non-significant risk factor while individual-level acculturation was a significant risk factor for the three outcomes. Pest troubles and not having been breastfed as an infant intensified the positive association between ethnic density and bronchitis. Increases in ethnic density intensified the odds of wheezing in sleep if the child was not low birth weight or was not economically deprived.
Results suggest that increasing individual-level acculturation is detrimental for US Hispanic children's respiratory health in this Hispanic majority setting, while high ethnic density neighborhoods are mildly risky and pose more significant threats when other individual-level factors are present.
To assess the prevalence, awareness, treatment and control of hypertension among adults in Ireland and to describe the determinants of awareness, treatment and control in order to inform public health policy.
A cross-sectional study of a nationally representative sample of community living adults aged 50 years and older using data collected from 2009 to 2011 for the first wave of the Irish Longitudinal Study on Ageing (TILDA) (n = 5857). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg and/or currently taking antihypertensive medications.
The prevalence of hypertension was 63.7% [95% confidence interval (CI) 62.3–65.1%]. Among those with hypertension, 54.5% (95% CI 52.6–56.2%) were aware of their hypertensive status and 58.9% (95% CI 57.1–60.4%) were on antihypertensive medication. Among those on treatment, 51.6% (95% CI 49.3–53.9%) had their BP controlled to below 140/90 mmHg. Respondents facing financial barriers to primary care and medication were less likely to be on antihypertensive treatment compared with those without financial barriers.
A high prevalence of hypertension was identified in this cohort, with low levels of awareness, treatment and control. Population and primary care interventions are required to reduce prevalence and to improve awareness, detection and management of hypertension.
This study looked at the degree of weight gain between the first (Reception) and last year (Year 6) of primary school and how weight status in Reception predicts becoming overweight/obese by Year 6.
A longitudinal sample of 1863 children was created using two time points (2006/7, 2012/13) from the National Child Measurement Programme (NCMP) in South Gloucestershire. T-test and logistic regression were used to test the difference between the BMI z-scores and BMI percentiles, and predict the probability of being overweight (BMI ≥ 85th) or obese (≥95th) at Year 6 based on BMI percentile in Reception.
Of those children who were obese at Reception age, 68% were obese at Year 6. Compared with children with a BMI in the 2nd to 49th percentile range, children between the 75th and 84th percentiles of BMI at Reception age were 10 times more likely (odds ratio (OR) = 10.18, P < 0.01), and those with a BMI between the 85th and 94th percentiles were 13 times more likely (OR = 13.38, P < 0.01), to become obese by Year 6. Boys were more likely than girls to revert to a healthy weight.
This is the first study to link data from the NCMP. It provides estimates of prevalence and offers new evidence on obesity emergence and gender differences.
Brazil and Canada are on opposite poles of the spectrum for life expectancy in America. We identified factors underlying Brazil's lower life expectancy relative to Canada, with emphasis on the role of injury compared with other major causes.
We computed life expectancy at birth in Brazil and Canada in 2010 and identified the ages and causes of death responsible for the gap between both countries. The main outcome measure was the contribution of homicide and traffic accidents to the gap, compared with other causes of death.
Relative to Canada, life expectancy was lower in Brazil by 8.2 years (men) and 5.2 years (women). Injury lowered life expectancy of men in Brazil by 2.2 years, or more than a quarter of the gap, mainly due to homicide and traffic accidents between ages 20 and 64 years. Homicide and traffic accidents contributed more than all circulatory diseases combined. In women, circulatory disease was the most important cause of lower life expectancy.
In 2010, homicides and traffic accidents were the principal cause for short life expectancy of men in Brazil. Improving life expectancy in Brazil requires addressing the root causes of inequalities that drive illicit drug trade, violence and accidents.
To report the level and correlates of oral cancer literacy in a deprived area of the UK.
This study is part of the East London Oral Health Inequality Study, which included a representative sample of adults 16–65 (n = 2343) years old living in Waltham Forest, Redbridge and Barking and Dagenham in 2009–10. This cross-sectional study adopted a multi-stage, stratified, random sampling approach. Data were collected through home visits by trained examiners and interviewers. Hierarchical logistic regression modelling was adopted.
Only 26.7% participants were aware that a small lesion in the mouth can develop into oral cancer, and 39.5% were aware that early treatment could prevent a lesion from developing into oral cancer. Adjusted odds ratios confirmed the social gradient in awareness that a small lesion in the mouth can develop into oral cancer, even after adjusting for age, gender and ethnicity. Inequalities in awareness that a small lesion in the mouth can develop into oral cancer were significantly attenuated after forcing education level into the equation. Interestingly, adjusting for education cancelled the difference previously observed between manual/routine and professional/managerial occupations.
Oral cancer literacy is poor among adults in Outer North East London, and we have identified particularly vulnerable sub-populations.
Few studies have focused on relating physical activity (PA) and sedentary behaviour (SB) to identify homogeneous groups. This study aimed to identify patterns of PA and SB in France general population and their correlates.
A sample of 3294 (mean age 44 ± 17 years) from the general population in France was included. PA and SB were assessed by the World Health Organization Global Physical Activity Questionnaire. Cluster analysis was used to identify PA and SB patterns, with polytomous logistic regression to identify their correlates.
Five clusters were identified: (i) ‘low total PA, active-transportation and low SB’ (41%), (ii) ‘low total PA and moderate SB’ (22%), (iii) ‘low total PA, leisure-time PA and high SB’ (15%), (iv) ‘high total PA, moderate occupational PA and moderate SB’ (17%) and (v) ‘high total PA, vigorous occupational PA and low SB’ (5%). Occupational PA substantially contributed to total PA which depended on socioeconomic status (SES): low total PA and high SB in higher SES and high total PA and low SB in lower SES.
Based on PA and SB, French adults were clustered into groups with socioeconomic differences emphasizing that adapted interventions may be more beneficial for health.
We report development of a group-based lifestyle intervention, Let's Prevent, using the UK Medical Research Council (MRC) framework, and delivered by structured education to prevent type 2 diabetes mellitus (T2DM) in people with impaired glucose regulation (IGR) in a UK multi-ethnic population.
Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) is the first national T2DM programme that meets National Institute for Health and Care Excellence criteria and formed the basis for Let's Prevent. An iterative cycle of initial development, piloting, collecting and collating qualitative and quantitative data, and reflection and modification, was used to inform and refine lifestyle intervention until it was fit for evaluation in a definitive randomized controlled trial (RCT). The programme encouraged IGR self-management using simple, non-technical language and visual aids.
Qualitative and quantitative data suggested that intervention resulted in beneficial short-term behaviour change such as healthier eating patterns, improved health beliefs and greater participant motivation and empowerment. We also demonstrated that recruitment strategy and data collection methods were feasible for RCT implementation.
Let's Prevent was developed following successful application of MRC framework criteria and the subsequent RCT will determine whether it is feasible, reliable and transferable from research into a real-world NHS primary healthcare setting.
Health assessments are used to prioritize community-level health concerns, but the role of individuals' health concerns and experiences is unknown. We sought to understand to what extent community health assessments reflect health concerns of the community-at-large versus a representation of the participants sampled.
We conducted a health assessment survey in 30 rural African American churches (n = 412). Multivariable logistic regression produced odds ratios examining associations between personal health concern (this health concern is important to me), personal health experience (I have been diagnosed with this health issue) and community health priorities (this health concern is important to the community) for 20 health issues.
Respondents reported significant associations for 19/20 health conditions between personal health concern and the ranking of that concern as a community priority (all P < 0.05). Inconsistent associations were seen between personal health experience of a specific health condition and the ranking of that condition as a community priority.
Personal health concerns reported by individuals in a study sample may impact prioritization of community health initiatives. Further research should examine how personal health concerns are formed.
We report an outbreak of Clostridium perfringens in a care home in North East England.
A retrospective cohort study was used to investigate this outbreak. Faecal samples were obtained from symptomatic residents. Environmental Health Officers carried out a food hygiene inspection and formal statements were taken.
Fifteen residents reported illness and the epidemic curve was suggestive of a point source outbreak. Results suggest that illness was associated with consumption of mince & vegetable pie and/or gravy. There were a number of issues with food served, in particular the mince products had been cooked, cooled, reheated and served again over a period of several days. Faecal sampling revealed the presence of C.perfringens enterotoxin gene and four samples were indistinguishable by fluorescent amplified fragment length polymorphism, indicating a likely common source. The operator of the home was charged with three offences under the General Food Regulations 2004 and the Food Hygiene (England) Regulations 2006 and was convicted on all counts.
