Repeated systemic inflammation was associated with cognitive deficits in older Britons

AbstractIntroductionThe relationship of C-reactive protein (CRP) to cognition in the older old group (≥75 years) has recently been found positive on both sides of the Atlantic. We hypothesized that higher levels of CRP and fibrinogen are related to worse episodic memory throughout later life (≥50 years).MethodsData are drawn from older Britons free of dementias in the English Longitudinal Study of Aging 2004–2013. We applied growth trajectory models to repeated observations of episodic memory, CRP, and fibrinogen levels (and sociodemographic confounders). We accounted for practice effects in repeated tests of cognition.ResultsHigher levels of both inflammatory markers were associated with worse episodic memory, where a fibrinogen effect is evident throughout later life (coefficient −0.154; 95% confidence interval [CI] −0.254 to −0.054). Most importantly, the CRP effect is strongly negative among the older old group (coefficient −0.179; CI −0.320 to −0.038).DiscussionHigher levels of fibrinogen are detrimental to older people's cognition, and among the older old, raised CRP levels are comparably deleterious. Repeated measures of inflammation can be considered in clinical practice as part of a response to the challenge of dementias

Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study

Background Childsmile School adopts a directed-population approach to target fluoride varnish applications to 20% of the primary one (P1) population in priority schools selected on the basis of the proportion of enrolled children considered to be at increased-risk of developing dental caries. The study sought to compare the effectiveness of four different methods for identifying individuals most in need when a directed-population approach is taken. <p></p> Methods The 2008 Basic National Dental Inspection Programme (BNDIP) cross-sectional P1 Scottish epidemiological survey dataset was used to model four methods and test three definitions of increased-risk. Effectiveness was determined by the positive predictive value (PPV) and explored in relation to 1-sensitivity and 1-specificity. <p></p> Results Complete data was available on 43470 children (87% of the survey). At the Scotland level, at least half (50%) of the children targeted were at increased-risk irrespective of the method used to target or the definition of increased-risk. There was no one method across all definitions of <i>increased-risk</i> that maximised PPV. Instead, PPV was highest when the targeting method complimented the definition of <i>increased-risk</i>. There was a higher percentage of children at <i>increased-risk</i> who were not targeted (1-sensitivity) when caries experience (rather than deprivation) was used to define <i>increased-risk</i>, irrespective of the method used for targeting. Over all three definitions of <i>increased-risk</i>, there was no one method that minimised (1-sensitivity) although this was lowest when the method and definition of <i>increased-risk</i> were complimentary. The false positive rate (1-specificity) for all methods and all definitions of <i>increased-risk</i> was consistently low (<20%), again being lowest when the method and definition of <i>increased-risk</i> were complimentary. <p></p> Conclusion Developing a method to reach all (or even the vast majority) of individuals at <i>increased-risk</i> defined by either caries experience or deprivation is difficult using a directed-population approach at a group level. There is a need for a wider debate between politicians and public health experts to decide how best to reach those most at need of intervention to improve health and reduce inequalities. <p></p&gt

Levels and patterns of physical activity and sedentary time among superdiverse adolescents in East London: a cross-sectional study

