Showing papers in "Journal of Public Health in 2015"

Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey

Abstract: Background ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England. Methods A nationally representative survey was undertaken (n ¼ 3885, aged 18–69, April–July 2013). Socio-demographically controlled proportional hazards analyses examined the associations between the number of ACE categories (,18 years; e.g. child abuse and family dysfunction such as domestic violence) and cancer, diabetes, stroke, respiratory, liver/digestive and cardiovascular disease. Sibling (n ¼ 6983) mortality was similarly analysed as a measure of premature mortality. Results Of the total, 46.4% of respondents reported � 1 and 8.3% � 4 ACEs. Disease development was strongly associated with increased ACEs (e.g. hazard ratios, HR, 0 versus � 4 ACEs; cancer, 2.38 (1.48–3.83); diabetes, 2.99 (1.90–4.72); stroke, 5.79 (2.43–13.80, all P , 0.001). Individuals with � 4 ACEs (versus no ACEs) had a 2.76 times higher rate of developing any disease before age 70 years. Adjusted HR for mortality was strongly linked to ACEs (� 4 versus 0 ACEs; HR, 1.97 (1.39–2.79), P , 0.001). Conclusions Radically different life-course trajectories are associated with exposure to increased ACEs. Interventions to prevent ACEs are

Impact of the Ebola outbreak on health systems and population health in Sierra Leone

Abstract: Background The current Ebola outbreak has proved devastating to vulnerable populations in West Africa. Health needs assessments were conducted in two districts of Sierra Leone to identify and quantify the impact of the outbreak on population health and health systems. Methods Mixed qualitative and quantitative methods were employed including interviews, focus groups, and interrogation and analysis of data from health facilities, district health records and burial teams. T-tests were performed to compare periods before and during the outbreak. Results A breakdown in relations between the health system and communities was demonstrated leading to marked and significant reductions in utilization of health facilities including: paediatric all-cause and malaria admissions, maternity admissions and attendance in the community. High avoidable all-cause mortality was identified (3.4 times higher than normally registered for the period, 42% deaths in children ,5 years, 2% attributed to Ebola). Negative impacts on the health workforce, health system leadership and governance, and disruption of health programmes and systems were demonstrated. Reductions in vaccination coverage and a rise in teenage pregnancy were noted. Conclusions The findings indicate a public health emergency as a legacy of the Ebola outbreak. Sustained commitment of the international community is required to support health system re-building.

Methanol mass poisoning in Iran: role of case finding in outbreak management.

Abstract: Background There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. Methods A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. Results A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to othercities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available.

Excess winter deaths in 30 European countries 1980–2013: a critical review of methods

Abstract: Background: Extreme temperatures (both excess heat and excess cold) are associated with elevated mortality risk. Methods and Results: This paper reviews historical data on cold-related deaths in Europe (1980 ? 2013). It outlines the classic ?excess winter deaths? methodology used to estimate cold-related mortality, and explores the inaccuracies which are associated with this generic estimation method: it yields relatively accurate estimates of the actual public health impacts of cold temperatures in only 2 of 30 European countries. This is an issue of concern, given the prominent role of excess winter deaths monitoring in public health policymaking and research. An alternative estimation method is proposed, based on heating degree days, which could yield more accurate estimations of the public health implications of cold weather in Europe, and how these vary across different countries. Conclusions: Further research is needed to scrutinise core assumptions underlying EWD methodology, particularly as to whether it has equal validity for estimating public health impacts across the widely diverse climatic conditions which prevail across Europe. In the mean time, given data on heating degree days are freely available for European countries, it is recommended that this approach replace the conventional methodology.

