The Role Of Local Authorities In Health Issues: A Policy Document Analysis

Prior to the passing of the Health and Social Care Act 2012 the Communities and Local Government (CLG) Select Committee conducted an investigation into the proposed changes to the Public Health System in England. The Committee considered 40 written submissions and heard oral evidence from 26 expert witnesses. Their report, which included complete transcripts of both oral and written submissions, provided a rich and informed data on which to base an analysis of the proposed new public health system. This report analyses the main themes that emerged from the evidence submissions and forms part of our preliminary work for PRUComm’s PHOENIX project examining the development of the new public health system

Risk and protective factors for meningococcal disease in adolescents: matched cohort study

Objective: To examine biological and social risk factors for meningococcal disease in adolescents. Design: Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner. Setting: Six contiguous regions of England, which represent some 65% of the country’s population. Participants: 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls. Methods: Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression. Results: 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection. Conclusions: Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority

Variation in lung function as a marker of adherence to oral and inhaled medication in cystic fibrosis

Study aim: The aim of this study was to characterise adherence in an adult population with CF and to investigate if variation in lung function was a predictor of adherence to treatment. Patients and methods: Patients aged ≥ 16 years from an adult CF centre undertook adherence measures by medication possession ratio (MPR) and self-report and were assigned to one of three adherence categories (<50%, 50-<80%, 80% and above) by their composite score (MPR). Ordinal regression was used to identify predictors of adherence including coefficient variation measures for forced expiratory volume in 1 second (FEV1), weight and C-reactive protein, measured up to 6 and 12 months. Results: MPR data for 106 of 249 patients [mean age 29.8 (±9.2) years] was retrieved, indicating a mean adherence of 63%. Coefficient of variation FEV1 was inversely related to adherence and was a univariate predictor of adherence (6 months: 0.92 [0.87-0.98] p= 0.005 and 12 months: 0.94 [0.93-0.99], p=0.03]) and remained significant in the final models. The coefficient variation of weight and C-reactive protein were not predictive of adherence. Conclusions: Coefficient of variation FEV1 was identified as an objective predictor of adherence. Further evaluation of this potential marker of adherence is now required

Rapid desensitization for non-immediate reactions in patients with cystic fibrosis

AbstractNon-immediate hypersensitivity reactions to antibiotics in patients with CF represent a real-life challenge for clinicians. Desensitization is often performed in patients who have exhausted all therapeutic options. Whilst desensitization is an established procedure for immediate reactions we assessed the outcomes and safety of desensitization for non-immediate reactions.We retrospectively reviewed 275 desensitization procedures in 42 patients with a range of non-immediate reactions to six commonly used antibiotics. Desensitization was performed using a 7-step rapid intravenous protocol on a normal medical ward.250 (91%) of overall desensitization procedures were successful; however, this figure incorporates certain individuals having multiple successful procedures. Individual patient success ranged from 55% with tazocin through to 88% with tobramycin. In the 25 patients who failed desensitization the reactions were mild and the majority occurred within 48h of starting treatment. Prophylactic anti-histamines and steroids did not reduce the risk of reaction.Whilst the mechanisms remain uncertain we can confirm that rapid desensitization is a safe and effective way of re-introducing an antibiotic to a patient with a non-immediate reaction

Healthcare choice: Discourses, perceptions, experiences and practices

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic