Open data on health-related neighbourhood features in Great Britain

Our study details the creation of a series of national open source low-level geographical measures of accessibility to health-related features for Great Britain. We create 14 measures across three domains: retail environment (fast food outlets, gambling outlets, pubs/bars/nightclubs, off-licences, tobacconists), health services (General Practitioners, pharmacies, dentists, hospitals, leisure centres) and the physical environment (green space and air quality). Using the network analysis process of Routino, postcode accessibility (km) to each of these features were calculated for the whole of Great Britain. An average score for each domain was calculated and subsequently combined to form an overall Index highlighting ‘Access to Healthy Assets and Hazards’. We find the most accessible healthy areas are concentrated in the periphery of the urban cores, whilst the least accessible healthy areas are located in the urban cores and the rural areas. The open data resource is important for researchers and policy makers alike with an interest in measuring the role of spatial features on health

ProsocialLearn: D2.5 evaluation strategy and protocols

This document describes the evaluation strategy for the assessment of game effectiveness, market value impact and ethics procedure to drive detailed planning of technical validation, short and longitudinal studies and market viability tests

Impact of community-based chronic obstructive pulmonary disease service, a multidisciplinary intervention in an area of high deprivation: A longitudinal matched controlled study

Objective: To examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions. Design: A longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the intervention population to a matched comparison population, five years before and after implementation. Setting: A deprived district in the North West of England between 2005 and 2016. Intervention: A community-based, consultant-led COPD service providing diagnostics, treatment and rehabilitation from 2011–2016. Main outcome measures: Emergency hospital admissions, length of stay per emergency admission, and emergency re-admissions for COPD. Results: The intervention was associated with 24 fewer emergency COPD admissions per 100,000 population per year (95%CI -10.6 to 58.8, p=0.17) in the post-intervention period, relative to the control group. There were significantly fewer emergency admissions in populations with medium levels of deprivation (64 per 100,000 per year; 95%CI 1.8 to 126.9) and amongst men (60 per 100,000 per year; 95%CI 12.3 to 107.3). Conclusion: We found limited evidence that the service reduced emergency hospital admissions, after an initial decline the effect was not sustained. The service, however, may have been more effective in some subgroups

The longitudinal NIHR ARC North West Coast Household Health Survey: exploring health inequalities in disadvantaged communities.

BACKGROUND: The Household Health Survey (HHS) was developed to understand the socioeconomic determinants of mental and physical health, and health inequalities in health and social care. This paper aims to provide a detailed rationale of the development and implementation of the survey and explore socio-economic variations in physical and mental health and health care. METHODS: This comprehensive longitudinal public health survey was designed and piloted in a disadvantaged area of England, comprising questions on housing, physical health, mental health, lifestyle, social issues, environment, work, and finances. After piloting, the HHS was implemented across 28 neighbourhoods - 10 disadvantaged neighbourhoods for learning (NfLs), 10 disadvantaged comparator sites, and eight relatively advantaged areas, in 2015 and 2018. Participants were recruited via random sampling of households in pre-selected neighbourhoods based on their areas of deprivation. RESULTS: 7731 residents participated in Wave 1 (N = 4319) and 2 (n = 3412) of the survey, with 871 residents having participated in both. Mental health, physical health, employment, and housing quality were poorer in disadvantaged neighbourhoods than in relatively advantaged areas. CONCLUSIONS: This survey provides important insights into socio-economic variations in physical and mental health, with findings having implications for improved care provision to enable residents from any geographical or socio-economic background to access suitable care

Magnetic Field Structures in a Facular Region Observed by THEMIS and Hinode

The main objective of this paper is to build and compare vector magnetic maps obtained by two spectral polarimeters, i.e. THEMIS/MTR and Hinode SOT/SP, using two inversion codes (UNNOFIT and MELANIE) based on the Milne-Eddington solar atmosphere model. To this end, we used observations of a facular region within active region NOAA 10996 on 23 May 2008, and found consistent results concerning the field strength, azimuth and inclination distributions. Because SOT/SP is free from the seeing effect and has better spatial resolution, we were able to resolve small magnetic polarities with sizes of 1" to 2", and we could detect strong horizontal magnetic fields, which converge or diverge in negative or positive facular polarities. These findings support models which suggest the existence of small vertical flux tube bundles in faculae. A new method is proposed to get the relative formation heights of the multi-lines observed by MTR assuming the validity of a flux tube model for the faculae. We found that the Fe 1 6302.5 \AA line forms at a greater atmospheric height than the Fe 1 5250.2 \AA line.Comment: 20 pages, 9 figures, 3 tables, accepted for publication in Solar Physic