Poorer mental health in UK bisexual women than lesbians: evidence from the UK 2007 Stonewall Women's Health Survey

Abstract: Background Bisexual- and lesbian-identified women have significantly worse mental health than heterosexual women. Less evidence exists about mental health differences between lesbian and bisexual women. Methods Self-completion survey with community-based, opportunistic sampling recruited 937 bisexual-identified and 4769 lesbian-identified women. Associations between sexual identity and mental health indicators were assessed by logistic regression, controlling for age, income, student status and employment. Results As a group, bisexual women were younger, poorer, and more likely to be trans-identified, minority ethnic identified and to use marijuana, compared with lesbians. Bisexuals were more likely than lesbians to report eating problems (adjusted odds ratio (AOR) ¼ 1.64, P , 0.001), self-harm (AOR ¼ 1.37, P ¼ 0.001), depressed feelings (AOR ¼ 1.26, P ¼ 0.022) and anxiety (AOR ¼ 1.20, P ¼ 0.037). Fewer bisexual women attended lesbian or bisexual social events, were ‘out’, or had experienced any sexuality-related discrimination, compared with lesbians. Conclusion More bisexual women reported poor mental health or psychological distress than did lesbians. Bisexual women may be more likely to experience social stress due to the ‘double discrimination’ of homophobia and biphobia. This stress, experienced mainly as internalized and felt stigma, could result in greater risk for poor mental health compared with lesbians. Addressing both biphobia and homophobia within UK society has important preventative mental health implications.

To be or not to be a doctor, that is the question: a review of serious incidents of violence against doctors in China from 2003–2013

Abstract: Background The fact that violence against doctors is occurring in China is a hot topic worldwide today. Many doctors have been killed and injured. To gain a better understanding of this phenomenon in China, we collected evidence of serious violence against medical practitioners in China in order to appeal to the Chinese government and urge them to take action.

Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies

Abstract: Background To investigate the efficacy and the adverse effects (AEs) of the electronic cigarette, we performed a systematic review of published studies. Methods We selected experimental and observational studies examining the efficacy (as reduction of desire to smoke and/or number of cigarettes smoked and/or quitting or as reduction of nicotine withdrawal symptoms) and the safety of EC (AEs self-reported or clinical/laboratory). The following search engines were used: PubMed, ISI Web of Knowledge and Cochrane Controlled Trials Register. Results Finally, six experimental studies and six cohort studies were included. In the prospective 12-month, randomized controlled trial, smoking reduction was documented in 22.3 and 10.3% at Weeks 12 and 52, respectively (P , 0.001 versus baseline). Moreover, two cohort studies reported a reduction in the numberof cigarette/day (from 50 to 80%) after the introduction of the EC. ‘Mouth and throat irritation’, ‘nausea’, ‘headache’ and ‘dry cough’ were the most frequently AEs reported. Conclusions The use of the EC can reduce the number of cigarettes smoked and withdrawal symptoms, but the AEs reported are mainly related to a short period of use. Long-term studies are needed to evaluate the effects of the EC usage after a chronic exposure.

Smoking patterns in Great Britain: the rise of cheap cigarette brands and roll your own (RYO) tobacco.

Abstract: Background In Britain, the tobacco industry segments cigarettes into four price categories—premium, mid-price, economy and ultra-low-price (ULP). Our previous work shows that tobacco companies have kept ULP prices stable in real terms. Roll your own (RYO) tobacco remains cheaper still. Methods Analysis of 2001–08 General Household Survey data to examine trends in use of these cheap products and, using logistic regression, the profile of users of these products. Results Among smokers, the proportion using cheap products (economy, ULP and RYO combined) increased significantly in almost all age groups and geographic areas. Increases were most marked in under 24 year olds, 76% of whom smoked cheap cigarettes by 2008. All cheap products were more commonly used in lower socio-economic groups. Men and younger smokers were more likely to smoke RYO while women smoked economy brands. Smokers outside London and the South East of England were more likely to smoke some form of cheap tobacco even once socio-economic differences were accounted for.

Go slow: an umbrella review of the effects of 20 mph zones and limits on health and health inequalities

Abstract: BACKGROUND: Transport is an important determinant of health and there is a well-established association between socio-economic status (SES) and risk of road accidents. Effective traffic calming interventions such as 20 mph zones and limits may therefore improve health and reduce health inequalities. METHODS: Systematic review methodology was used to identify systematic reviews of the effects of 20 mph zones (including speed limits and road humps) and 20 mph limits on health and SES inequalities in health amongst adults and children. RESULTS: Five systematic reviews were included. Overall, they provide convincing evidence that these measures are effective in reducing accidents and injuries, traffic speed and volume, as well as improving perceptions of safety in two of the studies. There was also evidence that such interventions are potentially cost-effective. There was no evidence of the effects on SES inequalities in these outcomes. CONCLUSION: Twenty mile per hour zones and limits are effective means of improving public health via reduced accidents and injuries. Whilst there was no direct evidence on the effects of interventions on health inequalities, targeting such interventions in deprived areas may be beneficial. Further controlled evaluations that specifically examine SES effects are required.

