A systematic review of economic evaluations of local authority commissioned preventative public health interventions in overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation in the United Kingdom

Background Since 2013, local authorities in England have been responsible for commissioning preventative public health interventions. The aim of this systematic review was to support commissioning by collating published data on economic evaluations and modelling of local authority commissioned public health preventative interventions in the UK. Methods Following the PRISMA protocol, we searched for economic evaluations of preventative intervention studies in four different areas: overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation. The systematic review identified studies between January 1994 and February 2015, using five databases. We synthesized the studies to identify the key methods and examined results of the economic evaluations. Results The majority of the evaluations related to cost-effectiveness, rather than cost-benefit analyses or cost-utility analyses. These analyses found preventative interventions to be cost effective, though the context of the interventions differed between the studies. Conclusions Preventative public health interventions in general are cost-effective. There is a need for further studies to support justification of continued and/or increased funding for public health interventions. There is much variation between the types of economically evaluated preventative interventions in our review. Broader studies incorporating different contexts may help support funding for local authority-sponsored public health initiatives

Using alcohol unit-marked glasses enhances capacity to monitor intake: evidence from a mixed-method intervention trial

Aims: People tend to have poor knowledge of government guidelines for alcohol use, and lack the motivation and skills required to use them to monitor their drinking. The study aim was to determine whether using glasses marked with such guidelines would improve knowledge and attitudes, increase frequency of counting units, and lower alcohol intake. Methods: 450 adults participated in an intervention-control study with 1-month follow-up. The intervention group was encouraged to use glasses supplied by the researchers that indicated the unit content of drinks of different strengths and volumes, and stated the intake guidelines. Interviews with 13 intervention group participants focused on their experiences of using the glasses and recommendations for their use. Results: Analyses adjusted for baseline variables showed that the intervention improved: knowledge of unit-based guidelines; ability to estimate the unit content of drinks; attitudes toward the guidelines; and frequency of counting unit intake. However, there was no significant change in alcohol consumption. Interview data confirmed that the glasses provided useful information that encouraged people to think about their drinking and to discuss alcohol with other people. However, their design was not appealing to all, and their initial impact did not always persist. Conclusions: Use of unit-marked glasses led to changes in people’s use of unit-based guidelines to monitor their drinking. The qualitative data suggested that the glasses could have an impact at the individual level (on knowledge and attitudes) and at a broader level (by prompting discussion of alcohol use)

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in southeast England

Objective: In most developed countries substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare. Design and Setting: Qualitative study in Southeast England. Participants: Twenty-six adults from BME backgrounds (13 men, 13 women; aged >18 years) were recruited to two focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings, and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services. Results: Participants identified two broad themes that influenced access to mental health services. First, Personal and environmental factors included inability to recognize and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health, and financial factors. Second, factors affecting the relationship between service user and healthcare provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity and discrimination towards the needs of BME service users, and lack of awareness of different services among service users and providers. Conclusions: People from BME backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Healthcare providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from BME backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access

Exploring Ways of Vocabulary Instructional Practices in ESL Classrooms in Pakistan

Word Power offers a key role when it comes to effective communication and comprehensive reading. Language teaching-learning is a complex phenomenon especially in learning L2 vocabulary. A learner is provided with a complete package of textual and non-textual language-based content to develop all four skills of L2 of a learner. A language curriculum is based on text aided by co-curricular activities like role plays, presentations, speeches/debates or declamation, essay writing competitions, etc. to improve the language proficiency of a learner. In such activities, vocabulary has a secondary role to play, whereas, it is hard to find such activities where the prime focus is to be given on the development of language learner’s vocabulary size. Language learners view vocabulary enhancement as one of the most challenging domains while learning a language Çelik & Toptaş, (2010). The present study reflects a brief overview of the most frequently practiced pedagogical practices of vocabulary items. This study is qualitative, where secondary level school learners are the target population. The researcher has chosen semi-structured interviews with students (n=20). The study finds that the vocabulary instructional process in Pakistani ESL learners lacks the proper induction of vocabulary teaching strategies. It doesn’t target the utilization of vocabulary items in a meaningful context. In addition, vocabulary items are heavily taught explicitly and implicit instructional methods are not taken much into consideration. Thus, the researcher recommends the integration of best teaching practices into the traditional language pedagogical process. It may involve CALL methods and other incidental and intentional approaches that can enable learners to enhance vocabulary size, retain, and use vocabulary items in a real-life context. Keywords: Vocabulary teaching/learning, ESL learners, CALL, traditional practices, pedagogical practices, vocabulary development, language learners DOI: 10.7176/RHSS/10-24-09 Publication date: December 31st 2020

Opinions of women from deprived communities on the NHS stop smoking service in England - person-centered perspectives

Background: In most European countries, women are relatively more susceptible to smoking-related diseases, find it more difficult to quit and are more likely to relapse than men. With the aim of improving the understanding of women’s needs from smoking cessation services, this qualitative study examines perceptions of women from deprived communities on the National Health Service stop smoking service in England, UK. Methods: A qualitative study of 11 women, smokers and ex-smokers, who had used the stop smoking service located in disadvantaged communities in East Sussex, England, UK. Data were collected through focus group and semi-structured interviews and were subjected to thematic analysis. Results: Women felt that services tailored to their needs would improve cessation rates. They expect smoking cessation facilitators to be non-judgemental and to offer psychological insight into addiction. However, women’s opinions differed on the importance for facilitators to be female or ex-smokers and on the preference of group or one-to-one services, some women expressed a preference for women only groups. The women praised the continuity of care, capacity for peer support, flexibility of time and location and free cessation aids offered. Conversely, the women felt that services were poorly advertised, that access was not universally good and that services at the work place and drop-in groups would improve access for working women and women with young children. Conclusion: Flexible, person-centered services that are tailored towards the needs of individual smokers and better dissemination of information regarding the range of services available could facilitate greater uptake of smoking cessation services for women in deprived communities