An outbreak of C.perfringens occurred in a care home. The likely cause was consumption of mince & vegetable pie and/or gravy. Epidemiological evidence can be used to help prosecute businesses with food safety offences in such circumstances.
Tobacco companies use a host of strategies to undermine public health efforts directed to reduce and eliminate smoking. The success, failure and trends in domestic litigation used by tobacco companies to undermine tobacco control are not well understood, with commentators often assuming disputes are trade related or international in nature. We analyse domestic legal disputes involving tobacco companies and public health actors in high-income countries across the last decade to ascertain the types of action and the success or failure of cases, develop effective responses.
WorldLii, a publicly available online law repository, was used to identify domestic court cases involving tobacco companies from 2004 to 2014, while outcome data from LexisNexis and Westlaw databases were used to identify appeals and trace case history.
We identified six domestic cases in the UK, Australia and Canada, noting that the tobacco industry won only one of six cases; a win later usurped by legislative reform and a further court case. Nevertheless, we found cases involve significant resource costs for governments, often progressing across multiple jurisdictional levels.
We suggest that, in light of our results, while litigation takes up significant time and incurs legal costs for health ministries, policymakers must robustly fend off suggestions that litigation wastes taxpayers' money, pointing to the good prospects of winning such legal battles.
This research examined the influence of sit-to-stand desks on classroom sitting time in primary school children.
Pilot controlled trials with similar intervention strategies were conducted in primary schools in Melbourne, Australia, and Bradford, UK. Sit-to-stand desks replaced all standard desks in the Australian intervention classroom. Six sit-to-stand desks replaced a bank of standard desks in the UK intervention classroom. Children were exposed to the sit-to-stand desks for 9–10 weeks. Control classrooms retained their normal seated desks. Classroom sitting time was measured at baseline and follow-up using the activPAL3 inclinometer.
Thirty UK and 44 Australian children provided valid activPAL data at baseline and follow-up. The proportion of time spent sitting in class decreased significantly at follow-up in both intervention groups (UK: –9.8 ± 16.5% [–52.4 ± 66.6 min/day]; Australian: –9.4 ± 10% [–43.7 ± 29.9 min/day]). No significant changes in classroom sitting time were observed in the UK control group, while a significant reduction was observed in the Australian control group (–5.9 ± 11.7% [–28.2 ± 28.3 min/day]).
Irrespective of implementation, incorporating sit-to-stand desks into classrooms appears to be an effective way of reducing classroom sitting in this diverse sample of children. Longer term efficacy trials are needed to determine effects on children's health and learning.
The NHS Health Check Programme was introduced in 2009 to improve primary prevention of coronary heart disease, stroke, diabetes and chronic kidney disease; however, there has been debate regarding the impact. We present a retrospective evaluation of Leicester City Clinical Commissioning Group.
Data are reported on diagnosis of type 2 diabetes, hypertension, chronic kidney disease, high risk of type 2 diabetes and high risk of cardiovascular disease. Data on management following the Health Check are also reported.
Over a 5-year period, 53 799 health checks were performed, 16 388 (30%) people were diagnosed with at least one condition when diagnosis of being at high risk of cardiovascular disease was defined as ≥20%. This figure increased to 43% when diagnosis of high cardiovascular risk ≥10% was included. Of the 3063 (5.7%) individuals diagnosed with type 2 diabetes, 54% were prescribed metformin and 26% were referred for structured education. Of the 5797 (10.8%) individuals diagnosed at high risk of cardiovascular disease (≥20%), 64% were prescribed statins.
A high proportion of new cases of people at risk of cardiovascular disease were identified by the NHS Health Check Programme. Data suggest that this has translated into appropriate preventative measures.
NHS Health Checks are a national cardiovascular risk assessment and management programme in England and Wales. We examined the experiences of patients attending and healthcare professionals (HCPs) conducting NHS Health Checks.
Interviews were conducted with a purposive sample of 28 patients and 16 HCPs recruited from eight general practices across a range of socio-economic localities. Interviews were audio recorded, transcribed, anonymized and analysed thematically.
Patients were motivated to attend an NHS Health Check because of health beliefs, the perceived value of the programme, a family history of cardiovascular and other diseases and expectations of receiving a general health assessment. Some patients reported benefits including reassurance and reinforcement of healthy lifestyles. Others experienced confusion and frustration about how results and advice were communicated, some having a poor understanding of the implications of their results. HCPs raised concerns about the skill set of some staff to competently communicate risk and lifestyle information.
To improve the satisfaction of patients attending and improve facilitation of lifestyle change, HCPs conducting the NHS Health Checks require sufficient training to equip them with appropriate skills and knowledge to deliver the service effectively.
To evaluate the effect of NHS Health Checks on cardiovascular risk factor detection and inequalities.
Matched cohort study in the Clinical Practice Research Datalink, including participants who received a health check in England between 1 April 2010 and 31 March 2013, together with matched control participants, with linked deprivation scores.
There were 91 618 eligible participants who received a health check, of whom 75 123 (82%) were matched with 182 245 controls. After the health check, 90% of men and 92% of women had complete data for blood pressure, total cholesterol, smoking and body mass index; a net 51% increase (P < 0.001) over controls. After the check, gender and deprivation inequalities in recording of all risk factors were lower than for controls. Net increase in risk factor detection was greater for hypercholesterolaemia (men +33%; women +32%) than for obesity (men +8%; women +4%) and hypertension in men only (+5%) (all P < 0.001). Detection of smoking was 5% lower in health check participants than controls (P < 0.001). Over 4 years, statins were prescribed to 11% of health -check participants and 7.6% controls (hazard ratio 1.58, 95% confidence interval 1.53–1.63, P < 0.001).
NHS Health Checks are associated with increased detection of hypercholesterolaemia, and to a lesser extent obesity and hypertension, but smokers may be under-represented.
Socio-demographic factors characterizing disadvantage may influence uptake of preventative health interventions such as the NHS Health Check and research trials informing their content.
A cross-sectional study examining socio-demographic characteristics of participants and non-participants to the NHS Health Check and a nested trial of very brief physical activity interventions within this context. Age, gender, Index of Multiple Deprivation (IMD) and ethnicity were extracted from patient records of four General Practices (GP) in England.
In multivariate analyses controlling for GP surgery, the odds of participation in the Health Check were higher for older patients (OR 1.05, 95% CI 1.04–1.07) and lower from areas of greater deprivation (IMD Quintiles 4 versus 1, OR 0.37, 95% CI 0.18–0.76, 5 versus 1 OR 0.42, 95% CI 0.20–0.88). Older patients were more likely to participate in the physical activity trial (OR 1.04, 95% CI 1.02–1.06).
Younger patients and those living in areas of greater deprivation may be at risk of non-participation in the NHS Health Check, while younger age also predicted non-participation in a nested research trial. The role that GP-surgery-specific factors play in influencing participation across different socio-demographic groups requires further exploration.
To identify the barriers and facilitators to uptake of the HPV vaccine in an ethnically diverse group of young women in the south west of England.
Three school-based vaccination sessions were observed. Twenty-three young women aged 12 to 13 years, and six key informants, were interviewed between October 2012 and July 2013. Data were analysed using thematic analysis and the Framework method for data management.
The priority given to preventing cervical cancer in this age group influenced whether young women received the HPV vaccine. Access could be affected by differing levels of commitment by school staff, school nurses, parents and young women to ensure parental consent forms were returned. Beliefs and values, particularly relevant to minority ethnic groups, in relation to adolescent sexual activity may affect uptake. Literacy and language difficulties undermine informed consent and may prevent vaccination.
The school-based HPV vaccination programme successfully reaches the majority of young women. However, responsibility for key aspects remain unresolved which can affect delivery and prevent uptake for some groups. A multi-faceted approach, targeting appropriate levels of the socio-ecological model, is required to address procedures for consent and cultural and literacy barriers faced by minority ethnic groups, increase uptake and reduce inequalities.
Immunization advice services can support health professionals by providing rapid access to accurate and reliable current information and advice. The Vaccine Advice for Clinicians Service (VACCSline) is a service for health professionals working within the Thames Valley Area of the UK.
We reviewed all 4299 enquiries received by VACCSline over 3 years. Queries were summarized by vaccine type and topic of enquiry. Associations with profession and workplace of the enquirer were tested using Fisher's exact tests.
Incomplete immunization status and non-UK schedules were the most common topics of enquiry. Practice nurses were the main service users followed by doctors. Enquiries varied by professional role. Alterations to the immunization programme led to temporary changes to enquiry content and some more persistent adjustments in the balance of enquiries were identified, such as an increase in enquiries relating to vaccination in pregnancy.
The content of enquiries to VACCSline is broad, confirming the need for immunizers to have a wide knowledge base and access to specialist advice to assist with complex scenarios. Systematic data capture provided intelligence to guide training and materials to support immunizers. A wider networked application of this approach could improve support for immunizers.
The burden of disease relating to undiagnosed HIV infection is significant in the UK. BHIVA (British HIV Association) recommends population screening in high prevalence areas, expanding outside traditional antenatal/GUM settings.
RUClear 2011–12 piloted expanding HIV testing outside traditional settings using home-sampling kits (dry-blood-spot testing) ordered online. Greater Manchester residents (≥age 16) could request testing via an established, online chlamydia testing service (www.ruclear.co.uk). Participant attitudes towards this new service were assessed. Qualitative methods (thematic analysis) were used to analyse free-text data submitted by participants via hard copy questionnaires issued in all testing kits.
79.9% (2447/3062) participants completed questionnaires, of which 30.9% (756/2447) provided free-text data. Participants overwhelmingly supported the service, valuing particularly accessibility and convenience, allowing individuals to order tests any time of day and self-sample comfortably at home; avoiding the invasive nature of venipuncture and avoiding the need for face-to-face interaction with health services. The pilot was also clinically and cost-effective.
Testing via home-sampling kits ordered online (dry-blood-spot testing) was felt to be an acceptable and convenient method for accessing a HIV test. Many individuals undertook HIV testing where they would otherwise not have been tested at all. Expansion of similar services may increase the uptake of HIV testing.
Delay in presentation contributes to poorer survival of older women with breast cancer. Research has shown the effectiveness of the promoting early presentation (PEP) intervention when delivered by radiographers in the NHS Breast Screening Programme. This paper investigates the effectiveness of the intervention when delivered by practice nurses in general practice.
The Breast Cancer Awareness Measure was used to compare participants' awareness of breast cancer before, 1 month after and 12 months after the delivery of the PEP intervention. Five hundred and fifty-six women aged over 70 years took part, 308 of whom returned all three surveys.
The intervention was associated with increased awareness of non-lump breast symptoms and reported breast check frequency. There was a marked increase in breast cancer awareness which persisted for 12 months. Less than 5% of women were classified as ‘breast cancer aware’ before the intervention, rising to over 25% 1 month afterwards. This percentage dropped slightly after 1 year to just below 20%.
Delivery of the PEP intervention in general practice was very effective at raising the awareness of breast cancer among older women. Primary care settings are well placed to enhance the reach of this kind of intervention to at-risk women.
Referrals to ophthalmology are predominantly made from general practitioners (GPs) and optometrists. These two groups of referrers receive differing types and levels of training and are equipped with different instrumentation. The purpose of this study was to determine whether the quality of referrals to the hospital eye service (HES) differs between GPs and optometrists in Walsall.
Referrals into the HES were identified from Q1 2014 retrospectively until 1000 notes had been reached. Each record was scrutinized using a standard template. Data were analysed and summary statistics produced including positive predictive values and interobserver agreement.
We achieved our target of auditing 1000 records. The false-positive rate (patients being discharged from HES with a ‘normal vision’ diagnosis) was 7.7% of referrals from GPs and 6.2% of referrals from optometrists. Concordance between referred condition and diagnosed condition at HES between optometrists and ophthalmologists was 76.1%, and between GPs and ophthalmologists was 67.2%.
In view of findings from this study, it is important for commissioners in the new reconfigured National Health Service to ensure that enhanced ophthalmic services are commissioned only on the basis of hard evidence sourced from local data rather than opinion or on data from another geographical area.
Body mass index (BMI) tends to be higher among shorter adults, especially women. The dependence of BMI–height correlation on age and calendar time may inform us about temporal determinants of BMI.
Series of cross-sectional surveys: Health Survey for England, 1992–2011. We study the Benn Index, which is the coefficient in a regression of log(weight) on log(height). This is adjusted for age, gender and calendar time, allowing for non-linear terms and interactions.
By height quartile, mean BMI decreased with increasing height, more so in women than in men (P < 0.001). The decrease in mean BMI in the tallest compared with the shortest height quartile was 0.77 in men (95% CI 0.69, 0.86) and 1.98 in women (95% CI 1.89, 2.08). Regression analysis of log(weight) on log(height) revealed that the inverse association between BMI and height was more pronounced in older adults and stronger in women than in men, with little change over calendar time.
Unlike early childhood, where taller children tend to have higher BMI, adults, especially women and older people, show an inverse BMI–height association. BMI is a heterogeneous measure of weight-for-height; height may be an important and complex determinant of BMI trajectory over the life course.
The limited research on police sexual misconduct (PSM), a common form of police misconduct, suggests that no evidence-based strategies for prevention are available for use by police departments. To identify new avenues for prevention, we critically evaluated ‘front-end’ police recruiting, screening, hiring and training procedures.
Internal Affairs records were linked with administrative reports and police academy graduation data for officers accused of sexual assault or misconduct between 1994 and 2014. Logistic and proportional hazards regression methods were used to identify predictors of discharge for sustained allegations of PSM and time to discharge, respectively.
Officer's graduating class size was positively associated with odds of discharge for PSM. For every one-officer increase in class size, the rate of discharge for PSM increased by 9% [hazard ratio (HR) = 1.09, P < 0.01]. For particularly large classes (>35 graduates), discharge rates were at least four times greater than smaller classes (HR = 4.43, P < 0.05).
Large class sizes and more annual graduates increase rates of PSM. Officer recruitment strategies or training quality may be compromised during periods of intensive hiring. Trainee to instructor ratios or maximum class sizes may be instituted by academies to ensure that all police trainees receive the required supervision, one-on-one training, feedback and attention necessary to maximize public safety.
It is early Saturday morning: a day for heroes. Bogged down with various costumes, capes and action figures, young Nikoli bounds downstairs to catch reruns of Teen Titans. He puts his newly acquired reading skills to work, studying comic books and recreating the adventures therein. Nikoli imagines himself as the hero in his comics, defeating villains and saving victims, imitating the poses and catchphrases in the mirror. Although children like Nikoli will never gain super strength or the ability to fly, the superheroes they emulate in play are examples of people they can aspire to be. They don't even have to be fictional heroes—if we widen the scope of children's superheroes to include those that address real-life issues, or even real-life heroes who have made breakthroughs in fields such as public health, the impact could be tremendous. Imagine a world where Superman is mentioned in the same breath as Ignaz Semmelweis, the man who revolutionized sanitation in health care by demonstrating that hand washing prevents the spread of infection. Children who idolize the champions of health care could someday grow up to be heroes themselves, fighting epidemics and saving lives through education, treatment and research. Their wildest fantasies could become a reality.
Non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), cancer, lung disease and diabetes are major public health challenges for emerging economies. However, Masters of Public Health (MPH) curricula in the USA do not provide germane coursework.
To assess the availability of global NCD courses in MPH curricula, we searched the websites of the 50 schools accredited by the Council on Education for Public Health as of 1 July 2013. Our questionnaire queried availability of a global or international health department or track, availability of an NCD track, and the presence of courses on NCD, NCD risk factors, CVD or global NCDs as well as global health infrastructure.
All schools had online course coursework available. Thirty-one schools (62%) offered a global/international health track or certificate; 38 (76%) offered an NCD course but only 4 (8%) offered a global NCD course. Of the schools with a global health program, none required an NCD course but all offered courses on global health economics or infrastructure.
For public health schools to be aligned with global realities and to retain a leadership role, curricular initiatives that highlight the NCD epidemic and its societal complexities will need new emphasis.
The aim of this study was to examine if government spending is associated with an individual's decision to participate in physical activity and sport which is regarded as healthy behavior given the positive health effects documented in previous research.