Why fat taxes won't make us thin

Abstract: Increasing prevalence of overweight and obesity has led policy-makers to consider health-related taxes to limit the consumption of unhealthy foods and beverages. Such taxes are currently already in place in countries in Europe (e.g. Hungary, France and Finland) and in various states in the USA. Although these taxes are possibly efficient in reducing by a small amount the consumption of targeted products if the tax is fully transmitted to the consumer, there is too little available evidence on what will be consumed instead and whether these food substitutions undermine the hoped-for health benefits of the tax. We also know very little on how the food supply side will respond and what overall impact this will have. Without a proper appreciation of the potential indirect impacts we do not know the overall impact of taxes foods on unhealthy foods and beverages and further that there is a very real possibility that they may not be beneficial for health after all.

Invited debate: NHS Health Checks—a naked emperor?

Abstract: We briefly review here the evidence that the NHS Health Checks (NHSHC) programme represents an ineffective strategy and is currently wasting scarce resources. The NHSHC programme invites everyone in England aged 40–74 without cardiovascular disease (CVD) for a check every 5 years. The NHSHC website advertises that health checks can • prevent heart disease, diabetes, kidney disease stroke and dementia, • provide support and advice to help individuals manage and reduce their risk of future disease.1 However, the NHSHC programme fails to achieve both of these primary objectives. Furthermore, it relies on weak concepts, denies strong scientific counter-evidence and ignores persistent implementation issues. The 10 World Health Organization (WHO) Screening Criteria have been evaluated and refined over four decades.2 They remain a valuable test of any screening proposal (Table 1). This is crucial, because all screening has the potential for harm, and screening science can be counterintuitive.3 The NHSHC programme can be assessed against each of the 10 WHO Criteria. These cover the disease targeted, the test used and the treatment programme. We assess each of these areas in turn and whether NHSHC pass or fail on each criterion.

Neural tube defects in the Republic of Ireland in 2009–11

Abstract: BACKGROUND Neural tube defects (NTDs) are associated with deficient maternal folic acid peri-conceptionally. In Ireland, there is no mandatory folic acid food fortification, partly due to declining NTD rates in recent years. The aim of this study was to ascertain the incident rate of NTD during the period 2009–11 and describe epidemiologically NTD in Ireland. METHODS Cases were ascertained through multiple sources, including three regional congenital anomaly registers, all maternity hospitals nationally and paediatric hospitals providing care for children with spina bifida in the Republic of Ireland during the period 2009–11. RESULTS From 225 998 total births, 236 NTDs were identified, giving an incidence of 1.04/1 000 births, increasing from 0.92/1 000 in 2009 to 1.17/1 000 in 2011. Of all cases, 45% (n ¼ 106) had anencephaly, 49% (n ¼ 115) had spina bifida and 6% (n ¼ 15) had an encephalocoele; 78% (n ¼ 184) were liveborn or stillborn and 22% (n ¼ 52) were terminations abroad. Peri-conceptional folic acid supplement intake was 13.7% among the 52.5% (n ¼ 124) of cases whose folic acid supplement intake was known. CONCLUSION The incidence of NTDs in the Republic of Ireland appears to be increasing. Renewed public health interventions, including

Determinants of multiple sexual partnerships in South Africa

Abstract: Background This paper aims to examine determinants of multiple sexual partnerships (MSPs) among South African men and women using a nationally representative sample. Methods Quantitative and qualitative data from a 2008 population-based cross-sectional survey were used. The analysis focused on the 6990 (33.6% of total sample) who were 15 years and older and reported sexual activity in the prior 12 months. The qualitative component consisted of 15 focus group interviews investigating values underlying MSP behaviors. Results Predictors of MSP common across gender were race, having a history of STI, being in a short relationships (,1 year) and suspecting the current partner of infidelity. MSP among men enjoyed greater community acceptance and was mainly done for social status. Furthermore, men reporting MSP were mostly younger (15‐24 years old) and use condom at last sex. Among women, determinants of MSP included economic vulnerability, younger age at sexual debut and living in formal urban rather than formal rural areas. Conclusions The data presented in this paper reinforces the importance of MSP as a risk factor for HIVand outline factors that should strongly be considered in strengthening condom use promotion and of partner reduction programs messaging in South Africa.

