To systematically review the available evidence on the impact of organizational partnerships on public health outcomes (health improvement and/or a reduction in health inequalities) in England between 1997 and 2008.
Systematic review of quantitative (longitudinal before and after) and qualitative studies (1997–2008) reporting on the health (and health inequalities) effects of public health partnerships in England.
Eighteen electronic databases (medical, social science and economic), websites, bibliographies and expert contacts.
Only 15 studies, relating to six different interventions, met the review criteria and most of these studies were not designed specifically to assess the impact of partnership working on public health outcomes. Of the studies reviewed, only four included a quantitative element and they produced a mixed picture in terms of the impacts of partnership working. Qualitative studies suggested that some partnerships increased the profile of health inequalities on local policy agendas. Both the design of partnership interventions and of the studies evaluating them meant it was difficult to assess the extent to which identifiable successes and failures were attributable to partnership working.
This systematic review suggests that there is not yet any clear evidence of the effects of public health partnerships on health outcomes. More appropriately designed and timed studies are required to establish whether, and how, partnerships are effective.
The aim of this work was to describe the television (TV) viewing time of preschoolers and to examine factors that may be associated with it.
A representative sample of 2374 Greek children aged 1–5 years was examined (GENESIS study). Several anthropometric, socio-demographic and lifestyle characteristics were recorded.
The mean value of children's TV viewing time was 1.32 h/day. Twenty six percent of participants spent ≥2 h/day in TV viewing. The percentage of children whose TV viewing time was longer than 2 h/day was higher in children aged 3–5 years (32.2%) than in those aged 1–2 years (11.1%). Multiple logistic regression revealed that the time parents spent viewing TV and the region of residence were significantly associated with child's TV viewing time among children aged 3–5 years. Among children aged 1–2 years, the maternal educational status, the region of residence and the maternal TV viewing time were found to be related to child's TV viewing time.
The current findings suggest that almost one third of Greek preschoolers exceed the limit of 2 h/day TV viewing and that parental TV viewing time may be the most important determinant of children's TV viewing time.
There are doubts whether diabetes care is equitable across UK ethnic groups. We examined processes and outcomes in South Asians with diabetes and reviewed the UK literature.
We used name search methods to identify South Asians in a regional diabetes database. We compared prevalence rates, processes and outcomes of care between November 2003 and December 2004. We used standard literature search techniques.
The prevalence of diabetes in South Asians was 3–4 times higher than non-South Asians. South Asians were 1.11 times (95% confidence interval 1.06, 1.16) more likely to have a structured review. South Asian women were 1.10 times more likely to have a record of body mass index (95% CI 1.04, 1.16). HbA1c levels were 1.03 times higher (95% CI 1.00, 1.06) among South Asians, retinopathy 1.36 times more common (95% CI 1.03, 1.78) and hypertension 0.71 times as common (95% CI 0.58, 0.87).
We found evidence of equity in many aspects of diabetes care for South Asians in Tayside. The finding of higher HbA1c and more retinopathy among South Asians needs explanation and a service response. These findings from a region with a small non-White population largely support the recent findings from other parts of the UK.
The incidence of and mortality from alcohol-related conditions, liver disease and hepatocellular cancer (HCC) are increasing in the UK. We compared mortality rates by country of birth to explore potential inequalities and inform clinical and preventive care.
Analysis of mortality for people aged 20 years and over using the 2001 Census data and death data from 1999 and 2001–2003.
England and Wales.
Standardized mortality ratios (SMRs) for alcohol-related deaths and HCC.
Mortality from alcohol-related deaths (23 502 deaths) was particularly high for people born in Ireland (SMR for men [M]: 236, 95% confidence interval [CI]: 219–254; SMR for women [F]: 212, 95% CI: 191–235) and Scotland (SMR-M: 187, CI: 173–213; SMR-F 182, CI: 163–205) and men born in India (SMR-M: 161, CI: 144–181). Low alcohol-related mortality was found in women born in other countries and men born in Bangladesh, Middle East, West Africa, Pakistan, China and Hong Kong, and the West Indies. Similar mortality patterns were observed by country of birth for alcoholic liver disease and other liver diseases. Mortality from HCC (8266 deaths) was particularly high for people born in Bangladesh (SMR-M: 523, CI: 380–701; SMR-F: 319, CI: 146–605), China and Hong Kong (SMR-M: 492, CI: 168–667; SMR-F: 323, CI: 184–524), West Africa (SMR-M: 440, CI, 308–609; SMR-F: 319, CI: 165–557) and Pakistan (SMR-M: 216, CI: 113–287; SMR-F: 215, CI: 133–319).
These findings show persistent differences in mortality by country of birth for both alcohol-related and HCC deaths and have important clinical and public health implications. New policy, research and practical action are required to address these differences.
Smoking is a main contributor to health inequalities. Identifying strategies to find and support smokers from disadvantaged groups is, therefore, of key importance.
A systematic review was carried out of studies identifying and supporting smokers from disadvantaged groups for smoking cessation, and providing and improving their access to smoking-cessation services. A wide range of electronic databases were searched and unpublished reports were identified from the national research register and key experts.
Over 7500 studies were screened and 48 were included. Some papers were of poor quality, most were observational studies and many did not report findings for disadvantaged smokers. Nevertheless, several methods of recruiting smokers, including proactively targeting patients on General Physician's registers, routine screening or other hospital appointments, were identified. Barriers to service use for disadvantaged groups were identified and providing cessation services in different settings appeared to improve access. We found preliminary evidence of the effectiveness of some interventions in increasing quitting behaviour in disadvantaged groups.
There is limited evidence on effective strategies to increase access to cessation services for disadvantaged smokers. While many studies collected socioeconomic data, very few analysed its contribution to the results. However, some potentially promising interventions were identified which merit further research.
The intensification of livestock production has led to situations where the amount of manure that is produced exceeds the amounts needed in some areas. The objective of this study was to evaluate the relationship between the intensity of livestock activities and manure products, particularly in swine farms, and the prevalence of diarrhea in adults.
A survey was carried out on 8702 adults living in 161 municipalities in Quebec areas with intensive farming activities. Data were collected by a telephonic interview on diarrheal symptoms that occurred during the previous week of the interview, on water consumption and on selected risk factors. Statistical analysis was performed using a ‘generalized estimating equations’ model.
Prevalence of diarrhea was found to be highest in adults aged between 25 and 34 years. No association was found between swine density or liquid manure application and diarrheal prevalence. There was also no association between cattle or total animal density and diarrheal prevalence. In the areas studied, there was no increase in risk associated with the consumption of tap water with suboptimal treatment and susceptible to microbiologic contamination.
