In December 2006, all UK NHS trusts introduced smoke-free regulations prohibiting smoking on all NHS sites. These rules are to be enforced by all NHS trust staff. We have investigated the implementation of these regulations by health care workers when they encounter smokers on a NHS hospital site.
Eighty-five medical and nursing staff working in acute medicine at the Queen Elizabeth Hospital, Gateshead, completed a questionnaire reporting their behavior when exposed to smokers on NHS hospital sites.
Over 50% of medical and nursing staff reported that they would not challenge patients, staff or visitors smoking on NHS trust site. There was a trend for employees to be more likely to challenge patients than visitors, and to be more likely to challenge visitors than other staff. Fear of aggression was the most commonly reported reason for not challenging smokers.
Most medical and nursing staff report that they do not enforce NHS smoke-free regulations and do not challenge smokers on NHS sites. This is due to many real and perceived barriers including fear of aggression. Overcoming these barriers is an important area of research to guide successful implementation of future smoking policy. There may be scope for improvement through training in NHS policy and in non-confrontational communication skills.
Binge drinking has been highlighted as a growing problem in the UK, particularly amongst females aged 18–25 years. University of Leeds is situated within a population that has one of the highest reported statistics of binge drinking in the UK. In September 2006, the ‘Unit 1421’ campaign was launched at University of Leeds with the aim to promoted sensible drinking amongst students. The aim of this study is to explore female perspectives on binge drinking and on ‘Unit 1421’ campaign in the University of Leeds.
Using a purposive sample, two focus groups were conducted with 12 female students aged 18–23 years within university grounds. Participants were recruited via email and poster advertisements on campus.
Four main themes emerged from the data: (i) lay perception of binge drinking; (ii) pressures of matching the drinking patterns of male peers; (iii) student rite of passage; (iv) evaluation of the ‘Unit 1421’ campaign.
The social context of student life impacts greatly upon students' choices to binge drink. The norms, beliefs and morals governing student culture and the use of alcohol to assert identity should be considered when tailoring health promotion efforts to this target audience. Larger qualitative and ultimately quantitative studies are warranted to extrapolate and test the social pressures on drinking in this age group.
Perpetrators' experiences of violence during childhood are considered a risk factor for intimate partner violence (IPV). The objective of this study is to systematically review the characteristics and quality of papers which analyse the association between being battered during childhood, witnessing marital violence as a child within the family of origin and having an absent or rejecting father and the occurrence of IPV.
Nine scientific databases were consulted (1960–2004). After applying the exclusion criteria, 10 studies were analysed. Variables are sample characteristics, directionality/study design, IPV and perpetrators' childhood measurements, findings, limitations and interventions.
All the studies found an association. Conflict Tactics Scale was the main tool used to measure the IPV. Different instruments were used to measure violent childhood experiences in men as an exposure. Recall bias (seven papers) and retrospective data (four papers) were reported as the main methodological limitations. Despite these, 50% of the studies proposed treatments/preventive measures.
Our findings support the results of previous studies, implying that action recommendations within IPV prevention are still not evidence based. Methodological problems of the papers reviewed should be solved to obtain more useful data. Scientific evidence about the aetiology of IPV should be increased to guide effective prevention programmes.
The UK Food Standards Agency Board identified four options to increase folate intake in women of reproductive age in order to reduce the risk of neural tube defect (NTD) affected pregnancies; these ranged from continuing with current policy, to mandatory fortification of bread or flour with folic acid. In order to appraise these options, the agency carried out a consultation, and also commissioned four pieces of research. This paper provides detailed information about two of the research studies, which used qualitative research approaches to gather consumer evidence.
Study 1: This was carried out with people from a wide range of demographic backgrounds. A ‘reconvened group’ methodology was used, with five groups convened twice, in five geographical locations. In addition paired, in depth face-to-face interviews were conducted with female black and ethnic minority consumers. Study 2: This was carried out with young mothers living in deprived communities. The approach used for this study was in depth face-to-face interviews (n = 24). In addition, discussions were held in seven friendship groups.
