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Wende D, Karmann A, Weinhold I. Deprivation as a fundamental cause of morbidity and reduced life expectancy: an observational study using German statutory health insurance data. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:257-277. [PMID: 38580883 DOI: 10.1007/s10754-024-09374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/11/2024] [Indexed: 04/07/2024]
Abstract
Across all developed countries, there is a steep life expectancy gradient with respect to deprivation. This paper provides a theoretical underpinning for this gradient in line with the Grossman model, indicating that deprivation affects morbidity and, consequently, life expectancy in three ways: directly from deprivation to morbidity, and indirectly through lower income and a trade-off between investments in health and social status. Using rich German claims data covering 6.3 million insured people over four years, this paper illustrates that deprivation increases morbidity and reduces life expectancy. It was estimated that highly deprived individuals had approximately two more chronic diseases and a life expectancy reduced by 15 years compared to the least deprived individuals. This mechanism of deprivation is identified as fundamental, as deprived people remain trapped in their social status, and this status results in health investment decisions that affect long-term morbidity. However, in the German setting, the income and investment paths of the effects of deprivation were of minor relevance due to the broad national coverage of its SHI system. The most important aspects of deprivation were direct effects on morbidity, which accumulate over the lifespan. In this respect, personal aspects, such as social status, were found to be three times more important than spatial aspects, such as area deprivation.
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Affiliation(s)
- Danny Wende
- BARMER Institute for Health Systems Research, Berlin, Germany.
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Kienast-von Einem C, Panter J, Ogilvie D, Reid A. Exploring residential relocation- differences between newcomers and settled residents in health, travel behaviour and neighbourhood perceptions. Health Place 2024; 87:103254. [PMID: 38701677 DOI: 10.1016/j.healthplace.2024.103254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
This study explores whether people who have recently moved to an area differ from longer-term residents in their health, travel behaviour, and perceptions of the environment. Using a large, representative sample from the UKHLS, Newcomers demonstrate significantly lower mental and physical health, reduced car commuting, and a higher likelihood of liking their neighbourhood. Area deprivation, urbanicity, household income, and age emerge as influential moderators with i.e. Newcomers in affluent areas experiencing lower physical health than Settled Residents, and rural Newcomers expressing less neighbourhood satisfaction. Our findings highlight that Newcomers' perceptions of their environment diverge and environmental influences vary among population segments, potentially impacting related health behaviours such as active travel. Furthermore, residential relocation introduces Newcomers with distinct characteristics into areas, affecting the context in which potential population health interventions aiming to influence health behaviours operate. This necessitates a deeper understanding of what influences reactions to the environment as well as ongoing adaptation of environmental interventions to respond to changing contexts within the same location over time.
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Affiliation(s)
- Caroline Kienast-von Einem
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - Alice Reid
- Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
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Ingle L, Martindale R, Salami B, Fakorede FI, Harvey K, Capes S, Abt G, Chipperfield S. Health and lifestyle advisors in support of primary care: An evaluation of an innovative pilot service in a region of high health inequality. PLoS One 2024; 19:e0298955. [PMID: 38578752 PMCID: PMC10997055 DOI: 10.1371/journal.pone.0298955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/01/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION A health and lifestyle advisor service embedded within primary care was piloted in Kingston-upon-Hull from January 2021. We aimed to evaluate the first two years of service delivery by identifying patient demographics referred to the service, reason for referral, determine uptake and retention rates, and monitor individual lifestyle-related risk factor changes following discharge. METHODS Anonymised data were extracted from the SystmOne database for all patients referred to the service between January 2021 and January 2023. RESULTS In the initial two years of the service, 705 unique patients were referred at a mean rate of ∼29 per month. Each unique patient received a median (robust median absolute deviation; [MAD]) of 3 (Steel N, et al 2018) planned consultations prior to discharge over this period. The majority of referrals were for symptom management and health promotion purposes (95%). Of those referred, 69% attended their appointments, and 14% did not attend. The majority of referrals were white British (55%), however, the service did receive a substantial number of referrals from minority ethnic groups, with only 67% of referrals speaking English as their main language. Eighteen distinct languages were spoken. Most referrals were classified as class I obese (59.4%). Across initial and final appointments, median (robust MAD) systolic blood pressure was 130 (15) mmHg and 130 (15) mmHg, and median (robust MAD) waist circumference was 103.0 (13.3) cm and 101.0 (13.3) cm. CONCLUSION The evaluation highlighted the demand for this service embedded within primary care settings in Kingston-upon-Hull. Service engagement was evident, and a large proportion of those who engaged were from minority ethnic groups. A high proportion of referrals presented with obesity and/or hypertension which requires further investigation.
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Affiliation(s)
- Lee Ingle
- School of Sport, Exercise and Rehabilitation Science, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Rachel Martindale
- School of Sport, Exercise and Rehabilitation Science, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Boluwatife Salami
- School of Sport, Exercise and Rehabilitation Science, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Funsho Irete Fakorede
- School of Sport, Exercise and Rehabilitation Science, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Kate Harvey
- The Health and Wellbeing Service - Primary Care, City Health Care Partnership CIC, Marfleet Lane Surgery, Hull, United Kingdom
| | - Sarah Capes
- The Health and Wellbeing Service - Primary Care, City Health Care Partnership CIC, Marfleet Lane Surgery, Hull, United Kingdom
| | - Grant Abt
- School of Sport, Exercise and Rehabilitation Science, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Sarah Chipperfield
- School of Sport, Exercise and Rehabilitation Science, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
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Han H, Xu M, Wang J, Li MD, Yang Z. CRISPR/Cas9 based gene editing of Frizzled class receptor 6 (FZD6) reveals its role in depressive symptoms through disrupting Wnt/β-catenin signaling pathway. J Adv Res 2024; 58:129-138. [PMID: 37321345 PMCID: PMC10982865 DOI: 10.1016/j.jare.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/18/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION As one of the common psychiatric diseases, depression poses serious threats to human health. Although many genes have been nominated for depression, few of them were investigated in details at the molecular level. OBJECTIVES To demonstrate Frizzled class receptor 6 (FZD6) functions in depression through disrupting Wnt/β-catenin signal pathway. METHODS The FZD6 edited cell line and mouse model were generated by using CRISPR/Cas9 technique. The expression of key genes and proteins in Wnt/β-catenin pathway was determined by qRT-PCR and Western blotting, respectively. Animal behavioral tests, including open field test (OFT), elevated plus maze test (EPM), forced swimming test (FST), tail suspension test (TST), and sucrose preference test (SPT), were employed to determine anxiety- and depressive-like behaviors. Immunofluorescent staining was used to assess cell proliferation in the hippocampus of mouse brain. RESULTS Among patients with depression, FZD6, one of the receptors of Wnt ligand, was significantly decreased. In CRISPR/Cas9-based FZD6 knockdown cells, we showed that FZD6 plays a significant role in regulating expression of genes involved in Wnt/β-catenin pathway. Subsequently behavioral studies on Fzd6 knockdown mice (with a 5-nucleotide deletion; Fzd6-Δ5) revealed significant changes in depressive symptoms, including increased immobility duration in FST, less preference of sucrose in SPT, reduction of distance traveled in OFT, and decreased time spent in open arms in EPM. Immunofluorescent staining showed decreased cell proliferation in the hippocampus of Fzd6-Δ5 mice with reduced number of Ki67+ and PCNA+ cells. Moreover, decreased Gsk3β mRNA expression, phosphorylated GSK3β, and cytoplasmic β-catenin in the hippocampus of Fzd6-Δ5 mice provided further evidence supporting the role of Fzd6 in depression. CONCLUSION Together, above findings proved the significant role of FZD6 in depression through its effect on hippocampal cell proliferation and its ability to regulate canonical Wnt/β-catenin pathway.
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Affiliation(s)
- Haijun Han
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Mengxiang Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ju Wang
- VIT University, Chennai, India
| | - Ming D Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, China.
| | - Zhongli Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Gulyas BZ, Caton SJ, Edmondson JL. Quantifying the relationship between gardening and health and well-being in the UK: a survey during the covid-19 pandemic. BMC Public Health 2024; 24:810. [PMID: 38486178 PMCID: PMC10941614 DOI: 10.1186/s12889-024-18249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Rates of non-communicable diseases, including cardiovascular disease and type 2 diabetes, and mental health problems, such as anxiety and depression, are high and rising in the urbanising world. Gardening could improve both mental and physical health and help prevent a range of conditions by increasing fruit and vegetable (F&V) consumption, promoting physical activity, and reducing stress. However, good quality quantitative research in the area is scarce, and our understanding of the role of allotments and home gardens, and the effects of the level of engagement in gardening and involvement with food production has thus far been limited. METHODS We quantitatively assess the relationship between home and allotment gardening and various indicators and predictors of health and well-being using an online survey of gardeners (n = 203) and non-gardeners (n = 71) in the UK. The survey was composed of multiple validated questionnaires (including the Short Form Food Frequency Questionnaire (SFFFQ), the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), the Physical Health Questionnaire (PHQ) and the Self-Rated Health question (SRH)) and self-defined questions relating to participants' involvement with gardening and food production, and relevant demographic and lifestyle factors. Data were analysed using a series of hierarchical logistic and multiple linear regression models adjusting for socio-demographic variables. RESULTS After adjusting for relevant socio-demographic factors, gardening related variables were associated with better self-rated health, higher mental well-being, increased F&V consumption. Higher F&V intake was in turn also associated with better self-rated health and decreased odds of obesity. Thus, gardening had a positive association with four different aspects of health and well-being, directly or indirectly via increased F&V consumption. CONCLUSIONS Our results suggest that gardening in UK allotments and domestic gardens may promote different aspects of health and well-being via multiple mechanisms. Improving access to growing space and promoting regular gardening could provide a range of benefits to public health. More research on how socio-economic factors influence the health and well-being benefits of gardening will help policymakers devise strategies to maximise these benefits.
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Affiliation(s)
- Boglarka Z Gulyas
- Plants, Photosynthesis and Soil, School of Biosciences, University of Sheffield, S10 2TN, Sheffield, UK
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, S10 2TN, Sheffield, UK
| | - Samantha J Caton
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, S10 2TN, Sheffield, UK
| | - Jill L Edmondson
- Plants, Photosynthesis and Soil, School of Biosciences, University of Sheffield, S10 2TN, Sheffield, UK.
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Watson KT, Keller J, Spiro CM, Satz IB, Goncalves SV, Pankow H, Kosti I, Lehallier B, Sequeira A, Bunney WE, Rasgon NL, Schatzberg AF. Proteomic profiles of cytokines and chemokines in moderate to severe depression: Implications for comorbidities and biomarker discovery. Brain Behav Immun Health 2024; 36:100731. [PMID: 38435722 PMCID: PMC10906146 DOI: 10.1016/j.bbih.2024.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024] Open
Abstract
Objective This study assessed the proteomic profiles of cytokines and chemokines in individuals with moderate to severe depression, with or without comorbid medical disorders, compared to healthy controls. Two proteomic multiplex platforms were employed for this purpose. Metods An immunofluorescent multiplex platform and an aptamer-based method were used to evaluate 32 protein analytes from 153 individuals with moderate to severe major depressive disorder (MDD) and healthy controls (HCs). The study focused on determining the level of agreement between the two platforms and evaluating the ability of individual analytes and principal components (PCs) to differentiate between the MDD and HC groups. Additionally, the study investigated the relationship between PCs consisting of chemokines and cytokines and comorbid inflammatory and cardiometabolic diseases. Findings Analysis revealed a small or moderate correlation between 47% of the analytes measured by the two platforms. Two proteomic profiles were identified that differentiated individuals with moderate to severe MDD from HCs. High eotaxin, age, BMI, IP-10, or IL-10 characterized profile 1. This profile was associated with several cardiometabolic risk factors, including hypertension, hyperlipidemia, and type 2 diabetes. Profile 2 is characterized by higher age, BMI, interleukins, and a strong negative loading for eotaxin. This profile was associated with inflammation but not cardiometabolic risk factors. Conclusion This study provides further evidence that proteomic profiles can be used to identify potential biomarkers and pathways associated with MDD and comorbidities. Our findings suggest that MDD is associated with distinct profiles of proteins that are also associated with cardiometabolic risk factors, inflammation, and obesity. In particular, the chemokines eotaxin and IP-10 appear to play a role in the relationship between MDD and cardiometabolic risk factors. These findings suggest that a focus on the interplay between MDD and comorbidities may be useful in identifying potential targets for intervention and improving overall health outcomes.
