For the first time, and after considerable demand from past attendees, our annual conference on Public Health Science, held jointly in collaboration with the London School of Hygiene and Tropical Medicine, University College London, and the UK Health Forum, is taking place outside London—in Glasgow and in partnership with the European Public Health Association. The Lancet's experience in global health is that fostering and welcoming collaboration is the key to bringing evidence to bear on practice and policy.
Does a complex intervention by primary care nurses increase walking in older people? Outcomes at 3 and 12 months in the PACE-Lift (Pedometer Accelerometer Consultation Evaluation-Lift) cluster-randomised controlled trial
Tess Harris,Sally M Kerry,Christina R Victor,Ulf Ekelund,Alison Woodcock,Steve Iliffe,Peter H Whincup,Carole Beighton,Michael Ussher,Elizabeth Limb,Lee David,Debbie Brewin,Fredrika Adams,Annabelle Rogers,Derek G Cook
In the PACE-Lift trial, both step-counts and moderate-to-vigorous physical activity increased in people aged 60–75 years at 3 and 12 months. To our knowledge, this is the first trial in older people to show objective increases in moderate-to-vigorous physical activity, and it highlights the value of both accelerometry physical activity assessment and primary care as a setting for phyisical activity interventions. If these differences in physical activity are sustained they should lead to important differences in health outcomes.
Financial incentives for smoking cessation during pregnancy: a randomised controlled trial
David Tappin,Linda Bauld,David Purves,Kathleen Boyd,Lesley Sinclair,Susan MacAskill,Jennifer McKell,Brenda Friel,Alex McConnachie,Linda de Caestecker,Carol Tannahill,Andrew Radley,Tim Coleman
The scheme was both deliverable and acceptable to mothers and health-care staff in this field study. The scheme was extended (and will continue until at least December, 2014) in all three areas. A randomised controlled trial testing the effectiveness of the scheme is now planned.
Implementation of a fire-prevention injury prevention briefing in children's centres: a multicentre cluster-randomised controlled trial
The IPB, training, and facilitation did not increase parents' possession of fire-escape plans. Both the difficulties faced by children's centres in delivering the intervention to participating families and the secondary outcomes help to explain this outcome. Further research is required to explore both enhancement of penetration of interventions, such as the IPB, to disadvantaged communities and what single item questions about fire escape plans actually measure.
Towards enhanced community genetic literacy among a minority ethnic community: a participatory action research project
Development of appropriate community-level genetic literacy interventions can be achieved through participatory action research. Evaluative work is now needed to assess the effect on knowledge and service uptake.
Use of seemingly unrelated equations to assess changes in dietary behaviours during the UK's economic crisis
The findings of this study support the hypothesis that tighter food budgets might have led consumers to switch to lower-priced (per calorie) and less healthy food. The economic crisis might have therefore contributed to a further growth in obesity and related chronic diseases. Previous studies suggest that small effects at the population level can mask substantial inequalities across different socioeconomic groups. This study pioneers, in the field of public health, the use of an advanced econometric approach applied to a market information database.
Successful ageing, education, and functional trajectories in later life: a longitudinal latent variable modelling analysis
Theodore D Cosco,Graciela Muniz,Blossom C M Stephan,Carol Brayne
Education is independently associated with a high psychosocial-physiological functioning trajectory—ie, successful ageing. These results provide evidence for the long-term, beneficial effects of education in a sample of older British adults, with implications for policy, such as promotion of continued education, and for public health, such as fostering lifelong wellbeing.
Active monitoring of potential adverse immunisation events with hospital admission data and linked analysis in Scotland
Heather Murdoch,Mag McFadden,Alison Smith-Palmer,Beatrix von Wissmann,Claire Cameron
We have developed a timely active system for monitoring adverse events potentially associated with vaccination in Scotland. The system is limited to specified events, but it supplements MHRA reporting to provide added assurance of robust monitoring. Signals of interest can be rapidly further investigated, including near-time data linkage to the national childhood immunisation records, leading to formal epidemiological studies, if required.
Explaining ethnic inequalities in health in Scotland: a pilot study linking primary care to census data to account for ethnic variations in cardiovascular disease
Anne Douglas,Genevieve Cezard,Markus Steiner,Colin Simpson,Colin Fischbacher,Aziz Sheikh,R Bhopal,on behalf of SHELS Investigators
The high rate of hospital admissions for cardiovascular disease among Pakistani people can be explained partly by higher rates of diabetes, but not smoking. Our dataset is a non-representative sample, so results should be treated with caution. However, we have shown potential value (for further research and for health-care planning) in linking primary care to census data to shed light on ethnic variations in cardiovascular disease.
What do people fear about cancer? A systematic review and meta-synthesis
Charlotte Vrinten,Lesley M McGregor,Małgorzata Heinrich,Christian von Wagner,Jo Waller,Jane Wardle,Georgia B Black
This qualitative meta-synthesis drew out the multidimensionality of fear of cancer with a view of cancer as an enemy at its core, thus reprising the war-on-cancer theme that dominates the media. This enemy has various characteristics that could influence whether fight or flight is most appropriate. The view of cancer as an unpredictable and external threat can discredit messages about early detection, or impede the adoption of preventive health behaviours; future policies should focus on removing mixed messages in the public portrayal of cancer.
