Health needs assessment in a male prison in England

Objectives

To assess the health needs of prisoners in a male category B prison in Bristol, England, to identify areas for improving health in the prison.

Study design

Cross-sectional and qualitative.

Methods

Analysis of prisoners’ self-reported health needs at reception and at a secondary health screen; prisoners’ access to primary care, inpatients, mental health, sexual health and substance misuse services; and prescribed medications. Random selection of prisoners for interviews. Focus groups and interviews with staff and stakeholders.

Results

18 prisoners were interviewed (29% of those randomly selected), five focus groups were held with staff and stakeholders involved in health care provision in the prison and four interviews were held with staff and stakeholders. The areas of greatest health needs were identified as dental care, mental health and substance misuse. Prisoners and staff generally reported good access to most health care staff, provision of prescribed medication, bloodborne virus vaccination and treatment of substance misuse. Twenty nine recommendations were identified with five high-priority areas for improvement including an urgent review of dental services; stronger joint commissioning arrangements for health and social care; installing an integrated IT system; prevention of disease and health promotion; better use of the voluntary sector. A detailed action plan was developed to address all the recommendations and this has formed the basis of a programme of ongoing quality improvement work which is monitored by the Prison Partnership Board. Progress has been made against all key areas.

Conclusions

The mixed methodology which involved analysis of health data and talking to a wide group of stakeholders, including prisoners, helped triangulate the data. The process of undertaking the health needs assessment shifted the focus from ’health care’ to ’health’. This has facilitated a significant reframing of the concepts of ’health’ and ’health need’ with ongoing work now focused on the prison as a whole system, not merely on the provision of health care within the prison. Many improvements have already been made in response to the assessment.     

Pay-for-performance step-by-step: introduction to the MIMIQ model

Objectives

Pay-for-performance is increasingly used as a system intervention to support quality improvement. Programs are however developed, implemented and evaluated in a heterogeneous way. This is partly due to the broad and disparate theoretical and empirical foundation of P4P practice, which is rapidly evolving.This paper guides the reader through the essential steps which should be taken into consideration when setting up a P4P program. To this end a model called ‘Model for Implementing and Monitoring Incentives for Quality’ (MIMIQ) is presented.

Methods

Literature review was performed with a search of multiple databases, reference screening and expert consultation.

Results

Central to the step-by-step approach is a Plan-Do-Check-Act cycle which incorporates communication, implementation and evaluation as key phases next to program development. In addition, the model explains how the decision making and results of each phase is modified by contextual factors. The model puts emphasis on quality and quality measurement as first items to develop. Only after these are in place, the development of the incentive component can be addressed.

Conclusions

The model presents guidance for designing and implementing P4P programs in a practically structured way. According to future findings the MIMIQ model will continuously evolve as an up to date P4P policy and practice tool.     

Adverse events after tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine administered to adults 65 years of age and older reported to the Vaccine Adverse Event Reporting System (VAERS), 2005-2010

Background

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine was not licensed for use in adults aged ≥65 years due to lack of sufficient efficacy and safety data.

Objective

To characterize reports to the Vaccine Adverse Event Reporting System (VAERS) among adults aged ≥65 years who received Tdap vaccine ‘off-label’ to assess for potential vaccine safety concerns.

Methods

We searched VAERS for US reports of adverse events (AEs) in subjects aged ≥65 years who received Tdap vaccine from 9/1/2005 to 9/08/2010. Medical records were requested for all reports coded as serious (death, hospitalization, prolonged hospitalization, permanent disability, life-threatening-illness). Proportional reporting ratio (PRR) was used to assess for higher proportionate reporting for AEs after Tdap compared with Td reports in subjects aged ≥65 years.

Results

VAERS received 243 reports following Tdap administered to persons aged ≥65 years. Eleven (4.5%) reports were serious, including two deaths. Most common AEs were local reactions in 100 (41.2%) reports. Seventy-eight (32.1%) reports contained coding terms that denoted inappropriate administration of vaccine. ‘Cough’ was the only term associated with disproportionately higher reporting after Tdap compared with Td. Six of seven Tdap reports containing the term ‘Cough’ were non-serious. Clinical review of serious reports identified no unusual patterns of AEs.

Conclusion

Our VAERS review of the ‘off-label’ use of Tdap vaccine in adults ≥65 years did not find any safety concerns that warrant further study. These data will provide useful baseline information to assist CDC and FDA with monitoring efforts as permissive recommendations for Tdap in older persons are adopted.     

