609 research outputs found
Child injury prevention: a survey of local authorities and health boards
Aims: Unintentional home injuries are a significant global public health issue and are a major cause of mortality and morbidity. Within each country, injuries disproportionately affect children from low income families. Recent guidance issued in the UK recommends actions to be taken by local authorities to reduce injury rates and inequalities. This study aimed to describe and quantify child home injury prevention activities of local authorities (LAs) in England and health boards (HBs) in Wales.
Methods: A questionnaire was sent to Directors of Public Health (DsPH) in all 153 upper-tier LAs in England and 7 HBs in Wales. The questionnaire covered the five broad areas recommended for injury prevention activities by NICE guidelines.
Results: A response rate of 58% was achieved. NICE guidance (75%) and Public Health England guidance (57%) were most commonly used to support child injury prevention decision making. Half (50%) of respondents had a child injury prevention alliance in their area. One fifth (19%) reported that their area had a written child injury prevention strategy. Fewer than half of responders provided training to practitioners about child unintentional injury prevention (43%), home safety assessments (43%) or an equipment scheme (43%). Of the 43% of areas with equipment schemes, most (59%) were small scale, supplying up to 200 families per year with equipment.
Conclusions: Although some LAs/HBs show implementation of recent guidance on preventing home injuries in childhood, most do not. LAs/HBs are likely to need support to implement guidance in order that child injury rates and inequalities can be reduced
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Primary care under threat: time for the Government to address the urgent challenges
Dear Editor
We are grateful to Levene and colleagues for discussing current issues and future priorities for primary care in the post-covid-19 era.(1) However, we were surprised that health promotion, a crucial component of holistic care was not mentioned.(2)
At the First International Conference on Health Promotion in 1986 the World Health Organisation succinctly described health promotion as âthe process of enabling people to increase control over, and to improve their health.â(3) Importantly, health promotion can play significant roles at all stages of wellness and disease, that is at primary, secondary and tertiary levels. But general practice has remained largely focused on secondary and tertiary.
There are considerable opportunities for promoting health in the primary care setting and many major topics can be effectively addressed. Accident prevention, exercise promotion, healthy eating, and mental health are just a few notable ones. Linked and underlying all these is the pervasive issue of inequalities.
However, there are challenges for all those working to promote health in this setting including: high workload; stress levels; recruitment and retention; lack of public health training; and balancing the needs of individuals with the needs of the population.(4-7) Some of these were quite rightly highlighted by Levene and colleagues.(1)
Working in primary care is a complex but tough occupation, nonetheless it is made harder than it should be by neglecting doctorsâ health and wellbeing. Moreover, recent research has highlighted that workload pressures are increasing and that staff are showing symptoms of depression and anxiety, and high levels of stress and burnout.(6-9) These are crucial issues as they are likely to influence patient care and satisfaction, medical errors, and retention and recruitment of GPs.(6-9)
For many practices, premises, IT infrastructure and administrative support all need to be addressed.(5,10) In addition, and critically, a robust workforce strategy that is recurrently funded is required to enable expansion to meet the needs of current and future communities.(10)
We have previously described the gold standard for health promotion in this setting: the Health Promoting General Practice.(4) Essential components of this include monitoring and promoting the health of staff, and creating supportive environments. Doctors workplaces should become a model that other employers could emulate.
Primary care has for a long time been the "sleeping giant" of public health, its enormous potential to promote the health of individuals and communities has never truly been tapped.(4,11-13) We have seen some rapid âservice shiftsâ as a result of the pandemic, demonstrating progressive changes are possible, but this momentum needs to be maintained.(14)
Primary care is the cornerstone of the NHS and the setting for ninety percent of all NHS patient contacts.(5) Registration with a GP provides an important link with an individual that can last many years. There are, therefore, many opportunities for promoting the health of individuals and their families.
In addition to knowledge about individuals, many GPs have a good knowledge of their local community including information about local negative and positive factors that may influence health. This presents opportunities for practices to play more roles in tackling certain public health issues.
An underlying theme hindering practices achieving their true potential is underinvestment.(5,10,15,16) Surprisingly, in 2017, general practice was receiving just 8.1% of the NHS budget (excluding the reimbursement of drugs).(16) We believe that primary care should receive a larger proportion of overall NHS spending. The BMA general practitioners committee has called for a minimum of 11% of the NHS budget to go to general practice.(16)
The work of GPs is fundamental to the success of the NHS and key to promoting the health of individuals, families and their communities. It is imperative that we tackle the issues outlined above so that we have a revitalised profession and they can achieve all the benefits possible. It is time to invest in primary care: strong Government support is urgently needed
Modifiable risk factors for scald injury in children under 5 years of age: a multi-centre caseâcontrol study
Objective: To determine the relationship between a range of modifiable risk factors and medically attended scalds in children under the age of 5 years.
Methods: Multicentre matched case-control study in acute hospitals, minor injury units and GP practices in four study centres in England. Cases comprised 338 children under 5 presenting with a scald, and 1438 control participants matched on age, sex, date of event and study centre. Parents/caregivers completed questionnaires on safety practices, safety equipment use, home hazards and potential confounders. Odds ratios were estimated using conditional logistic regression.