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Affiliation(s)
- Kathleen T. Watson
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
| | - Caleb M. Spiro
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
| | - Isaac B. Satz
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
| | - Samantha V. Goncalves
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
| | - Heather Pankow
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
| | | | | | - Adolfo Sequeira
- Department of Psychiatry & Human Behavior, University of California, Irvine, CA, USA
- School of Medicine, Irvine, CA, USA
| | - William E. Bunney
- Department of Psychiatry & Human Behavior, University of California, Irvine, CA, USA
- School of Medicine, Irvine, CA, USA
| | - Natalie L. Rasgon
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
| | - Alan F. Schatzberg
- Department of Psychiatry and Behavioral Health, Stanford School of Medicine, Stanford, CA, USA
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Gkiouleka A, Wong G, Sowden S, Kuhn I, Moseley A, Manji S, Harmston RR, Siersbaek R, Bambra C, Ford JA. Reducing health inequalities through general practice: a realist review and action framework. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-104. [PMID: 38551093 DOI: 10.3310/ytww7032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities. Objectives We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice. Design Realist review. Main outcome measures Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria. Review methods Realist review based on Pawson's five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence. Results Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people's experience is affected by many of their characteristics; • flexible to meet patients' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships. Limitations The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care. Conclusions Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred. Future work Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice. Study registration This trial is registered as PROSPERO CRD42020217871. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences and Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Annie Moseley
- Patient and Public Involvement Representative, Norwich, UK
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | - Rikke Siersbaek
- Health System Foundations for Sláintecare Implementation, Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John A Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Gilmore I, Jawad A. People before profits: why we need a coherent health policy approach to tobacco, alcohol, and unhealthy food. BMJ 2024; 384:q473. [PMID: 38423555 DOI: 10.1136/bmj.q473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
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Kumar L, Kumar H, Samiullah F. Comment on: Association Between the AHA Life's Essential 8 Score and Incident All-Cause Dementia: A Prospective Cohort Study From UK Biobank. Curr Probl Cardiol 2024; 49:102077. [PMID: 37716541 DOI: 10.1016/j.cpcardiol.2023.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Laksh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Haresh Kumar
- Liaquat National Medical College, Karachi, Pakistan
| | - Fnu Samiullah
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
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Hanson S, Belderson P, Player E, Minihane AM, Sweeting A. "Taking from Peter to pay Paul": The experience of people in receipt of fuel and food vouchers from a UK foodbank. NUTR BULL 2023; 48:500-512. [PMID: 37723996 DOI: 10.1111/nbu.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.
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Affiliation(s)
- Sarah Hanson
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Pippa Belderson
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Emily Player
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | | | - Anna Sweeting
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
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McKevitt S, White M, Petticrew M, Summerbell C, Vasiljevic M, Boyland E, Cummins S, Laverty AA, Millett C, de Vocht F, Junghans C, Vamos EP. Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England. J Public Health (Oxf) 2023; 45:878-887. [PMID: 37608490 PMCID: PMC10687598 DOI: 10.1093/pubmed/fdad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs. METHODS We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation). RESULTS Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods. CONCLUSIONS English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.
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Affiliation(s)
- Sarah McKevitt
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Martin White
- MRC Epidemiology Unit, School of Clinical Sciences, University of Cambridge, Cambridge, UK
| | - Mark Petticrew
- Department of Public Health, Environments & Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carolyn Summerbell
- Centre for Translational Research in Public Health, Fuse, Newcastle, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Milica Vasiljevic
- Centre for Translational Research in Public Health, Fuse, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration Northwest London (NIHR ARC), London, UK
| | - Cornelia Junghans
- NIHR Applied Research Collaboration Northwest London (NIHR ARC), London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Buckland G, Taylor CM, Emmett PM, Northstone K. Prospective association between adherence to UK dietary guidelines in school-age children and cardiometabolic risk markers in adolescence/early adulthood in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Br J Nutr 2023; 130:1766-1778. [PMID: 37066640 PMCID: PMC10587371 DOI: 10.1017/s0007114523000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Research into how alignment to UK dietary guidelines during childhood affects cardiometabolic health is limited. The association between adherence to UK dietary guidelines during childhood and overall cardiometabolic risk (CMR) in adolescence/early adulthood was explored using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC children with diet diaries completed at 7, 10 and 13 years of age, and data on CMR markers at 17 years (n 1940) and 24 years (n 1957) were included. A children's Eatwell Guide (C-EWG) score was created by comparing dietary intakes at each age to UK dietary guidelines for nine foods/nutrients. Cardiometabolic health at 17 and 24 years was assessed using a composite CMR score. Multivariable linear regression models examined associations between C-EWG scores at 7, 10 and 13 years and the CMR score at 17 and 24 years, adjusting for confounders. C-EWG scores were generally low. However, a higher score (adherence to more dietary guidelines) at 7 years old was associated with a lower CMR score at 17 and 24 years: β -0·13 (95 % CI -0·25, -0·01) and β -0·25 (95 % CI -0·38, -0·13) for a 1-point increase in C-EWG score, respectively. A higher C-EWG score at 10 years was also associated with a lower CMR z-score at 24 years. No clear associations were evident at other ages. Greater adherence to UK dietary guidelines during mid-childhood was associated with a better overall cardiometabolic profile, suggesting that encouraging children to eat in this way has long-term benefits to health.
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Affiliation(s)
- Genevieve Buckland
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline M. Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pauline M. Emmett
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Northstone
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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13
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Weight N, Moledina S, Rashid M, Chew N, Castelletti S, Buchanan GL, Salinger S, Gale CP, Mamas MA. Temporal analysis of non-ST segment elevation-acute coronary syndrome (NSTEACS) outcomes in 'young' patients under the age of fifty: A nationwide cohort study. Int J Cardiol 2023; 391:131294. [PMID: 37625485 DOI: 10.1016/j.ijcard.2023.131294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/25/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The characteristics and risk factor profile of young patients presenting with non-ST segment elevation acute coronary syndrome (NSTEACS) and how they may have changed over time is not well reported. METHODS We identified 26,708 NSTEACS patients aged under 50 presenting to United Kingdom (UK) hospitals between 2010 and 2017 from Myocardial Ischaemia National Audit Project (MINAP). We calculated incidence of NSTEACS per 100,000 UK population, using Office of National Statistics (ONS) population estimates, prevalence of comorbidities, ethnicity, and in-hospital mortality. We formed biennial groups to enable comparison, 2010-2011, 2012-2013, 2014-2015 and 2016-2017. RESULTS The incidence of NSTEACS per 100,000 population showed minimal change between 2010 and 2017 (2010: 5.4 per 100,000 and 2017; 4.9 per 100,000). Rates of smoking (2010-11; 58% and 2016-17; 53%), and family history of coronary artery disease (CAD) (2010-11; 51% and 2016-17; 44%) fell, but the proportion of patients from an ethnic minority background (2010-11; 12% and 2016-17; 20%), with diabetes mellitus (DM) (2010-11; 14%, and 2016-17; 18%) and female patients (2010-11; 22% and 2016-17; 24%) increased over the study period. Mortality from NSTEACS remained unchanged (2010-11; 1% and 2016-17; 1%). CONCLUSIONS The incidence of NSTEACS in patients aged under fifty has not reduced despite reduction in prevalence of risk factors such as smoking hypercholesterolaemia in those admitted to UK hospitals. Despite improved rates of early invasive coronary angiography and percutaneous coronary intervention in 'young' NSTEACS patients, in-hospital mortality remains unchanged.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, (Italy)
| | - Gill Louise Buchanan
- Cardiology Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Sonja Salinger
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK.
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14
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Radfard M, Hashemi H, Baghapour MA, Samaei MR, Yunesian M, Soleimani H, Azhdarpoor A. Prediction of human health risk and disability-adjusted life years induced by heavy metals exposure through drinking water in Fars Province, Iran. Sci Rep 2023; 13:19080. [PMID: 37925586 PMCID: PMC10625539 DOI: 10.1038/s41598-023-46262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
Exposure to heavy metals in contaminated drinking water is strongly correlated with various cancers, highlighting the burden of disease. This study aimed to assess the non-carcinogenic and carcinogenic risks associated with exposure to heavy metals (As, Pb, Cd, and Cr) in drinking water of Fars province and evaluate the attributed burden of disease. Non-carcinogenic risk assessment was performed using the hazard quotient (HQ) method, while the carcinogenic risk assessment utilized the excess lifetime cancer risk approach. The burden of disease was evaluated in terms of years of life lost, years lived with disability, and disability-adjusted life years (DALY) for three specific cancers: skin, lung, and kidney cancer. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr) and lead (Pb) were determined to be 0.72, 0.4, 1.10 and 0.72 μg/L, respectively. The total average HQ of heavy metals in drinking water in the study area were 0.127, 0.0047, 0.0009 and 0.0069, respectively. The average ILCRs of heavy metal in the entire country were in the following order: 1.15 × 10-5 for As, 2.22 × 10-7 for Cd and 3.41 × 10-7 for Cr. The results also indicated that among the various counties analyzed, Fasa experiences the greatest burden of disease in terms of DALYs, with a value of 87.56, specifically attributed to cancers caused by exposure to arsenic. Generally, it can be said that the burden of disease is a critical aspect of public health that requires comprehensive understanding and effective intervention.
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Affiliation(s)
- Majid Radfard
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Hashemi
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Baghapour
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Samaei
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Soleimani
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abooalfazl Azhdarpoor
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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15
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Lynch M, Peat G, Jordan K, Yu D, Wilkie R. Where does it hurt? Small area estimates and inequality in the prevalence of chronic pain. Eur J Pain 2023; 27:1177-1186. [PMID: 37345222 PMCID: PMC10947147 DOI: 10.1002/ejp.2148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/05/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Chronic pain affects up to half of UK adults, impacting quality of life and demand on local health services. Whilst local health planning is currently based on subnational prevalence estimates, associations between pain and sociodemographic characteristics suggest that inequalities in the prevalence of chronic and high-impact chronic pain between neighbourhoods within local authorities are likely. We aimed to derive lower super output area (LSOA) estimates of the prevalence of chronic and high-impact chronic pain. METHODS Presence of self-reported chronic and high-impact chronic pain were measured in adults aged 35+ in North Staffordshire and modelled using multilevel regression as a function of demographic and geographic predictors. Multilevel model predictions were post-stratified using the North Staffordshire age-sex population structure and LSOA demographic characteristics to estimate the prevalence of chronic and high-impact chronic pain in 298 LSOAs, corrected for ethnic diversity underrepresented in the data. Confidence intervals were generated for high-impact chronic pain using bootstrapping. RESULTS Data were analysed from 4162 survey respondents (2358 women, 1804 men). The estimated prevalence of chronic and high-impact chronic pain in North Staffordshire LSOAs ranged from 18.6% to 50.1% and 6.18 [1.71, 16.0]% to 33.09 [13.3, 44.7]%, respectively. CONCLUSIONS Prevalence of chronic and high-impact chronic pain in adults aged 35+ varies substantially between neighbourhoods within local authorities. Further insight into small-area level variation will help target resources to improve the management and prevention of chronic and high-impact chronic pain to reduce the impact on individuals, communities, workplaces, services and the economy. SIGNIFICANCE Post-stratified multilevel model predictions can produce small-area estimates of pain prevalence and impact. The evidence of substantial variation indicates a need to collect local-level data on pain and its impact to understand health needs and to guide interventions.