Reflections and best practice recommendations for interdisciplinary working: a case study on the identification of the determinants of addiction from the Addiction and Lifestyles In Contemporary Europe Reframing Addictions Project (ALICE RAP)
Interdisciplinary work is challenging; however, our recommendations for interdisciplinary collaborations, identified through expert interviews, could be used to facilitate the successful planning and management of interdisciplinary work in the specialty of substance use disorders and beyond.
Effect of the Great Recession on US and European health: an econometric analysis
The original contribution of this study was the finding of a beneficial effect of the Great Recession on mortality rates, self-assessed health, and health inequalities. Health benefits could be due to fewer working hours than before the recession, safer workplaces, better health behaviours, and lower pollution and traffic. Low-income groups might gain more because of a greater reduction in dangerous employment, pollution, and traffic.
Primary care competition and the effect of new providers on quality of care in England
Felix Greaves,Anthony A Laverty,Utz Pape,Anenta Ratneswaren,Azeem Majeed,Christopher Millett
The introduction of contracts for new alternative providers to deliver primary care services in England has not led to improvements in quality and might have resulted in worse care. Strengths of our study include use of a 5-year national data sample. Limitations include risk of lack of adjustment for unmeasured confounding factors. Regulators should ensure that new entrants to clinical-provider markets are performing to adequate standards and at least as well as traditional providers.
Attitudes towards lung cancer screening within socioeconomically deprived and heavy smoking communities: a qualitative study
Samantha L Quaife,Andy McEwen,Samuel M Janes,Jane Wardle
The recruitment of smokers of lower socioeconomic status indicates that this hard-to-reach target group can be engaged in public health research by use of existing community networks, although these methods are labour-intensive and difficult to replicate. The generalisability of our findings is restricted to English-speaking urban communities. Our findings indicate that attitudes towards lung cancer screening are complex and not wholly positive, and must be considered carefully in designing screening invitations.
Interpretation and use of official drinking guidelines by adults in England and Scotland: a qualitative study
Governments need to ensure that guidance they provide on alcohol consumption is useful and meaningful to drinkers, and understand how people use it to inform their behaviour. Our findings suggest a disconnect between the drinking guidelines and commonplace drinking practices, and a credibility gap that is a barrier to the guidelines' effective use. People responsible for developing and designing drinking guidelines should seek to better reflect drinking practices and evidence concerns when communicating guidance.
National supervised toothbrushing programme in Scotland, 1986–2009: trends over time, reduction in inequality, and cost analysis
Yulia Anopa,Alexander Douglas McMahon,David Ian Conway,Graham Edmund Ball,Emma McIntosh,Lorna Margaret Davidson Macpherson
An improvement and reduction in inequalities in the dental health of 5-year-old children was detected and was associated with the uptake of nursery toothbrushing. The costs associated with the actual and anticipated dental treatments for 5-year-old children decreased over time. In the eighth year of the toothbrushing programme the savings were more than two and a half times the costs of the programme implementation.
Measurement of the incidence of poisonings, fractures, and burns in children and young people with linked primary and secondary care data: a population-based cohort study
Our algorithms to identify injury events and their timing across primary and secondary care data show that use of linked data to increase injury ascertainment is crucial. Although non-medically attended injuries will not be captured in this study, our estimates provide useful information about the burden of medically attended injuries, which is important for health service planning. Our methods also provide essential information about the recording of injury mechanisms according to data source—an issue of importance for injury prevention practice and research.
Spatial variation in heart failure and air pollution in Warwickshire, UK: an investigation of small scale variation at the ward level
Oscar Bennett,Ngianga-Bakwin Kandala,Chen Ji,John Linnane,Aileen Clarke
This study showed distinct spatial patterns in heart failure morbidity and mortality in Warwickshire, suggesting a potential role of air pollution beyond individual-level risk factors. Environmental factors should therefore be taken into account when considering the wider determinants of public health and the effect that changes in air pollution might have on the health of a population.
Use of the child health utility and strengths and difficulties outcome measures in economic evaluations of school-based interventions: data from a cluster-randomised controlled trial in Northern Ireland
The SDQ and CHU9D are able to measure outcomes in children aged 8–10 years within an educational setting and there is initial evidence that they are related in their measurement properties. To our knowledge, the SDQ and CHU9D have not yet been used to predict longer-term outcomes within an economic evaluation context. This is an important avenue for further research because issues remain as to whether these childhood measures could be extrapolated into adulthood. A decision analytic model for long-term analysis is now being developed.
Age-friendly towns and cities: a mixed methods approach to developing an evaluation instrument for public health interventions
Data collection has highlighted key dimensions to be incorporated in the evaluation instrument. These dimensions include consideration of the extent to which AFC initiatives are informed by a needs assessment and robust research evidence, political will, availability of resources, attention to target group perspectives, and plans for evaluation.
Evaluation of diagnosed incidence rate as a measure of performance: an ecological study of England's national chlamydia screening programme
Lakshmi Chandrasekaran,Bethan Davies,Jeffrey W Eaton,Helen Ward
Greater socioeconomic deprivation strongly influenced whether local authorities attained the recommended DIR. This finding could reflect increased disease burden rather than more appropriate targeting of testing. Consequently, use of the DIR to compare performance of local authorities is difficult. Local-authority-specific DIR targets that reflect local disease burden might be more effective than a single national target. Additionally, the results indicate that an increased proportion of tests done in a genitourinary medicine setting was associated with a reduced likelihood of reaching the DIR target, which suggests the need for more testing outside of this setting, particularly in the least deprived areas.
