How health care may modify the effects of illness determinants on population outcomes: the Leicester SEARCH conceptual framework for primary care.

To research, evaluate, and deliver health care that effectively improves health outcomes across populations, relationships between the numerous variables that determine these outcomes should be understood. Conceptual frameworks can aid the description and analysis of health in populations. Investigators usually have an implicit framework underpinning their research. Population health lags behind other disciplines, such as psychology and sociology, in the use of conceptual frameworks;1 currently published frameworks are not configured ideally for primary care-focused research. In this article, we aim to fill an important gap by describing a new and comprehensive conceptual framework for population health that can assist both research and service in primary care. The framework provides a schematic overview of presumed relationships between variables, recognising that many variables do not ‘behave’ consistently in every situation

Rail short-wavelength irregularity identification based on wheel-rail impact response measurements and simulations

Long and short-wavelength dip defects unavoidably exist on railway track top surface. Several manual measurement methods and AK track measurement car were used to measure and to identify these types of defects in a selected track section. The paper considers rail dip irregularities in detail when measured, the dip can be considered as two components. The first one is the large, long dip profile, which can be measured by the survey leveling. The other is a small short dip profile, which is superimposed on the large profile and can be measured using the dip gauge. The corresponding measurement and processed data from AK car were analysed and compared with the manual measurements. It has been found that the severities as indicated by the AK car for the short-wavelength dips in the bandwidth of 0.1~1.0m were in agreement with those measured by the dip gauge. Simulation analyses were also carried out in order to fully understand wheel-rail impact behaviours due to dip defects using the VAMPIRE package and the CRE-3D VTSD model. There was good agreement between the simulation results and the measurements from the AK car, and the simulations show that the impact accelerations are principally caused by the small dip profile

Risk factors for asthma attacks and poor control in children: a prospective observational study in UK primary care

Objective To identify risk factors for asthma attacks and poor asthma control in children aged 5–16 years. Methods Prospective observational cohort study of 460 children with asthma or suspected asthma from 10 UK general practices. Gender, age, ethnicity, body mass index, practice deprivation decile, spirometry and fraction of exhaled nitric oxide (FeNO) were recorded at baseline. Asthma control scores, asthma medication ratio (AMR) and the number of asthma attacks were recorded at baseline and at 6 months. The above independent variables were included in binary multiple logistic regression analyses for the dependent variables of: (1) poor symptom control and (2) asthma attacks during follow-up. Results Poor symptom control at baseline predicted poor symptom control at 6 months (OR 4.4, p=0.001), while an increase in deprivation decile (less deprived) was negatively associated with poor symptom control at 6 months (OR 0.79, p=0.003). Higher FeNO levels (OR 1.02, p A decrease in AMR was also associated with an increased OR for future asthma attacks (OR 2.99, p=0.003) when included as an independent variable. Conclusions We identified risk factors for poor symptom control and asthma attacks in children. Routine assessment of these factors should form part of the asthma review to identify children at an increased risk of adverse asthma-related events.</p

Lung function and asthma control in school-age children managed in UK primary care: A cohort study

Background: Spirometry and fraction of exhaled nitric oxide (FeNO) are commonly used in specialist centres to monitor children with asthma. The National Institute for Health and Care Excellence recommends spirometry for asthma monitoring from 5 years in all healthcare settings. There is little spirometry and FeNO data in children managed for asthma in UK primary care to support their use. Objectives: To study the prevalence of abnormal spirometry and FeNO in children with asthma managed in primary care and to explore their relationship with asthma control and unplanned healthcare attendances (UHA). Methods: Prospective observational cohort study in children aged 5-16 years with suspected or doctor-diagnosed asthma attending an asthma review in UK general practice. Spirometry, FeNO, asthma control test (ACT) scores and number of UHAs were studied. Results: Of 612 children from 10 general practices, 23.5% had abnormal spirometry, 36.0% had raised FeNO ≥35 parts per billion and 41.8% reported poor control. Fifty-four per cent of children reporting good asthma control had abnormal spirometry and/or raised FeNO. At follow-up, the mean number of UHAs fell from 0.31/child in the 6 months preceding review to 0.20/child over the 6 months following review (p=0.0004). Median ACT scores improved from 20 to 22 (p=0.032), and children's ACT from 21 to 23 (p<0.0001). Conclusions: Abnormal lung function and FeNO are common in children attending for asthma review in primary care and relate poorly to symptom scores. A symptoms-based approach to asthma monitoring without objective testing is likely to miss children at high risk of future severe asthma attacks

A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED)