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Affiliation(s)
| | - George Peat
- School of MedicineKeele UniversityKeeleUK
- The Centre for Applied Health & Social Care ResearchSheffield Hallam UniversitySheffieldUK
| | | | - Dahai Yu
- School of MedicineKeele UniversityKeeleUK
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16
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Liu J, Huang B, Ding F, Li Y. Environment factors, DNA methylation, and cancer. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:7543-7568. [PMID: 37715840 DOI: 10.1007/s10653-023-01749-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
Today, the rapid development of science and technology and the rapid change in economy and society are changing the way of life of human beings and affecting the natural, living, working, and internal environment on which human beings depend. At the same time, the global incidence of cancer has increased significantly yearly, and cancer has become the number one killer that threatens human health. Studies have shown that diet, living habits, residential environment, mental and psychological factors, intestinal flora, genetics, social factors, and viral and non-viral infections are closely related to human cancer. However, the molecular mechanisms of the environment and cancer development remain to be further explored. In recent years, DNA methylation has become a key hub and bridge for environmental and cancer research. Some environmental factors can alter the hyper/hypomethylation of human cancer suppressor gene promoters, proto-oncogene promoters, and the whole genome, causing low/high expression or gene mutation of related genes, thereby exerting oncogenic or anticancer effects. It is expected to develop early warning markers of cancer environment based on DNA methylation, thereby providing new methods for early detection of cancers, diagnosis, and targeted therapy. This review systematically expounds on the internal mechanism of environmental factors affecting cancer by changing DNA methylation, aiming to help establish the concept of cancer prevention and improve people's health.
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Affiliation(s)
- Jie Liu
- Department of General Surgery, Second Hospital of Lanzhou University, Lan Zhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Second Hospital of Lanzhou University, Lan Zhou, China
| | - Binjie Huang
- Department of General Surgery, Second Hospital of Lanzhou University, Lan Zhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Second Hospital of Lanzhou University, Lan Zhou, China
| | - Feifei Ding
- Department of General Surgery, Second Hospital of Lanzhou University, Lan Zhou, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Second Hospital of Lanzhou University, Lan Zhou, China
| | - Yumin Li
- Department of General Surgery, Second Hospital of Lanzhou University, Lan Zhou, China.
- Key Laboratory of the Digestive System Tumors of Gansu Province, Second Hospital of Lanzhou University, Lan Zhou, China.
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17
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Putra IGNE, Polden M, Wareing L, Robinson E. Acceptability and perceived harm of calorie labeling and other obesity policies: A cross-sectional survey study of UK adults with eating disorders and other mental health conditions. Int J Eat Disord 2023; 56:2049-2061. [PMID: 37507841 PMCID: PMC10947290 DOI: 10.1002/eat.24031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We assessed perceptions of recently proposed UK obesity policies (mandatory calorie labeling, banning of advertisements of unhealthy food and drinks online and before 9 pm on TV, and banning "buy one get one free" deals for unhealthy food and drinks) in people with an eating disorder (ED) and other mental health conditions. METHOD A total of 1273 participants with a self-reported lifetime mental health condition (N = 583 with an ED) completed an online survey in September-November 2022. Multinomial logistic regression was used to examine support for and potential adverse effects of policies in participants with and without an ED. A qualitative analysis of the potential effects of the policy on current ED symptoms was also conducted to better understand how and why policies may be damaging or beneficial. RESULTS Participants with an ED had a lower level of support for the implementation of the calorie labeling policy compared to those without an ED (43% vs. 58%). Half of the participants with an ED (55%) reported that labeling may worsen their ED symptoms. Qualitative data indicated perceived potential harm (e.g., a gateway to relapse, negative effects on mood) and perceived benefits (e.g., feeling informed and reassured) of calorie labeling in participants with an ED. No differences in support or perceived harms of the other two policies were observed between participants with versus without an ED. DISCUSSION Future studies are warranted to explore the potential effects of calorie labeling and how to mitigate negative impacts on people with an ED. PUBLIC SIGNIFICANCE This research is the first to assess the perceptions of UK obesity-related policies in people with an ED and other mental health conditions. Participants with an ED (vs. without) were more likely to disagree with the government implementing the calorie labeling policy. These findings highlight the potentially harmful effects of calorie labeling in people with an ED and the need for future research to understand how to mitigate negative impacts.
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Affiliation(s)
| | - Megan Polden
- Department of Primary Care and Mental Health, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
- NIHR Applied Research Collaboration North West CoastLiverpoolUK
| | | | - Eric Robinson
- Department of Psychology, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
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18
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Schofield B, Hoskins R, Rolfe U, McClean S, Voss S, Benger J. Health promotion in emergency care settings: investigating staff views and experiences. Emerg Nurse 2023; 31:26-32. [PMID: 37070267 DOI: 10.7748/en.2023.e2156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 04/19/2023]
Abstract
BACKGROUND Emergency departments (EDs) afford 'teachable moments' for health behaviour change, but staff may not see themselves as public health practitioners and it can be challenging to undertake health promotion activities in emergency care settings. Furthermore, the evidence on health promotion in these settings is limited. AIM To investigate the views and experiences of emergency nurses and ambulance service paramedics regarding health promotion in emergency care settings. METHOD A convenience sample of emergency nurses (n=3) and ambulance service paramedics (n=3) was recruited. An inductive and descriptive qualitative study design using semi-structured interviews and thematic analysis was employed. FINDINGS The participants understood health promotion and were willing to have conversations about it with patients. However, they cited several barriers to health promotion, including understaffing, a lack of understanding of the relevance of health promotion among staff, a lack of training and information, and the sensitivity of topics such as body weight and sexual health. Lack of time was not cited as a barrier. CONCLUSION There are opportunities for developing the health promotion aspect of practice in emergency care settings, where staff and patients would benefit from a more structured, system-wide approach to health promotion.
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Affiliation(s)
- Behnaz Schofield
- School of Health and Social Wellbeing, University of the West of England, Bristol, England
| | - Rebecca Hoskins
- School of Health and Social Wellbeing, University of the West of England, Bristol, England
| | - Ursula Rolfe
- Midwifery and Health Sciences Department, Bournemouth University, Bournemouth, England
| | | | - Sarah Voss
- University of the West of England, Bristol, England
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19
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Karreman N, Huang Y, Egan N, Carters-White L, Hawkins B, Adams J, White M. Understanding the role of the state in dietary public health policymaking: a critical scoping review. Health Promot Int 2023; 38:daad100. [PMID: 37665718 PMCID: PMC10476878 DOI: 10.1093/heapro/daad100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Despite evidence that dietary population health interventions are effective and widely accepted, they remain the topic of intense debate centring on the appropriate role of the state. This review sought to identify how the role of the state in intervening in individuals' food practices is conceptualized across a wide range of literatures. We searched 10 databases and 4 journals for texts that debated dietary population health interventions designed to affect individuals' health-affecting food practices. Two co-authors independently screened these texts for eligibility relative to inclusion and exclusion criteria. Thirty-five texts formed our final corpus. Through critical reflexive thematic analysis (TA), we generated 6 themes and 2 subthemes concerning choice, responsibility for health, balancing benefits and burdens of intervention, the use of evidence, fairness, and the legitimacy of the state's actions. Our analysis found that narratives that aim to prevent effective regulation are entrenched in academic literatures. Discourses that emphasized liberty and personal responsibility framed poor health as the result of 'lifestyle choices'. Utilitarian, cost-benefit rationales pervaded arguments about how to best balance the benefits and burdens of state intervention. Claims about fairness and freedom were used to evoke powerful common meanings, and evidence was used politically to bolster interests, particularly those of the food industry. This review identifies and critically analyses key arguments for and against population dietary public health policies. Our findings should motivate public health researchers and practitioners to avoid unreflexively embracing framings that draw on the languages and logics of free market economics.
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Affiliation(s)
- Nancy Karreman
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Yuru Huang
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Natalie Egan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Lauren Carters-White
- SPECTRUM Consortium, Usher Institute of Population Health Sciences and Informatics, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Benjamin Hawkins
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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20
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Badeenezhad A, Soleimani H, Shahsavani S, Parseh I, Mohammadpour A, Azadbakht O, Javanmardi P, Faraji H, Babakrpur Nalosi K. Comprehensive health risk analysis of heavy metal pollution using water quality indices and Monte Carlo simulation in R software. Sci Rep 2023; 13:15817. [PMID: 37740101 PMCID: PMC10517167 DOI: 10.1038/s41598-023-43161-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023] Open
Abstract
Rapid urbanization, population growth, agricultural practices, and industrial activities have led to widespread groundwater contamination. This study evaluated heavy metal contamination in residential drinking water in Shiraz, Iran (2021). The analysis involved 80 groundwater samples collected across wet and dry seasons. Water quality was comprehensively assessed using several indices, including the heavy metals evaluation index (HEI), heavy metal pollution index (HPI), contamination degree (CD), and metal index (MI). Carcinogenic and non-carcinogenic risk assessments were conducted using deterministic and probabilistic approaches for exposed populations. In the non-carcinogenic risk assessment, the chronic daily intake (CDI), hazard quotient (HQ), and hazard index (HI) are employed. The precision of risk assessment was bolstered through the utilization of Monte Carlo simulation, executed using the R software platform. Based on the results, in both wet and dry seasons, Zinc (Zn) consistently demonstrates the highest mean concentration, followed by Manganese (Mn) and Chromium (Cr). During the wet and dry seasons, 25% and 40% of the regions exhibited high CD, respectively. According to non-carcinogenic risk assessment, Cr presents the highest CDI and HQ in children and adults, followed by Mn, As and HI values, indicating elevated risk for children. The highest carcinogenic risk was for Cr in adults, while the lowest was for Cd in children. The sensitivity analysis found that heavy metal concentration and ingestion rate significantly impact both carcinogenic and non-carcinogenic risks. These findings provide critical insights for shaping policy and allocating resources towards effectively managing heavy metal contamination in residential drinking water.
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Affiliation(s)
- Ahmad Badeenezhad
- Department of Environmental Health Engineering, School of Medical Sciences, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Hamed Soleimani
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Shahsavani
- Department of Environmental Health Engineering, Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Parseh
- Department of Environmental Health Engineering, School of Medical Sciences, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Amin Mohammadpour
- Department of Environmental Health Engineering, School of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Azadbakht
- Department of Radiobiology and Radiation Protection, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Parviz Javanmardi
- Department of Environmental Health Engineering, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
| | - Hossein Faraji
- Health Systems Research, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Kamal Babakrpur Nalosi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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21
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Bass S. Compassion in healthcare leadership and the reality of balancing it with effective and efficient service delivery at a time of crisis. Int J Palliat Nurs 2023; 29:455-458. [PMID: 37757809 DOI: 10.12968/ijpn.2023.29.9.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Steve Bass
- Lead clinical nurse for palliative and end of life care, University Hospitals Sussex NHS Foundation Trust, Palliative Care, Brighton
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22
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Buckland G, Northstone K, Emmett PM, Taylor CM. Adherence to UK dietary guidelines in school-aged children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Br J Nutr 2023; 130:454-466. [PMID: 36305030 PMCID: PMC10331434 DOI: 10.1017/s0007114522003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
Compliance to UK dietary recommendations was assessed in school-aged children from a population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). A Children's Eatwell Guide (C-EWG) score was developed to assess socio-demographic predictors of meeting dietary recommendations. ALSPAC children with plausible diet diary data at 7 years (n 5373), 10 years (n 4450) and 13 years (n 2223) were included in the study. Their dietary intakes (recorded between 1998 and 2006) were compared with dietary guidelines for total and saturated fats, free sugars, salt, fibre, protein, carbohydrates, fruit and vegetables, non-oily and oily fish and red/processed meat. The C-EWG score (0-9 points) indicated the number of recommendations met at each age. Cross-sectional associations between socio-demographic characteristics and C-EWG scores were assessed using multivariable regression. The lowest adherence to guidelines at 7 years was for sugar (0·1 % meeting recommendations), followed by fibre (7·7 %), oily fish (9·5 %), saturated fat (9·7 %) and fruit and vegetables (15·2 %). Highest adherence was for limiting red/processed meat (67·3 %) and meeting carbohydrate recommendations (77·3 %). At 7 years, 12·1 % of participants failed to meet any of the nine recommendations, 26·9 % met one and 28·2 % met two. Similar patterns were seen at 10 and 13 years. A lower social class and maternal educational attainment and higher maternal BMI were associated with meeting fewer recommendations. Most school-aged children in this cohort did not meet UK dietary recommendations, particularly children from lower socio-economic backgrounds. Additional public health initiatives are needed to improve the quality of UK children's diets, particularly targeting lower socio-economic groups.
