Harnessing education and lifestyle change to support transitional health for returning citizens: a feasibility study protocol

BACKGROUND

Exercise and healthy eating are known to reduce chronic disease risk; however, formerly incarcerated individuals (i.e., returning citizens) face significant social barriers when attempting to engage with existing community-based physical activity and nutrition programs. Given the high disease burden and unique educational needs of returning citizens, this proposed work fills an important gap in the support services currently offered to this population.

METHODS

This article describes a process for evaluating the feasibility and acceptability of a physical activity and nutrition intervention tailored to the needs of returning citizens via a partnership between an academic research organization and a community-based reentry program for returning citizens. Staff from the community-based reentry program will train four returning citizens as group fitness instructors and work with a nutritionist to design a 16-week nutrition education curriculum. Reentry program staff will enroll up to 15 formerly incarcerated adults (aged 18 +) in the exercise and nutrition program. Participants will take part in weekly nutrition classes led by the nutritionist and weekly group exercise classes led by a peer instructor. Research staff will evaluate program success in four domains: reach, preliminary effectiveness, implementation, and maintenance.

RESULTS

This feasibility study will allow us to design and test a program that can eventually be evaluated in a large, randomized trial. It also addresses the multitude of social determinants that impact the health of returning citizens and builds a framework for program sustainability. Individuals recruited as fitness trainers will acquire skills and certifications that may be used to sustain physical fitness activities within the reentry program.

CONCLUSIONS

This feasibility study will test our ability to address social determinants that impact the health of returning citizens through a peer-led physical activity and nutrition programming. In the long term, study results may inform development and implementation of reentry programming and policy on a wider scale.

Redistribution of ill-defined deaths: the Scottish Burden of Disease approach

Burden of disease (BoD) studies are an established method of quantifying health loss across - and within - a population. They aim to combine the impact of living with, and dying from, various health conditions to allow for comparability of conditions in an equitable manner. A key component of this is the calculation of the loss of years of life arising from premature death (Years of Life Lost (YLL)). Most high-income nations have robust death registration systems which ensure that deaths are routinely recorded, the causes are medically certified and the age at death is accurate. However, even in these situations the recording of ill-defined death (IDD) causes remains widespread and to some extent unavoidable, in that it is not always appropriate to undertake extensive investigation to establish an exact cause of death or the cause of death recorded does not map directly to disease groupings used routinely in BoD studies. The Scottish Burden of Disease (SBoD) uses cause of death data from the National Records of Scotland. These patient-level records include one underlying cause of death and up to 10 supplementary causes of death, all coded using ICD classifications. Around 12% of these deaths do not map directly to a BoD cause group and could therefore be considered ill-defined. The SBoD study have developed a 9-step hierarchical methodology for the redistribution of ill-defined deaths, utilising uses a mix of fixed and proportional redistribution and focusses on exploiting the data recorded on the death certificate at both an individual and population level. In this presentation we will describe the methodology used to redistribute ill-defined deaths in the Scottish study - the development, the application and the strengths and weaknesses of our approach. We will also discuss the example of COVID-19 and how competition between the underlying cause of death is likely to impact how we need to approach IDDs in the future.

Inequalities in the disease burden in Scotland: an area level analysis

In the context of increasing demand for evidence-based policy, attempts to address or mitigate the effects of disadvantage have been usefully informed by comprehensive indices of multiple deprivation. These indices combine indicators on a range of dimensions of deprivation to classify neighborhoods or localities. Through combining information on fatal and non-fatal health loss, burden of disease studies allow planners and policy-makers to have a better understanding of the contribution of different diseases and injuries to the total burden of disease. These estimates can be augmented through studies, stratified by investigating inequalities in the burden of disease due to area-based deprivation. Doing so, helps contribute to discussions about where prevention and service activity should be focused to address health inequalities. The Scottish Burden of Disease study uses the Scottish Index of Multiple Deprivation (SIMD) as means to report on of the extent of inequality in the burden of disease in Scotland between people living in the areas of greatest, and of least, multiple deprivation. The SIMD quantifies deprivation based on data zones, a geographical unit comparable to a postcode. Using pooled and weighted data from seven domains (employment, income, crime, housing, health, education and geographic access), each data zone is given a composite rank out of 6,505 data zones. The composite rank was then converted to a decile, with 1 assigned to the 10% most deprived data zones and 10 to the 10% least deprived. In this presentation we will show the key steps involved in undertaking an area-based analysis of health inequalities in the burden of disease in Scotland using results from the Scottish Burden of Disease 2019 study, and from our monitoring of COVID-19 disability-adjusted life years.

Combination therapy with ribavirin and interferon in a cohort of children with hepatitis C and haemophilia followed at a pediatric haemophilia treatment center

Nearly all children with bleeding disorders who received factor concentrates prior to the late 1980s were infected with hepatitis C. Treatment of adults infected with hepatitis C with combination therapy consisting of ribavirin and interferon has shown sustained response rates of 30-60%. Little data is available on the response of children infected with hepatitis C treated with combination therapy, especially those with bleeding disorders. We wish to report a single paediatric haemophilia treatment center's results of treatment of adolescents with haemophilia and hepatitis C infection with combination therapy. All patients followed at the haemophilia treatment center with hepatitis C, who were human immunodeficiency virus (HIV) negative and had a measurable hepatitis C viral load were eligible. Study patients received at least 6 months of 3 MU interferon-alpha via subcutaneous injection three times per week and 1000 mg day(-1) of ribavirin. Eleven patients agreed to participate in the study. Three patients had an un measurable viral load after 6 months of combination therapy. All three completed 12 months of medication and continued to remain free of hepatitis C for 12 months after discontinuation of therapy. Side-effects of combination therapy were significant but tolerable. The sustained response rate in this study is similar to the historical response rate seen in adults but less than the other reported response rates seen in children treated with combination therapy. Given the toxicity of combination therapy, and natural history of hepatitis C infection in children, consideration of a liver biopsy to evaluate disease progression prior to considering antiviral medications is warranted.