Results: Parents of cases were significantly more likely than parents of controls to have left hot drinks within reach of their child (adjusted odds ratio (AOR) 2.33, 95%CI 1.63, 3.31; population attributable fraction (PAF) 31%). They were more likely not to have taught children rules about climbing on kitchen objects (AOR 1.66, 95%CI 1.12, 2.47; PAF 20%); what to do or not do when parents are cooking (AOR 1.95, 95%CI 1.33, 2.85; PAF 26%); and about hot things in the kitchen (AOR 1.89, 95%CI 1.30, 2.75; PAF 26%).
Conclusions: Some scald injuries may be prevented by parents keeping hot drinks out of reach of children and by teaching children rules about not climbing on objects in the kitchen, what to do or not do whilst parents are cooking using the top of the cooker and about hot objects in the kitchen. Further studies, providing a more sophisticated exploration of the immediate antecedents of scalds are required to quantify associations between other hazards and behaviours and scalds in young children
Impact of the national home safety equipment scheme âSafe At Homeâ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis
Background: Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011 a national home safety equipment scheme was implemented in England (Safe At Home), targeting high injury rate areas and socio-economically disadvantaged families with children under 5. This provided a ânatural experimentâ for evaluating the schemeâs impact on hospital admissions for unintentional injuries.Methods: Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower layer Super-Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9,466)) matched with LSOAs in England and Wales where it was not implemented (control areas, n=9,466), with subgroup analyses by density of equipment provision.Results: 57,656 homes receiving safety equipment were included in the analysis. In the two years after the scheme ended, monthly admission rates declined in intervention areas (-0.33% (-0.47% to -0.18%)) but did not decline in control areas (0.04% (-0.11% to 0.19%), p value for difference in trend=0.001)). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond two years after the scheme ended.Conclusions: A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2-years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items
Human Leptospirosis Infection in Fiji: An Eco-epidemiological Approach to Identifying Risk Factors and Environmental Drivers for Transmission.
Leptospirosis is an important zoonotic disease in the Pacific Islands. In Fiji, two successive cyclones and severe flooding in 2012 resulted in outbreaks with 576 reported cases and 7% case-fatality. We conducted a cross-sectional seroprevalence study and used an eco-epidemiological approach to characterize risk factors and drivers for human leptospirosis infection in Fiji, and aimed to provide an evidence base for improving the effectiveness of public health mitigation and intervention strategies. Antibodies indicative of previous or recent infection were found in 19.4% of 2152 participants (81 communities on the 3 main islands). Questionnaires and geographic information systems data were used to assess variables related to demographics, individual behaviour, contact with animals, socioeconomics, living conditions, land use, and the natural environment. On multivariable logistic regression analysis, variables associated with the presence of Leptospira antibodies included male gender (OR 1.55), iTaukei ethnicity (OR 3.51), living in villages (OR 1.64), lack of treated water at home (OR 1.52), working outdoors (1.64), living in rural areas (OR 1.43), high poverty rate (OR 1.74), living <100m from a major river (OR 1.41), pigs in the community (OR 1.54), high cattle density in the district (OR 1.04 per head/sqkm), and high maximum rainfall in the wettest month (OR 1.003 per mm). Risk factors and drivers for human leptospirosis infection in Fiji are complex and multifactorial, with environmental factors playing crucial roles. With global climate change, severe weather events and flooding are expected to intensify in the South Pacific. Population growth could also lead to more intensive livestock farming; and urbanization in developing countries is often associated with urban and peri-urban slums where diseases of poverty proliferate. Climate change, flooding, population growth, urbanization, poverty and agricultural intensification are important drivers of zoonotic disease transmission; these factors may independently, or potentially synergistically, lead to enhanced leptospirosis transmission in Fiji and other similar settings
Cost-effectiveness of the âStay One Step Aheadâ Home Safety programme for the prevention of injuries among children under 5 years
Background Unintentional injuries are a common cause of morbidity and mortality in the under-5s, but undertaking home safety practices can reduce injury risk. Stay One Step Ahead (SOSA) is an evidence-based standardised home safety programme. This study evaluates the cost-effectiveness of SOSA versus usual care in Nottingham, UK.Methods Cost-effectiveness analysis from a National Health Service and personal social services perspective. SOSA activity data, injury occurrence and associated short-term healthcare costs were collected within a controlled before-and-after study from 2017 to 2020. The primary outcome was the incremental cost-effectiveness ratio (ICER) per additional home adopting three key safety practices (working smoke alarm, safe poisons storage and fitted stair gate). Secondary outcomes were ICERs per injury avoided and quality-adjusted life-years (QALYs) gained.Results SOSA costs ÂŁ30 per child but reduces short-term healthcare expenditure by ÂŁ42. SOSA increased the number of homes with three key safety practices by 0.02 per child, reduced injuries per child by 0.15 and gained 0.0036 QALYs per child. SOSA was dominant as it was cheaper and more effective than current practice. ICERs were âÂŁ590 per additional home deemed safe, âÂŁ77 per injury avoided and âÂŁ3225 per QALY gained. Focusing on healthcare expenditure alone, SOSA saved ÂŁ1.39 for every pound spent.Conclusions SOSA is a cost-saving intervention. Commissioners should consider implementing SOSA
Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study
Objective Evaluate the effectiveness of systematically delivered evidence-based home safety promotion for improving child home safety practices.Design Controlled before-and-after study.Setting Nine electoral wards in Nottingham, UK.Participants 361 families with children aged 2â7 months at recruitment living in four intervention wards with high health, education and social need; and 401 in five matched control wards.Intervention Evidence-based home safety promotion delivered by health visiting teams, family mentors and childrenâs centres including 24 monthly safety messages; home safety activity sessions; quarterly âsafety weeksâ; home safety checklists.Outcomes Primary: composite measure comprising having a working smoke alarm, storing poisons out of reach and having a stairgate. Secondary: other home safety practices; medically attended injuries. Parents completed questionnaires at 12 and 24 months after recruitment plus optional three monthly injury questionnaires.Results At 24 months there was no significant difference between groups in the primary outcome (55.8% vs 48.8%; OR 1.58, 95% CI 0.98 to 2.55) or medically attended injury rates (incidence rate ratio 0.89, 95% CI 0.51 to 1.56), but intervention families were more likely to store poisons safely (OR 1.81, 95% CI 1.06 to 3.07), have a fire escape plan (OR 1.81, 95% CI 1.06 to 3.08), use a fireguard or have no fire (OR 3.17, 95% CI 1.63 to 6.16) and perform more safety practices (ÎČ 0.46, 95% CI 0.13 to 0.79).Conclusions Systematic evidence-based home safety promotion in areas with substantial need increases adoption of some safety practices. Funders should consider commissioning evidence-based multicomponent child home safety interventions
An Overview of Approaches and Challenges for Retrieving Marine Inherent Optical Properties from Ocean Color Remote Sensing
Ocean color measured from satellites provides daily global, synoptic views of spectral water-leaving reflectancesthat can be used to generate estimates of marine inherent optical properties (IOPs). These reflectances, namelythe ratio of spectral upwelled radiances to spectral downwelled irradiances, describe the light exiting a watermass that defines its color. IOPs are the spectral absorption and scattering characteristics of ocean water and itsdissolved and particulate constituents. Because of their dependence on the concentration and composition ofmarine constituents, IOPs can be used to describe the contents of the upper ocean mixed layer. This informationis critical to further our scientific understanding of biogeochemical oceanic processes, such as organic carbonproduction and export, phytoplankton dynamics, and responses to climatic disturbances. Given their im-portance, the international ocean color community has invested significant effort in improving the quality of satellite-derived IOP products, both regionally and globally. Recognizing the current influx of data products intothe community and the need to improve current algorithms in anticipation of new satellite instruments (e.g., theglobal, hyperspectral spectroradiometer of the NASA Plankton, Aerosol, Cloud, ocean Ecosystem (PACE) mis-sion), we present a synopsis of the current state of the art in the retrieval of these core optical properties.Contemporary approaches for obtaining IOPs from satellite ocean color are reviewed and, for clarity, separatedbased their inversion methodology or the type of IOPs sought. Summaries of known uncertainties associated witheach approach are provided, as well as common performance metrics used to evaluate them. We discuss currentknowledge gaps and make recommendations for future investment for upcoming missions whose instrumentcharacteristics diverge sufficiently from heritage and existing sensors to warrant reassessing current approaches
An Overview of Approaches and Challenges for Retrieving Marine Inherent Optical Properties from Ocean Color Remote Sensing
Ocean color measured from satellites provides daily global, synoptic views of spectral water-leaving reflectances that can be used to generate estimates of marine inherent optical properties (IOPs). These reflectances, namely the ratio of spectral upwelled radiances to spectral downwelled irradiances, describe the light exiting a water mass that defines its color. IOPs are the spectral absorption and scattering characteristics of ocean water and its dissolved and particulate constituents. Because of their dependence on the concentration and composition of marine constituents, IOPs can be used to describe the contents of the upper ocean mixed layer. This information is critical to further our scientific understanding of biogeochemical oceanic processes, such as organic carbon production and export, phytoplankton dynamics, and responses to climatic disturbances. Given their importance, the international ocean color community has invested significant effort in improving the quality of satellite-derived IOP products, both regionally and globally. Recognizing the current influx of data products into the community and the need to improve current algorithms in anticipation of new satellite instruments (e.g., the global, hyperspectral spectroradiometer of the NASA Plankton, Aerosol, Cloud, ocean Ecosystem (PACE) mission), we present a synopsis of the current state of the art in the retrieval of these core optical properties. Contemporary approaches for obtaining IOPs from satellite ocean color are reviewed and, for clarity, separated based their inversion methodology or the type of IOPs sought. Summaries of known uncertainties associated with each approach are provided, as well as common performance metrics used to evaluate them. We discuss current knowledge gaps and make recommendations for future investment for upcoming missions whose instrument characteristics diverge sufficiently from heritage and existing sensors to warrant reassessing current approaches
Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study
Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services
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