Associations between neighbourhood environmental factors and the uptake and effectiveness of a brief intervention to increase physical activity

Background Evidence suggests behavioural interventions may exacerbate health inequalities, potentially due to differences in uptake or effectiveness. We used a physical activity intervention targeting deprived communities to identify neighbourhood-level factors that might explain differences in programme impact. Methods Individuals aged 40–65 were sent a postal invitation offering a brief intervention to increase physical activity. We used postcodes linkage to determine whether neighbourhood indicators of deprivation, housing, crime and proximity to green spaces and leisure facilities predicted uptake of the initial invitation or an increase in physical activity level in those receiving the brief intervention. Results A total of 4134 (6.8%) individuals responded to the initial invitation and of those receiving the intervention and contactable after 3 months, 486 (51.6%) reported an increase in physical activity. Area deprivation scores linked to postcodes predicted intervention uptake, but not intervention effectiveness. Neighbourhood indicators did not predict either uptake or intervention effectiveness. Conclusions The main barrier to using brief intervention invitations to increase physical activity in deprived, middle-aged populations was the low uptake of an intervention requiring significant time and motivation from participants. Once individuals have taken up the intervention offer, neighbourhood characteristics did not appear to be significant barriers to successful lifestyle change

What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review

Abstract Background Emergency departments (EDs) are facing unprecedented levels of demand. One of the causes of this increased demand is the ageing population. Older people represent a particular challenge to the ED as those older people who are frail will require management that considers their frailty alongside their presenting complaint. How to identify these older people as frail and how best to manage them in the ED is a major challenge for the health service to address. Objectives To systematically map interventions to identify frail and high-risk older people in the ED and interventions to manage older people in the ED and to map the outcomes of these interventions and examine whether or not there is any evidence of the impact of these interventions on patient and health service outcomes. Design A systematic mapping review. Setting Evidence from developed countries on interventions delivered in the ED. Participants Frail and high-risk older people and general populations of older people (aged > 65 years). Interventions Interventions to identify older people who are frail or who are at high risk of adverse outcomes and to manage (frail) older people within the ED. Main outcome measures Patient outcomes (direct and indirect) and health service outcomes. Data sources Evidence from 103 peer-reviewed articles and conference abstracts and 17 systematic reviews published from 2005 to 2016. Review methods A review protocol was drawn up and a systematic database search was undertaken for the years 2005–2016 (using MEDLINE, EMBASE, The Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium and PROSPERO). Studies were included according to predefined criteria. Following data extraction, evidence was classified into interventions relating to the identification of frail/high-risk older people in the ED and interventions relating to their management. A narrative synthesis of interventions/outcomes relating to these categories was undertaken. A quality assessment of individual studies was not undertaken; instead, an assessment of the overall evidence base in this area was made. Results Of the 90 included studies, 32 focused on a frail/high-risk population and 60 focused on an older population. These studies reported on interventions to identify (n = 57) and manage (n = 53) older people. The interventions to identify frail and at-risk older people, on admission and at discharge, utilised a number of different tools. There was extensive evidence on these question-based tools, but the evidence was inconclusive and contradictory. Service delivery innovations comprised changes to staffing, infrastructure and care delivery. There was a general trend towards improved outcomes in admissions avoidance, reduced ED reattendance and improved discharge outcomes. Limitations This review was a systematic mapping review. Some of the methods adopted differed from those used in a standard systematic review. Mapping the evidence base has led to the inclusion of a wide variety of evidence (in terms of study type and reporting quality). No recommendations on the effectiveness of specific interventions have been made as this was outside the scope of the review. Conclusions A substantial body of evidence on interventions for frail and high-risk older people was identified and mapped. Future work Future work in this area needs to determine why interventions work and whether or not they are feasible for the NHS and acceptable to patients. Study registration This study is registered as PROSPERO CRD42016043260. Funding The National Institute for Health Research Health Services and Delivery Research programme

'Putting Life in Years' (PLINY) telephone friendship groups research study: pilot randomised controlled trial