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Affiliation(s)
- Genevieve Buckland
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Northstone
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pauline M. Emmett
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline M. Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
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23
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Jephcote C, Clark SN, Hansell AL, Jones N, Chen Y, Blackmore C, Eminson K, Evans M, Gong X, Adams K, Rodgers G, Fenech B, Gulliver J. Spatial assessment of the attributable burden of disease due to transportation noise in England. ENVIRONMENT INTERNATIONAL 2023; 178:107966. [PMID: 37390771 DOI: 10.1016/j.envint.2023.107966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/14/2023] [Accepted: 05/07/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Noise pollution from transportation is one of the leading contributors to the environmental disease burden in Europe. We provide a novel assessment of spatial variations of these health impacts within a country, using England as an example. METHODS We estimated the burden of annoyance (highly annoyed), sleep disturbance (highly sleep disturbed), ischemic heart disease (IHD), stroke, and diabetes attributable to long-term transportation noise exposures in England for the adult population in 2018 down to local authority level (average adult population: 136,000). To derive estimates, we combined literature-informed exposure-response relationships, with population data on noise exposures, disease, and mortalities. Long-term average noise exposures from road, rail and aircraft were sourced from strategic noise mapping, with a lower exposure threshold of 50 dB (decibels) Lden and Lnight. RESULTS 40 %, 4.5 % and 4.8 % of adults in England were exposed to road, rail, and aircraft noise exceeding 50 dB Lden. We estimated close to a hundred thousand (∼97,000) disability adjusted life years (DALY) lost due to road-traffic, ∼13,000 from railway, and ∼ 17,000 from aircraft noise. This excludes some noise-outcome pairs as there were too few studies available to provide robust exposure-response estimates. Annoyance and sleep disturbance accounted for the majority of the DALYs, followed by strokes, IHD, and diabetes. London, the South East, and North West regions had the greatest number of road-traffic DALYs lost, while 63 % of all aircraft noise DALYs were found in London. The strategic noise mapping did not include all roads, which may still have significant traffic flows. In sensitivity analyses using modelled noise from all roads in London, the DALYs were 1.1x to 2.2x higher. CONCLUSION Transportation noise exposures contribute to a significant and unequal environmental disease burden in England. Omitting minor roads from the noise exposure modelling leads to underestimation of the disease burden.
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Affiliation(s)
- Calvin Jephcote
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Sierra N Clark
- Noise and Public Health, Radiation Chemical and Environmental Hazards, Science Group, UK Health Security Agency, UK
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK
| | | | - Yingxin Chen
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Claire Blackmore
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Katie Eminson
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Megan Evans
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Xiangpu Gong
- NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK
| | - Kathryn Adams
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Georgia Rodgers
- Noise and Public Health, Radiation Chemical and Environmental Hazards, Science Group, UK Health Security Agency, UK
| | - Benjamin Fenech
- Noise and Public Health, Radiation Chemical and Environmental Hazards, Science Group, UK Health Security Agency, UK; NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK.
| | - John Gulliver
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK.
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Wu J, Yu L, Liu Y, Xiao B, Ye X, Zhao H, Xi Y, Shi Z, Wang W. Hypoxia regulates adipose mesenchymal stem cells proliferation, migration, and nucleus pulposus-like differentiation by regulating endoplasmic reticulum stress via the HIF-1α pathway. J Orthop Surg Res 2023; 18:339. [PMID: 37158945 PMCID: PMC10169485 DOI: 10.1186/s13018-023-03818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Hypoxia can promote stem cell proliferation and migration through HIF-1α. Hypoxia can regulate cellular endoplasmic reticulum (ER) stress. Some studies have reported the relationship among hypoxia, HIF-α, and ER stress, however, while little is known about HIF-α and ER stress in ADSCs under hypoxic conditions. The purpose of the study was to investigate the role and relationship of hypoxic conditions, HIF-1α and ER stress in regulating adipose mesenchymal stem cells (ADSCs) proliferation, migration, and NPC-like differentiation. METHOD ADSCs were pretreated with hypoxia, HIF-1α gene transfection, and HIF-1α gene silence. The ADSCs proliferation, migration, and NPC-like differentiation were assessed. The expression of HIF-1α in ADSCs was regulated; then, the changes of ER stress level in ADSCs were observed to investigate the relationship between ER stress and HIF-1α in ADSCs under hypoxic conditions. RESULT The cell proliferation and migration assay results show that hypoxia and HIF-1α overexpression can significantly increase the ADSCs proliferation and migration, while HIF-1α inhibition can significantly decrease the ADSCs proliferation and migration. The HIF-1α and co-cultured with NPCs played an important role in the directional differentiation of ADSCs into NPCs. The hypoxia-regulated ER stress in ADSCs through the HIF-1α pathway, thereby regulating the cellular state of ADSCs, was also observed. CONCLUSION Hypoxia and HIF-1α play important roles in proliferation, migration, and NPC-like differentiation of ADSCs. This study provides preliminary evidence that HIF-1α-regulated ER stress thus affects ADSCs proliferation, migration, and differentiation. Therefore, HIF-1α and ER may serve as key points to improve the efficacy of ADSCs in treating disc degeneration.
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Affiliation(s)
- Jianxin Wu
- Department of Orthopaedics, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Shanghai, People's Republic of China
| | - Lei Yu
- Department of Orthopedic Surgery and Neurosurgery, No. 906 Hospital of the People's Liberation Army, Ningbo, Zhejiang, People's Republic of China
| | - Yi Liu
- Department of Orthopedics, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Kangfu Road, Tianjin, People's Republic of China
| | - Bing Xiao
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai, People's Republic of China
| | - Xiaojian Ye
- Department of Orthopaedics, Tongren Hospital of Shanghai Jiaotong University, No. 1111, Xianxia Road, Shanghai, People's Republic of China
| | - Hong Zhao
- Department of Orthopedics, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Kangfu Road, Tianjin, People's Republic of China
| | - Yanhai Xi
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai, People's Republic of China
| | - Zhicai Shi
- Department of Orthopaedics, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Shanghai, People's Republic of China
| | - Weiheng Wang
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai, People's Republic of China.
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Vodden A, Holdroyd I, Bentley C, Marshall L, Barr B, Massou E, Ford J. Evaluation of the national governmental efforts between 1997 and 2010 in reducing health inequalities in England. Public Health 2023; 218:128-135. [PMID: 37019028 DOI: 10.1016/j.puhe.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/05/2023] [Accepted: 02/27/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The pandemic has compounded existing inequalities. In the UK, there have been calls for a new cross-government health inequalities strategy. This study aims to evaluate the effectiveness of national governmental efforts between 1997 and 2010, referred to as the National Health Inequalities Strategy (NHIS). STUDY DESIGN population-based observational study. METHODS Using Global Burden of Disease data, age-standardised years of life lost due to premature mortality (YLL) rates per 10,000 were extracted for 150 Upper Tier Local Authority (UTLA) regions in England for every year between 1990 and 2019. The slope index of inequality was calculated using YLL rates for all causes, individual conditions, and risk factors. Joinpoint regression was used to assess the trends of any changes which arose before, during or after the NHIS. RESULTS Absolute inequalities in YLL rates for all causes remained stable between 1990 and 2000, before decreasing over the following 10 years. After 2010, improvements slowed. A similar trend can be observed amongst inequalities in YLLs for individual causes, including ischaemic heart disease, stroke, breast cancer and lung cancer amongst females, and ischaemic heart disease stroke, diabetes and self-harm amongst males. This trend was also observed amongst certain risk factors, notably blood pressure, cholesterol, tobacco and dietary risks. Inequalities were generally greater in males than in females; however, trends were similar across both sexes. The NHIS coincided with significant reductions in inequalities in YLLs due to ischaemic heart disease and lung cancer. CONCLUSIONS The findings suggest that the NHIS coincided with a reduction in health inequalities in England. Policy makers should consider a new cross-government strategy to tackle health inequalities drawing from the success of the previous NHIS.
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Affiliation(s)
- A Vodden
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - I Holdroyd
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - C Bentley
- Independent Population Health Consultant, UK
| | - L Marshall
- The Health Foundation, 8 Salisbury Square, London EC4Y 8AP, UK
| | - B Barr
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, L693GB, UK
| | - E Massou
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - J Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, EC1M 6BQ, UK.
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Hinde S, Harrison AS, Bojke L, Doherty PJ. Achieving cardiac rehabilitation uptake targets: What is the value case for commissioners? A UK case-study. Int J Cardiol 2023; 380:29-34. [PMID: 36958397 DOI: 10.1016/j.ijcard.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
Cardiac Rehabilitation (CR) has become an established intervention to support patient recovery after a cardiac event, with evidence supporting its effectiveness and cost-effectiveness in improving patient health and reducing future burden on healthcare systems. However, this evidence has focussed on the national value case for CR rather than at the point at which it is commissioned. This analysis uses the UK as a case-study to explore variation in current CR engagement and disassemble the value case from a commissioner perspective. Using data collected by the National Audit of CR (NACR), and an existing model of cost-effectiveness, we present details on the current level of CR uptake by commissioning region (Specialist Clinical Networks) in light of the current UK target of achieving 85% uptake. We then interrogate the value case for achieving the target at a commissioner level, highlighting the expected profile of health benefits and healthcare system costs over the long-term. Importantly we consider where this may differ from the national value case. Each commissioning region has a unique level of CR uptake and sociodemographic profile. Concurrently, the value case for commissioning CR relies on the upfront cost of the service being offset by long-term healthcare savings, and health improvements. The shift in the UK and internationally to more localised commissioning necessitates evidence of cost-effectiveness that better reflects the realities of those decision makers. This paper provides vital additional data to facilitate such commissioners to understand the value case in increasing CR uptake in line with national policy.
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Affiliation(s)
- S Hinde
- Centre for Health Economics, University of York, UK.
| | - A S Harrison
- Department of Health Sciences, University of York, UK
| | - L Bojke
- Centre for Health Economics, University of York, UK
| | - P J Doherty
- Department of Health Sciences, University of York, UK
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Bell OJ, Flynn D, Clifford T, West D, Stevenson E, Avery L. Identifying behavioural barriers and facilitators to engaging men in a community-based lifestyle intervention to improve physical and mental health and well-being. Int J Behav Nutr Phys Act 2023; 20:25. [PMID: 36879249 PMCID: PMC9990339 DOI: 10.1186/s12966-023-01425-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND There are few community-based lifestyle interventions designed to target physical and mental health of men. We conducted a qualitative focus group study with men to explore their perceived barriers and facilitators to uptake and engagement with interventions designed to improve their physical and mental health and wellbeing. METHODS A volunteer sampling approach (advertisements posted on a premier league football club's social media) was used to recruit men aged 28 to 65 years who were interested in improving their physical and/or mental health and wellbeing. Focus group discussions were conducted at a local premier league football club to 1) explore men's perceived barriers and facilitators to uptake of community-based interventions; 2) identify health issues considered important to address; 3) obtain participant views on how to best engage men in community-based interventions; and 4) use the findings to inform the development of a multibehavioural complex community-based intervention (called 'The 12th Man'). RESULTS Six focus group discussions were conducted (duration 27 to 57 min) involving 25 participants (median age 41 years, IQR = 21 years). Thematic analyses generated seven themes: 'Lifestyle behaviours for both mental health and physical health'; 'work pressures are barriers to engaging with lifestyle behaviour change'; previous injuries are barriers to engagement in physical activity and exercise'; personal and peer group relationships impact on lifestyle behaviour change'; relationships between body image and self-confidence on mastery of skills for physical activity and exercise'; building motivation and personalised goal setting'; and 'credible individuals increase uptake and continued engagement with lifestyle behaviour change'. CONCLUSIONS Findings suggest that a multibehavioural community-based lifestyle intervention designed for men should promote parity of esteem between physical and mental health. It should also acknowledge individual needs and preferences, emotions in the context of goal setting and planning, and be delivered by a knowledgeable and credible professional. The findings will inform the development of a multibehavioural complex community-based intervention ('The 12th Man').
