Showing papers in "Journal of Public Health in 2012"
TL;DR: Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.
Abstract: Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. Methods Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. Results Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3‐92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3‐94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7‐88.7%). There was considerable variation in accuracy rates between studies (50.5‐97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3‐92.1%) to 96.0% (IQR: 89.3‐96.3), P ¼ 0.020. Conclusion Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to
645 citations
TL;DR: It is concluded that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours.
Abstract: Background More remains unknown than known about how to optimize multiple health behaviour change. Methods After reviewing the prevalence and comorbidities among major chronic disease risk behaviours for adults and youth, we consider the origins and applicability of high-risk and population strategies to foster multiple health behaviour change. Results Findings indicate that health risk behaviours are prevalent, increase with age and co-occur as risk behaviour clusters or bundles. Conclusions We conclude that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours. To maximize positive public health impact, a pressing need exists for bodies of basic and translational science that explain health behaviour bundling. Also needed is applied science that elucidates the following: (1) the optimal number of behaviours to intervene upon; (2) how target behaviours are best selected (e.g. greatest health impact; patient preference or positive effect on bundled behaviours); (3) whether to increase healthy or decrease unhealthy behaviours; (4) whether to intervene on health behaviours simultaneously or sequentially and (5) how to achieve positive synergies across individual-, group- and population-level intervention approaches.
298 citations
TL;DR: In this article, the authors examined the application of this principle in a school lunchroom where healthier foods were made more convenient relative to less healthy foods and found that students increased their consumption of flavored milk, but flavored milk’s share of total consumption did not increase.
Abstract: Background In the context of food, convenience is generally associated with less healthy foods. Given the reality of present-biased preferences, if convenience was associated with healthier foods and less healthy foods were less convenient, people would likely consume healthier foods. This study examines the application of this principle in a school lunchroom where healthier foods were made more convenient relative to less healthy foods. Methods One of two lunch lines in a cafeteria was arranged so as to display only healthier foods and flavored milk. Trained field researchers collected purchase and consumption data before and after the conversion. Mean comparisons were used to identify differences in selection and consumption of healthier foods, less healthy foods and chocolate milk. Results Sales of healthier foods increased by 18% and grams of less healthy foods consumed decreased by nearly 28%. Also, healthier foods’share of total consumption increased from 33 to 36%. Lastly, we find that students increased their consumption of flavored milk, but flavored milk’s share of total consumption did not increase.
266 citations
TL;DR: This review synthesized the evidence on 'what works' to prevent multiple risk behaviour for policy-makers, practitioners and academics to identify promising intervention programmes and to give a narrative overview of the wider influences on risk behaviour, in order to help inform future intervention strategies and policies.
Abstract: The observed clustering, and shared underlying determinants, of risk behaviours in young people has led to the proposition that interventions should take a broader approach to risk behaviour prevention. In this review we synthesized the evidence on ‘what works’ to prevent multiple risk behaviour (focusing on tobacco, alcohol and illicit drug use and sexual risk behaviour) for policy-makers, practitioners and academics. We aimed to identify promising intervention programmes and to give a narrative overview of the wider influences on risk behaviour, in order to help inform future intervention strategies and policies. The most promising programme approaches for reducing multiple risk behaviour simultaneously address multiple domains of risk and protective factors predictive of risk behaviour. These programmes seek to increase resilience and promote positive parental/family influences and/or healthy school environments supportive of positive social and emotional development. However, wider influences on risk behaviour, such as culture, media and social climate also need to be addressed through broader social policy change. Furthermore, the importance of positive experiences during transition periods of the child–youth–adult phase of the life course should be appropriately addressed within intervention programmes and broader policy change, to reduce marginalization, social exclusion and the vulnerability of young people during transition periods.
209 citations
TL;DR: There is growing evidence that school-based interventions that contain a physical activity component may be effective in helping to reduce BMI in children.
Abstract: Background Childhood obesity predisposes to adult obesity and increases the risk of many diseases. Schools provide a vehicle to deliver public health interventions to all children. Methods Medline and Embase were used to undertake a systematic review of published studies of school-based interventions aimed at reducing the body mass index (BMI) of children � 18 years. Preferred reporting items for systematic reviews and meta-analyses guidelines were followed, and eligible studies subjected to a random effects meta-analysis. Results Between 1991 and 2010, 43 published studies provided 60 measurements of effect. The pooled effect was a 0.17 (95% CI: 0.08, 0.26, P , 0.001) reduction in BMI. Heterogeneity was high (I 2 ¼ 93.4%) but there was no significant small study bias (Egger’s test, P ¼ 0.422) nor significant variation by length of follow-up. The intervention comprised physical activity only in 11 (26%) studies, education only in three (7%), and combinations of these and improved nutrition in the remaining 29 (67%). On stratified analysis, physical activity used in isolation (20.13, 95% CI: 20.22, 20.04, P ¼ 0.001) or combined with improved nutrition (20.17, 95% CI: 20.29, 20.06, P , 0.001) was associated with significant improvements in BMI. Interventions targeted at overweight/obese children reduced their BMI by 0.35 (95% CI: 0.12, 0.58, P ¼ 0.003). Those delivered to all children reduced it by 0.16 (95% CI: 0.06, 0.25, P ¼ 0.002). Conclusions There is growing evidence that school-based interventions that contain a physical activity component may be effective in helping
188 citations
TL;DR: There is a strong and consistent body of evidence suggesting an association between preterm delivery and reduced IQ, with evidence of a dose-response relationship with gestational age.
Abstract: Background An increasing proportion of infants are born preterm, and their survival has improved. Therefore, their long-term sequelae are of increasing public health importance. Methods We conducted a systematic review covering a 30 year period (1980–2009). A random effects meta-analysis provided a pooled estimate of the difference in IQ score between individuals born preterm and term. Small-study bias was examined using a funnel plot and Egger’s test, and meta-regression was used to investigate possible causes of heterogeneity. Cumulative meta-analysis was used to determine if the magnitude of the association had changed over time. Results The 27 eligible studies covered 7044 individuals; 3504 (50%) delivered preterm and 3540 (50%) at term. They provided 37 estimates of difference in IQ. All demonstrated a reduced IQ among those delivered preterm and all but four reached statistical significance. Overall, IQ score was 11.94 (95% CI: 10.47–13.42, P , 0.001) points lower among children born preterm. There was moderate heterogeneity (overall I 2 74.2%, P , 0.001), but no significant small-study bias (P ¼ 0.524). The association between preterm delivery and IQ did not change significantly over time. There was a statistically significant, linear association across the gestational age range (adjusted coefficient: 20.91, 95% CI: 21.64, 20.17, P ¼ 0.018). Conclusions There is a strong and consistent body of evidence suggesting an association between preterm delivery and reduced IQ, with
182 citations
TL;DR: Multiple risk behaviour is prevalent in both genders during adolescence but the pattern of individual risk behaviour varies between boys and girls, and effective interventions are needed to address gender-specific patterns of risk behaviour during adolescence.
Abstract: Adolescent risk behaviours such as smoking, alcohol use and antisocial behaviour are associated with increased risk of morbidity and mortality. Patterns of risk behaviour may vary between genders during adolescence.
164 citations
TL;DR: Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health.
Abstract: Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young people's lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours.
157 citations
TL;DR: In general never smoking and affluence increased in England over this period and the disadvantaged did not experience the decline in smoking and smokers missed out from the increase in affluence.