Disinvestment and reinvestment in respiratory care: use of programme budgeting and marginal analysis in north Wales, UK
Joanna Mary Charles,Graham Brown,Kathrin Thomas,Ffion Johnstone,Andrew Jones,Rhiannon Tudor Edwards
This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and reinvestment decisions. This exercise, though in its early stages, could offer further support for changes in respiratory care implementation in north Wales, if recommendations were to be implemented. PBMA also has wider implications across health agencies in the UK for resource allocation decisions, such as diabetes care.
Communication of local cancer statistics to influence policy, and local engagement to improve cancer outcomes
This web resource enables local variations in data to be explored, highlighting the challenges and opportunities for improving outcomes locally, helping to raise cancer awareness, and identifying where action needs to be taken to reduce inequalities. Modelling results communicated with general practitioners face-to-face provides an improved indication of practice screening performance, and supports them in improving early diagnosis.
Behaviour change in 160 characters: a novel brief alcohol intervention for disadvantaged men
Iain K Crombie,Donald W Falconer,Linda Irvine,Brian Williams,Ian W Ricketts,Gerry Humphris,John Norrie,Peter Rice,Peter W Slane
Disadvantaged men were successfully recruited and retained in an alcohol intervention study. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. This feasibility study suggests that the intervention offers a low-cost method of reaching large numbers of hazardous drinkers.
Visual health inequalities: findings from UK Biobank
Phillippa M Cumberland,Jugnoo S Rahi,for the UK Biobank Eye & Vision Consortium
There are consistent patterns of associations between visual impairment across the full spectrum including, importantly, people with mild impairment, and known health determinants as well as key social outcomes. To our knowledge, our study provides evidence for the first time that policies tackling health inequalities as well as initiatives to address inequalities in ophthalmological clinical settings have the potential to improve visual health outcomes.
Do regional labour market conditions affect transitions into employment from health-related inactivity? Multilevel analysis of longitudinal UK Labour Force Survey data
Local labour market conditions fully account for regional differences in transition rates from health-related inactivity into employment. Higher regional employment rates are associated with increased rates of return to employment, and this association is similar to that for unemployed groups; however, overall rates of transition were low compared with unemployed groups. One limitation of our study is loss to follow-up. Local labour market improvement could potentially increase return-to-work rates for the sick and disabled.
Seasonal influenza in medical students: an outbreak simulation model based on a social network approach
Our results add to a small pool of evidence supporting targeting vaccination of individuals according to between-ness in an attempt to reduce the spread of influenza. However, in small, densely connected populations, vaccination according to degree might be preferential because of the rapid convergence and the relative ease of locating individuals with a high degree versus those with high between-ness. This study suggests that vaccination strategies that target highly connected individuals within a network might limit spread of infectious disease.
Use of retail data in the assessment of natural experiments: the case of Reducing the Strength, an intervention to reduce alcohol availability
Matt Egan,Triantafyllos Pliakas,Daniel Grace,Elizabeth McGill,Amanda Jones,Justin Wong,Simon Aalders,Karen Lock
Increasingly, researchers recognise the potential of retail data for evaluating interventions affecting social determinants of health and inequalities, such as local access to alcohol. However, shop-level data have frequently proved difficult for researchers to obtain. By obtaining such data we have been able to assess, using a quasi-experimental design, the effects of removing strong, cheap beers and ciders from shops. We have also been able to explore in more detail how to optimise the strengths and address some limitations of the data in ways that could potentially assist others planning to use this important data source in their research.
High risk of hepatitis B virus infection and unmet case-finding need among migrants in Bristol, UK: a cross-sectional study
In a large UK city, most GP-registered migrants, for whom a HBV test was recommended by NICE, had not been tested. The proportion not HBV tested in all migrants in Bristol might be higher because testing could be less likely in those not registered with a GP. Those migrants born in Eastern and South-Eastern Asia and West Africa were at greatest risk of infection.
Not that different or just not measurable? The contribution of health care to changes in population health outcomes in the UK before and after devolution
This study suggests that different NHS policies associated with political devolution has had little measurable effect on population health outcomes as measured by amenable mortality. An acceleration of the decline in amenable mortality since 2000 in all four countries might be indicative of an increase in the availability of resources for health care in each system.
Translating research into practice: a cross-sectional study using the Early Development Instrument to assess early years interventions in local level public health practice
Rosemary Geddes,Lisa Marks Woolfson,Stephanie McNicol,Josephine N Booth,Steven Wray,Samantha Hardie,Larry Doi,John Frank
The EDI is a robust instrument able to highlight developmental differences in children between socioeconomic groups and small-scale geographical areas. Its simplicity and usability lend themselves easily to community-wide implementation.
How do Cumulative Impact Policies work? Use of institutional ethnography to assess local government alcohol policies in England
Daniel Grace,Elizabeth McGill,Karen Lock,Matt Egan
Understanding the social and public health effects of CIPs requires innovative research strategies. Institutional ethnography offers important opportunities for methodological innovation in public health science. The map we developed reveals that CIPs must be viewed in relation to other alcohol initiatives. This qualitative research also generated nuanced questions about the social and public health effects of this alcohol intervention to which our ongoing quantitative analysis will contribute.
The effect of British Summer Time on outdoor physical activity
Owen Haswell,Liam West,Bryn Savill,Robert Whitham,Rhodri Martin
This preliminary study suggests that the number of people engaging in physical activity reduces abruptly after the end of BST, with reductions seen in both the evening and the morning observation timepoints. Despite the overall reduction in exercisers witnessed after the end of BST, there was a relative increase in the number of individuals engaged in activity at lunchtime. These changes suggest that daylight is an important determinant of outdoor physical activity behaviour. A larger study is warranted to explore the association between the determinants of the population's level of outdoor physical activity and available daylight hours.