Significant livestock production and excess of manure were not associated with the risk of diarrhea in adults.
In France, as in other industrialized countries, syndromic surveillance systems for the early detection of illnesses have proliferated, but few validation studies on these systems performances exist. In Bordeaux, a south-western city in France, a system using a network of general practitioners house calls, such as SOS Médecins, provided local health data used to guide health service response, in particular in case of flu-like pandemic. We explored the capacity of SOS Médecins system to identify and follow influenza outbreaks using data from the Sentinel network, considered as being a gold standard for tracking seasonal influenza in France.
Data from SOS Médecins were analysed and compared with data from the Sentinel network. The sensitivity and specificity of SOS Médecins system were evaluated for different simulated thresholds.
A relationship between the number of visits for influenza from SOS Médecins and the number of influenza cases from the Sentinel network was observed; data from the two systems were highly correlated. We showed the capacity of SOS Médecins system to identify outbreaks with a sensitivity and specificity of 93%.
The sensitivity and specificity of SOS Médecins for early outbreak detection showed the value of these data in monitoring influenza activity.
Influenza incidence thresholds are used to help predict the likely impact of influenza and inform health professionals and the public of current activity. We evaluate the potential of syndromic data (calls to a UK health helpline NHS Direct) to provide early warning of national influenza outbreaks.
Time series of NHS Direct calls concerning ‘cold/flu’ and fever syndromes for England and Wales were compared against influenza-like-illness clinical incidence data and laboratory reports of influenza. Poisson regression models were used to derive NHS Direct thresholds. The early warning potential of thresholds was evaluated retrospectively for 2002–06 and prospectively for winter 2006–07.
NHS Direct ‘cold/flu’ and fever calls generally rose and peaked at the same time as clinical and laboratory influenza data. We derived a national ‘cold/flu’ threshold of 1.2% of total calls and a fever (5–14 years) threshold of 9%. An initial lower fever threshold of 7.7% was discarded as it produced false alarms. Thresholds provided 2 weeks advanced warning of seasonal influenza activity during three of the four winters studied retrospectively, and 6 days advance warning during prospective evaluation.
Syndromic thresholds based on NHS Direct data provide advance warning of influenza circulating in the community. We recommend that age-group specific thresholds be developed for other clinical influenza surveillance systems in the UK and elsewhere.
To achieve the World Health Organization's Millennium Development Goal of reducing maternal mortality by three-quarters by 2015, a strong global commitment is needed to address this issue in sub-Saharan Africa where the risk to women is greatest. A comprehensive international effort must include both clinical and community-based interventions. In sub-Saharan Africa where the majority of women deliver babies at home without a trained attendant, the national plans must rely predominantly on community-level interventions.
This study compiles the Cochrane reviews whose outcome measure is maternal mortality. Nine reviews documented the effectiveness of specific drugs given during pregnancy while six reviews demonstrated that particular drug regimens and procedures actually increase maternal death. Two of the Cochrane reviews found no significant difference in maternal mortality risk due to antioxidant use or in training traditional births attendants.
The dearth of evidence highlights the need for increased focus on clinical and community-based interventions that are feasible in sub-Saharan Africa. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers.
This study aimed to investigate the effects of drinking water with high concentrations of iodine on the intelligence of children in Tianjin, China.
It was a population-based health survey utilizing a random cluster sampling design conducted in June 2005. Participants were recruited from the total population of primary school children attending years 1–4 with ages ranging from 8 to 10 years. Intelligence quotient (IQ) was assessed using the combined Raven's test, second edition. Linear regression analyses were applied to test for any association between water iodine concentration and IQ.
A total of 1229 students were recruited with a mean IQ of 105.8 (95% CI: 104.2–107.3). Water analyses indicated iodine concentrations were high in one rural region and exceedingly high in another with median values of 137.5 and 234.7 µg/l, respectively. There was a significant association between residing in the very high water iodine region and a reduction of IQ by an average of about nine points (P = 0.022), after adjusting for the potential confounding factors.
Exposure to high iodine concentrations in drinking water has detrimental effects on the intelligence of children.
Adolescent violence is a significant public health problem. The primary objective of this study is to assess the prevalence and correlates of violent behavior among adolescent students in Lebanon.
A cross-sectional study was conducted among a representative sample of 827 secondary students enrolled in public and private schools in Beirut. Using a series of multiple logistic regression techniques, socio-demographic variables which significantly associated with violent behavior were included as potential confounders in building the models for risk behavior.
Nearly 42 and 17% of adolescents reported being involved in physical fights and weapon carrying, respectively. Boys were significantly more likely to use violence than girls. Whereas associations with physical fights were stronger for socio-economic variables and perceived rank in class, weapon carrying was significantly associated with problem behaviors, such as unintentional injury, substance abuse and sexual activity, with effect measures being stronger than those estimated for physical fighting.
Compared with other countries, the rates of violent behavior in Lebanon are relatively high. The results from this study are discussed in light of the political ecology of Lebanon which may contribute to a culture that perpetrates violent behavior and may have influenced the clustering pattern of risk behaviors.
To estimate the prevalence, awareness and control of prehypertension (preHT) and hypertension (HT) as defined by JNC-7 criteria in the Trabzon Region and its associations with demographic factors (age, sex, obesity, marital status, reproductive history in women and level of education), socioeconomic factors (household income and occupation), family history of selected medical conditions (diabetes, hypertension, obesity and cardiovascular disease), lifestyle factors (smoking habits, physical activity and alcohol consumption) in the adult population.
In this cross-sectional survey, a sample of households was systematically selected from the central province of Trabzon and its nine towns. A total of 4809 adult subjects (2601 women and 2208 men) were included in the study. Demographic and socioeconomic factors, family history of selected medical conditions, and lifestyle factors were obtained for all participants. Systolic blood pressure (BP) and diastolic BP levels were measured for all subjects. The persons included in the questionnaire were invited to the local medical centers for blood examination between 08:00-10:00 following 12 hours of fasting. The levels of serum glucose (FBG), total cholesterol (Total-C), high density cholesterol (HDL-C), low density cholesterol (LDL-C) and triglycerides were measured with autoanalyzer. Definition and classification of HT was performed according to guidelines from the US JNC-7 report. Prevalence, awareness, treatment and control of HT were assessed.