What kinds of policies to reduce health inequalities in the UK do researchers support

Abstract: Background Despite a wealth of research and policy initiatives, progress in tackling the UK’s health inequalities has been limited. This article explores whether there appears to be consensus among researchers about the kinds of policies likely to reduce health inequalities. Methods Ninety-nine proposals for addressing health inequalities were identified from multiple sources. Forty-one researchers participated in a survey assessing the extent to which they believed each proposal would reduce health inequalities, based on three criteria. The 20 proposals generating most support were employed in a second stage, in which 92 researchers indicated which proposals they felt would have the greatest impact on reducing health inequalities. Results Some consensus exists among researchers about the policy approaches likely to reduce UK health inequalities: a more progressive distribution of income/wealth, greater investment in services for deprived communities, plus regulatory policies to limit the impact of lifestylebehavioural risks. However, researchers’ support for proposals varies depending whether they are asked to express their expert opinion or to comment on the strength of the available evidence. Conclusions When consulting researchers about health inequalities, policymakers need to consider whether they are seeking research-informed expertise or assessments of the available evidence; these questions are likely to yield different responses.

The influence of psychological well-being on academic success

Abstract: To investigate the influence of psychological well-being on academic success in school and to test for interaction effects of socioeconomic status (SES) and subjective well-being (SWB) on academic success. The analyzed data set contained information on 508 boys and girls in the sixth grade. The study had a cross-sectional design. The KIDSCREEN-27 questionnaire, an instrument for assessment of health-related quality of life in children and adolescents, which contains scales such as “Psychological well-being” and “School environment”, was used in this study. The combined average grade (CAG) in German and mathematics served as the indicator of academic success. The statistical analyses were using multiple linear regressions. Our analysis revealed an unexpected negative effect of psychological well-being on the CAG, but also an indirect positive effect, which was detected on the School Environment scale. The two effects more or less cancelled each other out overall. No interaction with socioeconomic status could be detected. The results of the present study are inconsistent and are only partly in conformity with the findings of previous empirical research on this topic, which rarely reported both negative and positive effects of well-being on academic success.

Estimating the yield of NHS Health Checks in England: a population-based cohort study

Abstract: Background This study aimed to evaluate the yield of the NHS Health Checks programme. Methods A cohort study, conducted in the Clinical Practice Research Datalink in England. Electronic health records were analysed for patients aged 40–74 receiving an NHS Health Check between 2010 and 2013. Results There were 65 324 men and 75 032 women receiving a health check. For every 1000 men assessed, there were 205 smokers (95% confidence interval 195–215), 355 (340–369) with hypertension (140/90mmHg) and 633 (607–658) with elevated cholesterol (5 mmol/l). Among 1000 women, there were 161 (151–171) smokers, 247 (238–257) with hypertension and 668 (646–689) with elevated cholesterol. In the 12 months following the check, statins were prescribed to 18% of men and 21% of women with 20% cardiovascular risk and antihypertensive drugs to 11% of men and 16% of women with 20% cardiovascular risk. Slight reductions in risk factor values were observed in the minority of participants with follow-up values recorded in the 15 months following the check. Conclusions A universal primary prevention programme identifies substantial risk factor burden in a population without known cardiovascular disease. Research is needed to monitor interventions, and intermediate- and long-term outcomes, in those identified at high risk.

The demographic impact on the demand for emergency medical services in the urban and rural regions of Bavaria, 2012-2032.

Abstract: Aim In most regions of the world, the proportion of older people in the population has increased during the last decades. As this entails major consequences for the healthcare sector, this study isolates and quantifies the impact of an aging population on the demand for emergency medical services in different types of regions in Bavaria between 2012 and 2032.