Risk of future harm in adolescents admitted to hospitals in England for injury related to victimisation, self-harm, or drug or alcohol misuse: a retrospective cohort study
The risk of emergency re-admission or death from an adolescent admission for adversity-related injury is twice as high as that from accident-related injury. Since International Classification of Diseases 10 codes used were moderately sensitive for identifying adversity, the true relative risk could be higher than our estimates. Development of hospital-based interventions in adolescents with adversity-related injury, such as motivational interviewing, which has shown promise for reducing alcohol-related injury in the USA, could reduce this risk.
The push me, pull you of financial incentives and health inequalities: a mixed methods study investigating smoking cessation in pregnancy and breastfeeding
Pat Hoddinott,Heather Morgan,Gillian Thomson,Nicola Crossland,Shelley Farrar,Deokhee Yi,Jenni Hislop,Victoria Hall Moran,Graeme MacLennan,Stephan U Dombrowski,Kieran Rothnie,Fiona Stewart,Linda Bauld,Anne Ludbrook,Fiona Dykes,Falko F Sniehotta,David Tappin,Marion K Campbell
Participatory research has potential to empower those involved and to lead to interventions that have an effect on socially excluded populations. However, there are justified concerns about academic rigour with limited guidance on how to overcome practical challenges. With increasing adoption of this approach, opportunities for sharing best practice need to be developed.
A new concept of health—implications for public health policy and practice: a qualitative analysis
Marielle Jambroes,Trudi Nederland,Marian Kaljouw,Katja van Vliet,Marie-Louise Essink-Bot,Dirk Ruwaard
The new concept fits with the changing burden of disease and the contribution of individual behaviour to health outcomes. The main challenge of this concept for public health policy and practice will be to preserve primary prevention through the collective efforts of society. The main task will be to incorporate essential public health operations in the different sectors (health, housing, education, social policy) and to integrate public health in community care programmes.
Association between cardiovascular risk factors and concurrent depressive symptoms in cardiometabolic disease: a cross-sectional study
Bhautesh Dinesh Jani,Jonathan Cavanagh,Sarah Barry,Geoff Der,Naveed Sattar,Frances S Mair
Patients with coronary heart disease, stroke, and diabetes had a higher probability of having symptoms of depression, for cardiovascular risk factor values at both extremes. These findings could have important implications for secondary prevention strategies and risk stratification, but further investigation is needed to determine the nature and direction of the observed association.
Association of depression screening in cardiometabolic disease with future vascular events and mortality: a cohort study
Bhautesh Dinesh Jani,Charles Boachie,Colin McCowan,Sarah Barry,Jonathan Cavanagh,Frances S Mair
Screening for depression was associated with a reduction in all-cause mortality and vascular events in patients with cardiometabolic diseases. The uptake of screening was poor for unknown reasons. The possibility of reverse causality and the possible confounding effect of disease severity are important limitations. Further research to determine reproducibility and explore underlying mechanisms is merited.
Systematic reviews and meta-analyses on the effects of active and passive smoking on respiratory health outcomes: the SmokeHaz online resource
Leah Jayes,John Britton,Constantine Vardavas,Jo Leonardi-Bee,on behalf of the Tobacco Control Committee of the European Respiratory Society
The findings from the systematic reviews have been translated into easily digestible content and published on the SmokeHaz website. We are now evaluating the effectiveness, usability, and accessibility of the website for the public and policy makers.
Social return on investment analysis of an art group for people with dementia
Carys Jones,Rhiannon Tudor Edwards,Gill Windle,on behalf of the Dementia and Imagination research team
SROI is an attempt to move towards broader economic evaluation in interventions that aim to have a wider effect on wellbeing than on health alone. The non-controlled study design would be a limitation for traditional cost-effectiveness analysis; however, establishing the effect through considering attribution, displacement, and drop-off are key parts of SROI analysis and are used to minimise the risk of overinterpreting the effect of the intervention.
Improving measurement of the distribution of alcohol consumption across locations, beverages, and drinkers in England and Scotland: a cross-sectional telephone survey
Jessica Li,John Holmes,Petra Meier,Anne Marie MacKintosh
UK alcohol issues are often framed in terms of binge drinking in on-trade settings (pubs, bars). We found that most drinking occurs in people's own homes. Through its novel method of improving participants' recall of drinking through its breakdown of consumption into multiple locations, our survey underestimated the level of drinking to a much smaller degree than previous estimates when compared with sales data. The identification of the places and contexts of risky drinking can allow for public health interventions aimed at reducing alcohol-related harms in locations such as the home (eg, altering container sizes, televised advertising) to be more targeted to drinking patterns of concern.
Social and lifestyle characteristics and burden of ill-health associated with self-reported hearing and vision impairments in older men in the British community: a cross-sectional study
Ann E M Liljas,S Goya Wannamethee,Olia Papacosta,Kate Walters,Lucy T Lennon,Livia A Carvalho,Sheena E Ramsay
Older men with hearing impairment and vision impairment have a high risk of disability, poor health, and poor social interaction. Policy efforts for early detection and treatment of sensory impairment could be crucial for independent living in old age.
Environmental conservation activities for health: building on systematic review methods to consider a disparate, dispersed, and limited evidence base
Conservation activities can offer a win-win situation, with potential to improve both the environment and health and wellbeing through one delivery mechanism. Although the extended review process maximised the available evidence, further robust research is needed.