The prevalences of HT and preHT were 44.0% (46.1% in women and 41.6% in men) and 14.5% (12.6% in women and 16.8% in men), respectively. Overall, only 41% of the hypertensive individuals had been previously diagnosed. Furthermore, 54.5% of the hypertensive subjects were being treated with antihypertensive drugs (AHD), but only 24.3% of treated subjects had their BP adequately controlled. Among all hypertensive subjects (known and newly diagnosed), only 5.43% had their BP under control. The prevalence of HT increased with age, being highest in the 60- to 69-year-old age group (84.4%) but lower again in the 70+ age group. Interestingly, the prevalence was 16.9% in the 20-to 29-year old age group. HT was associated positively with marital status, parity, cessation of cigarette smoking, and negatively with level of education, alcohol consumption, current cigarette use, and physical activity. Multinomial logistic regression analysis revealed that HT were significantly associated with age, male gender, BMI, low education level, nonsmoking, positive family history of selected medical conditions, occupation, and parity.
The Trabzon Hypertension Study data indicated that HT is very common and is an important health problem in the adult population of Trabzon. Patients who are unaware of their status and treated uncontrolled hypertensives are at high risk of early cardiovascular morbidity and mortality. To control preHT and HT, effective public health education and urgent precautions are needed. The precautions include serious health education, a well-balanced diet and increasing physical activity.
Prompt utilization of health services on detecting breast symptoms can improve breast cancer (BC) survival. Little is known about Chinese women's help-seeking behaviour. Our aim was to determine patterns of self-referral among Hong Kong Chinese women with self-detected breast symptoms.
We recruited 37 women awaiting their first consultation at public hospitals for breast symptoms. Interviews were transcribed and analysed based on the grounded theory approaches.
A two-stage help-seeking model provided the best interpretation of the data. Symptom recognition was triggered by symptom interpretation, symptom progression and social messages. Painful lumps were seen as symptomatic, but atypical symptoms were often dismissed as benign as they responded to dietary change. Symptom intensification and discussions with someone who had faced BC prompted consultation. Service utilization involved fear of consequences, confirmation need, symptom distress, lay referral, media prompts and opportunistic presentation. Fearing cancer as incurable delayed consultation. Utilization barriers included cost, uncertainty about referral pathways, competing priorities and embarrassment.
Atypical and painless presentation was more common among women delaying presentation. Barriers included cost, access, time and embarrassment. Education should emphasize atypical symptoms, the high-cure rate and the need for early presentation. Reduced cost and improved access to clinics would enhance early consultation.
A recent report by the UK Drugs Policy Commission has highlighted the high levels of drug use in Britain and this has been interpreted as indicative of ineffective drug polices. However, the interpretation was based on sporadic self-report data and indirect extrapolation. This paper assesses trends in the prevalence and incidence of drug misuse in the UK from 1998 to 2005 as recorded in general practice.
The study was a retrospective analysis of the General Practice Research Database. The study cohort comprised ~900 000 patients each year from 183 general practices.
Among the Government's key target age group (16–24 years), there was a marked decrease in both prevalence and incidence of illicit drug misuse from 1998 to 2002 (P < 0.01). In older adults (25–59 years), the pattern was more variable during the first part of this period, but incidence remained stable from 2002 to 2005.
These data indicate that the problematic drug use in the UK may be declining and that the policies may be more effective than has been previously thought. General Practice data are nonetheless only part of the picture in terms of understanding the prevalence of problematic drug use.
Getting incapacity benefit (IB) claimants into work has become a focus for policy makers. Strategies to help this group depend on an understanding of the reasons for claiming benefit at a local level where variations from a national strategy may be needed.
Data supplied by the Department for Work and Pensions (DWP) was analysed to establish reasons for claiming benefit in Scotland and Glasgow between 2000 and 2007.
There has been a continuing rise in mental health diagnosis and a corresponding fall in musculoskeletal diagnosis during this period. More people were claiming because of mental health problems in Glasgow than in Scotland. Also those with a poor employment history (credits-only claimants) are more likely to claim IB because of a mental health problem. This study has shown a breakdown into 25 categories those claiming IB because of a mental health problem.
DWP data can be used to provide important insights into the trends in reasons for claiming IB, in particular those claiming because of mental health problems. This study also highlighted the growing importance of problems caused by alcohol and drug-abuse claimants, a subset of the mental health category. DWP data should be used at a local as well as a national level to guide and evaluate interventions to help this vulnerable group.
Evidence from developed countries has shown that abortion-related mortality and morbidity has decreased with the liberalization of the abortion law. This study aimed to assess the trend of hospital-based abortion complications during the transition of legalization in Ethiopia in May 2005.
Medical records of women with abortion complications from 2003 to 2007 were reviewed (n = 773). Abortion and its complications with regard to legalization were described by rates and ratios, and predictors of fatal outcomes were analyzed by logistic regression.
The overall and abortion-related maternal mortality ratios (AMMRs) showed a non-statistically significant downward trend over the 5-year period. However, the case fatality rate of abortion increased from 1.1% in 2003 to 3.6% in 2007. Late gestational age, history of interference and presenting after new abortion legislation passed have been found to be significant predictors of mortality.
Decreased trends of abortion ratio and the AMMR were identified, but the severity of abortion complications and the case fatality rate increased during the transition of legal revision.
Rising rates of obstetric interventions in the UK are a concern for health-care providers and the public. Our aims were to identify the socio-demographic and clinical factors (case mix) predictive of one of the most common obstetric interventions, induction of labour (IOL), and quantify the extent to which observed rates can be explained by case mix factors.
We conducted a comparative analysis of induced and spontaneous labours, using contemporary clinical data from the Aberdeen Maternity and Neonatal Databank. Cases complicated by antenatal intrauterine death or a previous or planned caesarean section were excluded. In total, 17 736 cases were included in the analysis.
In 5727 (32.3%) cases labour was induced and in 12 009 (67.7%) cases it was spontaneous. Multivariate logistic regression modelling was used. In total, 18 case mix factors were predictive of IOL. Among these were well-recognized clinical indications for IOL such as pre-labour rupture of membranes (OR 3.29, 95% CI 2.90, 3.73) and prolonged pregnancy (OR 4.15, 95% CI 3.82, 4.50) and previously unreported case mix factors (residing an intermediate distance and travel time from hospital) (OR 1.27, 95% CI 1.18, 1.37; BMI >35 OR 1.37, 95% CI 1.14, 1.65). Case mix explained 71.5% of the observed rate of IOL.
More than one-quarter of the rate of IOL remains unexplained by case mix factors. This may be explained by women's preferences for care and clinicians' practice.
To evaluate hospital-acquired infections (HAIs) in somatic (all admissions other than psychiatric) and psychiatric patients admitted to a tertiary university hospital in Oslo, before and after reorganization of the Norwegian healthcare system in 2002.
Point prevalence studies were conducted four times per annum and over the period from 1995 to 2007.