Individual-level data (n = 25 243) containing socio-demographic information are combined with national-level data on government spending (5-year average) in 27 European countries. Given the hierarchical data structure, i.e. individuals are nested within countries; multi-level analyses are applied.
The multi-level models show that it is mainly education spending that has a significant positive association with participation in sport of various regularities. Health spending has some association with participation in other physical activity and sport of a lower regularity.
While health spending can be considered a relevant policy tool for increasing sport participation rates, education spending is required more since the effects are larger and it affects both physical activity and sport. This suggests that health spending will have most effect combined with earlier influences from education spending.
Risky health behaviours such as tobacco and alcohol abuse, physical inactivity and poor diet may play an important role in disease development. The aim of the present study was to assess the geographical distribution and socio-demographic determinants of risky health-related behaviours in 27 member states (MSs) of the European Union (EU).
Data from the 2009 Eurobarometer survey (wave 72.3; n = 26 788) were analysed. Tobacco use, alcohol consumption, physical activity and fruit consumption were assessed through a self-reported questionnaire provided to participants from 27 EU MSs. Within the analyses, participants with three or more lifestyle risk factors were classified as individuals with co-occurrence of risk factors.
Among respondents aged 15 or older, 28.2% had none of the aforementioned behavioural risk factors, whereas 9.9% had three or more lifestyle risk factors. Males [adjusted odds ratio (aOR) = 2.50; 95% confidence interval (95% CI): 2.17–2.88] and respondents of middle (aOR = 1.60; 95% CI: 1.36–1.89) or lower income (aOR = 2.63; 95% CI: 2.12–3.26) were more likely to report co-occurrence of behavioural risk factors, as well as respondents in Northern (aOR = 1.43; 95% CI: 1.14–1.78), Western (aOR = 1.28; 95% CI: 1.06–1.56) and Eastern Europe (aOR = 1.28; 95% CI: 1.06–1.55), when compared with Southern European respondents.
The above analyses indicate significant geographical and social variation in the distribution of the co-occurrence of behavioural risk factors for disease development.
Hearing and vision problems are common in older adults. We investigated the association of self-reported sensory impairment with lifestyle factors, chronic conditions, physical functioning, quality of life and social interaction.
A population-based cross-sectional study of participants of the British Regional Heart Study aged 63–85 years.
A total of 3981 men (82% response rate) provided data. Twenty-seven per cent (n = 1074) reported hearing impairment including being able to hear with aid (n = 482), being unable to hear (no aid) (n = 424) and being unable to hear despite aid (n = 168). Three per cent (n = 124) reported vision impairment. Not being able to hear, irrespective of use of hearing aid, was associated with poor quality of life, poor social interaction and poor physical functioning. Men who could not hear despite hearing aid were more likely to report coronary heart disease (CHD) [age-adjusted odds ratios (ORs) 1.89 (95% confidence interval 1.36–2.63)]. Vision impairment was associated with symptoms of CHD including breathlessness [OR 2.06 (1.38–3.06)] and chest pain [OR 1.58 (1.07–2.35)]. Vision impairment was also associated with poor quality of life, poor social interaction and poor physical functioning.
Sensory impairment is associated with poor physical functioning, poor health and poor social interaction in older men. Further research is warranted on pathways underlying these associations.
This study sought to describe the total mortality trend by socioeconomic deprivation (SED) in the Madrid Autonomous Region, by sex and age group.
Cross-sectional ecological study by census tract, in two periods: 1994–2000 (P1) with SED of 1996 census and 2001–07 (P2) with SED of 2001 census. We calculated the relative risks (RRs) and their 95% credibility intervals (95% CIs) by SED quintile (Q), taking the quintile of least deprivation as reference. Besag–York–Mollié ecological regression models and the Integrated Nested Laplace Approximation procedure were applied. The absolute differences in age-standardized rates were compared by SED quintile.
Inequalities decreased in young adults: among men aged 20–39 years, the RR in Q5 versus Q1 ranged from 2.73 (95% CI, 2.51–3.02) in P1 to 1.93 (95% CI, 1.76–2.15) in P2, due to the greater improvement in the most underprivileged groups. In contrast, there was an increase in SED-related mortality in the 40–79 age group. Among men aged 40–59 years, the RR in Q5 versus Q1 rose from 1.88 (95% CI, 1.76–2.02) in P1 to 2.29 (95% CI, 2.17–2.43) in P2; the improvement was greater in the most privileged groups.
In a context of an economic boom, inequalities were observed to increase among adults by a greater improvement in the most privileged groups.
Low socioeconomic position (SEP) is associated with increased cardiovascular (CV) disease risk, but the relative importance of SEP in childhood and adulthood, and of changes in SEP between these two life stages, remains unclear. Studies of families may help clarify these issues. We aimed to assess whether SEP in young adulthood, or change in SEP from childhood to young adulthood, was associated with five continuously measured CV risk factors.
We used data from 286 adult Australian families from the Victorian Family Heart Study (VFHS), in which some offspring have left home (n = 364) and some remained at home (n = 199). SEP (defined as the Index of Relative Socioeconomic Disadvantage) was matched to addresses. We fitted variance components models to test whether young adult SEP and/or change in SEP was associated with systolic blood pressure, diastolic blood pressure, body mass index (BMI), total cholesterol or high-density lipoprotein cholesterol, after adjustment for parental SEP and within-family correlation.
An increase in SEP of 100 SEIFA units from childhood to adulthood was associated with a lower BMI (β = –0.49 kg/m2, P < 0.01) only.
These results suggest that a change in SEP in young adulthood is an important predictor of BMI, independent of childhood SEP.
To investigate the influence of premature birth on conditions among children aged 6–17 years.
The National Survey of Children's Health in the USA added a question on premature birth for the first time in the 2011–12 wave. The influence of being born premature on different conditions while controlling for sociodemographic factors was assessed using logistic regression. A total of 6882 out of 62 078 (11.1%) of children aged 6–17 years were born premature.
Compared with children who were not born premature, those who were born premature were more likely to have cerebral palsy [odds ratio (OR) = 9.6, confidence interval (CI): 7.4–12.4], vision problems (OR = 2.3, CI: 2.0–2.6), hearing problems (OR = 1.7, CI: 1.6–2.0) and a special healthcare need (OR = 1.7, CI: 1.6–1.8). Children who were born premature had an increased likelihood of not being on a sports team or not taking sports lessons after school or on weekends during the past 12 months than those who were not born premature (OR = 1.2, CI: 1.1–1.3).
Prematurity may be associated with negative outcomes as infants transition into childhood and adolescence. Interventions within the life-course perspective are needed to alleviate the long-term consequences of prematurity.
This study explored ethnic inequalities in dental caries among adults and assessed the role of socioeconomic position (SEP) in explaining those inequalities.
We analysed data on 2013 adults aged 16–65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults and children living in East London in 2009–10. Participants completed a questionnaire and were clinically examined for dental caries at home. Dental caries was measured using the number of decayed, missing and filled teeth or DMFT index. Ethnic inequalities in dental caries were assessed in negative binomial regression models before and after adjustment for demographic (sex and age groups) and SEP measures (education and socioeconomic classification).
White Eastern European and White Other had higher DMFT, whereas all Asian (Pakistani, Indian, Bangladeshi and Other) and all Black (African, Caribbean and Other) ethnic groups had lower DMFT than White British. Similar inequalities were found for the number of filled and missing teeth, but there were no differences in the number of decayed teeth between ethnic groups.
This study showed considerable disparities in dental caries between and within the major ethnic categories, which were independent of demographics and SEP.
The aim of this descriptive epidemiological study was to analyze the mortality trend of prostate cancer in Serbia (excluding the Kosovo and Metohia) from 1991 to 2010.
The age-standardized prostate cancer mortality rates (per 100 000) were calculated by direct standardization, using the World Standard Population. Average annual percentage of change (AAPC) and the corresponding 95% confidence interval (CI) was computed for trend using the joinpoint regression analysis.
Significantly increased trend in prostate cancer mortality was recorded in Serbia continuously from 1991 to 2010 (AAPC = +2.2, 95% CI = 1.6–2.9). Mortality rates for prostate cancer showed a significant upward trend in all men aged 50 and over: AAPC (95% CI) was +1.9% (0.1–3.8) in aged 50–59 years, +1.7% (0.9–2.6) in aged 60–69 years, +2.0% (1.2–2.9) in aged 70–79 years and +3.5% (2.4–4.6) in aged 80 years and over. According to comparability test, prostate cancer mortality trends in majority of age groups were parallel (final selected model failed to reject parallelism, P > 0.05).
