Darren Shickle

• MB BCh, MPH, MA, MD
• Professor at University of Leeds

In 2009, the European Centre for Disease Prevention and Control (ECDC) developed a competency framework to support European Union countries and the European Commission in ensuring a competent public health workforce for Europe. The coronavirus disease (COVID-19) pandemic emphasised the importance of harmonised public health strategies and competenc...

The WHO-ASPHER Competency Framework for the Public Health Workforce in the European Region is aimed at policy-makers, human resources for health planners and professionals with a particular interest in the public health workforce, and other stakeholders, such as education institutions, public health institutes and others responsible for implementin...

Care farming (also called social farming) is the therapeutic use of agricultural and farming practices. Service users and communities supported through care farming include people with learning disabilities, mental and physical health problems, substance misuse, adult offenders, disaffected youth, socially isolated older people and the long term un...

Care farming (also called social farming) is the therapeutic use of agricultural and farming practices. Service users and communities supported through care farming include people with learning disabilities, mental and physical health problems, substance misuse, adult offenders, disaffected youth, socially isolated older people and the long term un...

Background: The use of cannabis is criminalized in Nigeria and punitive law enforcement is the primary drug control strategy. Young cannabis users conceal use because of stigma, criminal identity and social ostracism. This qualitative study explored young people’s perspectives about how criminalization affects the use of cannabis in Lagos, Nigeria....

Background: Many countries have developed competency frameworks for public health practice. While the number of competencies vary, frameworks cover similar knowledge and skills although they are not explicitly based on competency theory. Methods: A total of 15 qualitative group interviews (of up to six people), were conducted with 51 public heal...

Objectives To assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment...

Background Care farms (CFs), in which all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed the feasibility of determining the cost-effectiveness of CFs in improving quality of life compared with comparator sites among probationers undertaking community orders (COs)....

Objective To determine the prevalence of, associations with and diagnoses leading to mild visual impairment or worse (logMAR >0.3) in middle-aged adults in the UK Biobank study. Methods and analysis Prevalence estimates for monocular and binocular visual impairment were determined for the UK Biobank participants with fundus photographs and spectra...

Background: To quantify the economic impact of sight loss and blindness in the United Kingdom (UK) population, including direct and indirect costs, and its burden on health. Methods: Prevalence data on sight loss and blindness by condition, Census demographic data, data on indirect costs, and healthcare cost databases were used. Blindness was de...

Background: The Public Health workforce needs to adapt to a policy environment in which the need to improve public health is not only a key challenge but also has to be delivered within financial constraints. Methods: A total of 14 qualitative individual interviews or focus groups (of up to 10 people), were conducted with senior Public Health st...

Objective: The aim of this study was to determine the prevalence of vitreoretinal interface abnormalities (VRIA), the degree of visual impairment and associations with VRIA among adults, aged 40-69 years, in the UK Biobank study. Methods and analysis: Colour fundus photographs and spectral domain optical coherence tomography images were graded f...

Background: Small-area analysis of National Health Service (NHS)-funded sight test uptake in Leeds showed significant inequalities in access among people aged <16 or ≥60. Methods: Data were extracted from 604 126 valid General Ophthalmic Services (GOS)1 claim forms for eye examinations for Essex residents between October 2013 and July 2015. Expe...

The pressure of rising demand on ophthalmic services in the United Kingdom, and the negative effect of capacity shortfall on clinical outcomes are well-attested.¹ With the major ophthalmic conditions of public health interest, cataract, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR), being strongly associated with i...

For two decades prior to 2004, a steady state existed of ~14 million general Accident and Emergency (A&E) annual attendances in England. This total has risen each year since, with 22.9 million attendances recorded in 2015/16 (https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2016/06/Monthly-AE-Report-December-16.pdf

Purpose: To identify a minimum list of metrics of international relevance to public health, research and service development which can be extracted from practice management systems and electronic patient records in primary optometric practice. Methods: A two stage modified Delphi technique was used. Stage 1 categorised metrics that may be record...

Working in an eye clinic in Dewsbury, West Yorkshire (with its large South Asian migrant population) in the 1990s, Andy Cassels-Brown noticed the large number of young South Asian patients who presented with much more advanced keratoconus than their Caucasian counterparts, who tended to be detected much earlier. This indicated an inequality in acce...

