Chief Social Work Officers and Secure Care

This research was a qualitative study of Chief Social Work Officer (CSWO) perceptions; and of CSWO and local authority approaches to the use of secure care in Scotland. The central focus of the study was an examination of how the role and responsibilities of CSWOs in relation to secure care, as defined in legislation and related guidance and policy, are translated in practice, within the context of their local authority’s approach to children and young people who are extremely vulnerable and who pose a very high risk to themselves and/or to other people. The project sought to understand how the personal and professional value base of individual CSWOs, and their role within each local authority context, impacts on perceptions of; approaches to; and usage of; secure care and complementary or alternative services

Plain Tobacco Packaging: A Systematic Review

(From the Executive Summary): This systematic review outlines findings from 37 studies that provide evidence of the impacts of plain tobacco packaging. The review was conducted following the publication of the March 2011 White Paper Healthy Lives: Healthy People which set out a renewed Tobacco Control Plan for England. One of the key actions identified in the plan was to consult on possible options to reduce the promotional impact of tobacco packaging, including plain packaging. This systematic review was commissioned to provide a comprehensive overview of evidence on the impact of plain packaging in order to inform a public consultation on the issue

A New Model for Evaluation of Interventions to Prevent Obesity in Early Childhood

Background: Childhood obesity is a serious public health issue. In Australia, 1 in 4 children is already affected by overweight or obesity at the time of school entry. Governments around the world have recognized this problem through investment in the prevention of pediatric obesity, yet few interventions in early childhood have been subjected to economic evaluation. Information on cost-effectiveness is vital to decisions about program implementation. A challenge in evaluating preventive interventions in early childhood is to capture long-term costs and outcomes beyond the duration of an intervention, as the benefits of early obesity prevention will not be realized until some years into the future. However, decisions need to be made in the present, and modeling is one way to inform such decisions.Objective: To describe the conceptual structure of a new health economic model (the Early Prevention of Obesity in CHildhood (EPOCH) model) for evaluating childhood obesity interventions; and to validate the epidemiologic predictions.Methods and Results: We use an individual–level (micro-simulation) method to model BMI trajectories and the progression of obesity from early childhood to adolescence. The equations predicting individual BMI change underpinning our model were derived from data from the population-representative study, the Longitudinal Study of Australian Children (LSAC). Our approach is novel because it will account for costs and benefits accrued throughout childhood and adolescence. As a first step to validate the epidemiological predictions of the model, we used input data representing over 250,000 children aged 4/5 years, and simulated BMI and obesity trajectories until adolescence. Simulated mean BMI and obesity prevalence for boys and girls were verified by nationally-representative data on children at 14/15 years of age.Discussion: The EPOCH model is epidemiologically sound in its prediction of both BMI trajectories and prevalence of obesity for boys and girls. Future developments of the model will include socio-economic position and will incorporate the impacts of obesity on healthcare costs. The EPOCH model will help answer: when is it best to intervene in childhood; what are the most cost-effective approaches and which population groups will benefit most from interventions

Is there an association between early weight status and utility based health-related quality of life in young children?

Purpose Few studies focus on the health-related quality of life (HRQoL) of preschool children with overweight or obesity. This is relevant for evaluation of obesity prevention trials using a quality-adjusted life year (QALY) framework. This study examined the association between weight status in the preschool years and HRQoL at age 5 years, using a preference-based instrument. Methods HRQoL [based on parent proxy version of the Health Utilities Index Mark 3 (HUI3)] and weight status were measured in children born in Australia between 2007 and 2009. Children’s health status was scored across eight attributes of the HUI3—vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain, and these were used to calculate a multi-attribute utility score. Ordinary least squares (OLS), Tobit and two-part regressions were used to model the association between weight status and multi-attribute utility. Results Of the 368 children for whom weight status and HUI3 data were available, around 40% had overweight/obesity. After adjusting for child’s sex, maternal education, marital status and household income, no significant association between weight status in the preschool years and multi-attribute utility scores at 5 years was found. Conclusions Alternative approaches for capturing the effects of weight status in the preschool years on preference-based HRQoL outcomes should be tested. The application of the QALY framework to economic evaluations of obesity-related interventions in young children should also consider longitudinal effects over the life-course

Fluctuating asymmetry in brain structure and general intelligence in 73-Year-olds

SRC, MEB, JMW, IJD were supported by MRC grants MR/M013111/1 and MR/R024065/1. IJD is additionally supported by the Dementias Platform UK (MR/L015382/1), and he, SRC and SJR by the Age UK-funded Disconnected Mind project (http://www.disconnectedmind.ed.ac.uk). The work was done within the University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology; it was funded by the MRC and the BBSRC (MR/K026992/1) and supported SJR, IJD, and JMS. SRC, SJR, MEB and IJD were supported by a National Institutes of Health (NIH) research grant R01AG054628. JMW was supported by the Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) collaboration (http://www.sinapse.ac.uk).Fluctuating body asymmetry is theorized to indicate developmental instability, and to have small positive associations with low socioeconomic status (SES). Previous studies have reported small negative associations between fluctuating body asymmetry and cognitive functioning, but relationships between fluctuating brain asymmetry and cognitive functioning remain unclear. The present study investigated the association between general intelligence (a latent factor derived from a factor analysis on 13 cognitive tests) and the fluctuating asymmetry of four structural measures of brain hemispheric asymmetry: cortical surface area, cortical volume, cortical thickness, and white matter fractional anisotropy. The sample comprised members of the Lothian Birth Cohort 1936 (LBC1936, N = 636, mean age = 72.9 years). Two methods were used to calculate structural hemispheric asymmetry: in the first method, regions contributed equally to the overall asymmetry score; in the second method, regions contributed proportionally to their size. When regions contributed equally, cortical thickness asymmetry was negatively associated with general intelligence (beta=-0.18,p <.001). There was no association between cortical thickness asymmetry and childhood SES, suggesting that other mechanisms are involved in the thickness asymmetry-intelligence association. Across all cortical metrics, asymmetry of regions identified by the parieto-frontal integration theory (P-FIT) was not more strongly associated with general intelligence than non-P-FIT asymmetry. When regions contributed proportionally, there were no associations between general intelligence and any of the asymmetry measures. The implications of these findings, and of different methods of calculating structural hemispheric asymmetry, are discussed.Publisher PDFPeer reviewe

Assessing Cost-Effectiveness in Obesity (ACE-Obesity): an overview of the ACE approach, economic methods and cost results

Background : The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study. Methods : The Assessing Cost-Effectiveness (ACE) approach combines technical rigour with \u27due process\u27 to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their \u27current practice\u27 comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were \u27equity\u27, \u27strength of the evidence\u27, \u27feasibility of implementation\u27, \u27acceptability to stakeholders\u27, \u27sustainability\u27 and \u27potential for side-effects\u27.Results : The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum) and when expressed as a \u27cost per child\u27 estimate (from &lt;AUD1.0 [reduction of TV advertising of high fat foods/high sugar drinks] to &gt;AUD31,000 [laparoscopic adjustable gastric banding for morbidly obese adolescents]). High costs per child reflected cost structure, target population and/or under-utilisation. Conclusions : The use of consistent methods enables valid comparison of potential intervention costs and cost-offsets for each of the interventions. ACE-Obesity informs policy-makers about cost-effectiveness, health impact, affordability and 2nd stage filters for important options for preventing unhealthy weight gain in children. In related articles cost-effectiveness results and second stage filter considerations for each intervention assessed will be presented and analysed.<br /

Sustainable Diets: another hurdle or a better food future?,

The notion of sustainable diets has emerged forcibly onto the food policy agenda in recent years, but has also met resistance. The article reviews the case for sustainable diets. It counterbalances the current dominant policy emphasis on raising food output as the best route to a sustainable food future. The article suggests that a process of democratic experimentation is underway. Some official guidelines have emerged alongside a mix of civil society and academic formulations. More coherence of data, principles and purpose is needed at the global and regional policy-making levels for these to become effective in the common task of reducing the food system’s negative impact on health, environment and economies