The increasing prostate cancer mortality trend implies the need for more effective measures of prevention, screening and early diagnosis, as well as prostate cancer treatment in Serbia.
Cancer mortality constitutes a major health burden in Europe. Trends are different for men and women, and across Europe. This study aims to map out Belgian cancer mortality trends for the most common cancer types in both sexes between 1979 and 2010, and to link these with trends in cancer mortality and smoking prevalence across Europe.
Mortality and population data were obtained from the World Health Organization Mortality Database. Age-standardized mortality rates were calculated by direct standardization using the European Standard Population.
Belgian mortality decreased for the most common cancer sites between 1979 and 2010, except for female lung cancer. Yet, Belgian male lung and female breast cancer rates remain high compared with the remainder of Western Europe. For some cancer sites, mortality trends are similar among the European Regions (e.g. stomach cancer), yet for others trends are divergent (e.g. colorectal cancer).
Generally, cancer mortality shows a favorable trend in Belgium and Europe. Yet, female lung cancer mortality rates are increasing in Belgium. Furthermore, Belgium still has higher male lung and female breast cancer mortality rates compared with the European regional averages. Considering this and the current smoking prevalence, enduring tobacco control efforts should be made.
While heavier weight is known to increase the incidence of dyslipidemia, limited data are available on the relationship between weight gain and its development.
A total of 2647 males were categorized into the following four groups according to the difference between their self-reported weight at 20 years of age and their measured weight in 1994–95: a loss of ≥5% (decrease), loss of <5% or gain of <5% (no change), gain of ≥5 to <15% (increase) and gain of ≥15% (sizable increase). They were followed up until their 2002–03 health examination. Using the ‘no change’ group as reference, the multivariable-adjusted odds ratio (adjusted for age, body mass index at 20 years of age, physical activity, smoking and alcohol intake) and 95% confidence interval (95% CI) for the incidence of dyslipidemia were determined using logistic regression models.
A total of 1342 participants developed dyslipidemia during the follow-up period. The ‘increase’ and ‘sizable increase’ groups had odds ratios for the incidence of dyslipidemia of 1.97 (95% CI, 1.59–2.45) and 2.68 (2.15–3.34), respectively, demonstrating that there was a significant dose–response association between weight gain since 20 years of age and the incidence of dyslipidemia (P < 0.001 for trend).
These results suggest that dyslipidemia could be prevented by avoiding weight gain in adulthood.
To examine the relationship between reported high serum or red blood cell (RBC) folate status and adverse health outcomes.
We systematically searched PubMed/Medline and EMBASE (to May 2013), with no limits by study type, country or population, to identify studies reporting high folate concentrations in association with adverse health outcomes. Two reviewers screened studies and extracted data. Study quality was assessed.
We included 51 articles, representing 46 studies and 71 847 participants. Quantiles were used by 96% of studies to identify high folate concentrations. Eighty-three percent of serum folate and 50% of RBC folate studies reported a high folate cutoff that corresponded with a clinically normal concentration. Increasing values of reported high folate concentration did not demonstrate a consistent association with risk of adverse health outcomes. Overall, reported high folate concentrations appeared to be associated with a decreased risk of adverse health outcomes, though substantial methodological heterogeneity precluded complex analyses.
Our interpretation was complicated by methodological variability. High folate cutoffs varied and often corresponded with normal or desirable blood concentrations. In general, a negative association appeared to exist between reported high folate status and adverse health outcomes. Consistent methods and definitions are needed to examine high folate status and ultimately inform public health interventions.
Surveillance of physical activity (PA) is essential for the development of health promotion initiatives. The aim of the present study was to examine the prevalence of PA and sedentary behaviour with respect to socio-demographic factors in Chile.
A representative sample of 5434 adults aged ≥15 years (59% women) who participated in the Chilean National Health Survey (2009–2010) were included. Socio-demographic data (age, sex, environment, education level, income level and smoking status) were collected for all participants. PA levels were assessed using the Global Physical Activity Questionnaire.
19.8% [95% CI: 18.1–21.6] of the Chilean population did not meet PA recommendations (≥600 MET min week–1). The prevalence of physical inactivity was higher in participants aged ≥65 years, compared with the youngest age groups and was higher in women than in men. However, it was lower for participants with high, compared with low, education or income levels. The overall prevalence of sedentary risk behaviour (spending >4 h sitting per day) was 35.9% [95% CI: 33.7–38.2].
Physical inactivity correlates strongly with socio-demographic factors such as age, gender and educational level. Results identify social and economic groups to which future public health interventions should be aimed to increase PA in the Chilean population.
Understanding patterns of time use of children is helpful in developing target-tailored intervention. The purpose of this study was to investigate the clustering of sedentary behaviours and physical activity in Chinese children and to examine the associations between sociodemographic factors and the time use clusters.
Cluster analysis was conducted among 1013 Chinese children aged 9–13 years (49.5% boys) recruited in a cross-sectional survey study. Physical activity and sedentary behaviours were assessed using a validated questionnaire. Differences in sociodemographic variables were compared across the clusters.
Five clusters were identified for boys and girls, respectively. For boys, the five clusters were labelled ‘Actives’ (9.1%), ‘Inactives’ (59.4%), ‘Sedentary homeworkers’ (4.7%), ‘Sedentary TV viewers’ (16.6%) and ‘Sedentary games players’ (10.2%). For girls, they were labelled ‘Actives’ (11.9%), ‘Uninvolved inactives’ (39.6%), ‘Sedentary homeworkers’ (11.3%), ‘Sedentary TV viewers’ (8.5%) and ‘Sedentary Games players’ (28.8%). Only parental education was found to differ across the five clusters in boys.
The findings demonstrated that sedentariness in youth is multidimensional, and it could not be accurately represented by singular behaviour. There is a potential need when designing specific interventions to reduce a group of sedentary behaviours to tailor these interventions for specific clusters.
Waterpipe tobacco and electronic cigarettes (e-cigarettes) share several features: rising popularity, use of product flavourings and concerns about marketing to youth. We sought to compare prevalence and predictors of waterpipe tobacco and e-cigarette use, and explore knowledge of waterpipe tobacco and support for interventions.
We used convenience sampling methods to conduct a cross-sectional survey among adults in the ethnically diverse southeast London area. Multivariate logistic regression identified predictors of waterpipe and e-cigarette use. Predictor variables were age, gender, ethnicity and current (past 30-day) cigarette use.
Of 1176 respondents (23.0% aged 25–34 years, 56.0% male, 57.4% white ethnicity and 30.4% current cigarette smokers), 31.0% had tried waterpipe tobacco and 7.4% had tried e-cigarettes. Both products were significantly associated with younger age groups, non-white ethnicities and use of each other. Waterpipe tobacco was independently associated with consumption of cigarettes while e-cigarettes were not. Among those aware of waterpipe, a third answered incorrectly to knowledge questions. Among those self-identified as coming from a traditional waterpipe-using community, two-thirds supported further legislative and health promotion waterpipe interventions.
Waterpipe tobacco was common and more prevalent than e-cigarettes in this population. Interventions to prevent and control waterpipe are unlikely to marginalize traditional waterpipe-using communities.
The Neonatal BCG Immunisation programme is a key part of tuberculosis (TB) control efforts in the UK; however, there is considerable variability in the method of delivery of the programme and monitoring of performance. This study aimed to review the extent to which infants at risk of exposure to TB are being identified in Grampian and to assess the uptake of BCG vaccination in eligible infants.
The Practitioner Services database and Scottish Immunisation Recall System records for all babies born in Grampian in 2012 and 2013 were reviewed to identify the number of babies who had a TB risk status recorded and to assess the uptake of BCG immunization in at-risk babies.
The proportion of babies with a risk status recorded was 96.6% in 2012 and 95.5% in 2013. The uptake of BCG vaccination in at-risk babies was 85.9% in 2012 and 89.9% in 2013.
NHS Grampian has an efficient method for identifying infants at risk of exposure to TB and has good neonatal BCG vaccination coverage.
Improving the health of Traveller Communities is an international public health concern but there is little evidence on effective interventions. This study aimed to explain how, for whom and in what circumstances outreach works in Traveller Communities.
