Hear today but maybe not tomorrow - the implications of Glue Ear - research findings

Although Glue Ear has been known about for many years, and at one time was life threatening, today many educational professionals see it as a minor issue with no long term problems. While this may be the case for the majority of children, those who have the condition in the longer term may be impacted in psycho-social development, cognitive processing and academic performance. This article identifies aspects from the primarily quantitative research which suggest that the greatest impact is likely to be on those young people and their parents with the severe form of the condition. Some of the potential implications for EP practice are identified

An effectiveness hierarchy of preventive interventions: Neglected paradigm or self-evident truth?

© The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. Non-communicable disease prevention strategies usually target the four major risk factors of poor diet, tobacco, alcohol and physical inactivity. Yet, the most effective approaches remain disputed. However, increasing evidence supports the concept of an effectiveness hierarchy. Thus entive activities targeting individuals (such as 1:1 personal advice, health education, 'nudge' or primary prevention medications) consistently achieve a smaller population health impact than interventions aimed further 'upstream' (for instance, smoke-free legislation, alcohol minimum pricing or regulations eliminating dietary transfats). These comprehensive, policy-based interventions reach all parts of the population and do not depend on a sustained 'agentic' individual response. They thus tend to be more effective, more rapid, more equitable and also cost-saving. This effectiveness hierarchy is self-evident to many professionals working in public health. Previously neglected in the wider world, this effectiveness hierarchy now needs to be acknowledged by policy makers

Quantifying the Socio-Economic Benefits of Reducing Industrial Dietary Trans Fats: Modelling Study.

BACKGROUND: Coronary Heart Disease (CHD) remains a leading cause of UK mortality, generating a large and unequal burden of disease. Dietary trans fatty acids (TFA) represent a powerful CHD risk factor, yet to be addressed in the UK (approximately 1% daily energy) as successfully as in other nations. Potential outcomes of such measures, including effects upon health inequalities, have not been well quantified. We modelled the potential effects of specific reductions in TFA intake on CHD mortality, CHD related admissions, and effects upon socioeconomic inequalities. METHODS & RESULTS: We extended the previously validated IMPACTsec model, to estimate the potential effects of reductions (0.5% & 1% reductions in daily energy) in TFA intake in England and Wales, stratified by age, sex and socioeconomic circumstances. We estimated reductions in expected CHD deaths in 2030 attributable to these two specific reductions. Output measures were deaths prevented or postponed, life years gained and hospital admissions. A 1% reduction in TFA intake energy intake would generate approximately 3,900 (95% confidence interval (CI) 3,300-4,500) fewer deaths, 10,000 (8,800-10,300) (7% total) fewer hospital admissions and 37,000 (30,100-44,700) life years gained. This would also reduce health inequalities, preventing five times as many deaths and gaining six times as many life years in the most deprived quintile compared with the most affluent. A more modest reduction (0.5%) would still yield substantial health gains. CONCLUSIONS: Reducing intake of industrial TFA could substantially decrease CHD mortality and hospital admissions, and gain tens of thousands of life years. Crucially, this policy could also reduce health inequalities. UK strategies should therefore aim to minimise industrial TFA intake

A co-evolutionary arms race: trypanosomes shaping the human genome, humans shaping the trypanosome genome

<i>Trypanosoma brucei</i> is the causative agent of African sleeping sickness in humans and one of several pathogens that cause the related veterinary disease Nagana. A complex co-evolution has occurred between these parasites and primates that led to the emergence of trypanosome-specific defences and counter-measures. The first line of defence in humans and several other <i>catarrhine</i> primates is the trypanolytic protein apolipoprotein-L1 (APOL1) found within two serum protein complexes, trypanosome lytic factor 1 and 2 (TLF-1 and TLF-2). Two sub-species of <i>T. Brucei</i> have evolved specific mechanisms to overcome this innate resistance, <i>Trypanosoma brucei gambiense</i> and <i>Trypanosoma brucei rhodesiense</i>. In <i>T. b. Rhodesiense</i>, the presence of the serum resistance associated (SRA) gene, a truncated variable surface glycoprotein (VSG), is sufficient to confer resistance to lysis. The resistance mechanism of <i>T. b. Gambiense</i> is more complex, involving multiple components: reduction in binding affinity of a receptor for TLF, increased cysteine protease activity and the presence of the truncated VSG, <i>T. b. Gambiense</i>-specific glycoprotein <i>(TgsGP)</i>. In a striking example of co-evolution, evidence is emerging that primates are responding to challenge by <i>T. b. Gambiense</i> and <i>T. b. Rhodesiense</i>, with several populations of humans and primates displaying resistance to infection by these two sub-species