Study 1: only a minority of participants knew about a link between spina bifida and folic acid, and these tended to be women with young families. After the provision of some information about the causes and impacts of NTDs, the majority were in favour of action to tackle the issue. Support for mandatory fortification increased considerably during the study, and at the final discussion, this option was most preferred. Study 2: In this group, there was a fatalistic approach to pregnancy and to health. The women were less likely to change established habits if this required effort, money or doing something unfamiliar. They tended to actively avoid thinking about risks, by rationalizing them. Mandatory fortification was preferred by the majority of respondents.
In this research, mandatory fortification was the preferred option. There were outstanding concerns about risk, and the maintenance of consumer choice, which would need to be addressed in policy recommendations.
Escalating rates of childhood obesity are likely to have an impact on the prevalence of coronary heart disease and type-2 diabetes. We aimed to identify barriers to healthy lifestyles and evaluate the effectiveness of an action research approach to lifestyle modification in secondary schools.
An action research partnership between schools and university researchers involved pupils aged 11–15 in five inner-city secondary schools serving a predominantly South Asian population in Leicester, UK. Data collection included baseline and follow-up diet and physical activity questionnaires. Focus groups and observational visits were used to identify barriers, assist with developing tailored interventions and review the impact of the study.
Working with secondary schools presented challenges but a useful partnership was sustained. Qualitative feedback suggested that this had raised awareness of healthy lifestyle issues in participating schools. Barriers in pupils included low prioritization of health when making lifestyle choices. Sub-optimal diet and activity habits were identified at baseline. Overall, these persisted at follow-up, although some limited positive changes were identified.
Using action research methods in this context is challenging but can facilitate useful data collection and may have a modest impact on lifestyle behaviours.
The physical and social environment influences access to a healthy lifestyle, of which transport is one determining factor. This paper estimates the cost of transport on the island of Ireland.
Budget standards were developed on the basis of costs of baskets of core goods and services required for daily living. The transport budget was based on the needs of an urban living family. Financial capacity of the family relative to transport basket costs was determined.
Transport costs vary depending on family type and car ownership. The motoring costs for a family with two unemployed adults, with a weekly financial capacity of 388.28 and 427.70, respectively, for the Republic of Ireland and Northern Ireland, amount to 94.78 and 74.68, representing 18 and 10% of the family's weekly income.
The prohibitive costs of private transport present an opportunity for policy makers to consider creating supportive environments incorporating the more cost-effective and environmentally friendly options of public transport. Without such measures, dependence on private transport will exacerbate the incidence of food poverty and the health inequalities consequent upon it.
Ethnic inequalities in access to health services are difficult to monitor and address because of limited data. Within the health service, ethnicity data have been poor quality, partly because they are not seen as useful.
The analysis related age- and sex-standardized coronary revascularization procedures to defined measures of need, using proportional ratios derived from Hospital Episode Statistics records for London residents admitted to any hospital nationally in 2002–03 or 2003–04.
Although 2001 Ethnicity Categories were mandatory for the NHS from April 2001, by 2003–04 >20% of coronary heart disease (CHD) records still had no ethnic category coded. Hospital admission for CHD and revascularization by ethnicity varied widely, following known patterns of CHD incidence and mortality. There is much less variation between ethnic groups when comparing revascularization rate relative with CHD admission rates (whether all or emergencies). However, Bangladeshi patients had only two-thirds [proportional ratio 66.8, 95% confidence interval (CI) 60.7–73.3] and Black Caribbean and Black African patients four-fifths (proportional ratios 80.5, 72.0–89.9 and 80.7, 68.0–95.2, respectively) the revascularization rate in comparison with apparent need as the general population.
Even with imperfect data, the analysis of routine data can identify inequalities that warrant further investigation.
Incapacity Benefit (IB) is the key contributory benefit for people who are incapable of work because of illness or disability.