Going private: clinicians' experience of working in UK independent sector treatment centres

Objectives

With increased possibility that public healthcare services in the UK will be out-sourced to the private sector, this study investigates how clinicians working in Independent Sector Treatment Centres perceive the differences between public and private sectors.

Methods

Qualitative interviews with 35 clinicians recruited from two ISTCs. All participants were transferred to the independent sector from the public National Health Service. Interview data were analysed to identify shared experience about the variable organisation and delivery of services.

Results

Clinicians perceived differences between public and independent sectors in the areas of ‘environment and facilities’, ‘management’, ‘work organisation and care delivery’, and ‘patient experience’. The independent sector was described as offering a positive alternative to public services in regard to service environment and patient experience, but there were concerns about management priorities and the reconfiguration of work.

Conclusions

Clinicians’ experience of moving between sectors reveals mixed experiences. Although some improvements might legitimise the growing role of the independent sector, there remain doubts about the commercialisation of services, the motives of managers and the impact of clinical roles and capabilities. With policies looking to expand the mixed economy of public healthcare services, the study suggests clinicians will not automatically embrace a move between sectors.     

Welfare states, flexible employment, and health: a critical review

Objectives

The aim of this literature review is to identify whether differences between welfare regimes can manifest diverse consequences for the health effects of insecure and precarious employment, as well as to address challenging issues and implications for future research.

Methods

By searching PubMed, PsychINFO, Stork Social Science Citation Index, and Index Lilac, from 1988 to June 2010, a total of 104 original articles were selected (65 on job insecurity; 39 on precarious employment).

Results

After classifying selected empirical studies according to a six-regime welfare state typology (Scandinavian, Bismarckian, Southern European, Anglo-Saxon, Eastern European, and East Asian), this systematic review reveals that welfare regimes may be an important determinant of employment-related health. Precarious workers in Scandinavian welfare states report better or equal health status when compared to their permanent counterparts. By contrast, precarious work in the remaining welfare state regimes is found to be associated with adverse health outcomes, including poor self-rated health, musculoskeletal disorders, injuries, and mental health problems.

Conclusions

Future research should be conducted by employing conceptual models that specify how macro-economic processes, country-level welfare factors, and individual employment histories and environments relate to employment-related health inequalities.     

Does the use of standing 'hot' desks change sedentary work time in an open plan office?

Objective

This study assessed the use of standing ‘hot’ desks in an open plan office and their impact on sedentary work time.

Method

Australian employees (n = 11; 46.9 [9.8] years; BMI 25.9 [3.5 kg/m²]) wore an armband accelerometer for two consecutive working weeks (November-December 2010). In the second week, employees were encouraged to use a pod of four standing ‘hot’ desks to stand and work as often as possible. Desk use was recorded using time logs. The percentages of daily work time spent in sedentary (< 1.6 METs), light (1.6-3.0 METs) and moderate + (> 3 METs) intensity categories were calculated for each week, relative to the total daily time at work. Paired sample t tests were used to compare weekly differences.

Results

Employees spent 8:09 ± 0:31 h/day at work and ‘hot’ desk use ranged from zero to 9:35 h for the week. There were no significant changes in mean time spent in sedentary (difference of − 0.1%), light (difference of 0.8%) and moderate + (− 0.7%) intensity categories. However, individual changes in sedentary work time ranged from − 5.9 to 6.4%.

Conclusions

Volitional use of standing ‘hot’ desks varied and while individual changes were apparent, desk use did not alter overall sedentary work time in this sample.     

Spiritual and religious identities predict the use of complementary and alternative medicine among US adults

Objective

To determine whether spiritual and religious identities predict complementary and alternative medicine (CAM) use above and beyond other known influences such as gender, region of residence, social status, personality, health, and access to conventional medicine.

Methods

Analyzing data from the 1995-1996 National Survey of Midlife Development in the United States (n = 3032), this study examines the correlations between four aspects of spirituality/religiousness—i.e., spiritual only, religious only, both spiritual and religious, and neither spiritual nor religious—and six measures of CAM.

Results

Compared with spiritual only persons, the odds of using energy therapies are 86% lower for spiritual and religious persons, 65% lower for religious only persons, and 52% lower for neither spiritual nor religious persons. Compared to spiritual only persons, spiritual and religious individuals are 43% more likely to use body-mind therapies in general; however, when this category does not contain prayer, meditation, or spiritual healing, they are 44% less likely. Religious only individuals are disinclined toward CAM use.

Conclusions

After controlling for established predictors including educational attainment, personality, social support, and access to conventional medicine, the present study demonstrates that spirituality and religiousness are associated, in unique ways, with CAM use. Additional research on this topic is clearly warranted.     