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Affiliation(s)
- Oliver J Bell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Newcastle United Foundation, Newcastle Upon Tyne, UK
| | - Darren Flynn
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Tom Clifford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Daniel West
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma Stevenson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Leah Avery
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK. .,Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Newcastle Upon Tyne, UK.
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Dewez JE, Nijman RG, Fitchett EJA, Lynch R, de Groot R, van der Flier M, Philipsen R, Vreugdenhil H, Ettelt S, Yeung S. Adoption of C-reactive protein point-of-care tests for the management of acute childhood infections in primary care in the Netherlands and England: a comparative health systems analysis. BMC Health Serv Res 2023; 23:191. [PMID: 36823597 PMCID: PMC9947887 DOI: 10.1186/s12913-023-09065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The use of point of care (POC) tests varies across Europe, but research into what drives this variability is lacking. Focusing on CRP POC tests, we aimed to understand what factors contribute to high versus low adoption of the tests, and also to explore whether they are used in children. METHODS We used a comparative qualitative case study approach to explore the implementation of CRP POC tests in the Netherlands and England. These countries were selected because although they have similar primary healthcare systems, the availability of CRP POC tests in General Practices is very different, being very high in the former and rare in the latter. The study design and analysis were informed by the non-adoption, abandonment, spread, scale-up and sustainability (NASSS) framework. Data were collected through a review of documents and interviews with stakeholders. Documents were identified through a scoping literature review, search of websites, and stakeholder recommendation. Stakeholders were selected purposively initially, and then by snowballing. Data were analysed thematically. RESULTS Sixty-five documents were reviewed and 21 interviews were conducted. The difference in the availability of CRP POC tests is mainly because of differences at the wider national context level. In the two countries, early adopters of the tests advocated for their implementation through the generation of robust evidence and by engaging with all relevant stakeholders. This led to the inclusion of CRP POC tests in clinical guidelines in both countries. In the Netherlands, this mandated their reimbursement in accordance with Dutch regulations. Moreover, the prevailing better integration of health services enabled operational support from laboratories to GP practices. In England, the funding constraints of the National Health Service and the prioritization of alternative and less expensive antimicrobial stewardship interventions prevented the development of a reimbursement scheme. In addition, the lack of integration between health services limits the operational support to GP practices. In both countries, the availability of CRP POC tests for the management of children is a by-product of the test being available for adults. The tests are less used in children mainly because of concerns regarding their accuracy in this age-group. CONCLUSIONS The engagement of early adopters combined with a more favourable and receptive macro level environment, including the role of clinical guidelines and their developers in determining which interventions are reimbursed and the operational support from laboratories to GP practices, led to the greater adoption of the tests in the Netherlands. In both countries, CRP POC tests, when available, are less used less in children. Organisations considering introducing POC tests into primary care settings need to consider how their implementation fits into the wider health system context to ensure achievable plans.
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Affiliation(s)
- Juan Emmanuel Dewez
- grid.8991.90000 0004 0425 469XClinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruud G. Nijman
- grid.7445.20000 0001 2113 8111Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Elizabeth J. A. Fitchett
- grid.8991.90000 0004 0425 469XClinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca Lynch
- grid.8391.30000 0004 1936 8024Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Ronald de Groot
- grid.10417.330000 0004 0444 9382Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Centre for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud UMC, Nijmegen, The Netherlands
| | - Michiel van der Flier
- grid.461578.9Paediatric Infectious diseases and Immunology, Amalia Children’s Hospital, Radboudumc, Nijmegen, The Netherlands ,grid.417100.30000 0004 0620 3132Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ria Philipsen
- grid.10417.330000 0004 0444 9382Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Centre for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud UMC, Nijmegen, The Netherlands
| | - Harriet Vreugdenhil
- grid.7692.a0000000090126352Utrecht General Practice Training Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefanie Ettelt
- grid.8991.90000 0004 0425 469XDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK ,grid.506777.40000 0001 2295 4495Prognos AG, Basel, Switzerland
| | - Shunmay Yeung
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK. .,Department of Paediatrics, St Mary's Imperial College Hospital NHS Trust, London, UK.
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Wang C, Zhang X, Li B, Mu D. A study of factors impacting disease based on the Charlson Comorbidity Index in UK Biobank. Front Public Health 2023; 10:1050129. [PMID: 36699869 PMCID: PMC9868818 DOI: 10.3389/fpubh.2022.1050129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Objective With advances in medical diagnosis, more people are diagnosed with more than one disease. The damage caused by different diseases varies, so relying solely on the number of diseases to represent multimorbidity is limited. The Charlson comorbidity index (CCI) is widely used to measure multimorbidity and has been validated in various studies. However, CCI's demographic and behavioral risk factors still need more exploration. Methods We conduct multivariate logistic regression analysis and restricted cubic splines to examine the influence factors of CCI and the relationship between covariates and risk of CCI, respectively. Our research employs the Multivariate Imputation by Chained Equations method to interpolate missing values. In addition, the CCI score for each participant is calculated based on the inpatient's condition using the International Classification of Diseases, edition 10 (ICD10). Considering the differences in the disease burden between males and females, the research was finally subgroup analyzed by sex. Results This study includes 5,02,411 participants (2,29,086 female) with CCI scores ranging from 0 to 98. All covariates differed between CCI groups. High waist-hip ratio (WHR) increases the risk of CCI in both males [OR = 19.439, 95% CI = (16.261, 23.241)] and females [OR = 12.575, 95% CI = (11.005, 14.370)], and the effect of WHR on CCI is more significant in males. Associations between age, Body Mass Index (BMI) and WHR, and CCI risk are J-shaped for all participants, males, and females. Concerning the association between Townsend deprivation index (TDI) and CCI risk, the U-shape was found in all participants and males and varied to a greater extent in males, but it is a J-shape in females. Conclusions Increased WHR, BMI, and TDI are significant predictors of poor health, and WHR showed a greater role. The impact of deprivation indices on health showed differences by sex. Socio-economic factors, such as income and TDI, are associated with CCI. The association of social status differences caused by these socioeconomic factors with health conditions should be considered. Factors might interact with each other; therefore, a comprehensive, rational, and robust intervention will be necessary for health.
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Affiliation(s)
- Changcong Wang
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, China,Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China
| | - Xinyue Zhang
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, China,Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China
| | - Bai Li
- Department of Colorectal and Anal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Dongmei Mu
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, China,Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China,*Correspondence: Dongmei Mu ✉
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Mistry H, Enderby J, Court R, Al-Khudairy L, Nduka C, Melendez-Torres GJ, Taylor-Phillips S, Clarke A, Uthman OA. Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom. Health Technol Assess 2022:10.3310/QOVK6659. [PMID: 36562488 PMCID: PMC10068585 DOI: 10.3310/qovk6659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. METHODS In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)]. RESULTS Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained. FUTURE WORK AND LIMITATIONS We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy. CONCLUSIONS It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hema Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jodie Enderby
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Chidozie Nduka
- Warwick Medical School, University of Warwick, Coventry, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, UK
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Khanal S, Underwood M, Naghdi S, Brown A, Duncan C, Matharu M, Mistry H. A systematic review of economic evaluations of pharmacological treatments for adults with chronic migraine. J Headache Pain 2022; 23:122. [PMID: 36114468 PMCID: PMC9479409 DOI: 10.1186/s10194-022-01492-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022] Open
Abstract
Background and aims Chronic migraine is a common neurovascular brain disorder with substantial economic costs. We performed a systematic review to identify economic evaluations of pharmacological treatments for adults with chronic migraine. Methods We undertook systematic literature searches using terms for migraine/headache and prophylactic drug interventions, combined with economic/cost terms where appropriate. Using inclusion and exclusion criteria, two reviewers independently assessed the citations and abstracts, and full-text articles were retrieved. A review of study characteristics and methodological quality was assessed. Results Sixteen citations met the inclusion criteria and were model-based cost-utility studies evaluating: Botox (n = 6); Erenumab (n = 8); Fremanezumab (n = 2); and Galcanezumab (n = 1) as the main treatment. They varied in their use of comparators, perspective, and model type. Botox was cost-effective compared to placebo with an incremental cost-effectiveness ratio (ICER) ranging between £15,028 (€17,720) and £16,598 (€19,572). Erenumab, Fremanezumab and Galcanezumab when compared to Botox, was associated with ICERs ranging between £59,712 ($81,080) and £182,128 (€218,870), with the ICERs above the most common willingness-to-pay thresholds (WTPs). But they were cost-effective within the commonly used WTPs among the population for whom the previous treatments including Botox were failed. Three studies compared the cost-effectiveness of Erenumab against the placebo and found that Erenumab was dominant. All studies performed sensitivity analyses to check the robustness of their results. None of the findings from the included articles were generalisable and none of the included studies fulfilled all the criteria mentioned in the CHEERS 2022 reporting checklist and Phillips’s checklist for economic models. Conclusions Evidence to support the cost-effectiveness of pharmacological treatments of chronic migraine in the adult population using Botox and Erenumab were identified. Our findings suggest that both Botox and Erenumab, are cost-effective compared to placebo; although Erenumab had more incremental economic benefits compared to Botox, the ICERs were above the most common willingness-to-pay thresholds. Hence, Erenumab might be an acceptable treatment for chronic migraine for patients whom other treatments such as Botox do not work. Further research is needed to help characterise the data to adequately structure and parameterise an economic model to support decision-making for chronic migraine therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01492-y.
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Gentry SV, Paterson BA. Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? A rapid evidence summary. J Public Health (Oxf) 2022; 44:810-822. [PMID: 34231848 DOI: 10.1093/pubmed/fdab238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are traumatic events in childhood that can have impacts throughout life. It has been suggested that ACEs should be 'screened' for, or routinely enquired about, in childhood or adulthood. The aim of this work is to review evidence for this against the United Kingdom National Screening Committee (UKNSC) programme criteria. METHODS A rapid review of evidence on ACEs screening was conducted using the approach of the UKNSC. RESULTS Good quality evidence was identified from meta-analyses for associations between ACEs and a wide range of adverse outcomes. There was no consistent evidence on the most suitable screening tool, setting of administration, and time or frequency of use. Routine enquiry among adults was feasible and acceptable to service users and professionals in various settings. A wide range of potentially effective interventions was identified. Limited evidence was available on the potential for screening or routine enquiry to reduce morbidity and mortality or possible harms of screening. CONCLUSIONS Based on the application of available evidence to UKNSC screening criteria, there is currently insufficient evidence to recommend the implementation of a screening programme for ACEs. Further research is needed to determine whether routine enquiry can improve morbidity, mortality, health and wellbeing.