A total of 57 360 patients were studied over the whole time period: 80.5% in somatic wards and 19.5% in psychiatric wards. The HAI rate was 6.9%, of which 8.1% were somatic and 1.9% psychiatric. 13.4% of operated patients had HAI, including 6.2% due to surgical wound infections. In somatic wards, 0.6–1% were re-admitted with HAI, 15.2–23% had infections and 18–23% used antibiotics. There was a reduction in HAI until 2002. From 2003 on, HAI increased (P = 0.010) in somatic wards (P = 0.002), in non-operated patients (P = 0.024) and in extra costs. In 2002, the Norwegian healthcare system was reorganized. This reorganization led to a 30% increase in somatic patients treated from 2003 to 2007 (P = 0.054), 27% increase in the total workload per work position (P = 0.024) and 23.5% decrease in internal service work.
A declining trend of HAI was observed from 1995 to 2002 at the tertiary university hospital in Norway. In 2002, the Norwegian healthcare system was reorganized. From 2003 to 2007, HAI increased significantly as did the number of somatic patients and workload at our hospital.
This research investigated the representation of alcohol in radio output. The study was prompted by concerns that media output might be part of a developing culture of excessive drinking among young people.
Alcohol comments were examined across six radio stations in England. 1200 h of weekend output was screened and the sampling frame included periods when references to alcohol would be expected, such as the Christmas period. Statistical analysis identified the volume and proportion of comments, whereas qualitative analysis explored these in more depth, focusing on the themes and discourses surrounding alcohol talk.
Of 703 alcohol comments identified, 244 involved presenters. The volume of comments about alcohol varied between stations, being lower on BBC than on commercial stations and being influenced by music genre. Seventy-three percent of comments initiated by presenters, compared with 45% of comments from all sources, encouraged drinking. The majority of comments by presenters support drinking in relation to partying and socializing. Alcohol comments seem to create identity for programmes and forge connections between presenters and audiences, although some presenters achieve this without mentioning drinking. The assumption that alcohol is necessary to have a good time is seldom directly challenged.
While it may be unsurprising that much of this content reflected themes of weekend drinking and partying, the study suggests that alcohol comments play a particular role in marketing and branding of radio output. Comments about alcohol are shaped by broadcasting conventions that make it difficult to challenge discourses surrounding excessive drinking. Further research is needed on the influence that radio output may have on drinking behaviour among young people.
We assessed change between 1996 and 2006 in the opinions of the general public on priorities for the prevention of health problems.
Postal questionnaire surveys in 1996 and 2006, in representative samples of the general population of Geneva, Switzerland. Participants indicated, for each of 13 health problems, a priority rating for the spending of prevention resources.
There were 742 participants in 1996 (response rate 75%) and 1487 in 2006 (response rate 76%). According to participants, in 2006, resources should be spent, with priority, for: the prevention of sexual abuse of children (67% answered ‘high priority’), illegal drugs (58%), AIDS (55%), tobacco smoking (45%), road traffic accidents (43%), alcoholism (42%), family violence (42%), suicide in young people (39%), mammography screening for breast cancer (37%), abuse of medications (27%), cannabis use (24%), poor diet (22%) and lack of physical activity (20%). Between 1996 and 2006, the largest change was observed for tobacco smoking (+18.6% answered ‘high priority’), poor diet (+11.4%), lack of physical activity (+10.8%) and AIDS (–10.8%, P < 0.001 for all change scores).
Smoking, poor diet and lack of physical activity were more likely to be perceived as priorities in 2006 than in 1996, whereas priority ratings decreased for AIDS. The prevention of sexual abuse of children was perceived as the highest priority by all respondent groups.
Most projections of climate change suggest an increased frequency of heatwaves in England over coming decades; older people are at particular risk. This could result in substantial mortality and morbidity.
To determine elderly people's knowledge and perceptions of heat-related risks to health, and of protective behaviours.
Semi-structured interviews: 73 men and women, 72–94 years, living in their own homes in London and Norwich, UK.
Few respondents considered themselves either old or at risk from the effects of heat, even though many had some form of relevant chronic illness; they did recognize that some medical conditions might increase risks in others. Most reported that they had taken appropriate steps to reduce the effects of heat. Some respondents considered it appropriate for the government to take responsibility for protecting vulnerable people, but many thought state intervention was unnecessary, intrusive and unlikely to be effective. Respondents were more positive about the value of appropriately disseminated advice and solutions by communities themselves.
The Heatwave Plan should consider giving greater emphasis to a population-based information strategy, using innovative information dissemination methods to increase awareness of vulnerability to heat among the elderly and to ensure clarity about behaviour modification measures.
To describe the use of NICE, the acronym for the UK National Institute for Health and Clinical Excellence, as both an adjective and noun in peer-reviewed journal article titles.
Systematic review of titles retrieved by electronic database searches.
Ovid databases (MEDLINE, All EBM Reviews, EMBASE, ERIC, CINAHL and PsycINFO) covering the formation of NICE in 1999 to February 2008.
Independent review of eligible titles by both authors and resolution of disagreements based on consideration of full text articles.
2274 articles were retrieved that included reference to NICE in their titles. Of these, 167 (7.3%) used NICE as an adjective, most commonly in conjunction with the terms ‘work’, ‘not so’ (NICE), ‘nasty’, ‘mess’ and ‘try’.
The work of NICE has been widely referenced in peer-reviewed journal article titles, sometimes with apparent humorous intent when used as an adjective. Well-chosen names may increase the recognizability of public health organizations and help to communicate their roles.
Birthweight varies according to ethnic group, but it is not clear why such differences exist. We examine the contribution of socioeconomic, maternal and behavioural factors to differences in mean birthweight and the prevalence of low birthweight across ethnic groups.
Data from the nationally representative UK Millennium Cohort Study (n = 16 157) on White, Indian, Pakistani, Bangladeshi, Black Caribbean and Black African infants were analysed. Cohort members were born in 2000–02, and data on birthweight, maternal, infant, behavioural and socioeconomic factors were collected by home interviews.
Indian, Pakistani and Bangladeshi infants were 280–350 g lighter, and 2.5 times more likely to be low birthweight compared with White infants. Black Caribbean infants were 150 g and Black African infants 70 g lighter compared with White infants, and Black Caribbean and Black African infants were 60% more likely to be low birthweight compared with White infants. For Black Caribbean, Black African, Bangladeshi and Pakistani infants, socioeconomic factors were important in explaining birthweight differences and, for Indian and Bangladeshi infants, maternal and infant factors were important in explaining birthweight differences.
Future policies aimed at reducing inequalities in birthweight must pay attention to the different socioeconomic and culturally-related profiles of ethnic minority groups in the UK.
There were few reports about the relationship between unemployment and mortality in Central Eastern European countries experiencing economic transition.