Abstract: Background Since 2000 various tobacco control measures have been implemented in the UK. Changes in the smoking status of low and high socioeconomic status (SES) groups in England during this period (2001–08) are explored. Methods Secondary analysis of the Health Survey for England general population samples was undertaken. Over 88 000 adults, age 16 or over, living in England were included. Smoking status (current, ex or never) was reported. SES was assessed through a count of seven possible indicators of disadvantage: National Statistics Socio-Economic Classification (NSSEC), neighbourhood index of multiple deprivation, lone parenting, car availability, housing tenure, income and unemployment. Results Smoking rates were four times higher among the most disadvantaged [60.7% (95% CI: 58.2–63.3)] than the most affluent [15.3% (95% CI: 14.8–15.8)]. Smoking prevalence declined between 2001 and 2008 except among the multiply disadvantaged. This trend appeared to be due to an increase in never smoking rather than an increase in quitting. Disadvantage declined among non-smokers but not smokers. Conclusions In general never smoking and affluence increased in England over this period. The disadvantaged, however, did not experience
156 citations
TL;DR: The majority of public health interventions assessed are highly cost-effective, and the next challenge is to provide commissioners with a framework that allows information from economic analyses to be combined with other criteria that supports making better investment decisions at a local level.
Abstract: Background The need to make best use of limited resources in the English National Health Service is now greater than ever. This paper contributes to this endeavour by synthesizing data from cost-effectiveness evidence produced to support the development of public health guidance at the National Institute of Health and Clinical Excellence (NICE). No comprehensive list of cost-effectiveness estimates for public health interventions has previously been published in England. Methods Cost-effectiveness estimates using English cost data were collected and analysed from 21 (of 26) economic analyses underpinning public health guidance published by NICE between 2006 and 2010. Results Two hundred base-case cost-effectiveness estimates were analysed, 15% were cost saving (i.e. the intervention was more effective and cheaper than comparator). Eighty-five per cent were cost-effective at a threshold of £20 000 per quality-adjusted life year and 89% at the higher threshold of £30 000. A further 5.5% were above £30 000 and 5.5% of the interventions were dominated (i.e. the intervention was more costly and less effective than comparator). Conclusions The majority of public health interventions assessed are highly cost-effective. The next challenge is to provide commissioners with a framework that allows information from economic analyses to be combined with other criteria that supports making better investment decisions at a local level.
123 citations
TL;DR: The onset of multiple risk behaviours, such as smoking, anti-social behaviour, hazardous alcohol consumption and unprotected sexual intercourse, cluster in adolescence and are associated with increased risk of poor educational attainment, future morbidity and premature mortality.
Abstract: The onset of multiple risk behaviours, such as smoking, anti-social behaviour, hazardous alcohol consumption and unprotected sexual intercourse, cluster in adolescence and are associated with increased risk of poor educational attainment, future morbidity and premature mortality....
TL;DR: The intention of the NHI to ensure equity, address the inequalities presented by the current private and public health system and present an ambitious plan to change the face of the South African health care system over the next fourteen years is described.
Abstract: A brief overview of the Green Paper on the National Health Insurance (NHI) policy of South Africa is presented. It describes the intention of the NHI to ensure equity, address the inequalities presented by the current private and public health system and present an ambitious plan to change the face of the South African health care system over the next fourteen years. It provides the context of the currents system that provides the case for the change. It also provides some detail on the structure of the proposed new Re-engineered Primary Health Care system as well as the future financing of this bold new health care system for South Africa. The challenge will be in its implementation.
TL;DR: The findings confirm that the home environment represents an important site for the spread of pathogens responsible for foodborne diseases and consumers need to be informed about safety procedures of domestic food handling, storage and preparation.
Abstract: To define food safety and risk perception of foodborne diseases in the private home setting and identify specific behaviours during food purchase, storage and preparation in a large survey study. A large sample of individuals (n = 1,000) living in the area of Cassino, Italy, volunteered to participate in the study. All participants were randomly recruited and underwent a questionnaire-based interview at their home regarding food-safety measures. Logistic regression analyses were used to test for correlations between demographic characteristics and knowledge/behaviours of food diseases. Risks of hazardous practices in the home were calculated according to educational, physical, occupational and marital status. All analyses were performed using the EPIINFO 3.5 statistical program. Our data showed that there was an insufficient amount of knowledge regarding foodborne diseases and pathogens. In most families, we found that there was a lack of correct adherence to food hygiene, mainly due to errors during both food preparation and storage. There was a higher risk for food safety errors in families with children, older persons and pregnant women. Our findings confirm that the home environment represents an important site for the spread of pathogens responsible for foodborne diseases. In order to adopt good hygiene practices in the home setting, consumers need to be informed about safety procedures of domestic food handling, storage and preparation.