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Affiliation(s)
- S V Gentry
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK.,Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - B A Paterson
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK
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Brennan A, Angus C, Pryce R, Buykx P, Henney M, Gillespie D, Holmes J, Meier PS. Effectiveness of subnational implementation of minimum unit price for alcohol: policy appraisal modelling for local authorities in England. Addiction 2022; 118:819-833. [PMID: 36367289 DOI: 10.1111/add.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
AIMS Evidence exists on the potential impact of national level minimum unit price (MUP) policies for alcohol. This study investigated the potential effectiveness of implementing MUP at regional and local levels compared with national implementation. DESIGN Evidence synthesis and computer modelling using the Sheffield Alcohol Policy Model (Local Authority version 4.0; SAPMLA). SETTING Results are produced for 23 Upper Tier Local Authorities (UTLAs) in North West England, 12 UTLAs in North East England, 15 UTLAs in Yorkshire and Humber, the nine English Government Office regions and England as a whole. CASES Health Survey for England (HSE) data 2011-13 (n = 24 685). MEASUREMENTS Alcohol consumption, consumer spending, retailers' revenues, hospitalizations, National Health Service costs, crimes and alcohol-attributable deaths and health inequalities. FINDINGS Implementing a local £0.50 MUP for alcohol in northern English regions is estimated to result in larger percentage reductions in harms than the national average. The reductions for England, North West, North East and Yorkshire and Humber regions, respectively, in annual alcohol-attributable deaths are 1024 (-10.4%), 205 (-11.4%), 121 (-17.4%) and 159 (-16.9%); for hospitalizations are 29 943 (-4.6%), 5956 (-5.5%), 3255 (-7.9%) and 4610 (-6.9%); and for crimes are 54 229 (-2.4%), 8528 (-2.5%), 4380 (-3.5%) and 8220 (-3.2%). Results vary among local authorities; for example, annual alcohol-attributable deaths estimated to change by between -8.0 and -24.8% throughout the 50 UTLAs examined. CONCLUSIONS A minimum unit price local policy for alcohol is likely to be more effective in those regions, such as the three northern regions of England, which have higher levels of alcohol consumption and higher rates of alcohol harm than for the national average. In such regions, the minimum unit price policy would achieve larger reductions in alcohol consumption, alcohol-attributable mortality, hospitalization rates, NHS costs, crime rates and health inequalities.
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Affiliation(s)
- Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert Pryce
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,School of Humanities and Social Science, University of Newcastle, Callaghan, NSW, Australia
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Duncan Gillespie
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Reynolds JP, Ventsel M, Hobson A, Pilling MA, Pechey R, Jebb SA, Hollands GJ, Marteau TM. Evaluation of physical activity calorie equivalent (PACE) labels' impact on energy purchased in cafeterias: A stepped-wedge randomised controlled trial. PLoS Med 2022; 19:e1004116. [PMID: 36346795 PMCID: PMC9642872 DOI: 10.1371/journal.pmed.1004116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent meta-analysis suggested that using physical activity calorie equivalent (PACE) labels results in people selecting and consuming less energy. However, the meta-analysis included only 1 study in a naturalistic setting, conducted in 4 convenience stores. We therefore aimed to estimate the effect of PACE labels on energy purchased in worksite cafeterias in the context of a randomised study design. METHODS AND FINDINGS A stepped-wedge randomised controlled trial (RCT) was conducted to investigate the effect of PACE labels (which include kcal content and minutes of walking required to expend the energy content of the labelled food) on energy purchased. The setting was 10 worksite cafeterias in England, which were randomised to the order in which they introduced PACE labels on selected food and drinks following a baseline period. There were approximately 19,000 workers employed at the sites, 72% male, with an average age of 40. The study ran for 12 weeks (06 April 2021 to 28 June 2021) with over 250,000 transactions recorded on electronic tills. The primary outcome was total energy (kcal) purchased from intervention items per day. The secondary outcomes were: energy purchased from non-intervention items per day, total energy purchased per day, and revenue. Regression models showed no evidence of an overall effect on energy purchased from intervention items, -1,934 kcals per site per day (95% CI -5,131 to 1,262), p = 0.236, during the intervention relative to baseline, equivalent to -5 kcals per transaction (95% CI -14 to 4). There was also no evidence for an effect on energy purchased from non-intervention items, -5 kcals per site per day (95% CI -513 to 504), p = 0.986, equivalent to 0 kcals per transaction (95% CI -1 to 1), and no clear evidence for total energy purchased -2,899 kcals per site (95% CI -5,810 to 11), p = 0.051, equivalent to -8 kcals per transaction (95% CI -16 to 0). Study limitations include using energy purchased and not energy consumed as the primary outcome and access only to transaction-level sales, rather than individual-level data. CONCLUSION Overall, the evidence was consistent with PACE labels not changing energy purchased in worksite cafeterias. There was considerable variation in effects between cafeterias, suggesting important unmeasured moderators. TRIAL REGISTRATION The study was prospectively registered on ISRCTN (date: 30.03.21; ISRCTN31315776).
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Affiliation(s)
- James P. Reynolds
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- School of Psychology, Aston University, Birmingham, United Kingdom
- * E-mail: (JPR); (TMM)
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alice Hobson
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark A. Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (JPR); (TMM)
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McGowan VJ, Bambra C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. Lancet Public Health 2022; 7:e966-e975. [PMID: 36334610 PMCID: PMC9629845 DOI: 10.1016/s2468-2667(22)00223-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has exacerbated endemic health inequalities resulting in a syndemic pandemic of higher mortality and morbidity rates among the most socially disadvantaged. We did a scoping review to identify and synthesise published evidence on geographical inequalities in COVID-19 mortality rates globally. We included peer-reviewed studies, from any country, written in English that showed any area-level (eg, neighbourhood, town, city, municipality, or region) inequalities in mortality by socioeconomic deprivation (ie, measured via indices of multiple deprivation: the percentage of people living in poverty or proxy factors including the Gini coefficient, employment rates, or housing tenure). 95 papers from five WHO global regions were included in the final synthesis. A large majority of the studies (n=86) found that COVID-19 mortality rates were higher in areas of socioeconomic disadvantage than in affluent areas. The subsequent discussion reflects on how the unequal nature of the pandemic has resulted from a syndemic of COVID-19 and endemic inequalities in chronic disease burden.
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Affiliation(s)
- Victoria J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.
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36
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Nicholls N, Caryl F, Olsen JR, Mitchell R. Neighbourhood natural space and the narrowing of socioeconomic inequality in years of life lost: a cross-sectional ecological analysis of the Scottish Burden of Disease. J Epidemiol Community Health 2022; 76:976-983. [PMID: 36253097 DOI: 10.1136/jech-2022-219111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Natural space is associated with reduced risk of, and narrower socioeconomic inequalities in, diseases that affect older populations, and some contributors to premature mortality in younger individuals. Burden of disease measures such as years of life lost (YLL) are influenced by premature poor health and death. We hypothesised some association between natural space and both rates of and inequalities in YLL might be present. METHODS The outcome data were the YLL component from Scottish Burden of Disease 2016, provided at small-area level (datazone) for males and females under 65 years of age in Scotland, UK. Exposure variables were the percentages of land cover within each datazone defined as 'natural space' (NS), and 'natural space and private gardens' (NSG). Together with a measure of area income deprivation, these were fitted in a multilevel Poisson model accounting for intra-datazone level variation, and spatial autocorrelation between datazones. RESULTS An increased percentage cover of NSG was associated with lower YLL in males (incident rate ratio (IRR) 0.993, 95% credible interval (CrI) 0.989 to 0.997) and females (IRR 0.993, CrI 0.987 to 0.998); each 10% increase of natural space cover was associated with a 7% decrease in the incidence rate. An increased amount of natural space within local areas was associated with reduced disparity in YLL between the most and least income deprived areas. CONCLUSIONS The health benefits of natural space also apply when indicators sensitive to health events at younger ages are used. An increased amount of natural space within local areas has the potential to reduce the disparity in YLL between the most and least income deprived areas-the 'equigenic' effect.
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Affiliation(s)
- Natalie Nicholls
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Fiona Caryl
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jonathan R Olsen
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Richard Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Knowles G, Gayer-Anderson C, Blakey R, Davis S, Lowis K, Stanyon D, Ofori A, Turner A, Dorn L, Beards S, Pinfold V, Reininghaus U, Harding S, Morgan C. Cohort Profile: Resilience, Ethnicity and AdolesCent mental Health (REACH). Int J Epidemiol 2022; 51:e303-e313. [PMID: 35348706 PMCID: PMC9557858 DOI: 10.1093/ije/dyac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gemma Knowles
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Charlotte Gayer-Anderson
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Rachel Blakey
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Samantha Davis
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Katie Lowis
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Daniel Stanyon
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Aisha Ofori
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Alice Turner
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Lynsey Dorn
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | | | | | - Stephanie Beards
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- National Children’s Bureau, London, UK
| | | | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health,
Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Seeromanie Harding
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty
of Life Sciences & Medicine, King’s College London, London, UK
| | - Craig Morgan
- Corresponding author. ESRC Centre for Society and Mental Health,
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5
8AF, UK. E-mail:
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Reeve NF, Best V, Gillespie D, Hughes K, Lugg-Widger FV, Cannings-John R, Torabi F, Wootton M, Akbari A, Ahmed H. Myocardial infarction and stroke subsequent to urinary tract infection (MISSOURI): protocol for a self-controlled case series using linked electronic health records. BMJ Open 2022; 12:e064586. [PMID: 36137640 PMCID: PMC9511592 DOI: 10.1136/bmjopen-2022-064586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION There is increasing interest in the relationship between acute infections and acute cardiovascular events. Most previous research has focused on understanding whether the risk of acute cardiovascular events increases following a respiratory tract infection. The relationship between urinary tract infections (UTIs) and acute cardiovascular events is less well studied. Therefore, the aim of this study is to determine whether there is a causal relationship between UTI and acute myocardial infarction (MI) or stroke. METHODS AND ANALYSIS We will undertake a self-controlled case series study using linked anonymised general practice, hospital admission and microbiology data held within the Secure Anonymised Information Linkage (SAIL) Databank. Self-controlled case series is a relatively novel study design where individuals act as their own controls, thereby inherently controlling for time-invariant confounders. Only individuals who experience an exposure and outcome of interest are included.We will identify individuals in the SAIL Databank who have a hospital admission record for acute MI or stroke during the study period of 2010-2020. Individuals will need to be aged 30-100 during the study period and be Welsh residents for inclusion. UTI will be identified using general practice, microbiology and hospital admissions data. We will calculate the incidence of MI and stroke in predefined risk periods following an UTI and in 'baseline' periods (without UTI exposure) and use conditional Poisson regression models to derive incidence rate ratios. ETHICS AND DISSEMINATION Data access, research permissions and approvals have been obtained from the SAIL independent Information Governance Review Panel, project number 0972. Findings will be disseminated through conferences, blogs, social media threads and peer-reviewed journals. Results will be of interest internationally to primary and secondary care clinicians who manage UTIs and may inform future clinical trials of preventative therapy.
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Affiliation(s)
- Nicola F Reeve
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Victoria Best
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Kathryn Hughes
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Pinto J, Bradbury K, Newell D, Bishop FL. Lifestyle and health behaviour change support in traditional acupuncture: a mixed method survey study of reported practice (UK). BMC Complement Med Ther 2022; 22:248. [PMID: 36131271 PMCID: PMC9490899 DOI: 10.1186/s12906-022-03719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
Aims Complementary medicine therapists such as traditional acupuncturists are a large resource for supporting public health targets to improve health behaviours. Our objectives were to determine the prevalence and patterns of UK acupuncturists’ provision of lifestyle change support, test theory-based hypotheses about facilitators and barriers to supporting lifestyle changes and to explore associated characteristics and attitudes. Methods A mixed methods design in which British Acupuncture Council members (Sept 2019-April 2020) completed an online questionnaire assessing prevalence of lifestyle change support, typical patterns across patients and behaviours, Theory of Planned Behaviour constructs, practitioner characteristics and open-text responses regarding additional behaviours and clinical decisions to introduce lifestyle change. Results Three hundred fifty-two traditional acupuncturists participated (Mean age = 51.5 years, SD 9.9; 81.8% (n = 288) female). 57.7% (n = 203) reported offering support for lifestyle change during their most recent consultation. 91.7% (n = 323) reported supporting lifestyle change ‘always or most of the time’ for patients with chronic conditions and 67.9% (n = 239) reported this for patients with acute conditions. The pattern of typical support for different health behaviours ranged from 44.6% (n = 157) for smoking reduction (acute conditions) to 95.2% (n = 335) for diet support (chronic conditions). A linear regression model found that frequency of support for lifestyle change in acute patients was predicted by acupuncturists’ attitudes to both clinical role and importance of health behaviours, confidence in their ability to provide lifestyle change support and use of fewer behaviour change techniques. The decision to first offer lifestyle change support was guided by perceived patient receptiveness, whether presenting condition/diagnosis were likely to improve with lifestyle change and whether a strong therapeutic relationship was established. Conclusions Traditional acupuncturists’ reports suggest their work supports key public health targets for promoting healthy behaviours. Less frequent support for alcohol/smoking may reflect user characteristics but may suggest training needs for acupuncturists. Increase could be made for support in acute presentations, however the importance of patient receptiveness, linking advice to condition, and therapeutic alliance should be explored further. There may be important differences between acupuncture practice and mainstream healthcare (e.g. high level of contact, longer visits, holistic approach) which impact mechanisms of action of behaviour change. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03719-6.
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Li H, Zhao M, Fei G, Wang Z, Wang S, Wei P, Li W. Epidemiological trends and incidence prediction of lung cancer in China based on the Global Burden of Disease study 2019. Front Med (Lausanne) 2022; 9:969487. [PMID: 36203776 PMCID: PMC9530458 DOI: 10.3389/fmed.2022.969487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Lung cancer remains the most common malignancy in China. This study aims to provide scientific support for the prevention and treatment of lung cancer by analyzing the epidemiological trends of lung cancer in China from 1990 to 2019. Based on the global health exchange database (GHDx), joinpoint and age-period-cohort analyses were performed to explore the trend of lung cancer incidence and mortality rates from 1990 to 2019. According to incidence rates from 1990 to 2019, a model was constructed to predict the incidence rates in the next 5 years. In addition, changes in risk factors associated with lung cancer deaths were compared between 1990 and 2019 and between males and females in 2019. The results are as follows. The age-standardized incidence rates (ASIRs), and age-standardized death rates (ASDRs) of lung cancer among Chinese had overall upward trends from 1990 to 2019. The ASDRs of females and males in China decreased since 2010. Interestingly, from 2016 to 2019, the ASIRs and ASDRs of females rose significantly. The age-period-cohort model showed that the incidence and mortality rates of lung cancer in China increased with age, and the growth rate accelerated after 45 years old. After 2004, the relative risks of lung cancer incidence increased with the passage of the period. Also, after the 1950–1954 birth cohort, the risks of lung cancer incidence and death began to decrease. The autoregressive integrated moving average (ARIMA) model predicted that the incidence rates of lung cancer in China would continue to rise in the next 5 years. The top five risk factors for lung cancer deaths of both genders in 2019 were smoking, ambient particulate matter pollution, secondhand smoke, high fasting plasma glucose, and household air pollution from solid fuels. The above results provided precise clues for the prevention and treatment of lung cancer in China.
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Affiliation(s)
- Han Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Meng Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Gaoqiang Fei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Zemin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Shuai Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- *Correspondence: Wei Li
| | - Wei Li
- Department of Quality Management, Children's Hospital of Nanjing Medical University, Nanjing, China
- Pingmin Wei
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Macaulay L, O'Dolan C, Avenell A, Carroll P, Cotton S, Dombrowski S, Elders A, Goulao B, Gray C, Harris FM, Hunt K, Kee F, MacLennan G, McDonald MD, McKinley M, Skinner R, Torrens C, Tod M, Turner K, van der Pol M, Hoddinott P. Effectiveness and cost-effectiveness of text messages with or without endowment incentives for weight management in men with obesity (Game of Stones): study protocol for a randomised controlled trial. Trials 2022; 23:582. [PMID: 35869503 PMCID: PMC9306253 DOI: 10.1186/s13063-022-06504-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity increases the risk of type 2 diabetes, heart disease, stroke, mobility problems and some cancers, and its prevalence is rising. Men engage less than women in existing weight loss interventions. Game of Stones builds on a successful feasibility study and aims to find out if automated text messages with or without endowment incentives are effective and cost-effective for weight loss at 12 months compared to a waiting list comparator arm in men with obesity. METHODS A 3-arm, parallel group, assessor-blind superiority randomised controlled trial with process evaluation will recruit 585 adult men with body mass index of 30 kg/m2 or more living in and around three UK centres (Belfast, Bristol, Glasgow), purposively targeting disadvantaged areas. Intervention groups: (i) automated, theory-informed text messages daily for 12 months plus endowment incentives linked to verified weight loss targets at 3, 6 and 12 months; (ii) the same text messages and weight loss assessment protocol; (iii) comparator group: 12 month waiting list, then text messages for 3 months. The primary outcome is percentage weight change at 12 months from baseline. Secondary outcomes at 12 months are as follows: quality of life, wellbeing, mental health, weight stigma, behaviours, satisfaction and confidence. Follow-up includes weight at 24 months. A health economic evaluation will measure cost-effectiveness over the trial and over modelled lifetime: including health service resource-use and quality-adjusted life years. The cost-utility analysis will report incremental cost per quality-adjusted life years gained. Participant and service provider perspectives will be explored via telephone interviews, and exploratory mixed methods process evaluation analyses will focus on mental health, multiple long-term conditions, health inequalities and implementation strategies. DISCUSSION The trial will report whether text messages (with and without cash incentives) can help men to lose weight over 1 year and maintain this for another year compared to a comparator group; the costs and benefits to the health service; and men's experiences of the interventions. Process analyses with public involvement and service commissioner input will ensure that this open-source digital self-care intervention could be sustainable and scalable by a range of NHS or public services. TRIAL REGISTRATION ISRCTN 91974895 . Registered on 14/04/2021.
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Affiliation(s)
- Lisa Macaulay
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK.
| | - Catriona O'Dolan
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
| | - Alison Avenell
- Health Services Research Unit, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Paula Carroll
- Department Sport & Exercise Science, Waterford Institute of Technology, Main Campus Cork RoadCo. Waterford, Waterford City, Ireland
| | - Seonaidh Cotton
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Stephan Dombrowski
- Faculty of Kinesiology, University of New Brunswick, 3 Bailey Drive, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada
| | - Andrew Elders
- NMAHP Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, G4 0BA, Glasgow, UK
| | - Beatriz Goulao
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Cindy Gray
- School of Social and Political Sciences, University of Glasgow, 25-29 Bute Gardens, Glasgow, G12 8RS, UK
| | - Fiona M Harris
- School of Health & Life Sciences, University of the West of Scotland, High Street, Paisley, Renfrewshire, PA1 2BE, UK
| | - Kate Hunt
- Institute for Social Marketing and Health, Pathfoot Building, University of Stirling, Stirling, FK9 4LA, UK
| | - Frank Kee
- Centre for Public Health, UKCRC Centre of Excellence for Public Health Research (NI), Institute Clinical Sciences A, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland
| | - Graeme MacLennan
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | - Michelle McKinley
- Queen's University Belfast, University Road, Belfast, BT7 1NN, Northern Ireland
| | | | - Claire Torrens
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
| | - Martin Tod
- Men's Health Forum, 49-51 East Rd, Hoxton, London, N1 6AH, UK
| | - Katrina Turner
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Marjon van der Pol
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Pat Hoddinott
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
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Andrews C, Schultze A, Curtis H, Hulme W, Tazare J, Evans S, Mehrkar A, Bacon S, Hickman G, Bates C, Parry J, Hester F, Harper S, Cockburn J, Evans D, Ward T, Davy S, Inglesby P, Goldacre B, MacKenna B, Tomlinson L, Walker A. OpenSAFELY: Representativeness of electronic health record platform OpenSAFELY-TPP data compared to the population of England. Wellcome Open Res 2022; 7:191. [PMID: 35966958 PMCID: PMC9346309 DOI: 10.12688/wellcomeopenres.18010.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Since its inception in March 2020, data from the OpenSAFELY-TPP electronic health record platform has been used for more than 20 studies relating to the global COVID-19 emergency. OpenSAFELY-TPP data is derived from practices in England using SystmOne software, and has been used for the majority of these studies. We set out to investigate the representativeness of OpenSAFELY-TPP data by comparing it to national population estimates. Methods: With the approval of NHS England, we describe the age, sex, Index of Multiple Deprivation and ethnicity of the OpenSAFELY-TPP population compared to national estimates from the Office for National Statistics. The five leading causes of death occurring between the 1st January 2020 and the 31st December 2020 were also compared to deaths registered in England during the same period. Results: Despite regional variations, TPP is largely representative of the general population of England in terms of IMD (all within 1.1 percentage points), age, sex (within 0.1 percentage points), ethnicity and causes of death. The proportion of the five leading causes of death is broadly similar to those reported by ONS (all within 1 percentage point). Conclusions: Data made available via OpenSAFELY-TPP is broadly representative of the English population. Users of OpenSAFELY must consider the issues of representativeness, generalisability and external validity associated with using TPP data for health research. Although the coverage of TPP practices varies regionally across England, TPP registered patients are generally representative of the English population as a whole in terms of key demographic characteristics.
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Affiliation(s)
- Colm Andrews
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Anna Schultze
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Helen Curtis
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - William Hulme
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - John Tazare
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Stephen Evans
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Amir Mehrkar
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Sebastian Bacon
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - George Hickman
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | | | - John Parry
- TPP, TPP House, Leeds, Yorkshire, LS18 5PX, UK
| | | | - Sam Harper
- TPP, TPP House, Leeds, Yorkshire, LS18 5PX, UK
| | | | - David Evans
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Tom Ward
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Simon Davy
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Peter Inglesby
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Ben Goldacre
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Brian MacKenna
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
| | - Laurie Tomlinson
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Alex Walker
- Bennett Institute of Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, OX26GG,, UK
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43
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Pan X, Xing Z, Yang G, Ding N, Zhou Y, Chai X. Obesity Increases In-Hospital Mortality of Acute Type A Aortic Dissection Patients Undergoing Open Surgical Repair: A Retrospective Study in the Chinese Population. Front Cardiovasc Med 2022; 9:899050. [PMID: 35903673 PMCID: PMC9315262 DOI: 10.3389/fcvm.2022.899050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The prevalence of obesity is increasing worldwide, and the role of the obesity paradox in cardiovascular surgery remains controversial. In this study, we redefined obesity according to the Chinese criteria and examined the relationship between obesity and in-hospital mortality in patients with acute type A aortic dissection (AAD) undergoing open surgical repair. Materials and Methods A total of 289 patients with AAD (between 2014 and 2016) were divided into the non-obese group and obese group for correlation analysis, general information, demographic factors, blood biochemistry, surgical details, and complications, which were used as covariates. Survival was estimated by the Kaplan–Meier method, and any differences in survival were evaluated with a stratified log-rank test. Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression were used to evaluate the effect and interaction of obesity on surgical mortality. Results All the 289 patients had a mean age of 48.64 (IQR 44.00–55.00) and 74.39% were men. Of the 289 patients, 228 were non-obese (78.89%) and 61 were obese (21.11%). Patients with obesity were younger and more prone to unstable blood pressure [systolic blood pressure (SBP) and diastolic blood pressure (DBP)], preoperative hypoxemia and delirium, prolonged operative time, and surgical wound deep infection (p < 0.05). In the fully adjusted model, we observed an increased risk of in-hospital mortality in patients with obesity after fine-tuning other covariates including age and sex (HR = 2.65; 95% CI = 1.03 to 6.80; p = 0.042). The interaction suggested that obesity was more likely to cause death in elderly patients (age ≥ 60), although it was more common in younger patients (test for interaction, p = 0.012). Conclusion Obesity, interacting with age, increases the risk of in-hospital mortality in patients with AAD undergoing open surgical repair. Although more verification is needed, we believe these findings provide further evidence for the treatment of AAD.