Point-of-care testing versus standard practice for chlamydia: a new approach to assessing the public health effect of rapid testing and treatment at local level
Catherine M Lowndes,Ellie Sherrard-Smith,Ciara Dangerfield,Yoon H Choi,Nathan Green,Mark Jit,Rob D Marshall,Catherine Mercer,Emma Harding-Esch,Anthony Nardone,Rebecca Howell-Jones,John Bason,Owen A Johnson,Christopher P Price,Charlotte A Gaydos,S Tariq Sadiq,Peter J White
The effect of POCT was dependent on both the test performance characteristics and the assumptions about the implementation of the test across local services. Exploration of many uncertainties surrounding chlamydia epidemiology and screening implementation is possible with this model. This method can complement local and national knowledge, and contribute to local-level management of chlamydia infection.
The communication of systematic review research findings: a randomised experiment of whether readers can understand the key messages from summaries of Cochrane reviews without reading the full review
The differences between the groups were not statistically significant but suggest that the audio summary might improve knowledge transfer compared with written summaries. Further research should incorporate a larger sample size, and use more than one review alongside qualitative research to understand how people engage with summaries.
Attitudes and preferences towards screening for dementia: a systematic review
Steven Martin,Sarah Kelly,Sarah Cullum,Tom Dening,Greta Rait,Chris Fox,Cornelius Katona,Carol Brayne,Louise Lafortune
As for all screening programmes, screening for dementia raises complex issues around preference and choice for clinicians and the public; the specific factors that promote or reduce screening acceptance the most are unclear. Overall, the level of evidence is low, few large scale studies have been undertaken, but none were conducted in representative samples, all affecting the generalisability of identified themes across health-care contexts. Nevertheless, our findings suggest that population screening for dementia might not be acceptable to either the general public or health-care professionals, and highlight where focused efforts are needed to gain insights into dementia specific issues.
Assessment of liver disease in Tower Hamlets, London, UK: foundation for integrated solutions
Complex factors contribute to the picture of liver disease in Tower Hamlets. For example, high rates of hazardous alcohol use within some population groups are masked by high abstinence rates among others (such as the large Bangladeshi population). Insights from this work have facilitated the development of a joined-up tailored approach to address various contributing components. We are working with partners to develop clear care pathways, improve service provision, increase hepatitis screening, and consider universal hepatitis B immunisation in areas of high prevalence.
Choosing between different alcohol pricing and taxation strategies: a comparative policy appraisal using the Sheffield Alcohol Policy Model
Pricing policies can be implemented in ways that balance the priorities of increasing government revenue, maximising harm reductions, and targeting heavy drinkers, while protecting moderate consumers from excessive burden.
Investigating local policy drivers for alcohol harm prevention: a comparative case study of two local authorities in England
John D Mooney,John Holmes,Alan Brennan,Petra S Meier,Matt Hickman,Karen Lock
Devolved responsibility for alcohol harm prevention clearly presents the potential for local authorities to tailor policies closely to their identified population needs. The exercising of responsible authority status in reducing availability through licensing approaches is best achieved however when fully integrated into the full spectrum of alcohol harm reduction activities, from prevention through to treatment-based interventions.
Weight status and breast cancer incidence in the UK Women's Cohort Study: a survival analysis
Michelle A Morris,Claire Hulme,Graham P Clarke,Kimberley L Edwards,Janet E Cade
We found a clear association between BMI and breast cancer incidence, especially in postmenopausal women. We did not see an association in premenopausal women. These results are supportive of existing scientific literature and highlight the importance of maintaining a healthy weight in adulthood, especially after the menopause. Health-care professionals should consider referral of overweight and obese women to weight loss services as a protective measure before menopause.
Walking to improve cardiovascular health: a meta-analysis of randomised control trials
Elaine M Murtagh,Linda Nichols,Mohammed A Mohammed,Roger Holder,Alan M Nevill,Marie H Murphy
These findings support the important role of walking in physical activity for health promotion. Health professionals involved in the primary prevention of cardiovascular disease should prescribe walking confident of the benefits it can provide in fitness, blood pressure, and adiposity.
Brief interventions for reducing violence: a rapid review of evaluations and recommendations
Fergus G Neville,Christine A Goodall,Damien J Williams,Peter D Donnelly
The review was a valuable exercise in assessing the existence of brief interventions for reducing violence and summarising their key characteristics. It was, however, constrained by the potentially overly restrictive search criteria, which limited the number of included interventions and follow-up data for some interventions, thereby preventing assessment of effectiveness. Nonetheless, brief interventions are potentially useful in the prevention of interpersonal violence among young men. The findings of the review will inform the development of a brief intervention for reducing violence with young men in Scotland who have sustained injuries through interpersonal violence.
Sexual assault and harassment, perceived vulnerability, and association with alcohol use in a student population: a cross-sectional survey
Fergus G Neville,Christine A Goodall,Damien J Williams,Peter D Donnelly
Prevalence rates for experiencing sexual harassment or assault were high, and participants underestimated their own vulnerability compared with peers. Although hazardous drinkers were more likely to report experiencing sexual harassment or assault than non-hazardous drinkers, this finding was not shown in their judged vulnerability, again suggesting a misperception. The role of alcohol and vulnerability misperceptions should be considered in future interventions. The study was limited by oversampling female first-year students, thereby producing a non-representative sample.