A realist synthesis was undertaken. Systematic literature searches were conducted between August and November 2011. Grey literature was sought and key stakeholders were involved throughout the review process. Iterative steps of data extraction, analysis and synthesis, followed by additional searches were undertaken.
An explanatory framework details how, why and in what circumstances participation, behaviour change or social capital development happened. The trust status of outreach workers is an important context of outreach interventions, in conjunction with their ability to negotiate the intervention focus. The higher the outreach worker's trust status, the lower the imperative that they negotiate the intervention focus. A ‘menu’ of reasoning mechanisms is presented, leading to key engagement outcomes.
Adopting a realist analysis, this study offers a framework with explanatory purchase as to the potential of outreach to improve health in marginalized groups.
Recognizing the mindless nature of many food decisions, it has been suggested that attempts to increase healthy eating should not focus on convincing people what is ‘right’ but rather aim to adjust the environment such that people are automatically directed toward healthy choices. This study investigated a nudge aiming to promote healthy food choices in train station snack shops.
The nudge involved a repositioning of food products: healthy foods were placed at the cash register desk, while keeping unhealthy products available elsewhere in the shop. Three snack shops were included: a control condition; a nudge condition repositioning healthy products and a nudge + disclosure condition employing the same nudge together with an explanatory sign. Next to examining its effectiveness during 1 week, the study assessed customers' acceptance of the nudge.
Controlling for a baseline week, more healthy (but not fewer unhealthy) products were sold in both nudge conditions, with no difference between the nudge and the nudge + disclosure condition. A majority of customers reported positive attitudes toward the nudge.
Repositioning healthy foods is a simple, effective and well-accepted nudge to increase healthy purchases. Moreover, disclosing its purpose does not impact on effectiveness.
There is a limited evidence on the effectiveness of lifestyle interventions in achieving and maintaining a significant level of weight loss in morbidly obese patients. This study evaluated the impact on weight loss and psychological well-being of a community-based weight management service for morbidly obese patients [body mass index (BMI) ≥35 with related co-morbidities or BMI >40] in Derbyshire county.
Five hundred and fifty-one participants entered the service since 2010, and 238 participants were still active within the service or had completed the 2-year intervention in April 2013. A one-group pre–post design was used to determine average weight loss (kg) and impact on mental health and well-being [using the validated clinical outcomes of routine evaluation-outcome measure (CORE-OM) questionnaire] among participants. Measurements were recorded at baseline, 12 weeks, 24 weeks, 1 year, 18 months and 2 years, and significance (P ≤ 0.05) was determined using the paired sample t-test.
Statistically significant weight loss was recorded at each measurement point for those participants who remained engaged with the service (4.9 kg weight loss at 12 weeks to 18.2 kg at 2 years). There was a significant positive impact on psychological well-being demonstrated by CORE-OM score.
Findings show clinically and statistically significant weight loss among participants with improvements in physical and mental health.
In India, it has been estimated that 50% of family spending on healthcare is on unnecessary medications or investigations. This, combined with the wide availability of medications, has seemingly contributed to increasing rates of antibiotic resistance and further impoverishment. In this literature review, we aim to characterize the extent of misuse and describe underlying factors contributing to the misuse of medication in India.
This literature review included relevant articles published after 2000 that assessed medication use and misuse in India. A narrative review framework was used to analyse each article, confirm its inclusion, extract relevant information and group the findings under thematic areas.
There were 115 articles included in this literature review. The literature demonstrated that the misuse of medications in India is widespread. The factors resulting in this involves all levels of the health system including regulation, enforcement and policy, healthcare providers and consumers.
This is one of the most comprehensive reviews of medication misuse in India. It indicates the widespread nature of the problem and so highlights the need for action. This review provides a detailed understanding as to the complex interplay of factors that result in medication misuse in India.
Ageing of the population often leads to polypharmacy. Consequently, potentially inappropriate prescribing (PIP) becomes more frequent. Systematic screening for PIP in older patients in primary care could yield a large improvement in health outcomes, possibly an important task for community pharmacists. In this article, we develop an explicit screening tool to detect relevant PIP that can be used in the typical community pharmacy practice, adapted to the European market.
Eleven panellists participated in a two-round RAND/UCLA (Research and Development/University of California, Los Angeles) process, including a round zero meeting, a literature review, a first written evaluation round, a second face-to-face evaluation round and, finally, a selection of those items that are applicable in the contemporary community pharmacy.
Eighteen published lists of PIP for older patients were retrieved from the literature, mentioning 398 different items. After the two-round RAND/UCLA process, 99 clinically relevant items were considered suitable to screen for in a community pharmacy practice. A panel of seven community pharmacists selected 83 items, feasible in the contemporary community pharmacy practice, defining the final GheOP3S tool.
A novel explicit screening tool (GheOP3S) was developed to be used for PIP screening in the typical community pharmacy practice.
2016-06-06T08:18:42-07:00Background In most parts of the world, neonatal mortality rates have shown a slower decline when compared with under-5 mortality decline. A sick newborn can die within minutes if there is a delay in presentation, thus early diagnosis and treatment are essential for the survival of a critically ill newborn. This study investigated factors responsible for delays in healthcare services for the sick newborn and maternal socio-demographic variables that influence these delays in Enugu, South-East Nigeria. Methods This was a community-based descriptive study. A total of 376 respondents were randomly selected from 4 of the 17 local government areas of Enugu State. Mothers and/or caregivers that were nursing or had nursed a child in the previous 2 years were enrolled. Self-reported data on delays encountered during healthcare for sick newborn were collected using pretested structured questionnaire. Chi-square and multivariate logistic regression were used to determine the association between causes of delays in newborn healthcare services, maternal socio-demographics and relationships with newborn mortality. Results Delays in reaching healthcare facilities accounted for the most common delays encountered by respondents, 78.0%, in this study, followed by delays at household level, 24.2% and delays at health facility level 16.0% (P = 0.000). Mothers with knowledge of ≥3 WHO recognized danger signs compared with those with ≤2 were significantly less likely to delay at household (level 1: 40.7 versus 59.3%) (P = 0.017) and reaching healthcare service (level 2: 19.9 versus 80.1%) (P = 0.028). Delays at health facility level (level 3) occurred more at tertiary health facilities (59.0%), secondary health facilities (39.1%) and primary healthcare facilities (19.7%) compared with private health facilities (13.5%) (P = 0.000). Conclusions Delays in seeking healthcare at all levels especially those related to transporting the sick newborn to[...]
Patient registries (PRs) are important tools for public-health surveillance and rare-disease research. The purpose of this study is to identify the most important criteria for the creation of a rare-disease PR that could be used by public-health authorities to develop health policies.
A consensus-development Delphi study was used, with participants selected for their expertize in rare diseases and registries. Participants were asked to complete a questionnaire on the most important criteria for creating PRs. Three rounds were performed.
Agreement was reached on half the questions in the first round and on 89% of questions in the final round, with a total expert participation rate of around 60% by the final stage. This study made it possible to reach a broader consensus starting from experts' initial assessment of the features that should be considered for the creation of a rare-disease PR.
The consensus method used made it possible to define the characteristics of a PR based on expert opinion within a rare-disease framework. This study may serve as a guide for helping other researchers plan and build a rare-disease PR.
2016-06-06T08:18:42-07:00Background The Impact of Weight on Quality of Life for Kids (IWQOL-Kids) is the first self-report questionnaire for assessing weight-related quality of life for youth. However, there is no Chinese version of IWQOL-Kids. Thus, the objective of this research was to translate IWQOL-Kids into Mandarin and evaluate its psychometric properties in a large school-based sample. Methods The total sample included 2282 participants aged 11–18 years old, including 1703 non-overweight, 386 overweight and 193 obese students. IWQOL-Kids was translated and culturally adapted by following the international guidelines for instrument linguistic validation procedures. The psychometric evaluation included internal consistency, test–retest reliability, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity and discriminant validity. Results Cronbach's α for the Chinese version of IWQOL-Kids (IWQOL-Kids-C) was 0.956 and ranged from 0.891 to 0.927 for subscales. IWQOL-Kids-C showed a test–retest coefficient of 0.937 after 2 weeks and ranged from 0.847 to 0.903 for subscales. The original four-factor model was reproduced by EFA after seven iterations, accounting for 69.28% of the total variance. CFA demonstrated that the four-factor model had good fit indices with comparative fit index = 0.92, normed fit index = 0.91, goodness of fit index = 0.86, root mean square error of approximation = 0.07 and root mean square residual = 0.03. Convergent validity and discriminant validity were demonstrated with higher correlations between similar constructs and lower correlations between dissimilar constructs of IWQOL-Kids-C and PedsQL™ 4.0. The significant differences were found across the body mass index groups, and IWQOL-Kids-C had higher effect sizes than PedsQL™4.0 when comparing non-overweight and obese groups, supporting the sensitivity[...]