Road traffic accidents in Libya: An undeclared War

To The Editor: In his outstanding article regarding Road Traffic Accidents (RTAs) in Libya [1], Dr Abdulmajid Ali has raised awareness and started a debate about this extremely important issue. Before responding to some points in Dr Ali’s article, I would like to tell a real story of a tragic accident that happened last week, which highlights several issues related to RTAs in Libya. A 55 year old driver left after Fajr prayer to the vegetable market to buy a few things for his daughter’s wedding lunch. While trying to avoid a big pothole in the middle of the road, he was hit by a truck without headlights coming from the opposite direction. The truck driver continued driving as if nothing had happened. None of the road users cared to help the victim but he was able to contact his son by mobile phone to come and help him out of the wreckage. His son took him to the main Trauma Hospital in Tripoli. The patient had no external injuries. He was admitted for observation only. A few hours later the patient died as a result of major internal haemorrhage. Further information revealed that the truck driver had no driving licence and the truck was not road worthy.This story is not unique However, it highlights the complex and intermingled issues that need to be addressed to have any real impact on this disastrous problem in Libya. The specific points I would like to add to Dr Ali’s article are:There is no doubt that RTAs are a major killer in Libya especially in the young age group. The annual reporting of road causalities is considered to be the yard stick to measure the effectiveness of any national traffic policy,; in the UK for example the target is to reduce fatalities from RTAs by 50% by 2010 [2]. It is a disgrace not to have accurate official statistics published at least annually of fatalities, injuries, disabilities and the economic consequences of this undeclared war in Libya. There is evidence to support that there could be a positive impact when national health challenges are tackled systematically [3-5]. It is perplexing not to have a Libyan National Traffic Policy to deal with this very serious issue comprehensively.The majority of serious accidents in Libya occur on motorways. Internationally, motorways are organised in such a way that traffic can only leave or join the motorway through specified junctions. In contrast, in Libyan motorways, other vehicles can join the motorway unpredictably at any point, left or right and sometimes from above or below! Personally I think that the lack of a Highway Code or its implementation is a major contributing cause for serious RTAs.The Libyan Traffic Police Force needs a shakeup to root out the few corrupt officers who brought what used to be a highly regarded force into disrepute because of their indiscipline. The force needs support, respect and incentives, one of which is to link their pay rise to the national reduction of RTAs.To be slightly provocative, I would like to call for a public inquiry into the issue of RTAs in Libya. This is a very robust way to learn lessons and implement corrective changes (please see www.hse.gov.uk Railway Public inquiries). Dr Ali touched on the importance of ATLS. As we can learn from the above story the issue is not as simple as we think. I will not scratch the issue of the role of Blood transfusion Service in this situation. Suffice it to say this is a colossal national challenge and deserves equal resources.I would like to express my disagreement with Dr Ali’s suggestion to exert our pressure on the Libyan Ministry of Health. I do not believe that we have any power to exert over the politicians

A qualitative study of the contribution of pharmacists to heart failure management in Scotland