Management of a cluster of invasive group A streptococcus infection in elderly patients linked to a district nursing team in the UK
Although the review of nurse contacts suggests a link to the district nursing team, and one nurse in particular, this conclusion should be interpreted with caution because of a lack of microbiological evidence and the challenges of identifying all members of the team in contact with cases. Positive screening results can assist with targeting control measures, but a negative result cannot rule out an individual as the source of infection given the limitations of screening, particularly the potential for carriage of group A streptococcus from a non-screened site.
Evaluation of Talk Cancer, a cancer awareness training programme for community-based health staff and volunteers
Kirstie Osborne,Emily Power,Leanne Crook,Caroline Philpott,Helen George
Talk Cancer training increased awareness of prevention and early diagnosis and increased confidence to talk about cancer. It helped trainees feel more open about cancer and more able to have conversations with the public, particularly about the importance of early diagnosis. Although post-workshop surveys were completed immediately after the workshops and the sample for interviews was small and self-selected, use of quantitative and qualitative methods helped to verify findings and enrich results.
Will moving into social and affordable housing in East Village, London, UK, increase family physical activity levels? Evaluation of a natural experiment
Christopher G Owen,Bina Ram,Venediktos Kapetanakis,Alicja R Rudnicka,Anne Ellaway,Ashley R Cooper,Angie Page,Daniel Lewis,Steve Cummins,Billie Giles-Corti,Derek G Cook,Peter H Whincup
This study offers an important opportunity for a natural experiment. Behavioural theories, particularly social learning theory, which can underpin potential benefits of a changed built environment, will be explored. Although the opportunity is unique, the results might also be generalisable to other urban building projects and should inform future evidence-based urban planning.
Patients' experience of obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review
Priyamvada Paudyal,Carrie Llewellyn,Jason Lau,Mohammad Mahmud,Helen Smith
Our systematic review found that self-sampling for diagnostic testing is well accepted, with most people having a positive experience and willingness to use it again. Most studies were conducted in non-specialist health-care settings, making the findings of our review more generalisable. Standardisation of self-sampling procedures and rigorous validation of outcome measurement will lead to better comparability across studies. Future studies need to conduct rigorous economic evaluations of self-sampling to develop an effective policy for the management of sexually transmitted infections.
Survey of life support training in teachers and provision of automated external defibrillators in secondary schools in South Wales
The results suggest that only a small number of teachers in South Wales have life support training and access to an AED, and yet most teachers questioned expressed a desire to be trained in life support and to have access to an AED. Limitations to this study include the low response rate, which could reflect an inherent bias in the methodology whereby only interested teachers or schools with AEDs on site replied to the survey. These initial findings warrant further investigation at a national level, which would include a feasibility study exploring the implementation of a nationwide AED provision and training programme in schools.
Evaluation of Cwm Taf Health Board's knee-joint care programme a year from its completion: a professional-led dietetic and exercise intervention for obese patients with knee osteoarthritis
Samuel Pickles,Daniel Evans,Diane Gibbons,Natalie Hazard,Rachel Williams,Angela Jones,Rhodri Martin
Statistically significant changes in 30 s sit to stand scores require investigation on a larger scale. Limitations include small sample size and lack of a control group. Sessions were run during working hours and no clear referral pathway was set up. Evening classes would allow working patients to participate, and incorporation of referral pathways within existing National Health Service structures would allow the programme to run at capacity. A larger study should advertise exit routes from the programme to enable long term success.
Early life predictors of adult leisure-time physical inactivity: prospective findings from the 1958 British Birth Cohort
Our study, based on self-report, focuses only on leisure-time inactivity. However, to have repeat, prospective data on inactivity spanning several decades in adulthood is rare, and leisure-time inactivity is likely to be amenable to modification. Adult inactivity is only moderately stable, providing opportunities for behaviour change. Factors from early life are associated with adult inactivity, allowing for early identification of groups vulnerable to later inactivity.
Comparison of national mortality data with routinely collected health-care data to measure the occurrence of liver cirrhosis: an observational study
Mortality rates underestimated liver cirrhosis incidence by at least four times between 1998 and 2009. Alternative sources of routinely collected data could be used to more accurately monitor the trends in this disease. The strength of this study is the comparison of two measures of disease occurrence over the same time period; the limitation is the validity of cause of death.
Routine screening during prenatal care: a systematic comparison of the do not do recommendations of the National Institute for Health and Care Excellence with North American evidence-based guidelines
Seven of 18 prenatal screening recommendations from North American guidelines are in line with NICE do not do recommendations. The differences in six screening recommendations might be explained by specific contextual factors related to national health-care systems such as organisational aspects or disease prevalence. The comparison of international evidence-based guidelines can facilitate the re-evaluation of national public health programmes and can be a starting point for the appraisal of interventions in the national context.
The prevalence of anxiety disorders across the life course: a systematic review of reviews
Methodological factors related to survey instruments and participant sampling (clinical vs community-based, random vs non-random) contributed to prevalence variability. Since existing diagnostic criteria might not account for cultural and age-specific presentations of anxiety, recommendations were made for the development and use of indigenously based and age-appropriate anxiety measures.
Implementing disinvestment decisions in practice: a qualitative investigation of patient and clinician perspectives
This research provides initial insights into how disinvestment is experienced by patients and clinicians in practice. Our findings indicate a need for future research into the effectiveness and acceptability of different approaches to implementing disinvestment. Furthermore, consideration should be given to how far disinvestment should be made explicit to patients. This study is limited through its consideration of one surgical case study, though the findings have relevance to policy makers involved in disinvestment decision making in others specialties.
Supporting self-management for people with hypertension: a meta-review of quantitative and qualitative systematic reviews
Anna Schwappach,Gemma Pearce,Hannah Parke,Eleni Epiphaniou,Hilary Pinnock,Stephanie J C Taylor
This mixed methods meta-review provides an overview of what works in self-management support interventions for hypertension and why, and will help inform hypertension policy. We suggest that services should acknowledge and incorporate patients' concerns and perspectives and work with them to use a variety of self-management support interventions that are tailored to individuals.
Use of public health science to inform Scotland's National Parenting Strategy: an outcomes framework approach
To our knowledge, this is the first study to formally identify changes in trend for lifespan variation and which ages cause change. The timing of the change and higher working age mortality in Scotland might be associated with deprivation, which existing research shows to be more extreme than in England and Wales. Reducing deaths among the working age population in Scotland will not only increase life expectancy but also compress lifespan variation.
The Improving Access to Psychological Therapies programme in Bolton, UK: a qualitative realist analysis
Realist evaluation begins with programme theory and ends with refined programme theory; its findings are always provisional. The theories presented here could be used by policy makers to shape their local programmes, thereby creating an opportunity to test these hypotheses. Evaluators could direct their data collection to finding evidence to support, refute, or adjudicate between them. These refined theories could help to guide policy makers implementing similar programmes, within their own unique and changing local contexts.
Motivated for employment? A qualitative study of benefit recipients
Stipulations placed on incapacity benefit recipients fail to recognise the range of employment barriers they face. Previous research has considered motivation as an individual issue; here we argue that motivation can be a problem, but largely beyond individual control. Policies to tackle motivation should not solely be aimed at individual incapacity benefit recipients: the improvement of motivation for employment requires an improvement in the capacity, opportunity, and social context required to become employed.
Socioeconomic inequalities in childhood mortality from congenital heart defects: need for internal comparison cohort
Deprivation was associated with an increased risk of death in children with congenital heart defects and without major congenital anomalies, but no evidence was found to suggest that the association with socioeconomic status was different between the two populations. These findings highlight the need to target health inequalities in children with congenital heart defects as well as in the general population.
The usefulness of general practice data to describe the mortality risk in children with congenital anomalies: a cohort study
Use of routinely collected health-care data provides estimates of the relative size of mortality risks for children with major congenital anomalies in direct comparison with the general population. Results are consistent with a previously published study from the USA. Despite variation by system-specific subgroup, children with major congenital anomalies who survive the neonatal period remain at high risk of death. Clinical and social explanations for these differences need further investigation to identify potential opportunities to prevent deaths in such children.
Risks and outcomes associated with primary intraocular lens implantation in children under 2 years old with congenital and infantile cataract: the UK and Ireland IoLunder2 cohort study
Ameenat Lola Solebo,Isabelle Russell-Eggitt,Phillippa M Cumberland,Jugnoo S Rahi,on behalf of the British Congenital Cataract Interest Group
Use of intraocular lenses in young children, particularly in settings where follow-up is limited, should be critically reassessed. The absence of visual benefit and the lack of a previously postulated protective effect against postoperative glaucoma question the value of intraocular lens implantation in unilateral disease. The association between intraocular lens implantation and better early visual outcomes in bilateral disease needs to be balanced against the risk of reoperation and exposure to general anaesthetics during a key neurodevelopmental period.
High-rise health: a qualitative study of the effect of social housing improvements on the health and wellbeing of residents in high-rise flats
In an area with limited research, this qualitative study provides insight into the perceived health effect of social housing improvements in a deprived area and represents an area for extended research. The housing improvements positively affected perceived health in the domains of warmth, safety, and psychosocial wellbeing, and might also have had indirect benefits in facilitating the adoption of healthy behaviours.
Operation Smoke Storm: qualitative evaluation of a novel intervention to prevent uptake of smoking in schoolchildren
Although data were only collected from two schools, this rigorously conducted study highlights that Operation Smoke Storm can be delivered by teachers to raise awareness about smoking-related issues. These promising findings are relevant for anyone looking to deliver a novel anti-smoking message to young people and for health policy makers aiming to reduce uptake of smoking. The ideas and issues raised by students and teachers are now being used to improve and extend the resource for further evaluation.
Is breast best in the west of England? Use of linked routinely collected data sources to quantify the protective effect of breastfeeding against infectious gastrointestinal and respiratory illness during the first year of life
Breastfeeding was associated with a significantly reduced risk of admission for infectious illness during the first year of life. The findings suggest that an increase in breastfeeding prevalence could bring considerable savings to the local health-care economy. The data linkage method using pre-existing routinely recorded data provided useful and robust findings in line with research typically requiring costly and lengthy primary data collection, and offers potential for more research of this type to be conducted closer to local service provision in future.
Ethnic variation in patients' ratings of communication: analysis of National Cancer Patient Experience Survey data
Effective communication and information provision are key aspects of the patient experience, and are very important to ensure that all patients are well informed and receive the best possible patient care. Ethnic inequalities, such as those identified here, should be addressed at both practice and policy level. Health-care professionals should be aware of the inequalities that exist and of their personal ethnic bias. Cultural and racial awareness training would help them to tailor their consultation to the cultural and linguistic needs of their patients.
