[Show abstract][Hide abstract] ABSTRACT: The way in which different communities respond to similar threats to their health can vary, from outrage to indifference and public health agencies are often taken by surprise leading to potential loss of public confidence. The objective of this systematic literature review was to seek to better understand the community-level drivers that might explain the variability in response.
A vigorous systematic cross-disciplinary literature review was undertaken searching thirteen bibliographic databases and a variety of grey sources were screened. The social amplification of risk framework and the risk perception management theoretical models were used to assess evidence and data were synthesised by Narrative review.
Sixteen studies meeting the agreed inclusion criteria described eleven different threats ranging from: infectious disease outbreaks to environmental disasters to cancer clusters, affecting two or more communities were identified from medical, psychological, social science and environmental science literature. There was wide heterogeneity between the type and quality of the studies. There was a general absence of theoretical underpinning community responses. Most studies did not report sufficient data to allow an appropriate amount of validity. Very low response rates in particular were common. Potential explanatory drivers suggested included, prior experience and visibility of threat, sociodemographic characteristics, volume and type of media coverage, government reaction and availability of social support.
This review confirmed that there are significant differences. Further work is needed to develop theoretical models that apply to the community level and do not assume that a community's response is simply the aggregate of individual level responses.
Science of The Total Environment 10/2013; 470-471C:759-767.
[Show abstract][Hide abstract] ABSTRACT: Nurses in primary care, who see a large proportion of the population, are well placed to discuss weight with patients and offer management advice. Interventions to promote weight loss have shown that there are effective ways of making small changes for patients.
To use qualitative semi-structured interviews to explore how practice nurses manage obesity within primary care and to identify good practice and explore barriers to achieving effective management.
Eighteen semi-structured interviews were conducted with practice nurses within two local health board areas in South Wales. Interviews were audio-recorded, transcribed and analysed qualitatively using a thematic approach.
Nurses described two roles. One role was providing obesity management to patients who had co-morbid conditions and were seen regularly in chronic disease clinics. All nurses perceived that these patients needed their weight addressing routinely. The other role was to broach the subject with overweight but healthy patients. Nurses were of divided opinion whether to address obesity with these patients and what primary care had to offer. Weight management advice, when given, lacked consistency of approach.
Broaching the subject of weight opportunistically with healthy but overweight patients may require a deeper appreciation of their motivations for change and discussion beyond future health risks. These patients also need clearer follow up to monitor their progress with weight loss. All overweight patients also need clearer guidance tailored to their own particular circumstances as to how to lose weight. For patients being counselled about their weight, interventions that promote consistency of advice are advocated to improve care.
[Show abstract][Hide abstract] ABSTRACT: To describe the characteristics of bruising and mode of presentation of children referred to the paediatric child protection team with suspected physical abuse (PA), and the extent to which these differ between the children where abuse was confirmed and those where it was excluded.
519 children, <6 years, referred to two paediatric child protection teams.
The mode of presentation, number, anatomical distribution, size and appearance of bruises according to whether PA was confirmed or excluded. ORs with 95% CI were calculated where relevant.
PA was confirmed in 69% of children; the rate varied from 84% when abuse was witnessed, admitted, alleged or where explanation for injury was absent or implausible, to 50% where there was a concerning history. Significantly more children with PA had bruises (89.4%) than PA-excluded (69.9%) and had significantly more sites affected (p<0.001). The odds of a PA child having bruising to: buttocks/genitalia (OR 10.9 (CI 2.6 to 46), left ear (OR 7.10 (CI 2.2 to 23.4), cheeks (Left (OR 5.20 (CI 2.5 to 10.7), Right OR 2.83 (CI 1.5 to 5.4)), neck (OR 3.77 (CI 1.3 to 10.9), trunk (back (OR 2.85 (CI 1.6 to 5.0) front (OR 4.74 (CI 2.2 to 10.2), front of thighs (OR2.48 (CI 1.4 to 4.5) or upper arms (OR 1.90 (CI 1.1 to 3.2) were significantly greater than in children with PA-excluded. Petechiae, linear or bruises with distinct pattern, bruises in clusters, additional injuries or a child known to social services for previous child abuse concerns were significantly more likely in PA.
Features in the presenting history, the extent and pattern of bruising differed between children with confirmed PA and those where abuse was excluded. These findings can provide a deeper understanding of bruising sustained from PA.