Objectives: Little is known about the physical activity (PA) and sedentary time (ST) habits of adolescents from superdiverse communities in the UK. The objectives of this study are to examine and report the patterns of PA/ST among adolescents in East London living in superdiverse communities, to identify opportunities/barriers to PA and inform policy/practice. Design: 1,260 young people (aged 11-13) young people from 7 secondary schools in East London completed a questionnaire on PA/ST over the past 7 days as part of the Newham's Every Child a Sports Person (NECaSP) intervention. Socio-demographic and anthropometric data were obtained. Significance tests were conducted to determine differences between socio-demographic and anthropometric predictors and PA/ST. Multinomial logit regression was used to explore the effects of ethnicity, sex and BMI on PA levels. Results: Males were significantly more likely to engage in PA at least 5 times during school in the past week (U=5.07, z= -11.76, p< .05). Obese participants were less likely to report engaging in PA 5 times in the past week (U=4.11, z= -1.17, p< .05). Black Caribbean girls (U=5.08, z= -1.92, p< .05) were significantly more likely to report engaging in no activity. Multinomial logit regression analyses revealed that girls with higher BMI were less likely to engage in PA at least 4 times after school in the last week than boys (b=.11, Wald X2(1)=9.81, p< .01). Walking (36.4%), jogging/running (29.9%), and football (28%) were the most frequently reported activities. Conclusion: Engaging girls in PA during and after school is important and making sports clubs and activities available and attractive to this target group may help increase engagement in PA and reduce ST. Findings support the need for more sex-specific and culturally responsive pedagogy in schools with curricula that respects diversity and individuality and has meaning and value amongst superdiverse young people. Finally, we need to extend current work presented and provide substantial evidence of the ways young people from minority ethnic groups process and act on the public health policy and the ways they understand and enact physical activity

Understanding influences and decisions of households with children with asthma regarding temperature and humidity in the home in winter a qualitative study

Objectives: This study aimed to understand the influences and decisions of households with children with asthma regarding keeping warm and well at home in winter. Setting: Community settings in Rotherham and Doncaster, South Yorkshire, UK. Participants: Individuals from 35 families and 25 health, education and social care staff underwent interview. 5 group interviews were held, 1 with parents (n=20) and 4 with staff (n=25). Outcome: measures This qualitative study incorporated in-depth, semistructured individual and group interviews, framework analysis and social marketing segmentation techniques. Results: The research identifies a range of psychological and contextual influences on parents that may inadvertently place a child with asthma at risk of cold, damp and worsening health in a home. Parents have to balance a range of factors to manage fluctuating temperatures, damp conditions and mould. Participants were constantly assessing their family's needs against the resources available to them. Influences, barriers and needs interacted in ways that meant they made ‘trade-offs’ that drove their behaviour regarding the temperature and humidity of the home, including partial self-disconnection from their energy supply. Evidence was also seen of parents lacking knowledge and understanding while working their way through conflicting and confusing information or advice from a range of professionals including health, social care and housing. Pressure on parents was increased when they had to provide help and support for extended family and friends. Conclusions: The findings illustrate how and why a child with asthma may be at risk of a cold home. A ‘trade-off model’ has been developed as an output of the research to explain the competing demands on families. Messages emerge about the importance of tailored advice and information to families vulnerable to cold-related harm

Education and its Effects on Income and Mortality of Men aged Sixty-five and over in Great Britain

We explore the effects of income and, additionally education on the income, selfreported health and survival of people aged sixty-five and over in Great Britain in order to identify benefits resulting from education which are omitted in the conventional analysis with its focus on labour income excluding employer contributions. We find, for men, that income at the age of sixty-five is significantly influenced by educational attainment and has a significant effect on survival. Even after controlling for circumstances at age sixty-five or when first observed, we identify benefits discounted to age sixty-five of £115,000 for men with higher education qualifications as compared to those with minimal qualifications

The association of cold weather and all-cause and cause-specific mortality in the island of Ireland between 1984 and 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This article has been made available through the Brunel Open Access Publishing Fund.Background This study aimed to assess the relationship between cold temperature and daily mortality in the Republic of Ireland (ROI) and Northern Ireland (NI), and to explore any differences in the population responses between the two jurisdictions. Methods A time-stratified case-crossover approach was used to examine this relationship in two adult national populations, between 1984 and 2007. Daily mortality risk was examined in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter (December-February) and cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship. Results In the ROI, the impact of cold weather in winter persisted up to 35 days, with a cumulative mortality increase for all-causes of 6.4% (95%CI=4.8%-7.9%) in relation to every 1oC drop in daily maximum temperature, similar increases for cardiovascular disease (CVD) and stroke, and twice as much for respiratory causes. In NI, these associations were less pronounced for CVD causes, and overall extended up to 28 days. Effects of cold weather on mortality increased with age in both jurisdictions, and some suggestive gender differences were observed. Conclusions The study findings indicated strong cold weather-mortality associations in the island of Ireland; these effects were less persistent, and for CVD mortality, smaller in NI than in the ROI. Together with suggestive differences in associations by age and gender between the two Irish jurisdictions, the findings suggest potential contribution of underlying societal differences, and require further exploration. The evidence provided here will hope to contribute to the current efforts to modify fuel policy and reduce winter mortality in Ireland