The aims were to establish the utility of routinely collected data for local evaluation and to provide a descriptive epidemiology of the IB population in Glasgow and Scotland for the period 2000–05 using data supplied by the Department for Work and Pensions.
Glasgow's IB population is large in absolute and relative terms but is now falling, mainly due to a decrease in on flow. Claimants, tend to be older, have a poor work history and suffer from mental health problems. The rate of decline has been greater in Glasgow than Scotland, although the rate of on flow is still higher.
Department for Work and Pensions (DWP) data can be used locally to provide important insights into the dynamics of the IB population. However, to be truly useful, more work needs to be undertaken to combine the DWP data with other information.
In England, the impact of increased use of antidepressant medications is unclear. We examine associations between antidepressant use, suicide and antidepressant poisoning mortality, adjusted for important covariates.
Data on suicide and antidepressant poisoning mortality were provided by the Office for National Statistics. Prescription data were provided by the Department of Health. Age- and sex-specific prescribing rates were estimated from The Health Improvement Network primary care data. We measured the association between prescribing, suicide and poisoning mortality after adjusting for age, sex, calendar year, prescribing rates and use of newer antidepressants drugs.
The prevalence of antidepressant treatment increased during the 1990s for all age and sex groups. Treatment prevalence remained constant from 2002 but declined among children and adolescents. Between 1993 and 2004, age-standardized rates for suicide decreased from 98.2 to 81.3 per million populations and for antidepressants from 9.2 to 7.4 per million populations. Before adjustment, increased antidepressant prescribing was associated with a decrease in suicide (rs = –0.90, P < 0.001) and antidepressant poisoning mortality rates (rs = –0.65, P = 0.023). This association disappeared after adjustment.
In England, at a population level, there does not appear to be an association between antidepressant prescribing and antidepressant poisoning mortality or suicide.
Performance measures of service standards, waiting time to treatment, satisfaction with care, in-hospital mortality and population-level survival were identified from secondary data sets for 167 acute hospitals and 34 cancer networks in England. We correlated rankings of networks and hospitals between the data sets using non-parametric statistics. At cancer network level, peer-review service standards were associated (P < 0.05) with 1-year survival for colorectal and lung cancers, and waiting times for lung cancer. At hospital level, standards were associated (P < 0.01) with waiting time to treatment for breast and colorectal cancers. However, there were stronger associations between specializations within hospitals: rankings of breast, colorectal and prostate cancers were highly associated (P < 0.001) for 5-year survival, patient satisfaction, standards and in-hospital mortality. Hospital-level differences appear to contribute more to variations in cancer performance than specialization differences within hospitals. The findings may be used for planning and commissioning better cancer services.
]]>There is limited evidence on the social determinants of A&E use and concerns over the equity of NHS Direct utilization.
We analysed data from the 2004–05 British General Household Survey, which included 20 421 participants. Logistic regression was used to examine individual casualty use in the last 3 months and household NHS Direct use in the last year.
Casualty use was higher for individuals living in rented accommodation or without car access, lower income groups, unskilled manual workers, current smokers and for individuals with limiting illness. In contrast, NHS Direct use was lower in households with older residents, low income, no car access and where the head of household was from a manual occupational group, a minority ethnic group or born outside the UK. The odds ratio for use of NHS Direct for households in the lowest equivalized income quintile was 0.67 (0.55–0.81). Adjustment for limiting illness increased the effect of socio-economic factors on NHS Direct use.
Reduced access to A&E services will disproportionately affect poorer individuals, whereas increased investment in telephone services will benefit affluent populations. Current national policy may widen inequities in access to emergency care.
The food-borne viruses in Europe (FBVE) network database was established in 1999 to monitor trends in outbreaks of gastroenteritis due to noroviruses (NoVs), to identify major transmission routes of NoV infections within and between participating countries and to detect diffuse international food-borne outbreaks.
We reviewed the total of 9430 NoV outbreak reports from 13 countries with date of onset between 1 January 2002 and 1 January 2007 for representativeness, completeness and timeliness against these objectives.