This study measures overall and cause-specific mortality rates in 47 247 subjects registered as unemployed in Danzig City and Danzig County for the period of 1999 and 2004 and compares them with the age-matched general population.
In unemployed male subjects, the age-standardized all-cause mortality rate was significantly higher than in men from the general population: 8.36 per 1000, 95% confidence interval (95% CI) 7.71–9.0 compared with 5.1 per 1000, 95% CI 4.94–5.21. The age-standardized mortality in unemployed women was also higher than in the reference population data: 5.55 per 1000, 95% CI 4.77–6.34 and 1.89 per 1000, 95% CI 1.81–1.97, respectively. External causes, suicides, alcohol and smoking-related causes explain the excess mortality among both men and women. Unemployment status was associated with a greater risk of death in men than in women: hazard ratio (HR) 2.02, 95% CI 1.33–3.08 and HR 0.74, 95% CI 0.37–1.5, respectively.
Possible explanations for this disparity may be the current regulations and sociocultural context in Poland. More research is needed to understand the differences in mortality risk associated with unemployment observed between men and women in Poland.
Although the association between poor health and deprivation is well-founded, a ‘Scottish effect’ has been observed, whereby the level of health appears even poorer than Scotland's higher level of deprivation should warrant. We consider whether ‘Scottish effects’ also occur within the regions of England and Wales.
Using ward-level data from the national census, we regress healthy life expectancies relative to total life expectancies on Carstairs deprivation scores, households' average disposable incomes, geo-spatial characteristics and regional dummy variables.
Higher incomes and lower Carstairs scores are each associated with longer proportions of lives expected to be spent in good health or without long-standing illness. Relative to the London region, the coefficients on the regional dummies are uniformly negative and mostly significant.
There exist differences in relative health expectancies between the regions of England and Wales, which are not fully explained by the differences in socio-economic circumstances. Conventional deprivation measures tend to understate the poorer health performances of the more deprived regions (Wales and the north of England), and the understatement increases with deprivation. The exception to the rule is London, where health expectancies are superior to those which deprivation leads us to expect.
To examine time trends and deprivation gradients in fire-related deaths and injuries.
A cross-sectional study and time trend analysis using data on fire casualties in England between 1995 and 2004 obtained from the Department for Communities and Local Government. Injury rates were calculated assuming a Poisson distribution. Incidence rate ratios (IRRs) were calculated to compare changes in deprivation gradients over time.
There were significant reductions in fatal and non-fatal fire injuries in children (fatal injuries IRR 21 = 11.18, P < 0.001; non-fatal injuries IRR 22 = 61.44, P < 0.001), adults (fatal injuries IRR 21 = 15.99, P < 0.001; non-fatal injuries IRR 22 = 183.25, P < 0.001) and older people (fatal injuries IRR 21 = 56.88, P < 0.001; non-fatal injuries IRR 22 = 54.09, P < 0.001) between 1995 and 2004. Adult and child fire deaths were most commonly caused by smokers' materials (e.g. cigarettes, cigars and tobacco), and cigarette lighters and matches, respectively. Cooking appliances caused most non-fatal fire injuries. Injury rates increased with increasing levels of deprivation and deprivation gradients did not change over 10 years.
Fire prevention interventions should promote the safe use of cooking and heating appliances and the responsible use of smokers' materials, lighters and matches, and should target those at greater risk of fire, including the socially disadvantaged.
To assess the effects of demographic factors on mental illness admission for victims of interpersonal violence.
A population-based retrospective cohort study was conducted to investigate victims of violence using the 1990–2004 linked data extracted from the Western Australia Hospital Morbidity Data System and the Mental Health Information System. Factors associated with the risk for hospitalization for mental illness were assessed by logistic regression analysis.
Among the 25 427 victims admitted to hospital for at least one episode of interpersonal violence during the study period, 6395 (25%) had been hospitalized with a mental illness diagnosis. Female [odds ratio (OR) 1.54, 95% CI 1.40–1.63] and Indigenous (OR 1.47, 95% CI 1.34–1.57) victims of violence were significantly more likely to be admitted for mental illness. The presence of additional co-morbidity also increased the risk (OR 1.49, 95% CI 1.44–1.54). Other variables that significantly increased the risk of mental illness admission were advancing age, other methods of assault and victims who had been separated, divorced or widowed.
The results are beneficial for designing and implementing intervention strategies to reduce the adverse consequences of interpersonal violence particularly for women and Indigenous victims of violence.
It is not known whether there are disparities in morbidity outcomes between south Asians and whites with established coronary disease.
Six-year prospective cohort study to determine whether improvement of angina symptoms differs between 196 south Asians and 1508 whites following revascularization or medical management.
43.9% of south Asians reported improvement in angina at 6 years compared with 60.3% of whites (age-adjusted OR 0.56, 95% CI 0.41–0.76, adjusted for diabetes, hypertension, smoking, number of diseased vessels, left ventricular function and social class OR 0.59, 95% CI 0.41–0.85). Similar proportions of whites and south Asians underwent percutaneous coronary intervention (PCI) (19.6% versus 19.9%) and coronary artery bypass surgery (CABG) (32.8% versus 30.1%). South Asians were less likely to report improved angina after PCI (OR 0.19, 95% CI 0.06–0.56) or CABG (OR 0.36, 95% CI 0.17–0.74). There was less evidence of ethnic differences in angina improvement when treatment was medical (OR 0.87, 95% CI 0.48–1.57).
South Asians were less likely to experience long-term improvements in angina than whites after receipt of revascularization. Further research is needed to identify why these ethnic groups differ in symptomatic prognosis following revascularization for coronary disease and how these differences may be mitigated.
Limited research has examined the association of individual trust, participation and social capital with obesity using objective measures of waist circumference (WC), body mass index (BMI) and network measures of social capital.
Data were obtained from a representative sample of Montreal residents. Participants completed questionnaires that included a position generator for collecting network social capital data. Measures of WC, height and weight were collected by registered nurses. To estimate associations with cardiometabolic risk, data on WC for individuals with BMI between 18.5 and 34.9 were extracted for analysis (n = 291). Using a proportional odds model with clustered robust standard errors, we evaluated the association of three different measures of individual social capital with elevated and substantially elevated WC and overweight and obesity categories of BMI. These measures were then evaluated in their associations with elevated WC and BMI, adjusting for socio-demographic and behavioral covariates.
Network social capital was inversely associated with the likelihood of being in an elevated WC risk category (odds ratio (OR) = 0.81, 95% confidence intervals (CI: 0.69, 0.96) and higher BMI category (OR = 0.81, 95% CI: 0.71, 0.92).