TL;DR: This work has shown that not only does a multiple risk behaviour approach increase the effectiveness of individual risk behaviour policy, but it is also conducive to a more cohesive, coherent and efficient approach to adolescent risk in general.
Abstract: Adolescence has long been considered a period of increased risk behaviour. This supposition has been supported by a wealth of empirical evidence and recently, health risk behaviours have been identified as a key mechanism for the general deterioration of adolescent health relative to other age groups. Research regarding adolescent risk behaviour suggests that there are often strong links between individual risk behaviours. The mechanisms for these associations have been attributed to common risk and protective factors, as well as gateway effects stemming from increased accessibility to additional risk behaviours. This has important implications for policy interventions designed to reduce risk behaviours in adolescence. Not only does a multiple risk behaviour approach increase the effectiveness of individual risk behaviour policy, but it is also conducive to a more cohesive, coherent and efficient approach to adolescent risk in general. Several examples of cohesive policy responses to multiple risk behaviours have emerged, but generally, policy remains segregated into individual risk domains. With increasing evidence for the effectiveness of integrated approaches, multiple risk behaviours require consideration to design and implement effective and efficient policy responses.
TL;DR: Urgent action is needed to reduce inequalities in SHS exposure, including emphasis on reducing smoking in cars and homes, and socioeconomic patterning in these changes is examined.
Abstract: Background: Secondhand smoke (SHS) exposure is higher among lower socioeconomic status (SES) children. Legislation restricting smoking in public places has been associated with reduced childhood SHS exposure and increased smoke-free homes. This paper examines socioeconomic patterning in these changes.
Methods: Repeated cross-sectional survey of 10 867 schoolchildren in 304 primary schools in Scotland, Wales and Northern Ireland. Children provided saliva for cotinine assay, completing questionnaires before and 12 months after legislation.
Results: SHS exposure was highest, and private smoking restrictions least frequently reported, among lower SES children. Proportions of saliva samples containing 3 ng/ml cotinine. Smoking restrictions in homes and cars increased, although socioeconomic patterning remained.
Conclusions: Urgent action is needed to reduce inequalities in SHS exposure. Such action should include emphasis on reducing smoking in cars and homes.
TL;DR: Observers of Ramadan lose on average about a kilogram of weight over 4 weeks, and the lost weight is quickly regained, suggesting that further research is needed on the justification of the 'do not skip meals' advice.
Abstract: Background During Ramadan, observant Muslims fast from sunrise to sunset for a month. Knowing whether Ramadan fasting affects body weight has implications for health advice to the Muslim community, for understanding the effects of skipping meals on body weight, and for general weight management advice. Methods We compared body weight before and after the Ramadan fast and 1 month later in observant Muslims attending a Mosque in East London, UK. Results In 202 participants who provided weight at the beginning and the end of Ramadan, there was a small weight decrease (20.84 kg, 95% CI ¼ 20.6 to 21, P , 0.0001), with 46% of participants losing .1 kg. Participants who fasted throughout Ramadan lost significantly more weight (1 kg) than those who occasionally broke fast (0.3 kg, P ¼ 0.013). In 87 participants who provided weight at the beginning and end of Ramadan and also 1 month later, all the lost weight was regained (þ0.1 kg, 95% CI ¼ 0.2‐0.5, P ¼ 0.504 compared with baseline). Conclusions Observers of Ramadan lose on average about a kilogram of weight over 4 weeks, and the lost weight is quickly regained. Current weight management treatments generally assume that skipping meals leads to weight gain and advise against it. The finding suggests that further research is needed on the justification of the ‘do not skip meals’ advice.
TL;DR: In this article, the authors present a systematic summary of studies examining the relationship between acculturation and physical activity among immigrants and ethnic minority populations in English, German or French, and provide statistical information to judge the level of significance.