The association between employment and the health of people with intellectual disabilities:a systematic review

Background:  There is strong evidence indicating that paid employment is generally good for the physical and mental health of the general population. This systematic review considers the association between employment and the health of people with intellectual disabilities.  Methods:  Studies published from 1990 to 2018 were identified via electronic literature databases, email requests and cross-citations. Identified studies were reviewed narratively.  Results: Twelve studies were identified. Studies were generally consistent in reporting an association between being in paid employment and better physical or mental health status.  Conclusions: This review supports the view that the well-established association between employment and better health is similar for adults with and without intellectual disabilities. However, evidence establishing causality is lacking and further research to determine specific health benefits attributable to employment for people with intellectual disabilities and the causal pathways that operate is required

A knowledge translation project on community-centred approaches in public health

This paper examines the development and impact of a national knowledge translation project aimed at improving access to evidence and learning on community-centred approaches for health and wellbeing. Structural changes in the English health system meant that knowledge on community engagement was becoming lost and a fragmented evidence base was seen to impact negatively on policy and practice. A partnership started between Public Health England, NHS England and Leeds Beckett University in 2014 to address these issues. Following a literature review and stakeholder consultation, evidence was published in a national guide to community-centred approaches. This was followed by a programme of work to translate the evidence into national strategy and local practice. The paper outlines the key features of the knowledge translation framework developed. Results include positive impacts on local practice and national policy, for example adoption within National Institute for Health and Care Evidence (NICE) guidance and Local Authority public health plans and utilisation as a tool for local audit of practice and commissioning. The framework was successful in its non-linear approach to knowledge translation across a range of inter-connected activity, built on national leadership, knowledge brokerage, coalition building and a strong collaboration between research institute and government agency

Using routine data to monitor inequalities in an acute trust: a retrospective study

<p><b>Abstract</b></p> <p><b>Background</b></p> <p>Reducing inequalities is one of the priorities of the National Health Service. However, there is no standard system for monitoring inequalities in the care provided by acute trusts. We explore the feasibility of monitoring inequalities within an acute trust using routine data.</p> <p><b>Methods</b></p> <p>A retrospective study of hospital episode statistics from one acute trust in London over three years (2007 to 2010). Waiting times, length of stay and readmission rates were described for seven common surgical procedures. Inequalities by age, sex, ethnicity and social deprivation were examined using multiple logistic regression, adjusting for the other socio-demographic variables and comorbidities. Sample size calculations were computed to estimate how many years of data would be ideal for this analysis.</p> <p><b>Results</b></p> <p>This study found that even in a large acute trust, there was not enough power to detect differences between subgroups. There was little evidence of inequalities for the outcome and process measures examined, statistically significant differences by age, sex, ethnicity or deprivation were only found in 11 out of 80 analyses. Bariatric surgery patients who were black African or Caribbean were more likely than white patients to experience a prolonged wait (longer than 64 days, aOR = 2.47, 95% CI: 1.36-4.49). Following a coronary angioplasty, patients from more deprived areas were more likely to have had a prolonged length of stay (aOR = 1.66, 95% CI: 1.25-2.20).</p> <p><b>Conclusions</b></p> <p>This study found difficulties in using routine data to identify inequalities on a trust level. Little evidence of inequalities in waiting time, length of stay or readmission rates by sex, ethnicity or social deprivation were identified although some differences were identified which warrant further investigation. Even with three years of data from a large trust there was little power to detect inequalities by procedure. Data will therefore need to be pooled from multiple trusts to detect inequalities.</p