Purpose: The purpose of this paper is to investigate the potential of using primary care optometry data to support ophthalmic public health, research and policy making. Methods: Suppliers of optometric electronic patient record systems (EPRs) were interviewed to gather information about the data present in commercial software programmes and the...

Purpose of review: Policies that limit young people's access to cannabis may reduce early onset of use and minimize health-related harm. This review article provides an update of recent research examining the influence of the cannabis policy frameworks on the use of cannabis by young people. Recent findings: There are significant concerns that o...

Objectives: Poor knowledge of eye health, concerns about the cost of spectacles, mistrust of optometrists and limited geographical access in socio-economically deprived areas are barriers to accessing regular eye examinations and result in low uptake and subsequent late presentation to ophthalmology clinics. Personal Medical Services (PMS) were in...

Introduction: Care farms, where all or part of the farm is used for therapeutic purposes, show much potential for improving the health and well-being of a range of disadvantaged groups. Studies to date have been qualitative or observational, with limited empirical evidence of the effectiveness of care farms in improving health and well-being. Unde...

The model for delivery of primary eye care in Europe varies from country to country with differing reliance on ophthalmologists, optometrists and dispensing opticians. Comparative analysis of models has tended to focus on interprofessional working arrangements, training and regulatory issues, rather than on whether a particular model is effective f...

The privacy concerns discussed in the 1990s in relation to the New Genetics failed to anticipate the relevant issues for individuals, families, geneticists and society. Consumers, for example, can now buy their personal genetic information and share it online. The challenges facing genetic privacy have evolved as new biotechnologies have developed,...

Background: Preventable sight loss is an indicator within the Public Health Outcome Framework 2013-2018 for England. Routinely available optometric data do not permit small area analysis of access inequalities. Methods: Data were extracted from 17 680 General Ophthalmic Services (GOS1) claim forms for eye examinations conducted in Leeds during F...

Public health leadership has been criticized as being ineffective. The public health profession is relatively small. Critics have argued that there is over-emphasis on technical aspects and insufficient use of the 'community as a source of public health actions'. The paper analyses the resources, motivations and skills utilized by high-profile indi...

Public health leaders have been criticized for their policy stances, relationships with governments and failure to train the next generation. New approaches to the identification and training of public health leaders may be required. To inform these, lessons can be drawn from public health 'superheroes'; public health leaders perceived to be the mo...

Purpose: Most research on attitudes to eye health has focussed on older people, reflecting the higher prevalence of eye diseases in older age groups. Little is known about younger people's attitudes to eye health. This paper explores young adults understanding of eye health and the purpose of eye examinations and the reasons why they do or do not...

Preventable sight loss is one of the Public Health Outcome Indicators in England. Despite availability of NHS-funded eye examinations, many people do not take up their entitlement. This paper explores older adults understanding of eye health and the purpose of eye examinations and the reasons why they do or do not attend for eye examinations. The a...

This chapter applies the principles contained within the Universal Declaration on Bioethics and Human Rights to ethics and governance issues arising in the context of biobanks. Biobanks are structured resources that can be used for the purpose of genetic research, which include (a) human biological materials and/or information generated from the an...

The privacy concerns discussed in the 1990s in relation to the New Genetics failed to anticipate the relevant issues for individuals, families, geneticists and society. Consumers, for example, can now buy their personal genetic information and share it online. The challenges facing genetic privacy have evolved as new biotechnologies have developed,...

In this chapter we aim to outline some of the ways in which the debate over the right to know and the right not to know has moved on since this book was first published in 1997. The issues in genetics and genomics have moved even further out of the clinic, notably in the context of population-wide genomics research and commercial testing. At the ti...

Objective: The aim of our study was to examine cross-sectional and longitudinal associations between cigarette smoking and alcohol drinking, in a representative sample of English pupils. Method: Data from 13,635 school pupils in the Longitudinal Study of Young People in England (LSYPE) on usage of cigarettes from 2004 (typical age 14) to 2006 (a...

Background: Patient autonomy in antenatal screening is a high priority for policy developers in many countries. Objective: This paper presents women's understandings of how health professionals should facilitate informed screening choices with an emphasis on their understandings of autonomy and advice. Design, setting and participants: The stu...

Objective: Among adults, slower and more variable reaction times are associated with worse cognitive function and increased mortality risk. Therefore, it is important to elucidate risk factors for reaction time change over the life course. Method. Data from the Health and Lifestyle Survey (HALS) were used to examine predictors of 7-year decline in...

Conscientiousness is a strong predictor of health behaviours and better health outcomes. However, longitudinal data from representative samples of the population and from adolescents are rare. Therefore, the objective of this study was to establish whether school-related conscientiousness was associated with the onset and change in alcohol drinking...

Alcohol impairs judgement and could be causally implicated in sexual risk taking. However, meta-analytic studies do not find an association between alcohol use and unprotected sexual intercourse at the event level, where both behaviours refer to the same point in time. Associations between personality traits and sexual risk taking have been replica...

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

A literature review was carried out to identify the key challenges in the implementation of telehealth. This was followed by a survey of organisations in England involved in telehealth projects in order to understand the challenges they faced. Ten of the 13 health or local authority organisations surveyed had telehealth projects and three were at t...

To model and test direct and indirect pathways connecting general cognitive ability (g) with cardiovascular disease risk factors, via socioeconomic status (SES) and multiple health behaviors. A sample comprising participants in the Health and Lifestyle Survey, a prospective cohort study of a representative sample of U.K. adults in 1984/5 (n = 4939,...

Many biobanks have struggled to deliver on the high expectations and claims made for them because of insufficient samples, inadequate infrastructure, cost of establishing and maintaining a large enough resource over the long term, and satisfying legal, ethics and governance requirements. Increasingly, networks have formed to help with the collectio...

Men who have sex with men remain a high-risk group for human immunodeficiency virus (HIV) infection in the United Kingdom. Quantitative psychological approaches to modelling sexual risk-taking have originated from two theoretical traditions: social-cognitive (e.g. perceived behavioural control over HIV) and trait/dispositional (e.g. personality tra...

Screening may be defined as a selection procedure for further investigation, applied to a population of asymptomatic individuals, with no personal or family history to suggest that they are at a higher risk of the disease than the rest of the population. The term population when used in the epidemiological sense can be applied to subgroups not nece...

Public health practice is characterized by measuring population health, assessing needs for health care and the provision (directly or indirectly) of services to protect and promote the public's health. It is increasingly explicitly concerned with issues of equity. Publications discussing ethical issues in public health. Unlike the duties of clinic...

The use of race in biomedical research has, for decades, been a source of social controversy. However, recent events, such as the adoption of racially targeted pharmaceuticals, have raised the profile of the race issue. In addition, we are entering an era in which genomic research is increasingly focused on the nature and extent of human genetic va...

An extended version of Box 1 that includes supporting quotations from the cited references for each example concern.

Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring o...

To understand European citizens' opinions on water fluoridation, as part of research on their attitudes to the tensions between private and public interest. Sixty-eight focus groups held (with an average of eight people per group) in September and October 2003 in 16 countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, It...

As part of a larger study exploring how European citizens' balance issues of public and private interest and the extent to which they are prepared to accept State intervention on a range of public health issues, focus group participants were asked whether childhood immunisation should be a matter of parental choice or State compulsion. The question...

Unlike the duties of clinicians to patients, professional standards for ethical practice are not well defined in public health. This is mainly due to public health practice having to reconcile tensions between public and private interest(s). This involves at times being paternalistic, while recognising the importance of privacy and autonomy, and at...

Large prospective biobanks are being established containing DNA, lifestyle and health information in order to study the relationship between diseases, genes and environment. Informed consent is a central component of research ethics protection. Disclosure of information about the research is an essential element of seeking informed consent. Within...

Unlike the duties of clinicians to patients, professional standards for ethical practice are not well defined in public health. This is mainly due to public health practice having to reconcile tensions between public and private interest(s). This involves at times being paternalistic, while recognising the importance of privacy and autonomy, and at...

Young people who are concerned that consultations may not remain confidential are reluctant to consult their doctors, especially about sensitive issues. This study sought to identify issues and concerns of adolescents, and their parents, in relation to confidentiality and teenagers' personal health information. Recruitment was conducted in paediatr...

The Mental Capacity Act 2005 covers all decisions on personal welfare including financial matters, relating to people who temporarily or permanently lack mental capacity. This paper outlines the most important provisions of the Act and describes some of the implications for healthcare professionals. For example, the Act permits advance decisions to...

