Metcalfe D.,Institute of Clinical Education |
Price C.,Health science Research Institute |
Powell J.,Health science Research Institute
Journal of Public Health | Year: 2011
Background Celebrity diagnoses can have important effects on public behaviour. UK television celebrity Jade Goody died from cervical cancer in 2009. We investigated the impact of her illness on media coverage of cervical cancer prevention, health information seeking behaviour and cervical screening coverage. Methods National UK newspaper articles containing the words 'Jade Goody' and 'cancer' were examined for public health messages. Google Insights for Search was used to quantify Internet searches as a measure of public health information seeking. Cervical screening coverage data were examined for temporal associations with this story. Results Of 1203 articles, 116 (9.6%) included a clear public health message. The majority highlighted screening (8.2%). Fewer articles provided advice about vaccination (3.0%), number of sexual partners (1.4%), smoking (0.6%) and condom use (0.4%). Key events were associated with increased Internet searches for 'cervical cancer' and 'smear test', although only weakly with searches for 'HPV'. Cervical screening coverage increased during this period. Conclusion Increased public interest in disease prevention can follow a celebrity diagnosis. Although media coverage sometimes included public health information, articles typically focused on secondary instead of primary prevention. There is further potential to maximize the public health benefit of future celebrity diagnoses. © 2010 The Author Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
Cabre E.,Hospital Universitari Germans Trias i Pujol |
Cabre E.,CIBER ISCIII |
Manosa M.,Hospital Universitari Germans Trias i Pujol |
Manosa M.,CIBER ISCIII |
Gassull M.A.,Health science Research Institute
British Journal of Nutrition | Year: 2012
Background & Aim: Despite their well known anti-inflammatory actions, the clinical usefulness of omega-3 PUFA in inflammatory bowel disease is controversial. We aimed to systematically review the available data on the performance of omega-3 PUFA as therapeutic agents in these patients. Methods: Electronic databases were systematically searched for RCT of fish oil or omega-3 PUFA therapy in both active and inactive ulcerative colitis or Crohn's disease, without limitation on either the length of therapy or the form it was given, including nutritional supplements and enteral formula diets. Eligible articles were assessed for methodological quality on the basis of the adequacy of the randomisation process, concealment of allocation, blinding of intervention and outcome, possible biases, and completeness of follow-up. The five-point Oxford quality score was calculated. Results: A total of 19 RCT were finally selected for this review. Overall, available data do not allow to support the use of omega-3 PUFA supplementation for the treatment of both active and inactive inflammatory bowel disease. Negative results are quite consistent in trials assessing the use of omega-3 PUFA to maintain disease remission, particularly ulcerative colitis, and to a lesser extent Crohn's disease. Trials on their use in active disease do not allow to draw firm conclusions mainly because the heterogeneity of design (ulcerative colitis) or their short number (Crohn's disease). In most trials, the appropriateness of the selected placebo is questionable. Conclusion: The present systematic review does not allow to make firm recommendations about the usefulness of omega-3 PUFA in inflammatory bowel disease. © 2012 The Authors.
Silvester K.M.,Health science Research Institute |
Silvester K.M.,University of Warwick |
Mohammed M.A.,University of Bradford |
Harriman P.,Sheffield Teaching Hospitals NHS Foundation Trust |
And 2 more authors.
Age and Ageing | Year: 2014
Background: Hospitals are under pressure to reduce waiting times and costs. One strategy that may be effective focuses on optimising the flow of emergency patients. Objective: we undertook a patient flow analysis of older emergency patients to identify and address delays in ensuring timely care, without additional resources. Design: prospective systems redesign study over 2 years. Setting: the Geriatric Medicine Directorate in an acute hospital (Sheffield Teaching Hospitals NHS Foundation Trust) with 1920 beds. Subjects: older patients admitted as emergencies. Methods: diagnostic patient flow analysis followed by a series of Plan Do Study Act cycles to test and implement changes by a multidisciplinary team using time series run charts. Results: 60% of patients aged 75+ years arrived in the Emergency Department during office hours, but two-thirds of the admissions to GM wards were outside office hours highlighting a major delay. Three changes were undertaken to address this, Discharge to Assess, Seven Day Working and the establishment of a Frailty Unit. Average bed occupancy fell by 20.4 beds (95% confidence interval (CI) -39.6 to -1.2, P = 0.037) for similar demand. The risk of hospital mortality also fell by 2.25% (before 11.4% (95% CI 10.4-12.4%), after 9.15% (95% CI 7.6-10.7%) which equates to a number needed to treat of 45 and a 19.7% reduction in relative risk of mortality. The risk of re-admission remained unchanged. Conclusion: redesigning the system of care for older emergency patients led to reductions in bed occupancy and mortality without affecting re-admission rates or requiring additional resources. © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Keown P.,Queen Elizabeth Hospital |
Keown P.,Newcastle University |
Weich S.,Health science Research Institute |
Bhui K.S.,Queen Mary, University of London |
Scott J.,Newcastle University
BMJ | Year: 2011
Objective: To examine the rise in the rate of involuntary admissions for mental illness in England that has occurred as community alternatives to hospital admission have been introduced. Design: Ecological analysis. Setting: England, 1988-2008. Data source: Publicly available data on provision of beds for people with mental illness in the National Health Service from Hospital Activity Statistics and involuntary admission rates from the NHS Information Centre. Main outcome measures: Association between annual changes in provision of mental illness beds in the NHS and involuntary admission rates, using cross correlation. Partial correlation coefficients were calculated and regression analysis carried out for the time lag (interval) over which the largest association between these variables was identified. Results: The rate of involuntary admissions per annum in the NHS increased by more than 60%, whereas the provision of mental illness beds decreased by more than 60% over the same period; these changes seemed to be synchronous. The strongest association between these variables was observed when a time lag of one year was introduced, with bed reductions preceding increases in involuntary admissions (cross correlation -0.60, 95% confidence interval -1.06 to -0.15). This association increased in magnitude when analyses were restricted to civil (non-forensic) involuntary admissions and non-secure mental illness beds. Conclusion: The annual reduction in provision of mental illness beds was associated with the rate of involuntary admissions over the short to medium term, with the closure of two mental illness beds leading to one additional involuntary admission in the subsequent year. This study provides a method for predicting rates of involuntary admissions and what may happen in the future if bed closures continue.