Abstract: The acculturation process presents numerous challenges that could benefit or adversely affect immigrants’ health practices. The goal of this review was to present a systematic summary of studies examining the relationship between acculturation and physical activity among immigrants and ethnic minority populations. Systematic review based on 44 original studies found in electronic databases (Psychinfo/Psyndex, Eric, Pubmed/Medline, Web of Science, SportDiscus). Studies were eligible if they were written in English, German or French, incorporated a measure of acculturation and physical activity, exercise, or sport as independent and dependent variables, and provided statistical information to judge the level of significance. The 44 studies found included 760,242 participants. A narrative synthesis was performed. Causality of effects was examined based on seven criteria: consistency, strength of associations, specificity of effects, temporality, gradient, plausibility and experimental evidence. Acculturation was associated with higher leisure time physical activity in 57% of all studies (even after controlling for potential confounds), independent of participants’ gender, age and ethnic background. The main limitations of this review are that findings were not weighted for sample size and that publication biases might have contributed to an overestimation of the relationships. Prevention programs aimed at stimulating participation in physical activity among immigrants should give priority to individuals with low acculturation levels and it should consider culturally specific beliefs and constraints. Additionally, prevention programs could make an effort to promote acculturation among immigrants. Future studies should use longitudinal designs which include objective assessments of physical activity and which use multidimensional and bidirectional definitions of acculturation.
TL;DR: Reducing ethnic inequalities and inequities in health needs to become a higher priority for public health research, and more emphasis is needed on justice, fairness and equality, participation and communicating effectively.
Abstract: Reducing ethnic inequalities and inequities in health needs to become a higher priority for public health research. Active involvement of migrant and ethnic minority populations in European population health research is necessary, for data show important inequalities but evidence, particularly on effectiveness, is sparse and strategic overviews rarer still. Ethnically disaggregated health surveillance systems are developing slowly, and pragmatically, often using country of birth. The principles to adopt, given the gaps between the ideal and the current reality, need wider discussion. Ethics may provide both principles and impetus. Doing no harm, doing good, respecting the research participants’ autonomy are good starting points. More emphasis is needed on justice, fairness and equality, participation and communicating effectively. Ethnic minority groups are willing participants in trials once linguistic and trust-related barriers are overcome, though recruitment costs are higher. Guidelines and strategies by European bodies with research funding or enforcement responsibilities are needed. The research community needs an infrastructure within which to collect and utilize evidence. Research can help migrant and ethnic minority groups to participate more fully in our multi-ethnic societies.
TL;DR: HZ, and particularly PHN, is associated with considerable levels of pain that have a significant impact on the QoL of participants across six European countries.
Abstract: Aim
To investigate the impact of an entire episode of herpes zoster (HZ) or post-herpetic neuralgia (PHN) on an individual’s quality of life (QoL).
TL;DR: Cognitive, emotional and social processes were uncovered and creative craft hobbies such as quilting can be a meaningful vehicle for enhancing wellbeing.
Abstract: Background Within public health, activities that promote and maintain wellbeing remain limited and relatively unexplored. In particular, little is known about the relationship between creative craft hobbies and wellbeing in the general population. Methods Twenty-nine semi-structured interviews were conducted with women from a local quilting group. Ideas and experiences of quilting in relation to wellbeing were explored with participants. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Results Cognitive, emotional and social processes were uncovered, which participants identified as important for their wellbeing. Participants found quilting to be a productive use of time and an accessible means of engaging in free creativity. Colour was psychologically uplifting. Quilting was challenging, demanded concentration and participants maintained and learned new skills. Participants experienced ‘flow’ while quilting. A strong social network fostered the formation of strong friendships. Affirmation from others boosted self-esteem and increased motivation for skill development. Quilts were often given altruistically and gave quilting added purpose.
TL;DR: Sustained campaigning to maintain awareness about and promote periconceptional consumption of folic acid in order to reduce the incidence of NTDs is clearly needed.