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Affiliation(s)
- Xiaogao Pan
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ning Ding
- Emergency Department, Changsha Central Hospital, University of South China, Changsha, China
| | - Yang Zhou
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Xiangping Chai,
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44
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Rizmie D, de Preux L, Miraldo M, Atun R. Impact of extreme temperatures on emergency hospital admissions by age and socio-economic deprivation in England. Soc Sci Med 2022; 308:115193. [PMID: 35843128 DOI: 10.1016/j.socscimed.2022.115193] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
Climate change poses an unprecedented challenge to population health and health systems' resilience, with increasing fluctuations in extreme temperatures through pressures on hospital capacity. While earlier studies have estimated morbidity attributable to hot or cold weather across cities, we provide the first large-scale, population-wide assessment of extreme temperatures on inequalities in excess emergency hospital admissions in England. We used the universe of emergency hospital admissions between 2001 and 2012 combined with meteorological data to exploit daily variation in temperature experienced by hospitals (N = 29,371,084). We used a distributed lag model with multiple fixed-effects, controlling for seasonal factors, to examine hospitalisation effects across temperature-sensitive diseases, and further heterogeneous impacts across age and deprivation. We identified larger hospitalisation impacts associated with extreme cold temperatures than with extreme hot temperatures. The less extreme temperatures produce admission patterns like their extreme counterparts, but at lower magnitudes. Results also showed an increase in admissions with extreme temperatures that were more prominent among older and socioeconomically-deprived populations - particularly across admissions for metabolic diseases and injuries.
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Affiliation(s)
- Dheeya Rizmie
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, UK.
| | - Laure de Preux
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, UK
| | - Marisa Miraldo
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, UK
| | - Rifat Atun
- Harvard T.H. Chan School of Public Health, Harvard Medical School, Harvard University, USA
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45
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Tsai E, Allen P, Saliba LF, Brownson RC. The power of partnerships: state public health department multisector collaborations in major chronic disease programme areas in the United States. Health Res Policy Syst 2022; 20:80. [PMID: 35804420 PMCID: PMC9264297 DOI: 10.1186/s12961-021-00765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multisector collaboration between state public health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs in the United States and different types of organizations addressing chronic disease in and outside of the health sector. METHODS SHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each programme area was calculated. One-way analysis of variance (ANOVA) with Tukey's post hoc tests were used to assess differences in collaborator heterogeneity between programme areas. RESULTS A total of 574 participants were surveyed. Results indicated that the cancer programme area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco programme areas. CONCLUSIONS While collaborations with health sector organizations are commonly reported, public health departments can increase collaboration with sectors outside of health to more fully address chronic disease prevention.
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Affiliation(s)
- Edward Tsai
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Louise Farah Saliba
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Ross C Brownson
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
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46
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Clarsen B, Nylenna M, Klitkou ST, Vollset SE, Baravelli CM, Bølling AK, Aasvang GM, Sulo G, Naghavi M, Pasovic M, Asaduzzaman M, Bjørge T, Eggen AE, Eikemo TA, Ellingsen CL, Haaland ØA, Hailu A, Hassan S, Hay SI, Juliusson PB, Kisa A, Kisa S, Månsson J, Mekonnen T, Murray CJL, Norheim OF, Ottersen T, Sagoe D, Sripada K, Winkler AS, Knudsen AKS. Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019. THE LANCET PUBLIC HEALTH 2022; 7:e593-e605. [PMID: 35779543 PMCID: PMC9253891 DOI: 10.1016/s2468-2667(22)00092-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
Background Methods Findings Interpretation Funding
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47
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Li Z, Zhao L, Ji J, Ma B, Zhao Z, Wu M, Zheng W, Zhang Z. Temporal Grading Index of Functional Network Topology Predicts Pain Perception of Patients With Chronic Back Pain. Front Neurol 2022; 13:899254. [PMID: 35756935 PMCID: PMC9226296 DOI: 10.3389/fneur.2022.899254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic back pain (CBP) is a maladaptive health problem affecting the brain function and behavior of the patient. Accumulating evidence has shown that CBP may alter the organization of functional brain networks; however, whether the severity of CBP is associated with changes in dynamics of functional network topology remains unclear. Here, we generated dynamic functional networks based on resting-state functional magnetic resonance imaging (rs-fMRI) of 34 patients with CBP and 34 age-matched healthy controls (HC) in the OpenPain database via a sliding window approach, and extracted nodal degree, clustering coefficient (CC), and participation coefficient (PC) of all windows as features to characterize changes of network topology at temporal scale. A novel feature, named temporal grading index (TGI), was proposed to quantify the temporal deviation of each network property of a patient with CBP to the normal oscillation of the HCs. The TGI of the three features achieved outstanding performance in predicting pain intensity on three commonly used regression models (i.e., SVR, Lasso, and elastic net) through a 5-fold cross-validation strategy, with the minimum mean square error of 0.25 ± 0.05; and the TGI was not related to depression symptoms of the patients. Furthermore, compared to the HCs, brain regions that contributed most to prediction showed significantly higher CC and lower PC across time windows in the CBP cohort. These results highlighted spatiotemporal changes in functional network topology in patients with CBP, which might serve as a valuable biomarker for assessing the sensation of pain in the brain and may facilitate the development of CBP management/therapy approaches.
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Affiliation(s)
- Zhonghua Li
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of TCM, Lanzhou, China
| | - Leilei Zhao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Jing Ji
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of TCM, Lanzhou, China
| | - Ben Ma
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Miao Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Weihao Zheng
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Zhe Zhang
- Institute of Brain Science, Hangzhou Normal University, Hangzhou, China.,School of Physics, Hangzhou Normal University, Hangzhou, China
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48
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Rotter G, Ortiz M, Binting S, Tomzik J, Reese F, Roll S, Brinkhaus B, Teut M. Mindful Walking in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:474-483. [PMID: 35363058 PMCID: PMC9232228 DOI: 10.1089/jicm.2021.0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: The objective of this study was to investigate the effectiveness of a mindful walking program (MWP) in patients with chronic low back pain (CLBP). Methods: The trial was a two-armed, randomized, controlled single-center open clinical trial. The study was performed in the Outpatient Clinic for Integrative Medicine of the Charité–Universitätsmedizin Berlin. The participants were adults aged 18–65 years with CLBP (≥3 months) and an average low back pain within the past 7 days measured on a visual analog scale (VAS, 0 = no pain, 100 = worst imaginable pain) of at least 40 mm. The patients received either eight weekly MWP sessions or no intervention (control). The primary outcome was the perceived pain intensity assessed with a VAS (0–100 mm) after 8 weeks. The secondary outcomes included back function assessed by the Hannover Functional Questionnaire Backache (FFbH-R) and perceived stress assessed by the 14-item Cohen's Perceived Stress Scale (PSS-14). The results were obtained by analysis of covariance adjusted for the respective baseline values. Results: In total, 55 patients were randomized (MWP: n = 29, 82.8% female, mean (±standard deviation) age: 52.5 ± 8.6 years, pain: 56.4 ± 14.1 mm; control: n = 26, 84.6% female, 54.8 ± 7.5 years, pain: 55.4 ± 13.1 mm). After 8 weeks, compared with the control conditions, the MWP was not associated with a statistically significant benefit for pain (VAS), adjusted mean − 9.6 [−22.3 to 3.1], p = 0.136, clinical benefits for back function (FFbH-R), adjusted mean 2.2 [−4.2 to 8.6], p = 0.493, or stress (PSS-14), adjusted mean − 1.6 [−4.8 to 1.6], p = 0.326. Conclusion: In conclusion, compared with no intervention, mindful walking did not significantly improve pain, back function, or perceived stress in patients with CLBP. Clinical Trial registration: ClinicalTrials.gov (NCT01893073).
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Affiliation(s)
- Gabriele Rotter
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Miriam Ortiz
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Sylvia Binting
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Juliane Tomzik
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Frauke Reese
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Michael Teut
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
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Hendra H, Sridharan S, Farrington K, Davenport A. Characteristics of Frailty in Haemodialysis Patients. Gerontol Geriatr Med 2022; 8:23337214221098889. [PMID: 35548325 PMCID: PMC9083032 DOI: 10.1177/23337214221098889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 01/29/2023] Open
Abstract
Background: Both frailty and cachexia increase mortality in haemodialysis (HD) patients. The clinical frailty score (CFS) is a seven-point scale and less complex than other cachexia and frailty assessments. We wished to determine the characteristics of frail HD patients using the CFS. Methods: Single centre cross-sectional study of HD patients completing physical activity questionnaires with bioimpedance measurements of body composition and hand grip strength (HGS). Results: We studied 172 HD patients. The CFS classified 54 (31.4%) as frail, who were older (70.4±12.2 vs 56.2 ± 16.1 years, p < 0.001), greater modified Charlson co-morbidity (3 (2–3) versus 1.5 (0–3), p < 0.001), and body fat (33 (25.4–40.2) versus 26.2 (15.8–34) %, p < 0.01), but lower total energy expenditure (1720 (1574–1818) versus 1870 (1670–2194) kcal/day, p < 0.01), lean muscle mass index (9.1 (7.7–10.1) versus 9.9 (8.9–10.8) kg/m2), and HGS (15.3 (10.3–21.9) versus 23.6 (16.7–34.4) kg), both p < 0.001. On multivariable logistic analysis, frailty was independently associated with lower active energy expenditure (odds ratio (OR) 0.98, 95% confidence limits (CL) 0.98–0.99, p = 0.001), diabetes (OR 5.09, CL 1.06–16.66) and HGS (OR 0.92, CL 0.86–0.98). Discussion: Frail HD patients reported less active energy expenditure, associated with reduced muscle mass and strength. Frail patients were more likely to have greater co-morbidity, particularly diabetes. Whether physical activity programmes can improve frailty remains to be determined.
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Affiliation(s)
- Heidy Hendra
- UCL Department of Nephrology, University College London, London NW, UK
| | | | - Ken Farrington
- University of Hertfordshire, Hatfield, UK
- Renal Unit, Lister Hospital, Corey’s Mill Lane, ST, UK
| | - Andrew Davenport
- UCL Department of Nephrology, University College London, London NW, UK
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Rinaldi C, D’Aguilar M, Egan M. Understanding the Online Environment for the Delivery of Food, Alcohol and Tobacco: An Exploratory Analysis of 'Dark Kitchens' and Rapid Grocery Delivery Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5523. [PMID: 35564918 PMCID: PMC9099441 DOI: 10.3390/ijerph19095523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022]
Abstract
Online spaces are increasingly important in the sale of food, alcohol and tobacco. This analysis focuses on two developments in online food delivery: delivery-only 'dark kitchens' and rapid grocery delivery services (RGDS), with the aim to understand and assess the availability of health harming and health promoting products through these services. Data was collected for one metropolitan local authority in London, UK, using publicly available online sources. Being explorative in nature, the analysis includes descriptive statistics and qualitative assessment. Three dark kitchens (renting kitchens to 116 food businesses), three grocery delivery apps, and 76 grocery businesses available through online delivery platforms were identified. Most businesses renting dark kitchen space were 'virtual restaurants' (52%) selling fast food (47%) or dessert (21%) through online delivery platforms. RGDS sold a variety of items, with a focus on pre-packaged foods high in fat, salt and sugar, alcoholic beverages and tobacco. These items were also most likely to be promoted through offers and promotional language. Fruits and vegetables were less commonly available and mainly on grocery delivery apps. Online delivery services increase the temporal and geographic availability and promotion of many unhealthy products. Research expanding on the geographic area of interest is needed.
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Affiliation(s)
- Chiara Rinaldi
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK;
| | | | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK;
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