The appraisal of public health interventions: the use of theory

Abstract: Background Public health decision-making is hampered by inappropriate adherence to underpowered randomized controlled trials (RCTs) which give inconclusive results and lead to decision-makers being loath to recommend interventions with strong theoretical and observational support. Methods We outline situations in which robust decisions about health interventions can be made without trial evidence. We present a new approach in which theory, causal models and past observations are given proper regard in the decision-making process. Results Using our approach, we provide examples where the use of causal theories and observations in areas, such as salt reduction, smoking cessation and gardening to improve mental health, is sufficient for deciding that such interventions are effective for improving health without needing the support of underpowered RCTs. Particularly where RCT evidence is inconclusive, our approach may provide similar aggregate health outcomes for society for vastly lower cost. Conclusions When knowledge and theoretical understanding are unable sufficiently to reduce doubt about the direction of effect from an intervention, decisions should be made using evidence-based medicine approaches. There are, however, many cases where the combination of robust theory, causal understanding and observation are able to provide sufficient evidence of the direction of effect from an intervention that current practice should be altered.

‘It has not ruined my life; it has made my life better’: a qualitative investigation of the experiences and future aspirations of young mothers from the North West of England

Abstract: Background Teenage pregnancy has been portrayed as problematic and leading to negative long-term health outcomes. However, this assumption has been questioned. This qualitative study explores the experiences and future aspirations of teenage mothers in North West England. Methods Ten in-depth qualitative interviews were conducted with teenage mothers recruited from children’s centres located in deprived areas. Results The young mothers felt motherhood was a positive experience, which provided them with a valued social role. Within the communities they lived, they felt well supported. For many of the young mothers, dislike of school had occurred pre-pregnancy and becoming a mother had led the young women to reassess the value of education and employment. However, in common with many older mothers, while their child is young they choose to prioritize motherhood. The young women relied heavily upon family and the support of trusted professionals. Conclusions Motherhood can be a positive experience that makes sense in the lives of young women from disadvantaged backgrounds. To be effective, policy must recognize the valued social role motherhood provides for these young women. The negative long-term outcomes observed may largely be a result of their disadvantaged position within society and this should be the focus of interventions.

Reasons for (non)compliance with intervention following identification of ‘high-risk’ status in the NHS Health Check programme

Abstract: Background The Department of Health introduced a risk assessment, management and reduction programme, NHS Health Checks, which aimed to reduce premature morbidity and mortality from cardiovascular diseases for those aged 40‐74. Those identified as at increased risk of CVD are offered prophylactic medication and lifestyle advice to reduce their risk. Health gains will only be achieved if patients are compliant with advice/ intervention however. This study sought to understand factors that influenced adherence to medication and advice in ‘high-risk’ patients. Methods Qualitative data were collected through 29 semi-structured interviews with a purposive sample of individuals who had been identified as at high-risk of CVD. Participants had been offered lifestyle advice, lipid lowering medications and attended at least one annual review. Results Findings explore the challenges and experiences confronting ‘high-risk’ individuals when making decisions about engaging with intervention. Key findings explore: statin adherence, as well as adherence to advice about diet, physical activity, alcohol consumption and smoking cessation. Conclusions Attention needs to be paid to the way prophylactic medications are prescribed and explained to high-risk patients. Consistent provision of tailored lifestyle advice and access to appropriate services could facilitate sustained changes to factors that increase CVD risk.

Representations of minimum unit pricing for alcohol in UK newspapers: a case study of a public health policy debate

Abstract: Background Mass media influence public acceptability, and hence feasibility, of public health interventions. This study investigates newsprint constructions of the alcohol problem and minimum unit pricing (MUP). Methods Quantitative content analysis of 901 articles about MUP published in 10 UK and Scottish newspapers between 2005 and 2012. Results MUP was a high-profile issue, particularly in Scottish publications. Reporting increased steadily between 2008 and 2012, matching the growing status of the debate. The alcohol problem was widely acknowledged, often associated with youths, and portrayed as driven by cheap alcohol, supermarkets and drinking culture. Over-consumption was presented as a threat to health and social order. Appraisals of MUP were neutral, with supportiveness increasing slightly over time. Arguments focused on health impacts more frequently than more emotive perspectives or business interests. Health charities and the NHS were cited slightly more frequently than alcohol industry representatives. Conclusion Emphases on efficacy, evidence and experts are positive signs for evidence-based policymaking. The high profile of MUP, along with growing support within articles, could reflect growing appetite for action on the alcohol problem. Representations of the problem as structurally driven might engender support for legislative solutions, although cultural explanations remain common.