Abstract: Background Studies in the 1990s have found that periconceptional dietary folate, supplementation of folic acid or supplemental multivitamins containing folic acid, help prevent neural tube defect (NTDs) if taken at the right time. This literature review assesses the extant folic acid public health campaigns literature and identifies some common variables used in folic acid consumption campaign evaluations. Methods This review was part of a larger study that searched PUBMED, PsycINFO and Embase from 1976 to 2010 to identify articles related to the psychosocial and economic impact of NTDs (especially spina bifida) on patients and caregivers. Results Awareness of folic acid levels prior to conception improved post-campaign from 6 to 41%. Knowledge about consumption and correct periconceptional use of folic acid also improved. However, in most studies more than 50% of women did not take folic acid as prescribed. Many factors were associated with or without taking folic acid post-campaign, including incomplete outreach, prior awareness and knowledge, closeness to pregnancy, demographics and other personal characteristics. Conclusions Sustained campaigning to maintain awareness about and promote periconceptional consumption of folic acid in order to reduce
TL;DR: Findings underscore the relationship between physical and social dimensions of urban form and their association with health behaviours and PA promotion efforts should take into account both physical (e.g. land-use planning) and social environments.
Abstract: BACKGROUND: Few studies have considered the joint effects of social and physical environments on physical activity (PA). The primary purpose of this study was to examine the compounding effects of neighbourhood walkability and social connectedness on PA. METHODS: Data were collected from adults (n= 380) in Waterloo, Ontario, Canada. Perceptions of neighbourhood social connectedness and walkability were measured via survey. Minutes of neighbourhood PA for recreation and transportation were captured with a detailed 7-day log booklet. Four groups were created (e.g. high walkability/low social connectedness) and two factorial ANOVAs examined group differences in minutes of recreational and transport-related PA. RESULTS: There were significant differences across the four walkability/social connectedness groups for both recreational (F = 11.36, P Language: en
TL;DR: Targeted case-finding in primary care demonstrated higher test uptake and diagnosis rates; however, to optimize diagnosis and referral of chronically infected individuals, alternative means of testing and retention in specialist care must be explored.
Abstract: Background In Scotland, a general practice-based case-finding initiative, to diagnose and refer hepatitis C virus (HCV) chronically infected former injecting drug users (IDUs), was evaluated. Methods Testing was offered in eight Glasgow general practices in areas of high deprivation and high HCVand IDU prevalence to attendees aged 30‐54 years with a history of IDU. Test uptake and diagnosis rates were compared with those in eight demographically similar control practices. Results Of 422 eligible intervention practice attendees, 218 (52%) were offered an HCV test and, of these, 121 (56%) accepted. Poor venous access in 13 individuals prevented testing. Of 105 tested, 70% (74/105) were antibody positive of which 58% (43/74) were RNA positive by PCR. Of 43 chronically infected individuals identified in intervention practices, 22 (51%) had attended specialist care within 30 months of the study, while 9 (21%) had defaulted. In control practices, 8 (22%) of 36 individuals tested were antibody positive. Test uptake and case yield were approximately 3 and 10 times higher in intervention compared with control practices, respectively.
TL;DR: The average value of BMI has increased over time; overweight and obesity among children and adolescents have become a serious public health problem.