Impact of a community-based cardiovascular disease service intervention in a highly deprived area

Objective: To examine the effects on emergency hospital admissions, length of stay and emergency re-admissions of providing a consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, based in a highly deprived area in the North West of England. Methods: A longitudinal matched controlled study using difference-in-differences analysis compared the change in outcomes in the intervention population, to the change in outcomes in a matched comparison population that had not received the intervention, five years before and after implementation. The outcomes were emergency hospitalisations, length of inpatient stay, and re-admission rates for cardiovascular disease (CVD). Results: Findings show that the intervention was associated with 66 fewer emergency CVD admissions per 100,000 population per year [95% CI 22.13 to 108.98] in the post-intervention period, relative to the control group. No significant measurable effects on length of stay or emergency re-admission rates were observed. Conclusion: This consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, was associated with a lower rate of emergency hospital admissions in a highly disadvantaged population. Similar approaches could be an effective component of strategies to reduce unplanned hospital admissions

What are the social predictors of accident and emergency attendance in disadvantaged neighbourhoods? Results from a cross-sectional household health survey in the north west of England.

OBJECTIVES: The aim of this study was to identify the most important determinants of accident and emergency (A&E) attendance in disadvantaged areas. DESIGN, SETTING AND PARTICIPANTS: A total of 3510 residents from 20 disadvantaged neighbourhoods in the North West Coast area in England completed a comprehensive public health survey. MAIN OUTCOME MEASURES: Participants were asked to complete general background information, as well as information about their physical health, mental health, lifestyle, social issues, housing and environment, work and finances, and healthcare service usage. Only one resident per household could take part in the survey. Poisson regression analysis was employed to assess the predictors of A&E attendance frequency in the previous 12 months. RESULTS: 31.6% of the sample reported having attended A&E in the previous 12 months, ranging from 1 to 95 visits. Controlling for demographic and health factors, not being in employment and living in poor quality housing increased the likelihood of attending an A&E service. Service access was also found to be predictive of A&E attendance insofar as there were an additional 18 fewer A&E attendances per 100 population for each kilometre closer a person lived to a general practitioner (GP) practice, and 3 fewer attendances per 100 population for each kilometre further a person lived from an A&E department. CONCLUSIONS: This is one of the first surveys to explore a comprehensive set of socio-economic factors as well as proximity to both GP and A&E services as predictors of A&E attendance in disadvantaged areas. Findings from this study suggest the need to address both socioeconomic issues, such as employment and housing quality, as well as structural issues, such as public transport and access to primary care, to reduce the current burden on A&E departments

Predictors of emergency department and GP use among patients with mental health conditions: a public health survey.

BACKGROUND: High demand for health services is an issue of current importance in England, in part because of the rapidly increasing use of emergency departments (EDs) and GP practices for mental health conditions and the high cost of these services. AIM: To examine the social determinants of health service use in people with mental health issues. DESIGN AND SETTING: Twenty-eight neighbourhoods, each with a population of 5000-10 000 people, in the north west coast of England with differing levels of deprivation. METHOD: A comprehensive public health survey was conducted, comprising questions on housing, physical health, mental health, lifestyle, social issues, environment, work, and finances. Poisson regression models assessed the effect of mental health comorbidity, mental and physical health comorbidity, and individual mental health symptoms on ED and general practice attendances, adjusting for relevant socioeconomic and lifestyle factors. RESULTS: Participants who had both a physical and mental health condition reported attending the ED (rate ratio [RR] = 4.63, 95% confidence interval [CI] = 2.86 to 7.51) and general practice (RR = 3.82, 95% CI = 3.16 to 4.62) more frequently than all other groups. Having a higher number of mental health condition symptoms was associated with higher general practice and ED service use. Depression was the only mental health condition symptom that was significantly associated with ED attendance (RR = 1.41, 95% CI = 1.05 to 1.90), and anxiety was the only symptom significantly associated with GP attendance (RR = 1.19, 95% CI = 1.03 to 1.38). CONCLUSION: Mental health comorbidities increase the risk of attendances to both EDs and general practice. Further research into the social attributes that contribute to reduced ED and general practice attendance rates is needed