The recruitment process for public health specialty training includes an assessment centre (AC) with three components, Rust Advanced Numerical Reasoning Appraisal (RANRA), Watson-Glaser Critical Thinking Appraisal (WGCT) and a Situation Judgement Test (SJT), which determines invitation to a selection centre (SC). The scores are combined into a total recruitment (TR) score that determines the offers of appointment.
A prospective cohort study using anonymous record linkage to investigate the association between applicant's scores in the recruitment process and registrar's progress through training measured by results of Membership Faculty Public Health (MFPH) examinations and outcomes of the Annual Review of Competence Progression (ARCP).
Higher scores in RANRA, WGCT, AC, SC and TR were all significantly associated with higher adjusted odds of passing Part A MFPH exam at the first attempt. Higher scores in AC, SC and TR were significantly associated with passing Part B exam at the first attempt. Higher scores in SJT, AC and SC were significantly associated with satisfactory ARCP outcomes.
The current UK national recruitment and selection process for public health specialty training has good predictive validity. The individual components of the process are testing different skills and abilities and together they are providing additive value.
The implementation of the ‘Removal of the Spare Room Subsidy’ in April 2013, commonly known as the ‘bedroom tax’, affects an estimated 660 000 working age social housing tenants in the UK, reducing weekly incomes by £12–£22. This study aimed to examine the impact of this tax on health and wellbeing in a North East England community in which 68.5% of residents live in social housing.
Qualitative study using interviews and a focus group with 38 social housing tenants and 12 service providers.
Income reduction affected purchasing power for essentials, particularly food and utilities. Participants recounted negative impacts on mental health, family relationships and community networks. The hardship and debt that people experienced adversely affected their social relationships and ability to carry out normal social roles. Residents and service providers highlighted negative impacts on the neighbourhood, as well as added pressure on already strained local services.
The bedroom tax has increased poverty and had broad-ranging adverse effects on health, wellbeing and social relationships within this community. These findings strengthen the arguments for revoking this tax.
Fuel poverty negatively impacts a population's health affecting life chances along the life course. Moreover, it represents a substantial inequality in the UK. Healthcare practitioners (HCPs) have a key role in identifying and supporting patients who are fuel poor.
A qualitative inquiry with District Nurses and General Practitioners, to explore their understanding and experiences of dealing with patients living in fuel poverty.
Participants recognize fuel poverty by observing material cues. They perceive their relationship with the patient as pivotal to recognizing the fuel poor. Practitioners' sense of responsibility for their patients' social concerns is determined by their knowledge about the link to health outcomes. The services that they sign-post to are motivated by their experience dealing with the service, or their patients' experiences of the service.
Participants' reliance on temporary material cues resulted in few experiences of recognition of the fuel poor. HCPs' perceptions of patient pride and the lack of personal relationship between doctor and patient presented barriers to identifying fuel poor patients. A limitation of this study is the small sample size of nine participants. These came from two professional groups, which afforded more depth of exploration, but may limit applicability to other professionals.
Data on diseases' determinants and health status of asylum seekers (ASs) are limited.
We performed a cross-sectional retrospective study in a large ASs centre in Italy. Data were collected during a 1-year period. Descriptive statistics were calculated. A 2 test was used to assess the association between socio-demographics characteristics of ASs and screening test results. A multiple logistic regression analysis was performed to identify diseases' predictors by using ICD-10 diagnoses classification as outcome variable, socio-demographic characteristics as independent variable and visits' number as confounding variable.
Overall, data on 792 ASs (mean age 27 years, 80% males, 58% from Africa) were assessed, 43% underwent voluntary infectious diseases screening and 2843 diagnoses were recorded. The most frequent diagnoses were: respiratory diseases, symptoms/signs not elsewhere classified, digestive diseases and infectious diseases. Gender was the most frequent predictor of ICD-10 diagnoses, while African origin, civil status and education were, respectively, predictive of cardiovascular and infectious diseases, genitourinary diseases and pregnancy-related disorders. Higher mean age was associated with syphilis, HIV and HCV infection and African origin with HIV infection.
Communicable diseases were not prevalent in the ASs population we analysed. A stronger cultural mediation support is needed to facilitate prevention, access and continuity of care for ASs.
The incidence of aplastic anemia (AA) is common in Asia than in western countries.
In a case–control study conducted at a tertiary care hematology center in northern India, 102 patients of AA and 201 controls of other blood disorders (OBD) were included. Sociodemographic data and exposure to drugs, toxins and radiation were collected from the study population using a standard questionnaire. Socioeconomic status (SES) was classified based on a calculated standard of living (SL) score. Univariate and multivariate analyses were carried out to delineate the factors associated with incidence of AA.
Patients with AA were significantly younger than those in control groups (mean age 27.5 ± 12.3 years, P < 0.01). The mean SL score was significantly lower in AA group (26.76 ± 12.88, P < 0.01) than in the controls. The mean monthly family income was significantly lower in AA group than in the controls (83.3% with monthly income <8000 INR, P < 0.01). On univariate analysis, AA group with lower SL score had >3 times higher odds of having the disease (odds ratio 3.41, 95% confidence interval 1.72–6.79, P < 0.0001) compared with the controls. On multivariate analysis, young age and low SES were found to be significantly associated with AA.
Lower SES is associated with higher incidence of AA in Indian population.
This study analysed the distribution of lung cancer deaths in areas with different urbanization levels in the Madrid Region and whether such differences persisted when deprivation and air pollution were considered.
This was a population-based cross-sectional study covering lung cancer deaths (2001–07). The exposure indicators were: a deprivation index based on 2001 census data; and the daily mean NO2 measurement (2002–07), both at the census tract level. Analysis was stratified by sex and age group and the Poisson regression models were applied to obtain rate ratios (RRs).
After adjustment for age, deprivation index and NO2, mortality was similar in the city and Greater Madrid areas and lower in the rural area for the over-64 age group (RR: 0.84 in men and RR: 0.66 in women, with respect to the city of Madrid), and significantly lower in the Greater Madrid area (RR: 0.84 in men and RR: 0.74 in women) and in the rural area (RR: 0.73 in men and RR: 0.51 in women) with respect to the city of Madrid for the under-65 age group.
The most urbanized areas of the Madrid Region are characterized by higher lung cancer mortality.
Amid local government budget cuts, there is concern that the ring-fenced public health grant is being appropriated, and Directors of Public Health (DsPH) find it difficult to make the case for investment in public health activity. This paper describes what DsPH are making the case for, the components of their case and how they present the case for public health.
Thirteen semi-structured telephone interviews and a group discussion were carried out with DsPH (November 2013 to May 2014) in the Southern region of England.
DsPH make the case for control of the public health grant and investing in action on wider determinants of health. The cases they present incorporate arguments about need, solutions and their effectiveness, health outcomes, cost and economic impact but also normative, political arguments. Many types of evidence were used to substantiate the cases; evidence was carefully framed to be accessible and persuasive.
DsPH are responding to a new environment; economic arguments and evidence of impact are key components of the case for public health, although multiple factors influence local government (LG) decisions around health improvement. Further evidence of economic impact would be helpful in making the case for public health in LG.
Rubella is usually a mild viral illness, but during pregnancy, it can have potentially devastating effects causing fetal losses and severe congenital malformations (congenital rubella syndrome). Rubella is now rare in most developed countries following a successful vaccination programme. We aimed to investigate differences in epidemiological profile of pregnant women screened antenatally in Liverpool to identify risk factors for rubella immunity.
All samples were tested with the Elecsys Rubella IgG immunoassay kit. A result <10 IU/ml was considered to be seronegative.
The seronegativity prevalence among pregnant women in Liverpool (6.3%) is higher than average value for the North West region (3.7%). The seronegative rates varied with age (15.4% for <15 years, 18.7% for 15–20 years, compared with 2% for 30–35 years). The areas with the highest seronegative rates correspond with areas of Liverpool with high pockets of socioeconomic deprivation.
The highest proportion of seronegative women were among the youngest age groups. Local areas with highest level of deprivation should be given priority and additional resources to develop targeted programmes and pathways to implement appropriate interventions such as MMR catch-up programmes and put in place arrangements for offering MMR vaccination in maternity units.
Rates of tuberculosis (TB) in UK South Asian communities are up to 17 times higher than in white British groups. Latent infection in new migrants provides only a partial explanation. We undertook a systematic review of the literature to establish existing knowledge about TB in South Asian communities.
We undertook a search for literature relating to TB and its management in South Asian communities in the UK. Articles initially identified were screened for relevance. A narrative review of relevant articles was then conducted.
We found 18 relevant articles. Associated risk factors for TB included poverty, deprivation, return visits to the Indian subcontinent, history of close contact with a case, gender, religion, possible dietary factors such as Vitamin D deficiency, duration of stay in the UK and country of birth. However, the evidence for these factors was often conflicting or weak, and suggests that commonly proposed hypotheses may not provide robust explanations for the higher rates of diagnosis.
Migration patterns and the demographic profile of the South Asian communities are constantly changing. Further research into the determinants of TB infection in these communities in the UK is urgently needed to inform the commissioning of TB health services.
Body mass index (BMI) can be used to group individuals in terms of their height and weight as obese. However, such a distinction fails to account for the variation within this group across other factors such as health, demographic and behavioural characteristics. The study aims to examine the existence of subgroups of obese individuals.
Data were taken from the Yorkshire Health Study (2010–12) including information on demographic, health and behavioural characteristics. Individuals with a BMI of ≥30 were included. A two-step cluster analysis was used to define groups of individuals who shared common characteristics.
The cluster analysis found six distinct groups of individuals whose BMI was ≥30. These subgroups were heavy drinking males, young healthy females; the affluent and healthy elderly; the physically sick but happy elderly; the unhappy and anxious middle aged and a cluster with the poorest health.
It is important to account for the important heterogeneity within individuals who are obese. Interventions introduced by clinicians and policymakers should not target obese individuals as a whole but tailor strategies depending upon the subgroups that individuals belong to.
Neural tube defects are largely preventable by the maternal periconceptual consumption of folic acid. The aim of this study was to examine the levels of synthetic folic acid in foods and the range of food stuffs with added folic acid available to consumers in Ireland at the current time.
Three audits of fortified foods available in supermarkets in the Republic of Ireland were conducted. Researchers visited supermarkets and obtained folic acid levels from nutrition labels in 2004, 2008 and 2013/4. Levels were compared using MS Excel.
The profile of foods fortified with folic acid in 2013/4 has changed since 2004. The percentage of foods fortified with folic acid has decreased as has the level of added folic acid in some food staples, such as fat/dairy spreads.
Bread, milk and spreads no longer contain as much folic acid as previously (2004 and 2008). This may contribute to a decrease in folate intake and therefore may contribute to an increase in NTD rates. Research on current blood concentrations of folate status markers is now warranted.
Prolonged sitting is linked to various deleterious health outcomes. The alterability of the sitting time (ST)–health relationship is not fully established however and warrants study within populations susceptible to high ST.
We assessed the mortality rates of post-menopausal women from the Women's Health Initiative (WHI) observational study, a 15-year prospective study of post-menopausal women aged 50–79 years, according to their change in ST between baseline and year six. A total of 77 801 participants had information at both times on which to be cross-classified into the following: (i) high ST at baseline and follow-up; (ii) low ST at baseline and follow-up; (iii) increased ST and (iv) decreased ST. Cox regression was used to assess the relationship between all-cause, CVD and cancer mortality with change in ST.
At the end of follow-up, there were 1855 deaths. Compared with high ST maintainers, low ST maintainers had a 51 and 48% lower risk of all-cause and cancer mortality, respectively. Reducing sitting also resulted in a protective rate of 29% for all-cause and 27% for cancer mortality.
These results highlight not only the benefit of maintaining minimal ST, but also the utility of decreasing ST in older women, if current levels are high.
2016-06-06T08:18:42-07:00Background Many families rely on formal day care provision, which can be problematic when children are unwell. Attendance in these circumstances may impact on the transmission of infections in both day care and the wider community. Methods Thirty-one semi-structured interviews were conducted to investigate how parents make decisions about nursery care when children are unwell. Topics for discussion included: illness attitudes, current practice during childhood illness and potential nursery policy changes that could affect decision-making. Results A combination of illness perceptions and external factors affected decision-making. Parents: (i) considered the severity of respiratory and non-respiratory symptoms differently, and stated that while most other contagious illnesses required nursery exclusion, coughs/colds did not; (ii) said decisions were not solely based on nursery policy, but on practical challenges such as work absences, financial penalties and alternative care availability; (iii) identified modifiable nursery policy factors that could potentially help parents keep unwell children at home, potentially reducing transmission of infectious illness. Conclusions Decision-making is a complex interaction between the child's illness, personal circumstance and nursery policy. Improving our understanding of the modifiable aspects of nursery policies and the extent to which these factors affect decision-making could inform the design and impleme[...]
Food behaviours are important in the context of health and obesity. The aim was to explore the environments and food behaviours of a sample of young people in the North East of England to further understanding of the relationship between eating behaviours and environmental context.
Focus groups were conducted with four groups of young people aged 16–20 years (n = 40; 28 male, 12 female) between November 2006 and June 2007. Analysis was informed by grounded theory methods and was an iterative process of identifying themes across the transcripts.
Topics explored included: their main environment, home food responsibility and cooking, food outside of the home, where food was purchased/obtained and where food was eaten and with whom. Emergent themes included: the value for money in food purchases, time convenience, the car as a means of accessing food and health perceptions.
The complexities of the food environment were illustrated. This work has highlighted the importance of the home food environment and parents, and indicated the importance of factors such as time and cost in this age group's food choices. The behavioural norms around food behaviours merit further exploration for this population in transition between adolescence and adulthood.
2016-06-06T08:18:42-07:00Background Alcohol, tobacco and other drug use (ATOD) among adolescent and young adult couples during prenatal and postnatal periods is a significant public health problem, and couples may mutually influence each others' ATOD behaviors. Purpose The current study investigated romantic partner influences on ATOD among adolescent and young adult couples during pregnancy and postnatal periods. Methods Participants were 296 young couples in the second or third trimester of pregnancy recruited from OBGYN clinics between July 2007 and February 2011. Participants completed questionnaires at prenatal, 6 months postnatal, and 12 months postnatal periods. Dyadic data analysis was conducted to assess the stability and interdependence of male and female ATOD over time. Results Male partner cigarette and marijuana use in the prenatal period significantly predicted female cigarette and marijuana use at 6 months postnatal (b = 0.14, P < 0.01; b = 0.11, P < 0.05, respectively). Male partner marijuana use at 6 months postnatal also significantly predicted female marijuana use at 12 months postnatal (b = 0.11, P < 0.05). Additionally, significant positive correlations were found for partner alcohol and marijuana at pre-pregnancy and 6 months postnatal, and partner cigarette use at pre-pregnancy, 6 months and 12 months postnatal. Conclusions Partner ATOD among young fathers, particularly during the pre[...]
2016-06-06T08:18:42-07:00Background Clustering of lifestyle risk behaviours is very important in predicting premature mortality. Understanding the extent to which risk behaviours are clustered in deprived communities is vital to most effectively target public health interventions. Methods We examined co-occurrence and associations between risk behaviours (smoking, alcohol consumption, poor diet, low physical activity and high sedentary time) reported by adults living in deprived London neighbourhoods. Associations between sociodemographic characteristics and clustered risk behaviours were examined. Latent class analysis was used to identify underlying clustering of behaviours. Results Over 90% of respondents reported at least one risk behaviour. Reporting specific risk behaviours predicted reporting of further risk behaviours. Latent class analyses revealed four underlying classes. Membership of a maximal risk behaviour class was more likely for young, white males who were unable to work. Conclusions Compared with recent national level analysis, there was a weaker relationship between education and clustering of behaviours and a very high prevalence of clustering of risk behaviours in those unable to work. Young, white men who report difficulty managing on income were at high risk of reporting multiple risk behaviours. These groups may be an important target for interventions to reduce prem[...]