Abstract: Background There is strong evidence of a positive secular trend in body mass index (BMI) and the prevalence of obesity has increased substantially over the last several decades. However, no studies on this trend have been reported in Shandong Province, China. The present study assessed the decennial change in BMI in Shandong Province during the past 25 years and the prevalence of overweight and obesity among children and adolescents. Methods The BMI of children and adolescents aged 7–18 was calculated using data from five national surveys on students’ constitution and health carried out by the government in 1985, 1995, 2000, 2005 and 2010 in Shandong Province, China. The distribution of BMI was reported, and the prevalence of overweight and obesity was obtained according to the screening criteria of overweight and obesity for Chinese students using BMI [Working Group on Obesity in China (WGOC) standard]. Overweight and obesity prevalence were also computed using the International Obesity Task Force (IOTF) cutoffs. Results In the past 25 years, the P50 (50th percentile) of BMI increased. The average increments of BMI were 2.18 kg/m 2 for boys and 1.21 kg/m 2 for girls, respectively. The prevalence of overweight and obesity increased rapidly: using WGOC standard, the prevalence of overweight increased from 1.91% for boys and 2.02% for girls in 1985 to 17.34% for boys and 11.97% for girls in 2010, and the prevalence of obesity increased from 0.27% for boys and 0.23% for girls in 1985 to 15.83% for boys and 7.12% for girls in 2010; using IOTF standard, the prevalence of overweight increased from 1.54% for boys and 1.27% for girls in 1985 to 19.06% for boys and 13.42% for girls in 2010, and the prevalence of obesity increased from 0.04% for boys and 0.03% for girls in 1985 to 9.33% for boys and 2.42% for girls in 2010, respectively. Conclusions The average value of BMI has increased over time; overweight and obesity among children and adolescents have become a serious public health problem. Comprehensive evidence-based strategies of intervention should be introduced, including periodic monitoring.
TL;DR: Cervical screening coverage was significantly lower in PCTs and practices serving higher percentages of younger-aged women, non-Caucasian individuals and those living in socioeconomic deprivation, it is therefore important to adopt strategies to improve cervical screening coverage in these groups.
Abstract: Background The National Health Service Cervical Screening Programme was established to decrease the incidence and mortality of cervical cancer in England. Methods To identify socioeconomic and general practice factors associated with cervical screening coverage in England, a national crosssectional study was conducted using data on 26 497 476 female patients registered with 7970 practices in 152 English primary care trusts (PCTs). The 2008–09 data on cervical screening coverage rates from the quality and outcomes framework (QOF) database were used with data on QOF indicators, staffing levels and socioeconomic status. Results The mean cervical screening coverage rate was 78.5% at the PCT level and 83.5% at the practice level. At both levels, cervical screening coverage was significantly negatively associated with the index of multiple deprivation score, percentage of female patients aged 25–49 years and percentage of ethnic minority patients. Also, at the practice level, the percentage of female patients aged 50–64 years, overall QOF score and records and information score were significantly positively associated with cervical screening coverage. Conclusions Cervical screening coverage was significantly lower in PCTs and practices serving higher percentages of younger-aged women, non-Caucasian individuals and those living in socioeconomic deprivation. It is therefore important to adopt strategies to improve cervical screening coverage in these groups.
TL;DR: NHS slimming on referral can successfully achieve short-term weight loss and patients attending Weight Watchers were most likely to lose weight than those attendingother providers.
Abstract: Background The aim of this study was to analyse the effect of provider, gender and obesity class on outcomes of National Health Service (NHS) slimming on referral. Methods Service evaluation in 12 UK general practices. Obese patients aged 16 were referred for 12 sessions to one of three commercial providers. Outcomes at 12 weeks were attendance, BMI, total and percentage weight loss, 5% and 5 kg weight loss and comparison across providers. Linear and multiple regression analyses were used, adjusting for confounders. Results One thousand four hundred and forty patients were referred; 1047 receiving vouchers and 880 attending at least one session. The mean weight change was 24.8 kg (95% CI: 25.1 to 24.5) and the percentage bodyweight loss was 24.6% (standard deviation: 3.7). Weight Watchers patients lost more weight [21.15 kg (95% confidence interval, CI: 21.25, 21.04), P , 0.001] and were more likely to lose 5% bodyweight [odds ratio: 1.81 (95% CI: 1.78, 1.83), P , 0.001] than those attending the provider with the least weight loss. Conclusions NHS slimming on referral can successfully achieve short-term weight loss. Patients attending Weight Watchers were most likely to lose weight than those attendingother providers.
TL;DR: The effects of parenting practices on adolescent outcome is examined and the effectiveness of parenting programmes for parents of adolescents are addressed and the need for a public health approach to parenting programmes is discussed.