Michel J.-P.,University of Geneva |
Gusmano M.,Hastings Center |
Blank P.R.,University of Zürich |
Philp I.,Health science Research Institute
European Geriatric Medicine | Year: 2010
Vaccine guidelines that advocate immunisation in adults aged ≥ 60 years and an international policy brief that explores the importance of life-course vaccination have been proposed. The guidelines, policy brief and associated data were considered by experts at two meetings during 2009. This paper amalgamates those discussions and recommends practical strategies that may contribute to the successful implementation of adult vaccination. The challenges posed by changes in the global age distribution may be confronted by preparing for healthy ageing early in life - a 'life-course' approach to health. Vaccination can provide cost-effective protection against a host of diseases throughout life, but remains an underused public-health strategy in adults for the promotion of healthy ageing. Without specific vaccination programmes for the adult population aged ≥ 50 years ('50+ vaccine programmes') infectious diseases will continue to be a cause of substantial morbidity and mortality in late adulthood. The reasons for low vaccination rates among adults ('what we know') are identified and the four common determinants for the successful implementation of 50+ vaccination programmes ('what we should do') are examined: vaccination programme objectives, the role of healthcare professionals, access to vaccines, and public awareness. To achieve the goal of healthy ageing, nationally customised measures should be instigated to address these determinants in the 50+ age group and to ensure access to vaccination for those who are expected to benefit. © 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
Powell J.,Health science Research Institute |
Gunn L.,Health science Research Institute |
Lowe P.,Aston University |
Sheehan B.,Health science Research Institute |
And 2 more authors.
Ageing and Society | Year: 2010
Dementia is one of the greatest contemporary health and social care challenges, and novel approaches to the care of its sufferers are needed. New information and communication technologies (ICT) have the potential to assist those caring for people with dementia, through access to networked information and support, tracking and surveillance. This article reports the views about such new technologies of 34 carers of people with dementia. We also held a group discussion with nine carers for respondent validation. The carers' actual use of new ICT was limited, although they thought a gradual increase in the use of networked technology in dementia care was inevitable but would bypass some carers who saw themselves as too old. Carers expressed a general enthusiasm for the benefits of ICT, but usually not for themselves, and they identified several key challenges including: establishing an appropriate balance between, on the one hand, privacy and autonomy and, on the other: maximising safety; establishing responsibility for and ownership of the equipment and who bears the costs; the possibility that technological help would mean a loss of valued personal contact; and the possibility that technology would substitute for existing services rather than be complementary. For carers and dementia sufferers to be supported, the expanding use of these technologies should be accompanied by intensive debate of the associated issues. Copyright © Cambridge University Press 2010.
Davies E.J.,Plymouth Hospitals NHS Trust |
Moxham T.,University of Exeter |
Rees K.,Health science Research Institute |
Singh S.,Glenfield Hospital |
And 4 more authors.
European Journal of Heart Failure | Year: 2010
To determine the effect of exercise training on clinical events and health-related quality of life (HRQoL) of patients with systolic heart failure. Methods and results: We searched electronic databases including Medline, EMBASE, and Cochrane Library up to January 2008 to identify randomized controlled trials (RCTs) comparing exercise training and usual care with a minimum follow-up of 6 months. Nineteen RCTs were included with a total of 3647 patients, the majority of whom were male, low-to-medium risk, and New York Heart Association class II-III with a left ventricular ejection fraction of <40. There was no significant difference between exercise and control in short-term (≤12 months) or longer-term all-cause mortality or overall hospital admissions. Heart failure-related hospitalizations were lower [relative risk: 0.72, 95 confidence interval (CI): 0.52-0.99] and HRQoL improved (standardized mean difference:-0.63, 95 CI:-0.80 to-0.37) with exercise therapy. Any effect of cardiac exercise training on total mortality and HRQoL was independent of degree of left ventricular dysfunction, type of cardiac rehabilitation, dose of exercise intervention, length of follow-up, trial quality, and trial publication date. Conclusion: Compared with usual care, in selected heart failure patients, exercise training reduces heart failure-related hospitalizations and results in clinically important improvements in HRQoL. High-quality RCT and cost-effectiveness evidence is needed for the effect of exercise training in community-based settings and in more severe heart failure patients, elderly people, and women. © 2010 The Author.