Method of invitation and geographical proximity as predictors of NHS Health Check uptake.

Abstract: Background Uptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities. Results Mean attendance (61.6%) was above the city and national average, but varied by practice (47.5-83.3%; P , 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR ¼ 2.87, 95% CI ¼ 2.26-3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR ¼ 1.04, 95% CI ¼ 1.03-1.04), female gender (OR ¼ 1.48, 95% CI ¼ 1.30-1.68) and living in the least deprived areas (OR ¼ 1.59, 95% CI ¼ 1.23-2.05) were all independent positive predictors of attendance. Conclusions Using verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations.

Factors influencing coroners' verdicts: an analysis of verdicts given in 12 coroners' districts to researcher-defined suicides in England in 2005.

Abstract: Background To investigate the variation between coroners in the verdicts given to deaths thought by researchers to be probable suicides and analyse factors associated with the coroners’ verdict. Methods Data were collected from 12 English coroner districts on all deaths in 2005 given a suicide, open, accidental or narrative verdict where suicide was considered a possibility. The data were reviewed by three experienced suicide researchers. Regression models were used to investigate factors associated with the coroners’ verdict. Results The researchers classified 593 deaths as suicide, of which 385 (65.4%) received a suicide verdict from the coroner. There was marked variation between coroner districts in the verdicts they gave. The suicide method was associated strongly with the coroners’ verdict; deaths from poisoning and drowning were the least likely to be given suicide verdicts. The other factors strongly associated with a coroner’s verdict of suicide were: whether a note was left, age over 60 years and being married or widowed compared with being single. Conclusion Coroners vary considerably in the verdicts they give to individuals who probably died by suicide. This may compromise the usefulness

The impact of tuition fees amount on mental health over time in British students

Abstract: Background Previous studies have shown a relationship between debt and mental health problems in students. This study aimed to examine the effect of differences in tuition fees amount on changes in mental health over time. Methods A prospective cohort study followed 390 first-year British students who differed on their tuition fees level at 4 time points across their first 2 years at university. Participants completed measures of global mental health, depression, anxiety, stress, alcohol-related problems at up to four time points in their first two years at university. Mixed-factorial ANOVAs were used to assess the impact of tuition fees amount on changes in scores over time. Results There was no difference based on fees at Time 1 for anxiety, stress, depression and global mental health. At Time 2, those charged £0‐2.9k or £3‐4k improved while those charged £8‐9k stayed the same. However, this trend reversed by Times 3 and 4. Conclusions Undergraduates mental health is partially affected by the level of tuition fees; however, the recent increase in tuition fees does not appear to have had a lasting impact at present.

Better health at work? An evaluation of the effects and cost–benefits of a structured workplace health improvement programme in reducing sickness absence

Abstract: Background This paper presents the results of an evaluation of the Better Health at Work Award—a structured regional workplace health programme which combined changes to the work environment with lifestyle interventions. Methods Baseline and follow-up data on sickness-absence rates and programme costs were collected retrospectively via a web survey of all participating organizations. Changes over time were calculated using 95% confidence intervals of the mean, supplemented by hypothesis testing using a t-test. The indicative cost–benefits of the intervention were also calculated. Results Participation was associated with a mean reduction in sickness absence of 0.26–1.6 days per employee per year depending on the length and level of participation in the programme. The estimated cost for the programme was £3 per sickness-absence day saved. Conclusions These results suggest that the Better Health at Work Award could be a cost-effective way of improving health and reducing sickness absence particularly in the public sector. However, controlled evaluations of future interventions are needed.