La auditoría energética: una herramienta de gestión en atención primaria

Objective

The aim of this study was to evaluate the viability of energy audit as a management tool in primary care to improve the energy efficiency and environmental performance of a health center by reducing its operating costs.

Method

We conducted 55 energy audits in health centers from 2005-2010. The health centers were sized between 500 and 3,500 m², were located in health areas with 3,500 to 25,000 users, and were built between 1985 and 2007.

Results

With an average investment of 11,601€ per site, energy consumption can be reduced by 10,801 kWh per year, saving 2,961€ with a mean payback period of 3.92 years, and preventing emission of 7,010 kg of CO₂.

Conclusions

Energy auditing is a practical tool to reduce the operating and maintenance costs of health centers and of improving the comfort of the facilities.     

Resemblance in Dietary Intakes between Urban Low-Income African-American Adolescents and Their Mothers: The Healthy Eating and Active Lifestyles from School to Home for Kids Study

Objectives

To examine the association and predictors of dietary intake resemblance between urban low-income African-American adolescents and their mothers.

Methods

Detailed dietary data collected from 121 child-parent pairs in Chicago during fall 2003 were used. The association was assessed using correlation coefficients, kappa, and percentage of agreement, as well as logistic regression models.

Results

Overall, the association was weak as indicated by correlations and other measures. None of the mother-son correlations for nutrients and food groups were greater than 0.20. Mother-daughter pairs had stronger correlations (0.26 for energy and 0.30 for fat). The association was stronger in normal-weight mothers than in mothers with overweight or obesity. Logistic models showed that mother being a current smoker, giving child more pocket money, and allowing child to eat or purchase snacks without parental permission or presence predicted a higher probability of resemblance in undesirable eating patterns, such as high-energy, high-fat, and high-snack intakes (P<0.05).

Conclusions

Mother-child diet association was generally weak, and varied considerably across groups and intake variables in this homogenous population. Some maternal characteristics seem to affect the association.     

Understanding the potential and challenges of adenoma treatment as a prevention opportunity: insights from the BeWEL formative study

Objectives

To explore prevention opportunities presented by colorectal adenoma diagnosis and inform engagement strategies for the BeWEL study (body weight and physical activity lifestyle intervention for colorectal cancer screening participants who have undergone adenoma removal).

Methods

Qualitative study comprising 4 purposively sampled focus groups conducted in urban and rural areas in Tayside, Scotland, with different deprivation levels. Participants were men and women (n = 17) aged 50-74 with BMI > 25 kg/m² with removal of adenoma detected by colorectal cancer screening.

Results

Adenoma diagnosis presents both opportunities and challenges for prevention. Some patients perceived adenoma as minor and not sufficiently motivating to act as a ‘teachable moment’. Patients had low awareness of the relationship between adenoma and lifestyle factors, and received little information on prevention during screening and treatment. Consequently they interpreted post-treatment ‘all clear’ messages as validation of existing lifestyles, and did not see the relevance of prevention advice. Receptiveness increased when the association between lifestyle, adenoma recurrence and other illness was explained.

Conclusion

The study illustrates the value of exploratory research into patient understanding to improve communications and health services. Without unduly worrying patients, professionals should explain how to reduce risk of adenoma, cancer and other diseases, particularly through diet, physical activity and weight reduction.     

Introducing taxes, subsidies or both: the effects of various food pricing strategies in a web-based supermarket randomized trial

Objective

Fiscal policies may form a solution in improving dietary intake. This study aimed to examine the effectiveness of varying taxing and subsiding schemes to stimulate healthier food purchases.

Methods

A randomized controlled trial with three levels of price reduction on healthy foods (no; 25%; 50%) × three levels of price increase on unhealthy foods (5%; 10%; 25%) factorial design was used. 150 participants were randomized into one of nine conditions and were asked to purchase groceries at a web-based supermarket. Data were collected in the Netherlands in January-February 2010 and analyzed using analysis of covariance.

Results

Subjects receiving 50% discount purchased significantly more healthy foods than subjects receiving no (mean difference = 6.62 items, p < 0.01) or 25% discount (mean difference = 4.87 items, p < 0.05). Moreover, these subjects purchased more vegetables (mean difference = 821 g; p < 0.05 compared to no discount). However, participants with the highest discount also purchased significantly more calories. No significant effects of the price increases on unhealthy foods were found.

Conclusion

Price decreases are effective in stimulating healthy food purchases, but the proportion of healthy foods remains unaffected. Price increases up to 25% on unhealthier products do not significantly affect food purchases. Future studies are important to validate these results in real supermarkets and across different countries.     

Real-world effectiveness of a German school-based intervention for primary prevention of anorexia nervosa in preadolescent girls

Objective

Anorexia nervosa (‘AN’) is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program (‘PriMa’) for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls.

Method

Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n = 1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge.

Results

After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d = .24) and body self esteem (d = .29), but not for eating behavior.

Conclusion

The PriMa intervention provides an efficient and practical model to increase AN-related protection factors.     

Willingness of pregnant women to vaccinate themselves and their newborns with the HPV vaccine

Objective

To evaluate the willingness of pregnant women to accept the HPV vaccine for their newborns as well as themselves.

Methods

An 18-item questionnaire was distributed to antepartum women. Demographic data about the respondent's current pregnancy and her knowledge of HPV and the HPV vaccine was collected. Information about the respondent's HPV and HPV vaccine status as well as her acceptance of the vaccine for herself during pregnancy and her newborn son and/or daughter after delivery was also collected.

Results

Three hundred surveys were completed and available for review. Only 6 respondents (2%) had received the HPV vaccine. Despite the small group of patients who had previously been vaccinated, 112 respondents (37.3%) stated that they would receive the HPV vaccine during pregnancy if recommended by an obstetrician. 99 respondents (33%) stated that they would vaccinate their newborn female infant and 83 (27.7%) stated would vaccinate their male infants.

Conclusion

Providing the HPV vaccine to pregnant women as well as newborns could be an important way to increase the patient population who is protected against HPV. A percentage of pregnant women are willing to accept the vaccine for themselves and their newborns.     

Markers for the Validation of Reported Dietary Intake in Adults with Cystic Fibrosis

Objective

To identify different markers in order to validate the assessment of dietary intake in adults with cystic fibrosis (CF).

Design

Cross-sectional survey.

Setting

Tertiary care.

Subjects

We assessed 37 adults with CF whose nutritional and respiratory condition was stable and 37 healthy adults, matched for age, sex, and nutritional status.

Interventions

A consecutive, 7-day, prospective dietary survey was given to all the participants. Anthropometric variables were measured and a fasting blood sample was drawn to measure the composition of the serum phospholipid fatty acids by gas chromatography. We also measured fecal fat and nitrogen at 72 hours and 24-hour urine nitrogen.

Results

The ratio of energy intake to basal metabolic rate expenditure was significantly greater in the patients (2.1±0.4) than the controls (1.79±0.4) and the percentage of patients with the ratio of energy intake to basal metabolic rate lower than 1.55 was 24% in the controls (n=9) vs 8% in the patients (n=3). Fecal nitrogen correlated significantly with total energy and the intake of carbohydrates, lipids, and proteins. In the patients, total dietary energy and fat and protein intake correlated positively with fecal fat. The protein and fat intake and fecal nitrogen and fat correlated significantly with urine nitrogen. In the controls, significant correlations were seen between different parameters of intake and the percentage of certain serum phospholipid fatty acids. These correlations in the patients were either absent or less marked.

Conclusions

Use in persons with CF of the energy intake to basal metabolic rate ratio, measurement of fecal fat and nitrogen at 72 hours and of urine nitrogen may be useful to validate dietary surveys. The serum phospholipid fatty acid profile, however, may be less useful for this purpose in these patients.     

Estimating the impact of pictorial health warnings and “plain” cigarette packaging: Evidence from experimental auctions among adult smokers in the United States

Objective

To estimate differences in demand for cigarette packages with different packaging and health warning label formats.

Methods

Adult smokers (n = 404) in four states participated in experimental auctions. Participants bid on two of four experimental conditions, each involving a different health warning label format but with the same warning message: (1) text on 50% of pack side; (2) text on 50% of the pack front and back; (3) text with a graphic picture on 50% of the pack front and back; and (4) same as previous format, but without brand imagery.

Results

Mean bids decreased across conditions (1: $3.52; 2: $3.43; 3: $3.11; 4: $2.93). Bivariate and multivariate random effects models indicated that there was no statistically significant difference in demand for packs with either of the two text only warnings; however, demand was significantly lower for both packs with prominent pictorial warnings, with the lowest demand associated with the plain, unbranded pack.

Conclusions

Results suggest that prominent health warnings with graphic pictures will reduce demand for cigarettes. Regulators should not only consider this type of warning label, but also plain packaging policies for tobacco products.     

A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007-2008

Objective

To compare the prevalence estimates of selected health indicators and chronic diseases or conditions among three national health surveys in the United States.