Background: Loneliness in older people is associated with poor health-related quality of life (HRQoL). We undertook a parallel-group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of telephone befriending for the maintenance of HRQoL in older people. An internal pilot tested the feasibility of the trial and intervention. Methods: Participants aged >74 years, with good cognitive function, living independently in one UK city were recruited through general practices and other sources, then randomised to: (1) 6 weeks of short one-to-one telephone calls, followed by 12 weeks of group telephone calls with up to six participants, led by a trained volunteer facilitator; or (2) a control group. The main trial required the recruitment of 248 participants in a 1-year accrual window, of whom 124 were to receive telephone befriending. The pilot specified three success criteria which had to be met in order to progress the main trial to completion: recruitment of 68 participants in 95 days; retention of 80% participants at 6 months; successful delivery of telephone befriending by local franchise of national charity. The primary clinical outcome was the Short Form (36) Health Instrument (SF-36) Mental Health (MH) dimension score collected by telephone 6 months following randomisation. Results: We informed 9,579 older people about the study. Seventy consenting participants were randomised to the pilot in 95 days, with 56 (80%) providing valid primary outcome data (26 intervention, 30 control). Twenty-four participants randomly allocated to the research arm actually received telephone befriending due to poor recruitment and retention of volunteer facilitators. The trial was closed early as a result. The mean 6-month SF-36 MH scores were 78 (SD 18) and 71 (SD 21) for the intervention and control groups, respectively (mean difference, 7; 95% CI, -3 to 16). Conclusions: Recruitment and retention of participants to a definitive trial with a recruitment window of 1 year is feasible. For the voluntary sector to recruit sufficient volunteers to match demand for telephone befriending created by trial recruitment would require the study to be run in more than one major population centre, and/or involve dedicated management of volunteers

Is Leprosy Control In Urban Slums Possible ? - A Study In Bombay

Effectiveness of community-based leprosy control operations spanning almost a decade in two locations, a small self settled leprosy colony (I) of about 800 subjects as well as a large slum (II) with a population of about 20,000 in the metropolitan city of Bombay are compared. New case detection through survey in location I and voluntary reporting in location II during the period 1982-86 is taken as an index of the impact of the intervention, which consisted of field based administration of multi-drug therapy. Though the leprosy colony concentrates an abnormal reservoir of infectious cases in a small population, it was relatively easier to achieve success in reducing the transmission rate through field-based chemotherapy programme. The same degree of success however, could not be achieved in a normal slum. Health care delivery system in relation to leprosy eradication at the grass-root levels has to be planned giving maximum importance to cost-effective methods of identification of multi-bacillary leprosy patients and monitoring their movements carefully during the treatment phase

Associations between neighbourhood environmental factors and the uptake and effectiveness of a brief intervention to increase physical activity: findings from deprived urban communities in an English city

Background: Evidence suggests behavioural interventions may exacerbate health inequalities, potentially due to differences in uptake or effectiveness. We used a physical activity intervention targeting deprived communities to identify neighbourhood-level factors that might explain differences in programme impact. Methods: Individuals aged 40–65 were sent a postal invitation offering a brief intervention to increase physical activity. We used postcodes linkage to determine whether neighbourhood indicators of deprivation, housing, crime and proximity to green spaces and leisure facilities predicted uptake of the initial invitation or an increase in physical activity level in those receiving the brief intervention. Results: A total of 4134 (6.8%) individuals responded to the initial invitation and of those receiving the intervention and contactable after 3 months, 486 (51.6%) reported an increase in physical activity. Area deprivation scores linked to postcodes predicted intervention uptake, but not intervention effectiveness. Neighbourhood indicators did not predict either uptake or intervention effectiveness. Conclusions: The main barrier to using brief intervention invitations to increase physical activity in deprived, middle-aged populations was the low uptake of an intervention requiring significant time and motivation from participants. Once individuals have taken up the intervention offer, neighbourhood characteristics did not appear to be significant barriers to successful lifestyle change