Scholars of differing political affiliation and the President's Council on Bioethics have called for regulation of assisted reproductive technology (ART) that would emulate many aspects of the regulatory system of the United Kingdom, in particular that of the Human Fertilisation and Embryology Authority. Specifically, scholars and the Council have...

Health Improvement Programmes (HImPs) are a means of documenting the health needs of a population and are intended to be translated into commissioning decisions by the Strategic and Financial Framework (SaFF). This paper examines some major influences on the process of translating the HImP into the SaFF. The Directors of Public Health in two Health...

Objectives. To determine the general public’s preferences over the design and use of UK Biobank; and the design for optimum recruitment. Design. Discrete choice face-to-face interviews using a fractional factorial design and multinomial logit regression modelling. Setting. 180 sampling points across 11 regions of the UK. Participants. Members of...

Previous research with primary health care professionals has demonstrated consistently that education, training and support are necessary before there should be any expansion in primary care genetics. The genetic liaison nurse role has been suggested as one means of providing this education and support. The aim of this study was to evaluate GP resp...

Background. Previous research with primary health care professionals has demonstrated consistently that education, training and support are necessary before there should be any expansion in primary care genetics. The genetic liaison nurse role has been suggested as one means of providing this education and support. Objective. The aim of this study...

It is widely accepted that medical and social progress has resulted in longer life and greater health, compressing morbidity into a shorter proportion of an increasing life span. This paper presents a range of morbidity data, mortality rates and economic indicators to argue that whilst this may be true for individuals, population morbidity indices...

To examine the relationship between knowledge of travel health matters, health preparation for travel and risk of travel related illness. Travellers on holiday charter flights from Cardiff-Wales Airport provided information on holiday preparation before departure and were surveyed 2 weeks after return for details of holiday lifestyle and travel ill...

The project Euroscreen 2 has examined genetic screening and testing with particular reference to implications for insurance, commercialization through marketing of genetic tests direct to the public, and issues surrounding raising public awareness of these and other developments in genetics, including the practical experiment of a Gene Shop. This p...

The word enhancement is value laden and potentially misleading in the context of genetics. Dictionary definitions of enhance include and The term geneticenhancement would be better replaced with a more neutral term such as to reflect the fact that the consequences of as yet largely untried technology may be beneficial, balanced, or harmful. The aim...

There are three main categories of rationale for withholding information or telling lies: if overwhelming harm can only be averted through deceit; complete triviality such that it is irrelevant whether the truth is told; a duty to protect the interests of others. Public health authorities are frequently having to form judgements about the public in...

Background: Given the limited specialist resources available to cope with the rising demand for genetic services, it has been proposed that at least some of these services are provided by primary care in the future. Objective: We aimed to explore GPs' attitudes towards new developments in genetics, to establish the role they envisage for primary...

In the past, there was a tendency for public policy to be produced without any attempt to canvass the views of the public. Any input to policy making tended to be via proxies of public opinion such as lobby groups or the media. This is changing with policy makers and politicians being increasingly influenced by market research surveys, focus groups...

This collection of essays represents the work produced in the course of a three-year project funded by the Commission of the European Communities under the Biomed I programme, on the ethics of genetic screening, entitled 'Genetic screening: ethical and philosophical perspectives, with special reference to multifactorial diseases'. The short title o...

Analysis and comparison of genetic screening programs shows that the extent of development of programs varies widely across Europe. Regional variations are due not only to genetic disease patterns but also reflect the novelty of genetic services. In most countries, the focus for genetic screening programs has been pregnant women and newborn childre...

Most people travelling abroad on holiday from the United Kingdom consult a travel brochure and book with a travel agent. Travel brochures are therefore potentially an important source of travel health advice. We assessed the quantity and quality of health advice of 143 travel brochures for 1994/5 winter and 1995 summer seasons available from a high...

The Government in the UK is encouraging consumerism within health care and is requiring Health Authorities to consult with the public on prioritisation of resources. Public consultation within the National Health Service (NHS) has had limited success in the past. Many of the techniques used are flawed. Despite the limited scope of the public survey...

Population carrier screening for cystic fibrosis (CF) was offered to all patients aged 16-45 in one general practice in South Wales, excluding those in couples with a current pregnancy. Out of 1553 patients in this group, 481 subjects were tested, giving an overall uptake rate of more than 30%. The rate of uptake varied with the mode of invitation....