Pregnancy outcomes of patients with ultrasound-indicated and history-indicated mcdonald cervical cerclage

Objective: To assess pregnancy outcomes of patients with ultrasound-indicated and history-indicated McDonald cervical cerclage. Materials and methods: This was a cross-sectional study of pregnant women who had cervical cerclage performed at Aga Khan University Hospital, Karimabad campus. We obtained Institutional Review Board approval and reviewed the medical records of patients. A purposive continuous sampling technique was used. A total of 88 patients were included. There were no exclusion criteria. Outcome data were collected from the medical record of patients from January 2010 to December 2016. Results: Analysis reported a statistically significant lower gravidity and parity in the scan-indicated group as compared with other groups (p = 0.000 and p = 0.001, respectively). Previous history of cervical cerclage, history of mid-trimester miscarriage, and preterm labor were significantly associated with indication for cerclage (p = 0.001, 0.046, and 0.001, respectively). Cervical length was also significantly associated with the indication for cerclage (p p = 0.003 and p = 0.04 and 0.004, respectively). Conclusion: Our study showed that patients with a history suggestive of cervical incompetence or short cervix on ultrasound should be offered cerclage to prevent preterm birth and to improve neonatal outcomes. Ultrasound-indicated cerclage after the first trimester indicates that universal cervical-length screening by transvaginal ultrasound in the mid-trimester can pick silent cases, and inserting cerclage can prolong pregnancy to term. Clinical significance: Screening cervical length will help clinicians to reduce preterm birth rate, especially in resource-limited underdeveloped countries

Methodological issues of using placebos in interventions based on digital technology

Background/Aims: Use of placebo is the ideal for comparison in clinical trials to reduce biases. With digital technology being used more frequently in healthcare interventions, how do we determine the placebo effect where interventions exploit technology? If placebo in medicine is traditionally defined by a lack of pharmacological agents, how might we begin to move towards controlling for effects of digital technology? Method: This paper explores the traditional placebo effect and discusses its impact in healthcare contexts with digital technology with reference to a particular trial. Different meanings of placebo in the context of evaluating technology suggest new challenges and positive consequences. Results: Methodological considerations are discussed, which enabled the development of a placebo-controlled evaluation of a digital technology in healthcare and rehabilitation. Conclusion: Digital placebo was controlled in our trial by employing technology across all groups in the absence of evidence-based practice and shows how to control for unknown and hidden effects of technology

Therapeutic potential and ownership of commercially available consoles in children with cerebral palsy

Introduction: We conducted a survey amongst families of children with cerebral palsy (CP) to ascertain the ownership and therapeutic use and potential of commercial games consoles to improve motor function. Method: 300 families in southeast England were identified through clinical records,and were requested to complete an anonymised questionnaire. Results: A total of 61 families (20% response) returned a completed questionnaire with 41 (68%) males and 19 (32%) females with Cerebral Palsy, with a mean age of 11Y5M (SD 3Y 7M). The large majority of families, 59 (97%), owned a commercial console and the child used this for 50-300 minutes a week. Returns by severity of motor impairment were: Gross Motor Function Classification System (GMFCS) I (21%), II (31%), III (13%), IV (15%), V (18%). Consoles were used regularly for play across all GMFCS categories. Conclusion: The potential of games consoles, as home-based virtual reality therapy (VRT), in improving the motor function of children with cerebral palsy should be appropriately tested in randomised controlled trial. Wide ownership, and the relative ease with which children engage in the use of commercial-based VRT systems suggests potential as a means of augmenting therapy protocols,taking advantage of interest and participation patterns of families. What the study has added: This study shows that there is wide ownership/use of commercial games consoles amongst children with CP; and this offers great potential to test therapeutic efficacy of home-based virtual reality therapy to improve motor function in children. Key messages: Children with Cerebral Palsy frequently access and use commercial consoles during play at home. Consoles are used by children across severity of gross motor function levels. Some families had utilized the consoles for therapeutic purposes, with anecdotal improvements in motor function. Opportunity exists for using commercial consoles within home based therapy protocols and for recreational participation across all GMFCS levels

Developing a quality-of-life measure for autistic children and young people in schools

Aim: To develop a quality-of-life measure to be used by both school staff and autistic children and young people (CYP) in schools, in which public and community involvement (PCIE) is at the heart of the research.  Method: A prevalence questionnaire survey will be conducted with 20 primary and secondary schools across Kent, Surrey, and Sussex (KSS). 10 semi-structured interviews will be conducted with autistic CYP. This will inform development of a quality-of-life measure for autistic CYP. Results: Work so far has included PCIE in the early stages of the project, in which young people, school staff and collaborators have contributed to the study set up and designing study materials. Conclusion: With PCIE included in the planning of the project, the research team is confident that this will be useful further along in the project with dissemination and validating and implementing a quality-of-life measure for autistic CYP in schools