The Warm Homes for Health project: exploring the cost-effectiveness of improving population health through better housing
Housing has a major effect on the health and wellbeing of individuals. There are an estimated 40 000 more deaths in the UK during the coldest months of the year (December to March) than during the rest of the year. Two-thirds of these excess deaths are related to dangerously cold homes. An estimated 20% of the National Health Service clinical budget is spent on avoidable illness (such as cardiovascular and respiratory disease) caused or exacerbated by issues such as poor housing. Housing modifications to improve warmth and damp can help to improve population health.
Improving the usefulness and practice of evidence synthesis: views and experiences of public health decision makers and review authors in the UK
The findings support the assertion that systematic reviews have a crucial role in knowledge exchange, and the data reiterate recommendations for clear communication of useful, timely evidence for evidence users. Issues specific to systematic reviews point to substantial challenges in the production of useful systematic reviews. The consultation was small, limiting the generalisability of the findings. Nevertheless, the apparent tension between producing timely, actionable findings for decision makers and the resource implications in producing complex reviews that include diverse sources of evidence presents a serious threat to the usefulness of reviews.
Efficient national surveillance for health-care-associated infections
Bram A D van Bunnik,Mariano Ciccolini,Cheryl L Gibbons,Giles Edwards,Ross Fitzgerald,Paul R McAdam,Melissa J Ward,Ian F Laurenson,Mark E J Woolhouse
Our results show that the present surveillance system used in Scotland is not optimal in detecting novel pathogens compared with a gold standard. However, efficiency gains are possible by better choice of sentinel hospitals, or by increasing the number of hospitals involved in surveillance. Similar studies could be used elsewhere to inform the design and implementation of efficient national, hospital-based surveillance systems that achieve rapid detection of novel health-care-associated infections for minimum effort.
Early life and adult multiple risk behaviours in the 1958 British Birth Cohort: a prospective study of associations with midlife central adiposity
Karin van Veldhoven,Snehal Pinto Pereira,Leah Li,Christine Power
Self-reported risk behaviours and possible reverse causation are limitations, but the large, nationwide sample and lifetime risk behaviours are study strengths. Modifiable risk behaviours for large waist circumference are prevalent in the general population and co-occur across the lifetime.
Self-reported influenza vaccination uptake in people with chronic diseases: data from Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI)
Francesco Venturelli,Giuliano Carrozzi,Letizia Sampaolo,Lara Bolognesi,Sandro Baldissera,Nicoletta Bertozzi,Stefano Campostrini,Benedetta Contoli,Gianluigi Ferrante,Maria Masocco,Valentina Minardi,Angelo D'Argenzio,Pirous F Moghadam,Luana Penna,Alberto Perra,Elisa Quarchioni,Mauro Ramigni,Massimo O Trinito,Stefania Salmaso,on behalf of the PASSI regional and corporate coordinators
In the past few years, prevalence of influenza vaccination in Italian adults with at least one chronic disease was well below the Ministry of Health's goal (75% minimum) and showed a downward trend. A major reason of this evolution is probably the changing public perception of the benefits and risks of vaccines. PASSI is a source of useful data not otherwise available for public health intervention.
Interactive digital interventions for sexual health promotion: a systematic review and meta-analysis of randomised controlled trials
Sonali Wayal,Julia V Bailey,Elizabeth Murray,Greta Rait,Richard W Morris,Richard Peacock,Irwin Nazareth
IDIs can effectively enhance knowledge, self-efficacy, intention, and sexual behaviour. Further evidence is needed to understand how IDIs work, their cost-effectiveness, and how these positive effects can be translated into improved sexual health.
The association between normalising attributions and help-seeking for cancer alarm symptoms in the community: a cross-sectional survey
Katriina L Whitaker,Suzanne E Scott,Kelly Winstanley,Susanne Cromme,Una Macleod,Jane Wardle
Attributing symptoms to normal everyday causes was associated with delayed help-seeking for four cancer alarm symptoms. Attributions such as smoking and sun exposure, which are themselves risk factors for cancer, were among the attributions that undermined help-seeking. The substantial proportion of missing data for the attribution item suggests some reluctance to complete open text responses. More research is needed into how people make help-seeking decisions.
Burden of recurrent emergency hospital admissions in children and young people in England: a cohort study
Linda Wijlaars,Pia Hardelid,Jenny Woodman,Janice Allister,Ruth Gilbert
This snapshot of hospital flow during 2 years shows that recurrent emergency admissions account for a substantial minority of all emergency admissions and predominantly affect children and young people with chronic conditions. Since we only included inpatient hospital data, our analysis provides a limited overview of health-care use. Interventions to reduce re-admissions should consider discharge planning for support by community services for parents caring for children with chronic conditions.
The pragmatic use of evidence to inform breastfeeding peer support guidance for Scotland
Adopting this pragmatic approach has enabled meaningful engagement that takes account of professional experience. This approach has helped produce guidance that is realistic in aiming to change and enhance current breastfeeding practice in Scotland.
Age-friendly cities and environments: an investigation of the living environment of older people in England based on the MRC Cognitive Function and Ageing Study II
Yu-Tzu Wu,A Matthew Prina,Carol Brayne,on behalf of the Medical Research Council Cognitive Function and Ageing Collaboration
Older people in England live in a wide variety of environments with potential effect on health and wellbeing. Use of new technology can help to observe and explore variations in living environments at the small area level systematically and comprehensively; this provides opportunities to identify important environmental features related to healthy ageing and develop practical guidelines for policy planning to create age-friendly cities and environments through an evidence-based approach.