Rates of reporting ranged from a yearly average of 1.8 in 2003 to 11.6 in 2006. Completeness of reporting of an agreed minimum dataset improved over the years, both for epidemiological and virological data. For the 10 countries that provided integrated (epidemiological AND virological) reporting over the 5-year period, the completeness of the minimum dataset rose from 15% in 2003 to 48% in 2006. Two countries have not been able to combine both data types due to the structure of the national surveillance system (England and Wales and Germany). Timeliness of reporting (median days between the onset of an outbreak and the date of reporting to the FBVE database) differed greatly between countries, but gradually improved to 47 days in 2006.
The outbreaks reported to the FBVE reflect the lack of standardization of surveillance systems across Europe, making direct comparison of data between countries difficult. However, trends in reported outbreaks per country, distribution of NoV genotypes, and detection of diffuse international outbreaks were used as background data in acute questions about NoV illness and the changing genotype distribution during the 5-year period, shown to be of added value. Integrated reporting is essential for these objectives, but could be limited to sentinel countries with surveillance systems that allow this integration. For successful intervention in case of diffuse international outbreaks, completeness and timeliness of reporting would need to be improved and expanded to countries that presently do not participate.
Hospitals experience winter surges in admissions due to respiratory infections. The roles of acute bronchitis and influenza-like illness (ILI) in the timing and severity of these surges are examined over the years 1990–91 to 2004–05.
Respiratory admissions of persons aged ≥65 years in England and Wales were analysed in relation to patients with ILI or acute bronchitis diagnosed by community-based general practitioners from a sentinel surveillance network.
Acute bronchitis and ILI accounted for 46 and 7% of the variation in respiratory admissions, respectively: when admissions were lagged by 1 week, these estimates were 20 and 14%, respectively. Admissions peaked in weeks 52, 01 or 02 (late December to early January) in 14 of the 15 winters. Acute bronchitis peaked during weeks 01 or 02; ILI exhibited greater variability and peaks ranged from weeks 46 (mid-November) to 07 (mid-February). During winters where acute bronchitis and ILI peaked concurrently, surges on hospitals were most severe.
During each winter acute bronchitis provides a consistent and major contribution to the winter admissions surge in the elderly. The variable incidence of ILI can increase the surge in admissions, especially when ILI and acute bronchitis peak together.
Work is being undertaken across a wide range of agencies to ensure a high level of preparedness for pandemic influenza. In England, the Department of Health has published a range of guidance to support this. The impact of pandemic flu on care homes, especially if unprepared may have a major knock on effect on the rest of the health and social care system.
A rapid survey was undertaken of a small number of care homes in West Yorkshire to assess preparedness. The homes were both local authority and privately owned.
It was apparent that little preparation had been done at the time of the survey. A range of readily implementable ideas that may help this sector prepare was identified.
Planning for pandemic flu in this sector will require effort and coordination across a range of sectors; it might best be coordinated through Local Resilience Forums.
Evidence-based public health decision-making depends on high quality and transparent accounts of what interventions are effective, for whom, how and at what cost. Improving the quality of reporting of randomized and non-randomized study designs through the CONSORT and TREND statements has had a marked impact on the quality of study designs. However, public health users of systematic reviews have been concerned with the paucity of synthesized information on context, development and rationale, implementation processes and sustainability factors.
This paper examines the existing reporting frameworks for research against information sought by users of systematic reviews of public health interventions and suggests additional items that should be considered in future recommendations on the reporting of public health interventions.
Intervention model, theoretical and ethical considerations, study design choice, integrity of intervention/process evaluation, context, differential effects and inequalities and sustainability are often overlooked in reports of public health interventions.
Population health policy makers need synthesized, detailed and high quality a priori accounts of effective interventions in order to make better progress in tackling population morbidities and inequalities. Adding simple criteria to reporting standards will significantly improve the quality and usefulness of published evidence and increase its impact on public health program planning.