Mainstreaming prevention: Prescribing fruit and vegetables as a brief intervention in primary care

This is the author's PDF version of an article published in Public health© 2005.This articles discusses a project at the Castlefields Health Centre in Halton whereby primary care professionals issue a prescription for discounts on fruit and vegetables. The prescription is explicitly linked to the five-a-day message

Consumer use and response to online third-party raw DNA interpretation services

This study was funded in part by a pilot grant from the Boston University School of Public Health. (Boston University School of Public Health)Published versio

Estimating the prevalence and incidence of type 2 diabetes using population level pharmacy claims data: A cross-sectional study

Objective: To estimate the prevalence and incidence of type 2 diabetes using a national pharmacy claims database. Research design and methods: We used data from the Health Service Executive-Primary Care Reimbursement Service database in Ireland for this cross-sectional study. Prevalent cases of type 2 diabetes were individuals using an oral hypoglycemic agent, irrespective of insulin use, in 2012. Incident cases were individuals using an oral hypoglycemic agent in 2012 who had not used one in the past. Population level estimates were calculated and stratified by age and sex. Results: In 2012, there were 114 957 prevalent cases of type 2 diabetes giving a population prevalence of 2.51% (95% CI 2.49% to 2.52%). Among adults (≥15yrs), this was 3.16% (95% CI 3.15% to 3.18%). The highest prevalence was in those aged 70+ years (12.1%). 21 574 people developed type 2 diabetes in 2012 giving an overall incidence of 0.48% (95% CI 0.48% to 0.49%). In adults, this was 0.60% (95% CI 0.60% to 0.61%). Incidence rose with age to a maximum of 2.08% (95% CI 2.02% to 2.15%) in people aged 65-69 years. Men had a higher prevalence (2.96% vs 2.04%) and incidence (0.54% vs 0.41%) of type 2 diabetes than women. Conclusions: Pharmacy claims data allow estimates of objectively defined type 2 diabetes at the population level using up-to-date data. These estimates can be generated quickly to inform health service planning or to evaluate the impact of population level interventions

Rising obesity-related hospital admissions among children and young people in England: national time trends study

Objective: To describe the trends in hospital admissions associated with obesity as a primary diagnosis and comorbidity, and bariatric surgery procedures among children and young people in England. Design: National time trends study of hospital admissions data between 2000 and 2009. Participants: Children and young people aged 5 to 19 years who were admitted to hospital with any diagnosis of obesity. Main outcome measures: Age- and sex-specific admission rates per million children. Results: Between 2000 and 2009, age- and sex-specific hospital admission rates in 5–19 year olds for total obesity-related diagnoses increased more than four-fold from 93.0 (95% CI 86.0 to 100.0) per million children to 414.0 (95% CI 410.7 to 417.5) per million children, largely due to rising admissions where obesity was mentioned as a co-morbidity. The median age of admission to hospital over the study period was 14.0 years; 5,566 (26.7%) admissions were for obesity and 15,319 (73.3%) mentioned obesity as a comorbidity. Admissions were more common in girls than boys (56.2% v 43.8%). The most common reasons for admission where obesity was a comorbid condition were sleep apnoea, asthma, and complications of pregnancy. The number of bariatric surgery procedures has risen from 1 per year in 2000 to 31 in 2009, with the majority were performed in obese girls (75.6%) aged 13–19 years. Conclusions: Hospital admission rates for obesity and related comorbid conditions have increased more than four-fold over the past decade amongst children and young people. Although some of the increase is likely to be due to improved case ascertainment, conditions associated with obesity in children and young people are imposing greater challenges for health care providers in English hospitals. Most inpatient care is directed at dealing with associated conditions rather than primary assessment and management of obesity itself

Exploring willingness of elder Chinese in Houston to participate in clinical research

AbstractBackground and objectivesInadequate minority participation in clinical research can threaten the applicability and strength of scientific findings. Previous research suggests that trial participation rates are lowest among Asian Americans, compared to other groups. This study explored barriers to clinical research participation among elder Chinese living in Houston, Texas. Additionally we administered the Trust in Medical Researchers Scale (TIMRS), used previously in researching trust in medical researchers as related to research participation.DesignIn this mixed methods study, a semi-structured interview, including the TIMRS were administered to 30 adults of Chinese ancestry aged 50 years or older recruited from a Chinese community center. Interviews were conducted in English, Mandarin and Cantonese and independently coded and analyzed using thematic content analysis. TIMRS scores were calculated for participants.ResultsParticipants were 70% female, 70% were 60 or elder, all were foreign born and on average lived in the US for 21.8 years. Participants perceived risks to research participation and preferred language concordant research staff. Interviewees were more willing to participate if they perceived personal and community health-related benefits. The overall TIMRS score was 23.9 (±5.0), lower than the overall TIMRS for Whites in a previous study (P < 0.001).ConclusionsThe barriers and facilitators to research participation confirmed previous research among Asians. Our participant TIMRS scores were consistent with decreased levels of trust observed in the original TIMRS study for African Americans as compared and lower than Whites. Employing strategies that utilize language concordant staff who build trust with participants may aid in recruiting elder Chinese, especially if the research is personally relevant to those being recruited

A Descriptive Analysis Of The National Council For Accreditation Of Teacher Education Master\u27s In Teacher Leadership Programs From 1980 - Present