Study objectives: (1) To identify the medication management needs of chronic heart failure (CHF) patients and their caregivers; (2) To examine the perceived support for medication management available to these people from health professionals; (3) To identify the actual and potential perceived contribution of pharmacists to medication management. Setting: A mixed urban/ rural region in the west of Scotland. Design: Semi-structured qualitative research interviews. Participants: A total of 50 people with CHF (NYHA Class II and III) due to left ventricular systolic dysfunction (33 males; mean age 67 years, 17 females; mean age 68 years) and 30 nominated caregivers recruited from the outpatient departments of two hospitals in the West of Scotland. Sampling was purposive to include patients from a range of CHF severity, ages and sexes. Main results: Managing medications was a responsibility shared by both the patients with CHF and caregivers. Treatment regimens were reported to be difficult to comply with. Health professionals were seen to provide little support for medication management. Pharmacists were viewed as being a good and accessible source of practical assistance who were also knowledgeable about the individual’s heart health history. Participants reported valuing advice from pharmacists about the side effects of medications and for their assistance in reducing the complex logistics of medication management and in having medications delivered. Conclusions: Patients with CHF and caregivers voiced a willingness to try to manage their medication regimen accurately but had a limited capacity to do so. Pharmacists were viewed as providing valuable support to patients with CHF and their caregivers, in terms of medication management. The extended role of pharmacists in medication management of CHF should be encouraged

Comparing primary prevention with secondary prevention to explain decreasing Coronary Heart Disease death rates in Ireland, 1985-2000.

BACKGROUND: To investigate whether primary prevention might be more favourable than secondary prevention (risk factor reduction in patients with coronary heart disease(CHD)). METHODS: The cell-based IMPACT CHD mortality model was used to integrate data for Ireland describing CHD patient numbers, uptake of specific treatments, trends in major cardiovascular risk factors, and the mortality benefits of these specific risk factor changes in CHD patients and in healthy people without recognised CHD. RESULTS: Between 1985 and 2000, approximately 2,530 fewer deaths were attributable to reductions in the three major risk factors in Ireland. Overall smoking prevalence declined by 14% between 1985 and 2000, resulting in about 685 fewer deaths (minimum estimate 330, maximum estimate 1,285) attributable to smoking cessation: about 275 in healthy people and 410 in known CHD patients. Population total cholesterol concentrations fell by 4.6%, resulting in approximately 1,300 (minimum estimate 1,115, maximum estimate 1,660) fewer deaths attributable to dietary changes(1,185 in healthy people and 115 in CHD patients) plus 305 fewer deaths attributable to statin treatment (45 in people without CHD and 260 in CHD patients). Mean population diastolic blood pressure fell by 7.2%, resulting in approximately 170 (minimum estimate 105, maximum estimate 300) fewer deaths attributable to secular falls in blood pressure (140 in healthy people and 30 in CHD patients), plus approximately 70 fewer deaths attributable to antihypertensive treatments in people without CHD. Of all the deaths attributable to risk factor falls, some 1,715 (68%) occurred in people without recognized CHD and 815(32%) in CHD patients. CONCLUSION: Compared with secondary prevention, primary prevention achieved a two-fold larger reduction in CHD deaths. Future national CHD policies should therefore prioritize nationwide interventions to promote healthy diets and reduce smoking

An economic evaluation of salt reduction policies to reduce coronary heart disease in England: a policy modeling study

AbstractObjectivesDietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease causes approximately 35% of total UK deaths, at an estimated annual cost of £30 billion. The World Health Organization and the National Institute for Health and Care Excellence have recommended a reduction in the intake of salt in people's diets. This study evaluated the cost-effectiveness of four population health policies to reduce dietary salt intake on an English population to prevent coronary heart disease (CHD).MethodsThe validated IMPACT CHD model was used to quantify and compare four policies: 1) Change4Life health promotion campaign, 2) front-of-pack traffic light labeling to display salt content, 3) Food Standards Agency working with the food industry to reduce salt (voluntary), and 4) mandatory reformulation to reduce salt in processed foods. The effectiveness of these policies in reducing salt intake, and hence blood pressure, was determined by systematic literature review. The model calculated the reduction in mortality associated with each policy, quantified as life-years gained over 10 years. Policy costs were calculated using evidence from published sources. Health care costs for specific CHD patient groups were estimated. Costs were compared against a “do nothing” baseline.ResultsAll policies resulted in a life-year gain over the baseline. Change4life and labeling each gained approximately 1960 life-years, voluntary reformulation 14,560 life-years, and mandatory reformulation 19,320 life-years. Each policy appeared cost saving, with mandatory reformulation offering the largest cost saving, more than £660 million.ConclusionsAll policies to reduce dietary salt intake could gain life-years and reduce health care expenditure on coronary heart disease