Faller J.,University of Graz |
Scherer R.,University of Graz |
Costa U.,University of Barcelona |
Opisso E.,University of Barcelona |
And 4 more authors.
PLoS ONE | Year: 2014
Co-adaptive training paradigms for event-related desynchronization (ERD) based brain-computer interfaces (BCI) have proven effective for healthy users. As of yet, it is not clear whether co-adaptive training paradigms can also benefit users with severe motor impairment. The primary goal of our paper was to evaluate a novel cue-guided, co-adaptive BCI training paradigm with severely impaired volunteers. The co-adaptive BCI supports a non-control state, which is an important step toward intuitive, self-paced control. A secondary aim was to have the same participants operate a specifically designed selfpaced BCI training paradigm based on the auto-calibrated classifier. The co-adaptive BCI analyzed the electroencephalogram from three bipolar derivations (C3, Cz, and C4) online, while the 22 end users alternately performed right hand movement imagery (MI), left hand MI and relax with eyes open (non-control state). After less than five minutes, the BCI autocalibrated and proceeded to provide visual feedback for the MI task that could be classified better against the non-control state. The BCI continued to regularly recalibrate. In every calibration step, the system performed trial-based outlier rejection and trained a linear discriminant analysis classifier based on one auto-selected logarithmic band-power feature. In 24 minutes of training, the co-adaptive BCI worked significantly (p = 0.01) better than chance for 18 of 22 end users. The selfpaced BCI training paradigm worked significantly (p = 0.01) better than chance in 11 of 20 end users. The presented coadaptive BCI complements existing approaches in that it supports a non-control state, requires very little setup time, requires no BCI expert and works online based on only two electrodes. The preliminary results from the self-paced BCI paradigm compare favorably to previous studies and the collected data will allow to further improve self-paced BCI systems for disabled users. © 2014 Faller et al.
Poulsen G.,University of Oxford |
Wolke D.,Health Science Research Institute |
Kurinczuk J.J.,University of Oxford |
Boyle E.M.,University of Leicester |
And 3 more authors.
Paediatric and Perinatal Epidemiology | Year: 2013
Background Recent studies suggest that children born at late preterm (34-36 weeks gestation) and early term (37-38 weeks) may have poorer developmental outcomes than children born at full term (39-41 weeks). We examined how gestational age is related to cognitive ability in early childhood using the UK Millennium Cohort Study. Methods Cognitive development was assessed using Bracken School Readiness Assessment at age 3 years, British Ability Scales II at ages 3, 5 and 7 years and Progress in Mathematics at age 7 years. Sample size varied according to outcome between 12 163 and 14 027. Each gestational age group was compared with the full-term group using differences in z-scores and risk ratios for scoring more than -1 SD below the mean. Results Children born at <32 weeks gestation scored lower (P < 0.05) than the full-term group on all scales with unadjusted z-score differences ranging between -0.8 to -0.2 SD. In all groups, there was an increased risk (P < 0.05) of scoring less than -1 SD below the mean compared with the full-term group for some of the tests: those born at < 32 weeks had a 40-140% increased risk in seven tests, those born at 32-33 weeks had a 60-80% increased risk in three tests, those born at 34-36 weeks had a 30-40% increased risk in three tests, and those born at 37-38 weeks had a 20% increased risk in two tests. Conclusions Cognitive ability is related to the entire range of gestational age, including children born at 34-36 and 37-38 weeks gestation. © 2013 John Wiley & Sons Ltd.
Genesca M.,Health science Research Institute
Journal of Biomedicine and Biotechnology | Year: 2011
A vaccine inducing protective immunity in mucosal tissues and secretions may stop or limit HIV infection. Although cytotoxic T lymphocytes (CTLs) are clearly associated with control of viral replication in HIV and simian immunodeficiency virus (SIV) infections, there are examples of uncontrolled viral replication in the face of strong CD8 + T-cell responses. The number of functions, breadth, avidity, and magnitude of CTL response are likely to be important factors in the effectiveness of anti-HIV T-cell response, but the location and persistence of effector CD8 + T cells are also critical factors. Although the only HIV vaccine clinical trial targeting cellular immunity to prevent HIV infection failed, vaccine strategies using persistent agents against pathogenic mucosal challenge in macaque models are showing unique success. Thus, the key to control the initial focus of viral replication at the portal of entry may rely on the continuous generation of effector CTL responses at mucosal level. Copyright © 2011 Meritxell Genesc.