Higher individual network social capital is associated with a lower likelihood of elevated WC risk and overweight and obesity.
A range of evidence suggests that the dominant culture associated with the economic systems of ‘modern’ societies has become a major source of pressure on global resources and may precipitate a third revolution in human history, with major implications for health and well-being.
This paper aims to consider whether there are historical analogies with contemporary circumstances which might help us make connections between past and present predicaments in the human condition; to highlight the underpinnings of such predicaments in the politico-economic and cultural systems found in ‘modern’ societies; to outline questions prompted by this analysis, and stimulate greater debate around the issues raised.
We draw on evidence and arguments condensed from complex research and theorizing from multiple disciplines.
Contemporary evidence suggests that global depletion of a key energy resource (oil), increasing environmental degradation and imminent climate change can be linked to human socio-economic and cultural systems which are now out of balance with their environment. Those systems are associated with Western-type societies, where political philosophies of neo-liberalism, together with cultural values of individualism, materialism and consumerism, support an increasingly globalized capitalist economic system. Evidence points to a decline of psychological and social well-being in such societies.
We need to work out how to prevent/ameliorate the harms likely to flow from climate change and rising oil costs. Public health professionals face the challenge of preventing adverse health consequences likely to result from continued adherence to the have-it-all mindset prevailing in contemporary Western societies. Equally, we need to seek out the potential health dividends that could be realized in terms of reduced obesity, improved well-being and greater social equity, while not under-estimating the likelihood of profound resistance, from many sectors of society, to unwanted but inevitable change.
To evaluate a new military syndromic surveillance system (2SE FAG) set up in French Guiana.
The evaluation was made using the current framework published by the Centers for Disease Control and Prevention, Atlanta, USA. Two groups of system stakeholders, for data input and data analysis, were interviewed using semi-structured questionnaires to assess timeliness, data quality, acceptability, usefulness, stability, portability and flexibility of the system. Validity was assessed by comparing the syndromic system with the routine traditional weekly surveillance system.
Qualitative data showed a degree of poor acceptability among people who have to enter data. Timeliness analysis showed excellent case processing time, hindered by delays in case reporting. Analysis of stability indicated a high level of technical problems. System flexibility was found to be high. Quantitative data analysis of validity indicated better agreement between syndromic and traditional surveillance when reporting on dengue fever cases as opposed to other diseases.
The sophisticated technical design of 2SE FAG has resulted in a system which is able to carry out its role as an early warning system. Efforts must be concentrated on increasing its acceptance and use by people who have to enter data and decreasing the occurrence of the frequency of technical problems.
Worldwide efforts for measles elimination are made possible due to the availability of a highly effective measles vaccine. In spite of highly vaccinated population, a measles outbreak occurred in Qassim province of Saudi Arabia, during January–August 2007.
An outbreak investigation was conducted to describe the epidemiology of outbreak. An audit of performance of control measures taken by the Primary Health Care team was done according to World Health Organization standards.
Of 230 cases reported, more than one-third (37.8%) patients were 0–4 years of age. Children aged 6–11 months accounted for 51.7% cases amongst 0–4 years age group. The performance indicator targets of ≥80% for outbreak control measures were achieved regarding investigation of cases within 48 hours, and blood sample extraction within the optimal period. However, 66.8% cases reported within 48 hours of rash onset and only 16.4% of laboratory test results were received within 7 days of receipt of the specimen in laboratory.
This outbreak demonstrates the increased susceptibility of unvaccinated children aged 6–11 months. To prevent future outbreaks, community awareness, review of measles vaccination schedule, enhanced surveillance and measles ‘catch-up’ mass immunization campaign to interrupt chains of transmission, are required.
Acute chemical incidents involving chlorine have potentially important public health consequences. Swimming pools are the single most common setting for such incidents in the UK. This study systematically describes the distribution, characteristics and public health consequences of all acute chemical incidents associated with swimming pools in England and Wales over a 5-month summer period.
All chemical incidents occurring from June to October 2007 reported to the Health Protection Agency or identified through media reports were included. Standardized information on the incidents was collected from local Health protection units, emergency services and/or local authorities.
In the study period, 13 incidents were identified. In many of the incidents, evacuation and dispersal of those involved occurred before the arrival of emergency services and some individuals self-presented to clinical services. During the study period, no individuals suffered from severe health effects due to chlorine exposure.
Acute chemical incidents associated with swimming pools are relatively common and can lead to the evacuation of large numbers of people even when the release is confined to the pool plant room. The evacuation and dispersal of wet, poorly clad swimmers may have negative health consequences. Incident management protocols should include consideration of when full pool evacuation is justified and mechanisms to ensure the correct advice is available for affected individuals.
This study examined changes in adult daily smoking in 1981–2005 in Finland, in order to evaluate the impact of the 1995 Tobacco Control Act Amendment (TCAA) and accompanying measures on the proportion of daily smokers. The main focus of the TCAA was to prohibit smoking at workplaces (designated rooms excluded) in order to protect workers from environmental tobacco smoke.
The study was based on data from annual postal surveys among 15- to 64-year-olds in 1981–2005 (average response rate 73%). The data set for this study comprised men and women aged 25–64 years (n = 73 471). Logistic models were used to test the effect of the 1995 TCAA across employment status while controlling for the effect of changes in the real price of tobacco and in gross domestic product per capita, and adjusting for age, education, secular trend and prevalence of ever-smokers in each birth cohort.
Controlling for confounding factors, the odds ratio (OR) for daily smoking after 1995 among employed men was 0.83 (95% CI 0.73–0.94) compared with the OR (1.0) for the period ending 1994. The corresponding figure for employed women was 0.78 (95% CI 0.68–0.91). The results can be interpreted as a positive effect of the 1995 TCAA on employees’ daily smoking. Moreover, a similar decrease in daily smoking was not seen among those not targeted by the TCAA (including farmers, students, housewives, pensioners and the unemployed).
Smoking behaviour was and can be influenced by national tobacco policy measures.
In July 2007, legislation banning smoking in public places was introduced in England. This study investigates the impact of this legislation on smoking in Bury.
A postal survey was undertaken before the implementation of the legislation. The survey was repeated 3 months after the smoking ban. Smoking prevalence was then compared. Participants were randomly selected using the PCT database of people registered with general practitioners. In the baseline and second survey, 3500 questionnaires were sent to participants. In the baseline survey 59.5% responded. In the second survey 56.3% responded.
Results were standardized to age and gender bands from Bury's population. The baseline survey found that the standardized prevalence of smoking before the ban was 22.4% and after it was 22.6%. The proportion of smokers reporting that on average they smoked 20 cigarettes a day or greater fell from 27.6 to 21.8% (P = 0.044).