Methods

Data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2007 and 2008 (n = 807,524), the National Health Interview Survey (NHIS) in 2007 and 2008 (n = 44,262), and the National Health and Nutrition Examination Survey (NHANES) during 2007 and 2008 (n = 5871) were analyzed.

Results

The prevalence estimates of current smoking, obesity, hypertension, and no health insurance were similar across the three surveys, with absolute differences ranging from 0.7% to 3.9% (relative differences: 2.3% to 20.2%). The prevalence estimate of poor or fair health from BRFSS was similar to that from NHANES, but higher than that from NHIS. The prevalence estimates of diabetes, coronary heart disease, and stroke were similar across the three surveys, with absolute differences ranging from 0.0% to 0.8% (relative differences: 0.2% to 17.1%).

Conclusion

While the BRFSS continues to provide invaluable health information at state and local level, it is reassuring to observe consistency in the prevalence estimates of key health indicators of similar caliber between BRFSS and other national surveys.     

"Where have all the bicycles gone?" Are bicycle sales in Australia translated into health-enhancing levels of bicycle usage?

Objective

To explore whether the reported increase in bicycle sales in Australia is corroborated by increases in numbers of cyclists.

Methods

Australian representative data on cycling from annual Exercise, Recreation and Sport Surveys (ERASS) from 2001 to 2008 were used. Based on the weighted proportion of cyclists and ‘regular cyclists’ each year, the number of ‘new’ riders each year was calculated. Generous assumptions about the number of new bicycle purchased by new riders plus replacement bicycles by regular riders were compared with industry sales figures.

Results

Any cycling increased from 9.5% of all adults in 2001 to 11.6% in 2008, an increase of 2.1% [95% CI: 1.14 to 2.76]. This 2.1% represents an overall increase in cyclists of around 343,552 (95% CI from 186,500 to 441,710 new cyclists). The difference between the estimated number bought and the actual industry total average number of bicycles sold (n = 753,843 per annum) numbered at least 395,000 unused adult bicycles sold each year after sensitivity analyses.

Conclusions

There appear to be many more bicycles sold in Australia than are used. Further improvements may be needed in the cycling environment before a possible latent desire for cycling translates to participation.     

Implementing changes to hospital services: factors influencing the process and 'results' of reconfiguration

Objectives

Acute hospital reconfiguration is often presented as a problem to be solved by calculations of optimal design, a rational process amenable to influence by open and responsive consultation. We aimed to analyse factors in the process and ‘results’ of hospital reconfiguration in three case study sites in the English NHS.

Methods

In-depth semi-structured interviews were conducted with internal and external stakeholders at each site. Analysis within each case was complemented by cross-case analysis focusing on the relationships between the features of the origins and process of reconfiguration and progress in the implementation of plans.

Findings

We identified a number of inter-related factors operating in the process of implementation which influenced the ‘results’: the drivers for change, the reconfiguration, its content (particularly the extent to which services are withdrawn or made less accessible), the influence of stakeholders, such as local politicians, financial pressures, and the role of the management team.

Conclusions

We argue that the differences in reconfiguration implementation between the three cases reflected the nature of the proposed changes and local politics, rather than the strength of the ‘evidence’ for change. National policy has tended to over-emphasise the importance of consultation using ‘evidence’ and underplays these influencing factors.     

Parent awareness of young children's physical activity

Objective

Parents who overestimate their child's physical activity (PA) level may not encourage their children to increase their PA. We assessed parental awareness of child PA, and investigated potential correlates of overestimation.

Method

Child PA (accelerometer) and parent-classified child PA [‘active’ ≥ 60 min/day vs. ‘inactive’ < 60 min/day moderate and vigorous PA (MVPA)] were measured over 7 days [n = 329, 44% male, 39% Latino; mean (SD) 9.1 (0.7) years] in an obesity prevention study in San Diego (Project MOVE). Agreement between date-matched objective MVPA and parent-classified child PA was assessed; % days parental overestimation was the outcome variable. Associations between parental overestimation and potential correlates were investigated using three-level mixed‐effects linear regression.

Results

Children met the PA guidelines on 43% of days. Parents overestimated their children's PA on 75% of days when children were inactive. Most parents (80%) overestimated their child's PA on ≥ 1 measurement day. Parental support for child PA (transport, encouragement and participation with child) (p < 0.01) was positively associated with higher overestimation. Parents of girls showed more overestimation than parents of boys (p = 0.04).

Conclusion

Most parents incorrectly classified their child as active when their child was inactive. Strategies addressing parental overestimation may be important in PA promotion.