Differences in healthy life expectancy for the US population by sex, race/ethnicity and geographic region: 2008

Abstract: Background Healthy life expectancy (HLE) varies among demographic segments of the US population and by geography. To quantify that variation, we estimated the national and regional HLE for the US population by sex, race/ethnicity and geographic region in 2008. Methods National HLEs were calculated using the published 2008 life table and the self-reported health status data from the National Health Interview Survey (NHIS). Regional HLEs were calculated using the combined 2007-09 mortality, population and NHIS health status data. Results In 2008, HLE in the USA varied significantly by sex, race/ethnicity and geographical regions. At 25 years of age, HLE for females was 47.3 years and ∼2.9 years greater than that for males at 44.4 years. HLE for non-Hispanic white adults was 2.6 years greater than that for Hispanic adults and 7.8 years greater than that for non-Hispanic black adults. By region, the Northeast had the longest HLE and the South had the shortest. Conclusions The HLE estimates in this report can be used to monitor trends in the health of populations, compare estimates across populations and identify health inequalities that require attention.

Arts on referral interventions: a mixed-methods study investigating factors associated with differential changes in mental well-being.

Abstract: Background Art interventions may provide a cost-effective approach to improving mental well-being. Most evaluations concentrate on intervention characteristics and little is known about other factors which might contribute to successful outcomes. Methods This pre-and-post intervention mixed-methods study explored influences on differential changes in measured well-being among participants of an Arts on Referral (AoR) scheme in the UK. Measured well-being scores of 44 volunteers and findings from six semi-structured interviews were triangulated. Results Mean well-being scores improved by 8.0 (95% CI 4.8‐11.3, P , 0.0001); the numberof sessions attended and baseline scores were positively associated with outcome score. Participants from Black and Minority Ethnic (BME) groups and females appeared to show greater improvement in well-being scores than White British or male participants. Qualitative interviews supported and further explained these findings and suggested differential impacts of AoR may, in part, be explained by the importance of sharing experiences, reduced social isolation and external stressors. Conclusion This study supports the use of AoR interventions for improving well-being among those facing short- and long-term mental health challenges. However, given the reduced sample size and the pre-post design results should be interpreted with caution and potential differences between ethnic groups and genders should be furtherexplored.

Randomized test of a brief psychological intervention to reduce and prevent emotional eating in a community sample

Abstract: Background Emotional eating is associated with mental health problems and weight gain, but research has focussed on treatment rather than prevention. The present research tests a brief theory-based psychological intervention to reduce and prevent emotional eating in a community sample. Methods Two hundred and forty women were randomized to a control condition in which they were asked to identify emotional eating triggers and strategies for change (a 'volitional help sheet') or to an experimental condition in which they were asked explicitly to use the volitional help sheet to link emotional eating triggers with strategies for change and so form implementation intentions. Results Results showed that eating in response to boredom was more common than eating in response to anxiety or depression. There was a significant condition × time interaction showing that the formation of implementation intentions resulted in significantly lower levels of emotional eating in response to boredom at follow-up (d = 0.29). Conclusions The intervention shows promise in reducing and preventing emotional eating, but further research is required to refine the tool and to examine whether eating in response to anxiety or depression is more common among clinical populations.

A retrospective analysis of the cost of hospitalizations for sickle cell disease with crisis in England, 2010/11

Abstract: Background Sickle cell disease (SCD) is an inherited blood disorder which may result in a broad range of complications including recurring and severe episodes of pain—sickle ‘crises’—which require frequent hospitalizations. We assessed the cost of hospitalizations associated with SCD with crisis in England. Methods Hospital Episodes Statistics data for all hospital episodes in England between 2010 and 2011 recording Sickle Cell Anaemia with Crisis as primary diagnosis were used. The total cost of admissions and exceeded length of stay due to SCD were assessed using Healthcare Resource Groups tariffs. The impact of patients’ characteristics on SCD admissions costs and the likelihood of incurring extra bed days were also examined. Results In 2010–11, England had 6077 admissions associated with SCD with crisis as primary diagnosis. The total cost for these admissions for commissioners was £18 798 255. The cost of admissions increases with age (children admissions costs 50% less than adults). Patients between 10 and 19 years old are more likely to stay longer in hospital compared with others. Conclusion SCD represents a significant cost for commissioners and the NHS. Further work is required to assess how best to manage patients in