Objectives: We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression. Methods: Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis. Results: n = 152 eligible adults aged 18–65 were recruited (n = 95 completed 3-month and n = 85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t = 3.95, P  <  0.01), consumed more vegetables (t = 3.95, P  <  0.01), fruit (t = 2.10, P = 0.04), nuts (t = 2.29, P = 0.02), legumes (t = 2.41, P = 0.02) wholegrains (t = 2.63, P = 0.01), and vegetable diversity (t = 3.27, P  <  0.01); less unhealthy snacks (t = −2.10, P = 0.04) and red meat/chicken (t = −2.13, P = 0.04). The MedDiet group had greater reduction in depression (t = −2.24, P = 0.03) and improved mental health QoL scores (t = 2.10, P = 0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r = −0.298, P = 0.01), nuts (r = −0.264, P = 0.01), and vegetable diversity (r = −0.303, P = 0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health. Discussion: This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Grou

A 6-month randomised controlled trial investigating effects of Mediterranean-style diet and fish oil supplementation on dietary behaviour change, mental and cardiometabolic health and health-related quality of life in adults with depression (HELFIMED): Study protocol

Modern diets, characterised by excess consumption of processed foods, are accompanied by an epidemic of chronic diseases. Cardiovascular disease and depression carry large burden of disease, and overlap with each other. Poor dietary patterns have been identified as an independent risk factor for depression while healthy diets are protective. Traditional Mediterranean diets have been shown to reduce risk of cardiovascular disease; however there is a need for clinical trials in people with depression. This study reports the protocol and 3-month dietary outcomes of a Mediterranean-style diet randomised controlled trial (RCT) conducted in adults with self-reported depression. Methods: HELFIMED is a parallel 6-month RCT investigating whether dietary patterns can be improved in people with depressive symptoms and whether healthier diet combined with fish oil supplementation can improve mental and cardiometabolic health and quality of life. Adults aged 18-65 with self-reported depressive symptoms (N=164) were block-randomised on age and gender between May 2014 to June 2015 to receive nutrition education, food hampers fortnightly cooking workshops based on Mediterranean-style dietary principles for 3 months and fish oil supplementation for 6 months, or to attend fortnightly social groups (control group) for 3 months. All participants completed mental health, quality of life and dietary questionnaires and provided anthropometric measurements, blood and urine samples at baseline, 3 and 6 months. Dietary changes: Compared to the control group (n=44) at 3 months the treatment group (n=60) reported a higher Mediterranean diet score (P<0.001), consumed more vegetables (P=0.002), wholegrains (P=0.040), nuts (P=0.028), legumes (p=0.029) and fish (p=0.020), greater diversity of vegetables (p=0.001) and less takeaway food (p=0.070), unhealthy snacks (p=0.061) and meat/chicken (p=0.005). Discussion: Over 3-months this intervention improved dietary patterns of adults suffering depressive symptoms and may provide a useful protocol for sustainable dietary change. Sustainability of dietary changes will be assessed at 6 months. Further analyses using linear mixed modelling and regression analysis will investigate the effects of dietary changes and fish oil supplementation on mental and cardiometabolic health and quality of life

Geographical variation in rates of surgical treatment for female stress urinary incontinence in England: a national cohort study.

OBJECTIVE: To examine geographic variation in use of surgery for female stress urinary incontinence (SUI), mainly midurethral mesh tape insertions, in the English National Health Service (NHS). DESIGN: National cohort study. SETTING: NHS hospitals. PARTICIPANTS: 27 997 women aged 20 years or older who had a first SUI surgery in an English NHS Hospital between April 2013 and March 2016 and a diagnosis of SUI at the same time as the procedure. METHODS: Multilevel Poisson regression was used to adjust for geographic differences in age, ethnicity, prevalence of long-term illness and socioeconomic deprivation. PRIMARY OUTCOME MEASURE: Rate of surgery for SUI per 100 000 women/year at two geographic levels: Clinical Commissioning Group (CCG; n=209) and Sustainability and Transformation Partnership (STP; n=44). RESULTS: The rate of surgery for SUI was 40 procedures per 100 000 women/year. Risk-adjusted rates ranged from 20 to 106 procedures per 100 000 women/year across CCGs and 24 to 69 procedures per 100 000 women/year across the STP areas. These regional differences were only partially explained by demographic characteristics as adjustment reduced variance of surgery rates by 16% among the CCGs and 35% among the STPs. CONCLUSIONS: Substantial geographic variation exists in the use of surgery for female SUI in the English NHS, suggesting that women in some areas are more likely to be treated compared with women with the same condition in other areas. The variation reflects differences in how national guidelines are being interpreted in the context of the ongoing debate about the safety of SUI surgery

Victoria's perioperative response to the COVID-19 pandemic

Victoria's perioperative response to the COVID-19 pandemi

Learning spaces: Built, natural and digital considerations for learning and learners

Learning spaces: Built, natural and digital considerations for learning and learner