The study found that in Bury the smoking ban did not have a substantial impact on smoking prevalence but had an impact on the proportion of heavy smokers. The measurement of smoking prevalence before the change in legislation can be used to assess its long-term impact on smoking habits in Bury.
To monitor and disseminate the short-term effects of the English Smoke-free legislation on air quality and employee exposure in businesses of the hospitality industry.
Indoor particle concentrations and salivary cotinine levels were measured in businesses in the hospitality sector and non-smoking employees one month before and after the implementation of the legislation. Results were immediately released to the media to announce the improvements in air quality and employee exposure to the wider public.
Measurements were collected in 49 businesses and from 75 non-smoking individuals. Indoor PM2.5 concentrations decreased by 95% from 217 µg/m3 at baseline to 11 µg/m3 at follow-up (P < 0.001). Salivary cotinine in employees was reduced by 75%, from 3.6 ng/ml at baseline to 0.9 ng/ml at follow-up (P < 0.001). The findings were presented to the public through press releases and interviews and were cited in over 20 media articles.
The project demonstrates the positive effects of the English Smoke-free legislation on air quality and second-hand smoke exposure in the hospitality industry sector. We believe that quick and positive feedback to the public on the effects of smoking restrictions is essential when introducing public health legislation such as the Smoke-free legislation.
There is no study that had a sample size sufficient to study the association between sociodemographic and smoking with obesity in Iran. The goal was to investigate these associations in the Iranian women.
Multivariate statistical techniques included 14 176 women between 20 and 69 years of age. Height and weight were measured rather than self-reported.
In Iranian adult women, obesity ORS for the moderate and high education were 0.78 and 0.41, respectively, compared with basic level. Using low economy index as the reference, Obesity ORS for the urban women were 1.29, 1.25 and 1.28 for the lower-middle, upper-middle and high groups, respectively. Obesity ORS for the rural women were 1.71, 1.71 and 2.02 for the lower-middle, upper-middle and high groups, respectively. Obesity OR was 0.48 for active workforce compared with inactive group. Obesity OR was 0.70 for smokers women compared with nonsmokers. Using non-married as the reference group, Obesity ORS were 1.23 and 2.34 for married urban and rural women, respectively.
Our results on the associations between age, smoking, education level, workforce and obesity are consistent with most studies, but between economic level and obesity are consistent with some study in developing countries.
Overweight and obesity pose a challenge to public health in China. According to Chinese definition, 303 million Chinese are overweight (body mass index, BMI ≥ 24 kg m–2). Among them, 73 million are clinically obese (BMI ≥ 28 kg m–2). In line with the global trend, the rate of obesity in China continues to increase, with associated morbidity and mortality. This study was to identify interventions, which are effective in Mainland Chinese society.
All non-drug-controlled interventions (≥3 months) in Mainland China, which used anthropometric outcome measures, were selected from three Chinese and nine international electronic databases (before May 2006) and included in this systematic review.
A total of 20 studies met the selection criteria and were included in the review. Among them only one was published in an international journal. Most studies combined at least physical activity, dietary intervention and health education. Seventeen studies (85%) reported significant effects in anthropometric measurement outcomes.
Comprehensive interventions with at least physical activity, dietary intervention and health education may be effective in reducing obesity in Chinese children. The role of grandparents as carers in the one-child society is worth considering further. Current evidence of effective interventions for adults is limited. Publication bias in Chinese databases should be taken into account.
Health literacy (HL) has been recognized as an important public health issue in other developed countries such as the US. There is currently no HL screening tool valid for use in the UK. This study aimed to validate a US-developed HL screening tool (the Rapid Estimate for Adult Literacy in Medicine; REALM) for use in the UK against the UK's general literacy screening tool (the Basic Skills Agency Initial Assessment Test, BSAIT).
A cross-sectional survey involving 300 adult patients admitted to hospital for investigation of coronary heart disease were given the REALM and BSAIT tools to complete as well as specific questions considered likely to predict HL. These questions relate to the difficulty in understanding medical information, medical forms or instructions on tablets, frequency of reading books and whether the participant's job involves reading.
The REALM was significantly correlated with the BSAIT (r = 0.70; P < 0.001), and significantly related to seven of the eight questions likely to be predictive of HL.
This study has shown that the REALM has face, criterion and construct validity for use as an HL screening tool in the UK, in research and in everyday clinical practice. Further studies are needed to assess the prevalence of low HL in a wider population and to explore the links that may exist between low HL and poor health in the UK.
Recent case reports of scurvy indicate that vitamin C deficiency may be more prevalent that generally assumed. The Low Income Diet and Nutrition Survey (2003–05) of a representative sample of the low-income/materially deprived UK population included a plasma vitamin C measurement.
Adults aged ≥19 years from all countries/regions of UK were screened to identify low-income/materially deprived households. A valid plasma vitamin C measurement was made in 433 men and 876 women. The results were weighted for sampling probability and non-response.
An estimated 25% of men and 16% of women in the low-income/materially deprived population had plasma vitamin C concentrations indicative of deficiency (<11 µmol l–1), and a further fifth of the population had levels in the depleted range (11–28 µmol l–1). Being a man, reporting low-dietary vitamin C intake, not taking vitamin supplements and smoking were predictors of plasma vitamin C levels ≤28 µmol l–1 in mutually adjusted logistic regression models.
Health professionals need to be aware that poor vitamin C status is relatively common among adults living on a low income.
Compared with screening programs for breast and cervical cancer, reported participation rates for colorectal cancer (CRC) screening are low. The effectiveness of a screening program is strongly influenced by the participation rate. The aim of this study was to investigate the main reasons not to participate in a population-based, invitational CRC screening program.
In the Dutch study program for CRC screening, a random selection of 20 623 persons were invited received a faecal occult blood test. Of the non-participants, 500 were randomly selected and contacted for a standardized telephone interview from November 2006 to May 2007 to document the main reason not to participate.
In total, 312 (62%) non-participants could be included for analysis. Most frequently, reported reasons for non-participation were time-related or priority-related (36%), including ‘did not notice test in mailbox’ (13%) and ‘forgot’ (8%). Other reasons were health-related issues, such as ‘severe illness’ (9%), or emotional reasons, such as ‘family circumstances’ (7%).
The majority of the reported reasons not to participate reflect low priority for screening. Adding extra instructions and information, and addressing specific concerns through additional interventions should be considered to improve individual decision-making about participation in future CRC population-based screening programs.
Since 2003, the University of Leeds has been a pilot site for the National Chlamydia Screening Programme (NCSP), which offers opportunistic screening to asymptomatic people under the age of 25. Uptake among men is low. The purpose of this study is to explore perceptions and acceptability of the provision of Chlamydia screening in the University of Leeds among 18–25-year-old male students.