[Show abstract][Hide abstract] ABSTRACT: Little is known about the association between health and the quality of the residential environment. What is known is often based on subjective assessments of the environment rather than on measurements by independent observers. The aim of this study, therefore, was to determine the association between self-reported general health and an objectively assessed measure of the residential environment. We studied over 30,000 residents aged 18 or over living in 777 neighbourhoods in south Wales. Built environment quality was measured by independent observers using a validated tool, the Residential Environment Assessment Tool (REAT), at unit postcode level. UK Census data on each resident, which included responses to a question which assessed self-reported general health, was linked to the REAT score. The Census data also contained detailed information on socio-economic and demographic characteristics of all respondents and was also linked to the Welsh Index of Multiple Deprivation. After adjusting for both the individual characteristics and area deprivation, respondents in the areas of poorest neighbourhood quality were more likely to report poor health compared to those living in areas of highest quality (OR 1.36, 95% confidence interval 1.22-1.49). The particular neighbourhood characteristics associated with poor health were physical incivilities and measures of how well the residents maintained their properties. Measures of green space were not associated with self-reported health. This is the first full population study to examine such associations and the results demonstrate the importance for health of the quality of the neighbourhood area in which people live and particularly the way in which residents behave towards their own and their neighbours' property. A better understanding of causal pathways that allows the development of interventions to improve neighbourhood quality would offer significant potential health gains.
[Show abstract][Hide abstract] ABSTRACT: Background: Early consultation in primary care may provide an opportunity for early intervention in children developing pneumonia, but little is known about why some children do not consult a general practitioner (GP) before hospitalization. Objectives: To identify differences between children who consulted a GP and children who did not consult a GP before the day of hospital presentation with pneumonia or empyema. Methods: Carers of children aged six months to 16 years presenting to hospital with pneumonia or empyema completed a questionnaire, with a subset participating in an interview to identify physical, organizational and psychological barriers to consultation. Responses from those who had consulted a GP before the day of hospital presentation were compared with those who had not on a range of medical, social and environmental variables. Results: Fifty seven (38%) of 151 participants had not consulted a GP before the day of hospital presentation. On multivariate analysis, illness duration ≥ 3 days (odds ratio [OR] 4.36, 95% confidence interval [CI]: 1.67-11.39), prior antibiotic use (OR: 10.35, 95% CI: 2.16-49.55) and home ownership (OR: 3.17, 95% CI: 1.07-9.37) were significantly associated with early GP consultation (P < 0.05). Interviews with 28 carers whose children had not seen a GP before the day of presentation revealed that most had not considered it and/or did not think their child's initial symptoms were serious or unusual; 11 (39.3%) had considered consulting a GP but reported barriers to access. Conclusion: Lack of early GP consultation was strongly associated with rapid evolution of pneumonia.
[Show abstract][Hide abstract] ABSTRACT: The influence of neighbourhood deprivation on the risk of harmful alcohol consumption, measured by the separate categories of excess consumption and binge drinking, has not been studied. The study objective was to investigate the effect of neighbourhood deprivation with age, gender and socioeconomic status (SES) on (1) excess alcohol consumption and (2) binge drinking, in a representative population survey.
Cross-sectional study: multilevel analysis.
Wales, UK, adult population ∼2.2 million.
58 282 respondents aged 18 years and over to four successive annual Welsh Health Surveys (2003/2004-2007), nested within 32 692 households, 1839 census lower super output areas and the 22 unitary authority areas in Wales.
Maximal daily alcohol consumption during the past week was categorised using the UK Department of Health definition of 'none/never drinks', 'within guidelines', 'excess consumption but less than binge' and 'binge'. The data were analysed using continuation ratio ordinal multilevel models with multiple imputation for missing covariates.
Respondents in the most deprived neighbourhoods were more likely to binge drink than in the least deprived (adjusted estimates: 17.5% vs 10.6%; difference=6.9%, 95% CI 6.0 to 7.8), but were less likely to report excess consumption (17.6% vs 21.3%; difference=3.7%, 95% CI 2.6 to 4.8). The effect of deprivation varied significantly with age and gender, but not with SES. Younger men in deprived neighbourhoods were most likely to binge drink. Men aged 35-64 showed the steepest increase in binge drinking in deprived neighbourhoods, but men aged 18-24 showed a smaller increase with deprivation.
This large-scale population study is the first to show that neighbourhood deprivation acts differentially on the risk of binge drinking between men and women at different age groups. Understanding the socioeconomic patterns of harmful alcohol consumption is important for public health policy development.
BMJ Open 04/2013; 3(4).
Information provided on this web page is aggregated encyclopedic and bibliographical information relating to the named institution. Information provided is not approved by the institution itself. The institution’s logo (and/or other graphical identification, such as a coat of arms) is used only to identify the institution in a nominal way. Under certain jurisdictions it may be property of the institution.