Abstract: Background Poor parenting practices have been associated with adolescent emotional and behavioural problems which are potentially preventable. Parenting interventions that are based on behavioural and social learning theories have been repeatedly shown to be effective. However, few evidence-based parenting programmes are implemented and sustained at a population level. Little research is available on supporting the general population of parents during the adolescent years. Further, a substantial research–practice gap exists regarding the impact of a universal approach to parenting programmes for parents of adolescents. Method This article will first examine the effects of parenting practices on adolescent outcome. Afterwards, it addresses the effectiveness of
TL;DR: In the view of young people, school-linked sexual health services need to guarantee and promote the ideas of privacy, confidentiality and approachability if they are to be accessed and have an impact on behaviour.
Abstract: Background The potential for sexual health services to influence the sexual health and behaviour of school-aged young people is only likely to be realised if these services are accessed. This review and synthesis seeks to explore children and adolescents’ views and experiences of schoolbased and school-linked sexual health services to identify barriers to and facilitators of service use. Methods The study design is a systematic review of studies focusing on the views of children and adolescents (11–18 years) about relevant services. Sixteen databases were searched, titles and abstracts were screened against the inclusion criteria, data extraction and quality assessment of included studies were performed and thematic synthesis was undertaken. Results Nineteen relevant studies were identified, but only studies from the USA and the UK satisfied the inclusion criteria. The principal themes to emerge from the analysis were awareness and need, confidentiality and disclosure, perceptions of staff, service location, physical environment, costs and types of services on offer. These findings were consistent across country and type of service. Conclusions In the view of young people, school-linked sexual health services need to guarantee and promote the ideas of privacy, confidentiality and approachability if they are to be accessed and have an impact on behaviour.
TL;DR: Data show that SCD admissions are rising in England, particularly in London, and over half of patients admitted with SCD were discharged within 24 h, suggesting that some of these admissions could be prevented through better ambulatory care of patients.
Abstract: Background Sickle cell disease (SCD) is a rising cause of mortality and morbidity in England and consequently an important policy issue for the National Health Service. There has been no previous study that has examined SCD admission rates in England. Methods Data from Hospital Episode Statistics were analysed for all hospital episodes (2001/10) in England with a primary diagnosis of sickle cell anaemia with crisis (D57.0) or without crisis (D57.1). Secondary and tertiary diagnoses were examined among those patients admitted with either of these codes as their primary diagnosis. Results The overall SCD admission rate per 100 000 has risen from 21.2 in 2001/02 to 33.5 in 2009/10, a rise of over 50%. London accounts for 74.9% of all SCD admissions in England. 57.9% of patients admitted are discharged within 24 h. The largest rise in admission rates was seen among males aged 40-49 years where admission rates per 100 000 increased from 7.6 to 26.8 over the study period. Conclusions Our data show that SCD admissions are rising in England, particularly in London. Over half of patients admitted with SCD were discharged within 24 h, suggesting that some of these admissions could be prevented through better ambulatory care of patients.
TL;DR: UIP led to improved child growth, suggesting that vaccination programs-in addition to being a major intervention for reducing child mortality-might be considered a tool for mitigating undernutrition in developing countries.
Abstract: Background Childhood vaccination may protect children’s nutritional status and lead to improved child growth in developing countries. This study evaluates the effect of India’s childhood vaccination program Universal Immunization Program (UIP) on the growth of children ,4 years of age. Methods Regression models were estimated to examine the effect of UIP on vaccination status and children’s anthropometric outcomes, as well as to test whether UIP’s effect was uniform across various subpopulations of Indian children. Results UIP increased height-for-age and weight-for-age among children. This effect constituted a 22-25% reduction in the height-for-age deficit and a 15% reduction in the weight-for-age deficit of the average child. The program appears to have had no effect on other anthropometric indicators or vaccination status. UIP also led to differential changes in anthropometry and vaccination status, based on differences in wealth, maternal education and scheduled-caste status. Conclusions UIP led to improved child growth. This suggests that vaccination programs—in addition to being a major intervention for reducing child mortality—might be considered a tool for mitigating undernutrition in developing countries. This study also adds to the growing evidence that childhood vaccination programs are high-return investments because they produce long-term health benefits for children.