Using a purposive sample of 15 male students aged between 19 and 24, two focus group sessions were conducted within university grounds.
Thematic analysis of the data revealed that male attitudes about Chlamydia screening were affected by: (1) lack of knowledge about Chlamydia and screening; (2) social embarrassment about Chlamydia; (3) reluctance to seek medical help; (4) perception that Chlamydia was a ‘woman's disease’ and (5) indifference about health promotion campaigns.
To encourage the uptake of opportunistic screening of Chlamydia, men under 25 years should be made aware of their responsibility for their own sexual health. Emphasis can also be placed on the non-invasiveness, ease and privacy of the test.
Appropriate dental care is an important part of maintaining good oral health. We examined the relationship between socioeconomic status, neighbourhood deprivation levels and older people's dental service use.
We used logistic regression analysis to assess the relationship between self-reported dental service use and neighbourhood deprivation, adjusting for individual socioeconomic and health factors, in individuals aged 65+ in the 2005 Health Survey for England (n = 4240).
Among dentulous respondents, 69.9% reported attending for regular check-ups, 6.2% occasional check-ups, 18.4% only saw a dentist when in trouble and 5.6% never went to a dentist. In our adjusted model age, sex, region, education level, occupational social class, self-reported health and smoking status, but not degree of urbanization, were associated with use of dental services. Following adjustment for these other factors those living in the most deprived 20% of neighbourhoods, compared with those in the least deprived, had a relative risk ratio of 2.25 (95% confidence interval 1.59–3.17) of using dental services only when symptomatic, rather than going for regular or occasional check-ups. When alternative outcomes of reporting having recently seen a doctor or been a hospital inpatient were assessed these deprivation-related patterns in service use were not evident.
Levels of neighbourhood deprivation are associated with the use of dental services by older people. Action is needed to ensure older people in deprived communities access appropriate and comprehensive dental services.
Since 1997, UK guidance has advocated limiting antibiotic prescribing for otitis media. It is not known whether this has influenced general practitioner prescribing practice.
To investigate the trends in diagnoses and antibiotic prescribing for otitis media in children in relation to guidance.
We used the General Practice Research Database to conduct time-trend analyses of diagnoses and antibiotic prescribing for otitis media in 3 months to 15 years old, between 1990 and 2006.
A total of 1 210 237 otitis media episodes were identified in 464 845 children; two-thirds (68%; 818 006) received antibiotics. Twenty-two percent (267 335) were classified as acute, 85% (227 335) of which received antibiotics. Overall, antibiotic prescribing for otitis media declined by 51% between 1995 and 2000. Much of this reduction predated guidance. During this period, prescribing for otitis media coded as acute increased by 22%. Children diagnosed with acute otitis media were more likely to receive antibiotics than otitis media not coded as acute (P < 0.05). From 2000 prescribing plateaued, despite publication of further guidance. Otitis media diagnoses consistently paralleled prescribing.
The reduction in antibiotic prescribing for otitis media predated guidance. The simultaneous decrease in prescribing for non-acute otitis media and increase for acute otitis media suggest diagnostic transfer, possibly to justify the decision to treat.
Mental health is one of the most important public health issues because of major contributor to the global burden of disease. In this study, we examined the prevalence and predictors of mental disorders among married women from 15 to 49 years of age and the need for mental health services in the primary health care settings.
In this cross-sectional study, 270 women were selected using probability cluster sampling method at 95% confidence interval (91.5% response rate). The Structured Clinical Interview for DSM-IV (SCID-I) and women socio-demographic information form were used to collect data.
Although the prevalence of mental disorder was 25.9% (8.5% with one diagnosis; 17.4% were two or more diagnoses), 4.7% of these women had contacted a carer in the last year for psychological reasons. According to the SCID-I assessment, the most prevalent diagnoses were major depressive disorder (7.3%), phobic disorder (4.8%) and posttraumatic stress disorder (3.6%). In this study, comorbid diagnoses were present in 67.2% of patients. Logistic regression analyses revealed that domestic violence, history of previous trauma, anemia and cutaneous leishmaniasis were significant predictors of any mental disorders (P < 0.05).
These findings highlight the need for systematic development of community-based mental health services in conjunction with primary health care services for the screening, early identification and treatment of women suffering from mental disorders, and the improvement of anemia and cutaneous leishmaniasis control programme.
The National Audit Office (NAO) has produced prescribing indicators that Primary Care Trusts (PCTs) can use to judge their performance. One of the indicators is for the antiplatelet clopidogrel, measured as defined daily dose (DDD) per cardiovascular Specific Therapeutic Age Related Prescribing Unit (STAR-PU). Clopidogrel is used as an indicator because it is a more expensive medicine than the alternative (aspirin) and there may be scope for cost reduction. We aimed to establish if the NAO indicator for clopidogrel prescribing is a valid measure of prescribing performance.
Prescribing data for 152 PCTs and a range of explanatory variables were obtained. Correlation between variables was determined. A regression analysis was conducted to compare the dependent variable (prescribing) with the explanatory variables identified.
The percentage of patients on the coronary heart disease register and Index of Multiple Deprivation explained 30% of the variation in prescribing (DDD/STAR-PU) between PCTs. Even though DDD/STAR-PU is adjusted for age and sex other measures of need still have an impact on prescribing.
Using DDD/STAR-PU alone as a prescribing indicator might misidentify some PCTs, which are under- and over-using clopidogrel. Poor ranking against other PCTs using the NAO indicator should be fully explored taking into account other variables (cardiovascular morbidity and deprivation) before any corrective action is taken.
The recent significant improvement in most health indicators in Iran has not been explored deeply particularly in comparison with other countries in Eastern Mediterranean Region (EMR). We aimed to explore the temporal variations of five main indicators in Iran and compare their variations in EMR countries.
Data on DPT vaccination and birth weight were obtained from EMR office reports, and total fertility rate, under 5 mortality rate (U5MR) and adult literacy rate (ALR) were obtained from WHO sources for the time period 1995–2005. Using linear regression, we modeled the temporal variations in Iran and other EMR countries classified by their human development index (HDI) levels.
The estimated annual decline rate of U5MR in Iran as a middle HDI country was 2.5 per 1000 live birth which was much greater than the corresponding number in countries with medium HDI (1.85) and very close to countries with high HDI (2.67). The WHO data showed that Iran was very successful in increasing ALR.
It seems that most health indicators in Iran have improved more rapidly compared with countries with low and medium HDI in EMR. The improvement rates were also very close to countries with high HDI in the region.