This study focused on the 28 institutions that are members of the National Council for Accreditation of Teacher Education (NCATE) and offer Master\u27s in Teacher Leadership programs that they describe on their websites. Those programs were researched looking for similarities and differences across programs, specifically researching their Carnegie Foundation Classifications, geographical location, and basic program descriptors. A document-analysis was conducted on a sub-sample of three institutions that provided access to core course syllabi on-line looking for the embedded knowledge, skills, and dispositions within their coursework. These knowledge, skills, and dispositions were then compared to the Teacher Leader Model Standards developed by the Teacher Leader Exploratory Consortium to uncover if the program goals aligned with the standards. Recommendations are made for policy, practice and future research related to the development of teacher leadership

Measuring co-authorship and networking-adjusted scientific impact

Appraisal of the scientific impact of researchers, teams and institutions with productivity and citation metrics has major repercussions. Funding and promotion of individuals and survival of teams and institutions depend on publications and citations. In this competitive environment, the number of authors per paper is increasing and apparently some co-authors don't satisfy authorship criteria. Listing of individual contributions is still sporadic and also open to manipulation. Metrics are needed to measure the networking intensity for a single scientist or group of scientists accounting for patterns of co-authorship. Here, I define I1 for a single scientist as the number of authors who appear in at least I1 papers of the specific scientist. For a group of scientists or institution, In is defined as the number of authors who appear in at least In papers that bear the affiliation of the group or institution. I1 depends on the number of papers authored Np. The power exponent R of the relationship between I1 and Np categorizes scientists as solitary (R>2.5), nuclear (R=2.25-2.5), networked (R=2-2.25), extensively networked (R=1.75-2) or collaborators (R<1.75). R may be used to adjust for co-authorship networking the citation impact of a scientist. In similarly provides a simple measure of the effective networking size to adjust the citation impact of groups or institutions. Empirical data are provided for single scientists and institutions for the proposed metrics. Cautious adoption of adjustments for co-authorship and networking in scientific appraisals may offer incentives for more accountable co-authorship behaviour in published articles.Comment: 25 pages, 5 figure

A cluster randomized controlled trial of the effectiveness and cost-effectiveness of Intermediate Care Clinics for Diabetes (ICCD) : study protocol for a randomized controlled trial

Background World-wide healthcare systems are faced with an epidemic of type 2 diabetes. In the United Kingdom, clinical care is primarily provided by general practitioners (GPs) rather than hospital specialists. Intermediate care clinics for diabetes (ICCD) potentially provide a model for supporting GPs in their care of people with poorly controlled type 2 diabetes and in their management of cardiovascular risk factors. This study aims to (1) compare patients with type 2 diabetes registered with practices that have access to an ICCD service with those that have access only to usual hospital care; (2) assess the cost-effectiveness of the intervention; and (3) explore the views and experiences of patients, health professionals and other stakeholders. Methods/Design This two-arm cluster randomized controlled trial (with integral economic evaluation and qualitative study) is set in general practices in three UK Primary Care Trusts. Practices are randomized to one of two groups with patients referred to either an ICCD (intervention) or to hospital care (control). Intervention group: GP practices in the intervention arm have the opportunity to refer patients to an ICCD - a multidisciplinary team led by a specialist nurse and a diabetologist. Patients are reviewed and managed in the ICCD for a short period with a goal of improving diabetes and cardiovascular risk factor control and are then referred back to practice. or Control group: Standard GP care, with referral to secondary care as required, but no access to ICCD. Participants are adults aged 18 years or older who have type 2 diabetes that is difficult for their GPs to control. The primary outcome is the proportion of participants reaching three risk factor targets: HbA1c (≤7.0%); blood pressure (<140/80); and cholesterol (<4 mmol/l), at the end of the 18-month intervention period. The main secondary outcomes are the proportion of participants reaching individual risk factor targets and the overall 10-year risks for coronary heart disease(CHD) and stroke assessed by the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Other secondary outcomes include body mass index and waist circumference, use of medication, reported smoking, emotional adjustment, patient satisfaction and views on continuity, costs and health related quality of life. We aimed to randomize 50 practices and recruit 2,555 patients

Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for non-diabetic hyperglycemic patients referred by primary care in the UK

Objectives: To determine if a diabetes prevention program (DPP) delivered by a commercial weight management provider using a UK primary care referral pathway could reduce the progression to type 2 diabetes (T2D) in those diagnosed with non-diabetic hyperglycemia (NDH—being at high risk of developing T2D). Research design: This is a quasi-experimental translational research study. Methods: 14 primary care practices identified, recruited and referred patients with NDH (fasting plasma glucose ≥5.5 to ≤6.9mmol/L and/or glycated hemoglobin (HbA1c) ≥42 to 47mmol/mol (6.0%–6.4%)) and a body mass index (BMI) ≥30 kg/m2 to a DPP. Eligible patients were asked to contact Weight Watchers to book onto their DPP, an intensive lifestyle intervention which included a 90min activation session followed by the offer of 48 weekly Weight Watchers community group meetings. Patients’ blood tests were repeated by primary care, weight change plus self-reported data was recorded by Weight Watchers. Results: 166 patients were referred to the program and 149 were eligible. 79% of eligible patients attended an activation session (117 eligible patients) and 77% started the weekly sessions. The study sample was primarily female (75%), white (90%), with 5% living in the most deprived quintile in the UK. Using intention to-treat analysis, the DPP resulted in a mean reduction in HbA1c of 2.84 mmol/mol at 12 months (from 43.42±1.28 to 40.58±3.41, p<0.01). 38% of patients returned to normoglycemia and 3% developed T2D at 12 months. There was a mean weight reduction in BMI of 3.2 kg/m2 at 12 months (35.5 kg/m2 ±5.4 to 32.3 kg/ m2 ±5.2, p<0.01). Conclusion: A UK primary care referral route partnered with this commercial weight management provider can deliver an effective DPP. The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact